Tue | Sep 27, 2022

Michael Abrahams | Addressing the glaring gap in COVID-19 management

Published:Tuesday | October 5, 2021 | 12:05 AM

The development of vaccines has been a game changer in the management of COVID-19. The vaccines may not necessarily prevent infection, but they do reduce the risk of severe illness, need for hospitalisation and oxygen, and death.

According to the Centers for Disease Control and Prevention (CDC), unvaccinated individuals are 11 times more likely to die from COVID-19 than those who are not vaccinated.

When patients are ill enough to be hospitalised, the drugs and therapeutic interventions to be used are well known and utilised when available. Steroids such as dexamethasone, the antiviral drug remdesivir, and immune system-calming antibody therapies such as baricitinib and tocilizumab have saved countless lives.

But what of the patients who have been diagnosed with COVID-19 and are isolating at home with mild symptoms? How do we treat them? Everyone who died from COVID-19 was in the early stage of the infection at some point.

We know the risk factors for the development of severe COVID-19, and they include, but are not limited to, advanced age, obesity, diabetes mellitus and cardiovascular disease. But the disease and its progression are unpredictable, and there are factors such as the strength of a person’s innate immune response and the viral load they were initially exposed to that may influence the course of the infection but are impossible to accurately assess.

Currently, when patients are diagnosed and have mild symptoms, they are told to isolate at home, monitor their temperature with a thermometer and the oxygen saturation of their blood with a device called a pulse oximeter (if they are able to afford one), and call a doctor if their symptoms worsen. They may be given medication to ease their symptoms, such as painkillers or cough medicine, but often nothing to interfere with the disease process itself.

When our bodies are infected with SARS-CoV-2, the virus that causes COVID-19, the virus multiplies and begins to spread. If the body’s immune system is unable to fight it adequately, inflammation occurs, especially in the lungs, and if the inflammatory process continues, along with decreased oxygenation of the blood, widespread clotting and organ failure occurs, which often leads to death. Also, among the survivors, many struggle with long-term fatigue and mental impairment, and chronic lung, heart, kidney and neurological disease.

NO-BRAINER

The concept of early treatment is a no-brainer. The HPV vaccines were developed to decrease the risk of cervical and other cancers and diseases caused by the human papillomavirus. If a Pap smear detects abnormal changes in a woman’s cervix, indicating pre-cancerous disease, there are widely used procedures to obliterate the abnormalities and significantly reduce the risk of cancer. So, why is that approach to COVID-19 management not promoted by large global health authorities such the World Health Organization (WHO)?

As Steve Kirsch, Director of the COVID-19 Early Treatment Fund, so eloquently stated in his article titled ‘Early treatment for COVID is key to better outcomes’:

“A virus is like a fire and is always best treated ASAP. If your house was on fire, would you wait until the entire house was consumed by flames before you called the fire department? Of course not, you’d seek help as soon as the fire started. The biggest mistake we see is people waiting too long before seeing a doctor.”

Makes sense. First, seeing a doctor early in the course of the disease is crucial, and a favourable outcome may depend on this. Second, if the disease progresses from viral multiplication to inflammation and other deleterious sequelae, it would be prudent to target the earliest stages of the disease. Research is currently under way to develop new antiviral drugs to combat COVID-19. However, in the meantime, doctors worldwide have been aggressively attacking the disease in its early stages…and saving lives.

Supplements such as vitamin D3, vitamin C, zinc, melatonin, quercetin and turmeric, which are known to have beneficial effects on the immune system, have been used in several regimes, along with drugs, to mitigate the effects of the virus on the body. The use of menthol crystals in steam inhalation, as well as gargling and oral rinsing with substances such as Listerine, chlorhexidine and concentrated salt water may also be of value.

IVERMECTIN

Then there is ivermectin. Last year, researchers in Australia found that the drug kills the virus that causes COVID-19 in vitro, meaning in a lab. The dose used in that study was much higher than that allowed to safely be administered to humans. However, since then, over 60 studies involving the drug, at doses safe for humans, have found it to be useful in the management of COVID-19, especially for prevention and early treatment.

Critics of the drug are quick to point out that several of the studies are small, flawed, biased and poorly designed, and that a recent large trial showed no benefit. They are correct. However, it is unlikely that dozens of studies are all worthless.

Also, doctors experienced in using the drug for early treatment will tell you otherwise. In addition, observations of the situations in Peru and the state of Uttar Pradesh in India give much food for thought, as aggressive use of the drug was associated with lowered COVID-19 mortality rates at those locations.

And there are other drugs being examined for being repurposed for COVID-19, including the antidepressant fluvoxamine and the antibiotic doxycycline.

Vaccination is still widely regarded as the most important intervention to fight COVID-19, and early treatment is not meant to be a substitute for vaccination. However, my advice to anyone testing positive for COVID-19 or with symptoms strongly suggestive of it, is to demand early treatment if it is not prescribed in the early stages, especially in the first five days. And if your doctor is reluctant, find one who will do it. It could save your life.

For more information on early treatment, and research being conducted on it, check c19early.com, which provides real-time analysis of hundreds of studies.

Michael Abrahams is a gynaecologist and obstetrician, comedian and poet. Email feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or tweet @mikeyabrahams.