Evidence based medicine is not being practised enough in India. Many "official COVID19 treatments" in India have already been discarded by the world, but patients still receive long lists of drugs that only add to cost & side effects.
Chloroquine, Ivermectin, plasma, steam inhalation, 'coronil', azithromycin, doxycycline, oseltamivir, vitamin D (for people without proven deficiency), Zinc, vitamin C, PP inhibitors are still prescribed in India, despite lack of evidence. This is called polypharmacy.
2/10
"There is no harm in giving it" is not a scientific explanation that can justify irrational use. Besides, all harms need not be obvious to the prescriber.
Doctors are trained to use the minimum number, dose & duration of medication for any disease, and only if necessary.
3/10
In other words, NOT giving a 'prescription medication' is perfectly acceptable for many medical conditions, as long as the doctor is able to diagnose and educate the patient about the treatment plan to be followed.
Simply put, "treatment ≠ prescription"
Less can be More.
4/10
'Opinion-based' treatments not only add to cost, but also increase the chance of side effects & interactions (some of which can be dangerous). This is unethical. With all the evidence, it is time to stop such unscientific practices.
['opinion' is not the same as evidence]
5/10
In COVID-19, there are only 4 established life-saving treatments. They are oxygen, steroids (oral or IV), prophylactic LMW heparin & vaccines.
We must focus on giving these in the right dose to the right patient, as they are not useful for everyone.
6/10
There are a few other drugs like Tocilizumab & others that are used only by experts under certain circumstances; this thread is not meant to discuss these.
Will link the Massachusetts General Hospital guideline for those with academic interest.
In modern medicine, we follow evidence. It is important to systematically DISCARD treatment modalities that do not work, without prejudice.
It is not advisable to "fall in love with" certain 'favourite' drugs and continue to prescribe them against all accumulated evidence.
8/10
On this note, it is important to reiterate that antivirals (Remdesivir, Lopinavir) do not reduce mortality.
When observing a few patients, it is common for doctors to be fooled into thinking that a particular drug 'made a difference'.
That is why we do randomised trials.
9/10
The advantage of randomised trials is that they study large numbers of people, which means any chance of erroneous conclusion is removed, and bias by the treating team is also eliminated. Unfortunately, some people continue to act against such evidence.
This thread is a classic example of personal bias overriding scientific temperament. >80% COVID-19 patients recover with no medication, but credit is given to drug given.
Bacteria, their benefits apart, do not require to be killed, unless they cause secondary infection.
Besides no one gives any journal the license to make guidelines. Peer reviewed journals hold a high standard of eliminating fraudulent claims and at this time, they are a relatively credible source of evidence. Whether we adapt from the paper depends on many factors.
2/3
For starters, never believe the conclusions of any research paper. As a doctor you must have the basic knowledge of biostatistics to look at the methodology, raw data, primary outcomes, confidence intervals and the merits of the tests of association they used.
3/3
Cell entry mechanisms of SARS-CoV2. Fusion peptide molecules in the spike protein need to undergo a conformational change ("bending") to help "clip" the 2 membranes together (virus & human cell);energy is needed to overcome a repulsive hydration force. 1/n pnas.org/content/117/21…
The fusion process - or final conformational change- varies by availability of multiple cellular proteases, and may be facilitated by environmental factors (physical force/temperature/chemical) in addition to furin preactivation.
2/n
The SARS-CoV-2 virus is a 'more advanced model' than the original 2003 SARS virus, in that its RBD remains hidden (in lying down / 'off' position) helping it escape our immune surveillance.
While this might theoretically affect its ability to bind to the ACE-2 receptor,
3/6
Did elections contribute to the COVID-19 surge? We are always tempted to say yes. I decided to do a comparison. Surprisingly, the graphs I obtained from election & non election states are near-identical. This suggests that the wave is a seasonal surge in a geographic region. 1/9
The two images represent election states (where big outdoor gatherings occurred) on the right, and comparable non election states on the left. I have included two sets of pictures. The names of the states are on the graph. If you compare the timelines, it is near-identical.
2/9
The question is whether the surge would have occurred anyway, by pattern, and maybe the large election rallies amplified it to an extent.
This virus behaves in a wave-like pattern in most nations. The reason for the steep upward slope is exponential increase.
3/9
T cells work against variants & are not affected by E484K or N501Y mutation.
1 dose of vaccine is enough if past infection: the response was so amplified, it even covered the major variants B.1.351 & B.1.1.7. Note that vaccine is based on old virus.
But in naive patients, T cell response was lower with one dose of vaccine.
96% (22/23) of vaccinated post infection individuals made a T cell response to Spike protein, compared to 70% (16/23) of vaccinated naïve individuals.
2/5
After 1 dose, vaccination-naïve (no past infection) group attained similar antibody titers to the post infection group at 16–18 & 28–30 weeks.
The majority of SARS-CoV-2 immune naïve individuals made no nAb response to the B.1.1.7 (18/20) and B.1.351 (17/20) after 1 dose.
3/5
“It is time for India’s policymakers to trust those with relevant expertise, to make sure the necessary data are collected and available, and to accept the value of scientific findings, even if they do not fit the government narrative”