Here’s all you need to know about the Covid-19 treatments everyone is talking about

With Covid-19 casualties reaching 58 on Wednesday and daily cases crossing the 8,000 mark, Nepal’s health care system is buckling. Hospitals all over the country are beginning to get overwhelmed and medical supplies are already starting to run low. But with the second wave of the coronavirus sweeping the country, a lot of misleading information is spreading -- particularly regarding treatments related to Covid-19. 

On social media, a range of Covid-19 treatments -- from plasma therapy to self-medicating with oxygen inhalers -- are being shared widely. Numerous online stores have begun selling oxygen canisters at marked up prices while pharmacies are running out of remsidivir, dexamethasone, and budesonide inhalers. But what do these drugs do and how effective are any of these treatments? The Record spoke to doctors to find out.

Plasma therapy

What is it?

When someone contracts a viral disease, such as Covid-19, their immune system generates antibodies to fight the virus. These antibody proteins are found in blood plasma, the liquid that surrounds the blood cells.

Convalescent plasma therapy (or just plasma therapy) is the process in which doctors take blood plasma with antibody proteins from someone who has recently recovered from Covid-19 and isolate the antibodies that have been generated. These antibodies are then injected into someone with the virus to help them fight it.“Plasma treatment is only for those with severe infections,” said Dr Bipin Nepal, transfusion medicine expert at Tribhuvan University Teaching Hospital.

How effective is it?

According to a three-month study conducted by the National Health and Research Council last year on the use of convalescent plasma therapy, only 59.4 percent of patients who had severe and life-threatening infections recovered from the disease. 

“We’re still in the clinical trial phase,” said Dr Nepal. “The efficacy rate right now is promising, but there aren’t enough donors donating their plasma.”

In other countries, like the US, patients who were given plasma therapy quickly saw better outcomes, but the treatment was less effective on those who were treated longer and had to be put on ventilators, according to a study by the Mayo Clinic 

Other studies in India and the UK, however, show that plasma treatment does not reduce patients’ chances of getting seriously ill or dying.

So, do doctors recommend it?

“At TU, we have till date successfully treated more than 40 patients with this therapy,” said Dr Nepal. “It seems to give some patients a chance.”

However, there are risks associated with the treatment. Patients could get allergic reactions, have difficulty breathing, suffer lung damage or be susceptible to other more deadly infections such as HIV and hepatitis B and C.

Oxygen inhalers 

What do they do?

In normally functioning lungs, oxygen passes to the bloodstream through tiny air sacs. But in the lungs of a Covid-19 patient, the body’s efforts to fight the coronavirus inflame the area around those air sacs, filling the lungs with fluid and preventing the transfer of oxygen. This leads to difficulty breathing. 

In such a situation, oxygen supplementation, with the help of inhalers, can help to maintain delivery of oxygen to organs such as the heart, kidneys, and brain.

How effective are they?

“Inhalers can play a role to ease breathing for Covid-19 patients with very mild symptoms,” said Dr Anup Bastola, chief consultant at the Sukraraj Infectious and Tropical Diseases Hospital. “But they cannot be taken as a treatment measure in any way.”

And an inhaler alone will not be of any help if a patient’s oxygen level keeps dropping. 

“If oxygen levels go below 94 then a person will require an oxygen concentrator [machines that extract concentrated oxygen from atmospheric air] or oxygen in the hospital,” said Dr Bastola.

Do doctors recommend it?

“It is something handy to have for someone with very mild symptoms, but, if oxygen saturation drops and there’s fever, then go to the hospital,” said Dr Bastola.

Remdesivir

What does it do?

The antiviral drug Veklury, or remdesivir, is an emergency drug approved by many countries -- including the US and the UK -- for adults with Covid-19 who are hospitalized. Remdesivir is authorized to be administered only via an intravenous (IV) infusion in the hospital by a medical professional. 

How effective is it?

There have been different recommendations regarding the use of remdesivir. The American National Institutes of Health (NIH) recommends using remdesivir for certain hospitalized patients with Covid-19 while the World Health Organization (WHO) does not recommend using it for any Covid-19 patients due to a lack of data.

Do doctors recommend it?

In Nepal too, doctors are apprehensive. 

“It [remdesivir] is being used as a supportive treatment for serious patients but the effectiveness of this drug has been low globally and in Nepal,” said Dr Nepal. 

Despite this apprehension, demand for the drug has risen in the past few weeks, with prices jumping from Rs 5,300 to Rs 20,000 per vial, said Dr Nepal. 

“There is currently a scarcity of the drug here because there is a shortage in India, our main supplier. The only supply that is coming in is from Bangladesh,” he said.

Dexamethasone

What is it?

Dexamethasone is a corticosteroid used for its anti-inflammatory and immunosuppressive effects. It is a prescription drug available as an oral tablet, oral solution, eye drops, and ear drops, and can help a seriously ill Covid patient breathe easier. 

According to the WHO, for patients on ventilators, treatment with dexamethasone has shown to reduce mortality by about a third, and for patients requiring only oxygen, mortality was cut by about one fifth.

How effective is it?

“For some Covid-19 patients, particularly those on ventilators, dexamethasone has improved their health significantly in the second week of drug administration,” said Dr Nepal. “The drug is also easily available and cheap, costing only one rupee per tablet.”

Do doctors recommend it?

“In the current situation, dexamethasone has proven to help many patients,” said Dr Nepal. “Having said that, it should be reserved for patients who need it the most and should not be stockpiled by the public.”

Micronutrients 

What are they?

Micronutrients such as vitamins A,  D, C, and zinc play a vital role in promoting health and nutritional well-being. Foods having these micronutrients in large quantities, like turmeric, garlic, soybeans, and green tea, have antiinflammatory, antioxidant, and antiviral properties.

Are they effective?

“Yes, such nutrients are necessary for a healthy body, but contrary to what is being said, micronutrients will not do much to boost your immunity. If there is a deficiency in your body then they will simply fill that gap,” said Dr Nepal. “It’s not a treatment in any way, just a means to keep nutrients flowing in your body, which may help.”

Do doctors recommend them?

“Yes, if you want to be healthy then you can consume such vitamins,” said Bastola. “But it won’t help you much when it comes to fighting the virus. The best way to fight the virus is to stay safe: follow social distancing protocols and wear a mask.”