Thursday, September 16, 2021

Reliance



You might have asked your Local Government Units (LGU) or doctor if they are providing any Covid-19 treatment for outpatient individuals, and they answered "no". When I asked the LGU here they said all they gave was paracetamol. I thought this was insane. They just wait for people to get worse. This is the reason why when people have covid-19 symptoms, they will never tell the authorities, not even their doctors. Because apart from not getting treatment, you get punished: you are taken away into isolation for 14 days.

Physicians and local government authorities are following the Philippines unified algorithm and guidelines on Covid-19. This algorithm focuses on testing, contact tracing and isolation, and recommends only management of symptoms for outpatients, with no antibiotics or prophylaxis. Any investigational drugs for the treatment of Covid-19 are given only in the hospital setting. This means, you will have to be admitted to hospital to actually be treated for the disease. Understandably, this was the general case particularly in the early months of the pandemic because there were no known drugs or interventions for the treatment of of Covid-19 and all drugs and interventions considered may only be given in clinical trial settings.

The algorithm described above is probably what accounts for Covid-19 surge in hospitals and Covid-19 deaths. Consequently, under the algorithm, (1) you may need to be hospitalised if you cannot get early treatment at home; and (2) if you don't get early treatment at home you may get worse and receive treatment in hospital only when the disease is already in an advanced stage; and (3) hospitals are full due to (1) and (2), so patients are sent home without treatment.

To date, all drugs and interventions (including vaccines, with exception of Comirnaty by Pfizer recently approved by the FDA) remain investigational, approved for emergency use, allowed under compassionate use permits or experimental. In the meantime, a number of pharmaceutical companies are engaged in intensive research and testing to make available new drugs and interventions specifically made for the treatment of Covid-19. Some early known candidates are the oral Covid-19 drug PF-07321332 by Pfizer, molnupiravir for the prevention of Covid-19 by Merck, oral antiviral AT-527 by Roche and Atea Phrama, a DNA vaccine by Institut Pasteur, and ZyCoV-D a 3-dose needle-free DNA Vaccine from Zydus Cadila in India. At the same time, clinical trials are being undertaken to assess the efficacy of already existing drugs and interventions that may be repurposed for Covid-19 treatment.

With regard to FDA approved agents, there are no pre-exposure prophylaxis for Covid-19 at the moment. However, clinical trials are investigating several agents, including emtricitabine plus tenofovir alafenamide or tenofovir disoproxil fumarate, hydroxychloroquine, ivermectin, and supplements such as zinc, vitamin C, and vitamin D. Studies of monoclonal antibodies that target SARS-CoV-2 are in development.

You might ask, why not just get vaccinated? And I have been told many times, "the best way to get protected is to be vaccinated." The problem is there are individuals who cannot mount adequate responses to the vaccine. These include people who have immunocompromising conditions and those taking immunosuppressive medications. Also considered at risk for progression to severe Covid-19 infection are those who received the second vaccine dose in a two-dose series or a single-dose vaccine less than 2 weeks prior to Covid-19 exposure as well as those who may be fully vaccinated but the efficacy has waned over time. Pregnant and lactating individuals were not included in the initial vaccine trials, and clinical trials for some vaccines in younger age groups and clinical trials for other SARS-CoV-2 vaccine candidates are still currently ongoing. These circumstances exclude certain groups of individuals from vaccination. Vaccine availability in many developing countries is also very poor, and the long-term effects of new vaccines are yet unknown. Indeed, in Science, often the best answer is "I don't know."

Below is a small list of Covid-19 Treatment Guidelines and Protocols. It amazes me how little is known about these, particularly the fact that early outpatient treatment for Covid-19, despite their investigational status, are already allowed by pertinent official institutions. You will just need to find a compassionate and courageous physician to help administer the treatments.


