Dont believe quackery on Coronavirus treatment

For those short on time, I will cut right to the chase: as of today there are no approved drugs or vaccines for any coronavirus disease, not just COVID-19.

Now that does not mean that there are no potential drugs, and for the rest of the post I will focus on legitimate evidence-based treatment options and why it is dangerous to support any quack treatment options.

First a very quick explanation of terms. The novel coronavirus is called SARS-CoV-2. When it infects someone (usually by human to human transmission) it is a coronavirus infection. Many people who are infected with SARS-CoV-2 will have no or very mild symptoms. Other people will develop coronavirus disease, which is called COVID-19. The three common symptoms of the disease are fever, dry cough, and shortness of breath or difficulty breathing. The disease is currently screened by the symptoms, because people who are infected but aren’t sick don’t know it; they are unlikely to go to a doctor. In summary, out of a certain number of people who have coronavirus infection (SARS-CoV-2), a subset will develop coronavirus disease (COVID-19). Not everyone who has SARS-CoV-2 will get the disease, COVID-19 (and children seem to be mostly spared by the disease).

Those who have one or more clinical signs of the disease COVID-19 will be tested for the presence of the virus. This is important because the symptoms themselves are non-specific. In an early report the WHO found that 90% have fever, 70% have dry coughs, 30% have malaise or trouble breathing. Most people right now who have fever, cough, or shortness of breath have some other respiratory infection or illness, not COVID-19. So, the probability of having this disease is greater if someone has traveled to a region where there is an outbreak right now, or has been in contact with someone who has.

If the basic symptoms and one or more risk factors are positive, the clinician will take a throat or nose swab or a sputum sample and send it for a real-time genetic test against the virus. Because SARS-CoV-2 is an RNA virus and its genome has been sequenced, a real time reverse-transcriptase polymerase chain reaction (RT-PCR) is used. If there are SARS-CoV-2 viruses in the throat, nose, or sputum sample, it is amplified in real time giving a positive test for the virus. If there are no copies of the virus, or there are so few that it is below the limit of detection, then the test comes out negative because there is no sequence to be amplified. The test is highly specific, though false-positives can come from contamination of samples. A limitation of the test is that it usually takes 24-48 hours and requires a degree of technical expertise to complete (though in China, they got the time down to four hours on-site).

Now, I’ll get to the treatment. Novel coronavirus, SARS-CoV-2 is not the first coronavirus that humans have been infected by. There are four coronaviruses endemic to humans that cause anywhere from 10-20% of all common colds. Over the last few years, SARS-CoV and MERS-CoV have jumped from other animals into humans. There are no approved treatments against any coronavirus. There is no vaccine for any of them either. At least 20 candidate vaccines are in stages of development for SARS-CoV-2, though the earliest that any might go into development is sometime in 2021.

Although there are no approved drugs for COVID-19, a number of drugs for other diseases are being repurposed in clinical trials. Three drugs, remdesivir, chloroquine and lopinavir/ritonavir, seemed to have some effect on the virus at the cellular level. And there is a randomized control trial on COVID-19 patients using remdesivir funded by the NIH right now. In another post at a future date, I hope to talk about the targets of each of these candidate drugs.

COVID-19 is much more serious than the common cold, but I mentioned earlier that up to 20% of colds are caused by human coronaviruses. There are no cures for the common cold either. When you and I get the cold, we take medicines that help us to manage the symptoms of the cold such as congestion, cough, and runny nose, while our immune system fights off the virus itself. But these are palliative, they don’t treat the disease itself. It is very important to distinguish between drugs that fight the disease and those that lessen symptoms, are palliative, or treat other complications. Please keep this in mind for the next point.

Most cases of COVID-19 will resolve on their own. I want to stress that COVID-19 is more serious than a cold or the flu, but most people will get better on their own. Their immune systems will fight off the virus and might give them some immunity to that particular strain. As I noted earlier, most children might get the virus without even getting sick at all. We need a drug to help those who are immunocompromised, elderly, have other underlying diseases, or high at risk for respiratory or organ failure. When the vaccine is rolled out, it will be first given to these groups as well.

And because most people will get better on their own, we need randomized controlled trials in testing how drugs work. Let me explain. If a disease has a 100% fatality, in theory you don’t need to control with a placebo or no treatment compared to the experimental drug: you give the drug to everyone and see how many people get better. But with a disease in which 1-2% die, 98-99% of the population get better without drugs; how would you know what the effect of the drug is if it isn’t compared in a randomized controlled trial with a set of the population who hasn’t been given the drug? You wouldn’t and that would put those who truly need the drug to live at risk.

Let me give you an example. Let’s say right now you have the flu. You have aches, chills, and fever. I give you a quack treatment option to treat the flu, say concentrated cow-urine pills. You get better in four days and conclude that the pills made you better. But had you not taken the pills you would’ve gotten better anyway. We don’t know the urine pills made you better. This is where you shrug and say, “what harm does it do?” And I’ll tell you.

When we promote quack treatments we put the vulnerable population who need a real drug at risk. I mentioned the flu for a reason. Tens of thousands of elderly people die from it each year. Imagine if I had given one of the seriously ill a urine pill, or a water pill. or told them to stand on one leg for an hour each day, or clap their hands four times every morning to treat their serious ailment. They would’ve thought that they’d been given a legitimate treatment but at best might’ve had effects of a placebo. And that can be fatal.

When you forward a WhatsApp claim that doesn’t rely on evidence-based-medicine to someone who might need a real treatment to a disease, that is exactly what you are doing. You are doing more harm than you think. more