Transforming COVID-19 Treatment in Rural India: The Story of Dr. Sachin Balkunde and the Killari Protocol
Published : Mar 17, 2024

Dr. Sachin Balkunde
Dr. Sachin Balkunde developed the Killari Protocol to provide effective and accessible treatment options for COVID-19 patients in rural India, where healthcare resources are often limited. He is a medical officer in the public health department of Rural Government Hospital in Killari, District-Latur, Maharashtra, INDIA. He completed his MBBS and DCH from Lokmanya Tilak Medical College, Sion, Mumbai. He obtained a DNB in pediatrics in 2010 from Hyderabad. He received numerous accolades for his work during the COVID-19 pandemic, including the World's Greatest Deeds by the World's Greatest Records team. His observation study of Killari COVID protocol has been published.

Can You Tell us More About this Recognition and What Inspired Your Groundbreaking Approach to Treating COVID-19?

I joined this center in 2019 as a medical officer. It was devastated by an earthquake in 1993, impacting thousands of people. It is considered the deadliest earthquake in the stable continental crust in recorded history. The World Health Organization (WHO) officially proclaimed the COVID-19 pandemic on March 11, 2020. To prevent the virus from spreading further, the Indian government enforced a statewide shutdown. The lockdown included numerous stages, beginning on March 25, 2020, and continuing with the following unlock phases; however, we saw patients with COVID-19 long before the pandemic was declared. We saw the patients who visited with ...Read More

I joined this center in 2019 as a medical officer. It was devastated by an earthquake in 1993, impacting thousands of people. It is considered the deadliest earthquake in the stable continental crust in recorded history. The World Health Organization (WHO) officially proclaimed the COVID-19 pandemic on March 11, 2020. To prevent the virus from spreading further, the Indian government enforced a statewide shutdown. The lockdown included numerous stages, beginning on March 25, 2020, and continuing with the following unlock phases; however, we saw patients with COVID-19 long before the pandemic was declared. We saw the patients who visited with unknown origin of fever, generalized malaise, non-responding cough, etc., and we could guess something different was happening. Since we operate in a distant and rural area of India, the physicians there, including myself and my team, are under some obligation to provide the best possible care for their patients, especially in the absence of significant facilities. Our resources were relatively few. However, I used to examine a patient thoroughly and decided to apply my knowledge. I tried a few combinations of drugs initially, and there were no guidelines or even any diagnostic tests available. We developed the Killari Covid protocol out of necessity. According to a very famous proverb, necessity is the mother of invention. We worked in a rural hospital with limited resources and needed to find an effective and affordable way to treat COVID-19 patients. We started by examining patients thoroughly and observing their symptoms. Based on my observations, I concluded that COVID-19 should not be treated as adult respiratory distress syndrome (ARDS) but rather as hyaline membrane disease (HMD) of the newborn. HMD affects the type 2 alveoli of the lung parenchyma. This led us to use low-flow oxygen and prone positioning, which are common treatments for HMD in newborns. Thus, the consideration of the pathogenesis of SARS-COVID 2 proved to be very significant for us.

 

At first, hydroxychloroquine was recommended; however, a study that said that hydroxychloroquine should be taken carefully and is not very effective was released a short while later. Then I thought of adding artesunate to achieve a synergistic effect.  Injectable artesunate is another antimalarial medication that I considered using with hydroxychloroquine.  When I used this combination with a few additional regimens, I saw some encouraging improvements, including a substantial decrease in fever, malaise, body aches, and other main COVID-19 symptoms. These drugs were readily available at the government hospital in the rural area. I added deriphyllin to this combination for spasmodic and non-responding cough. For moderate to severe cases, we used injectable deriphyllin. And we then thought of adding prednisolone or dexamethasone for inflammation. After that, we added vitamin C to this regimen. Thus, the Killari protocol was developed. The situation was challenging as we had no CT scan available, and the RT-PCR came after some time. However, our protocol stayed the same, showing outstanding results and better outcomes. After discharge, patients were provided counseling and encouraged to follow healthy lifestyles, including yoga and pranayama. We recognized the challenges faced by patients in their region who needed help accessing costly drugs, such as remdesivir and tocilizumab, used in urban centers. The overall cost was one-tenth of the standard treatment that included remdesivir. Thus, our protocol showed excellent recovery rates and reduced the need for costly injections and invasive ventilation.

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Please Provide an Overview of the Killari COVID-19 Treatment Protocol and its Primary Components.

