COVID-19 Pandemic: Indian Government Should Recall Hydroxychloroquine (HCQ) From 55 Countries Who Were Gifted/Sold This Drug By India

Co-Written by Dr. P. S. Sahni & Shobha Aggarwal

 

In recent weeks the Indian Government has – in a seeming show of altruism – been gifting the drug Hydroxychloroquine (HCQ) to a number of countries ostensibly to be used as a prophylactic measure by health care professionals managing n-coronavirus patients. Those countries have – through return post/email – duly acknowledged the help. Almost at the speed of light both these acts – of HCQ being gifted and the benevolence being acknowledged by the recipient country with thanks – have been instantly and duly broadcasted several times a day by the state-controlled All India Radio. The blitzkrieg of publicity is repeated every time a new country is chosen to be extended the largesse. So far so good, perhaps – but just perhaps.

Surely the Indian health authorities are not oblivious to the scandalous developments – bordering on criminality – worldwide. In at least four continents HCQ is being used as a treatment drug for COVID-19 patients without a shred of evidence as to its usefulness. Why does the Indian Government assume that the drug supplied would not be misused by these 55 countries?

Infection with n-coronavirus adversely affects the lungs, heart, kidney, brain, skin; it is also seen to be causing clotting of blood. Thus a patient with n-coronavirus infection gets his/her heart bombarded through three ways – through the infection itself; through the side-effects of HCQ; and any other pre-existing heart problem.

The Guardian, in its International Edition dated 27 March, 2020 reported:

“Popular pressure for access to the drug has been ramped up by pronouncements from presidents Donald Trump in the US and Jair Bolsonaro in Brazil, both of whom have claimed it is a cure. An Australian businessman, the former politician Clive Palmer, has pledged to fund 1m doses “to ensure all Australians would have access to the drug as soon as possible”.”

The report also stated:

“One small trial in China … was far from sufficient to show that it works.”

The Guardian also informed:

“… the French government … decreed that hospitals could prescribe it for any Covid-19 patient…

That Italy has followed suit. The government announced … that chloroquine and hydroxychloroquine could be used to treat all Covid-19 patients and paid for entirely by the Italian national healthcare system.” (emphasis provided)

Meanwhile the National Institutes of Health (USA) declared on April 9, 2020:

“Many U.S. hospitals are currently using hydroxychloroquine as first-line therapy for hospitalized patients with COVID-19 despite extremely limited clinical data supporting its effectiveness,” (emphasis provided)

It mentioned that a clinical trial to evaluate the safety and effectiveness of HCQ for the treatment of adults hospitalized with coronavirus disease 2019 (COVID-19) has begun.

In India many healthcare workers who took HCQ reported side-effects like pain in the abdomen; nausea; and hypo-glycaemia (low blood sugar). This got revealed during a study conducted by the Indian Council of Medical Research (ICMR). This premier medical research institute is examining the side-effects and efficacy of HCQ as a prophylactic treatment. [The Times of India (ToI), 19.04.2020]

As if any more evidence was needed a report in the ToI dated 23 April, 2020 warned:

“a U.S. government funded analysis of how military veterans fared on hydroxychloroquine posted on a medical pre-print site on Tuesday found the drug had no benefit against COVID-19, and was associated with more deaths.”

In gross violation of ICMR guidelines right in the heart of Mumbai, the Brihanmumbai Municipal Corporation had earlier decided to give HCQ as a preventive medication to around a 100,000 people living in the city’s slums, Dharavi and Worli (COVID-19 hotspots). Later this decision was reversed – and rightly so. (ToI, 16.04.2020). If even within India HCQ was getting misused, one can imagine how the gifted medicine would get misused in the 55 countries which are recipient of the drug.

Politicians in USA, Europe, Australia and India have wittingly or otherwise drummed up a campaign for use of HCQ – which has now resulted in patients in ICUs being administered the drug as a first line therapy. This has resulted in deaths. Wisdom dictates that HCQ be recalled by India from all the 55 countries.

