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Are we doing everything to prevent COVID deaths?

Many people continue to die from COVID-19. Some will die because despite all that is done; their innate human condition causes the treatments we currently have to be ineffective. Others will die because they have an inadequate or significant delay in treatment early in the disease process.

For those who can be helped, treatment must be aggressive and timely to reduce the cascading viral load and inflammation that causes tissue damage and death (or disability) in “at risk” individuals. The problem is, we have no way to identify 100% of those who could have a negative sequelae. The elderly are at high risk, of that we are certain.

Prophylactic treatment in the U.S. for those exposed or testing positive for COVID has been, and continues to be, abysmal. Other countries are using different drug therapies in attempts to prevent deterioration leading to hospitalization and death; which may be why the US has a higher death rate from COVID. Sadly, many people exposed to COVID, testing positive for COVID, or showing symptoms; ask their doctors “What can I take to help me?” and they are told “nothing” or “Tylenol.” This “wait and see” attitude is not good enough and is costing lives for those “at risk.” Consider the timeline from the “Frontline COVID-19 Critical Care Alliance”:

¯ From day one — exposure — to day 11 there is viral replication in the body, which can be explosive. It is at this critical stage that the body either mounts enough of a defense to ward off the virus, or it continues to replicate. Symptoms can include fever, malaise, cough, headache, and diarrhea. The more it replicates, the higher the risk for severe health consequences. This is where many patients need help to reduce the viral load. (The only medication “officially” being offered in our area at this stage — on a limited basis — is the monoclonal antibody infusion treatment and steroids. Both are usually effective if given early enough. But not all who would benefit are offered the potentially life-saving antibody treatment, especially the elderly).

¯ After day five, immune dysregulation begins. Inflammation and viral debris begin to contribute to the symptoms, with “ground-glass” infiltrates beginning to occupy the lungs. (If a chest x-ray is not done, a doctor will not know this is happening; and if antivirals and anti-inflammatories are not prescribed, inflammation and infiltrates will progress, especially in elderly patients).

¯ From day 11 to 14, viral debris peaks, and immune dysregulation can rapidly increase. “Ground-glass” lung infiltrates increase. Symptoms now include mild shortness of breath and mild hypoxia, with low supplemental oxygen beneficial. Appropriate and aggressive treatment with anti-inflammatory and anti-viral medication should have been started before now to be most effective. (If a chest x-ray has not been done, a doctor will not know how much the lungs are affected. The later in this stage antivirals and anti-inflammatories are prescribed, the greater the risk for a poor outcome; especially in “high risk” individuals, like the elderly).

¯ From day 14 to 28 immune dysregulation escalates causing a “cytokine storm” of uncontrolled inflammation in the lungs and potentially throughout the body. Hypoxia and “ground-glass” infiltrates progress and worsen substantially. Decreasing the inflammation early in this stage is imperative and must be aggressive and timely. If this stage cannot be reversed, tissue damage is extensive and death is more likely to result.

There is hope for those of us left behind and who have lost loved ones to this horrible disease. The hope is that there are different treatments available, with more on the horizon. The only problem is that more doctors have to take the initiative and have interest in alternatives that offer hope to people that have little or none; or who want protection.

The alliance protocol is just one avenue to pursue. The information is available to all doctors, is free, accessible online, and can be used as a guide. The alliance offers treatment guidelines for prophylactic intervention — MASK protocols — to prevent deterioration and hospitalization; and critical care guidelines — MATH protocol — for hospitalized patients. The protocols use human Ivermectin (and several supplements), which has shown some positive effect in clinical studies. The drug is old, cheap, relatively safe, and the effects can be very dramatic if used early in the disease process.

There are some doctors who are “thinking outside the box.” Several weeks ago an 80-year-old patient on a ventilator in a Buffalo hospital was given two doses of Ivermectin and was able to be taken off the ventilator after two days. Despite this dramatic improvement, the hospital refused to continue the use of Ivermectin. The family had to obtain a lawyer, and a judge ultimately ordered the hospital to continue treatment as recommended by the patients PCP. This very same scenario played out several days later in a Rochester hospital. In addition, there is a doctor in the Buffalo area using Ivermectin in his nursing homes as a prophylactic treatment. He believes it has been beneficial to his patients.

So why isn’t Ivermectin being used more to treat COVID? The NIH recently changed their stance from “do not recommend its’ use” to “cannot recommend for or against its’ use.” This “neutral” stance essentially gives doctors permission to use it for COVID. This was the same classification given to tocilizumab (a drug used to treat rheumatoid arthritis), convalescent plasma, and neutralizing antibody therapy; which are now considered standard treatments. Some doctors refuse to use Ivermectin because it does not have “emergency authorization.” However, only newly formulated drugs are given an “emergency authorization”; not old or repurposed drugs.

Despite multiple small clinical studies demonstrating the benefits for treating COVID with Ivermectin, Merck pharmaceutical’s, (manufacturer of Ivermectin), has suddenly issued a statement saying the drug should not be used to treat COVID-19, citing “safety concerns.” Coincidentally, Merck has just been paid $356 million by the U.S. government for 60,000 to 100,000 doses of an experimental drug to treat gravely ill patients hospitalized with COVID-19. That being said, one would hate to think that Merck is discrediting the positives of Ivermectin, because their new medication would be more lucrative.

So why be concerned with all this? Because people are dying that don’t have to die. Why not offer an early treatment that has the potential of preventing hospitalization or death? COVID-19 does not have a “magic bullet” treatment. Every person is different and will have varying responses to drug therapies, even vaccinations. With mutations and variants a cause for concern, every single treatment with potential to help should be a part of every physician’s treatment “tool box.” Arrogance preventing an open mind, and reluctance to explore and try other options, will only unnecessarily increase deaths.

Patients and families deserve hope and doctors willing to explore every option to prevent their patients from dying. If a patient or their family understands and accepts the risks, they should be allowed to proceed. Unfortunately some doctors are much better than others when it comes to “the art of medicine.” We have a long way to go with COVID. Let’s go the distance without killing so many people.

Cathy Snyder is a Dunkirk resident.

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