The government on Friday recommended anti-malaria drug hydroxychloroquine to prevent Covid 19 in more categories of people considered vulnerable to the disease despite a World Health Organisation’s assertion that the drug might not be useful either in curing or preventing the infection.
The Union ministry of health and family welfare said that all healthcare workers, even those in non-Covid hospitals or in non-Covid blocks of Covid hospitals and asymptomatic frontline workers, such as surveillance workers deployed in containment zones and paramilitary or police personnel involved in COVID-19 related activities should take the medicine as per prescribed doses.
Everyone, however, should take the drug under medical supervision—given the safety concerns around the medicine, the government also said.
Incidentally, the advisory comes on a day a large observational study published in medical journal The Lancet said that seriously ill Covid-19 patients who were treated with hydroxychloroquine and chloroquine were more likely to die or develop dangerous heart arrhythmias—a long term cardiac rhythm problem.
In India, the drug was suggested for prophylaxis in only healthcare workers dealing with Covid patients and asymptomatic close contacts of lab confirmed cases. HCQ, along with antibiotic azithromycin, is also recommended in the country to treat Covid 19 patients in ICU.
The new decision, said the government, is being taken following reviews by the national task force on Covid 19 and a joint monitoring group with a number of experts drawn from multiple government agencies.
The ministry cited three studies, whose findings it claimed, have shown that the drug works in preventing Covid 19.
The first study cited included a retrospective case-control analysis by the Indian Council of Medical Research which found that there is a significant dose-response relationship between the number of prophylactic doses taken and frequency of occurrence of SARSCoV-2 infection in symptomatic healthcare workers who were tested for SARS-CoV-2 infection.
“Another investigation from 3 central government hospitals in New Delhi indicates that amongst healthcare workers involved in COVID-19 care, those on HCQ prophylaxis were less likely to develop SARS-CoV-2 infection, compared to those who were not on it,” said the revised advisory.
“The benefit was less pronounced in healthcare workers caring for a general patient population. ▪ An observational prospective study of 334 healthcare workers at AIIMS out of which 248 took HCQ prophylaxis (median 6 weeks of follow up) in New Delhi also showed that those taking HCQ prophylaxis had lower incidence of SARS-CoV-2 infection than those not taking it.”
Some health care specialists expressed shock at the development.
“The growing global evidence on the lack of efficacy and safety issues with the use of hydroxychloroquine is another red flag on the drug’s use for prophylactic purposes,” said Dr Anant Bhan, a health researcher who specializes in bioethics and health policy.
“Data published in the Lancet based on evidence from multiple countries today again reinforces the need for caution in promoting the drug for either prophylactic or treatment purposes. The new advisory hence is surprising given the data quoted to support the advisory is not available in the public domain to my knowledge or published.”
He warmed that the individuals who take the drug prophylactically might be put at risk.