[Dr. P. S. Sahni & Shobha Aggarwal are independent medico-legal researchers and members of ABVA. Email: aidsbhedbhavvirodhiandolan@gmail.com]

First published at: https://countercurrents.org/2020/04/covid-19-pandemic-indian-government-should-recall-hydroxychloroquine-hcq-from-55-countries-who-were-gifted-sold-this-drug-by-india

COVID-19 Pandemic: India Fourth Worst Affected Country In Asia; Worldwide 168 Countries Have Fewer Cases, Deaths Than India

by Dr. P. S. Sahni & Shobha Aggarwal

Accessed on 22.04.2020 at 9.49 a.m.

The grim message conveyed by the title of this article should make rulers in India sit up. Their initial complacency coupled with child-like attitude of being contended with the fact that Indians are better off than their counterparts in Europe and North America is the most mean, inhuman and unscientific way of dealing with COVID-19 pandemic. As a first step those at the helm of affairs in India should visit the following website daily for an update on where humanity stands: https://coronavirus.jhu.edu/map.html

This clarificatory note becomes necessary in the context of COVID-19 pandemic and India. The daily hourly news broadcasted (6 AM to 11 PM) on the state-controlled All India Radio gives a 10-minutes account – over a dozen times per day – of firstly developments in India and secondly, a passing, reference occasionally to what the rest of the developed world is going through; all the negativities of the countries in Europe and North America are highlighted. A few 1-hourly special broadcasts (8AM, 2PM, 8PM) are aired every day with reporting being aggressively nationalistic and exclusionist. The single projected leader of the country is praised no end for his benevolence e.g. sending Hydroxychloroquine (HCQ) to countries who have requested or not requested this drug of dubious role; and very ordinary people singing praises – by way of being quoted in these programmes – for receiving a few hundred rupees or so in their bank accounts courtesy the only leader of the country under this scheme or that scheme. Scores of doctors remind the listeners to maintain social distancing and wear a mask. There is not a word of criticism aired by any of these worthies about the policy being pursued in combating the COVID-19 pandemic. Indians are reminded ad infinitum by a particular bureaucrat – a Joint Secretary to boot – in the Union Health Ministry to be content with the fact that many countries in Europe and USA have more cases and deaths than in India. Some questions and comments are in order:

• Are Indians supposed to feel happy/contended that others in developed countries are suffering and are worse off than Indians?
• Why does the Indian Government not display courage and honesty to admit that about 168 countries have fewer cases and fewer deaths than India? Why not learn from their experience?
• An impression is being given that aggressive lockdown is the brainchild of Indian Government; the scientific way in which China has used it for full 77 days is never acknowledged.
• That lockdown and massive testing (as undertaken in China) together gives the best results; yet such testing was delayed in India.
• That countries with massive testing (South Korea) undertaken right at the early stage of the infection got good results.
• That countries without complete lockdown but full voluntary compliance of social distancing, use of mask have also fared better (Sweden).
• The All India Radio has been constantly bombarding us with the information that half of India does not have any infection; but we are never informed that it was northern Italy which bore the brunt and not its southern part; just as South Korea had huge number of cases, while North Korea escaped unscathed because of early closure/sealing of its international borders.
• The Chinese scientist had shared the genome structure of n-Coronavirus publicly on 10-11 January, 2020; the German medical scientist reportedly had the testing kits ready – hold your breath – by 16 January, 2020! Three months down the line the Indian Government is still struggling to get these kits imported!! Who all have then been found sleeping when India had sufficient time to be fully geared to face the COVID-19 pandemic? Those medical scientists, bureaucrats and politicians need to be named.

PM Narendra Modi hugs Donald Trump at Ahmedabad airport / Photo: @narendramodi / Twitter

Both leaders – President Donald Trump and Prime Minister Narendra Modi had met in Delhi on 25 February, 2020 for signing business deals including defense deals. Were these leaders oblivious to the unfolding COVID-19 pandemic?

The real heroes/heroines in the resistance against the spread of COVID-19 pandemic

The medical personnel – doctors, nurses, para medicals; sanitation workers; social workers e.g. ASHA workers involved in door-to-door surveys for detecting those people with flu-like symptoms; ensuring their isolation and quarantine at home; tracing of people in contact with positive cases or those with travel history are performing a thankless job. The medical personnel in clinics/hospitals are risking their lives to contain the spread of the virus; often working without the full personal protection gear; getting infected in the process and braving death. They are the real heroes/heroines in the national task.

