The old cliché that “desperate moments call for desperate measures” seems to be playing out quite nicely in the advent of the severe acute respiratory Corona virus infection (SARS CoV-2) christened COVID-19 by the World Health Organization (WHO).
The peddling of, and claims of cures from a range of remedies and certain unlikely suggestions from persons in high places are a major cause of concern. For decades, politicians, scientists, fiction writers and even prophets have warned us about a long overdue pandemic, based on historical trends, scientific modelling and a mere hunch in some cases.
It was even predicted that such a pandemic would most likely be viral, airborne (aerosol) and cause a respiratory illness which would easily spread within families, communities and across borders far and wide.
COVID-19 has proven to be the source of such a global health crisis with a swift and devastating effect on lives (with over 200,000 fatalities worldwide as at Saturday 25th April, 2020), the global economy (with most stocks down and businesses collapsing, including major airlines) and livelihoods (with 10s of millions instantly losing their jobs and sources of income almost overnight).
What is also true is that the majority of individuals who get the COVID-19 infection tend to have mild or moderate symptoms, mostly of a dry cough, sneezing, some bodily/muscle aches and fever which can easily pass for (but should not be confused with) a cold or catarrh or even the seasonal flu, or what in public health may be termed an “influenza-like illness (ILI) for which the majority will recover.
This partly explains why unlike in the last pandemic of 1909-1910 – the so-called“Spanish Flu” where 10s of millions of people died worldwide, in the present one, despite a high rate of virulence (or chances of getting the infection) which stood at more than2.8 million cases in over 210 countries and Territories as at Saturday 25th April 2020 (according to Johns Hopkins University), the death rate has remained relatively low.
Currently mortality is more in older adults and individuals with pre-existing chronic health conditions such as obesity and non-communicable diseases.The current rate of survival for those with severe disease requiring hospital admission and in some cases intensive care and mechanical ventilation is also testament to the advancements in science, technology, pharmacology, medicine and health care in general, and the goodwill and expertise of a range of stakeholders from cleaners and orderlies to nursing and medical consultants and other stakeholders.
Of particular importance to public health and ultimately the driver to how soon we can contain this pandemic and reopen communities and the world to business as usual, is the rate of community spread of the infection, particularly by the many individuals who may carry the virus but have mild or no symptoms at all.
Since a yardstick for our success in prevention and control of the virus is the case count, it means that the more people we find to have the infection (however mild)through testing and their isolation, the better the containment efforts and an early return to life as we knew it.
It is therefore no wonder that in many countries, the attention and focus has now turned to more testing, contact-tracing, monitoring of contacts, restriction of movement and social distancing
In addition, personal protection through appropriate face/nose covering, personal and hand hygiene and appropriate personal protective equipment (PPE) for frontline health workers is emphasized. Such public health measures, however uncomfortable and psychologically challenging, are necessary and critical to our success in preventing and controlling the spread of COVID-19.
Whilst prevention and control measures are key, there is a growing body of commentary, literature and talking points on radio, television and various social media platforms of remedies from the scientifically plausible to the most mundane, including from some of the most unexpected but powerful sources.
To begin with, viral illnesses are generally unlike bacterial and other infections which have well known and tested medications and evidence-based treatments. This is largely because of the very nature of these microorganisms, their natural history and our understanding of their biology and epidemiology.
Unlike bacteria which are whole cellular microorganisms and are historically and biologically well known, viruses are incomplete particles which embed in and only begin to thrive and replicate or reproduce themselves within the tissues and cells of the host (e.g. animal or human) using the hosts own genetic materials (e.g. RNA as in COVID-19 and other Corona viruses).
Furthermore, unlike traditionally known viruses such as the influenza, measles, small pox or poliovirus which became well known and scientifically understood over many decades and even Centuries thus allowing remedies such as vaccines to be produced, tested, used and improved upon for prevention and herd immunity, new viruses such as the SARS Corona viruses, originally more associated with animals, are mostly new to humans and for that matter, scientists have insufficient time to be able to identify immediate cures or protective remedies such as vaccination in a short space of time.
