The best doctors write to the government


New Delhi: A group of top doctors have made an open appeal to the Narendra Modi government, the states as well as the Indian Medical Association (IMA) for an “evidence-based response” to the current wave of Covid. They also called for an end to the use of drugs and diagnostics “inappropriate for the clinical management” of the virus.

In a letter, more than 30 health experts drew attention to issues of “unwarranted medications, tests and hospitalizations” being suggested to Covid patients. They pointed out that Covid “kits” and cocktails, vitamin combinations and a host of drugs were being prescribed to patients, which they called an irrational practice.

The practice of “unnecessary CT scans and a battery of lab tests” for asymptomatic and mild cases of Covid was also criticized in the letter.

Instead, the group of doctors have proposed updating the Directorate General of Health Services (DGHS) guidelines and issuing guidance on home care for Covid patients.

Here is the full text:

January 14, 2022

Open call to all State and Central Ministries of Health, Indian Medical Association and all healthcare professionals

Urgent need for an evidence-based response to the current wave of Covid-19 in India

Less than a year ago, the devastating delta wave of the pandemic resulted in the greatest public health emergency of our time. The response to the pandemic, while marked by countless examples of personal sacrifice and courage, has been riddled with missteps – many of which were avoidable.

Although there is still much uncertainty amid the outbreak of this new disease, there is now substantial high quality scientific literature that provides unequivocal guidance on the clinical management of Covid-19. Despite the weight of this evidence and the crushing toll of the Delta wave, we see the mistakes of the 2021 response repeating themselves in 2022.

We urge you to intervene to stop the use of inappropriate drugs and diagnostics for the clinical management of Covid-19. We draw your attention to three critical points:

  1. Unjustified drugs

The vast majority of patients with Covid-19, with asymptomatic and mild symptoms, will require little or no medication. Most of the prescriptions we’ve looked at over the past two weeks include multiple Covid-19 “kits” and cocktails. Prescribing combinations of vitamins, azithromycin, doxycycline, hydroxychloroquine, favipiravir and ivermectin to treat Covid-19 is an irrational practice. Such gratuitous drug use is not without danger, as the Delta wave showed. Epidemics of opportunistic fungal infections such as mucormycosis in India and aspergillosis in Brazil have been attributed to the widespread abuse of inappropriate drugs.

  1. Unwarranted trials

The vast majority of patients with Covid-19 will not need any further diagnosis after the first rapid positive antigen or PCR test, except – in some cases – home monitoring of their oxygen levels. There is also growing evidence that while Omicron can cause many breakthrough cases among previously infected or previously vaccinated populations, disease-associated morbidity and mortality among them will be lower. Yet CT scans and a battery of lab tests like d-dimers and IL-6 are routinely ordered by practitioners across the country in asymptomatic and mild cases, placing an undue financial burden on families.

  1. Unjustified hospitalizations

Patients continue to be admitted to hospitals without clinical justification. Unnecessary hospitalizations, in addition to further increasing the financial burden, also endanger the lives of hundreds of thousands of other non-Covid patients who cannot find hospital beds for more urgent conditions.

Two years after the start of the pandemic, there is no justification for these unwarranted practices to continue. Healthcare workers in India rely heavily on government guidelines which had unfortunately promoted expensive diagnostics and drugs with limited evidence. The public and the medical community are also the subject of blatant misinformation on social media. We believe it is incumbent upon state agencies and professional medical societies to end this travesty, in the best interests of the nation.

We therefore call on Central and State Governments to immediately institute the following policies, with respect to the Covid-19 medical response in India:

  1. Update June 2021 DGHS evidence-based guidelines. In particular, provide specific guidance on the use of monoclonal antibodies, given their limited efficacy for the Omicron variant and their continued widespread use.
  1. Through public education and vocational training, discourage the use of drugs that have no supporting evidence for the treatment of Covid-19, including alternative therapies, potions, antibiotics, “cocktails” and drugs like molnupiravir, which should be widely abused and inappropriately prescribed.
  1. Through public education and vocational training, discourage the use of unwarranted diagnoses, especially for asymptomatic and mild cases, where none is required except for antigen confirmation or PCR testing.
  1. Publish home care guidelines for rapid testing, quarantine, isolation and release, in all local languages, context-modified to suit local urban and rural contexts where the availability of rapid home antigen tests and PCR testing varies widely. Include a list of approved local resources, including hotline numbers.
  1. Stop any state-sponsored promotion or distribution medications, cocktails, alternative therapies or potions that are no scientifically proven therapies.

We underscore the importance of scaling up effective and proven public health strategies, including universal masking in all public places. Provide communities with the resources to do so through mass media campaigns and the regular distribution of appropriate three-ply masks. Provide all healthcare workers with adequate N95 and eye protection. Continue to accelerate vaccination, building on the current success.

We are ready to provide any assistance requested of us in the preparation of any of the above documents.

We sincerely hope that you will implement these policies with the urgency they deserve.

In the spirit of our shared mission to serve patients,

Dr Anant Bhan, Yenepoya (considered a university), Mangaluru

Dr Rajani Bhat, Pulmonologist,, Bangalore

Dr. Anjali Chhabria, Mind Temple

Dr Sonia Dalal, Dalal Medical Institute of Sleep and Chest, Vadodara

Dr. Bharat Gopal, Senior Chest Physician, New Delhi

Dr. Richa Gupta, Christian Medical College, Vellore

Dr Raghuraj Hegde, Manipal Hospitals, Bangalore

Dr. Rajeev Jayadevan, Sunrise Hospital, Kakanad, Kerala

Dr. Yogesh Jain, Sangwari, Chhattisgarh

Dr. Yogesh Kalkonde, Sangwari, Chhattisgarh

Dr. Charuta Mandke, Dr. RN Cooper Municipal General Hospital

Dr RK Mani, Yashoda Super Specialty Hospital, Ghaziabad UP

Dr Pavitra Mohan, Basic Health Services

Dr. Nachiket Mor, Banyan Academy of Leadership in Mental Health

Dr. Sanjay Nagral, Jaslok Hospital, Mumbai

Dr. Cyriac Abby Philips, The Liver Institute, Rajagiri Hospital, Kerala

Dr Ashish Satav, Mahatma Gandhi Tribal Hospital, Amravati

Dr. Tushar Shah, physician

Dr. Satendra Singh, University College of Medical Sciences, Delhi

Dr. Aqsa Shaikh, Hamdard Institute of Medical Sciences and Research, New Delhi

Dr. Zarir Udwadia, PD Hinduja National Hospital; Breaking Candy Hospital

Dr. Sonali Vaid, Public Health, Include Labs

Dr. Shitij Arora, Albert Einstein School of Medicine

Dr. Satchit Balsari, Harvard Medical School

Dr. Kartik Cherabuddi, Florida University of Health

Dr. Sumanth Gandra, University of Washington School of Medicine

Dr. Manoj Jain, Emory University, Rollins School of Public Health

Dr. Manoj Mohanan, Duke University

Dr. Madhukar Pai, McGill University

Dr. Priya Sampathkumar, Mayo Clinic

Dr. Bhavna Seth, Johns Hopkins School of Medicine

Dr. Amita Sudhir, University of Virginia

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