Bengaluru,25 June(HS): Thanks to both waves of Covid-19 and mutated viruses and the onslaught of information, misinformation and canards let loose on the media and social networking sites, these days even the average person lectures like a well informed medical practitioner. Added to suddenly acquired knowledge of medical science, there is no dearth of experiments engineered on the human body. Unfortunately, doctors on the ground despite a struggling day in and day out continue to face rough weather.
The experience of Dr Kavery Nambisan, a Kodagu based surgeon is no better. She has undertaken an enormous task on herself independently at a clinic in the Kodagu district with the help of two volunteer sources. Through them, she is trying to reach more people, mainly the labourers, tribals living in colonies and the working population.
A study by the All India Institutes of Medical Sciences (AIIMS)-Bhubaneswar in the state of Odisha found that two doses of potential drug ivermectin prophylaxis resulted in a 73% reduction in Covid-19 infection.
Between 20 September and 19 October 2020, 12 physicians of AIIMS-Bhubaneshwar conducted the study on healthcare workers (HCWs) at risk of virus exposure.
Ivermectin is one among several potential drugs currently in trials for its therapeutic and preventive role in Covid-19 infection.
Performed on two sets of HCWs, the study evaluated the association between the drug and the development of Covid-19 infection. In the two-cohort study, one set of HCWs received two-dose ivermectin prophylaxis at a dose of 300 μg / kg with a gap of 72 hours while workers in the other group received other prophylaxis.
With around 4,600 employees, over 625 employees of the institute tested positive for Covid-19.
The month-long study took place using 372 participants, including doctors, nurses, paramedics and sanitisation workers.
But, in fact, Dr Kavery Nambisan has been giving Ivermectin prophylaxis to hundreds of patients, relatives, friends and even doctors as well. Her experience with the wonder drug is not of late. On the other hand, it has started right from the beginning of the Pandemic in March 2020.
She admits: In the early months of the Pandemic — in March 2020, I started to use Hydroxychloroquine (HCQ) for treatment and prophylaxis of Covid patients. I prescribed it to 23 patients, along with an antibiotic and Vitamins. All but one recovered completely. A patient who was on dialysis for renal failure was referred to the hospital but died there. One patient who had Covid plus TB was also sent to the hospital. He recovered after a month and went back to work. In June, I started using Ivermectin along with Chloroquin for about a month and then switched to Ivermectin only…
On how she switched over to Ivermectin, Dr Kavery Nambisan asserts: I start treatment when early signs appear: cold, cough, fever, headache, loss of smell and taste, severe body ache, headache, diarrhoea and abdominal pain. It is best started within 3 days of onset of such symptoms, maybe one or two or three of them…
…If positive, I give Ivermectin to the entire family and advise home quarantine for 14 days with complete rest, non-oily home food and distancing within the family. I explain the disease to each and every patient — the two stages of the disease, the need for caution in the second week. I follow up closely so we do not miss any early signs of deterioration, she says.
About the treatment schedule for early cases, Dr Kavery Nambisan has been adhering to the following protocol:
Ivermectin 12 mg for 5 days (or 24 mg for first 2 days in severe or heavy-built patients).
Azithromycin or Doxycycline for 5 to 7 days.
Vit C, Zinc (50mg), Vit D3 (2000units) a day for 14 days.
Cough expectorant containing Terbutaline, or bromhexine
Antihistamine like levocetrizine or phenergan.
Butacort inhaler if cough is severe.
Usually, patients recover within 3 days but rest for 14 days is mandatory.
Second or Inflammatory stage: It can occur between 6 to 10th day of infection. If the patient continues to get a fever over 100 degrees, increasing cough, breathlessness, lowered oxygen (below 92%), I do blood tests to see if inflammation is high. If it is high, I treat with a five-day course of steroids (methylprednisolone 16 mg once daily) as a tablet. and continue all others as required. And add a blood thinner. The easily available and cheap one is Asprin 325 mg daily to be contd. for a few months. Or Clopidogrel 75 mg., says Dr Kavery Nambisan.
Prophylaxis: Ivermectin 12 mg on day 1, 3, 7 and then once weekly till risk persists. Any person who suddenly finds himself to have been exposed to a Covid patient should immediately start this course. (within 2 to 4 hours if possible.)…
…I have treated 486 confirmed cases. Unfortunately, in rural areas, people are scared of being tested and isolated in quarantine centres. Many will not go for testing. So it is better to start treatment first while trying hard to convince them to be tested, she feels.
“Almost all patients recovered very well and did not go for inflammatory complications. One patient 31-year-old with the oxygen of 81% came on the 3rd day of symptoms. I started the above treatment and referred for oxygen support in the hospital. He stayed there 10 days and has been fine after. Three patients needed steroid therapy and they did well…
…2 patients who went back to heavy work too soon suffer from body ache, headache and weakness…
…I now see many cases with post-Covid syndrome, mainly neurological symptoms, weakness and ‘brain fog’. Their treatment is long and complicated. All of them are kept on blood thinners to prevent stroke or emboli, recollects Dr Kavery Nambisan.
“For neurological symptoms, I use:
Fluvoxamine 50 mg twice daily for 14 days.
N acetylcysteine 600 mg twice daily for 14 days
Asprin
Vitamin E, C, Zinc, and D3
Metneurobion
At times others like Nortryptaline, Citicholine, Clonazepam, Pregabalin, concludes Dr Kavery Nambisan.
Ivermectin is a safe drug: Dr SR Narahari, Director Institute of Applied Dermatology(IAD), Kasargod in Kerala when asked for his reaction to the letter Dr Kaveri Nambisan wrote to the Union Health Minister recommending Ivermectin, shared his own experience: “What is written in the letter is not incorrect. Ivermectin is a safe drug and has many other uses. Other fringe benefits include the killing of helminthic (intestinal worms), Filarial worms and so on. Mass Drug Administration is a public health programme of the National Vector Borne Diseases Programme…
…It gives ivermectin to entire villages and population in the geographical area for eliminating filariasis. It is also being used for COVID 19. I am not competent to say how useful it is. But I regularly use it in practice for non-COVID reasons. Hence I can say that the drug is not harmful. But several scientific papers have appeared in support of using this drug to COVID. So supporting this letter is not unscientific, felt Dr SR Narahari.
If Ivermectin is a better, affordable and proven drug why then so much resistance and reluctance to adopt it in treatment? Well, there are several reasons, factors and business interests involved.
One health expert willingly admits: Oh, Ivermectin is shown to possess antiviral activity. But there are many other factors called confounding factors that prevented its wide use. The government could have done studies to prove it. Even now it can be done easily. The pharmaceutical lobby may be preventing it!
Probably after hearing such a plain ground situation, no amount of knowing the positive aspects of the medicine is going to make any sense to the players in the field!