[Dr. P. S. Sahni & Shobha Aggarwal are independent medico-legal researchers and members of ABVA. Email: aidsbhedbhavvirodhiandolan@gmail.com]

First Published at: https://countercurrents.org/2020/04/covid-19-pandemic-india-fourth-worst-affected-country-in-asia

To Ventilate Or Not To Ventilate Critically Ill n-Coronavirus Patients: Ask Medical Personnel In USA, Europe

Co-Written by Dr. P.S. Sahni & Shobha Aggarwal

Governments all over the world – and not just in the developed west – are scrambling to get ventilators imported from the few countries which manufacture this machine e.g. China, Germany. The cost per piece is about Rs. five hundred thousand (Rs. 500,000)! The figure is about one and a half times the cost of by-pass surgery undertaken in heart attack patients in India. Sophisticated ventilators could cost up to Rs. 15,00,000 per piece. Media reports indicate that Indian government is shopping for 200,000 ventilators by June 2020!! This would entail an expenditure of Rs. 100,000,000,000 (Rs. One hundred billion) on the cheaper version to be imported.

USA has ordered 100,000 ventilators from Germany but the manufacturing firm indicated that it could send only 10,000 machines.

It is worth looking at the outcome of critically ill patients on ventilators being treated in Intensive Care Units (ICU); and how medical personnel – daring to care – in ICUs are themselves becoming infected with n-Coronavirus!

The International Edition of ‘The Guardian’, dated March 29, 2020 reported:

“Data from the Intensive Care National Audit and Research Centre (ICNARC) showed that of 165 patients treated in critical care in England, Wales and Northern Ireland since the end of February, 79 died, while 86 survived and were discharged. The figures were taken from an audit of 775 people who have been or are in critical care with the disease, across 285 intensive care units. The remaining 610 patients continue to receive intensive care.”

And that:

““The truth is that quite a lot of these individuals [in critical care] are going to die anyway and there is a fear that we are just ventilating them for the sake of it, for the sake of doing something for them, even though it won’t be effective. That’s a worry,” one doctor said.”

Worse still:

“Many of us (medical personnel) are also worried that we may be infected, yet asymptomatic (showing no symptoms) and therefore could be a potential risk to our patients, colleagues and families. That is the last thing that we would want, but we simply do not know.”

In a respected journal ‘The Lancet Respiratory Medicine’ published online February, 21, 2020 Xiaobo Yang and colleagues described 52 of 710 patients with confirmed COVID-19 admitted to an ICU in Wuhan, China. The ICU mortality rate was 79-86%. All 52 were adults.

A very high figure indeed.

The Times of India, April 1, 2020 (Page 9) presented the grimmest picture emerging from USA and Italy – the countries said to be having the best of medical facilities in the world. Just have a look:

“A supervisor urged surgeons at Columbia University Irving Medical Center in Manhattan to volunteer for the front lines because half the intensive-care staff had already been sickened by coronavirus. “ICU is EXPLODING,” she wrote in an email.”

And:

“Another doctor at a major New York City hospital described it as “a petri dish,” where more than 200 workers had fallen sick. Two nurses in city hospitals have died.”

Finally:

“Doctors and nurses fear they could be transmitting the virus to their patients, compounding the crisis by transforming hospitals into incubators for the virus. That has happened in Italy, in part because infected doctors struggle through their shifts, according to an article published by physicians at a hospital in Bergamo, a city in one of the hardest-hit regions.”

What is a ventilator?

To put it simply it is a device by which air/oxygen under pressure is pumped into a patient’s lungs when the latter is unable to breathe voluntarily in the normal way and is severely breathless. The device may be used for non-invasive ventilation at ICU admission through a mask on the patient’s face covering nose and mouth; or for invasive ventilation through a tube inserted into the trachea via the mouth or through a hole created surgically in the trachea. Split ventilators are available which could service 2-8 patients through just one machine (akin to split ACs). The air exhaled back by the patient could pose a risk to the ICU staff. This risk becomes manifold if high quality Personal Protection Equipment (PPE) is not available to the medical team; and also if negative pressure isolation room is not available in the hospitals; or if the ventilator is not equipped to ‘neutralise’ the exhaled virus. In the absence of these safeguards the fate of the ICU team all over the world (no exception) is not difficult to imagine.

