Mumbai: 3 get Covid-19 twice in 40 days, treatment triggers debate

Three patients with lowgrade blood cancer tested positive for the novel Coronavirus twice in a gap of 40 days While they were given remdesivir and steroids on both occasions the cases have set off a debate with experts disagreeing with the repeated use of the drugs They say the medicines meant to provide relief in the first few days do not help Covid19 patients the second timeThe three patients were on chemotherapy when they contracted the infection said Dr Samrat Shah consultant physician Bhatia Hospital where they received care ldquoThey were treated with remdesivir and steroids for 40 days and 25 days These patients came back with highgrade fever and upon testing came out Covid19 positive again We administered remdesivir and steroids the second timerdquo said ShahThe youngest patient was a 30yearold woman from Gujarat while the others were senior citizens who had already received their first dose of vaccineldquoThis was in April first week when they turned positive and got hospitalised They got better and were discharged However the fever resurfaced and remained as high as 102103rdquo said Dr Shah The patients were given a repeat dose of remdesivir for five days and a smaller dose of steroids for a longer duration ldquoAll three did extremely well There was no secondary bacterial or fungal infection and there was no lung involvement They had a hyperimmune response which responded well to steroidsrdquo said Dr ShahAlso Read Covid19 Mumbai records lowest deaths at sevenSharad Mehta 65 one of the three patients treated by Dr Shah said during his first admission in another city hospital he was administered five doses of remdesivir ldquoI was discharged after turning negative but once home I got a highgrade fever with significantly low oxygen level I was again put on 5 doses of remdesivir and oral steroids for seven days I am finally home and betterrdquo said MehtaExperts however advised against the repeated use of remdesivir with steroids They said a person can remain positive for several days and there is no clinical evidence to back the administration of remdesivir again Dr Khusrav Bhajan consultant intensivist PD Hinduja Hospital said ldquoThe steroids should not be given for such a long time The maximum proven benefit is up to 10 days For a reinfection there needs to be a gap of 102 days with a negative RTPCR in between Remdesivir and steroids should not be used a second time The highgrade fever may have been a result of overuse of medicationsrdquoAgreeing with Dr Bhajan Dr Vasant Nagvekar an infectious disease expert at Global and Lilavati hospitals and also a member of Maharashtrarsquos Covid19 task force said ldquoWe have seen a few patients who have got fever 4 to 6 weeks after recovering from Covid19 You need to look into the cause of the infection It could have been multisystem inflammatory syndrome which is generally seen in children but we are seeing it in adults too Treatment is steroids but giving remdesivir again is not advisablerdquo said Dr NagvekarDr Gaurav Gupta consultant Covid19 and critical care physician Breach Candy Hospital said there is no recommendation or paper published for the use of remdesivir within a few months He said ldquoIt can be a dead virus There can be multiple reasons for fever in such cases including the inflammatory responserdquoAprilMonth when the trio got Covid19 for the first time