New Delhi, May 23, 2020: Even as medical journal The Lancet published a paper on Friday saying there were no confirmed benefits of anti-malarial drug hydroxychloroquine (HCQ) being given to Covid-19 patients, the Union health ministry issued an advisory expanding the pool of people to be given the medicine as a prophylactic to prevent them from contracting the infection, Hindustan Times reported.
“The Joint Monitoring Group and National Task Force have now recommended the prophylactic use of HCQ in the following categories: a) all asymptomatic healthcare workers involved in containment and treatment of Covid-19 and asymptomatic healthcare workers working in non-covid hospitals/non-covid areas of covid hospitals/blocks; b) Asymptomatic frontline workers, such as surveillance workers deployed in containment zones and paramilitary/police personnel involved in Covid-19 related activities; and c) Asymptomatic household contacts of laboratory confirmed cases,” the advisory said.
The earlier HCQ advisory on March 23 cleared its prophylactic use for two high-risk groups: asymptomatic healthcare workers involved in the care of suspected or confirmed cases, and asymptomatic household contacts of laboratory-confirmed cases.
“As a prophylactic drug, the medicine has shown results in India which is why it is advised for a larger group now. The Lancet paper that has come out will have implications for treatment regimen not prophylaxis,” said an Indian Council of Medical Research (ICMR) official, who did not wish to be identified.
ICMR began a ‘demonstration study’ on the efficacy of HCQ as a prophylactic medicine against Covid-19 in March to see if it will prevent people, especially those in close proximity with a positive case from acquiring the infection.
“What we have been doing in India is different from the studies done anywhere else in the world in the sense that we have been checking whether it could work as a prophylactic medicine, whereas everywhere else it was given to positive patients as a treatment option. The results look like favourable in our population,” said the official.
The Joint Monitoring Group under the chairmanship of Directorate General of Health Services, the government of India, and representatives from the All India Institute of Medical Sciences (AIIMS), ICMR, National Centre for Disease Control, etc reviewed HCQ’s prophylactic use in the context of expanding it to healthcare and other frontline workers.
“A retrospective case-control analysis at ICMR has found that there is a significant dose-response relationship between the number of prophylactic doses taken and frequency of occurrence of SARS-CoV-2 [that causes covid-19] infection in symptomatic healthcare workers who were tested for SARS-CoV-2 infection. Another investigation from 3 central government hospitals in New Delhi indicates that amongst healthcare workers involved in covid-19 care, those on HCQ prophylaxis were less likely to develop SARS-CoV-2 infection, compared to those who were not on it,” said the fresh health ministry advisory.
“The benefit was less pronounced in healthcare workers caring for a general patient population. An observational prospective study of 334 healthcare workers at AIIMS, out of which 248 took HCQ prophylaxis (median 6 weeks of follow up) in New Delhi also showed that those taking HCQ prophylaxis had lower incidence of SARS-CoV-2 infection than those not taking it.”
“At National Institute of Virology, Pune, the report of the in-vitro testing of HCQ for antiviral efficacy showed reduction of infectivity/log reduction in viral RNA copy of SARs-CoV2,” said the health ministry document.
In an earlier interview to HT, Union health minister Harsh Vardhan also said early reports from the pharmacovigilance programme indicate that there were no unexpected spikes of adverse reactions from the use of HCQ in the country.
Experts have also said the medicine must not be given to patients suffering from heart diseases, hypersensitivity etc. The drug is also not recommended as prophylaxis for children under 15 years of age, pregnant and lactating mothers.
For treatment purposes, the ICMR expert said, “It must be reviewed for treatment regimen in view of the emergence of new strong evidence. But for us in India, it is for prophylaxis.”
Doctors feel there is some more evidence required before confidence in the drug can be reinstated.
“We are not giving the drug now as enthusiastically as it was given in the beginning given the kind of evidence before us. We will have to look into all aspects of the evidence available. We will talk to experts on this,” said Dr Yatin Mehta, a critical care specialist at Gurugram’s Medanta Hospital.