The Right Thing, as Usual Late

INDIA’S DIRECTOR ATE General of Health Services recently came out with guidelines that took away most medicines that used to be prescribed for people infected with Covid. It will (hopefully) put a stop to doctors trying to carpet bomb the virus away with every inch a prescription paper can hold. The new guidelines are in keeping with studies that had been out there for some time. SP Kalantri, a public health specialist, who has for long been a voice for Covid treatment based on scientific evidence, was so pleasantly surprised, he tweeted: “I couldn’t believe my eyes. So I asked my colleague to read to me the recent Covid19 guidelines by DGHS. I couldn’t believe my ears too.”

In an interview to Rediff, he said he had treated 15 family members infected with Covid by giving them only paracetamol for fever and body aches. He added: “And they all got better. So, when today I see about a dozen drugs making its way into the doctor’s prescription—two antibiotics and hydroxychloroquine, ivermectin, favipiravir, vitamin A, vitamin C, vitamin D, zinc—I must have missed some more (laughs), I feel very sorry that the medical profession has failed.” The basis for such abandon by the medical profession had been the Government itself. For instance, the Indian Council of Medical Research, as recently as May 17th, recommended that for mild Covid disease, doctors may prescribe “Tab Ivermectin (200 mcg/kg once a day for 3 days)… OR Tab HCQ (400 mg BD for 1 day f/b 400 mg OD for 4 days).” Any doctor who did not prescribe these medicines would then have had a tough time explaining to patients why he was not interested in saving their lives.

What is striking is not that the Government became rational about Covid treatment, but that it did so just as the second wave is ending. All the evidence for limiting medicines was available at the beginning of the wave too. The mad scramble for remdesivir could have been prevented and family members of patients spared the agony if it had been made clear, as studies had shown, that not only was remdesivir far from a silver bullet, but a medicine whose limited efficacy is only in a small subset of patients.

Doing the right thing very late is now something of a hallmark in India’s war on Covid. Another example of perfect bad timing was in deciding the date of the second dose of Covishield. When the UK had been going by at least three months, India shifted to between two and three months. When India made it three months, the UK, relying on studies dealing with new variants, had amended it two months. We will no doubt change this too at some point. The medical establishment here seems reluctant to listen to what science is communicating. Instead, it looks at what other countries are doing and then waits for some time just to be safe before making policy. It is the fear of responsibility. Not doing something has very little consequences. No one gets fired for a guideline he didn’t make.

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Madhavankutty Pillai

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