Despite being defended by Brazil’s president, Jair Bolsonaro, the so-called “kit covid” or “early treatment” for coronavirus contributes to increasing the number of deaths of critical patients, according to doctors responsible for intensive care units consulted by the BBC.
More than a year after the onset of the pandemic in the South American nation, Bolsonaro continues to support the use of drugs such as hydroxychloroquine and ivermectin, although several research indicates that these drugs are not effective in the treatment of covid-19.
“Many have been saved in Brazil with this immediate assistance. In this same building (the government palace of Planalto, in Brasilia), more than 200 people contracted covid and almost all, as far as I know, including me, sought this Treatment with a number of products such as ivermectin, hydroxychloroquine, azithromycin,” the representative said earlier this month.
However, scientific research notes that these products have no effect on the prevention or early treatment of the virus. And doctors from hospitals consulted by BBC News Brazil say that the defense and use of the so-called “kit covid” contribute in different ways to increasing deaths in the country.
In total, the country recorded more than 11.6 million contagions and around 282,000 deaths as of March 16.
The recent increase in cases is attributed to the spread of highly contagious variants of the virus.
Intensive care doctor Ederlon Rezende, coordinator at a public hospital in Sao Paulo, notes that between 80% and 85% of people who were infected will not develop a severe form of covid-19.
For these patients, he explains, the use of the “covid kit” does not help at all. It also cannot cause harm if the person does not take excessive doses, does not develop side effects, or has conditions that can get worse with these medications.
But for 15% or 20% who need hospitalization, these medications can complicate treatment and contribute to Your Death.
“The biggest concern is about the 15% who develop a severe form of the disease and end up reaching the intensive care unit. It is in these patients that the adverse effects of these drugs occur most often, having an impact on their survival,” says Rezende, who was president of the Brazilian Association of Intensive Medicine.
Despite the questions, Bolsonaro defends the use of the “kit covid”. IMAGE SOURCE: REUTERS
Another factor pointed out by experts is that the “covid kit” can have indirect effects.
They indicate that its use causes delays in the search for clinical care by the infected, absorbs public resources that could be used for support drugs in situations of intubation and diverts attention from appropriate treatment protocols.
“There were some mayors who distributed a bag with the ‘covid kit’ and people who thought that taking these drugs would never have the disease. They then took too long to seek help when they became ill,” explains Carlos Carvalho, director of the Pneumology Division of a hospital in Sao Paulo.
Among the harmful effects of seeking late attention is intubation, when the lung is already seriously injured by the effort to breathe.
Patients who receive an oxygen mask or invasive mechanical ventilation before reaching acute respiratory failure are more likely to survive, intensive care physicians explain.
“Lack of centralized organization and uncoordinated information on ineffective medicines contributed to the greatest lethality in our population. I won’t say it accounts for 1% or 99% (of deaths), but it did,” adds Carvalho, who is also a university professor.
The pneumologist Carmen Valente Barbas states that most of the people she serves came to products of the so-called “kit covid”.
“Most are taking these medications. In every video consultation I make, people say they are taking them and taking them in large doses,” he told BBC News Brazil.
Brazil is one of the countries hardest hit by the pandemic. IMAGE SOURCE: REUTERS
The biggest concern of intensive care physicians is the side effect on patients who arrive at severe risks for the virus and who are already committed to the functioning of the virus of his vital organs.
“These medications don’t help, don’t prevent intubation, and have side effects, such as hepatitis, problems Renal, more bacterial infections, diarrhea, gastritis,…,” adds Beards.
Hydroxychloroquine, suggested by Bolsonaro on several occasions, is a commonly used medicine in patients with lupus, rheumatoid arthritis, photosensitive diseases and malaria.
Ivermectin, also part of the “kit covid” is a deworming used to fight worms, lice and ticks.
Azithromycin is an antibiotic that, according to doctors, should only be used in case of bacterial infection and not to prevent a virus.
Arrhythmias, delusions and kidney problems
Ederlon Rezende is one of the experts who warns that hydroxychloroquine can cause cardiac arrhythmia, just one of the possible side effects of the drug.
In a patient who develops a case of critical covid-19, it can have a critical side effect, because the disease caused by the coronavirus also affects the Heart, by promoting inflammation of the heart muscle and thrombosis in vessels and tissues.
The Brazilian government invested millions of dollars in unproven drugs against covid-19. IMAGE SOURCE: REUTERS
Rezende also notes that he observed problems in patients who need to be sedated for intubation and who wake up from sedation with greater mental confusion from the abusive use of ivermectin before arriving at the hospital.
