Management of mild to moderate COVID-19 during the wave in India; Doctor Believes Ivermectin Drug Can Help

With COVID-19 taking a tight grasp on the lives of people in India and around the world, experts have been tirelessly searching for existing medications that can help combat this relentless virus. While vaccines like Pfizer, Moderna, and AstraZeneca have been pivotal in the fight against COVID-19, there’s a growing interest in repurposing drugs. Among them, one that has gained significant attention is Ivermectin. In this comprehensive article, we delve into the potential of Ivermectin in managing mild to moderate COVID-19 cases, its history, and its current status in India.

Ivermectin: The Wonder Drug?

Ivermectin, an anti-parasitic drug, has a storied history. It has proven beneficial in treating various tropical diseases, including onchocerciasis, helminthiases, and scabies. However, its origins lie in veterinary medicine. In the 1960s, Satoshi Omura, a microbiologist at Tokyo’s Kitasako Institute, and William Campbell from New Jersey discovered that a culture of bacteria known as Streptomyces avermictilis was effective against worms. They later chemically modified its active component, avermectin, making it safer and more effective. This led to the birth of Ivermectin, which was commercialized for animal use in 1981.

Campbell’s vision extended beyond animals. He urged colleagues to explore Ivermectin’s potential as a treatment for onchocerciasis—a disease caused by worms transmitted through flies, often leading to blindness in Sub-Saharan Africa. Initial trials in Senegal yielded positive results, and in 1987, Ivermectin was approved for human use. Over 3.7 billion doses, donated by Merck labs, were distributed worldwide. This wonder drug also showed promise against lymphatic filariasis, another worm-related disease. In recognition of their groundbreaking work, Omura and Campbell were jointly awarded the Nobel Prize for Physiology and Medicine in 2015.

India Giving Ivermectin to Its COVID-19 Patients

Amid the relentless COVID-19 surge, Indian medical institutions have turned to Ivermectin for potential solutions. Hospitals and healthcare providers across the nation have started administering Ivermectin to COVID-19 patients off-label. Moreover, it is being prescribed as a prophylactic measure against the virus. This practice is widespread across several states, including Uttar Pradesh and Maharashtra.

Dr. Surya Kant Tripathi, Head of the Respiratory Medicine Department at King George Medical University in Lucknow, has been at the forefront of this initiative. He states that Ivermectin has been in use for over nine months without any major reported side effects. The drug is primarily being provided to patients in home isolation and those with mild cases of the disease.

Dr. Tripathi’s optimism about Ivermectin is grounded in its multifaceted properties. He believes it possesses not only antiviral and anti-parasitic capabilities but also potential anti-cancer and even anti-HIV properties. Dr. Tripathi was among the Indian experts who submitted a white paper on Ivermectin to the World Health Organization (WHO). This paper emphasized that Ivermectin appeared to significantly reduce the replication rate of the novel coronavirus, potentially by a thousand times. It was after this submission that the Uttar Pradesh government began recommending the drug to its citizens.

Addressing concerns about the lack of comprehensive clinical data on Ivermectin, Dr. Tripathi points out that approximately 8 out of 66 trials are currently underway in India, with none reporting any major side effects. Further supporting evidence comes from a study conducted by AIIMS Bhubaneswar, which revealed that two-dose Ivermectin prophylaxis reduced SARS-CoV-2 infection among healthcare workers by a remarkable 73 percent for the following month.

WHO Disapproves Use of Ivermectin on COVID-19 Patients

While Ivermectin has shown promise in India, the World Health Organization (WHO) has taken a cautious stance. On April 3, 2021, WHO announced its recommendation against the use of the anti-parasitic drug Ivermectin in COVID-19 patients. The organization permits its use only within the context of clinical trials, citing insufficient data to establish its benefits definitively.

As of now, there are 66 registered trials involving Ivermectin, with over 60,000 participants. WHO remains open to the possibility of more data emerging in the future that could shed light on Ivermectin’s role in managing the pandemic. This announcement closely followed a warning from the European Medicines Agency against the use of Ivermectin by medical practitioners. Furthermore, the U.S. Food and Drug Administration (FDA) has also advised against the use of Ivermectin for COVID-19 cases.

In conclusion, while Ivermectin has emerged as a potential tool in the fight against COVID-19, it’s crucial to acknowledge that there is no one-size-fits-all solution in the treatment of this virus. Multiple treatments are being explored worldwide, but none have been universally accepted as a definitive cure. As the scientific community continues to gather data and conduct trials, it’s essential for individuals not to self-medicate and always consult with medical professionals for guidance on COVID-19 symptoms and treatment.

Studies and research conducted on Ivermectin in the context of COVID-19.

1. Trials in India: India has been at the forefront of Ivermectin research concerning COVID-19. Several trials have been initiated across the country to assess the efficacy and safety of Ivermectin in managing COVID-19 cases. These trials vary in scale, ranging from small-scale observational studies to larger randomized controlled trials. Many of these studies are ongoing, but early results have shown promising outcomes, especially in reducing the severity of the disease and potentially slowing down the viral replication.
   
