A recent post doing the rounds on social media claims that Italy may have found a remedy to treating COVID-19. It also makes several assertions about the novel coronavirus's nature, what it does to a patient's body, and how it is being treated by doctors today. We received the query on mail as well.
The claims have been oversimplified, and are a clear example of ‘pseudo-science’, Dr Sumit Ray, a critical care specialist from Delhi, tells FIT. “Findings from scientific data have randomly been mixed up, twisted and misrepresented.”
We break down each of these and verify them for you.
Claim: It Is Not a Virus, but Bacteria
The message states, “Italian doctors have found that it is not a virus, but a bacteria that causes death.”
It is a known fact, however, that COVID-19 disease is caused by the novel coronavirus (belonging to a large family of viruses which may cause illness in animals and humans), first encountered in China’s Wuhan in December 2019; and this has been reiterated time and again by leading health organisations and government advisories.
The World Health Organisation (WHO) says, “The new coronavirus is a respiratory virus which spreads primarily through droplets generated when an infected person coughs or sneezes, or through droplets of saliva or discharge from the nose.”
The message talks explicitly about Italy, but even the Italian Ministry of Health has explained in its FAQ, “A novel coronavirus (nCoV) is a new strain of coronavirus never previously identified in humans.”
Dr Sumit Ray tells FIT that some COVID-19 patients may develop a secondary bacterial infection, but the primary pathogen that infects them and causes the illness in the first place is always SARS-CoV-2: a virus.
Claim: COVID-19 Causes Blood Clots; It Is Nothing But Disseminated Intravascular Coagulation (DIC)
This is only partly true, and has been exceedingly oversimplified and generalised.
It is known that the scientific community has found evidence of blood clots in some patients, as FIT had earlier reported, “A subset of coronavirus infected patients are developing ‘thrombosis’ or formation of blood clots within the blood vessels - which is also the possible reason for kidney damage, neurological issues and heart-related problems.”
In a guideline for COVID-19 related death reporting, the Indian Council of Medical Research (ICMR) acknowledged blood clotting in blood vessels as a cause of deaths. It said, "COVID-19 is reported to cause pneumonia/acute respiratory distress syndrome (ARDS), cardiac injury, disseminated intravascular coagulation and so on. These may lead to death."
Autopsy reports too have shown COVID-19 has a role in inducing coagulopathy and some people's lungs were filled with many micro-clots. As a result, some severe patients are being given anticoagulants and blood thinners as prophylaxis to fight the challenge.
Dr Sumit Ray. however, told us that bleeding can be a possible side effect of blood thinners, so their use needs to be carefully moderated. There has to be a balance between blood-thinning and clotting.
But is COVID-19 the same as DIC? And is DIC the only reason for COVID deaths?
This is where the claim falters. Not all patients of the disease develop the complication, with more than 80 percent being mild or asymptomatic and 5 percent having the possibility of converting into critical cases. Only a subset of the critically ill group ends up developing DIC, and even though it is one of the leading causes of deaths from COVID-19, it is not the only one.
Dr Ray explains, “DIC is one of the causes of death, along with ARDS, severe cytokine storm or a secondary bacterial infection and so on. This is true in almost all infections, the degree of risk from each factor may vary for different illnesses.” For instance, based on the evidence that exists so far, DIC is relatively more common in critically ill COVID-19 patients who die, and ARDS and bacterial infections in H1N1. But these are spectrums, the complication exists in other diseases too, by varying degrees.
According to a Lancet report from 6 April, respiratory failure has been found to be the leading cause of death from the disease.
Claim: COVID-19 Can Be Cured With Antibiotics & Anti-inflammatory Drugs
It needs to first be established that till date, there is no approved treatment or cure for the disease and patients are being treated symptomatically, accompanied by supportive care. Italy’s health ministry states the same, "at present, there is no specific treatment for the disease caused by the new coronavirus. Treatment remains mainly based on a symptomatic approach, providing supportive therapies (e.g. oxygen therapy, fluid management) to infected people, which can nevertheless be highly effective.”
