COVID-19 Second Wave in India – Wait or Act?

COVID-19 Second Wave in India – Wait or Act?

In the middle of January, many Indians and the government started to think that the Coronavirus disease 2019 (COVID-19) pandemic was receding. The situation took a turn for the worse in March. For those needing admission to the hospital, injection of remdesivir is the only treatment approved by the US Food and Drug Administration for COVID-19.¹

Whereas contemporary guidance from various government organizations recommends admission and injectable therapies for COVID-19 patients, this approach is contingent on the availability of beds. Shortages of hospital beds have prompted an urgent need to provide outpatient care. We treated a small group of moderate-risk patients waiting for admission using an outpatient strategy. To the best of our knowledge, no outpatient strategy has been studied in this group. Moderate risk was defined using biomarkers and radiographic study.^{2 , 3}

We treated 15 moderate-risk patients above the age of 60 years. All had evidence of lower respiratory tract involvement on computed tomography, with oxygen saturation ≥94% and at least one comorbidity. All patients had fever of <72 hours duration. We studied 2 biomarkers for enrollment: C-reactive protein and D-dimer. When at least one biomarker was elevated, along with a positive reverse transcription polymerase chain reaction test, the patient was given intravenous (IV) remdesivir on an outpatient basis, with a starting dose of 200 mg IV over 1 hour followed by 100 mg/day IV for 4 days. All patients were observed in the outpatient department for 1 hour post injection. Biomarker measurements were repeated on completion of therapy. Patients were encouraged to seek admission to the hospital for further treatment or in case of a decrease in oxygen saturation. However, due to the lack of a centralized system of admission and some reluctance from patients and relatives, only 3 were admitted, 2 in a stable state and one as an emergency due to hypoglycemia.

Irrespective of age and comorbidities, all patients showed a very good response at the end of therapy, with no fever, restored appetite, and improvement in oxygen saturation, as compared with baseline. The biomarkers stabilized in most patients, and no patient required emergency admission to the hospital for mechanical ventilation.

Our approach suggests that outpatient treatment is feasible, and setting up a daycare center can help preserve beds for the seriously ill and also save costs.