- Dr Budhiraja conducted country's first plasma therapy on a COVID patient
- After the first COVID wave, there was a slight complacency: Dr Budhiraja
- Follow COVID behaviour and get vaccinated, says Dr Budhiraja
New Delhi: The global fight against COVID-19 has evolved in the last 18 months. From not knowing anything about the disease to rolling out vaccines against the Novel Coronavirus, the pandemic has taught the world a lot. Dr Sandeep Budhiraja, Group Medical Director of Max Healthcare has been at the forefront of this fight from the early days of the pandemic. He performed the first plasma therapy to treat a 49-year-old COVID patient last year in April, a mode of treatment that was dropped from the list of COVID treatments earlier this year by the Indian Council of Medical Research (ICMR). There were similar fits and starts when it came to trying out different medicines to treat COVID-19, from Hydroxychloroquine, Remdesivir, Ivermectin, steroids to formulating guidelines and constructing physical infrastructure like isolation centres at a scale not seen before. In a special interview, Dr Budhiraja, who is a member of Oxygen Audit Committee created by the Supreme Court and was formerly a part of the Vaccination Sub Group by FICCI and Delhi Government’s Taskforce – five-member committee to combat the pandemic, spoke about the changes in treatment protocols, learnings from the COVID-19 pandemic and the way forward to achieve freedom from the pandemic and apply its learnings going forward.
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Despite Showing Effective Results, Why Has Plasma Therapy Been Dropped?
Plasma therapy is nothing but a passive vaccination. It involves the transfusion of antibodies from someone who has recovered from COVID-19 (convalescent coronavirus patient) into a critical patient. The therapy is based on the principle that the blood of a recovered patient is rich in antibodies needed to combat COVID-19. These antibodies are expected to help critical patients recover. Plasma therapy is a century old treatment process that has been used during various disease outbreaks like Measles, Diphtheria, Polio, Spanish Flu of 1918 and Ebola. Explaining why ICMR has changed its perspective on plasma therapy, Dr Budhiraja said,
It has not been rejected as a treatment. It is a treatment that one uses as a desperate measure for outbreaks that are new to humankind. Plasma can and should work in most of the diseases where we don’t have a specific treatment. Once a specific treatment, antiviral or antibiotic comes out, this becomes a treatment that is no longer needed. When we started using plasma, there was nothing in terms of treatment for COVID patients and let me tell you, it offers benefits provided given to the right subset of the population. It’s not needed for patients who have mild disease and is useless when a patient is dying. But useful for a subset of elderly patients where we see that inspite of oxygen and medicines, the disease is worsening. If you intervene at that time in this subset of patients, what we have seen is, it reduces mortality significantly.
Dr Budhiraja clarified that no medicine has proven to work against COVID-19. Even remdesivir, hydroxychloroquine, and ivermectin have been rejected. He added,
The only thing which is supposedly life-saving is steroids and once we come out with a statement like this, the steroids are abused, wrongly used, over used, used early where not indicated and it has led to an epidemic of fungal infection, the black fungus. None of the therapies or medicines is specific to COVID-19. They are being repurposed for use in COVID and if used at a right time, in a right fashion and in the right group of people, they do work.
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The Difference Between The First And Second Wave Of COVID-19 Pandemic
The second wave in India was worse than the first with the country reporting over four lakh cases a day. Dr Budhiraja and his team conducted a study comparing the two COVID waves. Here are some major findings of the study:
- Numbers were more than double in terms of daily hospitalistion.
- The severity of illness was much more. 40 per cent more deaths happened in wave two than in one.
- Higher mortality was reported among younger people also.
- A higher percentage of people were reporting secondary infections – bacterial and fungal infections in wave two.
According to the Indian SARS-COV-2 Genomic Consortia and National Centre For Disease Control Study, the Delta variant of the virus which is 50 per cent more transmissible was behind the second wave of the pandemic. Explaining the possible reasons behind a high mortality rate, Dr Budhiraja said,
The two contributing factors could be – the lack of availability of beds during peak. Patients who should actually be in the hospital were being managed at home on oxygen. By the time they came to the hospital, their oxygen saturation levels had dropped to 70-60 per cent and were critically ill. They came to the hospital late not by choice but because they had no choice. Secondly, many of these patients who should have been in ICU were not able to access ICU care even within the hospital.
