https://quadrant.org.au/opinion/qed/2021/01/covid-19-a-realistic-approach-to-community-management/
” This not the time for those who should know better to publicly argue for one or other COVID-19 vaccine, not when full and adequate evidence for any such choice is well down the line. What the current moment most definitely does demand is early treatment, especially for the aged and most vulnerable, and for this two cheap, proven and off-patent drugs are readily available — hydroxychloroquine and ivermectin.”
Historically, pandemics generate suspicion, speculation and emotion, before logic and empirical decisions determine optimal management. The current COVID-19 pandemic is no exception. Twelve months on, there is an emerging consensus supporting an integration of a four-pillar plan: public health strategies; vaccination; early pre-hospital treatment; and hospital treatment. This position replaces an early confusion, with supporting data appearing on a near daily basis.
Public health strategies are well understood and highly effective, forming the bedrock for disease control, while hospital management is a work in progress but with progressive improvement in outcomes. Typical data for high risk subjects (over 50 years of age with one or more co-morbidities) in the US is currently 18-20 per cent hospitalisation, with mortality around 1 per cent. Less attention has been given to ongoing symptoms, with about 80 per cent of hospitalised patients having profound fatigue and/or breathlessness 3-4 months after discharge. Many are unable to return to full time work six months after the infection is controlled.
The area of intense disagreement is community management combining prevention by vaccine and reduction of hospital admission, using pre-hospital treatment. There is a global expectation that vaccines will dramatically change the current face of COVID-19 while there is broad-based denial that any of the available (unpatented) drugs beneficially alter the natural history of infection. Expectation of a vaccine nirvana alongside therapeutic nihilism are both incorrect, although each is promoted with a vigour rooted in socio-political conviction (and supported by the Pharma industry).
The conclusion, based on logic and data, is that vaccines and early treatment strategies are both necessary for optimal disease control. As a result, a community plan has been formulated, aimed at keeping patients out of hospital. Experienced physicians have developed protocols based on evidence, with sequenced multi-drug regimens that support over 80 per cent reductions in admissions to hospital and death. Implementation of this approach would effectively end the US, UK, Canada, and EU hospitalisation crises.
The objective of this brief review is to argue in support of these conclusions, based on an untangling of the pathobiology of COVID-19 over the last 12 months; review of the available data on the three vaccines used in the Western world; and current data supporting significant benefit of pre-hospital drug treatment.