Sir,
The Indian Council of Medical Research issued recommendations on empiric use of hydroxychloroquine (HCQ) for prophylaxis of COVID-19 infection on March 22, 2020.[1] The advisory included asymptomatic health-care workers involved in care of suspected or confirmed cases of COVID-19. The stock available with the chemists soon vanished as hospitals and health-care workers lifted the available stocks from the chemist shops and by March 25, and there were reports that patients suffering from lupus and rheumatoid arthritis were not able to procure these medicines from retail chemist shops.[2] We conducted an online questionnaire-based survey of doctors and nurses from all over India on the use of HCQ for prophylaxis, which was voluntarily completed by 125 participants from 16 States of India. The results of survey are given in Table 1.
Table 1.
Results of hydroxychloroquine prophylaxis survey of Indian doctors and nurses
| Survey questions | Response |
|---|---|
| Age (mean) | 37.7±10.9 years |
| Female gender | 29.6% |
| Respondents | Resident doctors (45.6%), consultants (34.4%), nurses (6.4%) |
| Specialty | Medicine (32.5%), EM (20.3%), anesthesia (6.5%), ENT (7.3%), pediatrics (5.7%), surgery (4.7%) |
| Already took loading dose HCQ | 46.4% |
| Plan to take when on COVID duty | 35.2% |
| Plan to take when symptomatic | 18.4% |
| Read ICMR guidelines on HCQ | 86.4% |
| Took Loading dose of HCQ as recommended by ICMR | 75.8% |
| ECG done before taking HCQ | 30.2% |
| ECG done after HCQ | 16.4% |
| What motivated to take HCQ | ICMR guideline (71.4%), advise from senior fellow or colleague (23.8%) |
| Procurement mode for HCQ | Prescription based (47.6%), without prescription (52.4%) |
| Is HCQ safe for prophylaxis | Yes (59.7%), No (12.5%), don’t know (27.8%) |
| Gastrointestinal upset | 14% |
HCQ: Hydroxychloroquine, ENT: Otorhinolaryngology, EM: Emergency medicine, ECG: Electrocardiogram, ICMR: Indian Council of Medical Research
Most notable information from the survey was that despite clear instructions in the advisory, less than half of the participants took HCQ after a prescription. Less than 1/3rd got an electrocardiogram (ECG) before taking HCQ despite being knowledgeable of the fact that HCQ can cause QT prolongation. Gastrointestinal upset was reported by 14% though there were no serious side effects reported. 1/4th of the participants took a different dose of HCQ than mentioned in the advisory. 1/4th of the respondents took HCQ prophylaxis purely on the advice of a senior colleague without themselves going through the advisory. Therefore, the ICMR guidelines were not followed by the doctors and nurses in India properly and an initial panic might have led to a large number of doctors and nurses self-medicate with HCQ without prescription or pre-HCQ ECG. Exact numbers for how many health-care workers followed HCQ prophylaxis even when they were not posted in COVID-19 areas are not known.
ICMR has revised its advisory on 22nd of May in which it has included a new clause for having an ECG done before taking HCQ. It also says that weekly prophylaxis can be continued safely beyond 8 weeks. The revised HCQ prophylaxis guideline has expanded its coverage to include asymptomatic healthcare workers posted in non-Covid areas and also the frontline workers such as surveillance workers deployed in containment zones and paramilitary/police personnel involved in COVID-19 related activities.[3]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Technical Documents and Advisory. [Last accessed on 2020 May 08]. Available from: https://wwwicmrgov in/ctechdocadhtml .
- 2.Hydroxychloroquine Out of Stock in Chemist Shops-India News. [Last accessed on 2020 May 08]. Available from: https://wwwindiatodayin/india/story/hydroxy-chloroquine-out-of-st ock-in-chemist-shops-1659486-2020-03-25 .
- 3.Technical Documents & Advisory [Internet] Available from: https://wwwicmrgovin/ctechdocadhtml . Last cited on 2020 May 30.