Brazil: Early treatment with Covid Kit including HCQ is effective and safe

Palmer Foundation provides an english translation of an interview by Sandro Benites in Portuguese to O Progresso. Brazil: Early treatment with Covid Kit including HCQ is effective and safe, says MS doctor.  Excerpts in italics with my bolds.

Coordinator of the Integrated Toxicological Surveillance Center (Civitox), the toxicologist and nutritionist Sandro Benites is an advocate for the use of the Covid Kit, which includes drugs such as Hydroxychloroquine, Azithromycin, Ivermectin, Zinc and Vitamin D for early treatment of Covid-19.

In Campo Grande he led a group of 300 doctors who convinced Mayor Marquinhos Trad to adopt the service protocol that includes the distribution of the kit, with medical prescription in specific cases. The same protocol was adopted in 12 other Brazilian capitals and is being studied in the others. It was developed based on experiences that worked in countries like Spain and the United States, even before the pandemic reached Brazil, according to the doctor.

In an interview with O PROGRESSO, he was categorical in stating that these drugs are effective in early treatment and do not bring health data, as long as used following medical guidelines.

Read the interview here:

Q: Mayor Marquinhos Trad recently adopted the protocol proposed by you and a group of 300 doctors, which provides for the distribution of Kits against Covid-19. In practice, what changes from now on?

A: What changes is that several doctors were doing this initially in the office very successfully while others did not because they had a hard time supporting themselves. Today this group has the support and the release of the CRM (Regional Council of Medicine), the Medical Association of Mato Grosso do Sul, the Brazilian Medical Association and the Union of Doctors, in other words, it is easier for several colleagues to join. It is one thing for a doctor to act in isolation, another thing for a group of doctors to adopt this protocol together with the highest authority in the municipality, which in the case of Campo Grande is Mayor Marquinhos Trad.

Q: What is the purpose of this protocol?

A: Our goal is to make the population see that they cannot be isolated inside the home with symptoms. What society needs to understand is that a patient who arrives with fever, malaise or a cough, needs to be seen. He must have an x-ray, a blood count and be treated. The medical profession, which until then was acting in a way, needs to rethink this attitude of only attending or interning only if the patient is in a serious situation or with shortness of breath. From now on, like everything in medicine, if you start treatment early, the chance of success is greater. In this way, prevention is simpler, more efficient, more effective and cheaper.

Q: Do these drugs cure the disease?

A: There is no cure for the disease. It is a virus that is not even considered a living being.

These medications are intended to inhibit viral replication within the cell and the disease does not worsen, thus preventing the patient from having to go to an ICU tube, for example. The result of this is that we reduce this chaos that we are experiencing due to the lack of structure in hospitals.

Q: As you evaluate the current protocol used in most of the country, to diagnose the patient and not medicate, just send him to stay at home in isolation. Is that a risk?

A: This is a huge risk. Today the patient who has a headache, malaise and coughing goes home to take dipyrone. I prefer to take hydroxychloroquine. It is a safe medication that we have used in medical practice for over 80 years. I have worked in an intoxication center here in the State for almost 20 years and I have never seen hydroxychloroquine or ivermectin intoxication.

The same happens in other centers in Brazil. As a major in the Brazilian Army, I know that all military personnel in the Armed Forces, whether Navy, Army or Air Force, when the transfer to the Amazon region takes place_ and hundreds of families have been transferred for decades_ they use hydroxychlorquine or even chloroquine. And what risk do they have? None.

Q:How do you evaluate the deaths that occurred in Manaus due to the use of the medication?

A: There was work in Manaus, which in my view is something worthy of a crime.

Toxic doses were given to patients, up to five times more than the therapeutic dose, leading to the death of these people.

This group of scientists proved that when a lethal dose is given to a patient, lethality happens. This fact confused society. The doctor is part of society and when he sees this there, he is not used to using these drugs and this failure ends up happening. The result of this was that we ended up wasting a lot of time and certainly a lot of lives.

Q: What is the profile of the patient who will receive the medication and in what way?

