Carlos Alvarado: Self-medication is not recommended to treat covid-19

He arrived with his mask tight to his face and drenching his hands in alcohol. "We are in a pandemic", repeated the Minister of Health, Carlos Alvarado, to request the due withdrawal in the room of the Ministry where he gave us the interview. He also checked the issue of ventilation by observing the open windows that reveal the dome of the Municipal Theater. "Prevention comes first," he commented as he sat at the counter decorated with samples of drugs used to combat the different phases of covid-19. Alvarado, a physiatrist and occupational physician, has served as Minister of Health since 2018 and in turn holds the position of rector of the University of Health Sciences “Hugo Chávez”. Before starting the conversation, the Minister discovers that he has a mask caught in a sleeve of his jacket where he had kept it as a spare. "The most important task that Venezuelans have is to take care of ourselves, to take care of ourselves," he laughs at the surprising discovery.  

-What is the situation of the pandemic in Venezuela? 

-A pandemic is decreed when a disease appears unexpectedly. It began to grow in all parts of the planet and Venezuela did not escape that growth. This pandemic has had two peaks in Venezuela; in other parts of the world it has already had three and a fourth peak is beginning to be seen, which are times when the number of cases begins to increase. This is until the final situation occurs that helps end the pandemic, for example, that everyone is vaccinated and that the vaccine is effective against all the variants that exist or when the virus mutates into much less aggressive forms and becomes a common disease as happened with other diseases.  

-How does that second peak behave in Venezuela? 

-Venezuela is currently on the rise, at the top of the second wave. This is due, according to the analyzes made in the Presidential Commission, to the presence of a new variant that was generated in Brazil and that caused havoc in the north of that nation, Manaus, on the border with Venezuela. Studies have shown that this is a much more contagious variant and spreads faster than the original. And how it is transmitted faster makes more people sick, therefore there is greater demand for health services. People after three days begin to present much more florid symptoms, it worsens more easily and mortality increases, that is happening at this time. One of the most important tasks at this peak time is health promotion and prevention.  

-What does the prevention of this disease consist of? 

-It has two dimensions. In the first one, people have to know the disease, become familiar with the transmission mechanisms, know what they can and cannot do to avoid the disease. And, specific prevention has to do with what President Nicolás Maduro points out daily: the correct use of the mask in all environments.  

-Even inside the house? 

-Inside the house if there is someone who has symptoms or who we suspect has been in contact with a positive, people should wear a mask. The rest is not necessary because it is assumed to be a closed nucleus. The mask whenever we leave the house and when we return, sanitize ourselves, that is, wash, disinfect ourselves.  

-For this disinfection process, people began to gargle lemon with baking soda. That helps? 

-There are no conclusive investigations. There are those who point out that the use of gargles with local disinfectants could help, however, we as the Ministry of Health cannot say 'this is a proven and proven measure worldwide'. What is proven in many studies is that hot infusions contribute a lot to reducing the reproduction of the virus. It is very sensitive to heat. That from the point of view of natural medicine. In fact, our grandmothers used hot infusions or a soup broth when someone felt unwell.   

-We have observed many people self-medicating with Ivermectin, for example. What do you think? 

-Once the person becomes ill, the virus (which enters through the nose or mouth) begins to reproduce initially in the throat and nasal mucosa. When it begins to reproduce, the first symptoms appear: general malaise, sore throat, there may be fever. That is where what you ask happens, self-medication. But that is a virus that walks very fast. If I add the symptoms, I can take an acetaminophen and wait a few hours, but if that continues, I have to get tested. Avoid self-medication. Why? Because this virus, especially with the new variant, the reproduction is very fast and the advance is very fast. And if it is not evaluated ... people go out when they have respiratory difficulty and at that point the virus is no longer in the throat, the virus has already passed into the respiratory tract. Then it is much more difficult to manage and it is a patient who will probably require oxygen.  

-What do you recommend to those who self-medicate?   

-Avoid self-medication. It is true that right now with the internet, anyone looks for 'treatment for Covid' and a number of drugs appear. But it turns out that all these drugs are not indicated for all people: there are pregnant women, people with a previous disease or they may have another disease, such as malaria. Malaria gives you a fever, malaise. So if I start taking drugs for Covid having malaria, imagine the situation that I can cause. Hence, self-medication is not a topic that we never recommend. The person has to consult a doctor and he defines if there is a possibility that this is a Covid and sends him to do the test. And if there is a suspicion of Covid, immediately comprehensive care, which involves separating them from their family nucleus. We are going to protect you and we are going to protect your family.  

