Mark Goloviznin
Candidate of Medical Sciences, Associate Professor of the Department of Internal Medicine, Faculty of Dentistry, Moscow State University of Medicine and Dentistry. A. I. Evdokimova, member of the Council of the Association of Medical Anthropologists. Research interests: immunology, interdisciplinary research, medical anthropology.
People who choose to be treated for COVID-19 at home without going to a doctor are often unaware of the results self-medication can lead to. RBC Style talked about the hidden risks of such a decision with an immunologist.
- What can you take to prevent coronavirus without going to a doctor?
- In order to answer, it is best to abstract from the current pandemic. Then we get the question that we have heard many times before: "What should be done to prevent respiratory viral infections?" And the answer has long been ready: hardening, vitamins C and D in natural and medicinal form, gymnastics, walks, sports in the fresh air. Regarding the latter, there was even a relaxation of the regime in Moscow. True, from the point of view of medicine, and even common sense, sport is difficult to combine with wearing a mask. Nevertheless, a recent survey showed that one in five Russians (17%), when signs of coronavirus appear, would rather prefer self-medication than a visit to the doctor, while 41% will try to consult a doctor by phone. If so, then it is certainly importantwhat drugs can be used against coronavirus at home.
In early June, the Ministry of Health of the Russian Federation issued guidelines, where, as a prophylaxis for COVID-19 infection, it is recommended to introduce recombinant interferon alpha (IFN-α) through the nose. The document also states that hydroxychloroquine or mefloquine can be used as chemoprophylaxis drugs. It is specified that in a number of foreign countries, drug prevention of coronavirus infection is also carried out with chloroquine.
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- How safe is mefloquine for self-medication and prevention?
- Mefloquine (its analogue "Lariam" is better known) - a drug close to hydroxychloroquine, was synthesized in the United States for the prevention of malaria. For many years, Meflokhin was taken by the American military in Africa, Iraq, Afghanistan. It is noteworthy that in 2013 the FDA (US Food and Drug Administration) issued a warning that this drug, due to its neurotoxicity, caused psychosis and many suicides of military personnel in the US Army and its allies. And he was even called "the military's suicide pill." In addition, people who took this drug experienced irritability, insomnia, and nightmares. It should be said that the effect on the central nervous system is characteristic of all drugs of the chloroquine group, including hydroxychloroquine, but, judging by the publications,it is the safest among analogues. However, treatment with them, and even more so with mefloquine, cannot be an initiative.
- Another method of prevention from the recommendation of the Ministry of Health is the introduction of recombinant interferon alpha (IFN-α) through the nose. When should you take it? How does it work?
- Interferons and interferon inducers have long been accepted in our country for acute respiratory viral infections, and the attitude towards these drugs is ambiguous. From the point of view of fundamental immunology, interferons are proteins that stimulate the antiviral activity of immune killer cells. Alpha-interferon acts at the level of the epithelium of the lungs, gamma-interferon - in the bowels of the immune system. It is known that many viruses, and COVID-19 in particular, inhibit the production of interferons, and from this point of view, the introduction of interferons into the nasal cavity or the induction of their synthesis in the body should be useful and fully justified.
But the fact is that we still do not know everything about how the activation of the cytokine cascade occurs in response to the introduction of an infectious agent. It is known that the cytokine cascade is very mobile and variable. So, there is evidence that it turns into a storm with a decrease in interferon gamma in the blood, but there are also reports of a cytokine storm caused by interferon gamma itself. Apparently, therefore, in the domestic scientific community, the data of Chinese doctors about the effectiveness of so-called "interferon inducers" in COVID-19 were met with skepticism. Of these, Russian pharmacies offer "Kagocel", "Anaferon" and others. Firstly, there are still no convincing results for all of their therapeutic effect, verified using evidence-based medicine, and secondly, our immune system is so individual and so dynamic,that it is probably hardly advisable to induce interferon in the entire population of the country without individual control of its activity.
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- There was information in the news that hydroxychloroquine does not cure patients, but worsens their condition. And so the WHO has banned his testing on patients. How did this drug come into use? Was there a publication in a scientific journal?
