Doctors cautious over use of malaria drug as virus preventive

ICMR warns against its unrestricted use

25/03/2020, R. PRASAD,CHENNAI

It is still at an experimental stage, the Council said.AFPGERARD JULIEN

A day after the Indian Council of Medical Research (ICMR) approved the use of hydroxychloroquine as prophylaxis by healthcare workers taking care of COVID-19 cases and asymptomatic household contacts of confirmed cases, the Council on Tuesday cautioned against the unrestricted use of the drug, stating that “it is still at an experimental stage and is not recommended for public use.”

Hydroxychloroquine is an antimalarial drug that is also used for treating rheumatoid arthritis. The ICMR’s approval followed a recommendation from its task force for COVID-19.

“The recommendation is for empirical use of the drug based on available evidence and is restricted for use by only two categories of people and under strict supervision of a doctor,” Director-General of ICMR Balram Bhargava told The Hindu.

The clarification comes as none of the drug approving agencies across the world, including the FDA, has cleared the drug for prophylaxis or for treating COVID-19 patients.

The available evidence of the efficacy of the drug is a small study by French researchers involving 26 COVID-19 patients.

The study found “significant” reduction in viral load in over half the number of patients at end of six days of therapy. The results were published on March 17 in the International Journal of Antimicrobial Agents even before the 14-day follow-up was completed.

During a White House press briefing a few days ago, asked if there was any evidence that the drug can be used as a prophylactic or as treatment for COVID-19 patients, Director of the U.S. National Institute of Allergy and Infectious Diseases Anthony Fauci, said: “The answer is ‘no’ as it is [based on] anecdotal evidence.”

Despite Dr. Fauci’s clarification, two Nigerians are reported to have over-dosed on the drug after hearing U.S. President Donald Trump saying the drug could help treat people with COVID-19. A man in Arizona, U.S., died and his wife was hospitalised after they self-medicated with a home remedy of hydroxychloroquine.

Prof. Gagandeep Kang, executive director of the Translational Health Science and Technology Institute (THSTI) in Faridabad, told The Hindu: “At this moment there is no evidence available [about its effectiveness]. There are on-going trials. They must have waited for the results. Even the trials are for treating COVID-19 patients and not for prophylaxis.”

Virus scare: doctors denied houses on rent in Warangal

Fearing spread of COVID-19, many owners decline to accommodate them

25/03/2020, GOLLAPUDI SRINIVASA RAO,WARANGAL URBAN DT

At a time when the whole world is lauding the efforts of doctors, some paranoid residents in Warangal are refusing to give houses on rent to people in the medical profession, fearing the spread of coronavirus.

Scores of house surgeons of a new batch who joined duties on Monday and Tuesday and their seniors, who were located around the MGM Hospital, are facing severe problems due to non-availability of accommodation.

When the issue was brought to the notice of Telangana Panchayat Raj Minister Errabelli Dayakar Rao and district Collector Rajiv Gandhi Hanmanthu, they said the Kakatiya Medical College (KMC) authorities have allocated a new building to both senior and junior house surgeons. “Even the hostel rooms have been converted into quarantine wards and hence the problem. But it is now addressed,” the Collector said.

Most of these interns who hail from various parts of Telangana stay in rented houses near the hospital in the surroundings of Bhadrakali temple opposite KMC, Pochamma Maidan and Gopala Swamy temple until they complete their one-year internship in the MGM hospital. In the wake of virus pandemic, the house owners are reportedly asking them to vacate their houses.

A house surgeon working in MGM hospital has shared their woes on Facebook.

The post said that one of the owners called the doctors ‘dirty’ because of work in the hospital. “We are working without any protective equipment during this pandemic, without any holiday, without any stipend since five months while the nation is in lockdown,” the post read.

On condition of anonymity, one of the house surgeons described certain house owners as insensitive.

“They do not understand the risks we undergo to keep them healthy. It is really demoralising,” he said.

Meanwhile, GWMC Commissioner Pamela Satpathy responded to the viral post on Twitter and said “Few similar posts have come to our notice. The issue of accommodation has been resolved already. All Doctors/Medical Fraternity facing any such issue, are kindly requested to contact KMC Principal. ”

To transplant or not: a COVID-19 question

25/03/2020

The COVID-19 pandemic poses special challenges to patients with organ failure. Those waiting for transplant or who had received a transplant tend to have more severe disease due to weak immunity. Patients with severe heart, lung, or liver failure and waiting for transplant are at a high risk for dying if a transplant does not happen within a short period of time. But if there are clusters of COVID-19 disease in the region around the hospital or if there are COVID-19 patients already admitted in the hospital then, the course ahead becomes a quandry.

