For the first nine months of the COVID-19 pandemic, there were no officially approved outpatient treatments for combating the disease. The medical establishment expressed extreme caution regarding such treatments, and these warnings were amplified by major media hostile to President Trump, as when he touted the anti-malaria medicine hydroxychloroquine.
Although an estimated 12 percent to 38 percent of prescriptions are written for FDA-approved drugs used “off-label” (including Botox and Viagra), Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, declared early on that providers should dispense only medicines proven to be safe and effective for COVID patients through “randomized, placebo-controlled trials.” These can take months or years to conduct, often at great cost.
Some governments and independent practitioners considered that standard a recipe for inaction that meant likely death for untold numbers of victims. These medical dissenters instead treated COVID-19 as physicians have long responded to newly emerging infectious diseases: by administering designer cocktails of cheap, safe, and readily available agents—in this case including hydroxychloroquine, antibiotics, aspirin, and vitamins—that had proved effective in treating similar illnesses or showed promise due to mechanisms of action.
RealClearInvestigations spoke or corresponded with 12 such advocates for early outpatient treatment globally—from California, Texas and Honduras to France, Israel, and India. These physicians used their clinical experience to make educated guesses about what combinations of drugs might work. Few used the same cocktail, but all insisted the treatments proved most effective when administered as early as possible.
Researchers knew fairly early in the pandemic that COVID infections progressed through several stages. For example, it was known in March 2020 that the illness progressed from a viral phase to massive inflammation across the body. Anti-inflammatory drugs—such as colchicine, the choice of Dr. Darrell DeMello in Mumbai—could have been given at clinicians’ discretion.
By June 2020, it was known that COVID could cause major blood clotting. The blood thinner Plavix, another choice of Dr. DeMello, is often used to prevent and treat clotting. As Dr. Brian Tyson, a primary care physician in Imperial County, California, who champions outpatient treatment, explained, if patients are “showing inflammatory changes, let’s use an anti-inflammatory. We see people getting clots, dying of coronary artery clogs, let’s use a blood thinner.”
It wasn’t until April 2021 that the National Institutes of Health announced it would fund a large clinical trial to study repurposed drugs, including some of those favored by several of the doctors RCI interviewed. Why wasn’t there greater urgency to conduct studies like this one?
President Trump’s advocacy of hydroxychloroquine put him at odds with the Washington media and medical establishment. This may in part have colored public perceptions of the use of off-label drugs in the U.S. Articles in the highly influential medical journal The Lancet played a significant role—with one that pooh-poohed hydroxychloroquine being retracted after proving fraudulent. Although hydroxychloroquine is used around the world every day to treat various illnesses in adults and children, including lupus and malaria, health officials cast it as potentially dangerous. “As a result,” Dr. Scott Atlas, the often-dissenting adviser to the Trump White House Coronavirus Task Force, writes in A Plague Upon Our House, his new tell-all, “doctors were blocked from prescribing the drug, even though prescribing any other approved drug for an off-label use was routine.”
U.S. tech giants censored much discussion of outpatient treatment, branding it “misinformation.” YouTube in particular has silenced heterodox thinking, suspending the YouTube channel of Senator Ron Johnson (R-Wis.), a proponent of early treatment who convened two hearings on the matter in late 2020, and removing several of Senator Rand Paul’s (R-Ky.) YouTube postings.
Most of the regimens advocated by early outpatient treatment proponents also included ivermectin (IVM), a common drug that became controversial in the United States after the podcaster Joe Rogan said his doctor prescribed it off-label to him once he contracted COVID. Media voices opposed to unapproved treatments described the drug—widely given to people and livestock—as a “horse dewormer.” The FDA advised against using IVM against COVID—yet IVM is one of the repurposed drugs being tested in the NIH-sponsored trial that began in June.
Dr. Miguel Sierra-Hoffman, an associate professor of infectious disease at Baylor Scott & White Hospital and of pulmonary medicine at Texas A&M University, who has overseen the care of thousands of COVID patients at multiple hospitals, remains convinced that the embrace of outpatient treatments early on would have been a difference maker—and an economical one. “If we had given people aspirin, ivermectin, colchicine, and if they get complicated, a little dexamethasone, we could have saved the world with one dollar.”
For his part, Senator Johnson blames public health authorities for orchestrating a broader campaign against early treatment with repurposed drugs. “Rather than seriously consider evidence showing the potential of early treatments including ivermectin, your agencies prefer to mischaracterize, conflate and misconstrue anything that goes against the mainstream narrative and the financial interests of the pharmaceutical industry,” he wrote in an October 2021 letter to Biden Administration health officials.