Brazil: "Many people only realise it doesn't work when it's already too late"

Jamila Costa is a nurse working as part of an MSF team supporting the local COVID-19 response in Porto Velho, the capital of Rondonia, in northern Brazil.

27 Apr 21

In the North of Brazil, the “Kit-COVID” is king. This drug cocktail has been promoted as a panacea by Brazilian authorities since the beginning of the pandemic and includes hydroxychloroquine (an anti-malarial medication), ivermectin (an anti-parasitic) as well as some antibiotics. Whilst clinical studies have not shown their effectiveness in either preventing or treating COVID-19, those that take them have a false sensation of security, believing they are protected from the virus. This not only may lead to risk taking behaviour like ignoring social distancing, but when these patients fall ill with COVID-19, they tend to come late to health facilities, often already in severe or critical condition.

"Kit-COVID"

"Here in Rondonia the vast majority of patients who require medical attention due to COVID-19 have taken the “Kit-COVID”.

Last year, when I worked with COVID-19 patients in the outskirts of São Paulo, it wasn´t common to see people taking those medications but here in Northern Brazil their use seems to be widespread.

MSF supports Ji-Paraná's Municipal Hospital, in Rondônia state. Due to the pandemic's strain on the town's public health system, the hospital is now a COVID-19 referral center.

Day after day, we witness a great amount of vulnerability and fear, mixed with a great deal of misinformation about the disease.

Combined, this leads people to believe these drugs will give them some kind of much needed protection.

People who take the “COVID-kit” believe it will reduce their chances of contracting the disease.

If they are infected, the belief is that it drugs will stop the illnesses from evolving to severe or critical condition.

There are no clear guidelines from the authorities so doctors are free to prescribe them.

Sometimes it is the patient himself who takes the initiative and asks the doctor for the medications.

Even if the doctor refuses to prescribe them, some of the drugs can be obtained easily in almost any pharmacy.

“I haven´t been vaccinated yet, but I am taking the kit”, is a line we hear over and over again as if the drugs provide some kind of immunity.

MSF supports Emergency Care Units (known locally as UPAs) in Porto Velho, Rondônia state's capital, implements rapid-antigen testing in 6 basic care units and does at home follow-ups for high risk COVID-19 patients.

Misinformation leads to dangerour behaviours

The fact that they are easily available, and the way they are being widely disseminated with the help of misinformation, leads to very dangerous behaviours, that we see every single day.

“I'm happy because I'm getting better every day and I'm going to be discharged today. I have relatives who have had their lungs almost fully compromised," says Antônio da Consolação Pinho, COVID-19 patient.

Some people say they are taking higher doses than prescribed, and for a longer period, believing that this way they are protected against the new variants.

There are parents who give them to their small children. I saw a mother with a child, who looked about four years old, waiting for an appointment not related to COVID-19, at an emergency care unit.

“Kids don´t have any symptoms when they’re infected, so it´s better to give it to them so they won´t have anything to spread”, she said.

MSF supports Emergency Care Units (known locally as UPAs) in Porto Velho, Rondônia state's capital, implements rapid-antigen testing in 6 basic care units and does at home follow-ups for high risk COVID-19 patients.

When we encounter situations like that, we try to give our guidance, showing that the only effective preventative measures for COVID-19 are frequent handwashing, physical distancing, and the use of masks.

So-called “early treatment” is not effective

We had a whole family get sick whilst taking the “Kit-COVID”. The mother and the father were admitted to an emergency care unit, and they were lying side by side.

Their son was the person who brought their parents their meals every day, even though he too had tested positive for COVID-19.

"The reality is that we only realize things when we are here, when we see things and see what happens. I saw people who were admitted and within 3 days I had the news that they didn't survive," says Gisele de Souza, daughter of patient.

These emergency care units are not proper hospitals but are being used to relieve the burden on the overcrowded system.

Most of them don´t have the structure to provide meals or to distribute them to patients.

...The only effective preventative measures for COVID-19 are frequent handwashing, physical distancing, and the use of masks

It should be part of the nurses´ duty to feed the patients, but the cruel reality is that there are not enough human resources.

So, a family member usually takes on the task, at significant risk to themselves.

 Due to the over-saturated health system as a result of COVID, the UPAs, which usually only manage the stabilization of patients before they are transferred to higher level facilities, must take in more complex patients than they were designed to handle.

“We all took these medicines, and I am in a very bad shape. They are useless!”, the father, who had a pre-existing heart condition, reasoned during one of his son’s visits.

“Because of my health problems, it has become even worse”.

A few days later, he had to be intubated and died. His wife and son both recovered.

A harsh wake-up call

The fact that a whole family, who had all been taking the “Kit-COVID" got sick and one of their members died was a wake-up call to some of the other patients.

It´s really sad but it seems that it is only when a patient is intubated or dies that their relatives realise that this so-called “early treatment” is not effective.

None the less, even with all of this sadness and these challenges, our duty is to keep working every single day so that preventive measures against the disease that actually work, like hand washing, using masks and social distancing, are understood and followed in the community.”

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