In the context of COVID-19 pandemic do ventilators improve the over-all mortality rate of critically ill patients at a mass level in a country?

At a global level the overall mortality rate in n-Coronavirus is between 0-4%. In some countries this rate is more even with ventilators in use; whereas in some the figure is less even without ventilators or with a paucity of ventilators.

As data emerges from all the continents in the coming weeks and months one would get a fair idea on the usefulness or otherwise of ventilators. Even in ‘peace time’ i.e. when there is no epidemic around – the poorer sections of the society do not get access to ventilators particularly in developing/underdeveloped countries.

To define the role of ventilators a study along the following lines is in order:

Out of 10,000 patients who made it to ICUs each in USA/Italy/China during the COVID-19 pandemic what percentage died in spite of ventilator use? This should be compared with another 10,000 patients in three countries with poor health infrastructure where patients were not put on ventilators in hospitals/ICUs simply because ventilators were not available; what was the death rate amongst these patients? Do not be surprised with the results! Not a bit please.

To get an idea of what the results could be consider another common life-threatening disease – heart attack – where such studies have proved that at a mass level the morbidity and mortality rates are similar in the following two groups:

• those seemingly opting (read coerced) to get angiography, followed by angioplasty or by-pass surgery

 And

• those ‘opting’ out of such investigations and surgery say due to non-availability of sophisticated health infra-structure in countries referred to – derogatorily – as under-developed. In such countries patients could make do equally well just by taking a few medicines daily.

Guess how long it took to get at these results – decades. Why? Well the vested interest of transnational corporations, funders for such studies, medical personnel, elected representatives, insurance companies reigns supreme. Worse, even now doctors worldwide continue with business as usual.

References:

1. https://www.theguardian.com/society/2020/mar/28/coronavirus-intensive-care-uk-patients-50-per-cent-survival-rate
2. Yang X , Yu Y, Xu J et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med.2020; (published online Feb 21.) https://doi.org/10.1016/S2213-2600(20)30079-5

[Dr. P. S. Sahni & Shobha Aggarwal are members of AIDS Bhedbhav Virodhi Andolan (ABVA). Email: aidsbhedbhavvirodhiandolan@gmail.com]

This article was first published at: https://countercurrents.org/2020/04/to-ventilate-or-not-to-ventilate-critically-ill-n-coronavirus-patients-ask-medical-personnel-in-usa-europe

If n-Coronavirus Passionately Falls In Love With Me, This Is What I’ll Do As A Medical Doctor With Fifty Years Experience

by Dr P S Sahni

Into the seventieth year of life and having survived a life-threatening heart attack in January 2017, I’m fit as a fiddle – thanks to Mother Nature – and do my bit as an activist along with co-workers in Delhi. Were n-Coronavirus to take abode in my body and I develop mild symptoms like ‘flu’, I’ll quarantine myself strictly at home. Presently 1.25 billion people in India are anyway under a lockdown but are allowed to visit the market place for buying essential items; though of course I’ll have to stop these visits once flu-like symptoms appear. But what about millions who have no home or financial resources? Lockdown ordered in many countries across the globe should make everyone aware – at least now – of what Kashmiris and Palestinians have gone through in the last seven decades.

At home I’ll take a tablet of Crocin (Paracetamol) if fever rises above 100° F. Apart from my usual cardiac medicines I’ll avoid all drugs. Will keep myself well hydrated. Of course middle class existence ensures meals, but what about the working class during clamp-downs?

I do not underestimate the reach of the watchful eyes of the Big Brother; a District Magistrate can – under cover of the Epidemic Diseases Act, 1897 – dispatch a policeman to get me forcibly admitted in a hospital for ‘treatment’. Under protest I would agree. Once having settled there I’d try to ensure a letter-petition challenging the Constitutional validity of the Epidemic Diseases Act, 1897 – a law enacted by the erstwhile colonial rulers. This Act is a Draconian Law which takes away the civil liberties and democratic rights of a citizen. The Indian Higher Judiciary takes up Constitutional validity cases in the presence of real-life case, which I would have become by then.

