Doctors in Kashmir are struggling to save the lives of critically-ill COVID19 patients with little in their hands due to unaffordable medicines and unavailable plasma therapy.
At Sher-e-Kashmir Institute of Medical Sciences, parents of a doctor, severely sick with symptoms of COVID19, were provided plasma therapy last week. The patients are yet to be discharged from the hospital but doctors treating them are hopeful that they will make it. These patients had been administered "convalescent plasma therapy (CPT) on compassionate grounds", a senior medico who is part of the treating team at the Institute said.
However, although the deaths attributed to COVID19 have been mounting in Kashmir with each passing day, the treating doctors are restricted in their choices of medicines and therapies. A senior doctor said the hospitals treating moderately and severely sick COVID19 patients had for long been pressing for permission to start CPT in hope of better results. However, neither were the hospitals eligible to be empanelled as sites for clinical trials of CPT by Indian Council of Medical Research (ICMR), nor were the administrations receptive to allowing CPT on compassionate grounds.
The doctor said the Ethical Committees of both GMC Srinagar and SKIMS Soura were currently unregistered at the Department of Health Research (DHR), GoI. This, he said, made these institutes ineligible to participate in the ICMR's clinical trials of plasma therapy. "We could have initiated plasma therapy long back, but for the administrative inertia," he said.
Another doctor treating COVID19 patients said the critically-ill patients' families were also given "option" of purchasing Remdesivir and Toclixumab from the market. "However, we know it is out of reach for the most," he said. The doctor said the treatment with these new drugs that have shown some effectiveness against COVID19 cost between Rs 27000 to Rs 100,000 for a three day treatment course. "How many people can afford these and how many doctors would prescribe these, given the cost," he said.
Currently, at SKIMS Soura, the treatment involves Vitamin C and B Complex along with Famitidine as per case severity," Dr Aejaz Nabi Koul, faculty at department of medicine and head of the infectious diseases unit at SKIMS said. In early June "moderately sick patients" were administered Dexamethasone as some studies had shown it to be effective, he said.
Earlier, he said, the patients testing positive for COVID19 and having symptoms of the viral infection were given Hydroxychloroquine (HCQ) as per guidelines issued by ICMR. However, the drug has been discontinued "after more data came from the US and Europe showed these were not that effective ".
At Chest Diseases Hospital, a dedicated COVID19 facility under GMC Srinagar, the treatment involves HCQ and Azithromycin for mild cases, Dr Naveed Nazir Shah, head department of pulmonology at GMC Srinagar said. He said in patients where these drugs are contraindicated, Ivermectin and Doxycycline are prescribed. However, the GMC was also in the process of procuring Remdesivir and Favipiravir through JK Medical Supplies Corporation, he said.
"In very sick patients, we have been using Dexamethasone," Dr Shah said.
In addition, the hospital has been administering oxygen through various means. Although a civil society group has donated high-flow nasal oxygen equipment, a hospital administrator said they were facing issues connecting the equipment with the oxygen supply system at the hospital.
At SKIMS Medical College Hospital, the administration said, the national guidelines for management of COVID19 patients were being followed. Dr Riyaz Untoo, principal of the medical college said that the hospital has had the highest number of patients admitted among all COVID19 facilities in Kashmir. "We administer HCQs and have a huge high dependency unit, each bed with good oxygen supply," he said.
In the past two weeks, till Monday afternoon, 47 people had died in Kashmir due to COVID19, Government data states. The death toll attributed to the viral infection in J&K had reached 136. Of these 122 deaths took place in the Kashmir division.