Last Updated: 30th June, 2021
COVID-19 Medicines: COVID-19 is a biphasic disease in short. This denotes it has two separate phases that are separated by chronology. During these two layers, doctors have different opportunities to determine whether to conduct antiviral or immunomodulatory treatments. When the relevant treatment is started just at the proper moment, the benefit of the treatment is enhanced, and a life is saved.
The Two Phases Of COVID-19 Disease:
Phase I: From Day 1 to Day 6 of Infection
This is the viral replication phase. The coronavirus multiplies and produces copies in the nose, throat, and maybe a little bit in the lungs. Chronologically, the initial 5-6 days of COVID-19 infection are crucial because a robust immune response comes into play. This helps restrain the growth of the virus, improve symptoms and promote recovery.
Phase II: From Day 7 to Day 14 of Infection
This is the inflammatory response phase. The immune system may get dysregulated and cause the mild disease to turn into a moderate (or even a severe) disease.
Observe Each Phase Of This Biphasic Disease Methodically:
PHASE I: Viral Replication Phase
(Intent of the medications: symptomatic relief and reduction in the viral load)
Proposed COVID-19 medicines include:
- 2.Montelukast and Levocetirizine
Paracetamol is a Nonsteroidal anti-inflammatory drug (NSAIDs). It is approved for the treatment of fever and mild to moderate pain relief in adults and children aged two months and over. The World Health Organization (WHO) recommends using Paracetamol to relieve pain and reduce fever in COVID-19. Typically, the most moderate effective dose is recommended for the short time to relieve symptoms. The maximum daily dose of Paracetamol for adults must not exceed 3000mg It is advised not to take more than the recommended dose for fast relief as it can lead to side effects.
2. Montelukast And Levocetirizine
A combination of anti-allergic medicines, namely, Montelukast and Levocetirizine may be effective against symptoms like a cough in COVID-19. While Montelukast was found to have some virus preventive role, levocetirizine may curb the inflammation recognized in COVID-19.
It is an oral antiviral medication. Its use has been approved for the treatment of mild to moderate COVID-19 cases. Though it is considered to be an effective COVID-19 medicine, there is not enough evidence to support this. Misuse of this drug can lead to certain side effects. Hence, receive this medicine only when advised by a doctor. Other similar COVID-19 medicines like Lopinavir and Ritonavir have been found inefficiencies’ in treating COVID-19.
Ivermectin is an antiparasitic medicine. This medicine has been seen to suppress the replication of the novel coronavirus under laboratory conditions. MoHFW states in its guidelines for Home Isolation of mild/asymptomatic COVID-19 cases that Tablet Ivermectin (200 mcg/kg), once a day, on an empty stomach for a period of 3 to 5 days can be considered for treating the patient with mild/asymptomatic disease in home isolation.
However, in a recent tweet, WHOs chief scientist stated:
“Safety and efficacy are important when using any drug for a new indication. WHO recommends against the use of ‘ivermectin’ for COVID-19 except within clinical trials.” This is WHO’s second warning against the usage of Ivermectin for coronavirus in the past two months.
WHO does not recommend using antibiotics in COVID-19, especially in mild cases. COVID-19 is caused by a virus and antibiotics work only against bacteria, not viruses. Therefore, antibiotics should be unused for prevention or treatment. However, it may be prescribed to cover bacterial superinfections.
PHASE II: Inflammatory Phase
(The intent of the medication: to halt the stage of Pneumonia and promote recovery)
Proposed COVID-19 medicines include:
- 5. Steroids
- 6.Tocilizumab only to be given with steroids
- 7. Anticoagulants
- 8. Baricitinib
- ***Plasma Therapy
Steroids such as Dexamethasone have anti-inflammatory benefits. This may help prevent or mitigate uncontrolled and responsible inflammation for causing lung damage and multisystem organ dysfunction in severe COVID-19. As per the RECOVERY trial and other studies, the incidence of death was lower in hospitalized COVID-19 patients who were given dexamethasone as compared to those who received standard care. Steroids, when used judiciously, are the only COVID-19 medicines to save lives in the pandemic situation.
However, there is no evidence supporting the long-term use of steroids in patients with COVID-19. On the contrary, an extended course of steroids could be detrimental. As follows, while a brief course of steroids may deliver therapeutic benefits, a long-lasting course may inadvertently lead to poor treatment outcomes.
Studies suggest that Tocilizumab, when given along with corticosteroids, may provide some benefit in severely ill COVID-19 patients. It is usually given to patients who are hospitalized, rapidly deteriorating with increasing oxygen needs, and have a significant inflammatory response.
The NIH COVID treatment guidelines clearly state that Tocilizumab should only be given in hospital settings and combination with a course of dexamethasone therapy (or an alternative corticosteroid at a dose equivalency). It should be with caution as this medicine has its share of side effects.
WHO suggests using low-dose anticoagulants to prevent blood clot formation in hospitalized COVID-19 patients. Preventive doses of anticoagulants, preferably Low molecular weight heparin (LMWH) can be given unless there is a contraindication.
As per the Adaptive COVID-19 Treatment Trial (ACTT-2), the combination of baricitinib (an anti-inflammatory drug) and remedesivir (an antiviral) reduced the time of recovery among individuals hospitalized with COVID-19.
It was reported that baricitinib had an additional survival benefit when given along with corticosteroids (with or without remedesivir). This observation was based on the results of COV-BARRIER, a trial of baricitinib in hospitalized adults.
The SOLIDARITY Trial on Remdesivir conducted by WHO, showed no evidence to suggest that this medicine can reduce the length of hospital stay or save the life of a COVID-19 patient.
WHO suspended Remedesivir from their pre-qualified list of COVID-19 medicines as it showed no mortality benefit.
While antibiotics are unneeded during the first phase of illness, hospitalized patients may be prescribed antibiotics to overcome bacterial co-infections. Antibiotics may be indicated in patients with COVID-19 due to suspected or confirmed bacterial superinfection/secondary infection.
Convalescent Plasma Therapy (CPT) benefits are dependent on the concentration of specific antibodies in convalescent plasma that could neutralize the effects of the novel coronavirus. As per the PLACID trial conducted by ICMR, “CPT didn’t lead to a reduction in progression to severe COVID-19 or all-cause mortality.”
Plasma therapy was removed from COVID-19’s treatment recommendations.
A Word Of Advise!
Get assessed if you experience any symptoms of COVID-19. While you wait for the report, isolate yourself to prevent the virus from spreading to your friends and family. Until then, arrange an appointment with a doctor. Strictly follow your doctor’s guidelines and consult with him or her before undergoing any treatment.