-Some people who self-medicate say they feel improvement.  

-That is another of the negative characteristics of self-medication: people feel that as they are being treated, they will not complicate. That is not like that. It is not a mathematical norm. For example, if I am taking Ivermectin, it does not mean that the disease will not progress. Ivermectin, it has been shown, decreases the replication of viruses and can give in milder forms.  

-But that medicine was recently questioned by the World Health Organization (WHO). 

-There are always studies in favor and studies against. Ivermectin in particular is a drug that has been on the market for many years and its side effects are few. And there are studies that support that the replication of the virus in the body decreases, therefore we include it in the protocol. There are always those who question it and that with all medications, even with Remdesivir, which is one of the most accepted in the world.  

-Do all Covid patients have to use Remdesivir? 

-No. There is a protocol and I will say it as it is here. But I don't want them to later say: 'this is the recipe that the Minister said and I am going to do what the Minister said and I stay at home treating myself.' No. Every case must be dealt with. The first thing: special protection of confirmed and suspected patients, admitting them to health centers. We already talked about it. The asymptomatic and with mild symptoms, in health hotels, field hospitals, CDI, with daily medical evaluation. There must be about 4 thousand sanitary hotels throughout the country; because we are in high peak. 

-And what is the protocol for moderate and severe patients? 

-Moderate and severe cases are treated in sentinel hospitals that number 62 throughout the country. In them there must be intermediate care units, intensive therapy and oxygen. Twice a day the patient's vital signs must be measured: blood pressure, heart rate, respiratory rate, oxygen saturation. That is why a health staff has to be present. 

-When the person is informed that they tested positive for covid-19, they enter a process of anguish. How to handle that moment? 

-When they are diagnosed with Covid, people enter a process of despair, they think that it is going to get complicated, they have a neighbor who died ... then they enter that process of anguish. Hence, stretching and relaxation activities are very important to stay calm.  

-There are people who are treated at home under medical supervision. Is that healthy? 

-We prefer that it is not done to avoid contagion at home. But on some occasions that it is done, it has to be with some particular conditions: that it is supervised by a doctor, by a health personnel who knows and that that person is in isolation conditions from their family nucleus. It is happening to us: there are complete family nuclei that are infected and that has to do with the first person who had symptoms and was not isolated. And if you require oxygen, it must be administered in a health center. Having oxygen cylinders in the house is not recommended, because if the patient is complicated at night, who will attend to him.  

-What are the drugs approved by the Ministry of Health to treat Covid-19? 

-Here we have the list of drugs included in our therapeutic scheme: Interferon (improves immune response), Ivermectin or Chloroquine (reduces viral load and improves immune response), antivirals such as Remdesivir and Favipiravir that reduce the amount of virus and prevent Its reproduction. We do not recommend the use of Remdesivir at home, because it is a drug that is used intravenously and when it is used it is because the patient has a very careful moderate condition. Another drug we use is aspirin or anticoagulants, because one of the effects of the disease in the body is that it increases the generation of clots and can cause pulmonary thrombosis.  

-The protocol also includes antibiotics. 

-Yes. There we have the Azithromycin. It does not act on viruses, but many people with viral problems become superinfected with bacteria. We have also included Colchicine to prevent pulmonary fibrosis in more advanced patients. There are other complementary therapies used here such as ozone therapy, which improves the immune response and increases oxygenation of tissues. And our national drug the famous Carvativir, which reduces the replication of the virus and helps the development of immunity to prevent serious forms of the disease. This does not mean that none of these medications prevent you from getting sick, but it does prevent things from getting complicated. 

-A study of phase 3 of Carvativir is pending for its recognition by the WHO. Is it already finished? 

-It is already finished, it is in its review for the publication that the WHO requires to recognize it as a medicine. You have to have your phase 1, 2 and 3 studies published in international journals. Until now, Carvativir is recognized by the Ministry of Health as a natural product with therapeutic activities. It is a product that comes from indigenous plants of Venezuela. It is to make the disease asymptomatic or very mild; because it is important to understand that there is no medicine that will prevent a person from getting sick.  

