Alfred Dawes | Open windows and worm medicine in COVID-19 fight

It sounds crazy until you hear the science. Two of the greatest tools in the fight against COVID-19 are open windows and a 40-year-old drug, mostly used in Jamaica on pets, and to combat lice and intestinal parasites in humans. The reason why these powerful tools are still being discussed only on the fringes is a mystery. Some speculate that it is because nobody can create megaprofits from their widescale adoption, unlike less efficacious options being rammed down our throats. With the current spike in the infections and hospitalisations curve, it is worth examining every recommendation for merit.

Ivermectin was used very effectively in the treatment of river blindness, caused by a parasite. It is FDA-approved and has been on the World Health Organization model list of essential medicines. Its safety in humans is already settled and the only question is, can it live up to its hype in the fight against COVID-19 or will it simply be just another flop, as hydroxychloroquine was. So far, there is concrete evidence that Ivermectin is lethal to SARS-Cov2, at least in the lab. There was initial scepticism despite this finding because the concentrations of the drug required to kill the virus in the test tube were too high for the human body. However, it may be that it is the anti-inflammatory properties of the drug seen in lower doses than those required to kill the virus that make it work so well in COVID-19 patients.

Several studies, although not ideal ones, have shown that persons suffering from COVID-19 have a shorter course, less chance of dying, less severe symptoms and decreased chance of passing it on. In persons exposed to COVID-19 there is a decreased chance of contracting the disease if treated with Ivermectin. A huge part of the problem is that these studies are from second- and third-class countries and very little weight was placed on their validity until the University of Liverpool got involved. With a first-world European University showing the world that Ivermectin works, the mainstream health sector and media finally began to take notice. In fact, the National Institutes of Health has updated their position to say that they cannot recommend for or against Ivermectin until they get more evidence from more trials. This is a notch up from recommending against certain treatments that are shown not to work.

IMPROVEMENT IN SICK PATIENTS

Proponents of Ivermectin have described it as “a gift” and quote studies that highlight the vast improvement in sick patients including a decrease in the chance of dying from 20 per cent to two per cent. Sitting and waiting, while people die, for the ideal studies out of first-world countries highlights the inequalities of the post-colonial world manifesting in the field of research. Unfortunately, being guided by the vestigial organs of Bretton-Woods in the form of the WHO and PAHO will steer us in the direction of avoiding Ivermectin until “more information is obtained”. It is in the interest of the public that the Ministry of Health and Wellness to not close the window on this opportunity to save lives and return to some semblance of normality in a country where vaccine uptake and availability are concurrent issues. And speaking of windows, maybe it’s time you open yours.

If you measure the carbon dioxide levels in a closed room with people you will find that the levels go up over time, a sign that fresh air is not replacing the room air even with an air conditioner on, and that people are rebreathing each other’s air. This is not so bad if there wasn’t a pandemic caused by a virus that lives in microdroplets that linger in dead air. There is no question that COVID-19 spreads more easily indoors where the ventilation is poor, and less so outdoors where the wind scatters microdroplets as they are produced. From the beginning of the pandemic the Chinese discovered that the microdroplets could spread indoors long after the source patient had left the room, and that persons far from the source could be infected. This led to the implementation of ages-old practices to ensure adequate through ventilation in cars and buildings.

The hospital wards of old were wide open spaces with large windows and open floor plans to take advantage of the tropical breeze, and in the Spanish flu pandemic, patients were treated outdoors in tents. That knowledge was never passed on as respiratory infections were relegated as chronic diseases became the top killers, over-infectious diseases. As victims of our own success in overcoming diseases such as tuberculosis and pneumonia, we retreated to stuffy air-conditioned rooms in the name of modernity and comfort. A major part of why the winter is so deadly in the northern climes is that the cold population retreat indoors and create petri dishes with heating and closed windows. Trump was right when he said infections would subside as the weather warmed. What he didn’t see was that as it got cooler and they went back inside, there would be a resurgence.

We are blessed with a warm climate but as our architecture evolved, we are now forced to be cooped up in buildings trying to beat the heat as much as our temperate neighbours are nestled inside away from the cold. The non-mask-wearing market-goers and illegal parties are obvious culprits in driving the pandemic, but what is the role of those of us who are spreading the virus in poorly ventilated supermarkets and workplaces? Maybe it’s time we open the windows and doors and let the COVID-19 out.

Alfred Dawes is a general, laparoscopic, and weight-loss surgeon; Fellow of the American College of Surgeons; former senior medical officer of the Savanna-la-Mar Public General Hospital; former president of the Jamaica Medical Doctors Association. @dr_aldawes. Email feedback to columns@gleanerjm.com and adawes@ilapmedical.com.