Effective, affordable treatment for moderate to severe COVID-19: Ministry approves use of Dexamethasone

The Union Ministry of Health and Family Welfare advises use of dexamethasone as an alternative to methylprednisolone for managing moderate to severe COVID-19 cases.

COVID-19 cases in India has jumped from 1 lakh to over 5 lakhs in just 39 days. This is a matter for grave concern and experts are trying to find a way to control the pandemic in the country. The search for an effective drug is going on and scientists have identified a few hopeful candidates. Just a couple of weeks ago, Oxford University researchers identified a cheap and easily available steroid, Dexamethasone, and said that it may prove effective against severe COVID-19 cases. This was termed as the biggest breakthrough to date in the fight against the new variant of coronavirus and WHO also recommended the use of this drug in severe cases.

Cheap drug that can save lives

According to the Oxford researchers, the treatment is up to 10 days of dexamethasone and it costs about 5 pounds per patient. So essentially it costs 35 pounds to save a life. They said that the steroid can reduce the risk of deaths by a third for patients on ventilators and by a fifth for those on oxygen support. Now, the Union Ministry of Health and Family Welfare on Saturday released an updated clinical management protocol for managing COVID-19 cases, advising use of dexamethasone as an alternative to methylprednisolone for managing moderate to severe cases of the disease. Keeping pace with evolving knowledge about COVID -19, especially in terms of effective drugs, the Ministry released the updated clinical management protocol in which some changes have been made after considering the latest available evidence and after expert consultation.

Widely available steroid that reduces mortality rate

Dexamethasone is a corticosteroid drug used in a wide range of conditions for its anti-inflammatory and immunosuppressant effects. The drug has been tested in hospitalised patients with COVID -19 in the Recovery clinical trial by Oxford University. Scientists saw that it is effective in treating critically ill patients. It can apparently reduce mortality by about one-third for patients on ventilators, and by about one-fifth for patients on oxygen therapy. The drug is also a part of the National List of Essential Medicines (NLEM) and is widely available. Union Health Secretary Preeti Sudan has forwarded the updated protocol with all states and Union Territories to make necessary arrangements for availability and use of the updated protocol and dexamethasone at the institutional level also. The last update to the clinical management protocol was done on June 13.

Update on drug use

Dexamethasone is the first drug proven to treat COVID-19. According to the Ministry update, for patients with progressive deterioration of oxygenation indicators, rapid worsening on imaging and excessive activation of the body's inflammatory response, glucocorticoids can be used for a short period of time (3 to 5 days). According to recommendations, dose should not exceed the equivalent of Methylprednisolone 1 2mg/kg/day OR Dexamethasone 0.2-0.4 mg/kg/day. A larger dose of glucocorticoid will delay the removal of coronavirus due to immunosuppressive effects.

A prophylactic dose of UFH or LMWH (e.g., enoxaparin 40 mg per day SC) may be given for anti-coagulation. Care must be taken to control co-morbid conditions. For severe complications in pregnant women, consultations with obstetric, neonatal, and intensive care specialists (depending on the condition of the mother) are essential. Patients often suffer from anxiety and fear and they should be supported by psychological counselling.

Ministry lists various symptoms of COVID-19

As per the updated protocol, COVID -19 patients reporting to various COVID treatment facilities have reported signs and symptoms like fever, cough, fatigue, shortness of breath, expectoration, myalgia, rhinorrhea, sore throat and diarrhoea. Loss of smell (anosmia) or loss or taste (ageusia) preceding the onset of respiratory symptoms may also occur. Older people and those with low immunity may present with atypical symptoms like fatigue, reduced alertness, reduced mobility, diarrhoea, loss of appetite, delirium, and absence of fever, the protocol mentions. Children might not have reported fever or cough as frequently as adults.

As per data from the Integrated Health Information Platform (IHIP) or Integrated Disease Surveillance Programme (IDSP) portal case investigation forms for COVID -19 of 15,366 people as on June 11, the details on the signs and symptoms reported are fever (27 per cent), cough (21 per cent), sore throat (10 per cent), breathlessness (8 per cent), weakness (7 per cent), running nose (3 per cent) and others 24 per cent. The major risk factors for severe disease are age more than 60 years (increasing with age), underlying non-communicable disease (NCDs) such as diabetes, hypertension, cardiac disease, chronic lung disease, cerebro-vascular disease, chronic kidney disease, immune-suppression and cancer.

(With inputs from IANS)