The promotion of miracle cures politicizes the response to the pandemic in Latin America

The promotion of miracle cures and false preventive treatments against covid-19 is trading on the rise in Latin America where, despite the measures taken by governments and confinements, not all places have been able to stop the coronavirus curve. In the absence of a vaccine, the promotion of drugs and solutions whose effectiveness is not scientifically proven - and sometimes with evidence of negative effects - is being used by opportunists and leaders as a way to sell hope in the midst of uncertainty and fear. to contract the disease.

At the center of the debate on cures sold as miracle cures are chloroquine and hydroxychloroquine, two generic drugs used for decades to treat diseases such as rheumatoid arthritis, malaria or malaria. The World Health Organization (WHO) advised them against the fight against covid-19, but they have found firm allies in leaders as controversial and far away on the ideological spectrum as the presidents of the United States, Brazil or Venezuela. The politicization of the two drugs, which were exhausted in many countries, and whose misuse has led to deaths, puts the medication at the center of polarization to the point that, in Brazil, fans of President Jair Bolsonaro defend them with fervor, while those who dare to criticize them are branded "communists".

Desperation is also leading the population to resort to other drugs or concoctions whose efficacy has not been proven in the fight against coronavirus: from herbs, homeopathy and vapors to strengthen the immune system to solutions that, according to health agencies, can be harmful such as the antiparasitic Invermectin, the antiviral remdesivir or chlorine dioxide, a substance that confronts the interim Government with the opposition parliament in Bolivia and that promoted a group of bishops in Ecuador, causing the rejection of the country's medical societies.

Bolsonaro, the prophet of hydroxychloroquine

If there is a prophet of hydroxychloroquine in Latin America, it is Jair Bolsonaro. The Brazilian president has for months defended the use of this drug as a treatment against covid-19, although its effectiveness has not been scientifically proven. The president did not hesitate to take it live and transmit it on his social networks last July, when he was infected with coronavirus. Although he said he was not advertising, the exaltation of his supposed benefits is a constant in his speeches. "As they say that I am advertising, I will, but you have to consult your doctor," he once warned his followers with a box of the drug in hand.

That defense has not been left alone in the official discourse. After two doctors (Luiz Henrique Mandetta and Nelson Teich) stepped down as Minister of Health due to differences with the president regarding recommendations on chloroquine, Bolsonaro was finally able to implement a national protocol to encourage its use in public hospitals. It was last May, under the leadership of its third Minister of Health, the military Eduardo Pazuello. Although there are studies that warn that the harm of the substance may be greater than the benefits in patients with covid-19, the Brazilian protocol was extended to pregnant women and children.

Doctors are the ones who decide whether or not to prescribe the remedy and the patient must sign a document in which he declares to recognize the possible risks of taking it. According to the protocol in force in Brazil, which is consistent with the presidential speech, if the patient takes chloroquine at an early stage of the disease, there is less chance of getting worse and needing a bed in an intensive care unit. Although the thesis is not supported by scientific evidence, in different cities a cocktail of various drugs is being used, including chloroquine, for symptomatic and asymptomatic patients.

A cocktail of generic drugs in Venezuela

In the ideological antipodes of the president of Brazil, hydroxychloroquine and chloroquine have found another apostle in Nicolás Maduro. In a country where even water is scarce, so necessary to maintain hygiene that helps prevent the virus, the population tries multiple formulas to avoid contagion: from concoctions of malojillo and ginger, homeopathy and drops of the antiseptic chlorine dioxide. The therapeutic protocol for covid-19 in Venezuela, which has its health system on the ground and a shortage of medicines, has been through all kinds of treatments and miracle cures announced by government spokesmen. The country sees its epidemiological situation delayed due to low diagnostic capacity and the same seems to be the case with treatments.

In addition, although there is insufficient evidence, blood plasma from recovered patients has also been incorporated into the therapeutic guideline, long before the US government agency FDA approved it with suspicion from the National Institutes of Health due to the weakness of the evidence. Insistently, members of the Government call on the population to donate serum.

A few weeks ago, in addition, the antiparasitic Invermectin was included in the scheme, which was the subject of controversy and serious scientific questions mobilized, in part, by the Venezuelan doctor Carlos Chaccour, a researcher at the Barcelona Institute of Global Health, a specialist in malaria and emerging viruses. Its adoption by several countries has been based on a pre-print (version of a study without peer review) published in the scientific journal The Lancet , which used a dubious database, as happened before with the initial studies on hyroxychloroquine. . Along with this drug, the already scarce antiviral remdesivir, developed for Ebola, has been authorized in Venezuela, which is beginning to be requested urgently on social networks and which can cost more than $ 300 per dose in the informal market, almost 300 times a minimum wage .

