'Mistakes in COVID Response Being Repeated': Experts Write to Centre, States

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Nearly three dozen healthcare workers, medical researchers and public health experts have penned an ‘open appeal’ to the Central and state governments to heed to the now-large “high-quality scientific literature that provides unequivocal guidance on the clinical management of COVID-19”, and to prevent the mistakes of 2021 being repeated this year.

In the appeal, they enumerate three “critical issues” that they say are based on “limited evidence” and “misinformation” and together present a “travesty”: unwarranted medications, unwarranted tests and unwarranted hospitalisations. They subsequently propose five measures, from updating the home-care protocol to revising the June 2021 guidelines of the Directorate General of Health Services.

The Wire Science is publishing their appeal in full, followed by the list of signatories.

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Less than one year ago, the devastating delta wave of the pandemic resulted in the greatest public health emergency of our times. The response to the pandemic, while marked by innumerable examples of personal sacrifice and grit, was riddled with missteps – several of which were avoidable. While there continues to be much uncertainty amidst the outbreak of this novel disease, there is now substantive high-quality scientific literature that provides unequivocal guidance on the clinical management of COVID-19. Despite the weight of this evidence and the crushing death toll of the delta wave, we find the mistakes of the 2021 response being repeated in 2022.

We urge you to intervene to stop the use of medications and diagnostics that are inappropriate for the clinical management of COVID-19. We draw your attention to three critical issues:

1. Unwarranted medications

The vast majority of patients with COVID-19, with asymptomatic and mild symptoms, will require little to no medications. Most prescriptions we have reviewed in the past two weeks include several COVID-19 “kits” and cocktails. The prescribing of vitamin combinations, azithromycin, doxycycline, hydroxychloroquine, favipiravir, and ivermectin for treating COVID-19 is irrational practice. Such wanton use of drugs is not without harm as the Delta wave has shown. Outbreaks of opportunistic fungal infections like mucormycosis in India, and aspergillosis in Brazil were attributed to the widespread abuse of inappropriate medications.

2. Unwarranted tests

The vast majority of COVID-19 patients will need no additional diagnostics after the initial positive rapid antigen or PCR test, except – in some cases – home monitoring of their oxygen level. There is also growing evidence that while the omicron variant may cause many breakthrough cases among previously infected or previously vaccinated populations, the morbidity and mortality associated with the disease, among them, will be lower.

Yet, CT scans and a battery of laboratory tests like d-dimer and IL-6 are routinely being prescribed by practitioners across the country in asymptomatic and mild cases, placing undue financial burden on families.

3. Unwarranted hospitalisations

Patients continue to be admitted to hospitals without clinical justification. Unnecessary hospitalizations, besides further adding to the financial load, also risk the lives of hundreds of thousands of other, non-COVID patients that cannot find a hospital bed for more emergent conditions.

Two years into the pandemic, there is no justification whatsoever for allowing these unwarranted practices to continue. Health care workers in India rely heavily on government guidelines which have unfortunately promoted expensive diagnostics and medications with limited evidence. The public and the medical community are also subject to gross misinformation on social media. We believe it is incumbent on state agencies and on professional medical societies to put an end to this travesty, in the best interest of the nation.

We therefore request the Central and State governments to institute the following policies immediately, with regard to the COVID-19 medical response in India:

1. Update the evidence-based June 2021 DGHS guidelines. In particular, provide specific guidance on the use of monoclonal antibodies, given their limited efficacy for the Omicron variant, and their continued widespread use.
2. Through public education and professional training, discourage the use of medications that have no supporting evidence for the treatment of COVID-19, including alternative therapies, potions, antibiotics, “cocktails,” and drugs like Molnupiravir, which are expected to be widely abused and inappropriately prescribed.
3. Through public education and professional training, discourage the use of unwarranted diagnostics, especially for asymptomatic and mild cases, where none are required, except for confirmatory Antigen or PCR tests.
4. Publish home-care guidelines for rapid testing, quarantining, isolation and release, in all local languages, contextually modified to suit local urban and rural contexts where the availability of rapid antigen home tests and PCR tests varies widely. Include a list of vetted local resources including helpline numbers.
5. Stop any state-sponsored promotion or distribution of medications, cocktails, alternative therapies or potions that are not scientifically proven therapies.

We underscore the importance of ramping up proven effective public health strategies, including universal masking in all public places. Provide communities the resources to do so through mass media campaigns and the regular distribution of appropriate three-ply masks. Provide all healthcare workers adequate N95s and eye protection. Continue to accelerate vaccination, building on current success.

We stand ready to provide any assistance asked of us with preparing any of the above material.

We very much hope that you implement these policies with the urgency they merit.

In the spirit of our shared mission of serving patients,

1. Dr Anant Bhan, Yenepoya (deemed to be) University, Mangaluru
2. Dr Rajani Bhat, Pulmonologist, boardofdoctors.com , Bangalore
3. Dr Anjali Chhabria, MindTemple, Mumbai
4. Dr Sonia Dalal, Dalal Sleep and Chest Medical Institute, Vadodara
5. Dr Bharat Gopal, Sr Chest Physician, New Delhi
6. Dr Richa Gupta, Christian Medical College, Vellore
7. Dr Raghuraj Hegde, Manipal Hospitals, Bangalore
8. Dr Rajeev Jayadevan, Sunrise Hospital, Kakanad, Kerala
9. Dr Yogesh Jain, Sangwari, Chhattisgarh
10. Dr Yogesh Kalkonde, Sangwari, Chhattisgarh
11. Dr Arvind Kumar, Medanta – the Medicity, Gurugram
12. Dr Charuta Mandke, Dr. R. N. Cooper Municipal General Hospital
13. Dr R K Mani, Yashoda Super Specialty hospital, Ghaziabad UP
14. Dr Pavitra Mohan, Basic Healthcare Services, Rajasthan
15. Dr Nachiket Mor, Banyan Academy of Leadership in Mental Health
16. Dr Sanjay Nagral, Jaslok Hospital, Mumbai
17. Dr Cyriac Abby Philips, The Liver Institute, Rajagiri Hospital, Kerala
18. Dr Ashish Satav, Mahatma Gandhi Tribal Hospital, Amravati
19. Dr Tushar Shah, Advanced Multispecialty Hospital, Mumbai
20. Dr Satendra Singh, University College of Medical Sciences, Delhi
21. Dr Aqsa Shaikh, Hamdard Institute of Medical Sciences and Research, New Delhi
22. Dr Zarir Udwadia, PD Hinduja National Hospital; Breach Candy Hospital
23. Dr Sonali Vaid, Public Health , Incluve Labs
24. Dr Shitij Arora, Albert Einstein College of Medicine, US
25. Dr Satchit Balsari, Harvard Medical School, US
26. Dr Kartik Cherabuddi, University of Florida Health, US
27. Dr Sumanth Gandra, Washington University School of Medicine, US
28. Dr Manoj Jain, Emory University, Rollins School of Public Health, Atlanta, US
29. Dr Manoj Mohanan, Duke University, US
30. Dr Madhukar Pai, McGill University, Canada
31. Dr Priya Sampathkumar, Mayo Clinic, US
32. Dr Bhavna Seth, Johns Hopkins School of Medicine, US
33. Dr Amita Sudhir, University of Virginia, US

This list may be updated to include new signatories in future.