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Covid-19: India’s slow moving treatment guidelines are misleading and harming patients

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n278 (Published 10 February 2021) Cite this as: BMJ 2021;372:n278

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  1. Priyanka Pulla, freelance journalist
  1. Bengaluru, India
  1. emailpriyanka{at}gmail.com

The science of covid-19 treatments is fast moving. However, India’s health ministry is failing to keep pace, leaving a confusing and harmful vacuum, writes Priyanka Pulla

When Santosh Gaggar was admitted to hospital in December 2020 with severe covid-19 her doctors suggested an experimental treatment: plasma therapy.

Her doctors at the Hiranandani Hospital in Powai, Mumbai, told Santosh’s family that its efficacy was uncertain, but it had worked in other patients and considering Santosh’s condition they wanted to try it.

What the family didn’t know, however, was that in November India’s top government medical research agency, the Indian Council of Medical Research (ICMR),1 had explicitly advised against plasma therapy in patients like her who have had symptoms for over 10 days and have already developed immunoglobulin G in response (see box). Santosh’s antibody levels were confirmed by blood tests.

ICMR’s advice is based on three randomised controlled trials, including one done by ICMR itself, which found that plasma did not prevent death in patients who were moderately ill. Asked why Santosh’s doctors administered the intervention to a patient who did not meet the criteria, Swapnil Mehta, a pulmonologist at Hiranandani Hospital, said that while he was aware of the ICMR guidelines, they decided to try plasma as a “last resort.”

At the end of 2020, plasma therapy was being used routinely in many patients across India and was given the endorsement of political leaders. Despite the ICMR advice, guidelines from the health ministry, as well as multiple states, continue to recommend it for moderately and severely ill patients

“We are using our resources, equipment, blood banks and healthcare personnel for an intervention that does not work,” says S P Kalantri, an internal medicine specialist at Maharashtra’s Mahatma Gandhi Institute of Medical Sciences.

Plasma therapy is just one treatment being …

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