Is indiscriminate use of drugs the main reason for the problems encountered during the second wave of COVID-19 in India?

The commentary of Satchit Balsari and his colleagues
1
  • Balsari S
  • Udwadia Z
  • Sheikh A
  • Ghafur A
  • Kataria S
Contextualization of the evidence-based recommendations for the second wave of the COVID-19 pandemic in India.

on the second wave of COVID-19 in India offers interesting reading. While it is admirable on the part of the authors to offer simple test and management recommendations, it is disappointing that they incriminate the indiscriminate and unwarranted use of several drugs in the tribulations that occurred during the second wave. .

Without a doubt, the second wave hit India very hard and overwhelmed the health system simply by the number of patients. Surprisingly, Balsari and colleagues call favipiravir an ineffective therapeutic intervention when one of the authors (ZU) was the lead author of the article that showed the effectiveness of favipiravir.
2
  • Udwadia ZF
  • Singh P
  • Barkate H
  • et al.
Efficacy and Safety of Favipiravir, an Oral RNA-dependent RNA Polymerase Inhibitor, in Mild to Moderate COVID-19: A Randomized, Controlled, Open-label, Multicenter, Phase 3 Clinical Trial.

Likewise, a meta-analysis concluded that ivermectin is effective in the prevention and treatment of COVID-19.

3
  • Kory P
  • Meduri GU
  • Varon J
  • et al.
Review of emerging evidence demonstrating the efficacy of ivermectin in the prophylaxis and treatment of COVID-19.

There are many other publications supporting the use of other drugs (albeit at an appropriate time) that the authors mention.

In the information tsunami, practicing evidence-based medicine is a challenge. When evidence is lacking, opinions matter, and clinicians were rightly guided by the opinions of the elderly and experts. To complicate matters, the withdrawal of published evidence leading to a change in the guidelines is not unheard of. The most recent example involves two articles on angiotensin converting enzyme inhibitors and hydroxychloroquine that were withdrawn a few weeks after their publication.
4
  • Boetto E
  • Golinelli D
  • Carullo G
  • Deputy Fantini
Frauds in scientific research and how to overcome them if necessary.

In a desperate attempt to save lives, indiscriminate use has occurred in a few instances (I think it’s more common with steroids), but to generalize it’s a bit far-fetched.

It is also not correct to say that for almost a year, patients were counseled in institutional isolation. It is known that large COVID-19 care centers were put into emergency service for this purpose in July 2020, and a triage protocol based on simple clinical parameters such as oxygen saturation and respiratory rate was used successfully.
5
  • Kotnala RK
  • Tempe DK
  • Mishra P
  • Ramji s
  • Patil AP
Clinical triage in a large COVID-19 care facility with 2,000 beds: role of the anesthesiologist.

I also humbly disagree with the recommendation that patients with moderate illness can be managed at home. We have learned that these patients suddenly get worse, and prompt intervention with two-level positive airway pressure or high-flow nasal oxygenation is crucial to save them. This intervention is best provided in a hospital.

Finally, I would like to point out that clinicians, by fighting bravely and making every effort, have saved many lives. Overloading patients brought inevitable problems, especially in the absence of proven treatment, and even some developed countries were no exception.

I do not declare any competing interests.

The references

  1. 1.
    • Balsari S
    • Udwadia Z
    • Sheikh A
    • Ghafur A
    • Kataria S

    Contextualization of the evidence-based recommendations for the second wave of the COVID-19 pandemic in India.

    Lancet Infect Dis. 2021; 21: 905-907

  2. 2.
    • Udwadia ZF
    • Singh P
    • Barkate H
    • et al.

    Efficacy and safety of favipiravir, an oral RNA-dependent RNA polymerase inhibitor, in mild to moderate COVID-19: a randomized, controlled, open-label, multicenter, phase 3 clinical trial.

    Int J Infect Dis. 2021; 103: 62-71

  3. 3.
    • Kory P
    • Meduri GU
    • Varon J
    • et al.

    Review of emerging evidence demonstrating the efficacy of ivermectin in the prophylaxis and treatment of COVID-19.

    Am J Therapeutics. 2021; 28: e299-e318

  4. 4.
    • Boetto E
    • Golinelli D
    • Carullo G
    • Deputy Fantini

    Frauds in scientific research and how to overcome them if necessary.

    J Med Ethics. 2020; ()

  5. 5.
    • Kotnala RK
    • Tempe DK
    • Mishra P
    • Ramji s
    • Patil AP

    Clinical triage in a large COVID-19 care facility with 2,000 beds: role of the anesthesiologist.

    J Cardiothorac Vasc Anesth. 2021; 35: 2827-2830


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