  1. USA, Covid-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (Covid-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/ and https://files.covid19treatmentguidelines.nih.gov/guidelines/covid19treatmentguidelines.pdf (Full Guideline)
  2. USA, Front Line Covid-19 Critical Care Alliance Prophylaxis & Treatment Protocols for Covid-19 (USA). Available at http://www.flccc.net/ and https://covid19criticalcare.com/covid-19-protocols/
  3. Philippines, Healthcare Professionals Alliance Against Covid-19 (HPAAC) Philippine Covid-19 Living Recommendations. Available at https://www.psmid.org/philippine-Covid-19-living-recommendations/ (Note: This Philippine guideline offers no Prophylaxis or Early Treatment Protocols. The inpatient dosing regimen provided are for Remdesivir, Favipiravir, Dexamethasone, Interferon Beta -1a and Tocilizumab)
  4. Philippines, iProtect version 2 Covid-19 Prophylaxis or Early Treatment Protocols, Concerned Doctors and Citizens of the Philippines (https://cdcph.org/) available at https://img1.wsimg.com/blobby/go/37e9c191-8ed4-4d2c-a2b2-4e81a5039d79/downloads/I-Protect%20Protocol%20v2.pdf?ver=1629182479152 (Note: This updated protocol includes contraindications for Ivermectin. Regimen includes Doxycycline, Inhaled Budesonide, Ivermectin, oral steroids Methylprednisolone or Dexamethasone depending on severity).
  5. Philippines, Dr. Allan Landrito (https://drlandrito.com/) Prophylaxis, Early Treatment, Post Covid Exposure and Late Treatment Protocols available at https://drlandrito.com/dosing-of-ivermectin/ (Updated August 2021)
  6. China, "Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia" https://www.chinadaily.com.cn/pdf/2020/1.Clinical.Protocols.for.the.Diagnosis.and.Treatment.of.Covid-19.V7.pdf (Trial Version 7 March 2020) https://covid19.alliancebrh.com/covid19en/c100036/202008/12b9b42813a94755bbf442008fe86f63/files/b0ae9b6c1d9a47bf81d7dc1f5e7ddda5.pdf (Trial Version 8 August 2020) (Note: There is no outpatient Prophylaxis or Early Treatment Protocol. However, the treatment includes a section on Traditional Chinese Medicine which may be done inpatient through all stages of the disease. Since Lianhua has become popular in the Philippines since the pandemic, this document recommends Lianhua Qingwen only for fatigue and fever during medical observation and not for confirmed Covid-19 patients. TCM Protocols are for Mild to Critical.)
  7. India, "Covid-19 Treatment Guidelines for Kerala State version 3 April 2021" Available at https://dhs.kerala.gov.in/wp-content/uploads/2021/04/Guidelines-Treatment-Protocol-April-2021-merged.pdf (Note: Interesting that they base their categories on symptomatology (A-B-C) and Mild-Moderate-Severe for Clinical Severity with the corresponding aforementioned categories, and Respiratory Rate used for severity categories for treatment purposes. This usefully represents the stages/phases of Covid-19 disease alongside treatment. The Kerala protocol for outpatient includes Oseltamivir (Tamiflu, prior to a testing), Ivermectin and Inhalational budesonide. Protocols and guidelines for children and diabetics included).
  8. USA, Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19) by AAPS - Association of American Physicians and Surgeons. Available https://aapsonline.org/stem-the-tide-of-covid-hospitalizations-deaths/
  9. South Africa, Outpatient Alternative Management of COVID-19 - Perspectives from South Africa with Dr Shandara Chetty (Note: The mainstay of Dr Chetty's treatment is promethazine, an antipsychothic alternatively used as antihistamine. Dr Chetty serves a majority rural community with no access to tertiary healthcare, this is a very interesting case of inpatient treatment with very scarce resources). https://web.facebook.com/watch/live/?v=211929946998128

List of Covid-19 Clinical Trials https://clinicaltrials.gov/ct2/results?cond=COVID-19


Still, the best prophylaxis is good immune health (and not excessive hygiene; ever wonder why those families living out on the streets of Metro Manila are not dropping like flies from covid-19?) AND - if you believe in God, there's prayer. But still, as the Hadith on Reliance goes: Trust in Allah, but tie your camel!

Thursday, September 9, 2021

Self-Care Amidst the Pandemic




It has been nearly 3 months and no crocheting. I thought I was on my way to more crocheting and patterns. But that wasn't the case. Near the end of June, I had a psychiatric emergency and had to be taken to the mental health center on an ambulance. I was very close to realizing my long-term plan: to kill my husband, to burn the houses in our neighborhood and to kill myself.

The backstory is, I was seeing a psychologist from June 2020 to January 2021. I thought I would get better, I was hopeful and positive and always tried to make good of anything. But I was actually getting worse, each week after "therapy", I got worse and worse. So I quit therapy altogether in February and tried to do my own therapy.

That worked well for a while, but I still kept having "breakdowns." The last and most dangerous "breakdown" was in June. When I got to the mental health center, I met a very good and experienced psychologist. Again, I had high hopes and thought I would finally be on the way to recovery. But something terrible happened.

My psychologist and a medical doctor invited me to meet at the town's health center to meet the volunteers working there. It would be a sort of meet and greet. So I went, with such enthusiasm and hope. But when I got there, everything fell apart again.

When I arrived, what I saw was a very dark, depressive place and it wasn't clear if it was open, it looked like it was boarded up and abandoned. I felt like I was in a prison, I felt like I was captured and could not escape. As the minutes passed I felt more and more threatened so I needed to get out, both physically and psychologically. When people started talking all at once, with the sound of motor vehicles outside, it was just too much. The noise was just too much for me. The side of the house facing the sea was closed, and a little opening at the front of the house allowed noise from the highway to come in and not come out through the back. The terrifying noise just stayed inside the interior space. And everything was just very very dark. It was like a nightmare. So I walked away, crying and screaming.

At the moment, I am so much better. It was my desperation (and self-reliance) that helped me find the answers to my problems. For certain now I know I am suffering from Complex Trauma, and not depression as psychiatrists of ten thought (thus the drugs which were useless to me). It's not bi-polar disorder (as the psychologists often thought). It's not borderline personality disorder, it's not intermittent explosive disorder. They were all wrong. At the very root of all my problems for the past 15 years is Complex Trauma.

So I learned as quickly as I could about EMDR (Eye Movement Desenzitation and Reprocessing) and self-administered. I am very proud that I am healing myself. I may have wasted so much time trying to get help but that doesn't matter anymore. Again, I am very proud that I am healing myself. I am very proud that I am able to face more of life's difficulties, even with the pandemic. I live away from family but I am doing well. Some relatives have died from covid-19 illness and I grieve and move on. The biggest challenge was when I was tasked as decision-maker for my elderly aunt who got infected with covid-19, and I saw her through all the difficult stages of the illness until her death. I am able to grieve and become stronger from it. I learned more about covid-19 and the treatments that I never knew about before.

I am making drawings, but still cannot paint or crochet. I will get there.