The Killari COVID-19 treatment protocol is a holistic approach developed by medical professionals in the rural Indian town of Killari to manage COVID-19 cases. The protocol primarily utilizes the following components: The following medications were used to treat COVID-19 and improve the patient’s condition: Injection artesunate is an antimalarial drug that has shown the potential to inhibit the replication of several intracellular microorganisms, including coronaviruses. Artesunate helped cure COVID-19 infections by altering the pH of the cells’ endosomes, thereby inhibiting the virus’s progression to severe COVID-19. Tablet hydroxychloroquine, another antimalarial drug, has been used to treat COVID-19 due to its potential antiviral and anti-inflammatory ...Read More

The Killari COVID-19 treatment protocol is a holistic approach developed by medical professionals in the rural Indian town of Killari to manage COVID-19 cases. The protocol primarily utilizes the following components:

The following medications were used to treat COVID-19 and improve the patient’s condition:

  • Injection artesunate is an antimalarial drug that has shown the potential to inhibit the replication of several intracellular microorganisms, including coronaviruses. Artesunate helped cure COVID-19 infections by altering the pH of the cells’ endosomes, thereby inhibiting the virus’s progression to severe COVID-19.
  • Tablet hydroxychloroquine, another antimalarial drug, has been used to treat COVID-19 due to its potential antiviral and anti-inflammatory properties.
  • Tablet vitamin C is a nutrient that supports the immune system and has antioxidant properties.
  • Injection enoxaparin (LMWH) is a blood thinner used to prevent blood clots.
  • Injection cefotaxime or injection of amoxicillin + clavulanic acid, antibiotics used to treat bacterial infections.
  • Injection deriphyllin, a bronchodilator used to alleviate respiratory distress.

 

These medications and fluids were used to reduce inflammation and improve oxygenation. The Killari Covid protocol effectively reduces mortality and improves recovery rates in rural India. It is a low-cost, easy-to-implement protocol that can be used in resource-limited settings. The protocol involves administering these medications in specific dosages and combinations depending on the severity of the patient’s condition. It aims to control viral replication, reduce inflammation, prevent complications, and support the patient’s immune system.

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What Were the Challenges You Faced While Developing this Protocol? And How Did You Overcome Them?

The main challenge faced during the protocol’s creation was the need for robust scientific evidence on the effectiveness of the individual drugs and their combination in treating COVID-19. We relied on their clinical experience and a review of existing literature to select the protocol’s components. We also conducted a small-scale pilot study to assess the protocol’s safety and efficacy before implementing it on a larger scale. In the beginning, there were no guidelines or diagnostic tests available. The government released a diagnostic test, RT-PCR, soon after. However, as we were treating each patient symptomatically, the diagnostic test did not show ...Read More

The main challenge faced during the protocol’s creation was the need for robust scientific evidence on the effectiveness of the individual drugs and their combination in treating COVID-19. We relied on their clinical experience and a review of existing literature to select the protocol’s components. We also conducted a small-scale pilot study to assess the protocol’s safety and efficacy before implementing it on a larger scale. In the beginning, there were no guidelines or diagnostic tests available. The government released a diagnostic test, RT-PCR, soon after. However, as we were treating each patient symptomatically, the diagnostic test did not show to be particularly helpful for us. Since we lacked a CT scan machine, we had to rely on X-rays instead. Most of the time, the patient’s x-ray diagnosed with COVID-19 showed prominent bronchiovascular markings and haziness. In contrast to a patient with a lower CT score, we found that the patient treated with the Killari treatment recovered soon despite a comparatively higher CT score. Instead of relying on the CT score, we relied on the clinical score we developed to classify mild, moderate, and severe cases.

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Your Study Reports Remarkable Success With the Killari Protocol. What do You Attribute this Success to, and Were any Particular Cases that Stood Out to You?

The remarkable success of the Killari protocol is attributed to its unique combination of drugs and its focus on early intervention. For me, patient categorization was equally important for patient management. We treated almost 800 patients in total. During the first wave, we treated 400 patients, out of which more than 200 cases were moderately severe. We planned our treatment according to this categorization: mild, moderate, and severe cases. We took care that a moderate case should not progress to a severe case. The categorization was based on Oxygen saturation, breathing rate, fever grade, etc. For an example, Mild COVID: Patients ...Read More

The remarkable success of the Killari protocol is attributed to its unique combination of drugs and its focus on early intervention. For me, patient categorization was equally important for patient management. We treated almost 800 patients in total. During the first wave, we treated 400 patients, out of which more than 200 cases were moderately severe. We planned our treatment according to this categorization: mild, moderate, and severe cases. We took care that a moderate case should not progress to a severe case. The categorization was based on Oxygen saturation, breathing rate, fever grade, etc. For an example,

  • Mild COVID: Patients with any three of the following symptoms: respiratory rate 14 – 17/min, spO2 > 94% on room air, fever > 100 F⁰, acute breathlessness, hypotension – Blood Pressure < 120/80 mm Hg, or giddiness.
  • Moderate COVID: Patients with either respiratory rate > 24/min OR spO2 – 90 – 93% on room air.
  • Severe COVID: Patients with either respiratory rate > 30/min OR spO2 < 90% at room air.

