Ever since the COVID-19 outbreak has happened, we have been facing a two-front war, one against the pandemic and another against the infodemic.
A webinar titled ‘COVID-19: Myths Versus Reality’ by the government’s Press Information Bureau on Friday. Three eminent doctors: Dr. Rahul Kulkarni- Medicine Doctor and Intensivist at Sahyadri Hospital in Pune, Dr. Chaitanya H Balakrishnan, COVID Coordinator at St. John’s Medical College Hospital, Bangalore; and Dr. Nitin Yashas, Manipal Hospital, Goa busted some myths over Covid-19 and answered some queries.
Myth: Hot-water bath or drinking warm-water prevents COVID-19
Dr. Yashas: NO. Drinking hot water does not kill the coronavirus in the body nor does it cure the disease. In laboratory settings, you need a temperature of 60-75 degree Celsius to kill the SARS-CoV-2 virus. Now, the human body temperature is around 37 degree Celsius. These viruses remain within body cells and the human body maintains a temperature of around 37 degree Celsius.
Remdesivir for treatment of COVID-19
Dr. Kulkarni: Basically Remdesivir is an anti-viral agent. First of all, it cannot be given at home. Remdesivir is not the only treatment available for COVID-19. It was started to be used in COVID treatment after it was seen in a few clinical trials last year that it has shown some potency to stop or slow down the replication of the virus. It however cannot stop the disease. It is also not a life-saving medication. After some trials, the WHO has also issued a warning to not use Remdesivir. By my personal experience, I feel if it is used wisely in early cases (within seven days of COVID infection) and mainly if the patient is continuously progressively hitting toxic after being admitted in a hospital, then it will be a good choice to go ahead. But only within the first seven days. Afterwards, it hardly is useful, as proven by scientific data so far. If the patient is on a ventilator, it will hardly be of any use. It is solely the doctor’s responsibility to take a call on using it.
Dr. Balakrishnan: Yes, Remdesivir is one of the members of the limited armoury we have against COVID. But it is not a life-saving drug that you have to run behind for getting it for every patient. People are misinformed about it. There are two phases in COVID-19 infection: the first week in which the virus replicates in the system and the next in which the immune system is triggered. As Dr. Kulkarni said, the first one week is critical. If you are going to give Remdesivir, it should be within those first seven days. If the patient is already in the ventilator and a prolonged case of illness, it is not going to change anything. Infact , UK and US has put out a very strict notion that says: No Remdesivir for mild COVID and also severe COVID (patients on ventilator) and only Moderate COVID patients who are toxic may benefit. But, there is no 100 percent guarantee with Remdesivir. There are a lot more drugs. But, from personal experience, I have seen that if you choose the right patient at the right time, then with steroids and Remdesivir, you can get good outcomes. The timing of the medicine is extremely important. If used well, it is one of the drugs to help.
But then, it is the clinician’s decision based on what he is seeing and not what Whatsapp or Google is telling the family.
Dr. Kulkarni: It is also an anti-viral in oral form. In the first 3-4 days of the illness with mild symptoms, you can start with Favipiravir or Fabiflu. But that again is the decision of the clinician or the internal medicine expert. It is a weakly potent drug and a patient has to take a lot of tablets. That again is a concern. Hence, my advice is ‘Don’t go into the details of any anti-viral medication.
Just stick to the advice of your physician’.
Dr. Yashas: It is a form of steroid. Dexamethasone was perhaps the first medicine in the COVID era which showed some benefit in reducing deaths. Now the question is: on whom will it reduce deaths? We have scientific evidence to answer this question. The benefit with dexamethasone is the maximum for those who are having severe disease and are on ventilators. Those having moderate disease and are on oxygen can also derive benefits from the use of steroids. Mild patients or patients without any symptoms absolutely cannot use it.
Trials have also shown that it can be a bit harmful if mild patients take dexamethasone as it may actually suppress the immune system and prevent the body from fighting the virus in such cases. Hence, my humble request to public is: ‘Please do not panic and start stock-piling dexamethasone. It is to be prescribed only under the supervision of a physician for moderate and severe disease and that too, under specific circumstances’.
Effective usage of antibiotics in COVID-19
Dr. Balakrishnan: It's very clear from scientific data that giving antibiotics prophylactically in COVID-19 has no role. A couple of studies in the UK and also in Delhi have shown that injudicious use of antibiotics may rather increase the hospital stay or cause mortality in such patients. So, the tendency to take an over-the-counter azithromycin is completely unadvisable. If you are suspecting that you have symptoms of COVID, get tested, meet a COVID Care physician and take the appropriate step. Use of antibiotics in COVID-19 is completely avoidable. Taking an over-the-counter or Dr. Google prescribed antibiotic is a complete no-no in COVID cases.
Dr. Kulkarni: There are some patients who tend to copy paste the same prescription given to their relatives. Unfortunately that shouldn’t be done. Every patient has some set of symptoms. If you start following the same set of prescriptions for every patient, you might land up with some other side effects that can be harmful. Trust your clinician, follow whatever treatment they are prescribing and keep in touch with the clinician.
Dr. Yashas: My humble request to patients is that, when in doubt (about treatment), refer to credible sources (like WHO, AIIMS etc.)