The World Health Organization (WHO) has clarified on two drugs, dexamethasone and hydroxychloroquine, used in different settings to treat Covid-19.

Dexamethasone is not a preventive and should not be used in mild cases, WHO’s Dr Mike Ryan, Head of Emergency Programmes, said in a routine briefing.

“It’s exceptionally important that this drug is used under medical supervision. This is not for mild cases; this is not for prophylaxis. This is a very, very powerful anti-inflammatory drug. It can rescue patients who are in very serious condition where their lungs and their cardiovascular system around their lungs may be very inflamed. Patients are able to continue getting oxygen into their blood or their lungs for a very critical period by rapidly reducing inflammation at a critical period in the illness,” he said.

The role of dexamethasone in reducing mortality in critically-ill Covid patients, had generated much scientific discussion after preliminary results were shared from a UK trial led by the Oxford University.

“It is not a treatment for the virus itself; it is not a prevention for the virus. In fact, steroids, particularly powerful steroids, can be associated with viral replication; in other words, they can actually facilitate the division and replication of viruses in human bodies. So it's exceptionally important in this case that this drug is reserved for use in severely ill and critical patients who can benefit from it,” he said, adding “this is great news but it is part of the answer we need on the clinical side; oxygen, ventilation, the use of antivirals, the use of steroids and finding a combination of therapies that allows us to save as many patients as possible.”

HCQ arm dropped from trial

Responding to another query on antimalarial hydroxychloroquine (HCQ), Dr Ana Maria Henao-Restrepo, Head of the Research and Development Unit and working on a blueprint at WHO, said “the hydroxychloroquine arm will be stopped from the Solidarity trial.”

“But I want to emphasise that this does not constitute a WHO policy, that this is not a WHO policy recommendation, this is the result from trials and that this does not apply to the use or the evaluation of hydroxychloroquine as post-exposure prophylaxis in patients exposed to Covid-19,” she added.

“The internal evidence from the Solidarity Discovery trial, the external evidence from the recovery trial and the combined evidence from these large randomised trails, brought together suggest that hydroxychloroquine, when compared with the standard of care in the treatment of hospitalised Covid-19 patients does not result in the reduction of the mortality of those patients,” she said, and a review of this data led to the decision to drop the antimalarial from the trial.

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