Jamaica Gleaner

Addressing the glaring gap in COVID-19 management

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

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 SARSCoV-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 precancero­us 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.

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
Michael Abrahams

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