The treatment varied based on this classification as mentioned below: –

  • Mild COVID-19:
    Artesunate injection: 120 mg loading dose followed by four 60 mg doses over four days,
    Hydroxychloroquine: 400 mg loading dose followed by 200 mg daily for 7 days,
    Vitamin C: 40 mg once daily for 10 days,
    Dexamethasone: Low-dose for 5-7 days,
    Enoxaparin: 0.5 mg/kg subcutaneously twice daily,
    Azithromycin: 500 mg once daily for 3 days,
    Deriphyllin: 150 mg twice daily for 7-10 days to alleviate impending hypoxia.
  • Moderate COVID-19:
    A similar medication regimen that is used for a mild disease, but with increased steroid dosage (methylprednisolone) and earlier use of enoxaparin,
    Methylprednisolone: 2 mg/kg IV for 5-10 days,
    Ecosprin: 150 mg tablet initially, later switched to Enoxaparin,
    Low-flow oxygen at 2 liters/minute for hypoxia.
    Prone position.
  • Severe COVID-19:
    Similar initial medication as mild and moderate, with higher steroid dosage (methylprednisolone) and use of meropenem if symptoms persist,
    Deriphylline: 5 mg/kg IV for 7-10 days with heart rate monitoring,
    Strict low-flow oxygen at 2-4 liters/minute.

 

In all cases, careful monitoring and adjustment of treatment was necessary based on the patient’s response and evolving condition.

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How Did You Prevent Fatalities Among Your Patients When no Vaccine Was Available?

We were able to prevent fatalities among our patients during a time when there was no vaccine available by implementing the Killari COVID-19 treatment protocol. Early intervention is crucial for the protocol’s effectiveness, as it helps prevent the disease’s progression to more severe stages. The death rate in developed nations was around 3%, and in Maharashtra, it was 2.8%. In the Latur district, it was 2.8%, but in my center, it was 0.8%. The use of rational drugs holds equal importance. In our study of 110 patients, only one patient died, resulting in a death rate of less than 1%. ...Read More

We were able to prevent fatalities among our patients during a time when there was no vaccine available by implementing the Killari COVID-19 treatment protocol. Early intervention is crucial for the protocol’s effectiveness, as it helps prevent the disease’s progression to more severe stages. The death rate in developed nations was around 3%, and in Maharashtra, it was 2.8%. In the Latur district, it was 2.8%, but in my center, it was 0.8%. The use of rational drugs holds equal importance. In our study of 110 patients, only one patient died, resulting in a death rate of less than 1%. The patient who died was over 60 years old and had uncontrolled diabetes mellitus, which are both risk factors for severe COVID-19. The referral was significantly less. Recovery was good. Most patients with comorbidities such as diabetes and long-standing HTN were also cured. One patient with mitral valve stenosis recovered well after the referral who received the Killari protocol at our center earlier. No patient was found with Mucormycosis as a secondary complication. The success of the Killari protocol has been acknowledged by the Indian government, which has included it in the national guidelines for the management of COVID-19.

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How has Implementing the Killari Protocol Impacted Healthcare Delivery in Rural Setups?

Implementing the Killari protocol has significantly improved healthcare delivery in rural setups by providing an effective and accessible treatment option for COVID-19. The protocol is particularly well-suited for rural areas, as it does not require specialized equipment or expensive medications. The ingredients in the Killari protocol are widely available and affordable, making it a cost-effective option for resource-constrained settings. The protocol is easy to administer, allowing healthcare workers to treat patients quickly and effectively, even in remote areas with limited medical infrastructure. By reducing the number of severe cases and deaths, the Killari protocol has helped to ease the burden ...Read More

Implementing the Killari protocol has significantly improved healthcare delivery in rural setups by providing an effective and accessible treatment option for COVID-19. The protocol is particularly well-suited for rural areas, as it does not require specialized equipment or expensive medications. The ingredients in the Killari protocol are widely available and affordable, making it a cost-effective option for resource-constrained settings. The protocol is easy to administer, allowing healthcare workers to treat patients quickly and effectively, even in remote areas with limited medical infrastructure. By reducing the number of severe cases and deaths, the Killari protocol has helped to ease the burden on healthcare systems in rural areas, freeing up resources for other essential services. The Killari protocol’s success has also helped build trust between healthcare providers and communities in rural areas, leading to increased overall access to healthcare services.

