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Evidence Based management of COVID 19

Sept. 6, 2021


New Zealand is lucky in many regards that when finally, we do start living with COVID rather than working to eliminate it, we can do so with the knowledge and learnings from our peers around the world. Currently, all mild COVID cases are whizzed off to Jett Park or other MIQ facilities, and so are not dealt with in primary care. There must come a time when that no longer happens.

Our doctors have recently been involved in educational sessions with Prof Dee Mangin. Dee is a New Zealand GP who is currently Professor and Director of the Primary Care Research Group at the University of Otago, Christchurch. She is also the David Braley Nancy Gordon Chair in Family Medicine at McMaster University, Canada. We are lucky to be able to leverage off her experiences in Canada throughout the pandemic. Dee's Canadian team at McMaster pull together all the studies done worldwide on treating and managing COVID and present them in a useful format for doctors like us.

Dee's advice has given us much reassurance. We anticipate that when we start living with COVID, 90% of it will be managed by us in the community and that 10% will require hospitalisation. She has provided a framework for how to manage COVID in the community and we are primed and ready for when and if this happens.

Most of our team have been asked questions, by our patients, about treatment options for COVID, and Dee has advised that we stick to providing only evidence-based options. This week, Bryan Betty, the Medical Director for the RNZCGP has issued some advice on one drug that there is some misinformation circulating about. In copying this in full I hope that this will explain why we are not prepared to issue prescriptions for ivermectin off-license. Prof Mangin pointed out that in India many patients were given cocktails of drugs in desperation to manage COVID. The steroids they were given inadvertently led to increased levels of parasitic infections (common in India) which then responded to the ivermectin.

Royal New Zealand College of General Practitioners.

Medical Director update 3 September: Ivermectin and COVID-19

Ivermectin has become the subject of much debate and conjecture in both the popular press and social media for the treatment of COVID-19. While there is low-quality data that supports further evaluation of Ivermectin in well-conducted clinical trials, there is as yet no evidence that supports the use of Ivermectin for treatment of COVID-19 outside the setting of one of these trials.

Additionally, there is reason to doubt these trials will demonstrate benefit, as the level of Ivermectin required to inhibit SARS-CoV-2 in-vitro greatly exceeds the highest safe dose in humans.

Off-label use of Ivermectin for treatment of COVID-19 is strongly not recommended.

Ivermectin is a critical medicine for treating some parasitic infections, including Strongyloides stercoralis, which can rarely cause life threatening 'hyper infection syndrome' in people who receive immunosuppressive medications. As a result, Ivermectin is regularly used to treat proven or suspected Strongyloidiasis in patients who are treated with immunosuppressive medications, which include many of the proven treatments for COVID-19 (e.g., dexamethasone and tocilizumab). Some people with COVID-19, who have lived in areas endemic for Strongyloides, receive treatment for this condition in addition to other COVID-19 specific therapies.

Ivermectin can, and does, cause harm when misused. Prescribing it could well mean that even if the patient had given consent, the doctor could still be held liable for making an ill-informed decision on a medication that at this point has not been shown to provide benefit and could cause harm. It would be difficult to justify this position with either the Medical Council or the Health and Disability Commissioner.

Stay strong,

Dr Bryan Betty

MBChB, FRNZCGP, FACRRM

Medical Director | Mātanga Hauora