Ivermectin is great equalizer for poor, rich patients with Covid-19 — Dr. Castillo

Ivermectin is great equalizer for poor, rich patients with Covid-19 — Dr. Castillo

By Rafael Castillo, MD

The commentary seemed to have stirred the hornet’s nest, with a few things taken out of context. Some clarifications are in order.

ON VACCINATION

  1. I am NOT an anti-vaxxer. I clearly stated that in areas outside of the current covid hotbed areas, mass vaccination may proceed as planned.
  2. What I suggested was that in NCR and other areas with runaway (uncontrolled) transmission, it’s probably more prudent to suspend vaccination in the young and healthy adults 20-40 years of age, and reserve whatever limited supply of vaccines we have at the moment for the vulnerable sector of the population—the elderly, and younger but high-risk like those with heart disease, hypertension, diabetes, asthmatics, obese, etc,

The reason for this is that the healthy young adults are not that vulnerable and have an extremely low risk of dying, not much higher to the risk of dying from a vaccine-related reaction.

The second important reason is that between the first and second doses of the vaccine, the young adult is still sub-optimally protected in a scenario of rapidly rising community transmission. The risk of catching the virus is much higher than if community transmission was controlled. The asymptomatic, partially protected young adult may unknowingly carry the virus and spread it around.

What’s worse, because of the suboptimal immune protection, a part of the viral population is likely to survive and evolve into a new variant or mutation that will be resistant to the vaccine injected on the young adult. The mechanism is similar to the development of microbial resistance due to sub-optimal dosaging of antibiotics.

If you have thousands of these young adults serving as viral breeding reservoir and ‘training ground’ for the virus, the mid- to long-term consequences can be unimaginable. If the vaccines are shown to be already ineffective after 6 months or so, this may be the likely cause.

So it seems to be a more rational strategy to suspend, NOT cancel, mass vaccination in the young healthy adults in NCR and other hotbed areas; and resume only when community transmission has been adequately controlled. If we do our jobs well, this should only take a few weeks.

ON IVERMECTIN

My recommendation to use natural immune system boosters plus Ivermectin also seemed to have hit a sensitive nerve. I’m well aware of the advisory of the FDA and several other professional organizations stating that the evidence is still not sufficient.

My apologies, but assessment of sufficiency and insufficiency of data or evidence is somewhat relative and arbitrary depending on quite a number of factors. I have my highest respect for all those who drafted the ivermectin advisory. But in times of pandemic, with so many lives hanging on the balance each hour of the day, we don’t have to demand the same rigid criteria for acceptability as we do with a non-emergency indication like mild hypertension with many therapeutic agents already available.

For me, what we should primarily ensure is that there’s no potential for significant harm on the patient.

Ivermectin has a world of difference compared to Hydroxychloroquine (HCQ), which I rarely used even at the peak of its scientific and media hype. I was scared of HCQ’s potentially deadly complications in patients with or without heart problems.

But for Ivermectin, it’s reported to be one of the safest drugs with around 3.5 billion doses already given worldwide. Of the more than 40 studies published on it, none showed a signal for significant harm. In the low to moderate-quality studies, there remains a strong suggestion of benefit to the tune of around 70-83% reduction in deaths, and a vaccine-like efficacy of around 90% in preventing disease transmission.

Even if you discount its mortality benefits by 50% to account for the bias and study design flaws, the benefit with ivermectin is still immense, and much better than commonly used drugs and interventions like remdesivir, tocilizumab, monoclonal antibodies, extracorporeal membrane oxygenation (ECMO), etc. Costs of these expensive treatments are around 300 to 800 times more than a 3-dose regimen of ivermectin costing around P100 for the 3 capsules or tablets.

I think Ivermectin is the great equalizer for the poor and rich patients with Covid-19. During the last 2 weeks or so, when symptomatic Covid-19 patients could no longer be accommodated in the hospitals, I’ve personally treated and am still treating 14 patients with mainly a combination of high-dose melatonin and Ivermectin. Some were also given oral antibiotics.

With God’s mercy and grace, 9 have already recovered and 5 are still on treatment and doing well.

My only regret is that the pharmacy compounding the ivermectin for my patients was ordered to stop compounding the drug by the FDA 3 days ago. If the FDA cannot allow compassionate compounding of a potentially life-saving drug, then I proposed in my commentary that the government should make emergency procurement of the drug and distribute it for free to control transmission and treat the disease.

I was told that in India it only costs 5 pesos per tablet. So, with 15 pesos, we can give an indigent, sick Covid patient a fighting chance. Is that foolish, irrational thinking?

This is the challenge in solving the pandemic and treating individual covid patients. The science of covid is still dynamically evolving. It’s far from becoming thickened ice; we’re all treading on thin ice. But we have to try ti move to solid grounds, making sure each step we make is not a misstep.

I thank all who have read my commentary thoroughly and not only selectively. I sincerely thank Dr. Tony Dans and Dr. Mario Panaligan for reaching out to me to clarify their concerns. I thank all those who reacted either favorably or adversely. Whatever your reaction is, it means we share the same passion and desire to get us out of this pandemic bind.

I wish peace, love and harmony for our nation and the whole world. May God’s mercy and grace be upon all of us. (ai/mtvn)

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