COVID-19: Docs in Kerala’s GMC Chart Unique Four-drug Course to Recovery

KOCHI:
A four-drug mix for COVID-19 patients, who are at the initial stage of the accompanying pneumonia, is proving quite effective in saving their lives in a Kerala hospital and could even become an international model for treating the pandemic, doctors have said.

COVID-19 patients surely require intense observation and prompt tests, but this pioneering treatment, based on a four-drug mix, is earning global recognition following a string of success stories at the Government Medical College (GMC), said doctors at the healthcare institution on the city’s outskirts.

Citing an example, top physicians at the GMC recalled the case of British national Brian Lockwood who was admitted to the hospital last month. The 57-year-old tourist was brought to GMC at Kalamassery on March 15 just ahead of boarding a flight to Dubai. A 17-day isolation at the hospital, where the patient was simultaneously provided world-class treatment, helped Brian recover from Covid and reunite with his wife Jane Neil.

Giving details, Dr A Fathahudeen and Dr Jacob K Jacob of GMC pointed out that Brian had no signs of serious ailment when he was admitted to the hospital, having been brought from the international airport at Nedumbassery. Dr Fathahudeen, who heads the Pulmonary and Critical Care Medicine wing at GMC, is the nodal officer for Corona.

“He had only minor fever and cough. He came walking in,” revealed Dr Fathahudeen about Brian, who had arrived in Kerala on March 10 and visited the scenic Munnar hills. “The patient underwent an X-ray test. Seeing the report, we sensed all wasn’t well. We referred him for a CT scan.”

That step proved decisive in Brian’s recovery from corona. In the process, he became the first COVID-19 patient in India to undergo a CT scan. Dr Jacob, who is with GMC’s Internal Medicine Department, referred to another milestone in Brian’s path to recovery at the hospital’s ICU. That was on March 17 when he was given a unique mix of four medicines following breathing trouble for which the patient was first provided respiratory support.

“That day, the nurse on morning duty made her routine call to me. She said the patient’s state was satisfactory but for a ‘minor deviation’ in his blood oxygen level. Usually this isn’t taken seriously, but then we noted the patient also had his NLR above 3.5,” said Dr Jacob, referring to dangerously high neutrophil-to-lymphocyte ratio considered as a mark of subclinical inflammation.

Within hours, Brian was administered a mix of four drugs: two varieties of HIV anti-virus, hydroxychloroquine and azithromycin. “We did this with the permission of the state medical board and after getting the patient’s wife sign her approval,” said Dr Jacob. “We gave it as a compassionate medicine. Other countries can make this a model.”

Both Dr Fathahudeen and Dr Jacob noted that the patient’s relatives should be told about the details of the medicines being administered. Treatment can start only after securing a letter showing the patient’s approval to the use of the medicine. In any case, corona has by far no cure and only early diagnosis can guarantee any efficacy of the medicine.

“This treatment is less likely to have the desired result in a patient with advanced stage of corona. In Brian’s case, fever came down by the eighth day. That is the first sign of the patient recovering,” said Dr Fathahudeen.

The patient’s general state of health (before contracting corona) is vital, too, in charting the course to recovery, according to the physician. For substantiating his point, he cited the instance of the 69-year-old Malayali who died in GMC of COVID-19 on March 28. The Kochi resident was already diabetic and had a heart problem.

“The man had recently returned from the Gulf where he contracted coronavirus, and had let his new disease aggravate by remaining homebound for a few days before getting admitted to the hospital,” observed Dr Fathahudeen. “The driver of the cab that had earlier picked the man from the Kochi airport, too, went on to contract corona. He was young, and so we could enable his recovery.”

The patient can be discharged only if both two tests held 24 hours apart show corona-negative. Even at home, the patient should be in quarantine for 28 days as per medical advice.

The doctors said GMC owes its success to its medical team that also comprises nurses, paramedics and staff of the lab. One can wear the PPE kit for not more than four hours. After that, he or she needs rest for a stipulated time. “So we need to change our teams every four hours. They need to observe the patients with extreme care and caution,” they added.

Dr Thomas Mathew, Principal of the 1999-founded GMC, is the coordinator for the treatment of corona patients at the hospital, 20 km north of the city.