COVID 19 Treatment Success Story from Jaipur | Dr. Sudhir Bhandari & Dr. Anil Pareek

COVID 19 Treatment Success Story from Jaipur | Dr. Sudhir Bhandari & Dr. Anil Pareek


Dr. Anil Pareek: Dr. Sudhir Bhandari, congratulations
on the management of patients of COVID-19. I believe you have successfully treated three
COVID-19 positive patients. I think there were a couple of Italian patients. Dr. Sudhir Bhandari: Yes, yes, yes. Dr. Anil Pareek: Everybody wants to know how
to manage COVID-19 patients, can you please elaborate on what treatment was given to these
patients? Dr. Sudhir Bhandari: Thank you, Dr. Pareek,
it’s a pleasure talking to you. I represent one of the biggest pioneer Institute
of Asia SMS Medical College Institute. We were well aware of the Corona issue. COVID-19 is spreading all around, so we were
very sensitized. If you recollect, we had a great experience
of handling swine flu epidemic seven or eight years ago and we have been getting a lot of
cases of swine flu, most of them being the terminal, respiratory and pneumonia patients. So, we were prepared for this much before
the first COVID-19 patient came. We have a core team of consultants at SMS
Medical College. We studied a lot of literature, we checked
a lot of trials before handling the first three patients. The patients included one Italian couple and
an elderly Indian person from Dubai, second and third were the senior citizens with high-risk
groups. The second patient was a 69-year-old Italian
with emphysema, third was an 85-year-old Indian with renal failure. So, it was a real challenge for us. Whenever a COVID patient comes, it requires
intense medical and supportive management and definitely we had to work upon anything
which we can do to reduce viral replication and virus load. At the moment when these patients came, they
were corona positive, tested twice. They had significant medical issues of breathlessness,
high fever, and respiratory distress. Along with the standard medical management
and the supportive treatment we started working on the antiviral drug. Our bottom line was to reduce viral load. Having seen a lot of literature for Chloroquine
and Hydroxychloroquine along with a lot of trials which are going on, to have an antiviral
effect along with two antiviral drugs lopinavir as well as ritonavir, we started using a combination
of Hydroxychloroquine which we gave for five days then we coupled this with lopinavir and
ritonavir. Patients’ consent was taken before treatment. We started this protocol and we were monitoring
the side effect of it, if at all any. Dr. Anil Pareek: So, were they introduced
just a day after or how soon they were introduced with the combination of three drugs? Dr. Sudhir Bhandari: We introduced three drugs
at the moment they tested positive, and there is a definite indication of giving antiviral
drugs because they were significantly symptomatic. They were symptomatically symptomatic, saturation
was little compromised, breathlessness was there, so the moment the second sample confirmed
that they are Corona positive, we introduced this combination of three drugs. Dr. Anil Pareek: Did you consult ICMR also
for treating these patients. Are there any guidelines for practitioners
from ICMR on this? Dr. Sudhir Bhandari: Coincidentally, the ICMR
team happened to be in our institute the same day COVID-19 positive case was reported. We discussed with ICMR that we intended to
reduce the viral load and we want to use this protocol and probably it was consented by
them. So we used Hydroxychloroquine coupled up with
lopinavir and ritonavir. Dr. Anil Pareek: What is the benchmark to
consider if the patient has been treated successfully? Would it require repeated testing or how long
is required to follow up? Dr. Sudhir Bhandari: It was our initial experience,
so we were closely monitoring if at all any side effect. Day one along with this treatment and other
supportive treatment, the patient started improving. The first patient, who was 50 plus years of
age, became Corona negative within seven days. Two successful testing was required to label
her Corona negative. The second patient, an advanced cardiac patient,
and COPD patient because of being a chain smoker, also became Corona negative in the
next 10 days. The third patient, who was a senior citizen,
85 years old man with renal failure became Corona negative. All three patients were discharged happily. So if I couple up, I have a feeling that along
with giving standard medical treatment, we need to act in a direction to reduce virus
load, and viremia and this will be documented by fast recovery along with Corona being negative. Currently, we have six more COVID-19 positive
patients, which is the very beginning of our experience. We have put them on the same regime. First, we started Hydroxychloroquine and we
put on antiviral. All six have given consent for the treatment. Suppose we come across any person who has
