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Wednesday, February 24, 2021

“Some drugs that we gave to patients with COVID-19 could have been harmful”

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Although more than a year after the emergence of COVID-19, much more is known about the disease and its management in patients with different degrees of severity, the truth is that, in the meantime, more than two million people worldwide lost their lives.

“Doctors long for the agency, a power they can use to change the course of a sick patient’s life, however, For me and countless doctors, nurses and other healthcare professionals, COVID-19 has been a grim lesson in humility. Although we have learned a lot about this disease in such a short time, we are not yet assured of the ability to change the fate of patients with serious infections. Haider Warraich is a cardiologist and researcher at Brigham and Women’s Hospital, associate director of the heart failure program at VA Boston Healthcare System and instructor of medicine at Harvard Medical School, and has been featured in an American media op-ed for the Boston Globe. Media wondered if more people are currently surviving COVID-19 because doctors are doing less.

“Last month, as my colleagues and I took care of Mrs. Smith (not her real name), a middle-aged woman hospitalized with COVID-19, every day felt like an education on learned helplessness,” she recounted. No matter what our team did, his infection kept getting worse. At first, I was breathing only ambient air. Then, needed extra oxygen provided by a small tube placed under the nostrils. After that, he needed more oxygen through a mask. We gave him the drug remdesivir, but he didn’t get better. We gave him steroids in high doses, but he did not improve. We even gave her the antibody cocktail that President Trump and many of his high-profile allies received, but she did not improve. Mrs. Smith’s fever rose, her breathing worsened, and her spirits sank. Every time she called her husband, she was looking for a silver lining, but all she could share was one decrease after another. “

Thus, the specialist stressed that despite his best efforts, “She was transferred to the intensive care unit and connected to a mechanical ventilator to breathe for her. Shortly after he had a heart attack and, in a matter of days, he died “.

"A year after the pandemic, perhaps we now know more about what not to do. Perhaps fewer people die because doctors are forced to be introspective and careful," said Haider Warraich (Prepped Health)

For him, “like many other viral infections, COVID-19 became a graveyard for therapeutic interventions.” “The research my team carried out showed that over a period of two months At the beginning of this pandemic, American doctors wrote half a million prescriptions for hydroxychloroquine and The Food and Drug Administration (FDA), despite having no real evidence of its benefit in COVID-19, prematurely issued an emergency use authorization for the drug, which it later revoked due to concerns about heart complications”.

Then he reviewed how he Remdesivir, an antiviral drug, was approved by the FDA to treat COVID-19 in October 2020, “although the data supporting its use was marginal at best. Less than a month later, the World Health Organization recommended not to use it “.

He collected plasma Of People Recovering From COVID-19, Another Widely Publicized Treatment, “Turned To Be Useless In Patients With Moderate To Severe Infections”, noted Warraich, for whom “even antibody cocktails, often touted as a cure for the novel coronavirus, have not yielded favorable results: Clinical trials testing the antibodies developed by Regeneron and Eli Lilly among hospitalized patients have been stopped because the treatment is not effective ”.

And after ensuring that “To date, the only drug therapy that seems to clearly help critically ill COVID-19 patients is steroids”, the expert stated: “Now there is concern that some of the drugs we were giving COVID-19 patients were more than useless; in fact, they could have been harmful “.

He says this in reference, for example, to the fact that at the beginning of the pandemic, doctors noticed that COVID-19 patients had a propensity to form clots within blood vessels: much was said about the “hematological factor” of infection that could cause stroke or pulmonary embolism. “Doctors around the world started giving blood thinners to COVID-19 patients and some medical societies offered guidelines for aggressive use of these drugs. In an online survey, the majority of physicians indicated that they would prescribe high-dose blood thinners to COVID-19 patients who are believed to be at high risk for blood clots, ”Warraich noted in her opinion column.

04/28/2020 A health worker at the door of the room of a patient admitted to the Intensive Care Unit of the Infanta Sofía Hospital in San Sebastián de los Reyes (Madrid) where the head of the center

However, When the US National Institutes of Health (NIH) studied anticoagulants in a randomized trial, “the treatment was not only useless, but it could have been harmful for patients with severe COVID-19 infection by increase bleeding“, Said the expert, who added:” The trial was recently stopped in that group because a potential for harm in this subgroup could not be excluded. “

Another major international anticoagulant trial also halted the enrollment of critically ill patients, although enrollment of COVID-19 patients with less severe disease continues as no risk of harm was identified in those groups.

Blood thinners are far from the only treatments doctors gave COVID-19 patients that may have made things worse. Warraich said. At first, many physicians aggressively placed patients with low oxygen levels, but otherwise not critically ill, on respirators, an approach that carries both short-term and long-term risks.

All of these negative results make you wonder if a major reason COVID-19 death rates are dropping may not be because testing has been expanded or more is being done to combat the disease, “but because doctors are doing less. for patients who suffer from it “. “One year after the pandemic, we may now know more about what not to do. Perhaps fewer people die because doctors are forced to be introspective and careful ”, he considered.

For him, looking back, physicians should have made it easier to enroll patients in trials in order to learn more quickly about the impact of their actions. “While US academic physicians have published thousands of articles related to COVID-19, their contributions to randomized clinical trials, the gold standard of clinical evidence, have been limited,” he said. The UK has done a much better job enrolling patients in trials even though it is also being hit hard by the pandemic. “

AND, Although he acknowledged that “little” progress was made in the search for a cure for the disease, he highlighted that “exceptional progress was made in the search for ways to prevent the spread of the infection– From public health measures like wearing masks and physical distancing to the development of two incredibly effective vaccines now approved for use, and likely more to come, the ability to prevent this infection is sure to be the way you get out of it. this pandemic ”.

And he concluded: “I wish I had the audacity to take credit for cases that were not the fate of Mrs. Smith, but the truth is that when it comes to COVID-19, prevention has triumphed over our failed search for a cure. The need to control the spread of the virus has become even more crucial as we try to build a bridge to widespread vaccination”.


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