By Dr Siddhartha Sahu*
“Primum non nocere”, translated as “first do no harm”, has been one of the fundamental components of medical ethics. Hippocrates in his book the Epidemics, first mentioned this concept. He was concerned that in the uncertainty and panic surrounding the outbreak of an epidemic, caution often takes a backstage. He thought it fit to remind his students, that in cases where the outcome may be in doubt, always be sure that no harm come to the patient from an intervention.
After many decades modern medicine has faced a most diabolical foe in Covid 19. A disease so novel and so sinister, that physicians to begin with had no clue about the disease, when it first broke out. Physicians and scientists have spent sleepless nights throughout the world desperately trying to understand the disease. We now know quite a bit about, how the disease spreads and how it attacks the human body. The search for a cure continues.
To formulate a cure , one must understand the disease. For Charaka wrote in his treatise on Ayurveda, to cure a disease one must treat the cause and not merely the symptoms. Based on an understanding of the disease process, medical experts identify medicines likely to cure the disease. Such promising medicines need to be tested and retested, before one can be sure that the medicine works. What is equally important is testing the medicines for side effects, to understand how safe the medicine is.
Covid 19 as a new disease has no known cure. Medical experts have thought of and tested several promising medicines. Initial optimism for Hydroxychloroquine had to soon be abandoned. This despite a strong endorsement from the then president of USA, Mr Donald Trump, we now know that Hydroxychloroquine has little effect on Covid 19 while having potentially serious side effects.
Indian protocols have recently made drastic changes in treatment recommendations for Covid 19. Before this confuse you, remember Covid 19 is a rapidly evolving disease. The second wave has behaved so differently from the first one. Medicine is a rapidly evolving science trying to keep abreast with a rapidly mutating virus. This means that potentially promising medicines may be found. It is also equally likely that many of them in practice may be found useless or even potentially harmful.
Antivirals like Favipiravir and Remdesivir were originally designed to work against other viruses. Experts initially thought that they might also work against Covid 19. We now have enough evidence to show that these medicines do not work against Covid 19. Taking note of the growing evidence of ineffectiveness, recent Indian protocols no longer recommend them for Covid 19. Antibiotics like Azithromycin and Doxycycline are effective against bacteria and not viruses. They should only be used if there is a bacterial infection complicating Covid 19 infection. Taking cognizance of the risk of breeding antibiotic resistant super bugs, as well as possible side effects, recent Indian protocols do not advise routine use of antibiotics for mild cases of Covid 19.
Plasma therapy and Toclizumab too have not been found to be effective against Covid 19. They are no longer recommended in latest treatment protocols. Unnecessary use of steroids in high doses can lower immunity, worsen diabetic status of a patient and result in infections like black fungus. The latest protocols rightly advise caution while using steroids. CT scan is an expensive investigation that exposes the body to radiation. It is unnecessary in mild disease. The latest protocols advise that it be used only in seriously ill patients.
Remember self medication is the most dangerous. The information you obtain from the media is not a substitute for medical advice. Medicines that worked on your neighbours will not necessarily work on you. Enthusiastic endorsement of a cure by prominent people, needs the backing of hard science and evidence before being accepted. Please do not start any medicines without the advice of a doctor. Please remember pressurizing a doctor to prescribe medicines as per your wishes is not just futile, it could harm you too. Vaccines and prevention are still the best treatment.
The author is an orthopedic surgeon. He can be reached at [email protected]
DISCLAIMER: The views expressed in the article are solely those of the author and do not in any way represent the views of Sambad English.