CHENNAI: Despite well-established guidelines and repeated warnings from the State government, private hospitals in Chennai continue to prescribe and force Covid-19 patients to procure anti-viral drug Remdesivir for mild infections.
This is believed to be the primary reason behind the artificial demand for the drug and chaotic scenes outside the sale counter at Kilpauk Medical College (KMC) Hospital in the city. Express accessed the medical reports of half a dozen Covid-19 patients whose line of treatment did not sync with Covid- 19 protocols, especially when it comes to use of Remdesivir.
The prescription and dosage was significantly arbitrary in nature. For instance, 42-yearold Poonamallee resident Shanmugham, along with his wife and their 14-year-old son, got hospitalised on May 6 at a private hospital in Maduravoyal after testing positive for Covid- 19 a week earlier and their fever not having subsided fully during home quarantine. All three recovered enough to be discharged on May 11. Shanmugham’s wife and son tested negative and his chest CT severity score was 8 out of 40 at the time of discharge, which is considered very mild. He was advised to be in home isolation.
On the night after the discharge, Shanmugham developed a fever and body aches. Panicked, he rushed to another private hospital in Saligramam, where a doctor asked him to get admitted and take another chest CT scan. The scan report stated that features were suggestive of mild acute viral interstitial pneumonitis with severity score of 14/40 (mild category). Shanmugam was not in need of external oxygen support as his saturation levels were healthy. Despite this, the second hospital asked him to procure six vials of Remdesivir. A local politician and a realtor, Shanmugam managed to secure all the six vials from open market. By this time, over two weeks had passed from the date of detection of the infection.
Going by this, Shanmugham clearly does not qualify or in need of Remdesivir. Still, he is currently being administered the drug. The two hospitals together made him undergo CT scans thrice in seven days, which is increasingly becoming common and posing a risk to patients’ health. Earlier this month, AII MS Director Dr Randeep Guleria raised concerns over the overuse of CT scans and over the potential radiation that may escalate the risk of patients developing cancer.
He had said that one CT scan was equivalent to 300 chest X-rays. Similarly, 28-year-old Rema, an IT professional residing in Nanganallur, had a CT severity score of 16. She was asked to procure nine v i a l s of Remdesivir, clearly violating ICMR guidelines. This was even before she was admitted by a private hospital in Vadapalani. The family had to procure the drug from black market by paying Rs 15,000 a vial.
Likewise, Ramachandran, an Ambattur resident and an employee of a carmaker, was asked to purchase eight vials, again for a mild infection. In his case as well, over two weeks had passed since symptoms began. Dr TS Selvavinayagam, Director of Public Health and Preventive Medicine, told Express that Remdesivir is not a mandatory drug for Covid-19. Private doctors, however, are needlessly prescribing it.
“The guidelines are very clear. It is meant for restricted use in patients on oxygen support.” The Benefits of Remdesivir in Covid-19 care is still a debatable subject. A clinical trial by the World Health Organisation (WHO) found little or no effect on Covid-19 patients’ length of hospital stay or chances of survival. There are, however, a few peer-reviewed studies that claim the hospital stay can be reduced by 2-3 days.
AIIMS/ICMR guidelines for Remdesivir usage
(Based on limited available evidence and only under specific circumstances)
(Patients’ names changed)