Mallik Questions Reply
Mallik Questions Reply
Mallik Questions Reply
PART 1
1. Can you tell in detail how masks , sanitization and social distancing exactly
work?
A) Reduces risk of transmission by over 90-95% when all the above mentioned
things are followed in combination.
4. Are you following DGHS, IMA , ICMR , AIIMS and WHO guidelines,or are you
following your own? If so please detail and explain your guidelines
A) ICMR, kindly refer to the official website for details, its publicly available.
5. Antibiotics are prescribed to treat only bacterial infections, Then why are you
prescribing them for covid,which is a virus.
A) Not all patients require antibiotics. Kindly refer to your treating doctor if for a
particular patient. When prescribed, it is to treat superadded bacterial infection.
10. What have you studied about the drug induced thrombocytopenia (low
platelet count) ?
A) Wish I had scrolled down a bit earlier. Already answered above. I could write a
20 page essay on “What I have studied”, but its just going to waste my time and
not benefit anyone. Honestly, I have better things to do.
12. What are you prescribing to increase platelet production to control internal
bleeding due to low platelet count ?
A) Not everyone with decreased platelets(mild-moderate) is likely to bleed
internally. In severe thrombocytopenia, platelet infusion is considered on a case-
to-case basis.
14. Please tell us about the relation between RTPCR Ct value (viral load) and
disease severity ?
A) The is no established correlation between Ct values and disease severity.
15. Why are you not prescribing any replication inhibitors to control the virus load
in home isolation( first week of infection) ?
A) There is no approved replication inhibitor to be prescribed in the first week of
infection.
17. Why are you prescribing emergency approval drug to a home isolation
patient?
A) Question needs elaboration.
18. Why is Favipiravir still being continued, Why do you feel it’s Emergency
approval still continues?
A) Favipiravir though initially considered in mild-moderate cases to reduce the
duration of illness, is no longer recommended in Indian guidelines.
19. Despite the former japan prime minister’s hype in may 2020 why did the
japan regulatory still not approve Favipiravir ?
A) I’m not really sure what Japan is upto.
20. Why is Favipiravir approved in india and why is this emergency approved
drug still being sold in medical shops ?
A) Addressed in Question 18. Studies have conflicting results with no definite
result. Needs a government medical authority/pharmaceuticals to address this.
22. Why are you still prescribing favipiravir even after ICMR and DGHS removed
it from protocol ?
A) Me? No, I’m not. Please refer answer to Q18.
23. While giving plasma therapy are you matching patient and donor blood group
only or patient and donor variant also ? Please give reasons
A) Convalescent plasma therapy in no longer recommended for Covid 19.
24. Can you explain how without matching the variant how is plasma therapy
going to help the patient?
A) Please refer answer to above question.
26. What is the protocol you follow to identify and match the variant ?
A) Current medical infrastructure in India doesn’t allow for genomic sequencing
of samples to identify the variant for each patient. Government medical body to
address the issue better.
28. Are you monitoring AST / ALT after administering remdesvir on a daily
basis ?
A) Depending on patient condition, monitored anywhere between 24 hours to 72
hours.
29. What is the upper limit to discontinue the remdesivir if there is an abnormal
rise in AST and ALT?
A) We take it as 5 times the upper limit of normal for safety purposes.
34. Are you not monitoring neutrophils to lymphocytes ratio (NLR) at the time of
steroid treatment ?
A) NLR is monitored not only at the time of steroid treatment, but also at the time
of admission of patient to assess severity and risk of disease progression.
36. How will you control spike in neutrophils after giving steroids?
A) Refer to answers above. The proinflammatory state of covid likely causes
Cytokine release syndrome/NETosis. Steroids are given for their anti-
inflammatory role.
37. Since Lymphocytes are the main defence in covid battle , if steroids are
reducing the lymphocytes then how will the patient’s immuno defend against the
virus ?
A) Hence, timing and duration is important. Do not self-prescribe. Steroids are
reserved for moderate to severe cases, to protect from host inflammatory
response.