Diagnosed patients receive a treatment kit containing Invermectin, the experimental drug alpha interferon, hydroxychloroquine, chloroquine, aspirin, steroids, and vitamin C, depending on the severity of symptoms. Even the asymptomatic receive them. “Therapeutics is a pact of trust. It is a mistake to distribute generic kits when prescribing is an individual act. What Maduro and other presidents have done is intrusion. It cannot be that politicians are prescribing, ”criticizes internist José Felix Oletta, from the Venezuelan Alliance for Health, who also denounces that the rights of patients are violated by administering all these drugs, which are only for compassionate use, without informing about its limitations and possible effects.

The Venezuelan government has also put faith in the Cuban pharmacy with two products still under trial, such as alpha interferon and prevengho-vir homeopathic drops, which are being administered to health personnel, homeless people and the elderly. It is done preventively, because it supposedly raises the immune defenses. Maduro has also targeted Venezuela in human tests on the vaccine developed in Russia, of which there is no further data on its previous phases. The country will provide 500 volunteers.

Chlorine dioxide focuses the debate in Bolivia

The political dispute between the transitory government of Jeanine Áñez and the Plurinational Legislative Assembly, controlled in both chambers by the Movement Toward Socialism - the party of former president Evo Morales - may lead to the approval of a controversial measure in Bolivia. The president of the Senate, Eva Copa, gave an ultimatum to the president to promulgate the law that authorizes, in an exceptional manner, the elaboration, commercialization, supply and use of chlorine dioxide for the prevention and treatment of covid-19, after have been approved unanimously by the opposition bench. Otherwise, he said he will enact the law. "It is due to the need of the Bolivian people," she justified.

The Andean nation could thus become the first country in the world to allow human consumption of this chemical as a "preventive treatment" against the coronavirus. The World Health Organization (WHO) has advised against the prescription of this compound, since its main use is as a bleach or to decontaminate industrial surfaces. In the face of people's despair, chlorine dioxide is sold in Bolivia without a prescription as a "miracle cure" against covid-19, despite the absence of any scientific evidence.

The Health Ministry has threatened legal proceedings against anyone promoting the use of chlorine dioxide as a treatment for the coronavirus. Despite this, at least 450 doctors made up a committee that recommends its use. At the same time, the legislative assemblies of four departments have approved laws for the free and supervised production and distribution of the substance, while in other municipalities tests are carried out on volunteers who present symptoms to verify its effectiveness.

With more than 110,000 positives and a death toll of nearly 5,000, the Andean country faces the pandemic with an almost collapsed health system, without access to medicines and in the midst of one of the worst political crises in its history, which is spreading since last November pending the presidential elections, postponed by the pandemic, and set for October 18.

Vitamin C and seawater injections in Ecuador

Homemade solutions and miracle treatments have coexisted during the pandemic in Ecuador with trial and error in hospital protocols. In the first months, the public health network was betting on hydroxychloroquine or azithromycin to treat coronavirus patients receiving medical attention, since, before the collapse of health centers, less serious patients were sent directly to their hospitals. houses. Even today, there are doctors who continue to prescribe antibiotics, paracetamol, aspirin, mega doses of vitamin C and even ivermectin injections, for veterinary use.

Esteban Ortiz, a public health researcher at the University of Las Américas, questions that hospitals and authorities adopt experimental treatments such as Remdesivir, with 1,900 doses donated by the United States, without a follow-up study. "The State did not even have time for diagnoses and the work was very disorganized," he says. Now, he clarifies, hospitals apply specific treatments to each patient based on the symptoms they present. Corticosteroids, according to the WHO guidelines, are the main formula for fighting the symptoms of covid-19.

These changing medical patterns have coexisted in the country with eucalyptus sprays, garlic recipes that depleted stocks in stores, markets and supermarkets for weeks, seawater injections and two of the unscientific treatments that have also proliferated in other countries: plasma from cured patients and chlorine dioxide. "Tocilizumab ampoules have been prescribed and even today we see people asking for plasma donations even though it has not been studied enough to ensure its effectiveness," the researcher questions.

Chlorine dioxide became a recommendation in Ecuador at the beginning of July when a letter signed by 10 bishops of the Catholic Church circulated to President Lenín Moreno to promote it as an alternative treatment. In reaction, the country's medical societies came together to reject its use and confirm its toxicity to humans. The Ecuadorian National Agency for Regulation, Control and Sanitary Surveillance (Arcsa), finally, advised against its application to citizens because it does not have a sanitary registry and prohibited its consumption and commercialization as a therapeutic method against the coronavirus.