By María José Vargas and Ernesto Carrasco.
Peruvian doctors who signed the Open Letter to the Ministry of Health spoke exclusively with La República about the treatments applied to patients with coronavirus in Peru and the false expectations they generate in the population.
The doctors Julio Chirinos, internist and cardiologist (University of Pennsylvania), Vicente Corrales, internist and infectologist (The Ottawa Hospital) and Germán Málaga, an internal medicine doctor (Universidad Peruana Cayetano Heredia) were concerned about the use of hydroxychloroquine and ivermectin promoted by the health authorities in the country as a treatment for COVID-19.
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The specialists specified that both drugs are recommended by the Minsa, but numerous studies of significant credibility have reported a lack of effectiveness by the drugs when applied in order to treat the COVID-19.
After disseminating the letter on June 17, the group of doctors has not received a concrete response, but is confident that it will establish an official and sincere dialogue with the representatives of the ministerial portfolio.
“There is no reason to give a drug that has potential toxicity and is not effective, according to what has been reported in clinical trials,” said the doctor. Chirinos on hydroxychloroquine.
For his part, the internist and researcher at the Universidad Peruana Cayetano Heredia, Germán Málaga, warns that no one is an expert in COVID-19 because it is a disease that only lasts six months and states that in the country there has been an “over-dimension of a potential effect of treatments and that until now it has not been had.”
“The controversy arises when it is said that this (medicine) is a silver bullet against the coronavirus and what it generates is an overflow of expectations. In addition, a large number of people are taking it weekly to prevent the disease without presenting symptoms, “said Malaga.
In addition, he mentioned that he does not oppose the use of drugs, as long as he is supporting clinical trials and under strict epidemiological surveillance to obtain better results.
The Peruvian internist doctor and infectologist, who lives in Canada, Vicente Corrales considers that not every patient with COVID-19 you need specific antiviral treatment. “Most people who tested positive for the SARS-CoV-2 coronavirus have a mild infection and do not need any type of intervention,” he says.
He details that the treatment that can be offered is clinical surveillance for signs of worsening and isolation. “In these types of patients, the benefit of unproven therapies such as ivermectin is very low, but it may be a higher percentage than the benefit it can bring to people,” he explained.
“When you put excessive attention on a drug like ivermectina other things that can serve as isolation, avoid contacts and follow-up with patients are left aside “, he points out Chirinos from Pennsylvania, United States.
“The surprise factor has passed with the coronavirus”
The specialists agreed that the “surprise factor” in relation to the coronavirus has already passed because studies carried out in different parts of the world that show updated information are released daily.
Improving communications in Peru and around the world about the use of drugs is a latent need to avoid complications in active cases of the disease and in people who do not have the virus. “Clinical management and communication must be multidisciplinary when it comes to carrying a message to the population about treatments and the origin of the disease,” Chirinos said.
“When we say that the hidroxicloroquina it does not work, we do not refer to anecdotal situations but to well-done clinical trials; in the case of the ivermectina we don’t have any rehearsal well done. Until now there are no good reasons to assume a benefit and the balance of risk against benefit is very uncertain, “he said.
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Mass self-medication does not aid research
The doctor Málaga He emphasized that from the point of research, a population that self-medicates by following recommendations without any clinical support, misses the opportunity to generate pure, unbiased, and reliable valuable information.
He recalled that patients who self-medicate with corticosteroids to treat the COVID-19The days go by and they get complicated because they start to present rare bacteria that add to the already complicated picture of infection they have.
“It is difficult for a patient to resist the complication by self-medication and by the coronavirus. It is there when the press must help us a lot because what is generated is difficult handling for us doctors, “he said.
Research in Peru
Given the 282,365 cases of coronavirus that have been registered in the country to date, the specialists added that Peru may have a great opportunity to carry out a large-scale investigation because it has the professionals to do so.
“This is not going to be the only pandemic we go through, so it is necessary to promote clinical research in the country and educate the population to participate in these works, because it would actively help and determine the truth of things. “Finished Doctor Chirinos.