The COVID-19 pandemic has turned into a multidimensional phenomenon. Its effects spreads everywhere.
By
IQBAL MOCHTAR
·7 minutes read
Kompas
A pharmacy tech puts pills of Hydroxychloroquine in a bottle at Rock Canyon Pharmacy in Provo, Utah, on May 20, 2020. - US President Donald Trump announced May 18 he has been taking hydroxychloroquine for almost two weeks as a preventative measure against COVID-19.
The COVID-19 pandemic has turned into a multidimensional phenomenon. Its effects spreads everywhere.
One of them is the emergence of infodemic, namely a sudden and massive surge of various information and issues regarding a pandemic. The information spills over from various sources, often contradicting one another. As a result, it is difficult to sort between credible and not credible information. It is reasonable for the World Health Organization to state that the current war was not only against the pandemic but also the tsunami of information/infodemic.
In the infodemic, COVID-19 treatment is the dominant topic. The Reuters Institute reports that 48 percent of infodemic issues are related to treatment and the spread of COVID-19. Through mass media and social media, the public is exposed to the issue about the benefits of a number of modern drugs (chloroquine, convalescent plasma, remdesivir, methanol disinfectant) and traditional medicine (garlic, ginger, eucalyptus oil) in the treatment of COVID-19. Some are influenced and increase their consumption of garlic and ginger.
There are also those who consume chloroquine directly even though they only have a slight fever. In Iran, more than 700 people have died after drinking methanol disinfectant fluid. Some governments have also been affected. Only based on preliminary study reports in France, United States President Donald Trump immediately announced chloroquine as the right drug for COVID-19. In Indonesia, President Joko “Jokowi” Widodo also announced chloroquine as a COVID-19 drug and claimed to have ordered millions of the drug. In reality, the Lancet journal recently confirmed the harmful effects of this drug. WHO has even stopped researching the effects of chloroquine on COVID-19 due to the high mortality associated with its use.
In this digital age, everyone has the opportunity to express their opinions about health; there are no restrictions. As a result, a variety of health information is spilling over onto mass and social media. Some are credible, but others are only based on subjective feelings, opinions or personal experiences.
A picture taken on June 16, 2020 in Paris shows a box of Dectancyl, a drug manufactured by Sanofi containing dexamethasone. - The steroid dexamethasone has been found to save the lives of one third of the most serious COVID-19 cases, according to trial results hailed on June 16, 2020 as a "major breakthrough" in the fight against the disease.
Ironically, people are easily attracted to and believe in the information that contains a narrative of hope, which is simple and easy to do (hopeful and shortcut) compared to narration with scientific facts. In 2016, a website posted an article that dandelion seeds can cure cancer. This article became the top news because it was shared more than 1.4 million times. In reality, the information was the personal opinion of the writer and had no scientific basis.
In the field of health, every therapy or drug recommendation must be based on the principle of rational therapy. This principle emphasizes that therapeutic recommendations must aim to improve optimal health outcomes by considering the advantages and disadvantages that may arise based on a scientific approach and the use of reliable scientific evidence. In short, a therapeutic recommendation must be tested scientifically and taken into consideration through the principle of evidence-based medicine (EBM).
Effectiveness test
Before being recommended, the effectiveness of a new drug must be tested through a rigorous scientific process, namely through preclinical and clinical tests. Meanwhile, for established drugs, at least clinical tests are conducted. Recommendations cannot be based on anecdotal evidence such as feeling, opinions or personal experiences. Before entering clinical tests, drugs must be tested in vitro and in animals. Drugs that have been shown to be beneficial in vitro or animal testing may not necessarily be beneficial in humans. Therefore, clinical tests in humans are crucial.
The use of drugs that do not pass the clinical tests has the potential to cause turmoil. One of them was the tragedy of thalidomide in 1959-1962. At that time, thalidomide entered the market as a sedative without passing clinical tests and was used widely in 46 countries. A few years later, research found that the drug caused phocomelia, namely the shortening or absence of arms and legs in children.
Clinical tests have four stages. In stage one, the test is not about the effectiveness of the drug, but the determination of the dose of the drug that does not cause serious side effects. This stage is carried out gradually and includes observing side effects on the body system. In stage two, the drug is tested on 100 to 200 people using relevant research methods, especially randomized control trials. Stage three, the drug starts to be compared with a placebo or other drugs in at least 500 people. Stage four (post-marketing drug surveillance) is a survey on the effectiveness and side effects of drugs, which takes place for years.
Practically, it takes at least 10 years to undergo these four stages. Stage four can last longer. The reason is that the side effects of some drugs can occur after a long period. Rosiglitazone is a diabetes drug that has been undergoing clinical tests for 12 years before approval of its use. This drug sold well and reached a turnover of US$2.5 billion in 2006. However, in a meta-analysis in 2007, the drug was found to be associated with heart attacks and its circulation was withdrawn.
Evidence based-medicine
Drugs that have proven to be useful in effectiveness tests are not necessarily recommended. The reason is that other effectiveness tests might give different results. Up to the present, various studies on the benefits of coffee for one’s health has reported inconsistent results. Some say coffee protects the body from Parkinson\'s disease and diabetes, others conclude it is useless and even harmful. Finally, it is difficult for the medical profession to recommend this drink.
The variety of study results requires the medical sector to conduct a systematic analysis of clinical evidence using the EBM method. In EBM, the medical profession aligns the health problems being faced, clinical knowledge and experience, as well as available clinical evidence. They analyze in detail the clinical evidence, including the types of tests being carried out, the number and types of samples and the statistical analysis being used. In essence, they look for the accuracy of clinical evidence (higher quality of evidence) to justify their recommendations.
Based on this analysis, a drug recommendation decision is made, whether it belongs to category A (highly recommended), B, C or D (less/not recommended). Clinical evidence obtained from meta- analysis studies, systematic reviews and randomized control trials has the potential to obtain category A. The expert opinions that are not accompanied by clinical tests are more directed to category D.
Burden upon burden
Claims of COVID-19 drugs may please the public. They receive hope of a practical and inexpensive alternative medicine. Unfortunately, unilateral claims like these are not always in sync with medical views. The medical profession has strict and complex special standards for assessing the effectiveness of drugs. With these standards, they evaluate whether the claim is rational or a hoax.
Health claims that are not based on effectiveness tests and evidence-based medicine often have no place in medical arguments and are even considered a burden. In fact, some infodemic on drugs have degraded the attitudes and practices of some people towards the handling of COVID-19.
They practice actions that are not suitable or even contrary to the rational principle of COVID-19 treatment due to infodemic influences. WHO definitely mentions infodemic as an obstacle to mitigating a pandemic. As a result of infodemic, health workers face double burdens, namely restoring degraded attitudes and practices while still struggling to break the spread of the pandemic. Really, this is a burden upon burdens.
Iqbal Mochtar, Doctor and Observer of Health Problems.
