New Delhi: More than a year after Covid-19 turned into a pandemic, there are few therapies that have proven to work. Scientists and clinicians are studying a host of drugs and therapeutics to create a new line of defence against the virus but clinical trials are yet to lead to conclusive evidence on any of these. The COVID-19 Early Treatment Fund (CETF) takes a different approach to this by funding outpatient clinical trials for effective early treatments. In an interview to HT, the fund’s founder Steve Kirsch says India must focus on ensuring people begin treatment for Covid-19 early. Edited excerpts:
In your advocacy, you focus on early treatment of Covid-19. How important is it? Every virus, without exception, should be treated early. And this one, in particular, is devastating. So we’re talking about using repurposed drugs for Covid-19. It’s an advice that we have for other diseases and for other viruses. Dr David Ho (known for key research on HIV and AIDS) wrote a famous editorial years ago on how to treat HIV. And it said that you treat it early and hard. For Ebola, the advice from the World Health Organization was, don’t wait for treatments to be proven; take risks, make mistakes, but treat it. Hence now, it’s more important to treat it, maybe with something that isn’t defective, than it is for us to wait a year for clinical trials to prove that this particular medicine works. The two arguments we can repurpose, one from the Ebola one from HIV, is that in every single case, you must treat it early and you must treat it hard – that way you’re going to get better results. It took us 14 years to learn that with HIV.
There are two particular drugs you suggest should be used for early treatment – ivermectin and fluvoxamine. Tell us a little about the case for using these. There are 23 studies that have been done from hundreds of researchers all over the world. And every single one of them, except for one, shows that ivermectin always had a positive effect. And it was a large positive effect, like 65%, or 75%, or more. From one study that didn’t, they actually didn’t measure the patients directly. Real-world data actually shows in every single case, when you introduce ivermectin early, recovery times go down. But the World Health Organization believes it is dangerous, even though there’s not a single example or high-quality evidence showing so.
For fluvoxamine, people say you only have two studies — a double blind randomised control trial and a real-world evidence trial, where the patients got to choose. In the second one, 125 patients at Golden Gate Fields hospital (in US) who were treated recovered with full marks. None of them were hospitalised versus 12.5% of the patients who chose not to. And more importantly, none of them had any long-haul symptoms, versus 60% of the patients who didn’t get the drug. Now, you could say that’s because the patients who were healthy chose the drug but, in fact, patients who were healthy felt they did not need it and did not choose it. And if you can look at the stats, people who were in the treatment group had greater severity Covid when they enrolled.
You speak about the need to give them early. How does that make a difference? If instead of treating people in four days after symptoms, they treat people five days after symptoms, and instead of starting on, say 200mg, you start off with 50 milligrams a day, it’s set up for failure. And this happened before in sepsis, where a doctor, Paul Merrick, discovered that if you get vitamin C within four hours, every single person can be saved.
What’s your assessment of drugs and therapeutics that are on the horizon? Is there anything that seems promising at this moment? I think proxalutamide is very interesting. I’m impressed with the results. We are a team working to find out more drugs that work, and we look at 200 patients a day being treating in another country. I think we’re all believers that randomised clinical trials are not the best way to find out which drugs work in a pandemic because you find out after a year whether the drug worked or not. So we’re going to test the gamut of drugs that have promising evidence. Proxalutamide is interesting, interferon lambda is interesting. And then there are others like metformin, inhaled budesonide, and cyproheptadine.