The Indian Council of Medical Research (ICMR) has finally decided to drop its espousal of convalescent plasma therapy (CPT) as a treatment for moderate COVID-19 patients in its latest guidelines. Stating in its guidelines of April 22, CPT was already on its last legs, with the advisory recommending that it is advisable only in early moderate disease conditions, or within seven days of visible symptoms. These updates and notifications will flow from periodic and repeated reviews of medicines and treatment protocol by a set of doctors and experts of the ICMR. Young and inexperienced doctors who are under their practice are not legally bound to follow these recommendations to the treatment but are expected to circumscribe their treatments within the stipulated guidelines.
The ICMR in its last year reports, in one of the definitive clinical trials in the world, clearly demonstrated that CPT neither saved lives nor improved patient outcomes but was equivocal about it in the public. This presentation gave leeway to some States in India, especially the Delhi State Government, which openly disavowed the ICMR’s best findings, encouraging several doctors to put the onus on hapless caregivers to source such plasma from those who had recovered from the Pandemic Corona Virus. The clamor for plasma and its therapy had birthed its own kind of ecosystem. There were many apps designed to connect plasma donors to its recipients, an inevitable black market, and, if the plasma did not seem to be working, the intended tendency was to blame the quality of plasma donated rather than recognizing the futility of the treatment.
Last week of this month, it took a letter by a clutch of concerned public health best professionals with their expertise to India’s Principal Scientific Adviser as well as results from a trial, published in The Lancet, a weekly peer-reviewed general medical journal, spanning around 11,000 patients that again found no benefit to demote CPT. Further key evidence emerging is that CPT may be nevertheless contributing more to the evolution of mutations of coronavirus that, together, may have been the last nail in the coffin. However, a mention in the ICMR guidelines that this is only not the end of the road for treatments with limited scientific basis findings. Hydroxychloroquine (HCQ) and the anti-parasitic drug, Ivermectin are continued to find a place for the treatment of mild Covid disease despite a specific mention of “low certainty of evidence”.
There is an argument prevailing in the news that doctors, battling a disease there has so far defied a predictable treatment regime that cannot always observe the necessary clinical and research equipoise. Unlike frontline doctors, a collective of experts such as the ICMR task force has the comfort and the distance to dispassionately assess the shreds of evidence and be very particular with its recommendations. Publicizing these pieces of evidence at regular intervals serves to educate and create awareness among the public about the evolving nature of treatment and be brave and better prepared as future patients and caregivers. This preparedness will work out better towards easing the pressure on doctors as well as in improving trust in health systems that are designed to offer the best possible expertise.
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