ABSTRACT
Since the COVID-19 pandemic, the world began a frantic search for possible prophylactic options. We conducted a study to assess the role of hydroxychloroquine for COVID-19 prophylaxis in health-care workers. The study was a prospective cohort with four arms (high, medium, low dose, and control) of HCQ prophylaxis. Participants were grouped as per their opting for any one arm on a voluntary basis as per institute policy. The outcomes studied were COVID-19 positivity by RT-PCR and its severity assessed by WHO COVID-19 severity scale. Total 486 participants were enrolled, of which 29 (6%) opted for low dose, 2 (<1%) medium dose, and none for high dose HCQ while 455 (93.6%) were in the control arm. Of the 164 participants who underwent RT-PCR, 96 (58.2%) tested positive. Out of these 96 positive cases, 79 [82.3%] were ambulatory and were managed conservatively at home. Only 17.7% participants, all from the control group, required hospitalization with the mild-moderate disease. None of the participants had severe disease, COVID-related complications, ICU stay, or death. The difference in the outcome was statistically insignificant (p value >0.05). This single-centre study demonstrated that HCQ prophylaxis in healthcare workers does not cause a significant reduction in COVID-19 as well as mitigating its severity in those infected. At present, most of the trials have not shown any benefit. Though COVID-19 vaccines have reduced the need for prophylaxis, the search for a safe and reasonable chemoprophylaxis should continue until a large population of individuals gets vaccinated, especially in underdeveloped countries.
ABSTRACT
Background: Anti IL-6 monoclonal antibody Tocilizumab has produced mixed results in clinical trials for effectiveness against COVID-19. We conducted a retrospective cohort study to compare outcomes at 28 days of a cohort of patients with severe Covid-19 treated with Tocilizumab and standard care, with those receiving standard care only. Methods In this record based retrospective cohort study, patients hospitalized with Covid-19 were classified into non-severe and severe disease as per institutional protocol. One cohort received Tocilizumab with standard care and the second cohort received only standard care. Few patients also received high dose steroids as ‘pulse’ steroids on initial clinical deterioration. Data was collected for the treatment given including oxygen interface, steroids, antimicrobials, duration of hospital stay in survivors, requirement of mechanical ventilation and day of intubation from symptom onset. Results There was statistically significant mortality in Tocilizumab cohort as compared to standard care alone (HR 2.43, 95%CI 1.54–3.89). The need for mechanical ventilation was more in Tocilizumab cohort (85% vs 18%, P-value