-Not even the vaccines? 

-This first generation of vaccines attenuates the forms of the disease. Avoid making those shapes serious. The vaccine puts something that looks like the virus into your body, you are not injecting viruses. Vaccines develop defenses against the virus in the body. If I am vaccinated and come into contact with the virus, I already have antibodies that immediately act on that virus. A vaccinated person can carry the disease and may have the disease.  

-What is the status of vaccination in Venezuela? 

-As you well know, we are in a situation of blockade, of economic war, subjected to unilateral coercive measures. Why do I say this? Because Venezuela has enough resources in its foreign accounts to buy all the vaccines for the entire population. However, we do not have access to those resources due to the lockdown. For us to access vaccines we have to make 10 times more efforts than any other country. Then we have access to the Covax mechanism and we can access up to 20% of the vaccines that the country needs. But the resources to pay for the Covax fund are the resources we are looking to free up.  

-And how will they acquire the vaccines? 

-The President has instructed us to look for all alternatives. We have alliances, for example with Russia. With them we signed a document for the acquisition during this year 2021 of 10 million doses. Of those, 300 thousand vaccines have arrived for 150 thousand people, because there are two doses. Then we have 500 thousand doses of Chinese vaccines that have reached us for 250 thousand people.  

-Are all those doses used? 

-The second doses are in the process of application and of the last ones that arrived last week (Easter) they are still placing the first doses. 

-Who are they vaccinating? 

-As in all countries, the first line of people to be vaccinated are health workers. We have 230 health workers vaccinated, out of approximately 350, with at least one dose, some with two doses. The rest of the vaccines have been prioritized for older adults with more than one pathology, which is 4 million. Then, institutionalized older adults, who are in nursing homes, there are 10. Then we have workers who have not stopped their services in the pandemic: those who work in the transport of oxygen, food, water, firefighters, Civil Protection, among others. We also started to vaccinate a group of educators that number 200. That's when we thought we could start classes in April. Our goal in the national vaccination plan is to vaccinate 70% of the population, that implies 22 million people. 

-When does this general vaccination start for the entire population? 

-When the vaccines arrive. We return to the issue of the blockade and the difficulties. We are making mechanisms, resorting to all our diplomacy, our allies in the world. Access to vaccines is a global problem, it is not just a problem for Venezuela. Here are countries like Canada that have enough vaccines to vaccinate their population twice. The United States already has millions of people vaccinated, Europe too. They, who are the rich countries and also the vaccine producers, have concentrated the largest quantity of vaccines. Vaccines are concentrated in 10% of the countries. That inequity has made us reinvent things. 

-Last year they inspected some plants to manufacture vaccines in Venezuela. How is that project going? 

-Initially when we made the agreement with Russia, there was the possibility of manufacturing or at least packaging vaccines. But those vaccines are kept at minus 20 degrees and manufacturing and storage conditions are difficult for Venezuela. For us to have Sputnik throughout the country, we had to buy freezers with -20 degrees and also connect in places where we were certain that there is a circuit of a power plant that protects it and can be transported in trucks with less than 23 degrees. We had to make an investment and engineering to be able to take Sputnik to different parts of the country. The investment to manufacture vaccines in Venezuela is very high.  

-What alternatives do you explore? 

-We have a closer alternative, another ally, which is Cuba. Right now we are in the process of inspecting our vaccine plant with Cuban experts to see if we can start producing the Cuban vaccine in Venezuela. If it happens, it will ease the process of access to vaccines.  

-And what was the idea of ​​private companies importing vaccines? 

-The President has told us: if the private companies meet the characteristics and conditions, well, there are a number of requirements that must be met by anyone who wants to bring medicine from abroad. You have to ensure that the medicine is effective, that it was stored and transported in ideal conditions. Then, they are authorized and the State buys them for the population. Because otherwise, a situation of inequity will arise: whoever has money is vaccinated and whoever does not, is not vaccinated.  

-Is it in the process of studying whether these private companies meet the requirements? 

