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Coronavirus treatment needs a rethink; and why Hydroxychloroquine matters

New theories on coronavirus's impact on human body are emerging, on the basis of which new solutions and lines of treatment are being examined

E Kumar Sharma | Thursday, April 9, 2020 | 11:35 IST

KEY HIGHLIGHTS

Hydroxychloroquine still touted as an effective drug, along with others

It's the only drug that restricts virus and its replication

Use of ventilators and their effectiveness in question

Inflammation in the lungs, a growing concern

It is perhaps not pneumonia

Hypoxia new focus area as a person could actually be 'drowning' from lack of oxygen in the RBCs

Focus also on antigen-antibody reaction

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New questions are now being raised and multiple theories are doing the rounds on how coronavirus attacks the body, especially the lungs - the key reason for fatalities. Doctors and scientists say there is now reason to believe that the virus attacks the oxygen carrying capacity of the red blood cells in the body. The patient is technically drowning from lack of oxygen with the red blood cells in the body not having enough capacity to carry oxygen because of the attack from the virus. As a result, the efficacy of ventilators is being questioned under the circumstances.

This is one of the new thinking on coronavirus's impact on human body on the basis of which new solutions and lines of treatment are being examined. Dr Devi Prasad Shetty, founder and chairman of Narayana Health says, "It is perhaps not pneumonia and is possibly an antigen-antibody reaction that is happening, which is triggered by the virus. It is damaging the lung parenchyma (portion of the lung where gas transfer takes place)." And that has a subsequent reaction: "Whenever the lung parenchyma does not function, oxygen cannot reach the RBCs (red blood cells), resulting in hypoxia," he says though he remains quite clear on the way the virus enters the body.

"I do not see any controversy around how the virus enters the body. It generally enters through the respiratory tract through the droplets, going by the current knowledge. But, it does not appear to be an infection of the lung but is instead an inflammation of the lung produced by the anti-body, antigen reaction triggered by the virus." He is nonetheless, quick to remind us that "these are all still theories that need to be explored but are very important because, if it is pneumonia, then the line of treatment is different and if it is an antigen-antibody reaction then the line of treatment is dramatically different and may be the patient needs to be put on steroids. And if it is a viral infection causing pneumonia then you do not give steroids to the patient."

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Dr B S Ajaikumar, founder, chairman and CEO of Bengaluru-based HealthCare Global, agrees: "There is perhaps the inflammation in the lungs, especially in the regions where the exchange of gases (oxygen and carbon-dioxide) takes place and this needs to be reduced and therefore a thinking seems to be emerging that there may be need for a combination of antimalarial drugs like hydroxychloroquine, anti-inflammation drugs/steroids such as Methylprednisolone".

Lung inflammation tends to give a ground glass-like look to the lungs leading to the line of a treatment usually given for ARDA (Acute Respiratory Distress Syndrome) and the treatment is given accordingly. He feels, the ventilators may not be of much help under these circumstances as there is an inflammation that first needs to be reduced for it is only then that the lungs can take in the oxygen. "A group in Spain is now treating patients with high dose of steroids," says Dr Shetty.

In sharp focus now is the much touted theory on the effectiveness of hydroxychloroquine. It was mooted by many from day one as the drug that could restrict the virus from replicating further. However, it has been only tried on small groups of patients while large scale studies are underway. So far, it is a mechanism that needs to be proved. The World Health Organisation's (WHO) Solidarity Project is also looking at this and other drugs in its trials to find a possible solution. At the moment, the approach is linked to the viral load that the patient is carrying. Experts will now have to examine what is most effective and accordingly take a call on the most efficacious line of treatment.

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