IMPORTANT THREAD on #COVIDTreatments - What Works & What Does not. Will be an ongoing threat.
Start with Dr Zarir Udwadia of Mumbai.
Link to Dr Udwadia's Video
1st Point: 90000+ Medical papers on Covid. UNFORTUNATELY, big divergence in Observational Studies impact and Real World impact of a rigorous RCT
RCT is Randomized controlled trial.
A Good website is Covid19Primer.com
2) What Works ?
(A) Steroids are essential. #DEXAMETHASONE 6mg/day for Critically ill Covid Patients. Reduces Death by 33/20% for Patients on Ventilators & Oxygen.
(A) contd: #DEXAMETHASONE is however NOT good for #CovidPatients who didn't require Oxygen or Ventilators.
(A) Contd: Final View on USE OF steroids like #HydroCortisone also should NOT be used in the Intial phase of Covid Treatment since it might be detrimental. Best is to allow the natural immunity to work
(B) #REMDESIVIR - Does it Work ? It speeds up time to RECOVERY in the Severe disease Subgroup and those on Oxygen (Ordinal Score 5 - see attached slide) but DID NOT help patients on #Ventilators (Ordinal Score 7+). Worked better in patients who recived it 1-10 days of Symptoms.
(B) contd #REMDESIVIR - Does it Really work ?
The ACT 1 (1k) study sponsored by @GileadSciences (Innovator) showed Promise but the #SOLIDARITY trials (11k) which reflects REAL WORLD showed different results. Both However indicated NO POSITIVE IMPACT on 30 day Mortality.
(B) Contd: WHO actually recommended NOT using #REMDESIVIR. But then #REMDESIVIR was used in Combination with JK Inhibitor (#baricitinib) in another ACT 2 Trial of 1k people (Gilead) & showed that for Patients on Invasive Oxygen (Ordinal Score 6), it reduced Mortality
(3) ANTICOAGULANT - Do they help ?
Remember that the hallmark of #COVID19 is the #Thrombotic #MicroAngiopathy (blockage) of Smaller Vessels in the Lung. Summary: Use for All patients except Mild Patients. D-Dimer levels indicate daily usage & post discharge for 3 weeks.
(D) What about other Potentially Useful Treatments like (1) Inhaled Interferon (2) #Favipiravir (3) Monoc ANTibodies (4) Plasma (5) #tolicizumab
(1) Inhaled #Interferon: A small trial of 50 patients showed a staircal improvement in recovery. BUT it's important that this is INHALED using a #Nebulizer and not given #Intravenously. None the less mode data is required
(2) #Favipiravir - is it effective? It's neither US & EU approved. It's however approved in China, Japan, Russia & India. Just 2 peer Review papers. India study organised by Dr Udwadia indicated a marginal improvement in Recovery days.
(3) Monoclonal Anti-bodies. Very expensive. 3 different studies with 3 different Anti-bodies. Monoclonals have been added to the Oxford University Trials for Covid Patients. Let's see.
(4) Plasma - Does it help. 3 Studies in India, Brazil & Argentina. Both India & Brazil indicated NO advantage while Argentina trials indicated some improvement of given within 48 hours of a "Tighter Donor". BUT #ConvalescentPlasma was #Unsucessful in Recovery & hence Discontinued
(5) #Tocilizumab - it's an IL-6 Receptor. Several Studies have shown that it has NO SIGNIFICANT benefits on Recovery & Mortality (table attached). It has strong side effects. If you have to use it, use it ONLY Once and a max of 400mg. Best is NOT to use it.
#COVIDTreatments - What Certainly DOES NOT Work ?
#antibiotics like Azithromycin, #Doxycyclin, Antivirals like #lopinavir, #Oseltamivir, #HCQS, #ivermectin, unnecessary use of Vitamins.
An excellent article for the lay man on what works in Covid Treatment and what does not work. As you can see what @realDonaldTrump used during Recovery. It was a concoction.
Link coronapolicyimpact.org/2020/07/11/exp…
In Summary - What Works in Covid Treatment and what does not? Steroids have shown the best impact in Recovery but not mortality. #Remdesivir shows some help only when it's combined with an JK Inhibitor. Most suggested treatments by Docs are due to pressure from patients
It's a shame that the Govt Officials are recommending #REMDESIVIR which is does NOT work in isolation and Does not work in every situation.
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