-Correct. We are in that right now. They have to bring all their documentation. If I am a private person and I want to bring Chinese vaccines, for example, I have to prove to the Venezuelan State through the Ministry of Health that the vaccine that I am bringing is original, that it was produced there ... I have to prove that the product that I am bringing it's good and that has a process. Because the counterfeit vaccine already exists. Fake vaccines are circulating in the world. Everybody wants vaccines. It is normal. And we are doing everything possible to bring vaccines to everyone.  

Retail 

  • "What are the characteristics of this virus? When it is expelled, a part of them remains floating in the air and another part settles on surfaces. The one that remains floating in the air, if there is not good ventilation in the environment, they are there swarming. Those that fall to the surfaces, normally travel one meter depending on whether I speak, scream, sneeze, they fall and can last between 24 and 72 hours. On cold surfaces the virus is preserved; it likes the cold; on porous surfaces, paper, cardboard, clothing, it lasts less ”.   
  • “The most important transmission of the virus is that which enters directly through the respiratory tract; the secondary one is when we touch a contaminated surface and we put that hand to the face, to the respiratory zones. Therefore, the issue of sanitizing the hands is important ”.  
  • “The mask slows the release of microorganisms. This is very important: when we have a mask, like the one we are wearing at the moment, if I had the virus in my body, the way the virus comes out is through the droplets that I expel when I speak, cough, sneeze or breathe. Every time I breathe there are macroparticles and viruses go in them ”. 
  • “Most of the cases of the new variant (P1) are symptomatic. Last year we had 90% asymptomatic, people who did not have any symptoms. At this time, almost half of the cases have symptoms and this has put a very great pressure on the health system with a demand for oxygen, intermediate care services and moderate patient care, greater than last year. At this moment, Venezuela is going through a complex situation. All measures are being taken to increase the capacity of services for moderate and severe patients ”.  
  • “You have to avoid closed spaces. The meetings have to be held, if necessary, in spaces with natural ventilation ”.  
  • "At this time we have opened health hotels, comprehensive rehabilitation rooms for asymptomatic patients, so that people can perfectly start their treatment waiting for the response of the PCR and prevent the disease from continuing to spread in the sector, home or work"  
  • “The virus has another characteristic that is good to remember and that is that it does not reproduce in the environment. If the virus lands on this table and nobody touches it, it dies there. It only reproduces in a human organism. So far in Venezuela no coronavirus has been identified in animals. In order for it to live, there must be a living being that enters it. That is why it is important to stay at home, because if there are no viruses in the street, all those viruses will die. If there are fewer people on the street, the chains of transmission are broken ”.   
  • “We are at a high peak and the pandemic is growing in this new variant. It started in Caracas, La Guaira, Miranda; then Bolívar and from there the entire highway axis Anzoátegui, Monagas, Sucre, Nueva Esparta. Now is in Aragua, Carabobo, Yaracuy. And surely we are going to observe a behavior in Lara, Falcón, in the central-western states. This is how we are seeing the movement of the pandemic right now in the country "  
  • “One of the effects of the virus is that it dehydrates the person, it may be due to fever or the virus's replication activity. So it is always important water, natural juices, non-concentrated hot infusions. Herbs, when they are highly concentrated, can cause damage. Healthy and balanced food, citrus fruits, daily sunbathing. The intake of vitamins does not necessarily have to be for medications: if you eat in a balanced way, eat fruits, sunbathe, you have contributions of vitamins C and D ”.
  • “In many studies it has been determined that people with high blood pressure, cardiovascular diseases, diabetes, obesity or diseases that compromise immunity, are more prone to complications. People with these diseases have to be particularly careful. And that is impossible for them to be cared for at home. When you see the worldwide reports of the deceased, the majority are people in their 60s or with those diseases ”.  
  • “We cannot think that because we get vaccinated, we are going to remove our mask, we stop sanitizing ourselves, we avoid social distancing. The measures have to continue to be fulfilled even when we are vaccinated " 
  • “Post-Covid sequelae can be mental, that is, psychological. There are people who are left in a panic to go out on the street, in a panic to stay alone because they had been isolated for a long time. There is a whole job that must be strengthened with mental health teams. Then there are people who are left with respiratory problems, because they made fibrosis. They have to do physical therapy to improve breathing. There are others who are left with tension problems, who were not hypertensive and remain hypertensive later. These are things that must be individualized with a doctor ”.   
 

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