Self-medication can increase Covid severity, warn doctors

With the unavailability of Covid emergency treatment across the country due to a surge in cases, the issue of self-medication has become a talking point. Doctors have, however, very strongly warned against this and said self-medication can increase severity in Covid cases.

Popping antivirals, steroids and antibiotics besides injecting antivirals like remdesivir without consulting a doctor can lead to the severity in Covid-19, doctors at Post Graduate Institute of Medical Education and Research (PGIMER) have warned.

Professor GD Puri, Head Department of Anaesthesia and Intensive Care, Dean academics at PGI, Chandigarh said, "Whenever a patient tests positive for Covid-19 there is a fear in his mind. The patient starts running around for drugs to get rid of the Covid-19."

"Unfortunately there is a lot of misinformation about the drugs. There are certain drugs that may cause harm. Drugs like steroids and unnecessary use of Remdesivir, Tocilizumab and Itolizumab can prove harmful. Rather than helping the patient, it can increase the severity of the disease," he said.

ONLY 10-15% COVID CASES NEED MEDICATION

Professor Puri said that more than 80 per cent of people who test positive for Covid-19 may not require any medication. Only 10 to 15 per cent of patients will require paracetamol besides close monitoring of the oxygen saturation level.

Whenever a Covid-19 patient reaches the emergency facility of a Covid-care facility at PGI Chandigarh, he is asked to take a five-minute walk. He is only hospitalised if the oxygen levels drop below 94.

"The major problem in Covid-19 is the lung involvement which leads to the dropping of oxidation. This can simply be measured by a simple oximeter. If you keep monitoring the saturation and if the saturation is at baseline there is no need to worry," he said.

Professor Puri said if the saturation does not drop from the normal 99 to 97 after walking that means that the lung involvement is not significant.

CT SCAN REVEALS LUNG INFECTION, CAN'T DIAGNOSE COVID

Professor GD Puri said a CT scan can only reveal lung infection but cannot diagnose Covid-19 if the virus has not reached the lungs.

"Unfortunately some people believe that CT scan can diagnose Covid-19 which is totally wrong. CT scan may not show anything pertaining to Covid. Yes CT scan can show something if there is a lung involvement," he said.

STEROIDS CAN INCREASE COVID SEVERITY

Doctors at PGI Chandigarh have recommended judicious use of steroids that too under the supervision of a specialist. Case studies done by PGI have revealed that many patients were popping and injecting antivirals and steroids on their own which resulted in the severity of the disease.

"Steroids Can increase the replication of the virus in the body. If it is given in the early stages it can increase the severity of the damage caused by the virus. The right time is when the replication of the virus in the body is over," Professor Puri said.

Studies done by PGI have revealed that if steroids are given before the saturation starts dropping it can increase the mortality and morbidity in the patient.

Steroids should only be given when the patient's saturation level starts dropping from a normal of 97 to below 94.

"That is the time we should start administering the steroids," he said.

Prof Puri also advised not to use steroids even if the C-reactive protein (CRP) level is higher as there could be many reasons for the increase. CRP test is a blood test marker for inflammation in the body.

"Steroids should be avoided in the first week of the infection. These drugs should be given after the first week. When the fever is high and CT scan is showing some changes and CRP is high. Avoid using steroids even on the 9th or 10th day of the disease," Professor Puri said.

REMDESIVIR RECOMMENDED IN REPLICATION STAGE

Remdesivir is a drug that is used in the replication phase of the virus, and it is only given to the high-risk patients
with hypoxia.

"Administering this drug may not benefit the patient if he or she is on a ventilator," Professor Puri said.

Similarly, administering remdesivir when the patient is at home is never beneficial.

"This drug has not shown any increase in the possibility of survival in patients admitted in hospital. It is only helpful in decreasing the stay in the hospital," he said.

REMDESIVIR HARMFUL TO PEOPLE WITH LIVER, KIDNEY ISSUES

Remdesivir should be given to hospitalised patients under the supervision of the doctor that too after the requisite tests of the liver and renal function.

Antiviral drugs like remdesivir are not recommended for patients diagnosed with liver dysfunction. Similarly, remdesivir should be avoided if the renal function test reveals a high level of creatinine.

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