There isn’t time for clinical trials

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Foreign nationals checking at the busy Cape Town International Airport after the announcement by President Cyril Ramaphosa that visas will not be extended due to the COVID-19 outbreak. File picture: Phando Jikelo/African News Agency (ANA )

Pietro Vernazza’s story came to the fore in August 2016 at the International AIDS Conference it Durban.  Up until then, some “pretenders” had been guarding the gates of AIDS response.  It was a classic example of the old adage: “My mind is made up, don’t confuse me with the facts”. 

This same attitude could be affecting our ability to roll out “therapeutics” for the Covid-19 pandemic as well. Dr Vernazza worked as Chief of Infectious Diseases in a Swiss hospital.  Starting around 2003 he had sustained contact with people in permanent “magnetic relationships” – that is, one HIV positive and one HIV negative.  The condom was the state-of-the-art protection against HIV transmission, but it was also a form of birth control.  So when such couples wanted to have children they were told that they faced the risk of HIV transmission – by not condomizing. 

Dr Vernazza was open with them about their choices, and let them decide for themselves.  But after some time he noted – from observing those who chose to accept the risk for the sake of procreating – that seropositive partners who were taking ARV treatment were functionally un-infectious.  When he published his findings in the Bulletin of Swiss Medicine, he became a pariah.  Other researchers and academics went on the attack, mainly because he didn’t have clinical trials.  He only had anectodal evidence.

But eight years later, at the international AIDS conference in Durban in 2016 we learned that several formal research studies had vindicated his initial findings.  There was, it turns out, power in ARV treatment to prevent HIV transmission – as safely as condoms.  We now say that the sero-positive partner is “virally suppressed”.  Their “viral load” becomes undetectable. 

Put another way, seropositive people are not always sexually infectious.  But instead of a sense of relief and even delight that “magnetic couples” can normalize, Vernazza went through a long period of being infamous – not famous.  He was the Swiss pariah. Now it is déjà vu all over again!  First-responders in China have reported widely that a combination of antibiotics and ant-malarial drugs proved effective in treating Covid-19.  But there have been no clinical trials – research is still on-going.

Chloroquine has been around for a long time, it hardly needs clinical trials.  In fact, it started as an indigenous potion from South America.  The aboriginal people there had found that if you boiled down the bark of the Cinchona tree, you could get what we now call “quinine”.  (It also gives tonic water that bitter taste.)  This would cure you from malaria.  By the way, they discovered this somehow without clinical trials.

Chloroquine does have some side-effects when taken over long periods.  As a child, born and raised in central Africa, I took it weekly – as malaria profylaxis.  Decades later, when my hearing started to fail, the best guess of my audiologist was that the chloroquine may have been the cause.  It can also cause retinas to detach, but for a long time it was the only defense and treatment for malaria.  Now other drugs have been developed, so chloroquine has been redeployed to treat other ailments.

It is a potent drug, not available across the counter.  So you can only take it in dosages prescribed by professionals.  They know it, they know what it can do.  And somehow – even without those clinical trials – they found out that it helps against Covid-19.  It is not a cure, it only knocks that coronavirus for a loop, weakening it enough to give the host a chance to heal and overcome it.

In one embarrassing moment, President Trump mentioned that anti-malarial drugs could help, only to be “corrected” by one of his technical specialists.  Who said that there was no “proof” supporting any drug as a therapeutic.  Beware those pretenders.  They are the gate-keepers of the medical profession, and what worries them most is litigation.  They don’t want to get sued (if something should ever go wrong)!

President Ramaphosa and Health Minister Mkhize should co-endorse that our medical teams have all the tools they need in their tool box.  Smack this coronavirus hard, before it gets the upper hand.  Knock it for a loop in the early stages.  Don’t let the gate-keepers deny infected people of treatment that is available and familiar.

A former President and Health Minister colluded to deny people of treatment for another virus.  Let us not step into the trap of Denialism again.  South Africa, which has many smokers (about 27 prevalance among men) need all the help they can get, with a disease that mostly goes into the lungs.  And that takes out mostly men, old men who may have been smoking for a long time.  The correlation between smoking and Covid-19 is also self-evident.

Down with Denialism, down with!


Chuck Stephens works at the UNEMBEZA Desk based at the Tutu Centre for Leadership.