While we were physically dragging beds into the old hospital building and fortifying our “Red Zones,” a second, more insidious front was opening: the battle for the medical soul. In the early weeks of 2020, the vacuum of knowledge was being filled by a toxic mixture of desperation, political grandstanding, and pharmaceutical opportunism. As Medical Superintendent, I realized that my most difficult task would not be procurement of masks, but the procurement of truth.
The atmosphere in the global medical community had become feverish. Across the world, doctors were “panic-prescribing.” The logic was seductive: “In desperate times, we cannot wait for trials. We must do something.” But at Sevagram, we viewed this logic as a trap. We knew that doing “something” without evidence was often more dangerous than doing nothing at all.
The hydroxychloroquine mirage
In January 2020, Sahaj and Amrita had just finished their fellowship at the University of British Columbia, Vancouver, flying back to India via Guangzhou as the first whispers of a strange virus emerged from China. They wore N95 masks the entire journey, stepping straight into the Delhi home they shared with their parents.
Then the lockdown dropped.
Confined indoors with the world on pause, Sahaj had a front-row seat to a fast-moving panic. Television screens and policymakers were suddenly pushing hydroxychloroquine as a miracle shield. Even among our own faculty, some argued that waiting for proper data was a luxury we could not afford.
Late into the night, Sahaj pored over the preliminary reports. They were thin, anecdotal, and riddled with bias—a supposed wonder cure manufactured purely by volume, amplified all the way from the White House as President Trump eagerly endorsed the drug. Sahaj wrote the first draft and then reached out to me, alongside Ashwini and Pranav Ish. Together, we drafted a letter challenging the hasty promotion of the drug.
We batted drafts back and forth across rooms, stripping away every layer of academic fat until the prose was lean and sharp. The core warning was simple: desperate times do not excuse abandoning scientific reason. The Lancet rejected it, but The Lancet Infectious Diseases accepted it, publishing it in April 2020.
Our argument was direct:
“An ongoing pandemic justifies leeway in generation and interpretation of evidence in the interest of public health. However, all scientific reasoning cannot be abandoned citing desperate times. A blanket recommendation for chemoprophylaxis in the absence of credible evidence might be contentious to say the least…”
When the letter went live, we felt like a solitary outpost in a stormy sea. Some mocked us as armchair critics; others claimed a monopoly on the frontlines. For us, the true frontline was the integrity of science itself. History proved us right—the drug offered no benefit and carried real cardiac risks—but in that moment, it was simply a fight for the soul of how we practise medicine.
Then a strange thing happened. The letter sparked a debate, accumulating over 160 citations. Yet respected researchers and meta-analyses frequently misquoted it, attributing claims to us we had never made. It was a humbling reminder that even medical giants often fail to read the literature they cite.
One night, on 18 June 2020, a WhatsApp message landed from Dr. C.S. Pramesh, Director of Tata Memorial Hospital, asking if I would speak on practising evidence-based medicine during the pandemic. I had never seen him, let alone spoken to him until then, and I hesitated, struck by the quiet aura that surrounds the head of India’s premier cancer institution. After a moment’s thought, I tapped out a short reply: yes. A phone call followed the next day, and two days later, I made my Zoom debut—arguing simply that we must be guided by science, not anecdotes, to diagnose, prevent, and treat COVID.
That single exchange widened our circle, growing into a regular correspondence with Dr. Pramesh as he hosted weekly video discussions on scientific integrity. Those conversations opened doors to talks, a voice on Twitter, and a broader campaign pushing back against unscientific medicine.
The war on “irrational cocktails”
After HCQ came Azithromycin, Ivermectin, Zinc, Vitamin D, and eventually Convalescent Plasma — a return to alchemy dressed as progress. Patients were loaded with five or six unproven drugs at once; it wasn’t healthcare, it was the monetisation of fear. Favipiravir was marketed as a game-changer for mild cases at ₹12,500 a course — a staggering sum for the farmers and labourers who came to Sevagram — while shortening a fever by barely a day and doing nothing for viral load or mortality.
We made a collective decision: Sevagram would not use these “magic bullets” outside a sanctioned, high-quality trial. We stayed with oxygen, steroids where appropriate, and anticoagulants — boring, evidence-based basics that actually saved lives.
The war room
As the first wave crested, my role widened from managing a hospital to helping defend an entire district. The War Room was no metaphor — it was a room in the District Collector’s office in Wardha, and I spent more hours there than I could count, in bi-weekly reviews that stretched past midnight, sometimes joined by video link from the Chief Minister’s office.
I worked closely with two District Collectors, Vivek Bhimanwar and later Prerna Deshbhratar, and with Civil Surgeons Purushottam Madavi and Sachin Tadas, tracking migrant-worker movement, quarantine capacity, and the slow arrival of testing kits. I was appointed to chair the expert committee that would set Covid diagnosis, prevention, and management rules for the whole of Wardha district — physicians and anaesthesiologists from JN Medical College and the Civil Hospital building, in effect, a single Bible of treatment for a district in a panic.
The hardest part of that chair was not the bureaucracy; it was standing against the tsunami of irrationality moving through it. While other districts scrambled for Favipiravir or Ivermectin, I argued, in front of the Collector and the health officials, that public funds should not be spent on magic bullets that didn’t work. It was a lonely position — private hospitals were under pressure from wealthy families for “the latest drugs,” and here was the largest hospital in the district saying no. Our protocols stayed anchored to the RECOVERY and SOLIDARITY trials, not to marketing or social media. We admitted nearly 5,000 Covid patients over the pandemic and never used the magic bullets that were bankrupting families elsewhere.
The pressure over Remdesivir was the most intense administrative test I faced — the public saw it as a divine vial that could pull a patient back from death; the data showed it did neither reduce mortality nor the need for ventilation. From March 2021, while the rest of the country queued and black-marketed the drug, we cut our own usage by 90 per cent, using it only for a narrow window of patients, sparing them unnecessary hepatic and cardiac toxicity and their families the expense. Our steroid protocol followed the same discipline: a miracle for the hypoxic, a disaster for those breathing normally — and I feared, correctly, that the community’s “steroids for everyone” habit would come back to haunt us as Black Fungus.
In an interview with The Indian Express on 9 June 2021, I said plainly that we refrain from resorting to anecdotal evidence or promotional research. It became, in effect, the district’s motto for the rest of the pandemic. We didn’t just manage a crisis; we managed to keep our integrity while doing it — and as the second wave built toward its peak, the conversation in that War Room shifted from drug protocols to something even more elemental: the air our patients breathed.