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

The patients were given remdesivir and steroids on both occasions, but experts say there is no evidence to back repeat use of the drugs

Three patients with low-grade 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 Covid-19 patients the second time. 

The three patients were on chemotherapy when they contracted the infection, said Dr Samrat Shah, consultant physician, Bhatia Hospital, where they received care. “They were treated with remdesivir and steroids for 40 days and 25 days. These patients came back with high-grade fever and upon testing came out Covid-19 positive again. We administered remdesivir and steroids the second time,” said Shah.

The youngest patient was a 30-year-old woman from Gujarat, while the others were senior citizens who had already received their first dose of vaccine.

“This 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 102-103,” 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. “All 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 steroids,” said Dr Shah.

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Sharad 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. “I was discharged after turning negative but once home, I got a high-grade 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 better,” said Mehta. 

Experts, 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, “The steroids should not be given for such a long time. The maximum proven benefit is up to 10 days. For a re-infection there needs to be a gap of 102 days with a negative RT-PCR in between. Remdesivir and steroids should not be used a second time. The high-grade fever may have been a result of overuse of medications.”

Agreeing with Dr Bhajan, Dr Vasant Nagvekar, an infectious disease expert at Global and Lilavati hospitals and also a member of Maharashtra’s Covid-19 task force, said, “We have seen a few patients who have got fever 4 to 6 weeks after recovering from Covid-19. 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 advisable,” said Dr Nagvekar.

Dr Gaurav Gupta, consultant Covid-19 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, “It can be a dead virus. There can be multiple reasons for fever in such cases including the inflammatory response.” 

April
Month when the trio got Covid-19 for the first time

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