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What are the Implications of Your Study's Findings for Future Pandemics or Similar Healthcare Crises?

The conclusions of this study have substantial implications for responding to future pandemics and comparable healthcare emergencies. The Killari protocol provides a model for developing low-cost, effective treatment protocols that can be easily implemented in rural or other resource-constrained settings. The success of the Killari protocol demonstrates the importance of community engagement and collaboration in developing and implementing public health interventions. The study also highlights the need for further research on the long-term effects of the Killari protocol and other similar interventions. Future studies should also explore the potential for the Killari protocol to be adapted and used for other ...Read More

The conclusions of this study have substantial implications for responding to future pandemics and comparable healthcare emergencies. The Killari protocol provides a model for developing low-cost, effective treatment protocols that can be easily implemented in rural or other resource-constrained settings. The success of the Killari protocol demonstrates the importance of community engagement and collaboration in developing and implementing public health interventions. The study also highlights the need for further research on the long-term effects of the Killari protocol and other similar interventions. Future studies should also explore the potential for the Killari protocol to be adapted and used for other infectious diseases. By continuing to research and develop innovative and accessible treatment protocols, we can better prepare for and respond to future pandemics and healthcare crises.

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Based on Your Experience, What Advice Should You Give Healthcare Professionals Dealing with COVID-19 or Other Infectious Diseases in Resource-Limited Settings?

Prioritize resource allocation and establish triage systems to provide critical care to those most in need. Implement infection control measures to prevent the spread of disease. Educate healthcare workers on the importance of infection control and provide them with the necessary resources to protect themselves and their patients.  Collaborate with community leaders and organizations to implement public health measures such as social distancing, mask-wearing, and hand hygiene. Develop and implement training programs for healthcare workers on managing infectious diseases. Establish partnerships with other organizations to ensure access to essential supplies and equipment. Consider using alternative treatment protocols, such as the ...Read More

Prioritize resource allocation and establish triage systems to provide critical care to those most in need. Implement infection control measures to prevent the spread of disease. Educate healthcare workers on the importance of infection control and provide them with the necessary resources to protect themselves and their patients.  Collaborate with community leaders and organizations to implement public health measures such as social distancing, mask-wearing, and hand hygiene. Develop and implement training programs for healthcare workers on managing infectious diseases. Establish partnerships with other organizations to ensure access to essential supplies and equipment. Consider using alternative treatment protocols, such as the Killari protocol, which can be implemented in resource-limited settings. Monitor the situation closely and make adjustments to the response plan as needed.

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Can You Discuss Some Unique Challenges Faced When Treating COVID-19 in a Rural Setup and How the Killari Protocol Addresses these Challenges?

The Killari protocol relies on widely available and affordable medications, making it suitable for rural settings with limited access to specialized drugs and equipment. It is also designed to be easy for healthcare workers to administer with minimal training. This helps to address the challenge of staff shortages and allows for more efficient use of available resources. The Killari protocol involves a combination of oral medications and injectables, which addresses the challenge of patient adherence in settings where access to healthcare facilities may be limited or difficult.


Following the Success of Your Study, What are the Next Steps for the Killari Protocol? Are There Plans to Adapt or Expand its Use?

Further research is needed to confirm its effectiveness and safety in larger populations. The research could focus on adapting the Killari protocol in different settings, such as urban areas or low-resource countries. We also need to look for its expansion to use it for other respiratory viral infections.


Conflict of Interest Statement

This is a conversation. Please note that the protocol discussed in this interview is experimental and unproven.


Author Information

Guest: – Dr. Sachin Balkunde, MBBS DNB, Medical Officer, Government of Maharashtra, India.

Email- sach.in.balkunde@gmail.com

Host: – Dr. Sheetal Hiremath, Editor, medtigo Journal.


DOI

10.5281/zenodo.10890842


Cite this Article

Hiremath, S. (2024). Transforming COVID-19 Treatment in Rural India: The Story of Dr. Sachin Balkunde and the Killari Protocol. medtigo Journal, 2(1). https://doi.org/10.5281/zenodo.10890842