By GBOLAHAN DIYAOLU
As the saying goes, “knowledge is power” and “ignorance is bliss”. Not a single day goes by without reading about or seeing videos of novel miracle cures for COVID-19. From the absurdity of various concoctions of herbs, to the danger that will arise from ingestion and/or injection of household cleaning products or exposure to extended UV lights promulgated by the President of the United States of America, Mr. Donald Trump.
Please, stop the nonsensical: Chloroquine and Hydroxychloroquine are not efficacious against COVID-19. In vitro(inside test tube), they decrease the viral replications which reduces viral shedding in the nasal cavity but it does not translate into clinical efficacy. The study conducted by the veterans administration in America had to be stopped due to excessive death rate and non-efficacy. To put it colloquially, both proposed treatments struck out.
Moreover, the arrhythmias (irregular heartbeat) observed, with chloroquine and hydroxychloroquine, especially in patients with cardiovascular (heart) disorders outweighs any benefits. The various concoctions involving garlic, turmeric, ginger, lemon and any other thing your heart desires is plain and simple garbage. It may not hurt you but has no iota of an effect on COVID-19.
Scientists over the years developed a system to evaluate drugs for their safety and efficacy. This has worked for decades. Do we just discard the process for quick fixes? I say no! By the way, where did we get the notion that natural herbs are not dangerous? Labeling a product “Natural Herbs” is no carte blanche for danger of free use, or that it’s a cure for all!This attitude is not peculiar to us in Nigeria alone; same exists all over the world. Of course the pharmaceutical industries have capitalised on it. All they do is label things “ALL NATURAL “ and gullibly, we pay exorbitant price without question!
Herbs, in most cases contain alkaloids and phytosterols. Dosed approximately, can perform wonders, but can also cause serious injury to your liver, kidney and death when inappropriately taken. My fellow Nigerians, when was the last time we questioned the ingredients in the herbs mixtures you received or bought and are still under our beds from two years ago? Those herb mixtures, do they have expiration dates? Oh, because they are “natural herbs” they don’t expire or go bad.
I cannot stress this enough: there is no cure-all of any natural herbs on earth. Let me repeat, no single herb or combination of herbs that cures all illnesses.In this part of the world, we suffer from a disease I termed mental laziness. Hard work is not our issue, working smart usually is. Quick fixes are always our objectives regardless of our educational background. If I were to be offered a dollar for each fake remedy mentioned on line or videos, I will be a millionaire by now. It’s time to sieve through all and tell you the facts as they stand today.
To do that, it is paramount to know exactly how the virus works, or better still: how it damages our body. Upon gaining entrance to our body, it attacks the lungs. Of course, since we are perfectly created, the body tries to defend itself by producing substances called neutrophils, macrophages (immature neutrophils) and t-cells. These are our natural defense mechanisms to fight invading foreign substances like viruses or bacteria. To accomplish this, the body moves much fluids to the lungs, thereby suffocating it. In order for the lungs to get rid of these fluids, the body initiates the cough reflex.
Thus, the productive cough seen in COVID-19 patients. But the virus is so clever; once it senses these defensive substances, it produces protein substances of its own that disorient the immune system and confuses it. The confusion created causes immune system to kill off good cells in the lungs, which further damages the lungs and can lead to permanent lung damage.
Lo and behold, the lungs are now filled with fluids, dead lung tissues, life viruses and dead immune cells. Mixed with the above are other substances called cytokines which have inflammatory properties. These fluids are perfect media for bacterial growth. Thus, the resultant pneumonia seen in COVID-19 patients. Once the first wave of the immune cells are destroyed, it is followed by a second. Now, the immune cells are wiser to the tactics of the virus. They counter the virus disorientation proteins and start destroying the viruses. Thus, the spontaneous remission. This process takes six to 21 days from the first symptoms to remission or death. Thus, the term that COVID-19 is a self-limiting virus.
When it is all said and done, over 70% of the world population will get the virus. That’s a fact. It’s here to stay and eventually, there will be a vaccine. In lieu of that, effective treatment regimens are being crafted. To avoid runs to your local pharmacies and doctors, I will only mention treatments by drug classes not by name.
The essence of therapy is palliative treatment based on symptoms.
COVID-19 symptoms vary from cough (productive and non-productive), fever of varying degrees, malaise, dyspnea (shortness of breath), disorientation, body pain, fatigue, abdominal discomfort, loss of sense of smell and taste, respiratory distress, hypoxia (low oxygen in blood) to name a few. Some basic laboratory tests are critical for initial analysis of the patient’s status. These include but not limited to complete blood count with differentials, C-reactive protein, Liver function test, complete metabolic panel, procalcitonin, oxygen saturation, pCO2, D-Dimer, Erythrocyte sedimentation rate etc. Caveat: Before you take any drugs or supplements please consult your doctors or pharmacists.
The followings are what we know to date:
1. Judicious intake of fluids, vitamins C&D, and zinc.
2. Antipyretics around the clock to control the fever
3. Anti-inflammatory agents as needed. It could be glucocorticoids or NSAIDs.
4. For patients with cough, a good expectorant is a must. Sometimes a nebulisedmucolytic agents can be used;a beta adrenergic agonist inhaler or nebulized to stop the lungs from spasms; inhaled or nebulized glucocorticoids to limit inflammations of the lungs triggered by cytokines, and or quaternary ammonium compounds to dry up the mucous if and/or when indicated. Some antihistamines with strong anticholinergic activities may be employed.
5. Low molecular weight heparin to prevent thrombotic episodes as indicated.
6. Nasal cannula oxygen when indicated, and aggressive chest PT with the patient face down. This loosens the mucus and increase mucus drainage. The result is a better oxygen exchanges in the lungs.
7. The usage of ventilators are decreasing due to high death rate observed in a UK study. The study shows around 67% death rate in vented patients.
8. There is only one antiviral agent known to date to work but it has to be started quickly at the onset. Further studies are on-going and a compassionate usage of this drug is available.
9. In cases of pneumonia, macrolides antibiotics is indicated. There are two types of pneumonia seen, viral and bacterial pneumonia. The bacteria pneumonia is caused by typical bacterial. The beauty of macrolides are they function by attaching themselves to macrophages which drags them to the infected areas. Macrolides do have side effects of arrhythmias especially in patients with underlying cardiac conditions. Tetracycline derivatives may be an alternative to macrolides in cases of contraindications to macrolides.
10. The last therapy that has shown good to great success is the infusion of convalescent plasma.
The bottom line is to keep the patients alive by ameliorating symptoms; clearing the airways, proper hydration, making sure all other organs are functioning appropriately before the patient’s own immune systems take control.
It boils down to the basic medical covenant: “Do No Harm”.
Dr. Diyaolu is an Adjunct Professor of Clinical Practice at Massachusetts College of Pharmacy University.