Positive Health Online

This article is a discussion of the role of old-fashioned rest, and the widely used drug, Ivermectin in the treatment of Covid 19. We are now well into the second year of a pandemic that is decimating the population on a global scale.  National governments have followed different pathways towards control and hopefully, eradication of the virus with varying rates of success.  Some of the poorer African countries have done surprisingly well, and this has been linked to the routine use of Ivermectin (a drug which is widely used to treat parasitic infections) and has other medical effects. 

There is great enthusiasm about the rapid development and deployment of a range of vaccines, and this program seems to be bringing numbers down. However, the new Delta variant is on the rise and it seems to be more contagious and potentially more dangerous.

On the bright side, as vaccinations continue apace, the older population, many of whom are already vaccinated, are unlikely to get sick, or get very sick.  The concern is that the current vaccines tend to be somewhat less effective against the Delta variant, but still work pretty well. A more worrying feature of this situation is that the Delta variant is making younger people sick. As a result, some younger people (including those who were previously healthy and fit) are ending up with long Covid, even if their illness has been mild or even asymptomatic. 

Long Covid has many features in common with ME/CFS.  And if we reach back into the early history of ME/CFS, this illness has many features in common with polio.[1]  In fact, because it did not end in the permanent paralyses seen in polio, it has been called ‘atypical polio’. One similarity between polio and ME/CFS is that they most often begin with an apparently mild viral illness, and it seems that Covid often causes only mild illness. Nevertheless, even a mild attack can result in long Covid. One of the sad features of ME/CFS is the scepticism and even downright hostility which this illness seems to inspire in the medical profession and the general public. One fear amongst the current ME/CFS community is that long Covid sufferers may begin to attract the same attitudes and treatment. 

As the number of long Covid sufferers (or ‘long-haulers’) continues to rise, this feature of the disease is now being taken seriously and given respect within the medical community. Our hope is that this respect may gradually be accorded to others suffering from multisystem chronic diseases such as ME/CFS, fibromyalgia and chronic late-stage Lymes to name just a few of many examples. Covid is thought to be particularly mild in children.  So possibly mistakenly, it wasn’t thought of as a particular threat to children, more to the adults who work with them…teachers.  However, as long Covid becomes more common, this view is being re-evaluated. ME/CFS has been defined by the IOM (Institute of Medicine) as a disease in which the defining feature is that exertion of any type, physical, cognitive or emotional “may adversely affect many organ systems…”  Patient experience confirms that exertion makes all their symptoms worse, and that they must rest in order to counteract these effects.

People with long Covid also report that exertion brings on or intensifies their other symptoms. This brings us to the subject of rest.

Rest

In 1940s  America, when I was a child we expected to get, and get over, what were called ‘childhood diseases’.  It was important that we caught these diseases in childhood as they were known to be far more serious in adults.  The only available vaccines were against diphtheria, tetanus and small-pox.  Antibiotics had not arrived on the scene, let alone antiviral medicines. Without vaccines, the only way to acquire immunity was through having the illness. 

Therefore it was important to ensure that sufferers of these diseases were given every opportunity to boost their own natural defences. The Rule was that when we were sick (temperature of 100F), we had to go to bed and stay there.  (If it was measles, you had to go to bed in a darkened room.) This gave the immune system its best chance to overcome whatever pathogen was attacking us.

In 1949,  Ritchie Russell [1]  wrote that if people who had polio exerted themselves after the initial infection and during the time when the illness was invading the central nervous system, it was the exercised muscles which went on to become paralysed.  He recommended that all sports be suspended during the polio season (the summer months) for this reason.

Dr Melvin Ramsay prescribes an even more extreme form of The Rule for ME/CFS patients: The patient should have six months of enforced rest from the inception.[2]  And at that time, when any stay in hospital automatically meant being in bed, many people who got ME/CFS recovered completely, including Dr Ramsay’s patients. 

Among the many controversies surrounding these illnesses and how to treat them one fact is beyond question:  our immune system needs all the energy our body can provide in order to function effectively.