A: It is not for everyone to use. There is no medicine for 200 million inhabitants. Who should use the medication are the professionals in the risk area, who are on the front line of Covid-19, working in CTI, Emergency Room, hospital or UPA. These need to be paid preventively. Another audience that also needs to be medicated is that of people who had contact with someone who had Covid-19 and developed the disease. If your wife, son, father, or mother, for example, developed the disease, you need to take the medication to keep from developing too. I’m talking about the use of Ivermectin, hydroxychloroquine used in a preventive way. However, we are not talking about a medication protocol, since there is no miracle drug. We are talking about a care protocol, which provides, for example, what to be used in phase 1 of the disease, in phase 2a, in phase 2b and in phase 3, for example. The disease has several stages and each medication must be used by the doctor, with a medical prescription. There is no use going out desperate to buy medication, using an unnecessary way. This means that those who really need it end up not having access.

Q: Why is there still no scientific evidence for the effectiveness of these drugs in the case of Covid-19?

A: It is necessary to understand that there are the types of scientific evidence, scientific evidence and scientific evidence required by medical societies. Medical societies, where you find a doctor with a doctorate, post-doctorate, demand in peacetime, that you have to have scientific proof, that is, it takes months and years for a medication to be considered level A, B or C of evidence scientific. These are steps that cannot be skipped. It is logical that there is no scientific evidence of the way that some political and health authorities want. It is an insane thing for you to require scientific proof for nothing. What I’ll do? I’m going to let the patient run low, fold your arms and say you have no proof? Likewise, there is no evidence that if you intubate a patient with Covid-19 he will survive, so why am I not intubating him? There is no scientific evidence for this disease for practically nothing because the treatment framework for Covid-19 is empty.

Someone needs to be bold enough to go there to complement this picture. Either I start to put some medications or I leave the board empty. Bureaucratic medicine loses ground in times of war and in times of pandemic. No living doctor experienced a pandemic 100 years ago. So you need flexibility, boldness, humility, let go of pride and vanity, acknowledge mistakes, start over and that is not easy. Now if you think about the good of the population and the lives that can be saved, this task becomes easier. Look at the privilege we are having! A wonderful geographical privilege! We had this pandemic beginning in Asia, back in China, went to Oceania, Europe, North America and finally arrived here in South America. Many doctors in the world had positive and negative experiences without having time to publish a scientific article in indexed magazine.

This privilege is wonderful because we can see who had a positive result and copy it here. If a Brazilian doctor, Marina Bucar, presented a series of positive results back in Spain, with the same protocol that we have implemented here in Campo Grande, will I refuse to do it and cross my arms?

If the Jewish doctor, Dr. Vlademir Zelenko in New York saved more than 500 people with this protocol, will I say no? Will I wait for the scientific journal? There is no time because the hospitals are getting crowded.

Campo Grande is even more privileged because we are in the middle of the country, since this epidemic first arrived in São Paulo, the financial capital of the country, went to the administrative capital: Brasília, followed to the capital of Tourism: Rio de Janeiro and Manaus , for example. So doctors in those locations had to take action. In Belém do Pará, for example, Unimed made this protocol that we are implementing in Campo Grande when what we call the Health collapse was happening, which is when hospitals close their doors. People were unable to enter hospitals because it was padlocked. They died at the unit’s door. Do we want this for our city? No. When that happened in Belem they adopted this protocol and within a week they solved the problem. If this is not scientific evidence, for me, nothing else will be.

Porto Feliz, in São Paulo, adopted the same measure, that is, more action and less bureaucracy since we have no time to lose.

Q: Are these drugs bad for your health?

A: People are afraid of the possible side effect of the medication. I do not. I’m afraid of the effect of the virus, Covid-19. Let’s say that if I have to take the medication for five days and on the third day I have side effects, what do I do? I stop taking it, just that. The medication is not going to kill me. If I take it and give me diarrhea or vomit I stop. There are people who can’t take contraceptives, others can’t take Dipirona, it’s simple.

Q: Why is there so much resistance on the part of governments to adopt the use of these drugs as a protocol?

A: Do not know. Because it is useless to use rational arguments for something irrational not to adopt the service protocol. If I say that no Intoxication Center has registered the death of someone from the use of these drugs over the age of 35, it is a rational argument. If I say that all military personnel receive hydroxychloroquine and none have died over the past 50 years, it is a rational argument. If I say that the people who have it is lupus, psoriasis they use for years is a rational argument. If I say that if the person has any side effects, just suspend the use, it is a rational argument. So there is no point in using rational arguments for something that is irrational, that I cannot understand.

Q: What are the risks that municipalities like Dourados run in not adopting this protocol?

A; Losing lives that could be saved.

Q: What motivated you to oppose a good part of the medical profession and defend the use of this protocol?

