Covid-19: the treatment that is all the rage in Brazil despite its weak scientific demonstration

WASHINGTON.- There was the dreaded word, after 10 months of doing everything to avoid it: “Detectable”. My wife’s swab had tested positive. Some calls had to be made and potential complications assessed.

Over the past year, as Brazil’s inability to control the virus caused the collapse of the health system and triggered the worst humanitarian crisis in the country’s history, it haunted me to think about this that we would become if Emily or I got sick. It was a sudden panic that swept over me after interviewing someone who had lost a loved one without hospital care. Or when he read the alarming headlines in the local press.

“Rio de Janeiro: More than 1,100 Covid patients are waiting for a hospital bed.”

“More and more people are dying at home.”

“You can’t see the exit.”

“The private system’s intensive therapy is at 98% of its capacity.”

And now he had come to us. Hoping to escape the worst, but without any certainty, we made a few calls. We communicate with our doctor in the United States. He told us that without a doubt I was also infected, and advised us to rest, to isolate ourselves, to stay well hydrated, and a little more than that.

However, when we contacted some Brazilian doctors, they urged us to act more directly and without delay.

“It is important that they come to the clinic so that the situation does not worsen,” urged a doctor. In September, a friend of mine fell ill with symptoms of a headache and loss of smell, and that same doctor had prescribed a series of remedies that my friend had since fervently recommended. An antimalarial called chloroquine. An antiparasitic for live dogs and livestock called ivermectin. Azithromycin, a better known antibiotic. An anticoagulant, clexane. And a corticosteroid.

“They must start treatment as soon as possible,” insisted the doctor in one of these exchanges.

Distraught and not quite sure, we got Azithromycin and Ivermectin, and that’s how we found out about treatment plan for the coronavirus which is all the rage in Brazil, despite its weak scientific demonstration. This cocktail of pills, for which many crawl to the pharmacy, has been adopted by local authorities across Brazil and is even part of the recommendations of the federal government.

Officials call it “early treatment”, but street people have given it another name: it is the “Covid Kit”.

The uncertainty of the pandemic has led to the emergence of miracle cures around the world, and particularly in Latin America. In Bolivia, there are people who buy chlorine dioxide, a bleach used to clean water from sinks. In Venezuela, President Nicolás Maduro has ordered public hospitals to administer interferon alfo-2b, an antiviral and anticancer drug, to patients with coronavirus. And doctors in the area say there are hardly any patients who haven’t tried ivermectin.

But no one has pushed the unproven and potentially dangerous remedies with more zeal, drama and conviction than Brazilian President Jair Bolsonaro.

Her favorite pill was and still is hydroxychloroquine: promote her on social networks and sing her praises in the comments of her followers. In July, when he was infected, Bolsonaro ensured that he had self-medicated this antimalarial drug, and after his recovery, during a presidential ceremony, he lifted a box of the drug and stood. proclaimed “Dr. Bolsonaro ”.

“Early treatment saves lives,” said Eduardo Pazuello, Bolsonaro’s third health minister since the start of the pandemic.

We had our doubts, and the uncertainty continued until we were healed. But nothing compares to the emotional impact of contracting a virus that has killed millions of people and left millions more with lifelong scars. There is of course fear and uncertainty, but above all a terrible feeling of helplessness. Some doctors say we have to wait and see, but other doctors – and officials – say we can do a lot more.

We started by seeing more doctors: six in all. One told us to take the pills. Another doctor told us that she herself had taken azithromycin. It made me think of how many pharmacies you see in Brazil, sometimes three on the same block. According to the Federal Council of Pharmacy, the country has one of the highest rates of pill consumption in the world and Brazilians are very prone to self-medication. According to this popular logic, when in doubt, take the pill first, then find out.

“The culture of over-medication already existed,” explains Alexandre Kalache, an epidemiologist whom I frequently interviewed during the pandemic. “Here, the doctor who does not prescribe anything is a bad doctor.”

So when “Dr. Bolsonaro ”wrote his own recipe, who were the other Brazilians to judge him?

In Barra do Garças, a city in central Brazil, authorities are distributing free small “hygienic bags” containing azithromycin, ivermectin, chloroquine and analgesic and fever reducer novalgin. The state of Minas Gerais secured the purchase of nearly 380,000 chloroquine tablets to meet local demand. And the mayor of Itajaí, Doctor Volnei Morastoni, went even further: not only did he encourage people to take pills, but he also recommended a “simple and rapid” application of ozone by rectal probe.

“At least he’s doing something,” says Debora Fonseca, local representative of the health professionals’ union, and shrugs. “If he hadn’t had the support of the people, they wouldn’t have re-elected him just three months ago.”

Whether or not these treatments work is another question. The death rate in Itajaí was almost 60% higher than in Santa Catarina, a state considered to be average. The Amazon city of Manaus, where state and local authorities have openly encouraged the consumption of all kinds of pills, remains ravaged by the disease.

No pill has saved Brazil from having to bury more than 230,000 people, the second country with the most deaths after the United States. The inventor of the Covid kit, a doctor in the state of Mato Grosso, died of Covid-19 in September.

So, before going ahead with the cocktail of pills, we sought more medical advice and contacted Dr João Pantoja, one of the top pulmonologists in Rio de Janeiro. Pantoja opened our eyes and advised us against using this medicine.

“I don’t believe in any of these wonder drugs to prevent covid from getting worse,” Pantoja told us. “As much as I wish I had something like this available to me.”

He was the most convincing and trustworthy doctor for us. But in a country and region where the coronavirus does not stop its advance, who knows how many would be willing to take this advice. In recent weeks, there have been reports of doctors threatened not to prescribe this or that drug, no matter how useless. And in pharmacies in Manaus you see long queues to buy pills.

In a sense, the myth of “early treatment” is a product of the very nature of the coronavirus: many will believe that they were cured by taking a pill, when in fact the vast majority of those who were infected recover without it. need any medication.

“When someone improves, it’s because of what they took,” says Alberto Chebabo, vice president of the Brazilian Society of Infectious Diseases. “But when they get worse, they think it’s just because the virus is strong.”

My wife and I were convinced: we stopped taking the pills. We spend time resting, drinking lots of fluids, and watching bad movies. Another test confirmed that I too had had the virus. But a few weeks later, and beyond the disconcerting loss of taste and smell, we were almost completely recovered. And as for our fears about the health care system, we have never even come close to needing hospitalization.

Could it be ivermectin? Almost certainly not. Last month, the U.S. National Institutes of Health reported insufficient data to recommend its use.

But the myth remains.

A few days ago my father-in-law, who lives in the Dominican Republic, sent us an image that has gone viral all over Latin America. It was a fake bottle of beer, the label of which read: “Now with ivermectin”.

(Translation by Jaime Arrambide)

The Washington Post

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