No specific COVID-19 treatment so far

The Corona Expert Advisory Group (CEAG) has categorically stated that there is no evidence of any specific treatment for coronavirus currently, and it is not expected until next year, therefore it will keep changing its treatment plan according to the condition of each patient.

CEAG Chairman Dr Mahmood Shaukat Monday opposed the use of medicines for COVID-19 patients without doctor prescription. Actemra should be used in specific conditions, because there is no theoretical and academic background of its use for cure of coronavirus, he said.

“If we keep on using a medicine on asymptomatic patients, who are most likely going to get recovered on their own from the disease, the credit will be attributed to the use of the medicine and it will be a big blow to the research and the wrong usage will become a general practice,” he added. Regarding use of anti-viral drugs, he said we have adopted measures to avoid preventive deaths, which may increase if people use anti-viral drugs like dexamethasone.

He said that CEAG reviewed international literature and assessed internationally applied methods, which can be safely adopted in our society. “We only select those methods of treatments, which we consider as necessary for investigational purposes,” he added.

He said fortunately the disease did not affect children severely but, to some extent, they do get affected by it. “We make guidelines for children with the assistance of paediatric expert Prof Masood Sadiq.

“If any patient feels that he needs to be shifted to a hospital, he should contact Rescue-1122 instead of going out themselves for finding beds in hospitals. Our first priority is to use presently available resources efficiently,” he added. Our telemedicine helpline will be available 24/7.

He said we must combat fake news about coronavirus through social media, which distracted people into believing in it due to lack of information. Regarding smart lockdown, Prof Mahmood said that “strategies vary with reality. There is no rule of thumb and we have to think according to our own demographic realities.

“We have testing ability of 12,000 for a province of 12 corer people. Now we have to decide how to use these 12,000 efficiently. If we go for random sampling of 12,000, we might identify 200; it all depends on our resources.

“We review our decision on a daily basis and make amends to it according to the situation. We have epidemiologists, viral infection experts on board, and we decide our policies after thorough deliberations,” he added.

Prof Mahmood Shaukat said that 153 ventilators are still available in Lahore. So, the patients are advised to contact Rescue-1122 for medical assistance because they will take you to the hospital where ventilators are still available. COVID-19 patients sometimes do not get beds in hospitals because more than 100 ambulances are working for COVID-19 patients resulting in filling of the bed before arrival of an ambulance that had booked the bed. We will work on our data entry system regarding available facilities in hospitals and will make sure errors don’t happen in routine. We are also working on complaint portal; it will become operational very soon.

“We have already conducted 18 to 19 training sessions for doctors. We need more time and techniques to equip our doctors with complete knowledge,” he added.

Prof Saqib Saeed said that there was no definite cure for coronavirus and every treatment for COVID-19 patients was supportive. Currently, there is a lot of research on different medicines and Actemra is one of them. All licensing of this drug is for investigational purposes.

The Punjab Health Department has approved a trial of the medicine, and the doses of the drug have been made available at different public sector hospitals for trial on 570 patients. The drug is trial used on 120 patients with variable results so far.

Dr Javed Hayyat from Pakistan Kidney and Liver Institute (PKLI) said that recently a wrong practice of using plasma therapy had been introduced, which is an experimental method. It can harm the receptor as this is the product of the blood of other human being. Plasma therapy can also cause the transmission of other diseases into the patient. It is given to the patients only under special circumstance. “We will soon be developing a system to address the grievances of those who have sold plasma at excessive prices,” he added.

Regarding home isolation policy, Dr Bilqees Anwar said that the disease had three stages of mild, moderate and severe, adding that home isolation was only for those patients who have mild or no symptoms. The patients of moderate stage have some symptoms like fever and body pain but they are not oxygen dependent. The conditions for home isolation are: enough space at home, washroom facility should be separate, if not separate then it should be cleaned after every use, and home isolation is not allowed to the person living alone in a home so that if there is an emergency, somebody can take care of him/her timely. In case you are advised home isolation and your health deteriorates, you have to call Rescue-1122 immediately.

Dr Somia Iqtadar said that if a medicine is effective for which patient is decided by the doctors upon examining the condition of the patient. She said that there was no need to panic about the shortage of dexamethasone. It is only prescribed for patients on oxygen or ventilators. We have stock of dexamethasone on three levels i.e. provincial level stock, primary and secondary health (THQs/ DHQs level), and there are 13.6 million injectables in 45 specialised hospitals. Besides, there is one million stock at the man­ufa­cturing level and 1.3 million at the distribution level.

She said that initial studies on hydroxychloroquine suggest harmful effects resulting in severe heart related deaths. Keeping in view these results, the US Food and Drug Administration (FDA) withdrew its licensing, while the World Health Organisation (WHO) also banned its trial. Therefore, we are not in favour of the medicine, she added.

Secretary P&SHD Capt (retd) Muhammad Usman said that initially we were at 300 to 350 daily testing capacity; and in only two-and-a-half months, we have moved towards 12,000 daily testing capacity. What we have to understand is that with the testing ability of 12000, we have death ratio of 1.9%, but if we increase it to, say, 50,000, our death ratio will be less than 1%.

We have 32 functional labs: 13 in private and 19 in public sector. At the beginning of COVID-19, we had to get samples tested from Islamabad, but now we are fully equipped labs for COVID-19. The auto-extraction would double the capacity of the testing facility, he believes. We have established eight new laboratories, upgraded existing ones, collected extraction kits and diagnostic kits. It did not happen overnight, we have burned midnight oil to make this happen, he said.

“We are not following random sampling in cities under smart lockdown. After reaching the threshold of infection transmission, we will decide to eliminate or prolong the smart lockdown in selective eight cities of Punjab,” he added. The Health Department has declared trade of plasma an illegal act. We have sent instructions to the Punjab Healthcare Commission and PHOTA (Punjab Human Organs Transplant Authority) for action against those who are claiming 200ml or 100ml of plasma for treatment.