A: What motivated me was the fact that I see that I do not need an indexed scientific journal to take my course, in addition to perceiving other colleagues successfully, listening and having this flexibility and having the courage to do it here in Campo Grande.

I think the moment is not one of nitpicking, but of union. This is not the time for us to be divided. Doctors, population, managers, in short, everyone will benefit from it: managers for saving lives, doctors feeling fulfilled in their profession and the population losing their morbid fear of this virus, knowing that there is an effective treatment. We need to stop this political issue.

My fear cannot be greater than my responsibility as a doctor. It is unthinkable for a health professional to want scientific evidence at the time of tragedy. Medicine has never grown so much in major world wars or pandemics because bureaucrats are losing space. It is time for doctors of action and daring to act. So I think we are blessed, let’s put everything aside and let’s think more about our population. It’s very simple, the people who complicate it. When human beings want to complicate, they complicate.

Postscript:  See Also Local doctor pushing proven treatment of COVID into national debate from the Desert Review, Imperial Valley, California

From Dr. George Fareed’s letter to President Trump and the Task Force:

In my attempts to keep people alive, I have had an opportunity to use many different types of treatments — remdesivir, dexamethasone, convalescent plasma replacement, etc. Yet, by far the best tool beyond supportive care with oxygen has been the combination of hydroxychloroquine (HCQ), with either azithromycin or doxycycline, and zinc. This “HCQ cocktail” (that costs less than $100) has enabled me to prevent patients from being admitted to the hospital, as well as help those patients that are hospitalized.

The key is giving the HCQ cocktail early, within the first five days of the disease.

Not only have I seen outstanding results with this approach, I have not seen any patient exhibit serious side-effects. To be clear — this drug has been used as an anti-malarial and to treat systemic lupus erythematosus as well as rheumatoid arthritis, and has over a 50-year track record for safety. It is shocking that it only now is being characterized as a dangerous drug.

Moreover, I am in my seventies, and I (as well as some other older physicians in the hospital) use hydroxychloroquine and zinc as prophylaxis. None of us have contracted the disease despite our high exposure to COVID patients nor have we experienced any side-effects.

Despite the characterization in the mainstream media as the drug being “ineffective” and “dangerous,” the evidence in the literature tells a different story. I am not only an “MD,” but a former Harvard Medical School assistant professor and UCLA School of Medicine associate professor as well and am very competent at evaluating studies.

There is ample evidence now that the HCQ cocktail is effective and there is no good evidence that there are significant side effects.

I am writing to you out of the frustration of knowing that there is a solution, but watching as our country flounders in dealing with COVID-19. In my opinion, tens of thousands are dying unnecessarily. Our current approach of waiting for these high-risk patients to become ill and then hospitalizing them is failing. The answer is early diagnosis of the high-risk individuals, and then treating them as outpatients with the HCQ cocktail to prevent hospitalization.

So, what I am proposing is a drastic shift from our current approach: we need to ramp up our outpatient efforts of treating COVID-19 to decrease the burden on hospitals and save lives.

Such an approach requires an effective outpatient treatment — we have that in the HCQ cocktail.

Addendum:  Study from Portugal shows persons using HCQ for another condition were protected from coronavirus. Chronic treatment with hydroxychloroquine and SARS-CoV-2 infection.

By analyzing the Portuguese anonymized data on private and public based medical prescriptions we have identified all cases chronically receiving HCQ for the management of diseases such as systemic lupus erythematosus, rheumatoid arthritis, and other autoimmune diseases. Additionally, we have detected all laboratory confirmed cases of SARS-CoV-2 infection and all laboratory confirmed negative cases in the Portuguese population (mandatorily registered in a centrally managed database). Cross linking the two sets of data has allowed us to compare the proportion of HCQ chronic treatment (at least 2 grams per month) in laboratory confirmed cases of SARS-CoV-2 infection with laboratory confirmed negative cases.

Results: Out of 26,815 SARS-CoV-2 positive patients, 77 (0.29%) were chronically treated with HCQ, while 1,215 (0.36%) out of 333,489 negative patients were receiving it chronically (P=0.04). After adjustment for age, sex, and chronic treatment with corticosteroids and/or immunosuppressants, the odds ratio of SARS-CoV-2 infection for chronic treatment with HCQ has been 0.51 (0.37-0.70).

Conclusions: Our data suggest that chronic treatment with HCQ confers protection against SARS-CoV-2 infection.