This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research Article
Immaculee Mukankubito
WHO Regional Office for Africa
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: As of May 2021 no ethiotropic treatment for COVID-19 demonstrated safety and efficacy. A number of clinical trials are underway to investigate candidate products, most of them are repurposed products. As new evidenced emerges, WHO updates its recommendations on clinical management to support Member States amending their treatment protocols.
Hydroxychloroquine / Chloroquine (HCQ/CQ) and Lopinavir + Ritonavir arms of the Solidarity Trial were discontinued. There is strong recommendation against administrating these products to COVID-19 patients. In contrary, Corticosteroids were identified as lifesaving medicines, substantially reducing mortality for critically ill patients. This study aimed at checking the alignment of countries’ COVID-19 treatment protocols in the WHO African region with the WHO recommendations, and analyze their impact on supply chain and quality of care.
Methods: In October-November 2020, country treatment protocols were collected, and data on therapeutics were summarized in an Excel Sheet to facilitate their comparison with the WHO recommendations.
Results: From the thirty protocols collected, 50% were recommending HCQ/CQ for mild COVID-19. The proportion was quite similar for moderate and severe cases accounting 57% and 53 % of protocols respectively, while 27% were still recommending HCQ/CQ for critically ill patients. Antibiotics were recommended in 53% and 80 % of protocols for mild and moderate cases respectively. Only 47 % and 60% of protocols were recommending corticosteroids for severe and critical cases respectively. Convalescent Plasma was reflected in few protocols.
Discussion: HCQ and CQ were the standard treatment of COVID-19 in most of countries, diverting resources from the supply chain for essential services. There is a serious risk of antibiotic misuse, which can potentially lead to antimicrobial resistance surge, the increased rates of morbidity, mortality, treatment costs and financial burden for patients and communities. Slow uptake of corticosteroids may compromise the quality of care for severe and critical cases.
Conclusions: The COVID-19 pandemic has demonstrated that, in cases similar to COVID-19 without efficacious treatment, treatment protocols are handled as living documents to be timely amended. Proactive update of country protocols to reflect evolving scientific evidences is critical, to ensure that all patients benefit from high standard quality of care.
Keywords
Africa, COVID-19, Treatment, Guidelines, Protocols, Therapeutics, AMR
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No competing interests reported.
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research Article
Immaculee Mukankubito
WHO Regional Office for Africa
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 14 May, 2021
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: As of May 2021 no ethiotropic treatment for COVID-19 demonstrated safety and efficacy. A number of clinical trials are underway to investigate candidate products, most of them are repurposed products. As new evidenced emerges, WHO updates its recommendations on clinical management to support Member States amending their treatment protocols.
Hydroxychloroquine / Chloroquine (HCQ/CQ) and Lopinavir + Ritonavir arms of the Solidarity Trial were discontinued. There is strong recommendation against administrating these products to COVID-19 patients. In contrary, Corticosteroids were identified as lifesaving medicines, substantially reducing mortality for critically ill patients. This study aimed at checking the alignment of countries’ COVID-19 treatment protocols in the WHO African region with the WHO recommendations, and analyze their impact on supply chain and quality of care.
Methods: In October-November 2020, country treatment protocols were collected, and data on therapeutics were summarized in an Excel Sheet to facilitate their comparison with the WHO recommendations.
Results: From the thirty protocols collected, 50% were recommending HCQ/CQ for mild COVID-19. The proportion was quite similar for moderate and severe cases accounting 57% and 53 % of protocols respectively, while 27% were still recommending HCQ/CQ for critically ill patients. Antibiotics were recommended in 53% and 80 % of protocols for mild and moderate cases respectively. Only 47 % and 60% of protocols were recommending corticosteroids for severe and critical cases respectively. Convalescent Plasma was reflected in few protocols.
Discussion: HCQ and CQ were the standard treatment of COVID-19 in most of countries, diverting resources from the supply chain for essential services. There is a serious risk of antibiotic misuse, which can potentially lead to antimicrobial resistance surge, the increased rates of morbidity, mortality, treatment costs and financial burden for patients and communities. Slow uptake of corticosteroids may compromise the quality of care for severe and critical cases.
Conclusions: The COVID-19 pandemic has demonstrated that, in cases similar to COVID-19 without efficacious treatment, treatment protocols are handled as living documents to be timely amended. Proactive update of country protocols to reflect evolving scientific evidences is critical, to ensure that all patients benefit from high standard quality of care.
Figure 1
Figure 2
Figure 3
Figure 4
No competing interests reported.
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