On July 14, we published “West Texas Doctor Bartlett: Is He on to a ‘Silver Bullet’ with Use of Off-Label Inhaled Steroid as COVID-19 Treatment?” This doctor is using budesonide, an inhaled steroid asthma medicine as a key treatment for COVID-19. On August 19, the Texas Standard offered an update. They note that Dr. Bartlett has been using budesonide for COVID-19 patients for months. The medicine is proven safe, inexpensive, and easily available. The doctor says he stumbled on the idea while working an ER shift in March. “I laid down for a cat nap between patients. I woke up convinced that God had given me a winning strategy. And a week later, I had to try it out on my first two patients, and for every patient it’s working,” Bartlett has said. Dr. Bartlett has an emergency clinic at Lubbock, Texas, and, “privileges at three hospitals in west Texas”; upon being asked, he did not say how many people he has treated, “but he estimated that he and other doctors have prescribed budesonide to over 400 patients.”
“We Have Cracked the Code”
“My focus right now is not on tabulating numbers; my focus is not on curves and waves. My focus is on real Americans who need life-saving measures,” he reported. Dr. Bartlett also “prescribes zinc, aspirin, and clarithromycin, which prevents bacterial infection. But the budesonide, he says, is the key.” Targeting the dangerous inflammation in the lungs seen in COVID-19 patients, budesonide is an anti-inflammatory which can target the lungs. Inhaling the medicine, basically, “slams on the immune system’s breaks.” And the earlier the drug is used, the better the results. Bartlett has become a huge booster for budesonide; starting a website called covidsilverbullet.com. In multiple interviews (at least one of which was removed by YouTube) his message is the same: “We have cracked the code,” Dr. Bartlett opined. “We have an answer for this. We don’t need another answer. We have an answer.”
Experts Dubious of Hyperbole
One of Dr. Bartlett’s videos on YouTube “had millions of views,” and both Representative Louie Gohmert (R) Texas and Dr. Fauci have recently discussed the steroid. “You know, there are people that believe that budesonide and taking zinc is working . Is there any downside to doing it?” Fauci was asked recently. “You know, there’s a placebo effect to make you feel better, and less anxious, but in reality, Matthew, it doesn’t have any effect,” replied Fauci. Up to now, there is no clinical trial evidence for the treatment. “I think if you ask a lot of different doctors, I think most would say that when we hear about a silver bullet treatment, I think our ears perk up but not necessarily in the way of ‘Oh I can’t wait to get my hands on that,’” according to Doctor Anoop Nambiar, associate professor of medicine at the University of Texas Health Science Center in San Antonio.
Bartlett Focuses on Results Achieved
Bartlett says that his patients’ outcomes show that his treatment works, and that nations like Taiwan and Japan can track their low death numbers to inhaled corticosteroids as opposed to mask wearing or social distancing. He also pointed to studies which are ongoing to derive hard science for the treatment. One of them is being done by the Universities of Oxford and Queensland. 500 COVID-19 patients will use the steroid to test whether it mitigates the virus’s respiratory effects. Dan Nicolau, a researcher on this study who practices medicine and teaches mathematics at Oxford, is very hopeful. “Almost no matter how you look at it, it’s difficult to see a version of the future where this does not turn out to be helpful,” said Dr. Nicolau. Based on his research to date, Nicolau thinks the real question is not whether it will help, but quantitatively how much. “There’s a big difference if we keep 10 percent of people out of hospital versus 60 percent. Both would be useful, but if we keep 60 percent of people out of hospital, then, well, that’s the kind of thing we throw a barbecue over,” Dr. Nicolau said.
San Antonio Nurse Achieves Positive Results
Meanwhile, some providers are following Bartlett’s lead. Nurse anesthesiologist Andrea Malcolm near San Antonio said that in June and July, her hospital’s 25 beds began to fill with COVID-19 patients. And many would not get better. “Sometimes they would be there for six, seven days, and kind of look the same, and then all of a sudden they would just start going down,” said Malcolm. She and the hospital CEO saw a Dr. Bartlett video on Facebook and decided it was worth a try. “If we waited on double blind peer reviewed studies, we would have so many people dead, what would be the point? So, for me, if I’m not adding a risk, it’s worth seeing if there’s a benefit,” said Malcolm. She says most of her patients have gone home, instead of to a larger hospital.
TrialSite notes that doctors will have to decide how to proceed until the RCT-level evidence is in. We do note that in 2017, inhaled budesonide was tried for Acute Respiratory Distress Syndrome, similar to the worst effects of COVID-19. The 2017 RCT found “a significant difference” in oxygen and airway pressure in the treatment group compared with the placebo group.