But are anti-inflammatory and antibiotic drugs being used for all COVID19 patients? The prescription varies based on the patient.
For instance, to reduce a patient’s fever, doctors can prescribe paracetamol, but other drugs of this variety are used less often, as they may cause kidney damage in this particular setting. This is why self-medication can be dangerous, and medical supervision is a must. “They can be counterproductive in critically ill patients with high fever or ARDS,” Dr Ray says.
“WHO does not recommend self-medication with any medicines, including antibiotics, as a prevention or cure for COVID-19,” a spokesperson for WHO Philippines told AFP in an email on April 29, 2020.
1. ANTI-INFLAMMATORY DRUGS
Although these are not commonly used, Dr Ray explains that in some critical cases of COVID-19, an overreaction of the immune system can lead to a condition known as a cytokine storm, which causes inflammation. In such patients, anti-inflammatory drugs or steroids may be given to patients because the immune system has taken a hit, but again, it would depend on the particular case.
According to the NHS too, paracetamol may be a safer bet with fewer side effects in COVID19 patients.
2. ANTIBIOTICS
The use of antibiotics, again, only makes sense for patients who do develop a secondary bacterial infection or perhaps have the potential to develop one; and not for all patients.
This is because antibiotics are used only against bacteria, not viruses, as the WHO has also clarified. It says, “The new coronavirus is a virus, and, therefore, antibiotics should not be used as a means of prevention or treatment. However, if you are hospitalised for the disease, you may receive antibiotics since bacterial co-infection is possible.”
3. BLOOD-THINNERS
“Blood thinners will be given in severe cases, but they cannot be administered just like that, because their use could lead to complications. A patient could die of bleeding if their dosage is not checked. Again, every COVID patient does not need them,” Dr Ray explains.
A study at a New York hospital involving 2,733 patients found that using blood thinners can boost the chances of survival for severe COVID-19 patients. The results were published on 6 May in the Journal of the American College of Cardiology. Valentin Fuster, a physician in chief at Mount Sinai Hospital and one of the study’s authors said, “My opinion is cautious, but I must tell you I think this is going to help.” Doctors believe, however, that they need to be conservative in their approach, as the fine balance between bleeding and clotting needs to be considered.
Blood thinners, Dr Ray also says, are used when there is a possibility of coagulation in an ICU patient, but the doses will increase when we see a clear indication of clotting, which can be established through tests. This is not a blanket treatment and will have to be monitored on a case-by-case basis, considering the risk of bleeding.
“Taking aspirin in such settings will not help. The role of aspirin is very different,” he adds.
A systematic review of 73 studies by the WHO looked into some nonsteroidal anti-inflammatory drugs such as ibuprofen and aspirin and concluded, “At present, there is no evidence of severe adverse events, acute health care utilization, long-term survival, or quality of life in patients with COVID-19,” as a result of the use of NSAIDs.
A clinical trial on the use of aspirin is ongoing, and the results are expected in June.
Claim: Ventilators, ICUs Not Needed for COVID-19 Patients
As established, only 5 percent of the total infected patients turn critically ill. For those among these patients whose lungs are damaged and their oxygen supply is severely obstructed, ventilator support will be needed.
“The COVID patients who develop ARDS, for instance, will need ventilation. Patients with DIC may not need it, BUT it depends on many complex factors. If your oxygen levels fall dangerously low, a ventilator may be the only option,” Dr Ray explains.
While non-invasive methods are opted for in patients who don’t need a ventilator, it is almost certain that for the small subset whose lung alveoli is severely damaged, the latter may be necessary.
Dr Suranjit Chatterjee, a senior consultant of internal medicine at Indraprastha Apollo Hospitals, also told FIT that critically ill patients who need oxygen support are being ventilated, but this is usually done in a later stage.
Importantly, he says that the medical community is still in very early stages of the disease, and any claims made about the treatment or cure of the infection should not be believed unless further trials and studies are seen.
“These are complicated decisions meant for critical care specialists to finally evaluate the modality of a particular treatment,” he says.
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