Issues in COVID-19 Management Guidelines

Synopsis: The Health Ministry’s COVID-19 management guidelines show disregard for evidence, pricing, cost-effectiveness, and social relevance.

Introduction 

The Health Ministry released its first COVID-19 management guidelines about a year ago. This guideline included hydroxychloroquine for the treatment of Covid-19. It led to its panic buying.

Later, in a year, multiple studies rejected this claim. However, Health Ministry’s guidelines released on April 22 still prescribes hydroxychloroquine.

What are the other issues in the COVID-19 management guidelines?

• First, disregard for evidence. For example,
  • The ICMR after several trials has revealed that the use of convalescent plasma does not save the lives of those with COVID-19. At best the plasma can prevent progression to severe disease in mild cases. Yet, convalescent plasma is mentioned in the Ministry’s guidelines.
  • Ivermectin, a drug used against parasites, has been recommended in the guidelines. However, World Health Organization (WHO) recommended against its routine use.
• Second, it also overlooks the importance of pricing and cost-effectiveness. For example,
  • • One, there is supply-demand mismatch in Remdesivir due to black-marketing. It led to an increase in the cost of hospitalization due to the steep price of the drug in the black market.
    • Two, budesonide inhalers have been included as an option for mild patients based on the results of two clinical trials. Though it does not result in saving lives or reducing hospital admissions.
    • This will result in a lack of access to inhalers for patients with asthma and chronic obstructive pulmonary disease (COPD) due to panic buying by Covid patients.

What changes are needed?

• First, guidance on drugs being used for COVID-19 should be included. This is because, many unsafe drugs such as Azithromycin, Doxycycline, are being prescribed.
• Second, the most efficacious antivirals in COVID-19, the monoclonal antibodies should be mentioned.
• Third, the COVID-19 treatment guidelines should focus more on oxygen delivery, steroids, and anti-coagulants.

Rewriting the guidelines based on the available evidence, and keeping cost-effectiveness and the social relevance of the Indian health system should be the way forward.

Source: The Hindu