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Marcela Leiros – from Cenarium

MANAUS – The discussion between the validity of prescribing, or not, the early treatment for patients diagnosed with or just with a suspicion of Covid-19 is not restricted only to some states in the Legal Amazon. A survey conducted by CENARIUM showed that all the federative units of the region and their respective capitals are stages of debates about the possible risks and benefits of prescribing the drugs of unproven efficacy. Most governments have inserted protocols to freely prescribe the “Covid Kit”.

Maranhão was one of these states. As recently as May 2020, the State Health Department (SES) inserted a new drug protocol for the treatment of Covid-19 with mild symptoms. The measure would cover people with comorbidities, with the exception of heart disease, in the period from day 1 to day 5 of infection.

The protocol consisted of a kit with hydroxychloroquine, azithromycin, corticoids, vitamins C and D, as well as fever and pain medication, such as paracetamol and dipyrone.

The measure, instituted more than a year ago, remains in force, as can be seen in social networks. On Twitter, it is easy to find reports of people who received prescriptions for the medicines or even left the health units of the capital of Maranhão with the medicines in hand.

“Covid kit I got at the hospital. What to do?”, says user @marcoxrm, with a photo of hydroxychloroquine sulfate. “It’s the “Kit Covid” from a hospital here in São Luís [capital of Maranhão], you believe it”, he replies, when asked what the medicine refers to. The publication is from March 24 of this year.

Boa Vista

In Boa Vista, the scenario is no different. In the capital of Roraima, the free availability of medicines for early treatment in the municipal health network was approved in the city’s City Council on May 18 this year. The Law Project (PL), authored by councilmen Dr. Ilderson Pereira, Wan Kenobby, and Gabriel Mota determines that “the use of medications is conditioned to medical evaluation, starting from the attendance and identification of the mild symptoms of the disease and the performance of complementary exams in the health units”.

The proposal also lines up the prescribed drugs: hydroxychloroquine, ivermectin, azithromycin, bromhexine, nitazoxanide, zinc, vitamin C, vitamin D, dipyrone, prednisone, colchicine, anticoagulants, or “other drugs that may be released by the Ministry of Health (MH)”, according to the PL.

Macapá

As recently as 2020, the city hall of the capital of Amapa already freely distributed drugs such as azithromycin and ivermectin, under the nomenclature of “therapeutic suggestion against Covid-19”. Besides distributing the drugs, the city hall also set up a distribution point for drug kits and medical evaluation for respiratory symptomatology. The protocol was adopted after a suggestion from the Medical Committee for Confronting the disease in the city and has lasted until the current days of the administration of Mayor Antonio Furlan (Citizenship), who is also a cardiologist.

Among the protocol’s measures, four “basic centers” were set up in Covid with pharmacies in front to “make the treatment kit available to patients with a prescription (whether from a public or private health unit, or from any location). The measures were also carried out in quilombola and farming communities.

Still this year, the city hall of Macapa distributed about 150 thousand vitamin and medicine kits to increase the immunity of the population against the infectious disease. The kits included vitamins C and D, zinc, and ivermectin. The distribution of the items was aimed at the public between 18 and 70 years old, with membership not obligatory.

Cuiabá

Since July 2020, the City Hall of Cuiabá, capital of Mato Grosso, started to provide the “Kit Covid-19” for patients with mild symptoms of “flu syndrome”, upon medical prescription and consent form. By January, 25,939 kits composed of 5 tablets of azithromycin 500mg, 4 tablets of ivermectin 6mg, 20 tablets of dipyrone sodium 500 mg and 10 tablets of zinc 29.5 mg had already been distributed, according to the city hall news site.

The availability of the drugs translated into pressure to prescribe them, according to the newspaper O Globo. In April this year, the report “Doctors report dismissals, aggression and coercion to prescribe ‘early treatment'” showed that professionals working in Unidades Básicas de Saúde (UBSs) in the capital of Mato Grosso reported pressure to prescribe the drugs. A health professional, who preferred not to be identified, heard from a friend, when he was with Covid-19, “I will prescribe you these drugs, because I am obliged to, but please don’t take them”.

Rio Branco

In Rio Branco, capital of Acre, the Public Ministry of Acre (MP-AC) opened an investigation into the purchase and distribution of medicines from the “Kit Covid” by the Health Secretariat of Rio Branco (Semsa). The body paid $ 700 thousand for ivermectin and azithromycin in January this year alone. The mayor of the Acre capital, Tião Bocalom (PP), arduously defends the early treatment and has already had his accounts blocked in social networks, for defending the method.

In addition, the Federal Public Ministry (MPF-AC) also demanded explanations about statements made by the mayor regarding the treatment. In response, Bocalom claimed that he never advocated nor distributed the kit in the capital. “Including, we warn that the use of chloroquine drug is carried out by the Ministry of Health, not having competence of this municipal government for its acquisition. Moreover, we reinforce that we do not own its derivative, hydroxychloroquine”, he claimed.

Palmas

Palmas, in Tocantins, is also among the capitals where the municipal government has not instituted the early treatment policy or “Covid kit”. The mayor of the Tocantins capital, Cinthia Ribeiro, defends the recommendations of the World Health Organization (WHO) that institute that the only effective treatment against Covid-19 is the vaccine. But there are other agents who “row against this tide”.

In March this year, the public prosecutor Adriano Neves, from the 28th Prosecutor’s Office for Public Assets and Administrative Probity, filed a Public Civil Action against the mayor defending early treatment and trying to reverse restrictive measures, which determined the closure of non-essential activities in the city. Among the arguments of the prosecutor was the following passage: “It is well known that the preventive and/or early treatment with low-cost drugs that for decades have been used in combating other types of viruses and autoimmune diseases have proven effective in combating coronavirus, an irrefutable fact”, he says in the document. The action did not go forward.

The president of Brazil, Jair Bolsonaro, defends early treatment and influences decisions of governors and mayors in the fight against the pandemic (Carolina Antunes Pr Public photos)