More on Covid-19

MUMBAI: Worried that Covid-19 cases may rise exponentially in the city's densely populated slums, the Maharashtra government is considering giving hydroxychloroquine sulphate HCQS ) tablets as a "preventive medicine" to slum residents at highest risk of the infection.A high-ranking state government official said suspected patients kept in quarantine centres in Dharavi were likely to be the first to receive HCQS-an antimalarial drug that US president Donald Trump wanted India to supply to the US as it could be a "game-changer" in the fight against Covid-19. "In places like Dharavi, the plan is more a socio-demographic compulsion," the state government official said.If the state plans go through, it could be the first time that HCQS is used as a Covid-19 prophylaxis at the community level.Confirming the move, Maharashtra health minister Rajesh Tope said, "HCQS is used to treat malaria and there have been instances of it being used in the US as a preventive medicine against Covid-19. We plan to use it in areas like Dharavi where the risk of infection is high."Details such as the number of people, dosage and duration of treatment are being worked out.At present, the Indian Council for Medical Research (ICMR) approves HCQS as a preventive medicine for healthcare workers only.Dr Subhash Salunkhe, technical advisor to the state on pandemic control, said, “There is adequate medical literature to show that HCQS use will have definite advantages at this stage." He added the HCQS plan will have stringent exclusion criteria as it is known to affect heart and retina.Tope also said that there is no problem with HCQS supply in the state. “Of course, the whole of Dharavi will not be given the drug. We cannot waste resources like that," he said. People will categorised into groups: those in high risk, those in government quarantine, and those in contact with positive patients.HCQS is not only used to treat malaria, but is routinely prescribed to patients with diabetes, rheumatoid arthritis and lupus. Infectious diseases specialist Dr Om Srivastava said, “HCQS has a role as a preventive medication in Covid as it is can modulate the immune system." Dr Shashank Joshi, dean of Indian College of Physicians, said, “There have been no clinical trial to prove HCQS works, but it could prevent a cytokine storm in mild to moderate cases."TOI has learnt that the state will send a formal proposal to the Centre and ICMR within a day or two. “Once the paperwork is in place, we will distribute tablets among people in quarantine centres in Dharavi," said an official.Health officials are worried cases could spread rapidly in densely-populated areas. Another officer said that if the drug works well in Dharavi, “we may consider using it in other pockets as well".Both Tope and Dr Salunkhe refused to give details such as how many people would be provided the drug and when will the treatment will start. But sources said that the HCQS plan has already been discussed with the national Covid task force team.``In India, HCQS is being suggested as a preventive medicine or for those with mild symptoms. In the US, they want to use it for seriously ill patients but there is little evidence to suggest that it works in such cases,’’ said a public hospital doctor.