By and large, we manage the majority of respiratory viral illnesses by conservative methods such as controlling fever, cough and catarrh, maintaining social distancing, isolation of infected individuals etc. It is a commonly known experience within families to have 3 or 4 young children (and even the immediate caregiver) become infected with the common cold or flu because one child returned from the kindergarten or nursery with the cold. The sensible thing we often do is isolate the index child with cold/catarrh to prevent spread within the family.
COVID-19 in that sense is no different hence the guidance on commonsense and strict adherence to isolation/quarantine and prevention methods.
That notwithstanding, individuals who test positive with or without symptoms need remedies that would help to maintain their health and aid their recovery from illness.
In our quest for such remedies especially in the era of COVID-19 all sorts of treatments have been proposed, tried and reported both scientifically and apocryphally for which there continues to be a lot of debate and commentary.
In Ghana, in order to dissuade the public from believing any such claims e.g. of a traditional remedy being a “cure for COVID-19”, the Food and Drug Administration (FDA) recently issued an official statement stating that as the sole authority that gives approval for any clinical trial of a new medicinal product in the country, it had NOT approved any clinical trial for COVID-19 using any herbal remedy.
This is a very important intervention which in my view should extend to claims that are made on some radioadverts of various herbal products that are said by the announcers to “boost the immune system” and thereby help people to fight COVID-19.
Some such claims are also seen as footnotes on some TV channels. Left unchallenged, such adverts aimed at boosting the sales of products can at best be misleading and provide a false sense of security for unsuspecting individuals.
The popular antimalarial and anti-lupus drug hydroxychloroquine was reported to be “effective in the treatment of COVID-19” in a few clinical studies involving small samples of test subjects, and touted as treatment by certain powerful individuals in certain countries.
This was found not to be the case when the original study designs were scrutinized and found to have serious limitations; and multiple large clinical studies were conducted in different countries across the world which found the drug ineffective.
Despite the fact that the results of those trials have been published in reputable scientific journals and are now in the public domain, that has not stopped health authorities from including chloroquine in the treatment protocol for COVID-19, resulting in a price hike for the drug in some pharmacies.
Results of a clinical trial involving an already known antiviral drug (remdesivir) has also so far “proved inconclusive” at best. It is worth noting that the US Food and Drug Administration (FDA) allowed for these various drugs to be trialed in COVID-19 only for emergency reasons as they were previously approved only for other specific illnesses for which they have proven value as is usually the case.
Antibiotics such as Azithromycin have also been used as part of the treatment protocol for COVID-19 and reported to be helpful e.g. in Spain. To my mind, the effect of this (or other similar antibiotic) in the treatment of severe viral respiratory infection especially where there is painful sore throatis a no-brainer because of the real possibility of a secondary bacterial infection superimposed on the original viral illness.
Indeed if anything, the antibiotic is effective not against the virus, but the accompanying bacterial infection and so makes a lot of sense to include in the protocol (for moderate/severe disease as indicated and prescribed by an appropriately qualified physician).
Traditionally in Africa and elsewhere, herbal medicinal products (both approved and unapproved) including home remedies have been used when people are ill. These range from roots of plants to bark, whole stems or their chippings, to leaves, fruits, seeds etc.
Indeed different parts of plants are known to contain certain chemical ingredients, the composition of many of which are already known e.g. alkaloids found in neem, odum, bitter leaf etc.
Certain plant parts also contain so-called anti-oxidants such as vitamin C (e.g. various fruits including lemon, lime and bread fruit). Some such anti-oxidants are also found in e.g. cloves, garlic, onions and even soy beans.
That these various ingredients have been used as part of traditional remedies for the sick in African households is very well known. In some cases, inhaling the steam from boiling neem and / or guava leaves (and/or drinking the water) has been claimed to be helpful in treating colds, catarrh and even malaria.
Similarly there are those who swear to a blended mixture of garlic, cloves, ginger, lemon and other ingredients “curing” their flu. In the advent of COVID-19 which has no known cure to date, there are stories and video testimonies of “cures” from the virus by using these home remedies.
These are not new remedies and have been used by our ancestors before the advent of modern medicine and continue to be used by those who brew them at home and believe them to be helpful.
However, this should never be confused with a “cure” as such claims must be backed up by scientific evidence which by and large is lacking. I would therefore urge great caution in propagating the narrative of a cure from traditional herbal remedies at this point.