not been put on this regime, so shorter duration of the person on the regime to be Corona negative,
faster recovery, better being the respiratory symptoms, clearing of the pneumonia patch
on x-ray, improvement of the oxygen saturation requiring lesser of oxygen and lesser of BIPAP
support. I am sure, over a period of time all these
parameters are going to make our conviction stronger that we should be able to reduce
the virus load by using these newer drugs. Dr. Anil Pareek: There is a study from China
where Chloroquine has been used and it improved the pneumonia. There is also a study from France where they
have used Hydroxychloroquine with azithromycin. What are your views on this? Dr. Sudhir Bhandari: Chloroquine was used
in SARS and MERS. There was every valid reason that we could
use Chloroquine or Hydroxychloroquine in our patients. A similar study, although it was a shorter
study from France with only 26 patients found out in the people whom they gave Chloroquine
and azithromycin, recovers much faster and the patient became Corona negative. Although we do not want more patients to come,
but we have been following this protocol. As we are entering phase three, we started
getting more patients. We have been giving this combination of Chloroquine
or Hydroxychloroquine coupled up with the lopinavir which helps the patients to recover
faster and reduce the morbidity and mortality. Even a mildly symptomatic patient can be given
only Hydroxychloroquine or Chloroquine coupled with azithromycin. If a patient has significant symptoms, we
could combine later the newer antiviral drugs which are very safe. Preliminary observation is that it is worth
giving a trial to these patients because we have got all positive results. Dr. Anil Pareek: I think there is an in vitro
study which suggests the use of Hydroxychloroquine since it has a little longer half-life plus
a better concentration in the respiratory secretions may be preferable with that kind
of in vitro data. Dr. Sudhir Bhandari: Even an in vitro data
is worth considering but more important is that the toxicity of Hydroxychloroquine is
much lesser it is better tolerated. We need to take into consideration the in
vitro study definitely. But equally important is the lesser toxicity. The level of confidence in using Hydroxychloroquine
is much more than a simpler Chloroquine. I think another thing is that
we have been using Hydroxychloroquine in a number of other conditions. I have a feeling that having used even for
longer and longer duration the toxicity becomes very less and late. Dr. Anil Pareek: I think you have been a part
of our clinical studies as well, so your experience becomes very important. What is your advice to uncontrolled diabetic
patients? Dr. Sudhir Bhandari: The use of
Hydroxychloroquine was an integral part of my anti-diabetic treatment. To be honest, it has so many strengths, it
is economical, it has lesser toxicity, it brings about very good diabetic control and
it increases insulin sensitivity and reduces insulin resistance, so I feel it has a proven
anti-inflammatory advantageous effect in this metabolic disease also. I think this antiviral effect needs to be
considered with practically a very low toxicity profile. Dr. Anil Pareek: Another important issue is
how a practitioner should deal with this? What is the current situation in Rajasthan,
since there is a community spread, what measures should be undertaken to prevent this flu? Dr. Sudhir Bhandari: First of all, I must
tell you we are entering phase three of Corona spread. So far, this COVID-19 had come from international
travelers or from identified countries and some of the people who came in contact with
international travelers. Now we are fearing the interpersonal or community
spread. The honorable prime minister Narendra Modi
has been motivating for quarantine. I have a feeling that if each and every citizen
of our country follows these basic principles of total isolation for the next two to three
weeks, like frequent hand washing, preventing the congregation, not going into public places,
we could prevent the interpersonal community spread. Now, if we look at the other countries also,
the first three weeks was almost a flat curve, fourth and fifth week it zoomed up like anything. So I think we keep our fingers crossed. I have an appeal to all my fellow Indians,
fellow colleagues that please maintain quarantine, especially to my senior citizen colleagues,
who have diabetes, hypertension, kidney problems, immunocompromised, COPD patients, on steroids
or inhalers, and for any other reason they have low immune status, probably they need
to keep themselves away, keep taking all the measures of preventing the virus. Dr. Anil Pareek: Being in a high-risk group
that you mentioned besides isolation, do you recommend any prophylaxis for this disease. Dr. Sudhir Bhandari: There have been a lot
