Independen --- Sigit Purwanto was nervous after the result of a test swab he took came back and showed that he positive with the Coronavirus. It was mid-July when he and 46 other medical workers, nurses of the Pundong subdistrict Community Health Center (Puskesmas) in Bantul, Yogyakarta, took a swab test. As front-liners, they are in frequent contact with patients and, therefore, at risk of being exposed to the virus. Purwanto, however, was the only one who tested positive for Covid-19.
Purwanto had shown no symptoms such as cough and runny nose. He was then placed in an isolation room in a special ward at the Panembahan Senopati Regional State Hospital (RSUD), Bantul. "My wife was stressed and cried. [Despite] fearing [for myself], I tried hard to calm down," said Purwanto, Tuesday, August 11.
The 43-year old male received special treatment from a pulmonologist and heart specialist because of having a heart disorder arrhythmia. Doctors also declared that they found an infection in Purwanto’s lungs.
With his history of arrhythmia, doctors did not prescribe Purwanto with Chloroquine, a medicine that has been used as one of the experimental drugs to treat Covid-19 before a vaccine or a working antiviral medication is available. The problem is that chloroquine can cause serious heart-related side effects.
The American Food and Drug Authority or FDA had revoked permission for the emergency use of chloroquine to treat Covid patients on June 15. They viewed that the drug does not cure patients who are infected with Coronavirus.
Brazilian health authorities have also discontinued the use of the drug after several patients suffered potentially fatal heart complications. Some patients who were administered with a high dose of chloroquine suffered from irregular heartbeats.
Ten days into his self-isolation in the hospital, Purwanto had continuedly consumed Vitamin c, antivirals, and antibiotics. He also received a constant supply of fruit from his family. He ate nutritious food, drink milk regularly, and mung beans.
Besides that, he had decided to stop watching the television or listening to worrying and depressing news about the Corona pandemic. Instead, Purwanto regularly exercised to stretch his muscles and drove his boredom away by doing video calls with his family and best friend.
Finally, on July 26, Purwanto’s condition improved. He took another swab test on July 20 and 22 and was declared free from the virus. His advice for other recovering Covid-19 patients was: "Positive thinking is an effective therapy."
Siti Mulyani, a nurse at Kasihan Puskesmas, Bantul, was also not being treated with chloroquine while undergoing isolation with dozens of other patients at Covid-19 Special Field Hospital in Bambanglipuro, Bantul. The 46-year old female had a history of asthma.
Mulyani routinely consumed Vitamin C, B complex, honey, and eat food rich in protein and calory. She believed that keeping her hopes high in the middle of the pandemic fear was part of her healing therapy. "Think positively to maintain body immunity," she said.
In the shelter where she self-isolates, Mulyani rested orderly and obeyed all doctor’s advice. On July 30, her condition improved, and the doctor declared her negative after taking a swab test.
The mother of three said that she was upset when she found out that her swab test had come out positive. Siti was sobbing when she called her husband and told him the news. But she tried to overcome her fears slowly.
Despite the side effects, pulmonologists in many referral hospitals in Yogyakarta still used chloroquine for treating Covid-19. One of the hospitals was Dr. Sardjito State General Hospital (RSUP). Head of the hospital’s Airborne Disease Team, Ika Trisnawati, confirmed that the hospital was still using chloroquine for Covid-19 patients.
An expert review published on https://www.preprints.org/manuscript/202005.0190/v1 found that one out of 200 patients administered with the hydroxychloroquine and azithromycin for 24 hours suffered from an atrioventricular block. It is a kind of arrhythmia that occurs because of interference or blockage in part or the whole of electrical impulse conduction from the heart atrium toward the ventricles.
One of the cases was an Indonesian adult male with suspected Covid-19 pneumonia. “One case in 200 patients with hydroxychloroquine,” said Trisnawati.
