By Mary Beth Pfeiffer
A proven vaccine might yet bring us back from COVID-19 calamity. But make no mistake. Vaccines are the hoped-for, someday ceasefire. Months will pass before, and if, corona’s white flag is raised and the masses saved.
But right now, with a weekly average of 150,000 new U.S. cases daily, we are in the bloody, bitter throes of war.
In the midst of this onslaught, federal policy says to watch, wait and do nothing for the newly sick. “No specific antiviral or immunomodulatory therapy recommended,” states this nation’s COVID-19 care guidelines for outpatients. Instead, sicken in place.
And yet we have an arsenal of drugs, studies and data at the ready. Tapping it may well stop the surge in COVID hospital admissions, which rose 52 percent in just the last two weeks while deaths spiked nearly 40 percent.
Here, if you will, is a list of weapons and strategies to force COVID-19 into retreat now. Ignore them at our peril.
Try ivermectin — now.
This antiparasitic drug, for which the Nobel Prize in Medicine was awarded in 2015, is the single most promising development since the pandemic emerged. It is a potential cure – a “sleeper hit,” as one doctor called it — that, emerging studies show, prevented infection after exposure; successfully treated patients with early and moderate illness; stopped COVID’s cascade of damage, and spurred recovery in very ill patients. In other words, it helped in every stage.
Ivermectin “has demonstrated profound activity against COVID-19,” an alliance of critical care physicians has concluded. Beyond this, it is safe. “Numerous studies report low rates of adverse events,” a literature review found in 2016, and “a high margin of safety.” In a war, might this be one effective and low-risk weapon we should turn to?
Recognize the role of hydroxychloroquine.
The vilification of this old antimalarial drug will go down in history as a media-fueled debacle that cost lives. We should learn from it. Yes, HCQ fared poorly in some early studies that focused on hospitalized patients with advanced disease. But HCQ’s greatest potential has been documented in the first days of infection and viral replication: 22 early treatment studies showed efficacy, while five others were inconclusive. Treatment even before a positive test with an antibiotic and zinc seem key to success, practitioners say.
“HCQ was found to be consistently effective against COVID-19 when provided early in the outpatient setting,” a treatment review found. That study uncovered reports of heart arrhythmias that were deemed non-threatening. A separate safety review found this cheap old generic to have “substantially” reduced thrombosis and cardiac events in long-term lupus and rheumatoid arthritis patients. “HCQ should not be restricted in COVID-19 patients out of fear of cardiac mortality,” it said.
Spend the money.
The U.S. has committed $11.2 billion to vaccine development. Yet the search for an actual cure — that might keep people out of hospitals — is barely mentioned. On Nov. 11, nine months into this pandemic, the government issued a press release on the “urgent” need for early treatments, which it outlined in an article authored in part by U.S. COVID Czar Dr. Anthony Fauci. The article discussed several long-running trials for drugs that may help – someday. While inpatient care has improved, it asserted that “effective treatments for people with mild to moderate disease have been more elusive.” Not really.
What is elusive is the willingness and urgency to use them. Instead, it is national policy to let COVID infections fester before any treatments beyond pain relievers and expectorants are given. Then you’ll get care – but in a pricey hospital setting. Early treatment is a bedrock principle for many bacterial and viral infections and for HIV, TB, stroke and heart attack. Why not this?
Give physicians autonomy.
For centuries, medical practice has been part science, part art. FDA policies have long allowed doctors to use drugs off-label, namely for conditions other than for which they were approved, to see what works. But physicians have effectively been barred from following their instinct and experience with COVID-19. About half of states have prohibited or sharply limited the use of hydroxychloroquine, a safe, legal drug, effectively warning doctors not to step outside the lines. Will ivermectin be next?
The larger question, however, is this: Is withholding treatment, especially for older, immune-compromised outpatients, a better alternative than using safe drugs that studies suggest may save lives?
Take lessons from other countries.
The U.S. is failing miserably to control COVID-19. To be sure, it’s in good company with European countries like Belgium, Italy and Spain. But it could learn from less-developed countries like Peru, Bolivia, Brazil and India, where localities are wrestling COVID to a draw. Some made the decision to distribute prevention packets of ivermectin, hydroxychloroquine or a combination. In Haiti, meantime, widespread distribution of ivermectin for parasitic illness lymphatic filariasis may explain its negligible COVID rates.
The U.S. could find out if those distributions made a difference, but have instead given only lip service to treatments. The unfortunate exception is remdesivir. The drug, which costs $3,000 per course and must be given intravenously, was embraced early and inexplicably as a “standard of care.” Despite a host of side effects including kidney failure and poor performance, it was recently approved by the FDA as the first official COVID treatment.
In California, Texas, New York, Virginia and a few other places, a core group of brave physicians is using HCQ and, increasingly, ivermectin. Their clinical experiences align with emerging studies: few hospitalizations, few deaths. Each drug costs perhaps $20 for a typical course. And both already have FDA approval.
There are other simple steps we could take too. Evidence is pointing to the possible COVID-fighting benefits of vitamin D, zinc, magnesium, selenium, quercetin with Vitamin C and other supplements. Quite simply, doing nothing is no longer an option.
Mary Beth Pfeiffer is an investigative journalist, science writer and author of two books. Follow her on Twitter: @marybethpf.