The current Standard of Care in COVID is to let people Suffer with Fever,Cough with Supportive Care(paracetamol,cough syrups) till it become Severe enough that Oxygen levels fall and Patient has to be admitted or they spontaneously recover (at which stage steroids can be given)
This is not how we practice Medicine.
To let Lung Injury go on unabated will have consequences.
Early treatment is also prevention from Deterioration or long term COVID Symptoms after Recovery.
Unfortunately HCQS has largely failed in early treatment/post exposure trials
And current lot of oral Antivirals are weak and don't have solid data..
But I sympathize with clinicians who try to throw kitchen sink of weak Antivirals on Pascal's wager (till solid evidence is out)as weak Antivirals are likely to work only early
I believe More Early outpatient treatment trials should be held in India judging not only progression to ICU as end point,but also including prevention of Household transmission ,Amount of Symptoms developed and Long term COVID Symptoms at end of month as these are all important

• • •

Missing some Tweet in this thread? You can try to force a refresh

Keep Current with Anupam Singh

Anupam Singh Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!


Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @anupampom

18 Oct
A thread on Remdesivir and its role post SOLIDARITY trial.
There have been 4 trials of Remdesivir so far.(Two predominantly in US/Two outside)
First was Wuhan trial(published Mid April) which was cut short due to lack of cases ,which showed no mortality benefit with Remdesivir and a trend towards faster recovery.…
In the US trial (NIH-ACTT1)(published Mid May) of patients admitted with Severe COVID ..(poor oxygen level+pneumonia) Remdesivir did cut short Time to Recovery by 4 days .…
Read 18 tweets
22 Jul
A recent serosurvey by NCDC at start of July of Delhi suggests ,that 23.48% of Delhi population had IgG antibodies against SARS-COV2 .(implying thia many were exposed till 2 weeks back mid of
Commercial lab Antibody tests suggest similar Estimates
This implies wider spread than previously thought. However Infection fatality rate (Deaths typically taken 7-10 days back after Antibody formation or modelled as log normal distribution) has been estimated at 0.07% (3700 death/ 43-45 lakh affected out of 1.9 crore)..
It was similar in ICMR sero-survey earlier.
However these figures are very less than Estimates in Western Countries . A recent meta-analysis suggest a median IFR of 0.6%. CDC at start of June has revised its estimate multiple times [0.26% to 0.6%. ]
Read 25 tweets
12 Jul
A thread on Rapid Antigen testing in community.

All members of Bachhan Household were tested by Rapid Antigen test when Amitabh, Abhishek became Symptomatic.Rest were ASymptomatic
Amitabh, Abhishek turned Positive and were taken to Hospital. Aishwarya and her daughter tested negative and RT-PCR was repeated which came out to be positive. Jaya Bachhan tested negative in both.…
Thus False negative rate of Rapid Antigen test in this small sample was 50%.(2/4) ICMR study had informed us that it was between 20-50% ,so it is roughly at lower bound of this range.
Read 10 tweets
25 Jun
While Favipravir and Coronil Trial are being criticized for lack of Blinding and gaining approval via Press Release. Have major drug trials done better?
1. RECOVERY. Open label(No blinding). Evidence dexamethasone + . HCQ arm-(press release, pre-prints 2 week later)
2. SOLIDARITY Trial(WH0). No Blinding(open label)
3. Lopinavir/Ritonavir for Severe COVID. No Blinding.(responsible for dropping Lopinavir/Ritonavir from Indian guidelines in march)
4. Univ of Minesotta Hydroxychloroquine trial. Double Blind ,but imperfect blinding (Patient could guess Drug/Placebo in 50% of cases)
Read 6 tweets
24 Jun
A dive into'Patanjali Clinical Study'

According to registration on CTRI, Initial sample size was planned for 60 in each group (placebo and Coronil).Primary Endpoint was Virological "Cure" at 14 days.(PCR negative)for mild/moderate severity COVID Patients…
However when trial results were launched n Coronil Market blitz rolled out. It turned out only ASymptomatic and mild Patients recruited. And no moderate ones . (45 Coronil,50 Placebo). Also they stopped trial at 7 days only.…
Can a trial stop midway. Yes for efficacy ,if interim looks were planned (Both Remedesivir and Dexamethasone were stopped midway for efficacy) and p values adjusting for multiple comparisons. But unlikely that it was done here. An unprofessional look.
Read 18 tweets
30 May
ICMR has published a good epidemiological summary paper of COVID-19 cases from Jan22-April30 in India
I encourage you to read it at…

Here are key insights for me from this paper
Only 60% of COVID-19 cases have Fever at point of testing(thermal screening less likely to work in 40%). 31% have breathlessness (they present late in Moderate COVID stage). Many have atypical Symptoms .
Hence Testing Criteria should be expanded to include these symptoms and (not restricted to checking for Influenza like Illness only in hot zones) to detect early.
Read 14 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!