Performing a transplant surgery in such situation will increase the risk of exposure to the recipient during the surgery and in the recovery period. This exposure could happen from the donor or healthcare providers or other patients in the hospital. It is possible that the hospital resources could become limited due to COVID-19 cases and the care of the transplant recipients may get compromised.

Non-urgent transplant surgeries such as kidney transplants in relatively stable patients on dialysis may be avoided in areas of high prevalence of COVID-19. If the recipient is critically ill and the surgery is unavoidable then care must be taken to check both the donor and the recipient for COVID-19 prior to transplant.

Elective living donation transplants could continue in regions with low incidence and in hospitals with no infected patients. Deceased donation can continue in countries/regions with low incidence of COVID-19 but with stringent precautions.

Currently, there is no evidence to support blood-transfusion related transmission of the virus particles and no additional precautions need to be taken by the blood bank during transplant surgeries. But voluntary blood donation may decrease and hence available blood must be used judiciously.

All brain dead donors should be adequately screened for recent travel and potential exposure to virus. Deceased donation involves significant amount of interaction with the donor family, and increased human movement in hospital. Transplant coordinators should follow appropriate preventive measures to avoid exposure during evaluation. Donors with active infection or exposure to COVID-19 should not be considered for transplantation. Organ transportation throws additional challenges. Also deceased organ donation from hospitals with COVID-19 patients should be avoided due to risk of cross contamination.

Regular visits to the doctor should be limited during this period of virus spread. Physicians can use telemedicine to reduce visits but continue interacting with the patient. Routine investigations should be limited and any elective procedures must be postponed. Dialysis patients and their treating physician should identify another small volume unit for dialysis needs if the situation arises where the primary centre is overwhelmed with COVID-19 patients.

The role of pre-emptive placement of AV fistula should be evaluated in patients with advanced renal failure to avoid the occurrence of emergent needs during COVID-19 epidemic. Transplant recipients with mild symptoms including runny nose, cough, throat pain and low-grade fever should be considered as suspected case of COVID- 19. They should be asked to self-quarantine themselves at home and consideration must be given to lower the immunosuppression.

A majority of mild illnesses resolve spontaneously, with time and rest. However, such patients should be asked to closely monitor their symptoms. Patients with severe symptoms such as breathing difficulty, high fever and lack of oxygen should be admitted to the hospital.

Immunosuppressive therapy should be discontinued or reduced in patients with severe illnesses. Currently, there are no proven therapies to cure coronavirus infection. The treatment in the hospital includes oxygen and organ supportive care until the lung injury resolves. Certain anti viral medication have been used on experimental basis with some reported benefits.

Teachers told to remain on call

Directorate of Collegiate Education issues circular

25/03/2020, SPECIAL CORRESPONDENT,CHENNAI

The Directorate of Collegiate Education, in a circular, has instructed teachers and non-teaching staff coming under the purview of the Higher Education Department to remain on call.

The medical wing of Annamalai University, self-financing private colleges, nursing institutions and deemed universities are not under its purview. Teaching and non-teaching staff have been told to work from home except in case of evaluation and examination supervision. They must ensure that the institution’s premises and hostels are cleaned and ready for occupation.

University registrars, principals and hostel wardens have been advised to remain on standby and be prepared to arrive at the institution within 30 minutes, when called. The keys to the institution should be with a teacher who lives nearby. Institution heads should be prepared at all times to execute instructions issued by the Collector. Anyone who does not comply with the instructions would be liable for departmental action. Institutions have been instructed to ensure hygienic surroundings for foreign students in the hostels. All employees of the institutions must provide their phone numbers to their respective heads and be prepared to come in case of emergency.

MTC commuters get a taste of lockdown on Tuesday morning

25/03/2020, SPECIAL CORRESPONDENTCHENNAI

MTC commuters had a taste of the lockdown on Tuesday morning itself as limited bus services were operated. Though the lockdown was to fully come into effect only from 6 p.m. onwards, commuters, particularly those in the southern and western suburbs, faced severe hardships because of limited services. On some routes, buses were not operated at all.

