The Indian government, health authorities, companies, and elements within civil society continue to battle this most severe wave of the COVID-19 pandemic, powered by a virulent variant spread by migrant workers fleeing lockdowns as TrialSite reported on May 8. Since then, TrialSite reports that the government’s efforts to ensure an adequate supply of therapies listed on the nation’s national protocol intensifies while one notable drug may be dropped. Apparently, India’s authorized a five-fold increase in ivermectin production from 15 million 12 mg tablets in April to 77 million tablets in May. While the government actually claimed it’s also ramped up Remdesivir production by 10 times (1 million vials in April to 10 million vials in May), some material chatter in India’s press suggests that the Indian Council of Medical Research (ICMR) could drop Remdesivir from its nationwide COVID-19 protocol. Experts are apparently questioning the antiviral drug’s efficacy much like the World Health Organization has due to the results in the Solidarity study. The population-wide Ivermectin-based treatment protocol in Uttar Pradesh corresponds with a dramatic reduction in new cases—is there a connection?
Death Rate Concerns
While reports in the media and on the ground of hospital bed and oxygen shortages are common, this has also meant a lack of access to Remdesivir which is administered to patients in the hospital. On April 26, TrialSite reported that Prime Minister Modi’s government scrambled with an order to distribute 551 oxygen plants across the country in healthcare facilities. Despite new infection cases on the decline, the sum total of accumulating cases means millions will be sick and a race is on to do whatever is possible to reduce a death count. According to one data source India’s total number of COVID-19 infections is approaching that of America, still, the nation with the most cases at 33.8 million infections as compared to India’s 26 million infections. In America, a total of 602,000 have died as compared to 291,000 in India, although these numbers may be underreported.
Overall, if the numbers in these reports are accurate, the actual death rate in India is considerably lower in America. That situation could change, however, as there are still an enormous amount of accumulating cases, a low vaccination rate, and stretched healthcare system. On the positive side, a pragmatic embrace of approaches, such as Ivermectin, appears to be working.
But Some Positive Indicators
India’s total reported COVID-19 cases are now declining as measured by new daily cases. On May 6, 414,188 cases were reported in one day according to Johns Hopkins University data. Although ivermectin has been used by a number of states since last summer, TrialSite noted that by April 22 the anti-parasite drug was placed on the ICMR national protocol. Since then, in some states, an aggressive population-wide strategy may be leading to notable results.
Overall, the country now experiences a precipitous decline in daily new cases. By May 20, the daily new cases declined to 259,551. In the meantime, newly reported deaths are high at 4,209 reported in a single day on May 20 as the shortages of hospital beds, oxygen, and drugs such as Remdesivir contribute to the unfortunate statistic.
On May 12, TrialSite recently reported that in the nation’s most populated state, Uttar Pradesh, authorities have incorporated an aggressive, population-wide initiative using ivermectin and have seen results. The program is clearly working. On April 24, just two days after the national protocol included ivermectin, Uttar Pradesh recorded 37,944 new cases. By early May, the Ivermectin initiative intensified, and TrialSite reported on May 12 that the cases plummeted down to 18,023. Fast forward to Thursday, May 20, and the reported number of daily cases declined further to 6,681 according to the data from Johns Hopkins University.
Key Protocol Drugs & Coordinated Production
Although barely mentioned in the Western press, India’s national protocol includes Remdesivir, Enoxaparin, Dexamethasone and Ivermectin while non-protocol drugs include Favipiravir, Amphotericin and Apixaban.
As reported in the Business Standard, India’s health authorities closely the supply of drugs, especially ones on the protocol or as adjuvants but consider Ivermectin along with Remdesivir and Favipiravir “essential for treating moderate to critical COVID-19 patients.” A “three-pronged strategy” is employed here, including 1) supply chain management, 2) demand side management, and 3) affordability as reported in The Hindu.
According to the press, the Central Drugs Standard Control Organization (CDSCO) and the National Pharmaceutical Pricing Authority (NPPA) teamed to ensure production is robust: they recently reported that the number of production facilities making Remdesivir increased from 20 to 60 sites leading to triple the availability in just under a month.
But authorities are also talking about dropping Remdesivir. Multiple media, including Live Mint and the Business Standard, suggest the authorities may not keep Remdesivir on the protocol. As reported in Live Mint, Dr. DS Rana, Chairperson with the Ganga Ram Hospital in New Delhi, questioned the evidence backing the antiviral drug. He declared, “If we talk about other medicines which we use in COVID-19 treatment, there is no such evidence regarding Remdesivir that works in COVID-19 treatment. Medicines that do not have any activity to work, we will have to discontinue.”
Vaccination shortages reported by both Western and India press impacted the nation’s ability to administer accelerated vaccination programs.
The second most populous nation with 1.4 billion people, according to some data sources, only 147 million people have received at least one jab, representing just over 10% of the population. But only 41.2 million people have received both jabs, representing only 3% of the population. This is in a country with perhaps more vaccine manufacturing capacity than anywhere else in the world.