- To be more precise, the WHO, in a document dated May 26, recommended a pause until the end of June in the use of hydroxychloroquine for COVID-19 infection outside hospitals, until the results of large-scale clinical trials on its effectiveness and safety are analyzed. It should be borne in mind that from the very beginning, the emphasis was placed, firstly, on the combination of hydroxychloroquine with other drugs, which potentially increased their mutual toxicity, and secondly, on its antiviral effect, which is not entirely obvious.
At the same time, it is known that hydroxychloroquine has an experimentally confirmed mechanism that can be useful in COVID-19 infection - this is the inhibition of cytokine production. This drug has long been known not only as an antimalarial agent, but also as a moderate immunosuppressant. And its effectiveness has been confirmed by evidence-based medicine. Hydroxychloroquine has generated quite a stir in the world, for example, in the United States there is already a shortage of it.
I must also say that before the hype in the media about the effect of hydroxychloroquine in COVID-19, it was written in scientific journals. The very first publication about this appeared in the most authoritative "Nature" at the end of February. An article by ten doctors from Wuhan reported that hydroxychloroquine, together with the antiviral drug remdesovir, can suppress the activity of COVID-19 in experiments on cells. In April, a clinical study was published, carried out in Wuhan in accordance with the evidence-based medicine protocol. 64 patients with COVID-19 were divided into two groups: some received standard treatment with hydroxychloroquine, and others without it. The authors concluded that in the group where this drug was included, fever and cough passed significantly faster. The patients recovered.
I think everything could go on in a calm scientific way, if not for the irresponsible statements of some politicians. US President Donald Trump and Brazilian President Jair Bolsonaro hastily announced that people can be treated for COVID-19 with hydroxychloroquine, which is also cheap. The excitement began, the drug began to be bought in pharmacies. Naturally, the WHO was worried, because hydroxychloroquine is not harmless, especially with self-medication. When taken uncontrollably, it causes a disturbance in the heart rhythm, which can result in death.
In my opinion, the current WHO recommendations are largely dictated by the fear that the situation in the world will get out of control: people will prescribe their own dosage and take this drug without medical advice. In this "confusion and hesitation" it is important to hear the opinion of rheumatologists who have half a century of experience in the treatment of autoimmune diseases with hydroxychloroquine (lupus, rheumatoid arthritis).
So, according to rheumatologists, the drug is not harmless, but the complications from it are not so terrible and quite predictable. Coronavirus is not a reason for discontinuation of hydroxychloroquine in those patients who are already receiving it. It can be used in patients from the moment the diagnosis of COVID-19 is established, but subject to medical supervision with ECG and ophthalmic monitoring. If the infection progresses to a more severe stage, patients should be transferred to the intensive care unit, where treatment will be different. It seems to me that, based on the anti-cytokine effect, hydroxychloroquine will find its use in patients with COVID-19, but the patient should report on its side effects on the heart, nervous system, retina, bone marrow cells and consult a doctor.
- How do people self-medicate for COVID-19? What results does this lead to?
- The first result of any self-medication is the loss of precious time when the disease can be taken under control at an easy stage of the course. The second result is the side effects of drugs taken without a doctor's prescription. Unfortunately, the insidiousness of coronavirus infection lies in the fact that the most dangerous pulmonary symptoms, such as respiratory failure, increase gradually, gradually. In patients, wheezing in the lungs, typical for other pneumonia, may not be detected. There are cases when the characteristic signs on computed tomography were determined in patients with a complete absence of respiratory failure (nonspecific general complaints prevailed in the clinic: severe weakness, fever, headache, muscle pain). As a result - late hospitalization with all the ensuing consequences.
A marked decrease in the level of blood lymphocytes described in some patients, which is also not accompanied by obvious symptoms, is very alarming. Unfortunately, people have developed an addiction to treatment and diagnoses on the Internet (not least because of the "optimization" of healthcare). The question of the doctor-patient relationship and, let's say, the return of their mutual trust are the most important factors in our fight against the pandemic.
Immunologist - on the risk factors for coronavirus.