After the confirmatory tests for COVID-19 get undertaken, were I to develop breathing problem then X-ray chest/scanning of chest would be done to confirm presence of pneumonia. If prescribed antibiotics for pneumonia I’ll discuss with the treating physician since existing antibiotics cannot tackle pneumonia due to n-Coronavirus. I won’t let the treating doctor bluff me. I see no point in consuming medicines which are useless or harmful by way of side-effects. I won’t consent to being administered untested drugs even if  this has the tacit backing of W.H.O. Recently an Italian tourist visiting India – upon developing pneumonia due to n-Coronavirus – was administered such untested drugs. He subsequently died in a hospital in Rajasthan. This qualifies to be an ‘encounter death’ – a term used for cold-blooded murder of innocents by uniformed security personnel in India!

As for relief to my breathing problem I’ll consent to medication like steroids, bronchodilators for opening up my respiratory passages keeping in mind my underlying heart condition.

At a later stage – when breathlessness becomes severe, as it will likely – if need arises for a ventilator, I’ll deny consent for two reasons.

Why I will opt out of a ventilator?

Firstly, ventilators (along with their appendages) are difficult to be sterilised properly; and actually give patients another type of pneumonia (iatrogenic) which may be impossible to treat. Ventilators notoriously often become vehicles of introducing drug-resistant, hospital-borne infection – often fatal – against which existing antibiotics have become ineffective. My second reasoning is this:  I see no logic in this exercise.  I’ll explain –

True, ventilators could be of use in patients with severe pneumonia in which the causative organism is known and antibiotics – tested and duly approved – exist. In such a situation a course of antibiotics could clear the pneumonia (congestion/patch) in 1-2 weeks or more. Once the pneumonia has resolved and patient is able to breathe on one’s own (voluntarily), he/she is gradually weaned off the ventilator! A happy development in ordinary case of pneumonia. However in the case of COVID-19 pneumonia (really nasty one at that) no time-tested and duly approved medicine exists. In some countries (including India) untested drugs are being used in limited cases (like the Italian tourist treated in Rajasthan with fatal results).

About patients or their relatives (if patient is not conscious) who consent (read coerced) to untested drugs and also ventilator, the attending doctors feel they have done their best; the patient’s family, friends and well-wishers go through an emotionally exhausting period. It is the unconscious patient who suffers the ordeal; with the ventilator in place the patient has to be sedated 24×7. As the nurse regularly sucks the fluid out of the respiratory passage a perceptive person can observe the patient’s body twitch. And the pneumonia will not resolve since medicines don’t exist as of now; the doctors will not remove the ventilator on their own; these doctors would quote the Hippocrates oath in their defence. The immediate family members won’t have the courage to ask for the ventilator to be switched off; neither the priest nor a judge will provide a clear-cut answer.

Finally Mother Nature resolves the dilemma created between the doctor and patient by a machine called Ventilator. The weakened flesh of the patient succumbs to multi-organ failure after days of ‘avoidable medical torture.’ At that point of time sleep’s elder brother/sister – to wit death – takes over. The philosophical question remains un-answered. Whose life is it anyway?

After not consenting for a ventilator, I’ll request the medical staff to consider administering me oxygen through nasal tube; and intra-venous fluids in case I’m not able to eat anything orally. That done, I will thank the medical staff and request them to leave me alone. Every human being has a right to peaceful and graceful exit from planet earth.

P.S.

1. This piece is clearly not an advisory; patients should follow the advice of their attending doctor.
2. Yes, ventilators have a role in many conditions as a temporary aid & should be considered.
3. It is understandable if patients consent to un-tested drugs.
4. Mortality rate for n-Coronavirus infection is under four percent. Over ninety-six percent recover.

Dr. P. S. Sahni is a member of AIDS Bhedbhav Virodhi Andolan (ABVA) and has worked in six epidemics/infectious diseases – Cholera (1971) West Bengal, bordering Bangladesh; National Small Pox Eradication Program (1974) Bihar; Leprosy (1984-89); Cholera (1988) Delhi; Plague (1994) Delhi; HIV/AIDS (1988 onwards).

Email: aidsbhedbhavvirodhiandolan@gmail.com

This article was first published at: https://countercurrents.org/2020/04/if-n-coronavirus-passionately-falls-in-love-with-me-this-is-what-ill-do-as-a-medical-doctor-with-fifty-years-experience

Also in Millennium Post on 03 May, 2020

http://www.millenniumpost.in/sundaypost/inland/value-of-informed-choice-408184