Challenging Dr. Salvaña

By Modesto P. Sa-onoy

 

I discussed here earlier the letter of Dr. Marivic Villa of Florida addressed to Dr. Edsel Salvaña and I promised that if I got his response I will likewise give him space. However, I was informed that Salvaña posted something on FB but that has already been taken out or whatever but it disappeared. Anyway, I was told it did not address the issues raised by Dr. Villa. I cannot guess why Salvaña did not respond quickly although the issue was clear enough.

Then just as I started this column, I got an email – somebody was able to get Salvaña’s post. Indeed there is not much there in terms of responding to Dr. Villa, rather he presented his own protocol or method of dealing with those infected with the virus.

Let’s take a detour just a bit before proceeding to Dr. Villa’s second letter and comment on certain significant and relevant portions of Salvaña’s protocol.

His treatment for moderate cases: supportive only, no medication required; some people at risk for progression may be given antivirals (favipiravir, remdesivir) via compassionate use – never use meds without a doctor’s instruction and proper monitoring. Risk of death – less than one percent.

For severe cases, similar approach but still “with antivirals (favipiravir, remdesivir) via compassionate use – never use meds without a doctor’s instruction. Risk of dying: 5-10% with proper care; very high if without proper care.” How high?

For critical, the same protocol as severe is applied but requires ICU care. Some may need to be on a ventilator.

He cautions: The bottom line … Please do not self-medicate with God knows what since this may cause more problems than the original illness.

Let us momentarily ignore Salvaña’s backhanded side remarks, a whistling in the dark that attempts to “answer” Dr. Villa, and focus on his two medications.

First on the almost unknown (at least publicly in the Philippines), favipiravir. How great is this?

According to Med J Armed Forces India, published online on September 2, 2020, “favipiravir may emerge as a valuable drug in the treatment of mild to moderate symptomatic SARS-CoV-2–infected cases” in C19 patients in several countries. There are adverse effects, including induced infertility, but the list is long. Furthermore, the article said “larger RCTs are urgently needed before this drug can be unreservedly recommended, however.”

If Salvaña is using this drug, then the FDA and DOH have given it a go signal despite incomplete trials elsewhere and none in the Philippines.

In the case of COVID 19 infections, Salvaña prescribes remdesivir for moderate, severe and critical cases. The Department of Health (DOH) said Thursday that current stocks of COVID-19 investigational drugs remdesivir is used under Compassionate Special Permit and registered anti-inflammatory drug.

The Philippine Inquirer (April 12) said the use of these investigational drugs was allowed under the compassionate use permit of the Food and Drug Administration. Additional funding for each DOH hospital including specialty hospitals in the said regions will allow facilities to replenish stocks of their COVID-

19 medications (remdesivir).

Interestingly, the DOH said that for it to be able to procure these drugs, it must have an emergency use authorization and a positive recommendation from the Health Technology Assessment Council. The DOH-Disease Prevention and Control Bureau previously earmarked a P1-billion budget for the potential procurement of additional remdesivir.

“However, due to recent developments, the WHO Solidarity Trial has struck out the inclusion of remdesivir among its investigational drugs citing that it ‘had little or no effect on overall mortality, initiation of ventilation and duration of hospital stay in hospitalized patients,” DOH said.

So the EUA was issued to authorize DOH to buy this drug not because it is effective.

Will Salvaña continue to prescribe remdesivir despite this announcement of DOH? I wonder, however: where is the P1 billion allotted to buy remdesivir? And of those that had been purchased, which hospital received it? Since the patients paid P16,000 per shot (cost in India is P595) where is the P1 billion? Were these drugs approved just to justify the P1B budget?

In fairness to Dr. Villa, I will discuss remdesivir and the money involved later. Let’s tackle starting tomorrow her challenge to Salvaña with the hope he gets the courage to respond, or perhaps, a live debate beamed nationwide?