Covid, Treatments, and Trust – A Message From Your Health Care Community

Kelly Boeing, PA-C, Tony Butruille, MD, Lucca Criminale, PA-C, Kathy Fosnaugh, DO, Roselynn Gentles, MD, Jay Jerome, MD, Mara Merritt, DO, Miranda Raiche, MD, Geoff Richardson, MD, Corey Rubinfeld, PA-C and Eric Stirling, MD.

By: Kelly Boeing, PA-C, Tony Butruille, MD, Lucca Criminale, PA-C, Kathy Fosnaugh, DO, Roselynn Gentles, MD, Jay Jerome, MD, Mara Merritt, DO, Alexander Pelman, PA-C, Miranda Raiche, MD, Geoff Richardson, MD, Corey Rubinfeld, PA-C and Eric Stirling, MD, with Clint Strand

Two issues ago, the Leavenworth Echo devoted its front page exclusively to coverage of the Covid epidemic, how regional health care organizations are teaming up in response to the challenges we’re facing, and information on how to talk to your provider to best find options for treatment.

First, we appreciate efforts taken by the Echo to articulate the teamwork regional health care providers exhibit in treating our community members suffering from Covid, and the strains those efforts place on our health care system. For that, we are grateful.

It is in this spirit of togetherness that all Physicians and providers at Cascade Medical have crafted this response to information presented in that issue that were at times inaccurate, lacked context, and presented guidance that is not consistent with accepted medical consensus regarding what we know about Covid, how to prevent contracting it, and how to treat it.

Of most concern to us were statements in the Echo indicating to the reader that Ivermectin and hydroxychloroquine are acceptable therapies to treat Covid. Those assertions came from a group called the “Association of American Physicians and Surgeons.” Please note only 0.5% of all U.S. physicians belong to this group. They reflect a minority opinion, one that is not typically informed by evidence-based medicine.

Two weeks ago, the American Medical Association, the American Pharmacists Association, and the American Society of Health-System Pharmacists released a joint statement strongly opposing the ordering, prescribing, or dispensing of Ivermectin to prevent or treat COVID-19 outside of a clinical trial. Cascade Medical informed the Echo of this joint statement last week prior to the article’s publication. The author chose not to include that information to his readers.

So, let’s talk about Ivermectin. What really is it? Ivermectin is indeed approved by the U.S. Food and Drug Administration (FDA) for human use…to treat infections caused by internal and external parasites. It is not approved to prevent or treat COVID-19. Ivermectin is also available to treat certain veterinary conditions; medications formulated or intended for use in animals should not be used by humans. 

Cascade Medical practices evidence-based medicine, and here’s what the evidence tells us: although Ivermectin in vitro (in a test tube in the laboratory) exhibits very weak anti-viral activity at drug concentrations far above safe levels, subsequent clinical trials have failed to show a benefit in either prevention or treatment of COVID-19, and most importantly, this medicine can be potentially harmful. We will continue to practice medicine that is consistent with consensus medical guidelines from reputable sources in order to provide you the very best care. 

What about monoclonal antibody therapeutic treatments? Monoclonal antibody treatment provides a short-term, passive immune protection that can buy time for your body to fight against a COVID-19 infection. If given before severe symptoms set in, it can reduce the risk of severe illness in high-risk individuals. Monoclonal antibody treatment is administered through shots or intravenous (IV) infusions and can take up to 90 minutes to complete.

In comparison, it takes less than 30 minutes on average to get vaccinated, which produces a long term active immune response and reduces the risk of COVID-19 hospitalization by 71% (Johnson and Johnson), 88% (Pfizer), and 93% (Moderna) in individuals who are not immunocompromised.

Due to the demand of monoclonal antibodies, allocations in Washington are now distributed through the State Department of Health (DOH).  What’s more, monoclonal antibody treatment supplies are extremely limited and specific criteria must be met for patients seeking this treatment, such as pregnancy, obesity, diabetes, chronic kidney disease, high blood pressure, and asthma. Again, due to limited supplies, it is important to note local healthcare providers will not be able to accommodate every high-risk individual who technically qualifies for monoclonal antibody treatment.

We know you want choice in how you receive your care. Ideally, those choices would include therapies after you get sick. And, as with the case of monoclonal antibodies, we are seeing some limited therapeutic options for those we serve. However - we cannot stress this enough - prevention is the best treatment of an RNA respiratory virus like COVID-19, and we consider the currently authorized vaccines to be your best chance to reduce your risk of severe COVID-19, hospitalization, and death. 

We know, though, as much as some of your questions revolve around the vaccine…scratch the surface, and these questions are really about trust. Trust in your government, trust in experts, and trust in institutions.

During the past almost two years, various experts and public figures have changed positions with new findings, made good faith errors, politicized the virus, spread misinformation, and had disagreements across institutions. Every possible narrative on these occurrences have been amplified by the media, and especially on social media.

The path to restore trust must be shared between experts and the public alike. The effort won’t be easy. Many naturally distrust power. Trained experts have more knowledge on their specific area of expertise than those who don’t. Polarization, fear, and otherizing sell. The market for misinformation knows no limits. Bearing all of this in mind, please remember that shortcomings or skepticism in experts or institutions do not make fringe sources equally credible or trustworthy. If a doctor gets something wrong, you ask another doctor, not a carpenter. If a study gets something wrong, we don’t rely on anecdotes for truth, we update our studies with improved information.

It is possible to exhibit a healthy amount of skepticism while also gaining trust when earned by empirical evidence and expertise. Your primary care provider’s expertise is informed by knowledge of empirical evidence and forged through the scientific method. You receive care from your provider, no matter whether they are with Cascade Medical or another organization, because he or she is someone you trust.

Please, ask questions. But when you do, trust we are answering with your best health in mind

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