Despite doctors saying that treatments like plasma therapy and remdesivir do not have definite results, many are still placing their hopes of recovery on them

56-year-old Shanti (name changed), a teacher, succumbed to Covid-19 last week. Her treatment lasted for four weeks, in which her family members had to run a social media campaign for plasma donations. Even though she finally received it, it didn’t help and she succumbed to the virus. The infection had resulted in 80% damage to her lungs, which eventually took her life.

The trouble to first arrange bed, medicines, then plasma is a big cause of exhaustion to her family and well wishers. “We ran a social media campaign for almost one week for plasma as it seemed as the last hope,” said one of her students. “Some who came through these campaigns had either lost their Covid-19 positive report, or simply not eligible for plasma donation. Eventually one donor was arranged who took 25 thousand rupees. But since we were desperate, we had to take it anyhow.” 

Her family spent over a week on the false hope that something magical would happen and she would recover. Nothing of the sort happened.

On Monday, a government task force on Covid-19 removed plasma therapy from the Covid-19 treatment protocol. Until now, Covid-19 treatment protocol allowed “off label” use of convalescent plasma therapy — But in the early stage within seven days of the onset of symptoms.

“Plasma is not a definitive treatment.” Said Dr. Harjit Singh Bhatti, former president of AIIMS Resident Doctors’ Association.

“It is a century old treatment. When no definitive treatment is available, Doctors give plasma therapy assuming the antibodies from a recovered patient would work in the current patient.”

Plasma therapy was considered as the “magic bullet” during the first wave of Covid-19, when some patients recovered after plasma was administered. Bhatti believes that since there was no available evidence, administering plasma was used by some doctors. But now it is often given due to family pressure.

When a patient’s condition starts deteriorating, family members ask doctors to give plasma or injections like Remedesivir just to be sure that “some treatment is going on.” But in reality there is no definitive evidence that it stops mortality.

Echoing the same concern Dr Deepak Gupta, of AIIMS while speaking to India today said that around 180 patients were given plasma in AIIMS but “no definite result” was found.

However, the number of SOS messages demanding Plasma making rounds on social media suggests that plasma therapy is still considered to be the magic remedy by many. 

Although, scientists have raised concern over use of plasma before it was removed from treatment protocol. Professor K VijayRaghavan, principal scientific advisor to the Government of India, Dr Balram Bhargava, director general of ICMR and others, wrote a letter to the government flagging indiscriminate use of plasma therapy.

They in fact associated it with the emergence of mutants of Covid-19.“some very early evidence that indicates a possible association between emergence of variants with lower susceptibility to neutralizing antibodies in immunosuppressed people given plasma therapy.” the letter said.

 

No magic bullet

Dinesh Kumar Chouhan was in guilt as he was unable to find Remdesivir, for his 70 -year-old father. “People are hoarding these injections, I couldn’t find it despite trying a lot. When I finally got it after four days, the doctor refused to give it saying he is now in a severe condition.” said Chauhan over phone.

Chouhan’s father eventually died last week leaving him with guilt. He still believes that Remdesivir could have saved him. “Remdesivir may reduce hospitalisation” when given on time said Bhatti but “not mortality.” 

Doctors say that families often don’t realise that at some stage no treatment works. They kept their futile effort to find one drug, “They have no idea that these therapies are ineffective in certain disease stages.” Said Dr Raman Gangakhedkar to The print.

 

Self Medication

“In India WhatsApp is a doctor. People believe what they read.” said Bhatti. “They read that their relatives took Remdesivir and it somehow worked, then they think it will work for them too.”

“There are specific conditions and stages to take any treatment.”

“Thankfully plasma requires transfusion and extraction. Without which, you can’t take it. Otherwise people would have started taking it at home.”

WHO has issued several guidelines before self medicating, it has also warned against irrational use of antibiotics, herbal remedies, and other OTC drugs.

According to WHO people should consider, use, method and adverse effects and their management before self medicating. 

Scientists have also said that the course of treatment is a complex clinical decision. It must be based on existing clinical evidence. Therefore, treatment protocol must be followed.