Health Ministry includes low-cost Dexamethasone in Covid-care treatment

A low-cost steroid Dexamethasone has been newly added in the clinical management protocol of the Ministry of Health and Family Welfare for Covid-19 patients. In its revision of Covid-19 clinical management protocol, MoHFW has said that moderate and severe patients can be given oral tablet Dexamethasone, which is as an alternative to intravenous injection of methylprednisolone. Moderate patients are those who have pneumonia but with no signs of severe disease. The drug helps reduce inflammation in the body caused as a response to the virus in serious patients.

Further, the protocol says that for severe patients with progressive deterioration of oxygenation indicators, rapid worsening on imaging and excessive activation of the body’s inflammatory response, glucocorticoids (like Dexamethasone) can be used for a short time (3 to 5 days).”

In the UK's RECOVERY trial, Dexamethasone has been reported to reduce deaths of patients on ventilators by one third and by one fifth in those who require oxygen. No benefits were found in those who do not require respiratory assistance. Only preliminary results of studies are known as yet. More clinical trials across the world are evaluating the drug currently.

Experts caution against the misuse of the drug. “Dexamethasone is a very cheap drug, so there is a huge risk of this drug being used left right and centre in every fever and cough. Huge risk of it being irrationally used,” said SP Kalantri, Professor (Medicine), Mahatma Gandhi Institute of Medical Sciences, Maharashtra.

“If you start this drug in mild or moderate cases very early, it may cause more harm than good. This drug is meant for acute care in emergency settings,” said Amar Jesani, founder, Forum for Medical Ethics.

This is a fourth revision to the clinical management protocol since the start of the pandemic.

MoHFW has also advised that in severe cases, and chest X-ray shows complications with breathing issues, oxygen therapy should be started at various levels. Subjecting a patient to an invasive ventilator should be the last option. A severe case can include the onset of acute respiratory distress syndrome (ARDS), progressing to sepsis which provides for altered mental status, difficult or fast breathing, low oxygen saturation, reduced urine output, rapid heart rate, weak pulse, cold extremities or low blood pressure, skin mottling, which can lead to a septic shock.

The guidelines have also stated that controversial drug Hydroxychloroquine be also given to moderate patients but only after assessing their heart condition, as the drug is cited for having side effects on the heart and cannot be administered to patients with a weak cardiac condition.

The protocol puts in a cautionary note for HCQ stating, “Several large observational studies with severe methodologic limitations have shown no effect on mortality or other clinically meaningful outcomes. As such, the evidence base behind its use remains limited as with other drugs and should only be used after shared decision making with the patients while awaiting the results of ongoing studies.”

MoHFW has also cautioned that investigational therapies like Remdesivir, Tocilizumab and convalescent plasma are based on limited evidence. Long term data of how these work in Covid-19 still remains unknown. The availability of drugs is also limited in India currently.

As per data pulled out from Integrated Disease Surveillance Programme portal case investigation forms for Covid-19 for 15,366 patients, 27 per cent reported fever, 21 per cent reported cough, ten per cent reported sore throat, eight per cent reported breathlessness, seven per cent reported weakness, 3 percent runny nose, while 24 per cent other symptoms.

COMMENT NOW