Wednesday, March 24, 2021

Covid 27, Dr. Rafael Castillo on vaccine, Ivermectin, and lifting the lockdown

I'm reposting here three posts from Dr. Rafael Castillo, a famous and highly respected Filipino physician and weekly columnist in Inquirer Lifestyle’s Wellness page, https://lifestyle.inquirer.net/byline/rafael-r-castillo-md/. First paper was published in PDI, next two papers were shared in various Viber groups until today. Enjoy.
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Doctor suggests six urgent steps that may help turn health crisis around
By: Rafael Castillo MD / 05:06 AM March 22, 2021
https://newsinfo.inquirer.net/1409677/6-urgent-steps-to-turn-health-crisis-around 

I just read the report on rapidly developing “escape mutations” of the novel coronavirus, and tried to trace the development of the currently identified variants.

And it occurred to me that they all started in countries with massive vaccination clinical trials (the United Kingdom, South Africa, Brazil).

Now, additional escape mutations have been identified in countries like the United States after mass vaccination.

Just a coincidence? Or could the mass vaccination be paradoxically triggering the propagation of the virus? Hopefully not.

With a 400-percent surge in the number of COVID-19 cases, we definitely have to pause and rethink our situation.

I propose the following steps that may help us turn this medical crisis around, particularly in hotbed areas.

Moving target

At the rate escape mutations are developing, the current vaccines may no longer be effective in a few months, and it would require an urgent round of booster doses plus additional shots perhaps every three to six months to cover for the variants that could number in the hundreds within months.

The virus seems capable of mutating every 24-48 hours. It’s like shooting at a moving target, and as we hit one, it divides and creates new variants.

It’s time we recalibrated our anti-Covid strategy.

1. We should urgently shift from a vaccine-centric strategy to a more holistic multipronged approach. Vaccines are the least we need in Metro Manila and other hotbed areas.

2. Suspend vaccination for now and go full-blast with measures to control community transmission. Continuing the vaccination will only fuel the transmission and promote more mutations and resistance to vaccination.

3. Proceed with mass vaccination only in areas with controlled and stable community transmission.

20-40 age group

4. Withhold vaccination of the 20 to 40 year olds to reduce the rate of developing vaccine resistance. Vaccinating them will only create more breeding grounds for virus mutation and resistance development.

Besides, the risk of dying from COVID in the 20-40 age group is extremely low and just slightly higher than the risk of dying from vaccination-related adverse reactions.

It’s better to allow their system to develop natural, rather than vaccine-generated, immunity that can potentially weaken their innate immunity.

Let’s reserve the vaccination for the elderly, and other high-risk persons whose immune systems are no longer as healthy and reactive as the young adults’.

Ivermectin, etc.

5. Stop buying more vaccines for the next six months and reallocate the money to buy other immune-system- boosting agents like ivermectin, vitamins D and C, zinc, virgin coconut oil, and melatonin which should be provided for free in hotbed areas.

Face masks and shields should also be distributed for free in indigent barangays.

The government can invoke its police power and take over the manufacture of these products during this critical period. USP-grade ivermectin is not even available. The government should make emergency importation of this product, which can be easily procured from neighboring countries.

6. Agility in adapting and adjusting to prevailing circumstances is paramount.

Our previous plans on mass vaccination may not be suitable for now. It’s an excellent tool for prevention of future transmission, but is potentially disastrous in the current situation when community transmission is uncontrolled. 

This virus is making us think within the box as it slyly operates outside the box. It’s time we stopped being outsmarted by it.

With God’s mercy and grace, we can lick this virus for good. We just need to humble ourselves and stop believing we can solve this pandemic crisis on our own.

We need to unite, put our best ideas together, and swallow our pride if we want to win this crucial war against this unseen enemy.

Our window for survival is still very good, but quickly narrowing. It’s time to fight the war wisely, and with the right weapons.

God bless us all.
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March 23

IMPORTANT REJOINDER TO MY URGENT MESSAGE COMMENTARY 
Dr. Rafael R. Castillo 

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

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.
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March 24

DO YOU SEE WHAT I SEE? 
Dr. Rafael R. Castillo 

My dear Family and Friends,

In 6 months...

I see the level of covid-19 going down to such a level that would allow us to go back to our work, church and school;

I see ourselves shaking hands again, our children and grandchildren bowing in respect, and raising our right hand to their foreheads, saying, “Mano po (Bless);”

I see our malls bustling again with activity, where you can just sit in your favorite coffee shop, reading the morning newspaper as you sip your hot capuccino or tea;

I see ourselves travelling again, visiting our loved ones abroad, or simply enjoying the sites in popular travel destinations;

I see our church goers worshipping again together physically, holding hands as they sing praises to the Lord;

I see virtual conferences and conventions being transformed once again to face-to-face meetings, and you can say your piece or ask questions without having to worry that unstable internet connectivity might cut you off;

I see ourselves sitting next to people in waiting areas or in public transportation like we used to do, finally getting rid of the empty seats or spaces we now have to maintain between each other;

I see ourselves watching movies again in cinemas, together with our friends and loved ones, and eating lunch or dinner in the nearby food court afterwards;

I see our children coming back from school each day, bursting with glee as they relate the new things the have learned and the new friends they have met;

I see ample food back on our tables, without us worrying if we’ll still have some tomorrow;

I see ourselves sleeping soundly at night, assured that the company we’ve worked for in the last 25 years will still remain in business;

I see ourselves feeling confident and safe in going to our doctor’s clinic in the hospital for our regular check-up, and not feeling paranoid that we might come home with a dreaded virus;

I see our mommies and daddies hugging their little ones again as they tell them bedtime stiries, and tucking them to bed later on when they’re asleep;

I see and feel the warmth of relationships once more as we resume our regular visits to our parents and grandparents, and other loved ones, without having to worry that we may be infecting them with the virus;

I see people once again trooping to the tiangges (street markets) sampling the native delicacies or buying potpourris, souvenirs and gifts for the coming Christmas season;

I see our leaders and anti-covid managers really thinking of innovative and creative solutions that are suitable, effective and best for our country, and not only following what is being done in other countries;

I see our government shifting from a mainly vaccine-centered strategy to a holistic approach that can effectively cut disease transmission by at least 90 percent and prevent severe covid-19 by nearly 100 percent;

I see covid-19 being limited to no worse, and no more dreadful than the seasonal flu;

I see President Duterte again exercising his strong political will to implement a combined targeted vaccine + simple, affordable but effective strategy, and distributing for free this anti-covid preventive and therapeutic regimen to all baranggays in the country, with a cost less than a tenth of what the country would spend for a vaccine-centered strategy;

I see our medical experts loosening themselves from a rigid, strictly scientific and evidence-based mindset, and adopting guidelines and advisories based on best available evidence combined with pragmatism;

I see a nation filled with love and harmony, where people truly respect and care for one another;

I see our leaders and countrymen humbling themselves to God, and acknowledging Him as the only One who can provide the lasting solution to this pandemic;

I see ourselves learning from all the hard lessons this pandemic has taught us, and gaining the wisdom and fortitude to handle any other crisis that might confront us again in the future;

I see ourselves emerging from this crisis as victors, not as victims, and shining through as the ‘salt of the earth’ as we praise and glorify God for our victory.

What a wonderfully clear vision I see!

Do you see what I see?

Love,
Raffy
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See also:
Covid 24, Lockdown damages in the Philippines, February 09, 2021 
Covid 25, WEF celebrated global lockdowns, March 01, 2021 
Covid 26, CDC PH Statement on Ivermectin, March 20, 2021.

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