Director, AIIMS speaks out on unnecessary demand to put COVID patients on oxygen

Just 15 per cent of total COVID positives will deteriorate to moderate phase of COVID-19: Prof (Dr) Randeep Guleria, Director, AIIMS

Even as India’s cumulative vaccination coverage exceeds13.23 crores, India registered 3,14,835 new COVID-19 cases in the last 24 hours.

Three prominent doctors of the country, Prof (Dr) Randeep Guleria, Director, AIIMS, Dr Devi Shetty, Chairman, Narayana Health and Dr Naresh Trehan, Chairman, Medanta Hospital, addressed various issues related to the rational utilisation of Remdesivir, included under the category of investigational therapy under the National Treatment Protocol of the Health Ministry, and use of oxygen for treatment of COVID-19 patients in hospitals.

On COVID-19 vaccines

Dr Guleria emphasised that the COVID-19 vaccine is the key to beat the gloom that is usually associated with COVID-19: although it may not prevent us from getting the infection, the vaccine prevents us from getting the disease in the form of severe illness. He said that it was important to understand that even after the vaccination, we may become infected with COVID-19 which makes it important to continue to wear a mask even after getting vaccinated.

Oxygen

Dr Guleria reassured that healthy individuals with oxygen saturation in the range 93-94 per cent do not need to take high flow oxygen just to maintain their saturation at 98-99 per cent. Even those with oxygen saturation less than 94 need close monitoring (oxygen being optional).

“Oxygen is a treatment, it’s like a drug,” he stated to drive home the point that taking oxygen intermittently is an absolute waste of oxygen. There is no data that shows that this will be of any help to the patients and is therefore ill-advised.

Dr Trehan echoed his observations and observed that the country has enough oxygen if we try to use it judiciously. He requested the audience not to use oxygen as a “security blanket” pointing out that a waste of oxygen will only lead to depriving someone who needs it.

Dr Shetty noted that a saturation above 94 per cent is no problem. A doctor may be consulted if it dips after exercise/effortful work.

Remdesivir

All the doctors unanimously requested the audience to desist from seeing Remdesivir as a wonder drug. Most of the active cases who are in home isolation or in the hospital don’t actually need any specific treatment. Only a small percentage require Remdesivir.

They were of the view that as a country, if we work together, use oxygen and Remdesivir judiciously, then, there will be no shortage anywhere. In terms of the number of people who need oxygen and oxygen supply, we are well-balanced, they noted.

Dr Trehan agreed and added that his hospital has now made a protocol that Remdesivir is to be given not to everyone who tests positive. It is to be given only after doctors look at test results, symptoms, comorbidities of a patient. Remdesivir isn’t a ‘Ram-ban’, it only decreases viral load in people who need it.

To cope with the surge in cases, the DPIIT, in consultation with all stakeholders has reportedly issued a supply mapping plan for 12 high burden states till April 30.

The Home Ministry’s advisory on unhindered movement of oxygen across states, the installation of 162 PSA Oxygen plants (154.19 MT capacity) in 32 States/UTs from PM-CARES fund, operationalisation of the IT application, ‘Medsupply’ which tracks site readiness, plant delivery, installation and commissioning, augmentation of Remdesivir production to around 74.10 lakh vials/month (May) from 27-29 lakh vials/month (January-February), prohibition on the export of Remdesivir API and formulations by the DGFT, stringent actions on black marketing and hoarding of the drug are some decisions taken to ease the difficulty of those affected by COVID-19, as per health ministry data.

The Union Government has also taken various steps to manage stocks of remdesivir and boost the supply of oxygen to hospitals across the country, in the recent days.