“More than 1,100 coronavirus patients are waiting for a hospital bed in Rio de Janeiro.”
“Deaths at home rising.”
“No end in sight.”
“Private medical system at 98 percent capacity in the ICU.”
Now it was here, in our house. Hoping to stave off the worst, but not sure how, we started making calls. We phoned a doctor in the United States. He said it was all but certain I’d also been infected, and counseled rest, isolation, hydration — and little else.
Then we started calling doctors in Brazil. They urged a far more urgent, aggressive approach.
“It’s important you get [to my clinic] so it can’t get worse,” one doctor pressured. In September, she’d prescribed a friend of mine — whose symptoms included headaches and loss of taste and smell — a litany of medications that he came to swear by. Chloroquine, an antimalarial. Ivermectin, a parasite medication used on livestock and dogs. Azithromycin, an antibiotic. Clexane, an anticoagulant. A corticosteroid.
“We need to start your treatment soon,” the doctor added in a follow-up message.
Anxious and unsure, we got the azithromycin and ivermectin and — bottoms up — tumbled onto a coronavirus treatment plan that has swept the country, despite scant scientific proof. The pill plan, adopted by officials all over Brazil, has sent millions scrambling to pharmacies and worked its way into federal government guidelines.
Officials call it “early treatment.” People in the streets have another name: the Covid Kit.
The coronavirus pandemic has been a time of uncertainty and “miracle cures” everywhere. But this has been particularly true in Latin America. In Bolivia, people have bought chlorine dioxide, a bleach used to disinfect swimming pools. In Venezuela, President Nicolás Maduro has public hospitals requiring coronavirus patients to take interferon alfa-2b, a virus and cancer medication. Doctors across the region are finding it difficult to find patients who haven’t taken ivermectin.
But few have pushed the unproven and potentially harmful medications with the gusto, commitment and theatricality of Brazilian President Jair Bolsonaro.
His pill of choice has long been — and still is — hydroxychloroquine. He touts it on social media. He praises it in comments to supporters. When Bolsonaro was infected in July, he claimed to have medicated himself with the antimalarial, then waved a box of it at emu-like birds on the presidential palace lawn in Brasília. At a presidential ceremony after he recovered, he brandished another box of the drug and called himself “Dr. Bolsonaro.”
“Early treatment saves lives,” declared Eduardo Pazuello, Bolsonaro’s third health minister since the onset of the pandemic.
I was skeptical at the time — and remained so when we were infected. But it’s difficult to overstate the emotional impact of contracting a virus that has killed millions of people and left millions more with long-term health repercussions. There’s fear and uncertainty, yes, but mostly an overwhelming sense of helplessness. Some doctors say all you can do is wait and see. But other doctors — and government officials — are saying you can do more.
Whom do you trust? What do you do?
We started reaching out to more doctors. Six in all. One said take the pills. Another said she had taken azithromycin herself. I came away thinking about the pharmacies I’d seen throughout Brazil. They are absolutely everywhere, sometimes three in a single block. According to the Federal Pharmacy Council, the country is known for one of the highest rates of pill consumption in the world, and people are quick to self-medicate. When in doubt, the logic seems to go, swallow a pill.
“The culture of overprescribing was already here,” said Alexandre Kalache, an epidemiologist I’ve interviewed frequently throughout the pandemic. “The doctor who doesn’t prescribe is a bad doctor.”
So when “Dr. Bolsonaro” wrote out his prescription, who were Brazilians to argue?
In the central city of Barra do Garças, officials made little care packages of azithromycin, ivermectin, chloroquine and the painkiller dipyrone for public distribution free of charge. Minas Gerais state secured nearly 380,000 chloroquine tablets to meet local demand. And Itajaí Mayor Volnei Morastoni, a physician, went even further. He urged not only the pills but also a “simple, rapid” application of ozone — administered with a rectal catheter.
“At least he’s doing something,” Débora Fonseca, who represents the local union of health professionals, said with a shrug. “He wouldn’t have been reelected in November if people hadn’t supported it.”
But whether the treatments have been effective is another question. The death rate in Itajaí has been nearly 60 percent higher than the Santa Catarina state average. The Amazonian city of Manaus, where federal and state officials have urged all sorts of pills, has again been devastated by the disease.
No pill has saved Brazil from burying more than 230,000 people, the second most in the world after the United States. The creator of the Covid Kit, a doctor in Mato Grosso state, died of covid-19 in September.
So before continuing our pill regimen, we wanted more advice. We messaged another doctor, João Pantoja, one of Rio’s leading pulmonologists, whose contact Emily had somehow acquired. He disabused us of the idea of taking the medication.
“I’m not a believer in any of those ‘miracle drugs’ to ward off worsening of covid-19,” he wrote to us. “Although I would love to have one that actually worked at my disposal.”
He became the physician on whom we relied most. But in a country and region where the coronavirus continues to rage, it’s unclear how many will listen to such advice. In recent weeks, people have reportedly started threatening doctors who won’t prescribe medications, no matter how ineffective. Long lines have formed at Manaus pharmacies to buy the medications.
In some ways, the myth of early treatment is a product of the coronavirus itself. People will believe a pill cured them — or a loved one — when, in reality, the vast majority of people who contract the virus recover without any medical intervention.
“When someone gets better, it was because of their treatment,” said Alberto Chebabo, vice president of the Brazilian Society of Infectology. “But when they get worse, it’s because the virus is just that strong.”
Emily and I were convinced. We stopped taking the pills. We instead focused on rest, liquids and bad television. Additional testing confirmed that I had also contracted the virus. But after a few weeks — and a disorienting loss of taste and smell — we were pretty much recovered. For all those worries over the hospital system, neither of us were ever near sick enough to consider going to one.
Was it the ivermectin? Almost certainly not. The U.S. National Institutes of Health said last month that it had found insufficient data to recommend it.
But the myth continues.
The other day, my father-in-law, who lives in Santo Domingo in the Dominican Republic, sent us a viral image making the rounds in Latin America. It showed a fake beer bottle, emblazoned with a new marketing slogan: “Now with ivermectin.”
Heloísa Traiano contributed to this report.