As Donald Trump talks up the benefits of treating coronavirus with an experimental drug cocktail which has rarely been used outside trials, debate is raging over the best way to treat patients with the disease.
From Walter Reed national military medical centre in Maryland, where the US president was treated with Regeneron, zinc, vitamin D, famotidine, melatonin and aspirin; to Wuhan, China, where coronavirus entered global consciousness and large doses of intravenous vitamin C have been linked to improved mortality, novel approaches to warding off the respiratory illness can provoke scorn and scepticism. As yet, there are no proven treatments for COVID-19.
At Chelsea and Westminster Hospital in west London, a multidisciplinary, personalised approach to treating coronavirus patients may have led to a significant reduction in mortality among those with the worst symptoms compared to the UK average, new research suggests.
“We always try something different because we treat people like individuals,” says Chelsea and Westminster intensive care unit physician Dr. Marcela Vizcaychipi, whose background is in treating sepsis in Latin America.
Dieticians closely monitored and tailored diets and fluid intake, physiotherapy was provided from the outset, and patients were variously placed in the prone position to stimulate breathing and also received steroids, blood thinners and intravenous vitamin C.
Chelsea and Westminster reported an ICU death rate of 29.9 percent up until the 4th of June for 67 patients, compared to the national median 40.9 percent around that time, official figures from the Intensive Care National Audit & Research Centre (ICNARC) show, over the course of the six-week period recorded. An initial study went online at the time, before it was accepted in the Journal of Emergency Medicine and published on the 25th of September.
“The key is a multidisciplinary approach and seeing how the individual responds to treatment regardless of your colour and medical background,” Vizcaychipi tells VICE News.
The research, though limited in size, could reignite the debate over whether high-dose vitamin C – adequate levels of which are central to good immune health – helps people fight off coronavirus, as those with weaker immune systems are disproportionately impacted by the disease, though it was not possible to calculate the impact of the nutrient alone as it was a part of a host of treatments.
The key UK study for coronavirus treatments for critically ill patients, overseen by ICNARC, is evaluating the use of high-dose vitamin C for patients with severe community-acquired pneumonia caused by COVID-19. Depending on their weight, patients will receive about 3 grams of vitamin C, plus steroids and blood thinners four times a day for four days – following reportedly successful practices at a small number of ICUs in the US.
The NHS says that adults aged 19 to 64 need 40 milligrams of vitamin C a day and that everyone should be able to get all they need from their daily diet. Taking more than 1,000 milligrams a day can cause stomach pain, diarrhoea and flatulence, it warns, though these symptoms should disappear once you stop the intake.
Nutrition expert and author Patrick Holford says that vitamin C is expended at “an alarming rate” by patients with COVID-19, particularly during the final stage of cytokine storm as blood levels drop precipitously: “Several grams need to be given simply to restore normal physiology. Vitamin C needs to become a vital part of treatment.”
Last week an ICU in Barcelona reported that 17 out of their 18 COVID-19 patients tested for vitamin C had undetectable levels consistent with a diagnosis of scurvy.
But, with the jury firmly remaining outside the courtroom, Vizcaychipi is clear that the powerful nutrient – also known as ascorbic acid – is no panacea. “I don't think ascorbic acid is a magic drug,” she says.
Okay, so what made the difference in the Chelsea and Westminster patients? It was down to the combination of treatments, Vizcaychipi says.
“My ascorbic acid, plus the fluid, plus good oxygenation, plus anticoagulation,” she explains. “It's a combined approach to listen and hear what the patient’s body tells you.”
Those in the Chelsea and Westminster ICU were routinely given 1 gram of ascorbic acid twice daily (the equivalent of about 20 large oranges), while all information was digitised and nobody was triaged – deciding the order of treatment of patients – as part of a so-called near real-time “traffic light system” that was implemented on the 12th of April.
“Vulnerable groups become a self-fulfilling prophecy when implemented in triage decisions,” Vizcaychipi said. “Current triage criteria are overly restrictive and … COVID-19 admissions to critical care should be guided by clinical needs regardless of age.”
Her outside-the-box thinking was born from her own experiences treating patients on a shoestring. “I learned medicine in a small hospital in north-east Argentina in the late 1980s where we didn’t have any of the brilliant hi-tech equipment we use now,” she told HealthInsightUK in August. “Often the only treatment for badly infected patients was good nutrition and mineral and vitamin supplements to stabilise their system. I saw first-hand how effective that could be.”
As the spread of the virus shows no sign of abating, and the development of a vaccine at Oxford university is hampered by delays after a trial participant fell ill with unexplained neurological symptoms, there is a serious urgency to find a cure.
However, the lack of consensus among doctors over the best method means that patients’ treatments can differ from hospital to hospital and even doctor to doctor, the Wall Street Journal reported, and as global deaths grow while Trump lauds dubious remedies, there will be increasing focus on left-field solutions as new research emerges.