Should Uttar Pradesh be an Example to the World?

Here is a Tweet I just wrote, which seems to get some attention.

“Uttar Pradesh population: 231 million inhabitants; C19 active cases: 134! Guys, this is 0.000058% of the population! Could the world please replicate the Uttar Pradesh approach? (note: fully jabbed: approx 20%)”

Isn’t it amazing that it’s possible to enunciate a very plausible solution to the C19 crisis in a tweet that is less than 280 characters?

Note that the content of the linked article is of little interest, except for the mention of the 134 active cases.

Interestingly, someone mentioned the name of the drug Ivermectin in a comment on the Tweet. This prompted not only for that comment not to be sharable but also invited readers to the official WHO position, against hydroxychloroquine and ivermectin (both used in India) and with a qualified endorsement of remdesivir (also used in India, in hospital settings), even if the official position of the WHO regarding that drug is a recommendation against.

WHO recommends against the use of remdesivir in COVID-19 patients
20 November 2020

WHO has issued a conditional recommendation against the use of remdesivir in hospitalized patients, regardless of disease severity, as there is currently no evidence that remdesivir improves survival and other outcomes in these patients.

This recommendation, released on 20 November, is part of a living guideline on clinical care for COVID-19. It was developed by an international guideline development group, which includes 28 clinical care experts, 4 patient-partners and one ethicist.

The guidelines were developed in collaboration with the non-profit Magic Evidence Ecosystem Foundation (MAGIC), which provided methodologic support. The guidelines are an innovation, matching scientific standards with the speed required to respond to an ongoing pandemic.

Work on this began on 15 October when the WHO Solidarity Trial published its interim results. Data reviewed by the panel included results from this trial, as well as 3 other randomized controlled trials. In all, data from over 7000 patients across the 4 trials were considered.

The evidence suggested no important effect on mortality, need for mechanical ventilation, time to clinical improvement, and other patient-important outcomes.

The guideline development group recognized that more research is needed, especially to provide higher certainty of evidence for specific groups of patients. They supported continued enrollment in trials evaluating remdesivir.

Updated 20 November 2020

  • A conditional recommendation is issued when the evidence around the benefits and risks of an intervention are less certain. In this case, there is a conditional recommendation against the use of remdesivir. This means that there isn’t enough evidence to support its use.