How should we balance the need for speed with our duty towards care and rigor? In the first days of the pandemic doctors who were faced with patients sick and dying from an unknown disease turned by necessity to existing drugs, those known to work against viral illness or to be potentially beneficial in multiorgan inflammatory disease. The list of these “repurposed” drugs is long, many with honorable records of safety and effectiveness in other conditions.

Almost all have fallen under scientific scrutiny. The Recovery trial, so impressively established in the very first days of the pandemic,1 has given us one remarkable positive finding: that a cheap and widely available drug, dexamethasone, reduces mortality in critically ill patients.2 Apart from this, and some emerging evidence of benefit from monoclonal antibodies, trials have almost all given existing drugs the thumbs down.34

In response to the science, most countries have seen these drugs falling out of use for covid-19.5 But not so in India. As the country suffers a terrible second wave,678 patients with mild covid are receiving a “cocktail of multiple ineffective drugs and unneeded investigations” at great cost and unnecessary harm, say Akshay Baheti and colleagues, while those with moderate or severe covid struggle to procure indicated drugs and oxygen, even on the black market…Readmore