“The patient, awakening from intubation, may experience delirium. In patients with covid this is very common, because the virus crosses the blood brain barrier and affects the brain, especially the frontal region, causing inflammation,” he explains.
“Invermectin is a drug that also penetrates the brain when inflamed, further depresses the brain and worsens the awakening quality of the intubated patient. This has been a common complication in patients who used this medicine before reaching intensive care.”
ivermectin, he says, can also cause kidney damage, which makes it difficult for a patient with severe covid to heal, as the disease has the potential to cause kidney complications and require haemodialysis.
In recent weeks, Bolsonaro began mentioning nitazoxanida, known as Annita, as a candidate to be part of the covid kit.
The problem, besides not having any scientific evidence of effectiveness, is that people started taking this product along with ivermectin, poisoning the organism, as seen by Cármen Valente Barbas.
“The interaction of these drugs together is dangerous. People are taking Annita along with ivermectina and that’s absurd,” she says.
Another problem warned is the recent inclusion of corticosteroids in the “covid kit”.
Research shows that corticosteroids help reduce mortality among critically ill patients who need mechanical ventilation through masks or intubation.
But for the rest of the population its use can cause serious problems.
In Brazil they claim that patients seek “too late” medical care because they relied on the “covid kit”. IMAGE SOURCE: REUTERS
“For patients who are not symptomatic or asymptomatic, corticosteroids can even decrease immunity and cause other diseases. And, many times, (local authorities) authorized the use of a corticosteroid along with Antibiotics“Carlos Carvalho says.
“If the patient gets worse and has an infection, they will have a more serious infection because they are taking an immunosuppressive drug and will have an antibiotic-resistant bacteria that they burned, using it inappropriately,” he explains.
For his part, physician Jaques Sztajnbok also says that the “preventive” use of azithromycin and Corticosteroids inside the “covid kit” causes more mortality.
“If you give corticosteroids to a patient unnecessarily, their performance will be worse,” he said to BBC News Brazil.
The “false security”
Among the indirect consequences of the “covid kit” is, according to intensive care physicians, the “false safety” produced by these medicines, delaying the pursuit of medical care.
A recurring problem in Brazilian intents and seek care units, they say, is the arrival of critically ill patients who, feeling protected by hydroxychloroquine and the like, sought medical help when it was too late.
“This self-treation gives false security and people tend to further delay the search for care when it evolves to an fserious orma,” says Ederlon Rezende.
Among the risks of seeking help too late is damaging the lung to the point that the problem cannot be reverse with mechanical ventilation and intubation.
“The longer it takes between the need for intensive care and effective admission to the hospital bed, the higher the mortality,” says Sztajnbok.
The longer it takes between the need for intensive care and effective admission to the hospital bed, the higher the mortality. IMAGE SOURCE: REUTERS
The pneumologist Barbas, for her part, adds that acute respiratory failure can quickly evolve to death.
“Their condition can get worse very quickly and people can die at home, without having time to get to the hospital,” he says.
Proven treatment resources
Perhaps the biggest cause of death caused by the federal government’s focus on defending ineffective drugs is spending money and time.
These resources could be used to purchase equipment, vaccines, and produce a national protocol with guidelines for caring for critically ill patients with covid.
Unlike in European countries and the United States, after a year of pandemic, the Brazilian Ministry of Health did not produce a document with information to follow by health professionals.
“Time was wasted discussing early treatment without any scientific evidence and did not invest in disseminating effective care information for critical patients and techniques to identify respiratory failure,” says researcher Fernando Bozza, author of a survey that revealed that 80% of patients intubated in Brazil in 2020 died.
In addition, resources that could have been earmarked for the procurement and distribution of medicines needed for intubation or the creation of intensive care beds were spent on the purchase of chloroquine and other elements of so-called “early treatment”, without scientific evidence.
Data accessed by BBC News Brazil showed that the government’s spending on Bolsonaro hydroxychloroquine, Tamiflu, ivermectin, azithromycin and nitazoxanide exceeded US$16 million through January this year.
Meanwhile, doctors and pharmaceutical associations warn that the arsenal of drugs needed for intubation is about to run out.
For this reason, the pneumologist Barbas claims that lives could have been saved if resources had been invested in scientifically proven solutions.
“And it’s an expense that could also be used to buy vaccines,” he says