Unlike common respiratory infections such as the flu or angina, Covid-19 is a new infection that even experienced doctors often treat “by touch. A whimsical combination of antivirals, antibiotics or vitamins can help or make things worse. Even a specialist cannot be completely sure of the effectiveness of the chosen therapy because there are currently no scientifically proven medications for treating coronavirus at home.
However, many people experience a mild form of the infection and do not (or cannot) seek medical help. Access to medical care has become particularly difficult in those regions of Russia where the second wave of the coronavirus has essentially become the first. The question arises whether it is possible to simply buy medications found on the Internet or received from acquaintances according to treatment plans – and treat oneself at home.
“My aunt did not send her husband to the hospital, she followed the treatment protocol and treated him at home, she even bought an oxygen tank for home. What’s the point of going to a hospital in inhumane conditions, lying in corridors and taking pills? Just stay at home and take the same pills,” writes one of the users on Twitter.
In fact, the epidemiological situation in the regions is far from perfect, especially outside the regional centers: there are fewer resources than in the big cities, and many people have to wait, sometimes for a long time, both for testing and for professional medical care. There simply aren’t enough doctors for all the people who are sick; you often have to stand in line for hours, in a closed room with other people, and risk infecting them.
It is not surprising that under these conditions, many people begin self-treatment based on the experiences of those who have already recovered, as well as treatment regimens found on social networks. Often, these recommendations come from close people whom you trust by default. In recent months, social media users have been actively sharing “treatment protocols” for Covid-19 with their friends. These protocols come from both Russian and foreign doctors of varying degrees of authority. These protocols usually include several medications and even specify specific dosages – but using them without consulting a doctor can be dangerous.
“Considering that Covid-19 is a new and poorly understood infection, treatment algorithms change and improve every month or two,” says Ilya Akinfiev, a medical student and infectious diseases physician in the Covid Brigade of the 175th Moscow Polyclinic. “Therefore, even if you use the current recommendation, you can practically follow an old and ineffective scheme.”
The situation is exacerbated by the unavailability of many over-the-counter drugs in Russian pharmacies (even though they cannot legally be sold without a prescription). In October and November, due to a sharp increase in the number of sick people, there was a shortage of certain drugs in Russian pharmacies – especially antibiotics, antivirals and anticoagulants. It is even difficult to find vitamins D and C. We explain quickly, simply, and clearly what happened, why it matters, and what will happen next. The number of offers should remain: episodes. End of story Advertising Podcasts
According to Akinfiev, this situation is caused by buying medicines “just in case”. “As a result, patients who really need them do not receive their medication on time,” he explains. In several treatment schemes provided by doctors to Covid-19 patients (available to the BBC), there is a wide range of drugs. For example, one of the schemes includes an immunomodulator with unproven effectiveness abroad against anything, used in Russia for tuberculosis treatment – “glutoxim”. The drug is prescribed in the form of intramuscular injections – apparently it is assumed that the patient (or patients) will administer the injections themselves. The prescription includes other drugs of questionable efficacy – for example, “Amiksin”. It is often prescribed for the treatment of viral infections in Russia and Ukraine, although there is no information on human studies of the antiviral efficacy of this substance in the international database Pubmed. The same prescription includes the anticoagulant “Angioflux” and the nutritional supplement “Microhydrin”. And although such a treatment regimen may be fully justified as an individual medical recommendation for a specific patient, for other infected individuals this therapy may be not only useless, but also dangerous. For example, it is known that taking immunomodulators carries a risk of developing autoimmune and oncological diseases.
In another scheme, you can see the flu medicine “Arpeflu” and the broad-spectrum antibiotic “Amoxiclav”, as well as the antihistamine “Loratadine”, the cough medicines “ACC” and “Rengalin”, and vitamin C. Another protocol that the patient received from the “cool doctor” prescribed a broad-spectrum antibiotic “Ceftriaxon”, which is used to treat community-acquired pneumonia, “Tavanik”, and the anticoagulant “Clexane”. Zinc and vitamins C and D are often found in Covid-19 treatment protocols.
“Biologically active additives and folk medicine remedies have absolutely nothing to do with the treatment of coronavirus infection,” Akinfiev emphasizes. According to him, treatment with folk medicine preparations and seeking medical help only after a long period of self-treatment is “a peculiar feature of our mentality”. He notes that this trend has now intensified.
“This [self-medication] is indeed a very important issue and problem,” says Lilith Arakelyan, an infectious diseases physician at Moscow Hospital No. 40 in Kommunarka. “Unlike a doctor, who takes into account all the individual characteristics of the patient’s body and understands the benefits and harms of drugs at different dosages, people who decide to prescribe themselves drugs often don’t even know what exactly they are treating.” She notes that a rise in temperature is not always a sign of a coronavirus infection. “Currently, there is a seasonal increase in the incidence of acute respiratory viral infections, influenza, and other viral infections that require completely different treatment. And if you treat the flu or, for example, a herpes infection as a coronavirus infection, you can do a lot of damage to the body,” says Arakelyan.
In many Russian cities there is a shortage of medicines due to bulk purchasing. It is important to understand that each treatment plan is chosen individually – ideally after a discussion with the patient about his chronic diseases and medications already taken, as well as an analysis of vitamin and mineral deficiencies. According to Akinfiev, each patient may have contraindications to the medication, and only a doctor can adjust the therapy without reducing its effectiveness. In addition, some drugs have side effects, for the detection of which a doctor can prescribe tests. “There is a whole group of drugs indicated in the algorithms that can only be administered in a hospital because of the need for round-the-clock medical supervision,” the doctor explains. He is convinced that the patient can be harmed by both early and late treatment.
The two most common types of “medical recommendations” from treatment protocols are antibiotics and drugs that prevent blood clots (anticoagulants). An example of a therapy that cannot be started too early, especially without a doctor’s prescription, is the use of antibiotics. According to the protocols of the Ministry of Health, antibiotics are only necessary in the case of a bacterial infection accompanied by the coronavirus. Prescribing them “just in case” is not allowed, as they worsen the body’s microflora, which in turn can lead to a weakened immune system. However, even doctors often prescribe antibiotics in advance for bacterial infections. This is not possible because it is never possible to know in advance what specific bacteria are involved and what complications may arise, such as sinusitis, pneumonia, otitis, or something else, explains Maria Evdokimova, an ENT doctor from Rostov-on-Don, on her Facebook page.
“Broad-spectrum antibiotics” does not mean that they work against all bacteria at once. If the infection has already developed, we can roughly understand which bacteria may have caused it,” the doctor writes. The global result of the world’s fascination with antibiotics has been the emergence of antibiotic-resistant superinfections. Sometimes such infections cannot be cured even with a combination of several antibiotics. These infections can be transmitted to others, and there is a theoretical possibility that one’s immune system can fight them off on its own – but the likelihood is about the same as it was in the 19th and early 20th centuries before the invention of penicillin.
“The use of anticoagulants has become the standard of hospital treatment for COVID-19. The issue of prescribing these drugs to outpatients remains highly controversial,” writes cardiologist and candidate of medical sciences Anton Rodionov on his Facebook page. “I used to be quite categorical against the use of these drugs at home, but the feature of the second wave in the regions has become the forced necessity of treating fairly severe patients at home. However, it is still not advisable to prescribe them indiscriminately to everyone”.
Commonly prescribed anticoagulants do not so much “thin” the blood as they prevent it from clotting. As a result, the patient is at high risk of bleeding, including internal bleeding. Therefore, such drugs have numerous contraindications and side effects.
“Now everyone is talking about glucocorticosteroids (hormones) – prednisolone and dexamethasone,” adds Lilit Arakelyan. “In my practice there was a case where a patient, trying to reduce a high temperature, took prednisolone for three days, which actually led to the replication of the virus and, as a result, severe progression of the disease.” Also, according to her, one should not overindulge in cough remedies. “Expectorants, if used improperly, can intensify the cough, aggravate hypoxia (lack of oxygen in tissues – BBC) and increase the volume of expectorated sputum, which can clog the tracheobronchial tree and make breathing difficult,” the doctor believes.
There are no one-size-fits-all recipes, even for well-known diseases. Each physician prescribes treatment based on the available therapeutic options, taking into account the individual characteristics of the patient. In the case of coronaviruses, it is even more complicated.
“Even with a mild course of coronavirus infection, there are three different schemes described in the federal methodological recommendations,” notes Arakelyan. “We are all unique, and the new coronavirus infection progresses differently in different age groups. And even the initial therapy varies depending on the patient’s characteristics.”
It is worth reminding that despite aggressive advertising of some “antiviral” drugs and the release of several “coronavirus” drugs on the Russian market, there are currently no drugs with proven effectiveness for outpatient treatment of this infection. The only exception is the drug dexamethasone, but it is only prescribed for severe patients and only in a hospital setting.
“There are very few effective antiviral drugs, and even those that do exist are not always effective – this is a characteristic of viral infections. The advantage of viruses is that the immune system is often able to deal with them on its own, but the disadvantage is that when it cannot, treatment becomes more difficult,” says Maria Evdokimova. Therefore, it should be understood that any treatment for coronavirus patients is prescribed solely to alleviate symptoms – and ideally to try to prevent complications that the disease can cause in other organs, without allowing serious side effects. In the absence of specific drugs, taking any medication for the treatment or prevention of COVID-19 is essentially a lottery (with rather expensive tickets), with the chances of winning approaching zero. However, possible complications can be very serious and significantly worsen the patient’s condition. The main thing is not to panic and to think three times before listening to the recommendations of people who are not doctors, even if they refer to reputable medical professionals.