KUALA LUMPUR, June 17 — Malaysia’s Covid-19 team learned early during the outbreak that some patients were deteriorating not directly from the coronavirus, but from resulting inflammation, a Sungai Buloh Hospital clinician said.
Dr Suresh Kumar, an infectious diseases clinician at the main Covid-19 designated hospital in Malaysia, detailed how Malaysian Covid-19 clinicians learned early on that inflammation was the major culprit in the cause of death associated with Covid-19 infection. So treatment for these patients were modified accordingly to incorporate the use of anti-inflammatories, which subsequently prevented intensive care unit (ICU) admissions.
“Quite early on we learned to use anti-inflammatory agents in selected cases that were undergoing deteriorating, We were able to prevent the ICU admissions by doing that.
“If we had had the disease a lot later down the track we could’ve learned a lot more from the Italians and the Chinese and we learned early that some of these patients were deteriorating not because of the virus (directly) but because of the inflammation (caused by the virus),” Dr Kumar told Fifa Rahman for her report on the Malaysian response to Covid-19 that was written in collaboration with the Drugs for Neglected Diseases initiative (DNDi), a Geneva-based research and development non-profit.
The unknowns that came along with the novel coronavirus in deciding the right treatment for Covid-19 patients proved to be a great challenge for physicians, especially during the early days of the outbreak, as pointed out by Dr Kumar in his testimonial for DNDi’s report on the Malaysian response to Covid-19.
“We needed to work on what was available at that particular juncture. At that particular juncture — albeit there not being high quality evidence — we learned from Chinese experience that hydroxychloroquine works, we prescribed hydroxychloroquine early for all symptomatic patients,” he said.
He further emphasised that high-dose hydroxychloroquine was not used by Malaysian clinicians to treat Covid-19 patients, citing Brazil sources who claimed that high doses of the anti-malarial drug to be harmful as it can negatively affect the heart.
He also added that it was not part of Malaysian practice to use hydroxychloroquine with azithromycin, an antibiotic known to add to the cardiac side effects associated with the anti-malarial drug.
“We did use it not with azithromycin because we were worried about the cardiac problems. We monitored with ECG and we didn’t find anything major. It became our anchor when many patients became sick,” he explained, adding that other combinations of HIV drugs such as Kaletra and interferon were also used as experimental treatment for the coronavirus.
Recent upstir on the safe use of hydroxychloroquine to treat Covid-19 patients does not only focus on its benefit versus risk issue, but also on whether the anti-malarial drug works at all as an effective Covid-19 treatment.
A large-scale, critically designed study on hydroxychloroquine’s use in Covid-19 patients, also known as the Recovery trial, published earlier this month found that hydroxychloroquine does not work against Covid-19, as it does not prevent death. Researchers concluded that the anti-malarial drug should not be given to any more hospital patients globally, as reported by The Guardian.
Another study published earlier this month in the New England Journal of Medicine also found that hydroxychloroquine did not prevent those who were exposed to the novel coronavirus from developing the Covid-19 disease, as cited by STAT.