When alcohol-based hand sanitizers were recommended for use in hand hygiene, some people wrongly interpreted that to mean that drinking alcohol will protect them against the virus. This is a palpably false notion. Yet some recent news reports suggest that in some communities in Ghana e.g. the Ejisu farming areas, alcohol (akpeteshie) intake has increased even among young people in the mistaken belief that it protects against COVID-19 infection.
A major cause for concern is where‘unscientific theories’ of ineffective remedies or methods of treatment are peddled by powerful individuals who lack expertise or even a basic understanding of the subject matter.
One such occurrence which is currently trending is the notion that either extreme heat or ultraviolet light/radiation may be used to treat COVID-19 patients or worse still, the “injection of disinfectant” such as Lysol or Dettol might “enter the lungs and kill the virus” as purported by President Trump of the United States in a recent press briefing.
As would be expected, the president’s own scientific experts distanced themselves from his claim and scientists and medical experts condemned his statements in very strong terms for their potential impact on the population.
More importantly, the manufacturers of these cleaning agents have categorically refuted the suggestion and warned people against ingesting or using any of their products inappropriately and not for the primary intended purposes.
There are also media reports of an increase in the number of calls and queries to Poison Centres in the US and European countries following the US President’s statement, reflecting how much confusion such uninformed, ill-judged and unhelpful statements from powerful and influential individuals can generate.
It is important to note that high fever of temperatures above 38.5 degrees Celsius is part of the case definition of COVID-19. Such ‘burning’ temperature is part of the body’s response to the illness and is aimed at helping the body to fight the infection (as one of the scientists on the US White House COVID-19 Task Force, Dr. Birx reminded the US President).
However, true as it is that ultraviolet light of high enough intensity disintegrates the virus (and other viruses and bacteria) in air or certain body fluids, practically there is no way light of any kind can be shone on the body’s internal cells, and certainly not in the lungs where the virus resides at the tiny membrane interface between the lung tissue and tiny blood capillaries called the alveoli.
This is where exchange of oxygen (into the blood stream from the lungs) and carbon dioxide (from blood to be expelled through breathing from the lungs to the outside) occurs, and a favourite site for the COVID-19 virus hence the difficulty in breathing which is part of the presenting symptoms of at least moderate to severe disease.
Shining UV light on the body in the hope that it would reach the inside of the body to attack the virus is also dangerous as even where we use UV light as treatment e.g. for newborn babies with jaundice, the intensity of radiation has to be measured and the eyes must be covered to avoid permanent damage.
Furthermore, bleaches and other disinfectants are poisonous chemicals which ordinarily must be accompanied by a clear warning on the containers, including to keep away from children, avoid inhalation and exposure to the eye and skin.
If these chemicals are so dangerous to the external surface of our bodies, how much more on the inside? Therefore as a warning to all of us, please ignore any message which suggests that you should try bleach or extreme sunlight/exposure to heat as a way of treating COVID-19 regardless of who is saying it.
Ultimately we all want to see an end to this global health crisis and to return to normal life. The current focus is to continue to provide supportive treatment to those who have the disease whilst efforts at finding a vaccine have begun with clinical trials of new vaccine candidates in different parts of the world.
Whilst we remain hopeful of future clinical solutions, our best hope at the moment is that of public health measures that we must all understand and to which we must adhere. Among these measures, we must ensure that our frontline health workers are well protected by providing effective personal protective equipment (PPE) and that we all wear appropriate face masks and avoid close social contact at home and when outside.
We must also increase the rate at which we are testing (and early return of test results) and isolating contacts especially in the COVID-19 hotspots in our country to minimize and contain community spread of the virus.
In particular, contact-tracing requires strong community engagement, education, awareness and their full participation which I believe in Africa, will prove to be our saving grace. We must all continue to observe restrictions in travel and movement to minimize person-to-person spread of the virus.
Last but not least, we must dismiss unequivocally any notion that UV light or any form of high heat or household cleaning chemicals such as bleach will kill the virus and resist any temptation to use them internally as such. Improper use of these chemicals might kill us before they get to the virus and must never be tried at home.
The author Professor Amuna is writing in his personal capacity as a public health expert. He is also the current Dean of the School of Public Health, University of Health and Allied Sciences, Ho, Ghana.
By Professor Paul Amuna