BENGALURU: Fear and anxiety among the public and physicians treating Covid-19 patients has resulted in clinical practices and hospital triage decisions which are not evidence-based and often detrimental, according to an initiative.
The Choosing Wisely initiative, comprising an 18-member team from public health, epidemiology, general practice, primary care, infectious disease, virology, critical care, internal medicine, and pulmonology has come up with recommendations to avoid unnecessary medical interventions and help patients and physicians choose care free from harm.
The 10 recommendations, five of which are for the public and five for health workers, have been published in the journal Nature Medicine.Under the recommendation titled ‘Do not prescribe unproven or ineffective therapies for Covid-19’, the comment reads, “There are no data at present to support the use of Favipiravir, Ivermectin, Azithromycin, Doxycycline, Oseltamivir, Iopinavir-Ritonavir, Hydroxychloroquine, Itolizumab, Bevacizumab, IFN-2b, Fluvoxamine, Convalescent plasma or herbal preparations in the treatment of Covid-19. None of these are currently recommended by the WHO.”
The committee also warned against use of Remdesivir and Tocilizumab, except in specific circumstances. Tocilizumab is useful only in patients who are severely ill, are receiving steroids, have signs of inflammation and have rapidly increasing requirements of oxygen. Remdesivir has marginal efficacy in shortening the time to recovery in adults, but does not decrease mortality. “Do use steroids prudently only in patients with hypoxia and monitor blood sugar levels to keep them in the normal range,” the recommendations read.
Many of these deviations from evidence-based healthcare result in substantial harm, as they divert efforts and resources from outcome-based, data-driven best practices toward those that are of doubtful efficacy and are even harmful, the authors noted. They warned against routinely performing investigations that do not guide treatment, such as CT scans and inflammatory biomarkers.