COVID-19 prophylaxis: Top Dr recommends tablets for prevention of coronavirus

ISLAMABAD: Renowned professor of endocrinology/medicines Dr Rauf Niazi has prescribed tablets for prevention (prophylaxis) of coronavirus that has overwhelmed not only Pakistan but the whole world.

The federal capital’s most sought after medical expert has recommended one tablet, any one of these medicines - HCQ (Hydroxychloquine) 200mg; Oxycholor 200mg and Plaquin-H 200mg -, once every three weeks for all family members till the time the COVID-19 pandemic continues.

The tablets are basically meant for prevention of coronavirus induced lung damage to avoid respiratory nightmare that may claim one’s life. However, according to a prominent pulmonologist, lots of debates are going on the efficacy of Hydroxychloquine in the absence of vaccine but there are no right or wrong answers available. COVID-10 is a respiratory virus.

Prof Niazi, who is professor of endocrinology/medicines at the Pakistan Institute of Medical Sciences and Shaheed Zulfiqar Ali Bhutto Medical University, stated that his advice about the use of Hydroxychloquine 200mg; Oxycholor 200mg or Plaquin-H 200mg comes from the research done abroad, which says: “It is plausible that a single dose of 400mg or even 200mg can provide adequate lung tissue concentration to inhibit SAR-CoV-2. Since the half life after a single dose of 200mg is 22 days (US Food and Drug Administration data), a single dose every three weeks should be sufficient for prevention of SARS-CoV-2 induced lung damage. The blood or sinus concentration may not be sufficient to eradicate the virus, however, prevention of lung damage may convert this deadly infection into an upper respiratory infection.”

Meanwhile, the Indian ministry of health and family welfare, in its advisory, has said that the National Task Force for COVID-19 has recommended administering Hydroxychloquine as prophylaxis for SARS-CoV-2 infection for asymptomatic healthcare workers involved in care of suspected or confirmed cases of COVID-19.

It prescribed for doctors, post graduates, and nursing, office and paramedical staff two tablets of HCQ 200mg in the morning and evening on day one after meals and then weekly once two tablets for seven weeks after meals.

In support of his recommendation, Prof Niazi cited a study, which said chloroquine has been used in treating SARS-Cov-2 infection. It is a widely used anti-malarial with immunomodulatory effects. It was found to inhibit the growth of SARS-CoV-2 in vitro and in clinical studies.

The study said Hydroxychloquine is an analog of chloroquine that is widely used in treatment of common medical conditions particularly in rheumatological diseases and as treatment and prophylaxis in malaria. It has previously been shown to be much less toxic than chloroquine in animals. Recently, Hydroxychloquine was shown to be effective in inhibiting SARS-CoV-2 infection in vitro. With accumulating clinical evidence, Hydroxychloquine appears to be a clinically effective agent for the treatment of SARS-CoV-2 infection in combination with azitromycin.

The recommended dose of Hydroxychloquine is 400mg weekly. It is sufficient to prevent malaria in the bloodstream. The incidence and mortality of COVID-19 is much less in countries with malaria prevention than countries where no malaria prevention is recommended, the study said.

At EC50 values of 6.25 micromolar at 24 hours after a single dose of 800mg, Hydroxychloquine may be a promising drug for prevention of SARS-CoV-19. Hydroxychloquine metabolites can accumulate at highest concentration in liver, adrenal and lung tissue in rodents. Physiologically-based pharmacokinetic models implemented by integrating in vitro data and simulating the concentration of Hydroxychloquine in lung fluid suggests that a single dose of Hydroxychloquine at 800mg may provide a lung tissue concentration that is more than twenty times higher than EC50 values necessary to inhibit SARS-CoV-2 in the lung on day one.

In an era where it may take 12-18 months for the wide application of an effective vaccine, and while waiting for the results of properly conducted clinical studies for prevention of COVID-19, Hydroxychloquine may be a practical, cheap, safe and effective agent for prevention of potentially lethal SARS-C0V-2 infection.

In the meantime, US President Donald Trump has sought help from Indian Prime Minister Narendra Modi to export Hydroxychloquine tablets ordered by America to treat the growing number of coronavirus patients in his country. Trump spoke to Modi to make the request. India reluctantly agreed to export Hydroxychloquine to the US.

In the meantime, Prof Umar Farooq, dean and chief executive officer of Ayub Medical College (AMC) and Ayub Teaching Hospital (ATH) Abbottabad, says the US National Institute of Health (NIH) has approved a proposal of AMC and ATH to conduct trial, titled “effectiveness of Hydroxychloquine on COVID-19 patients”, to find out treatment for the coronavirus pandemic.

The trial that began a week ago is meant to find the effectiveness of Hydroxychloquine alone and adjuvant with azithromycin in mild to severe COVID-19 pneumonia patients admitted to their hospital. So far, three patients have recovered, the professor said. One group of patients will be given a combination of two drugs including Hydroxychloquine and Azithromycin while the second group will receive only Hydroxychloquine and the third will undergo traditional method of treatment.