INDIA - Hydroxychloroquine
Hydroxychloroquine prophylaxis for COVID-19 contacts in India
“More than a billion Indians currently stand at the precipice of a massive increase in cases of coronavirus disease 2019 (COVID-19). India had shown a staggered course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, with 1397 cases diagnosed between Jan 31, and April 1, 2020. However, there has been a recent surge in cases, with numbers rising to 5194 as of April 8...
“...The Indian Council of Medical Research, under the Ministry of Health and Family Welfare, has recommended chemoprophylaxis with hydroxychloroquine (400 mg twice on day 1, then 400 mg once a week thereafter) for asymptomatic health-care workers treating patients with suspected or confirmed COVID-19, and for asymptomatic household contacts of confirmed cases...
“... mathematical models estimate a worst-case scenario of 10 million cases of COVID-19 in New Delhi, India, alone in the coming weeks.5 In these chaotic times, no health-care system can screen such a large number of healthy contacts for concomitant QTc prolonging medicines, long QT syndromes, or glucose-6-phosphate dehydrogenase deficiency. Even a 0·1% proportion of serious complications would amount to more than 10,000 severe adverse events in New Delhi alone, a number an already overwhelmed health-care system would not be able to cope with. The drug is untested, the benefits unknown, and the risks not negligible, especially at this scale of use. Moreover, the safety of these immunomodulators in people at risk of a severe viral illness has never been evaluated.
Apr 17
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30313-3/fulltext
initial load then once a week?
COVID-19: endgames
... the hard reality is that the selfless actions of health-care workers will not alone restore the world to normality. Ending the COVID-19 pandemic will take many more months, if not years, so it is time to revisit what we know and make some difficult choices about mitigating subsequent infection waves...
.. Presently, one vaccine candidate is in a phase 2 trial, four in phase 1 trials, and 56 in preclinical studies, but the earliest any might be available is September. The key reason for the lockdowns is to allow health-care systems to cope with a spike of severe cases. However, many systems in high-income countries are still under-resourced. For example, only on April 10 did the UK Government publish a plan on managing personal protective equipment (PPE)...
emergency measures such as sterilising single-use respirator masks with H2O2 could be considered...
...contact-tracing is no longer feasible as a standalone approach. A complementary random, cross-sectional testing scenario where one in three to four people get tested every 14 days for both active infection and antibodies could be considered. This approach would fill gaps in contact-tracing and would allow people with confirmed immunity to return to work, easing pressures on government welfare schemes....
Apr 17
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30298-X/fulltext
:The COVID-19 situation in LMICs is discussed in The Lancet Global Health May 2020 Editorial. “ (NOTE: the link is active but the editorial hasn’t been posted yet)
“initial load then once a week?”
That’s the malaria prophylaxis, I believe. So they are just shot-gunning it, it seems. We ought to try that here for the folks who just have to be out.