Hydroxychloroquine is widely accepted in mild and moderate Covid-19 pneumonia. RSUP dr. Sardjito Pulmonologist Munawar Gani said that chloroquine was included in the list of drugs used by the Covid-19 Medical Expert Response Team. In addition to chloroquine, the guidelines that were drawn up by the team of experts include antibiotics, high dosage of Vitamin C, and other drugs according to the patient’s comorbid diseases.
The team consisted of the Indonesian Pulmonologist Association, Indonesian Internists Association, Indonesian Pediatricians Association, Indonesian Anesthesiologists and Intensive Therapy Association, and Indonesian Cardiovascular Specialists Association. “The trial for chloroquine was already stopped, but the five organizations still recommend it,” said Gani.
Tempo magazine reported that the World Health Organization (WHO) had announced the termination of the Solidarity Trial for hydroxychloroquine. The Organization viewed that the drug was not beneficial for treating Covid-19 patients. The joint clinical trials were carried out by more than 400 hospitals in 35 countries. One of WHO’s underlying decision was an Oxford University research that was published on June 5.
The research showed that hydroxychloroquine does not reduce the risk of death. As many as 26 percent of patients who had been administered with the drug died. In comparison, patients who had been treated with other medications had a fatality rate of 24 percent.
Secretary to Yogyakarta Health Office Siti Badriyah said that her Office had distributed 10,000 chloroquine pills from the Health Ministry since April. The chloroquine distribution, according to Badriyah, was done according to demands from referral hospitals. “[But] as time goes by, there are no more requests,” said Badriyah.
Pharmacy Professor at Yogyakarta’s Gadjah Mada University (UGM) Zullies Ikawati said that the administration of chloroquine is not effective for Covid-19 patients. Clinical evidence of chloroquine's effectiveness varied, and its significance for treating Covid-19 patients was never proven. An observational study in Indonesia has not shown any official report and clinical research that the administration of chloroquine shortens the treatment of Covid-19 patients in hospitals.
The side effects of this hard drug include arrhythmias, such as the prolongation of the QT interval (seen in electrocardiogram or EKG) and tachycardia. “It is not recommended for patients with a history of arrhythmia,” said Ikawati.
Long-term use can lead to vision problems. Other side effects are nausea, vomiting, and diarrhea. According to Ikawati, some hospitals in Indonesia had reduced the administration of this drug.
For treatment in Covid-19 patients, the drug was administered twice a day in 500-milligram dosages for 5-7 days. Most hospitals prefer to use cough medicines and analgesics. “It’s better to increase the immune system than chloroquine, which is not very effective,” she said.
Ikawati found that many patients in Wisma Atlet Emergency Hospital did not get much relief from taking chloroquine for up to 14 days into their quarantine periods. Together with the Indonesian Institute of Sciences (LIPI), Ikawati analyzed the clinical test for herbal immunomodulator candidates in treating Covid-19 in the hospital.
Temporary data showed there is no increase in the risk of death compared to other Covid-19 standard treatments issued by the Indonesian Food and Drugs Agency (BPOM). So far, there are no reports of sudden deaths caused by chloroquine or hydroxychloroquine in Indonesia.
In the meantime, President Joko “Jokowi” Widodo has purchased Chloroquine, the influenza drug developed by Toyama Chemical Japan. He had imported 3 million chloroquine pills when WHO had yet issued any drug recommendation for Covid-19 treatment. WHO is still trying to find the best drug to treat the disease.
On the other hand, the Indonesian government instead used hydroxychloroquine, a derivative of Chloroquine, for clinical trials of three combination drugs for Covid-19 through Airlangga University in Surabaya, East Java. UGM’s Pharmacy Professor Ikawati said there is no data in Indonesia on the drug combination, and therefore, such trial was justified.
To date, the guidance for Covid-19 therapy still includes the drug, but it is a doctor’s prerogative in the administration. “Whether to use it or not, is based on each clinician or doctor’s belief,” said Ikawati.
(Author by Shinta Maharani/D02)
