Mass prophylaxis of hydroxychloroquine in slums to avoid the spread of COVID-19 raises concerns

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    Concerns regarding hydroxychloroquine arose when BMC decided to use the drug as a seven-week course for mass prophylaxis for people living in the slum.
    Representative Image, Photo by Mumtahina Rahman on Pexels.com

    The COVID-19 pandemic has struck the entire world in a complete state of lockdown. This has affected millions of lives and an emerging health crisis. These countries have minimal medical facilities to treat all people infected by the disease. The lockdown protocol put forwards the need for isolation to control the spread and also practice social distancing while heading out for necessities. 

    The problem arises with the slums. It has little or no space for people to practice social distancing as slums in India are densely populated which makes people living in these slums vulnerable to the disease. 

    Concerns regarding hydroxychloroquine arose when BMC decided to use the drug as a seven-week course for mass prophylaxis for people living in the slum.
    Social distancing, Lockdown

    The state of Maharashtra has one of the most populated slums, Dharavi, which is home to 1.2 million people. The condition in this slum has only worsened with time. There is no proper sanitation facility available and the lanes are dirty with poorly ventilated houses. During the rainy season, when the entire city of Mumbai goes through tough times as the rains flood most of the areas, this slum struggles the most. High tide pushes all the garbage and human as well as animal feces to these slums from the sewage canal which makes it a breeding ground for many diseases. Many people in this slum have died due to these filthy conditions and now this slum has seen a surge in cases of COVID-19 making it a hotspot zone of the disease.

    To control the transmission, it has been sealed off by a municipal decree as stated by The Epidemic Diseases Act of 1857. But this measure might also increase the rate of transmission as the infrastructure of the slum makes it impossible to practice social distancing or isolate oneself. 

    Concerns regarding hydroxychloroquine and Chloroquine arose when Brihanmumbai Municipal Corporation (BMC) decided to use the drug as a seven-week course for mass prophylaxis for people living in the slum. The problem arises as studies suggest that this particular drug may have some side effects. There is no proper evidence regarding the risks and benefits of the drug and the decision to roll out the drug for mass prophylaxis in the slums without any convincing evidence is creating mistrust among the public. 

    However, the steps taken by the BMC to control the spread are commendable but the most important thing is to present the solution with convincing evidence that it would be not risky and then opt for it after monitoring people who would take it to avoid casualties. 

    The FDA has issued a caution against the use of hydroxychloroquine and Chloroquine for treating COVID-19 as it may have adverse effects and can be harmful to patients suffering from kidney and heart diseases. The drug may have adverse effects like cardiovascular and dermatologic effects, gastrointestinal disorders, hepatic impairment, renal impairment, etc so it should only be rolled out after rigorous monitoring and with strong evidence.

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