Physician answers questions  on COVID-19 treatment

In a continuing series, Dr. Jaya Parker, chief of staff for Hermann Area District Hospital, is supplying information to the community related to the ongoing coronavirus pandemic. In this column, Dr. Parker addresses common questions related to treatment of the virus.


The numbers of people affected with the COVID-19/SARS COV2, or coronavirus infection, is rapidly increasing and projected to reach a peak in the next two weeks or so in Missouri. We are fortunate that the number in Gasconade County has remained stable the last few weeks. Each person, from country leaders to the individual citizen, is to be commended for continuing their important role from the “shut-down” to social distancing, hygiene, and wearing of masks. These are why coronavirus has not overwhelmed us.


I see many of our health-care workers go above and beyond every day. I also commend those from this community who use local resources and talents to create and replenish PPE (personal protective equipment) at this critical time. 


Several people have lost someone they knew to COVID-19. It is natural to wonder about treatment options. Based on currently available data: 


Q:  Is there any medicine available to treat coronavirus infection?


A:  There is no particular medication proven to work against COVID-19.  Many studies are under way, testing different classes of medication, including anti-virals, antibiotics, and anti-inflammatory medications.  Some anti-viral agents are being used in COVID-19 infection, such as Remdesivir ,Favipiravir,  etc. Certain interferons are also being studied.  One of the most promising treatments may be convalescent plasma taken from patients who have fully recovered from the COVID-19 infection. This contains antibodies which can help sick individuals.


A vaccine, when developed, is the best way to create immunity.


Q:  I hear about hydroxychloroquine. How does it work and should I take it to prevent me from getting COVID-19 infection? 

A:  Hydroxychloroquine is a medication used for decades, including for rheumatoid arthritis and lupus.  Hydroxychloroquine has received emergency FDA approval to be used in certain COVID-19 patients who are seriously ill and hospitalized.  It has not been approved for mild disease or prevention.  


It is not certain how it works in COVID 19-infection. It is unclear if it has an actual anti-viral effect. It can help suppress the cytokine storm, an exaggerated immune response to the virus which occurs in some severely ill patients and can damage major organs.  It needs to be prescribed responsibly, as it can cause serious side effects and cardiac monitoring may be required. 


Q:  I have heard we should be drinking tonic water that contains quinine as well as taking lots of zinc and vitamin C.

A:  There is an early French study with a small number of patients that showed some reduction in the amount of virus.  Other small studies showed decreased viral burden in patients that took Hydroxychloroquine, along with Azithromycin, commonly referred to as a “Z-pak.”   So far, the studies are small and have methodological concerns.  Large clinical trials are under way, so we expect to know more soon. 


It cannot presently be said with certainty whether drinking tonic water, (and taking) zinc and vitamin C will help, as there is no reliable study. However, if taken in moderation (in recommended quantities), these are not harmful. But if you are taking other medications or have a health condition, check with your doctor or pharmacist for any potential interactions.


Tonic water has been used for years by people for treatment of leg cramps. It currently contains less than the recommended dose of quinine that is prescribed to treat leg cramps. Some studies show quinine to help with leg cramps.  However, the FDA issued warnings in 2006 and 2010 regarding use of quinine, as it has a potential for serious side effects on heart rhythm, decreased platelet counts, etc. There are now several other medications that may be used for leg cramps as well.


Q:  I hear certain blood pressure medications can be a problem, especially medications like ACE (angiotensin converting enzyme), inhibitors (lisinopril, enalapril, etc.), and ARBs (Angiotensin 2 receptor blockers like losartan, valasartan, etc.).


A: It is not certain that that these medications cause harm with COVID-19 infection, due to a lack of studies. Early experience actually shows some benefit in people who take ARBs.  Regardless, it is important to take your routine medications to control underlying conditions. People with underlying medical conditions are more vulnerable to COVID-19 infection, so it’s important to continue medication for diabetes and high cholesterol (such as statins).