By Dr Deepak Gupta
[Navratri Celebrations ongoing in India marks nine days worshipping of nine incarnations of Goddess Durga]
1.Steroids : Some benefit ( Dexamethasone/Hydrocortisone /MPA) : Useful only in patients on oxygen therapy/on ventilators. Don’t give in early first week, don’t give In mild cases ( More harm)
- Remdesvir +/- Baricitinib : Effective if given early within first 10 days of illness in patients on NIV/HFNC/ventilatory support. It speeds up time to recovery and has no effect on mortality.
3 Anticoagulants ( LMWH) followed by Oral anticoagulants ( Apixiban for 3 weeks) useful in all {if D Dimer high} but the mild disease.
- Plasma therapy : No Benefit …If at all then must be given within first 3 days from Plasma donor having very high antibody titres).
- Inhaled nebuliser interferons ( useful if available), Favipiravir ( improves time to clinical cure and cessation of viral shedding by 2-3 days) in mild to moderate disease , MoAB ( Superexpensive, can be used in mild high risk cases and helps in recovery , Tocilizumab ( IL6 antagonist) not effective for preventing death in moderate or severe covid patients and has sepsis risk. If one uses, use only one dose 400mmg only in select cases.
- What doesn’t work in Covid : Antibiotics ( azithromycin, doxycycline), Antivirals( Lopinavir), HCQS ( Chloroquine), Ivermectin, Vitamins
- Majority improve with body immunity without any treatment. Avoid steroids if you are asymptomatic and just RTPCR+ve.
- Oxygen therapy, HFNC/Ventilatory support if Oxygen saturation falls : Highly Recommended .
9 Vaccines : Covaxine, Covishield, Sputnik, Pfizer Moderna : 2 doses min 4 weeks recommended for all.
Remember : Covid virus is going to keep going until it infects everybody it possibly can: until it meets a vaccine or natural herd immunity … ( In India : with over 1 million cases in last 1 year and Vaccination drive at its superbest,,we are likely to achieve it soon). Just practice Covid appropriate behaviour ( Face Mask preferably N95 when outside home , Adequate hand washing, Physical distancing, Avoiding unnecessary travels outside).
The writer is dr deepak gupta, Sr Neurosurgeon, AIIMS.
