With input from Dr Monica Vasudev

1095: IMA-CMAAO Webinar on “Healthcare workers’ COVID protection - UP Government Protocol”

26^th September, 2020, 4-5pm

Participants: Dr KK Aggarwal, President CMAAO, Dr RV Asokan, Hony Secretary General IMA, Dr Ramesh K Datta, Hony Finance Secretary IMA, Dr Jayakrishnan Alapet, Dr SC Srivastava, Dr S Sharma

Faculty: Dr Surya Kant, Prof. & Head, Dept. of Respiratory Medicine, King George Medical University, Lucknow; Member, KGMU Corona Task Force

Key discussion points

• We have to prevent our medical fraternity and community from getting the infection till we get an effective vaccine. This is the only vaccine till then.
• ACE-2 receptors are found in the lungs, GIT, kidneys and blood vessels. Hence, they are the major targets of the coronavirus.
• There are seven steps in the lifecycle of the coronavirus: Infection, internalization, protease processing, membrane fusion and release of viral RNA, translation and RNA replication, packaging and assembly, exocytosis and release.
• It is important to differentiate between cold, flu and coronavirus. There are three pathognomonic differentiating features of coronavirus: fever, cough and shortness of breath (clinical triad for diagnosis).
• It is important for everyone to be aware of COVID-19 as concomitant COVID-19 infection can occur with any comorbid condition.
• RT PCR is the gold standard test for diagnosis. TrueNat and CBNAAT are used as screening tests and need confirmation by RT PCR tests.
• The rapid point of care antigen test can be used in field settings. All symptomatic negative patients need to be confirmed with RT PCR test.
• RT PCR is important around first 7 days. Its sensitivity is around 67% and as the duration increases, the sensitivity decreases. In 2^ndweek, it is only 54% and later on it is only 45%. The sensitivity of antibody titer goes on increasing as duration increases.
• No new drugs are available for COVID-19. Drugs used for other diseases are being repurposed (HCQ, azithromycin, ivermectin and remdesivir). Ivermectin has been the drug in debate. Plasma therapy has been tried, but is not promising.
• Ivermectin is a broad spectrum anti-parasitic agent, FDA approved, used for filariasis, onchocerciasis (river blindness), ascariasis, trichuriasis, strongyloidiasis, pediculosis and scabies.
• Ivermectin is called the wonder drug as it has helped to control two of the most disfiguring diseases – lymphatic filariasis and onchocerciasis.
• Ivermectin can be used both in prophylaxis and as treatment of coronavirus infection.
• An important pharmacokinetic feature is the longer terminal half-life of 81-91 hours. It has a prolonged mean residence time in the host associated with persistent effect, especially in the lung, where it can reside for up to 30 days. Its concentration in lungs is 3.5 times more than in the blood. These may be beneficial in COVID-19.
• It has a synergistic effect with doxycycline.
• Around 40 clinical trials are running worldwide, including 6 trials in India.
• There is 50 years of experience of using ivermectin; it is easily available and affordable; no resistance.
• UP is the first state in India to use ivermectin as prophylaxis as well as treatment.
• Ivermectin protocol of the UP government (As per Govt. of UP dated 6^th Aug):

o   For prophylaxis in household contacts of positive patients: Day 1 and Day 7: 12 mg od

o   For prophylaxis in healthcare workers: Day 1, Day 7 and Day 30: 12 mg od; repeated once a month.

o   For treatment of COVID positive patients (asymptomatic or mildly symptomatic): 12 mg od x 3 days along with doxycycline 100 mg twice daily x 5 days.

o   It should be given 2 hours after food; avoid citrus juice, milk and alcohol. Use with caution in liver diseases and seizure disorders, asthma.

o   Ivermectin is contraindicated in pregnant and lactating women and children younger than 2 years of age.

o   Doxycycline is contraindicated in pregnant and lactating women and children younger than 12 years of age.

• A White Paper on ivermectin has been published in India on 26.7.20 in the Indian Journal of Tuberculosis. More than 10 experts from across the country have participated in formulation of this white paper; this is the first white paper on ivermectin in the world.
• Prevention is the core theme of controlling COVID-19. If you protect yourself, only then can you help others.
• Prevention: Namaste, physical distancing, take off shoes at the entry of the house, hand wash, wear mask, immunity (meditation, yoga, exercise, good sleep, no addictions), respect and care of seniors, work from home.
• Prevention is best achieved by enhancing immunity. The four types of immunity are: Physical, organ specific (lung; steam inhalation, pranayama), mental and spiritual immunity.
• More than 100 vaccine trials are going on worldwide, including 3 in India. An effective vaccine will not be available this year, so the best way to control is prevention and enhancing immunity.
• Immunity is the best vaccine.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA