CARTA AL EDITOR / LETTER TO EDITOR
Scientifically unproven treatments for COVID-19
Martín S. Marcial-Coba1*
Available from: http://dx.doi.org/10.21931/RB/2020.05.04.3
Detected for the first time in late December 2019, a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the causative agent of an international outbreak of coronavirus disease 2019 (COVID-19). In late August 2020, approx. 24 000 000 cases, including 815 038 deaths, have been confirmed worldwide1. The WHO declared the outbreak of COVID-19 as a Public Health Emergency of International Concern, and it has been proposed that its spread may be interrupted by early detection, isolation, the implementation of a robust system to trace contacts, and a prompt treatment2. Nevertheless, there has not yet been any vaccine or effective treatment that has received approval3. Despite this, the FDA has recently issued an emergency use authorization for the investigational antiviral drug Remdesivir to treat COVID-19 in patients with severe disease4. Although there is still limited information regarding the safety and efficacy of this novel prodrug, it has shown potent in vitro antiviral activity against SARS-CoV-2 isolates, and therapeutic efficacy in animal models5.
Furthermore, patients treated with this investigational drug, in clinical trials, have shown a significant shortening in recovery time in comparison with control subjects6. Besides Remdesivir, other antiviral agents, including nucleoside analogs (e.g., ribavirin and favipiravir), protease inhibitors (e.g., Lopinavir/Ritonavir), endosomal acidification inhibitors (e.g., chloroquine/hydroxychloroquine), among others, have also been investigated as drug candidates for the treatment of COVID-19. However, detrimental side effects and variable efficiency have been associated with its application on several patients 6. Likewise, it has been reported that ivermectin, an anti-parasitic agent, inhibits the replication of SARS-CoV-2 in vitro, but clinical trials are still underway to test possible therapies7. Additionally, the potential interferon 1 (IFN1) treatment has been tested against SARS-CoV-2 both in vitro and in vivo, and combination or not with some of the above-mentioned antiviral agents, and it has been suggested that it may account for a safe and efficient treatment against COVID-19 in the early stages of infection8.
The lack of standardized treatments has led to the emergence of unproven health advice, which doesn’t rely on a scientific basis, for fictitiously treating or preventing COVID-19. In this context, the utilization of these fake therapies might be considered useless, but the consequences on human health can be innocuous to relatively harmless, or even absolutely dangerous. For instance, rumors indicating that garlic can be used as a home remedy for preventing COVID-19 have been widely spread. Even though garlic is considered a healthy food ingredient, there is no evidence suggesting that it can cure or prevent SARS-CoV-2 infection9. Additionally, the intake of copious amounts of garlic can result in throat inflammation and burns10. Other home recipes include drinking or gargling herbal tea and warm purified water, eucalyptus inhalant, essential oils, alcoholic beverages, and tinctures 11–13.
The consumption of non-tested or fraudulent medicines may lead to adverse events, including serious and life-threatening harm.
Remarkably, non-evidence-based information also proposes drinking disinfectant substances, such as colloidal silver and chlorine dioxide, not only as a home remedy but also as commercial products specifically “targeted” against SARS-CoV-2 infection14. It has been demonstrated that surface disinfection, and even wastewater treatment, using chlorine dioxide (ClO2) is effective against coronaviruses, when appropriate (over 2.2 mg/L) concentrations are applied15,16. However, to the best of the current knowledge, there is no research describing the safety and efficiency of these products for treating any pathology. Furthermore, regulatory institutions, like the FDA, have warned about the risks related to the intake these formulations, since they have received several reports of people suffering severe adverse effects (i.e., nausea, severe vomiting and diarrhea, acute liver failure, life-threatening low blood pressure caused by dehydration) after drinking chlorine dioxide products17.
The promotion of fraudulent products, claiming to prevent or cure COVID-19, is not ethical, and its consumption may mislead a correct diagnostic, interfere with the appropriate medical treatment, and harm the patient’s health. Therefore, the efforts of governmental regulatory agencies and legislation, all over the world, should be focused on preventing and sanctioning the occurrence of fraudulent products claiming to prevent or cure COVID-19. At the same time, scientists keep investigating multiple candidate therapies or vaccines against the novel coronavirus, authorities, health care professionals, and society, in general, reinforce biosecurity and social isolation strategies as preventive actions to avoid exposure to the virus. Additionally, scientific publications, mainly reviews, regarding the current state of research involving potential therapies against SARS-CoV-2, should be promoted and widely diffused, through appropriate mechanisms, to inform the majority of society.
1 World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. WHO. [Internet]. 2020. Available from: https://covid19.who.int
2 Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020; 76: 71–76.
3 Lotfi M, Hamblin MR, Rezaei N. COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clin Chim Acta 2020; 508: 254–266.
4 Food and Drug Administration. Coronavirus (COVID-19) Update: FDA Issues Emergency Use Authorization for Potential COVID-19 Treatment. FDA News Release. [Internet]. 2020. Available from: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-emergency-use-authorization-potential-covid-19-treatment.
5 Williamson BN, Feldmann F, Schwarz B, Meade-White K, Porter DP, Schulz J et al. Clinical benefit of Remdesivir in rhesus macaques infected with SARS-CoV-2. Nature 2020. doi:10.1038/s41586-020-2423-5.
6 Wang D, Li Z, Liu Y. An overview of the safety, clinical application and antiviral research of the COVID-19 therapeutics. J Infect Public Health 2020. doi:10.1016/j.jiph.2020.07.004.
7 Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res 2020; 178: 3–6.
8 Sallard E, Lescure FX, Yazdanpanah Y, Mentre F, Peiffer-Smadja N. Type 1 interferons as a potential treatment against COVID-19. Antiviral Res 2020; 178. doi:10.1016/j.antiviral.2020.104791.
9 Alschuler L, Weil A, Horwitz R, Stamets P, Marie A. Integrative considerations during the COVID-19 pandemic. Explore 2020.
10 Vargo RJ, Warner BM, Potluri A, Prasad JL. Garlic burn of the oral mucosa: A case report and review of self-treatment chemical burns. J Am Dent Assoc 2017; 148: 767–771.
11 Tasnim S, Hossain M, Mazumder H. Impact of rumors and misinformation on COVID-19 in Social Media. J Prev Med Public Heal 2020; 53: 171–174.
12 Love JS, Blumenberg A, Horowitz Z. The Parallel Pandemic: Medical Misinformation and COVID-19: Primum non nocere. J Gen Intern Med 2020; 35: 2435–2436.
13 Adams KK, Baker WL, Sobieraj DM. Myth Busters: Dietary Supplements and COVID-19. Ann Pharmacother 2020; 54: 820–826.
14 Larson HJ. A call to arms: helping family, friends and communities navigate the COVID-19 infodemic. Nat Rev Immunol 2020; 20: 449–450.
15 Wang XW, Li JS, Jin M, Zhen B, Kong QX, Song N et al. Study on the resistance of severe acute respiratory syndrome-associated coronavirus. J Virol Methods 2005; 126: 171–177.
16 Foladori P, Cutrupi F, Segata N, Manara S, Pinto F, Malpei F et al. SARS-CoV-2 from faeces to wastewater treatment: What do we know? A review. Sci Total Environ 2020; 743: 140444.
17 Food and Drug Administration. (COVID-19) Update: FDA Warns Seller Marketing Dangerous Chlorine Dioxide Products that Claim to Treat or Prevent COVID-19. FDA News Release. [Internet]. 2020.Available: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-warns-seller-marketing-dangerous-chlorine-dioxide-products-claim.
Received: 5 August 2020
Accepted: 27 August 2020
Martín S. Marcial-Coba1*
1Pontifical Catholic University of Ecuador
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