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Black-marketing of fake plasma and pharmaceuticals Rampant

Black-marketing of fake plasma and pharmaceuticals Rampant

 

What is visible in terms of sickness of about 11 lakh people and death of about 26000 persons, is only a tip of iceberg. Other aspects are domestic abuse, economic collapse, violence, famine, poverty, collapse of healthcare and education sectors and loss of human relationships.  Superadded is the hopelessness of rising numbers and failure to find a vaccine to prevent or specific drug to kill the China-virus. Not a day passes when a claim of vaccine or panacea remedy to contain the virus is not made. Latest drug to be allowed Itolizumab an anti-psoriasis (skin disease) drug, from Biocon, for restricted emergency use. USA, Russia and India are among several claimants to prepare a vaccine for early release. Not long ago an Indian entrepreneur had claimed to produce an Ayurvedic pill to prevent and cure the ailment, who later retracted.

While success of  prevention with vaccines or home remedies  or cure with drugs and plasma is still being debated, the gold –diggers in the black-markets; selling fake plasma or pharmaceuticals, have already made their presence felt. Similarly extracting lakhs of rupees per day for a hospital-bed by some corporate hospitals is now well known.

 

Prevention is the only silver bullet!

Face mask is very helpful modality.  The N 95 masks for medical use prevent transmission of aerosols and droplets from infected people to the ‘Care givers’ and vice versa. But cloth masks for ordinary use also minimize the transmission of the virus from the wearer to others. Under these circumstances, mask wearing represents a commitment that mask-wearer cares about the well-being of people. In Japan (mask-wearing universal), the COVID-related deaths are exceptionally low. Opposing the use of masks means that the person cares little about the health and economic welfare of  himself and his friends. Besides wearing mask, other precautions include avoiding crowded spaces as well as un-ventilated areas, frequent washing of hands with soap and water, supportive medical care including supplemental oxygen and ventilator support when indicated.

As we delve in the history of medicine, the term "silver bullet" was applied to the cure of untreatable contagious diseases of epidemic proportions in the past. Paul Ehrlich popularized the term "magic bullet" instead of silver bullet, when he pioneered a combination of silver and arsenic for the treatment of syphilis. Our best approach for the current epidemic is to develop a combination of antiviral and anti-inflammatory agents. The early use of anti-viral and the judicious use of anti-inflammatory agents could convert COVID into a more tolerable disease. While it is being said 80-85% of infected patients recover spontaneously with palliative treatment at home, small percentage only need hospitalization, who suffer severe ailment. An unknown number will develop permanent organ injury, affecting the lungs, heart, and brain. And some will develop progressive hypoxemia, myocardial injury, thrombo-embolic events and so on. Less than 2.6% die. This may climb down to 1% in due course; nearly the same as ordinary flue.

Many countries are fast-tracking to develop a vaccine. But the possibilities for a successful vaccine are not high, since the anti-bodies this virus produces are mild and they do not last long. Also, scientists were never able to develop a successful durable vaccine against past  strains of corona-virus. In the race to develop COVID vaccine nations must observe safeguards i e its safety, efficacy and affordability.

Too many drugs to beat COVID have confounded the scene

Different clinicians have tried different agents with despair and hope at various times. Drugs for the treatment of malaria, gout, rheumatoid arthritis, cancers, HIV, steroids and many more have been tried without much success. Hydroxy-chloroquine and its combination with Azithromycin, and antiretroviral Lopinavir-Ritonavir are being selectively used, along with palliative therapy. However, early popularity of hydroxychloroquine,  which showed promise in preclinical studies and was endorsed by President Donald Trump, waned gradually. Hydroxychloroquine was shown to have no survival benefit and in fact trended toward an increased risk of death among COVID patients. The antibiotic azithromycin has also been shown to be associated with an increased risk of cardiovascular death as per a study reported in June 2020 issue of Journal of American Medical Association. Tocilizumab, a drug used for Rheumatoid arthritis has also been tried. Favipiravir an anti-flue drug and Ivermectin an anti-parasitic drugs have also been used without much success.

Proponents of anti-oxidant supplements like quercetin say, it could be part of treatment regimen along with drugs like remdesivir  or convalescent  plasma.  It has been tried for its  protective effects against cancers, heart disease, and chronic ailments. This flavonoid like several home-remedies like Tulsi, Giloy, Ginger is worth a trial. Latest to get media headlines is stem cells implant trial; used in the past to treat some incurable conditions.

Ventilator is a panacea?

There was a hue and cry by mischief-mongers initially about the lack of availability of Ventilators in the country. It entails painful insertion of a hard tube under anesthesia into wind- pipe and allow the patient to breathe to the rhythm of the lung machine. Patient can't talk or eat or do anything natural - the machine keeps alive till death or recovery. After 20 days from this treatment, a young patient loses 40% muscle mass and gets trauma in the mouth or voice cords, as well as lung or heart complications. Simultaneously, they feed through another tube in stomach, a sticky bag around butt to collect excreta, another to collect urine, a line for intra-venous fluids and medicines.  Ward attendants move patient’s limbs passively every two hours. The loved ones cannot even come to visit.  The doctors and other health workers, who are required to be at the bedside constantly, sans food drink or even using toilet, are prone to commit Medical errors. But it is no panacea, death rate is about 88% in such cases.

 

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