Indian doctor who ran Dubai isolation centre tells of battle with Covid-19

Speaking from his hospital bed, Dr JS Rajkumar said he was struck down last week and immediately put on life-saving drugs

Dr JS Rajkumar is recovering from Covid-19 in India. The UAE resident led a team of medics in an isolation centre in Dubai’s Warsan area last year. Courtesy: Lifeline Hospital

A doctor in Dubai who tested positive for the coronavirus on a trip home to India said quick treatment and the antiviral drug remdesivir saved his life.

Dr JS Rajkumar, a general and laparoscopic surgeon, and his wife Chitrakala led a medical team who treated thousands of workers in an isolation centre in Warsan during the first wave of the pandemic last April, and he has treated Covid-19 patients in private hospitals.

He travelled to Chennai last week to to operate on his mother and other patients at Lifeline Hospital, which he founded.

On landing, Dr Rajkumar, 58, tested positive for the coronavirus, despite having received the second dose of a Sinopharm Covid-19 vaccine.

The body usually takes a month to develop antibodies to fight the virus.

Dr Rajkumar has a history of heart disease and has several stents, so doctors advised immediate hospital admission and use of aggressive medication to treat the virus.

"I thank my lucky stars I was in hospital," he told The National.

“Had I come in later and taken remdesivir 48 hours later, there is no guessing which route this would have gone.

“Early admission, instead of waiting to become low in oxygen, and starting me on early dosing of remdesivir – these were game changers.

“Also being on Indian remedies like gargling and inhalation with turmeric. I’m not giving all the credit to turmeric. But maybe it’s a combination that worked and why India’s mortality rate is among the lowest in the world.”

How effective is remdesivir?

Remdesivir was hailed as a wonder drug by former US President Donald Trump after he received an intravenous dose in May last year.

The World Health Organisation later advised doctors not to use the drug on Covid-19 patients in hospital, saying it had "no meaningful effect" on their chances of survival.

India has recorded more than 10 million infections, the second-highest in the world after the US.  A recent drop in cases and low mortality rate among patients has surprised experts.

Dr Rajkumar has watched doctors adapt treatment protocols since the start of the pandemic and said a flexible approach was key to saving lives.

“WHO has almost put a halt on remdesivir, saying there is not enough data, but in India many centres including ours quickly start patients on the antiviral without waiting for blood markers to drop,” he said.

Doctors examine proteins in the blood of infected people that act as predictive biomarkers for how sick a patient could become.

“If you look at most countries ... everyone firmly follows protocols. Whether you are in Wisconsin or New York, you will the same treatment, you will get remdesivir [only] if your blood markers fall, or you don’t get it.

In India, he said, “if doctors find some treatment is working better they jump to it. Keeping steroids on standby also worked for me.”

When to administer steroids?

Dr Rajkumar had expected to be given steroids in the first week but doctors told him they would administered in the second week, if needed.

His treatment also included the antibiotic azithromycin, anticoagulant enoxaparin, turmeric inhalation and gargling, and Immunizer, a sachet containing powdered vitamins and minerals, which is also recommended by the Indian health ministry.

Dr KP Dinakaran, the internal medicine consultant who treated Dr Rajkumar, said his patient did not require the steroid dexamethasone, which is given when immune systems go into overdrive and patients are at risk of hyper-inflammation.

“We have learnt lessons about reducing the replication of the disease, when to start an antiviral and steroids,” Dr Dinakaran said.

“In India, patients have benefited because of starting early with remdesivir and starting at the right time with steroids to stop the progression of the disease. For renal and liver patients we reduce the remdesivir dose.”

Exchanging information with other centres showed that people with co-morbid conditions such as diabetes, obesity or cancer, and some heart patients, should be placed in hospital early to avoid complications.

Liquid gold: the benefits of turmeric

Dr Rajkumar said patients and medics in India were open to using turmeric along with approved medication.

Resembling a ginger root, turmeric is known for antiviral and antioxidant properties.

In the US, the National Institutes of Health has said its health benefits are undetermined.

“The government of India has told people to gargle with turmeric. There is no hard evidence this works. Have they been subjected to multi-drug trials? No, they haven’t,” he said.

“Will it stand the scrutiny of the West, NIH or WHO? I don’t know. But this pragmatic approach, of taking the best out of all that is available, is working.”

Centres for moderately ill patients

As chairman of the medical group, Dr Rajkumar was admitted to hospital. But with the pressure on health services in most parts of the world, other patients are not as lucky.

He suggests increasing bed capacity and creating centres to treat moderately ill patients.

This will ensure regular blood tests and Cat scans to check the size of lesions in the lungs so that intervention is swift.

“The important question is: who needs hospitalisation and how soon should you start treatment?” Dr Rajkumar said.

“The need is to take in not just the critically ill but the moderately ill, to which I belong.”

He said the key was to treat people as early as possible to “avert disaster”.

Patients are usually asked to come to hospital if oxygen levels fall below 90. When he was admitted, Dr Rajkumar’s hovered at 92.

Hospitals restrict admissions so they can care for the seriously ill.

“The disease is spreading quicker with the UK and other variants, so we should get patients in earlier to middle-of-the-road centres instead of waiting until oxygen levels crash. Or people get treated a day or two later with possible bad effects,” Dr Rajkumar said.

He said that being a patient has also taught him some lessons.

“The pandemic has shown me, a pigheaded academic, that we have to think beyond the rigid discipline of trials,” he said.

“How much of all this worked, as a scientist I don’t know. As a patient, I don’t care as long as it helps.”