Low-value medical care in the pandemic-is this what the doctor ordered?

The humanitarian crisis India faces in the second wave of COVID-19—the rapid surge of cases, the collapsing health system, and the death and despair—are being documented in real time. However, the large-scale practice of low-to-minimal value care and its consequences have escaped notice.

A majority of those with COVID-19 disease have mild-to-moderate symptoms and are managed by qualified doctors out of hospital. A typical prescription for COVID-19 in India includes azithromycin, doxycycline, ivermectin, hydroxychloroquine, vitamin C, vitamin D, zinc, acetylcysteine, and inhaled budesonide or dexamethasone. The antiviral favipiravir became the top selling drug in India in April, 2021 despite not being recommended for COVID-19 by any major guidelines. Anticoagulants such as rivaroxaban are prescribed in outpatient settings, even for patients without increased thrombotic risk, against the recommendations of most international expert panels. Broad-spectrum antibiotics are added under the pretext of treating secondary infections.

In India, a battery of diagnostic tests is also being conducted for patients with COVID-19—blood counts, blood sugar, kidney and liver function tests, D-dimer, interleukin-6, procalcitonin, C-reactive protein, ferritin, and lactate dehydrogenase. Diagnostic laboratories are offering COVID-19 test packages.

Read the full article by Dr Soumyadeep Bhaumik and colleagues in The Lancet Global Health (Open Access)

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