of fewer studies of prophylaxis again with Hydroxychloroquine, but I would wait for some
more time for having definite value for this prophylactic proposal like I would let the
authenticated journal like the New England Journal published about it. Theoretically, I would say, sooner or later,
it will be included in the prophylactic armamentarium, but you know, we stay in such a country that
there has to be a rock-solid evidence for any advice, otherwise little misuse or overuse
of any prophylactic medication will be very documental. I would recommend for my general practitioner
colleagues and doctors that if they suspect COVID manifestation, if someone has a travel
history, contact history and now even without history because we are entering into phase
three, if someone has a fever or cold, and suspected symptoms it will be better to consult
a doctor. The new ICMR guidelines says that any person
who has a respiratory symptom with or without contact, need to be tested for COVID-19. Dr. Anil Pareek: This is a very important
thing that you are saying. Dr. Sudhir Bhandari: The new ICMR guidelines
are, any person who has a cough, cold, fever, even without contact with the suspect or contact
with the patient, needs to get himself investigated because we started having community cases. So, if you are COVID positive then I would
still feel Hydroxychloroquine is a great drug to begin in mild patients. With the newer studies, we may combine Hydroxychloroquine
with azithromycin which is again a harmless drug and in the moderate and severe symptoms
or if it is a patch of pneumonia on an x-ray or a falling oxygen saturation, falling blood
pressure, tachypnea breaths, general condition is low. I think we can club Hydroxychloroquine with
antiviral therapy which is very safe, very well, life effective, like lopinavir and ritonavir. So I am sure I must thank Dr. Pareek, I think
your dedication, your research of Hydroxychloroquine is helping us, India and the world. All compliments to you Dr. Anil Pareek. Dr. Anil Pareek: Finally, what is your advice
to practitioners in rural areas. Dr. Sudhir Bhandari: My advice to practitioners
in rural areas will be two-fold, Dr. Anil. The first advice in the present situation
of COVID-19 to practitioners is that we have to protect our country from entering into
phase 3. Ensure complete isolation, do not see non-critical
patients. If at all you see any critical patients with
respiratory symptoms, better protect yourself using N95. N95 mask is not essential for the public at
large. There has been a rat race of acquiring an
N95 mask by the public which is not required. N95 mask should be for doctors only. Dr. Anil Pareek: I think this is very important
advice to our rural colleagues. Dr. Sudhir Bhandari: So rural colleagues,
please educate people, simple three-layer surgical mask is enough if someone is coughing. Otherwise, for a common population, I again
repeat there is no need for a mask, maintain a distance of 5 to 6 feet from any person
whom you are talking to. Normal people do not require any mask. If someone has a cough, cold, sneezing he
can use a triple layer mask. N95 is only for medics, paramedics or consultants
who see a patient. The second one of the most important things,
I must share with you that this virus gets when someone coughs or sneezes. This virus settles down on any of the surfaces. Frequent hand washing is very important. One important advice I would like to give
to my rural colleagues that the first station, where this virus enters the body, is your
throat mucosal lining and the mucosal lining of the sinuses where the virus grows. So, if you can take warm water a few times
a day and steam inhalation through your nose and mouth a few times a day or after exposure
you deactivate the virus. I would strongly recommend my colleagues and
my countrymen in rural areas to drink warm water, to take steam and not to worry about
the mask. Maintain a distance, frequent hand washing,
are more valid for senior citizens and total isolation or quarantine at home for the next
three weeks. Now if someone develops the symptoms, doctor
colleagues in a rural area, what you should do is that if the patient has a cough, fever,
little breathlessness, make sure if you are confident, otherwise, consult with a higher
center or a senior consultant, get him examined for the COVID-19, which is a new ICMR guideline
to test everyone with suspected respiratory symptoms and the moment you find it will be
logical and prudent to start Hydroxychloroquine combined with azithromycin in mild cases,
moderate to severe cases you can combine antiviral drugs. Dr. Anil Pareek: Thank you, Dr. Sudhir. It is a pleasure talking to you. I hope to listen to this podcast we will give
the practitioner some insight on managing suspected COVID-19 patients. Thanks a lot. Dr. Sudhir Bhandari: My pleasure, so nice of you. Thank you, Dr. Pareek.

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