The number of people infected with Covid-19 continues to skyrocket, with nearly one million cases worldwide. But there’s no vaccine or cure for it, though human trials have started in the US based on their earlier research on the Middle East Respiratory Syndrome (MERS) and the Severe Acute Respiratory Syndrome (SARS). This means that doctors can do little more than offer supportive treatment to the very sick and hope their bodies can survive the infection.
With about 15 percent of Covid-19 patients suffering from severe disease and hospitals being overwhelmed, treatments are desperately needed. Now a coalition of researchers says that already approved drugs might hold the key to treatment. This includes a drug combo used against HIV, a malaria treatment first tested during World War II and a new antiviral whose promise against Ebola fizzled out last year.
WHO is looking for such drugs which have already been approved for other diseases and known to be largely safe. It is also looking at unapproved drugs that have performed well in animal studies to treat SARS and MERS. It is also looking for treatments to be given prophylactically to protect healthcare workers and others at high risk of infection. Treatments may also reduce the time patients spend in intensive care units, freeing critical hospital beds.
WHO has announced a large global trial called Solidarity to evaluate whether potential treatments are effective against Covid-19. Already, Argentina, Bahrain, Canada, France, Iran, Norway, South Africa, Spain, Switzerland and Thailand have joined this effort. The Solidarity trial will test four different drugs or combinations and compare their effectiveness to fight the virus. The trial is an unprecedented effort—an all-out, coordinated push to collect robust, scientific data rapidly during this pandemic. The study, which could include thousands of patients in a dozen countries has been designed to be as simple as possible so that even hospitals overwhelmed by Covid-19 patients can participate.
WHO is focusing on four most promising therapies: an experimental antiviral compound called remdesevir; malaria medications chloroquine and hydroxychloroquine; a combination of two HIV drugs, lopinavir and ritonavir, and the same combination plus interferon-beta, an immune system messenger. Some data on their use in Covid-19 patients has already emerged—the HIV combo failed in a small study in China—but WHO believes a large trial with a greater variety of patients is warranted.
In India, the Drug Controller General of India approved the two anti-HIV drugs for restrictive use for Covid-19 and ICMR cleared the prophylactic use of hydroxychloroquine for close contacts. The health ministry has approved use of the anti-flu drug oseltamivir (Tamiflu group) for the treatment protocol. Meanwhile, the Confederation of Medical Associations in Asia and Oceania has recommended a hydroxychloroquine and azithromycin combination. Hydroxychloroquine has been reported to inhibit SARS-CoV-2 in vitro.
Chloroquine is included in treatment guidelines from China’s National Health Commission and was associated with reduced progression of the disease. Treatment guidelines from the Commission include the interleukin (IL)-6 receptor inhibitor, tocilizumab, for patients with severe Covid-19. In the US, the FDA is accepting emergency investigational new drug applications for use of convalescent plasma for patients with severe Covid-19. A case series described the administration of plasma from donors who had completely recovered from Covid-19 to five patients who were on mechanical ventilation and had persistently high viral titters despite antiviral treatment. Twelve days later, they were found to have decreased disease severity, but these findings do not establish a causal effect.
Enhancing the body’s immunity plays an important role in maintaining optimum health. The ministry of AYUSH recommends the following self-care guidelines for boosting immunity with special reference to respiratory health.
* Drink warm water throughout the day.
* Daily practice of Yogasana, Pranayama and meditation for at least 30 minutes
* Spices such as turmeric, cumin, coriander and garlic are recommended in cooking
Meanwhile, ayurveda suggests the following measures for better immunity:
* Take 10 gm Chyavanprash in the morning. Diabetics should take sugar-free Chyavanprash
* Drink herbal tea/decoction made from basil, cinnamon, black pepper, dry ginger and raisins once or twice a day. Add jaggery and/or fresh lemon juice
* Have golden milk—half teaspoon turmeric powder in 150 ml hot milk once or twice a day
* Nasal application—apply sesame oil/coconut oil/ghee in both nostrils morning and evening
* Oil-pulling therapy—put a tablespoon of sesame/coconut oil in the mouth, swirl it for 2-3 minutes and spit it out, followed by a warm water rinse
* To tackle dry cough/sore throat, take steam inhalation with fresh mint leaves or caraway seeds daily. In addition, clove powder mixed with honey can be taken 2-3 times a day for throat irritation.
A stitch in time saves nine.
Cult practices & Covid-19
Even as the Nizamuddin catastrophe unfolds in Delhi, the spread of Covid-19 can be linked to cult practices in South Korea, Malaysia, Indonesia and Pakistan. In March, a Muslim congregation of over 2,000 people was organised in Nizamuddin, Delhi, by Tablighi Jamaat, a global Islamic missionary movement, leading to the spread of the virus all over India.
In South Korea, most Covid-19 cases can be traced back to the mysterious Shincheonji Church of Jesus where one person spread it to the others. Almost 63.5 percent of all confirmed cases in the country were related to Shincheonji. Some of its practices included secrecy, banning of health masks, praying in close proximity, kissing each other’s hands, singing hymns, not caring about worldly things and focusing on conversions even when someone is sick. They feel that getting sick is a sin as it prevents them from doing God’s work. Such behaviour defies physical distancing principles.
Tablighi Jamaat attendees believe only in their leader, that getting sick is a gift from Allah and dying in a mosque grants them heaven. The organisation urges Muslims to practise their religion as it was during Prophet Muhammad’s time. This is particularly so in matters of ritual, dress and behaviour. It has an estimated 150-250 million adherents, with the majority living in South Asia.
Between February 27 and March 1, the movement organised an international religious gathering at Sri Petaling Mosque in Kuala Lumpur, Malaysia. This was linked to more than 600 Covid-19 cases, making it the largest known centre of transmission in Southeast Asia.
A second gathering was scheduled on March 18 in South Sulawesi, Indonesia. Though the organisers initially rebuffed official directives to cancel the gathering, they subsequently complied. Yet another gathering was organised in Pakistan near Lahore for 1.5 lakh people. Despite officials’ requests, the participants communed together, leading to the spread of the virus overseas.
Meanwhile, the Nizamuddin faction of the Tablighi Jamaat held a congregation there every week of last month till March 21. There were reportedly other violations by foreign speakers here, including misuse of their tourist visas for missionary activities and not observing the 14-day home quarantine. It is believed the sources of infection were preachers from Indonesia. Many returned to their states in India and provided refuge to foreign speakers without the knowledge of local governments and eventually spread it in Tamil Nadu, Telangana, Karnataka, J&K and Assam.
Clinical experience suggests that certain situational or developmental features appear to make people more receptive to cults. These include high stress levels or dissatisfaction, lack of self-confidence, gullibility, desire to belong to a group and frustrated spiritual searching. Most cult leaders have a narcissistic personality disorder, an excessive need for admiration, disregard for others’ feelings, an inability to handle any criticism and a sense of entitlement. As for the followers, most would be going through a mental crisis and the cult seems to offer relief. Many ex-followers have issues readjusting to society.
—The writer is President, Confederation of Medical Associations in Asia and Oceania and former National President, IMA
Lead Photo: UNI