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Learnings From The COVID-19 Pandemic
The surge in COVID cases during the second wave had put a burden on the healthcare infrastructure and uncovered the gaps in the healthcare system. As a result of which, many patients had to be managed at home and the national capital Delhi even reported deaths due to a shortage of oxygen. The situation is under control now and according to Dr Budhiraja, this is the window of opportunity to learn from our past mistakes, fill the gaps and move forward so that if and when the third wave comes, we are better prepared. Key learnings from the pandemic:
- To remain prepared now and for the future. Whether in future, more waves of COVID will come or not but definitely as humankind, to protect our race and species, we have to be prepared for future, new pandemics which may arise.
- Create an infrastructure which is adequate to handle such unexpected pandemics.
- We need to be prepared to augment the infrastructure in a very short span of time whether that’s pre-fabricated material or cabins which can be just put and made functional to having procurement and supply of medications.
- Ensure production of life-saving drugs continues whether or not a surge or peak happens so that if it happens, we are prepared.
- Same for oxygen; hospitals now have Pressure Swing Adsorption (PSA) plants. There is a contingency plan that every state has to have backup storage for at least 24 hours. You need to have oxygen manufacturing capacity in the state or close by. There has to be a transport mechanism, adequate tankers, and railways have to be geared up for that.
- Teleconsulting got a big boost as milder cases were managed at home.
After the first wave was over, I think as a country, there was a slight complacency which had set in and we were sort of thinking that for us the worst is over and probably it won’t happen again. However, now, we are much better prepared to handle it. Had that happened after the first wave, the second wave would probably have been better managed in terms of surge capacity. I am sure we won’t be perfect in the third wave but much better off. The focus now needs to be on how we can reduce mortality, he said.
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Gaps In Healthcare System That We Still Need To Fill
In Dr Budhiraja’s words, three things need our focus – infrastructure, people and processes. This means, building hospitals and procuring medical equipment is not enough. We need the following things:
- Trained manpower to handle the caseload
- A robust manpower training upskilling programme
- Standardised guidelines on what is mild/moderate/severe disease, how to handle the disease, how to monitor patients at home, when to give oxygen and steroids, how to do reporting of sickness and mortality.
- A robust mechanism of information transmission not only within the same organisation but across organisations.
- Access to care; there is clearly inequality of care between rural and urban, tier 1 and tier 2 and 3 towns. We should bridge that gap to the best we can and have basic services and a hub and spoke mechanism. Milder cases can be managed at a local level through telemonitoring but as the patient gets sick, there should be a way to move him/her to a district hospital or better facility.
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COVID-19 Vaccination In India
India has set a target to vaccinate its adult population of 92 crore by the year end. As of August 13, 41.53 crore people have received the first dose of the vaccine. To achieve the target, Dr Budhiraja suggests three things:
- The government needs to ensure that there is enough supply of vaccines even in the remotest of rural areas. These could be indigenous or newer vaccines like Pfizer, Johnson and Johnson, Zydus Cadila and others. We should get all kinds of vaccines we can.
- Address vaccine hesitancy scientifically.
- If we have to tackle the Delta strain, we have to reduce the gap between the two doses especially for Covishield for which the dosing regimen has been revised multiple times. With the Delta strain, one dose of vaccine gives you about 30-40 per cent of protection. We definitely want that to be above 50-60 per cent which can happen with the second dose.
Attaining Freedom From COVID-19, The Way Forward
Looking back at the onset of the pandemic, Dr Budhiraja said,
At the start of the pandemic, the biggest challenge was getting adequate PPE. We used to import back then. Then we had to train doctors on how to wear and take off PPE because a lot of infections can happen during that process. After few months, we started acquiring the raw material and producing PPE indigenously. We used to literally see and feel each material; put water and blood on it and see if it percolates or not. We also had to ensure safe accommodation for our healthcare workers as they decided to stay away from their families. Normally, it takes years to produce a vaccine and bring it to the market but during COVID, this happened within 12 months. And then, when vaccination began, we created vaccination camps within 24-48 hours. We can set up isolation wards even while sleeping. Now, we have become experts in things which a year back were unimaginable.
Now, to continue this fight and ultimately win over the virus, Dr Budhiraja calls for sensible behaviour that is following COVID protocols and taking the vaccine. Once 80-85 per cent of the population is either infected or vaccinated, the COVID-19 will become endemic and we won’t see these surges.
Dr Budhiraja is not in agreement with the statement that the nation will see the third wave in August reason being, currently, there is no major mutant that is reported to be spread across the world. Third wave can happen if a new mutant starts spreading, he said.
I can clearly give one assurance that ultimately we will come up victorious. We will get freedom from the present COVID but one needs to remember that this is not the last epidemic or pandemic that humankind will see. As intelligent beings we need to learn from it and move on in life to have better lives for all of us, he said while signing off.
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NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.