Bus services were severely curtailed in some localities, which are already poorly connected, such as Sithalapakkam, Kovilancheri, Mambakkam, West Velachery, Pattabhiram, Valasaravakkam, and Mogappair.

T. Kumar, a resident of Sithalapakkam, said he found it difficult to reach Medavakkam as there were no MTC buses and finally had to pay double the cost by travelling in a share autorickshaw.

A senior official of MTC, denying that bus services were not adequate, said buses were operated normally.

As most of the drivers and conductors do not have personal transport, the buses were started late, he said.

30 flying squads formed

25/03/2020, ALOYSIUS XAVIER LOPEZ,CHENNAI

Chennai Corporation, the Revenue Department and the police have formed 30 flying squads to regulate congregation of more than five persons to contain the spread of COVID-19.

Corporation Commissioner G. Prakash held a meeting with police and revenue officials to regulate infection prevention and control in the city. “Residents who come out are requested to carry ID cards. Over 400 vehicles will patrol the streets. Eight check posts on stretches such as East Coast Road, Rajiv Gandhi Salai and Poonamallee High Road have been set up. All the 4.000 sanitary workers will get protective gear,” said Mr.Prakash.

Chennai goes into lockdown

Eight entry points to city closed; streets deserted

25/03/2020, VIVEK NARAYANAN,CHENNAI

Barricades put up on Kamarajar Salai near Marina Beach to regulate vehicles on Tuesday. R. Ragu

The usually bustling city wore a deserted look since Tuesday evening after the State came under a complete lockdown as a precautionary measure to prevent the spread of COVID-19. Policemen took over the streets after 6 p.m. to enforce Section 144 of Cr.PC and announcements were made on public address systems asking people to stay indoors.

As a measure to prevent the spread of COVID-19, Chief Minister Edappadi K. Palaniswami announced restrictive measures in the State from 6 p.m on Tuesday till March 31. The public and private transport, including autorickshaws and taxis, will not be allowed to ply. There will be no inter-district and inter-State transport. Shops selling groceries, milk, vegetables, poultry and fish will remain open. All other shops should be shut.

In the evening, Police Commissioner A.K. Viswanathan issued the order under Section 144 of Cr.PC prohibiting assembly of more than five persons at public places in Greater Chennai police limits from 6 p.m. on March 24 to 6 a.m on April 1. Those who contravene the order will be subject to prosecution under IPC.

Speaking to media, Mr. Viswanathan said that eight entry points into the city will be closed. Corporation Commissioner G. Prakash said that only retail traders will be allowed into Koyambedu market. “If thousands enter the market, our sanitisation efforts will not bear fruit,” he said. Many thronged the vegetable markets and groceries since morning to stock up vegetables and essential commodities. After 6 p.m, the number of vehicles and people on the road gradually started reducing and by 8 p.m., the streets became deserted. The usually bustling Dr. MGR Chennai Central Railway Station wore a deserted look and usual sound of blaring train announcements fell silent. All the entries into the station were blocked by the police personnel. “I have never seen the station so empty in my lifetime. This shows the intensity of the problem,” said a policeman

No MTC buses

Though the lockdown was supposed to be from 6 p.m., MTC buses returned to their respective termini by 2 p.m. The Dr. MGR bus terminus was also shutdown around 4 p.m. and the entry points were barricaded. “On Tuesday alone, close to 500 inter-district buses were operated for people to reach their home towns,” said an official from the transport department.

Though the beaches were already shut for the public already, the arterial Kamarajar Salai was also barricaded and policemen advised the motorists to reach home at the earliest and stay indoors. The traffic police utilised two-wheeled, self-balancing personal transporter to patrol the service lane. On Anna Salai too, the police asked shop keepers, other than those permitted, to down the shutters.

At important junctions, including Nandanam, policemen, with the help of public address systems, warned people to stay indoors and explained about the intensity of the virus. “If you are safe, your family will be safe. If you venture out, you are not only bringing danger upon yourself, but also on others,” said one of the messages.

Lines in front of shops

In Tiruvallur, the police will be making announcements through public address system and asking people to stay indoors. Tiruvallur police is planning to draw lines in front of shops selling essential commodities to ensure social distancing.