As COVID-19 surges again in parts of the U.S., driven by the Delta variant, statistics have shown vaccines remain the best way to protect against the virus. But some seek alternative, unapproved treatments.
Dr. John Rimmer, Chief Medical Officer at Hoboken University Medical Center, discussed COVID-19 treatments at all three CarePoint hospitals in Hudson County, including Bayonne Medical Center and Christ Hospital in Jersey City.
According to Rimmer, treatment is tailored to each patient’s specific needs.
“Young kids without any medical problems would really just require time, Tylenol, fluids, and I’ll repeat the word time,” Rimmer said. “COVID is a slow onset and a slow recovery, so people need to be patient with it.”
Rimmer continued: “As you start to escalate your risk profile, meaning age, obesity, diabetes, heart disease, primary lung disease, then you start to look at opportunities for more active therapeutics.”
From there, the next step in treatment would be administering monoclonal antibodies to the patient.
“Our mainstay currently is monoclonal antibodies, which should be given within seven days of symptoms’ onset,” Rimmer said. “The earlier you give them, the more efficacious they are. Some data was just released this week showing that there’s a potential 70 percent reduction in hospitalization for patients who received monoclonal antibodies.”
Monoclonal antibodies are still officially under an emergency use authorization by the Food and Drug Administration (FDA), similar to the vaccines, so a patient must give consent for the treatment after the risk benefits and alternatives are explained. The hospitals provide it to patients in the emergency room who qualify based on their risk factors.
“If you’re 20 years old and young and healthy without any medical problems, then per the emergency use authorization, you’re not a candidate for it,” Rimmer said. “But if you have a body mass index above 25, which is a measure of obesity, or if you’re above the age of 65, if you’re diabetic, or have primary lung disease, you would be a candidate for it.”
Rimmer said by administering it to patients in the emergency room, the drug works fairly well to avoid inpatient hospitalizations.
For patients with extreme cases, which do require inpatient admission to a hospital, more intensive treatments are used.
“First you need to treat whatever underlying conditions that they have, whether that be diabetes or hypertension,” Rimmer said. “Then we are offering medications such as Remdesivir, which is the antiviral medication which has been shown to help shorten hospitalizations. That’s usually a five-day course.”
Inpatients are also given the steroid Decadron.
“Initially, we though steroids were potentially harmful, and now they are found to be beneficial,” Rimmer said. “But only for patients who are receiving oxygen. Giving steroids prematurely before oxygen is required has actually been shown of no benefit and could even do harm. Giving steroids after you’re on oxygen has been proven to improve mortality.”
In addition to Remdesivir, steroids, and supplemental oxygen, other anti-inflammatory drugs may be administered.
Not included in that treatment is Ivermectin, which has recently grabbed headlines after some Americans sought it as an alternative to vaccinations.
“Ivermectin is a very effective drug for parasites,” Rimmer said. “The people who discovered the medication were awarded the Nobel Prize in 2015 for its antiparasitic properties. A disease in developing countries called river blindness, it has essentially cured that. Ivermectin has probably saved tens of thousands of lives in the developing word.”
Rimmer continued: “While Ivermectin does have veterinary purposes, it is an extraordinarily effective medication for the right purpose in humans. It’s not only a horse dewormer, it is an effective anti-parasitic medication in the human population, which is FDA approved for that.”
‘Needs further testing’
And while Ivermectin works well against parasites, it’s antiviral properties are unproven, according to Rimmer.
“Now whether it has additional antiviral properties is something that needs further testing,” Rimmer said. “My understanding is that there are some international studies currently underway regarding antiviral properties. But currently it is not recommended for that in the United States.”
Previous studies were inconclusive.
“Studies were done on it were in vitro, but in vivo studies were less supportive of efficacy,” Rimmer said. “Meaning when it was actually studied in the body, the fairly large studies did not show a statistically significant difference in outcomes.”
Not closing the door yet
But if it does prove effective, it could be added to treatment regiments.
“I’m hopeful that this medication does prove efficacy with more studies because it is a cheap medication which we understand the pharmacodynamics of very well,” Rimmer said. “We understand how the medication is processed in the body. We understand it’s side effects. But it hasn’t been given at a population scale yet, with which other things may be uncovered. So the medication still needs more study.”
Rimmer said patients should adhere to the recommended treatments.
“This medication is not without its side effects,” Rimmer said. “While minimal, it does carry risk. So if someone is worrying about the risk of a vaccine, they should also be worrying about the risk of Ivermectin in the same sense.”
According to Rimmer, the best way to prevent serious illness and death from COVID-19 is to get vaccinated.
“COVID right now is a preventable death,” Rimmer said. “The vaccines have proven that they prevent hospitalization and death with great reliability.”
Rimmer said that those who are unvaccinated will likely get the virus.
“The Delta variant is very contagious,” Rimmer said. “It’s likely more contagious than the prior variant. I would say it’s statistically inevitable that you will contract COVID if you’re not vaccinated. If you are vaccinated, you can still contract it but you essentially get a mild cold and are not in the hospital sick for two weeks. For those at high risk of complications, you’re not going to have potential mortality increase. So you can either take your chances with a very significant and risky virus, or you can take your chances with a vaccine with hundreds of millions of doses given out around the world with excellent monitoring to date and minimal side effects to date.”
Surge on the way?
This is especially important because Rimmer said the Northeast region of the United States has yet to witness a “true Delta surge.”
“This fall or winter we could really see the Delta variant surge,” Rimmer said. “We could see what happened in Florida or the South this summer happen in the Northeast this winter.”
While vaccination rates are improving, Rimmer said they are not yet at the point they would need to be to prevent a “significant Delta wave.”
Getting vaccinated “I would equate to jumping out of an airplane with a parachute,” Rimmer said. “You can take your chances jumping out of an airplane without a parachute, but the parachute is going to be much more effective preventing death.”
For updates on this and other stories, check www.hudsonreporter.com and follow us on Twitter @hudson_reporter. Daniel Israel can be reached at firstname.lastname@example.org.