To put it in your terms, some patients in their battle, enter a stage where their
“main defence” does more harm to the kingdom than the virus you are fighting
against. Steroids are given with the intention to help you recover from that
damage caused by your own immunity.
38. Does glucocorticoid (steroid) affect B cell antibody production are not ?
A) Not all steroids are glucocorticoids, but yes, glucocorticoids have
immunosuppressive activity.
39. If Glucocorticoid(steroid) spikes glucose level, then why is glucocorticoid
being prescribed to a diabetic patinent ? is there any alternative ?
A) The purpose of using steroids has been answered above. That host
inflammatory response for a diabetic patient and the role of glucocorticoids in
diabetics remains the same. Such patients are advised admission to a hospital,
regular blood sugar level monitoring and insulin as required if uncontrolled.
40. Isn’t steroid treatment the root cause of different fungal infections ?
A) Fungal infections in patients who previously were treated for Covid are being
increasingly observed in those who have received steroids for a particularly long
time, and also had Diabetes. But a short course of steroids is still indicated in
patients who are oxygen dependent and show evidence of inflammation. The
best practice would be to control the blood sugar levels along with following
hygiene.
42. Why are allopathic doctors reluctant in integrating allopathic and herbal
medicine ?
A) I cannot speak for everyone. Herbal medicine is not without side effects, we
have seen patients land up in fulminant hepatic failure. No one would be against
anything/reluctant if there are enough properly conducted studies on such
alternative forms of medicine, their efficacy, side effects and complications.
43. Why are so many allopathic doctors reluctant to replace ambroxol with
bromhexine syrup?
A) Because, currently there is no evidence to support that bromhexine has any
prophylactic or therapeutic benefit.And public aren’t guinea pigs to test out our theories on. Weird, right?
44. Why are doctors reluctant to replace low dose steroid with GOUTNILL?
A) Colchicine was studied for its possible benefit in patients with Covid 19.
Studies so far have failed to show significant benefit, where as steroids have
been effective.
45. Are you aware of the press release on February 4th 2021 by ivermectin
manufacturer MERCK ?
A) Yes.
46.Do you or not anticipate that third wave may hit India ?
A) Would be better answered by an epidemiologist.
47.Which variant would trigger and will be the dominant variant during third
wave?
A) It is too early to tell which variant, when the 2nd wave hasn’t ended. Better
answered by an epidemiologist.
48.There is an anticipation that third wave may affect kids on a large scale, what
is your opinion on this?
A) Third wave, if & when occurs, can affect anybody. Vulnerable groups, those
not vaccinated or those not previously affected by the disease are likely to be
affected the most.
49.What are the major factors that will make kids more vulnerable in third wave ?
Can you tell us about your supporting studies regarding this ?
A) Kindly refer to the answer above.
50.Do you think it is their ignorance that so many different countries are
panicking about delta plus variant ?
A) Would be better answered by an epidemiologist/government body.
51.Can you tell us the mutations in delta plus variant, and what the clinical
significance of those mutations are?
A) Delta plus variant has K417N mutation in its spike protein, hypothesized to
contribute to its immune escape.
52.Have you studied any autopsy report of a delta variant patient ? what are your
findings ?
A) Honestly, no. Autopsy reports are not made available to us as far as I know.
54.Is delta plus variant reporting or not low RTPCR Ct value ( high viral load) ?
A) I’m unsure of any such thing, we are currently not giving emphasis to ct values
for treatment. Also, the variant reporting/genomic sequencing is inadequate to
establish a correlation.
56.What replication inhibitors are recommended to manage viral load in kids and
adults?
A) Treatment with replication inhibitors or any drug for that matter is currently
based on clinical severity of the disease and not on viral load. Viral load does not
correspond to disease severity.
57.Are steroids recommended for delta plus variant which consist of P681R
mutation causing lympho elimination?
A) Already answered in two of the questions above and also in the question
about when steroids are indicated.