2. The Uttar Pradesh Experience: Uttar Pradesh, one of India’s most populous states, has been particularly proactive in using Ivermectin as a treatment and prophylaxis for COVID-19. The state government’s decision to recommend Ivermectin was influenced by local experts like Dr. Surya Kant Tripathi, who have been advocating for its use. The state’s experience has garnered attention due to the reported decline in COVID-19 cases and the absence of significant side effects associated with Ivermectin use.
   
3. Global Clinical Trials: Beyond India, various countries have also initiated clinical trials to explore Ivermectin’s potential in managing COVID-19. These trials are conducted in diverse settings and populations, adding to the breadth of data available. Researchers are closely monitoring parameters such as viral load, hospitalization rates, and mortality to assess the drug’s effectiveness.
   
4. Meta-Analyses and Systematic Reviews: To gain a more comprehensive understanding of Ivermectin’s impact on COVID-19, several meta-analyses and systematic reviews have been conducted. These studies compile data from multiple trials and studies, providing a more extensive overview of the drug’s potential benefits and limitations. While some of these analyses suggest positive outcomes, others emphasize the need for more rigorous research.
   
5. WHO’s Stance: The World Health Organization’s position on Ivermectin has been cautious, as mentioned earlier. While WHO does not endorse its widespread use, it acknowledges the ongoing trials and the possibility of future data altering its recommendations. This stance underscores the importance of rigorous research and the need for conclusive evidence.
   
6. Public Interest and Debate: The use of Ivermectin in COVID-19 treatment has sparked considerable public interest and debate. Advocates highlight its affordability and accessibility, especially in low-resource settings, while skeptics emphasize the need for robust clinical evidence before widespread adoption.

In summary, the landscape of Ivermectin studies in the context of COVID-19 is dynamic and evolving. While some studies suggest potential benefits, others call for caution and further investigation. It’s essential to recognize that scientific research is an ongoing process, and conclusions may change as more data becomes available. As such, decisions regarding Ivermectin’s use should be informed by the latest research findings and guidance from relevant health authorities.

Treatments for COVID-19

There are several treatments and therapeutic approaches that have been explored for the management of COVID-19. It’s important to note that the effectiveness of these treatments can vary, and they may be used in different stages of the disease. Here are some of the notable treatments for COVID-19:

1. Antiviral Medications:
   • Remdesivir: This antiviral drug was one of the first treatments authorized for emergency use in COVID-19 patients. It works by inhibiting the replication of the SARS-CoV-2 virus. It is primarily used for hospitalized patients with severe disease.
     
2. Monoclonal Antibodies:
   • Monoclonal antibody therapies: These are laboratory-made antibodies that mimic the immune system’s ability to fight off harmful pathogens. They have been used to treat COVID-19 patients, especially those at high risk of severe disease. Notable examples include Regeneron’s casirivimab and imdevimab, as well as Eli Lilly’s bamlanivimab and etesevimab.
     
3. Steroids:
   • Dexamethasone: Steroids like dexamethasone have been shown to reduce inflammation and improve outcomes in severe COVID-19 cases. They are particularly effective in reducing mortality among critically ill patients who require oxygen or mechanical ventilation.
     
4. Convalescent Plasma:
   • Convalescent plasma therapy: This involves using plasma from individuals who have recovered from COVID-19, as it contains antibodies against the virus. It has been used as a treatment for some COVID-19 patients, although its efficacy is still a subject of ongoing research.
     
5. Oxygen Therapy:
   • Supplemental oxygen: In cases where COVID-19 leads to respiratory distress, providing supplemental oxygen is a crucial treatment. This can range from simple nasal oxygen to mechanical ventilation in severe cases.
     
6. Anticoagulants:
   • Blood thinners (anticoagulants): COVID-19 has been associated with an increased risk of blood clots. Anticoagulant medications are often used to prevent or treat clotting complications in hospitalized patients.
     
7. Anti-Inflammatory Medications:
   • Tocilizumab: This medication, originally developed for rheumatoid arthritis, has been repurposed for COVID-19 treatment. It targets the overactive immune response seen in severe cases.
     
8. Supportive Care:
   • Supportive care: This includes measures such as maintaining hydration, controlling fever, and managing symptoms like cough and pain. These approaches are essential for the comfort and well-being of COVID-19 patients.
     
9. Ventilatory Support:
   • Mechanical ventilation: In cases of severe respiratory distress, mechanical ventilation may be necessary to assist with breathing. Non-invasive ventilation methods like CPAP and BiPAP are also used.
     
10. Vaccination:
    • While not a treatment for active COVID-19 cases, vaccines are a crucial tool in preventing infection and reducing the severity of the disease. Various COVID-19 vaccines, such as those developed by Pfizer, Moderna, AstraZeneca, and others, have been authorized for emergency use and mass vaccination campaigns worldwide.

It’s important to emphasize that the choice of treatment depends on the severity of the disease, the patient’s individual risk factors, and the availability of specific therapies in a given region. Additionally, research on COVID-19 treatments is ongoing, and new therapies may emerge as our understanding of the virus evolves. Medical professionals and health authorities continue to monitor and adapt treatment guidelines based on the latest scientific evidence.