COVID-19 Treatment Protocols in the WHO African Region - Results of a Survey

Abstract

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.

Need for standardization and compliance to treatment protocols for COVID-19 within the African Region of the World Health Organization

“…Six months into WHO guideline for clinical management of COVID-19, an assessment of quality of care was made within WHO AFRO, by conducting comparison of country treatment protocol to the WHO recommendations in 30 of the 47 member states of the region (7). More than half of the 30 countries were recommended HCQ/CQ combinations for major categories of COVID-19 cases (mild, moderate and severe), and a third recommended same drug combination for critical cases (7). Conversely, the protocols from the countries showed convalescent plasma was least recommended for critical and severe cases of COVID-19 (7).…”

“…More than half of the 30 countries were recommended HCQ/CQ combinations for major categories of COVID-19 cases (mild, moderate and severe), and a third recommended same drug combination for critical cases (7). Conversely, the protocols from the countries showed convalescent plasma was least recommended for critical and severe cases of COVID-19 (7). One-sixth of the countries recommended the use of lopinavir/ritonavir to replace HCQ/CQ combinations in case of allergy and a quarter of the countries recommended remdesivir for severe and critical diseases.…”

“…One-sixth of the countries recommended the use of lopinavir/ritonavir to replace HCQ/CQ combinations in case of allergy and a quarter of the countries recommended remdesivir for severe and critical diseases. Corticosteroid use was only for severe and critical cases in about a half of the countries while the use of interferon alfa-2 beta was only for mild and moderate cases in less than onetenth of the countries (7).…”

“…The review of the protocols further showed that against the recommendations of WHO guideline, 53% and 80% of the protocols recommended antibiotics for mild and moderate COVID-19 respectively (7). This has grave consequences for the epidemic of AMR, as overuse and misuse of antimicrobials constitute the largest drivers of AMR.…”