The Stigma of Rest

So when this pandemic confronted us with a viral infection against which we had no acquired immunity, no vaccine, and no effective medical treatment….when The Rule would have saved lives…we were told to wash our hands, keep our distance, and if we got symptoms, to get in our car and go for a test. No mention of rest.  

Alongside the development of antibiotics and widely available over-the-counter medicines to suppress symptoms (but not to cure our illness) there has developed a culture of contempt for so-called ‘sickness behaviour’. Consequently, bed-rest has become a stigmatized prescription.

This view (the biopsychosocial – BPS model) includes the idea that the more symptoms we have, the more likely it is to be ‘all in our heads’.  It has prevailed since 1970 when psychiatry took over. As a result, ME/CFS patients are routinely prescribed Cognitive Behaviour Therapy (CBT) and Graded Exercise Therapy (GET) for an illness which is defined as one in which symptoms get worse after exertion.  Despite ongoing attempts to have CBT and GET removed from the guidelines patients are still forced into treatments that require gradually increasing levels of exertion which predictably lead into inexorable deterioration.

Why are the similarities between ME/CFS and long Covid so crucial right now? Polio starts with a mild fever, and develops paralysis particularly in muscles that have been used as the virus continues to take hold.  ME/CFS usually starts with a mild fever, and only if the patient takes protracted rest does the immune system seem able to clear it completely.

Long Covid can set in despite the patient having had only mild symptoms, or even no symptoms at all. Any connection with exertion during and after the acute stage of the illness is apparently over has only recently been investigated, but, like polio and ME/CFS, it is often noted that the victim of chronic illness is a fit and active individual, with a formerly physically demanding life-style, who has tried to get back to exercise as soon as possible. Dr Ben Marsh talks with Dr Asad Khan Marsh about his experience of ME/CFS over the last 4 years, and what lessons the Long Covid community can learn about activity management, fatigue and post exertional malaise. https://www.youtube.com/watch?v=EBopHtgKV4g

 https://www.youtube.com/watch?v=EBopHtgKV4g

The section about Graded Exercise therapy (GET} with Dr Ben Marsh starts at minute 24

Dr Bruce Patterson has now provided a detailed explanation of why exercise worsens the symptoms of long Covid. Briefly, viral fragments remaining in the blood are scavenged by monocytes, whose function it is to clean up debris from the blood stream. These monocytes containing viral debris send a signal to the immune system which stimulates an immune response that produces inflammation. Dr Patterson explains that exercise sends the monocytes further around the body effectively increasing the inflammatory response. This is why he warns his patients against exercise.

 https://www.youtube.com/watch?v=TZuLLJpLObs

Dr Bruce Patterson explaining the exact mechanism of exercise doing harm. He specifically mentions harm of exercise at minute 17.

The complete recovery from ME/CFS for patients given six months of rest may be explained by the fact that this length of time allowed the immune system to completely clear any pathogen that was involved. Dr Patterson tells us that precision medicine can target specific symptoms of long Covid.  For those of us who do not have access to these it still makes sense to give our immune systems the best chance of overcoming our illness by following The Rule.  Clearly, we need more than that. Dr Patterson, along with others, already has a treatment protocol, a combination of supplements and prescription medicines which includes Ivermectin.  

What is Ivermectin?  Why should We be Interested in It?

Ivermectin was developed by Merck, and the scientists involved shared a Nobel Prize in 2015.  Many countries, especially in Africa, suffered devastating consequences from parasitic illnesses, including River Blindness.  Merck made it widely available as an international public health initiative, and many of these conditions were virtually eradicated.  In fact, its impact on health worldwide has been compared to that of penicillin.

It is now out of patent, produced all over the world, and costs a few pence for a dose in most countries where it is available.  It has an impressive safety record.  In many African countries the population routinely take a weekly dose, and it is estimated that a total of 3.7 billion doses has been administered worldwide over the years since it was developed, with not more than a few hundred adverse effects.  (Current claims by various institutions that it shouldn’t be used for Covid on the grounds that it has no safety record are both wrong and right.  It has the safety record described above; it has not yet had the kind of large double-blind random control exercise these people would insist on in relation to its use for the treatment of covid-19.)

By now there are mountains of data showing that if people are given ivermectin, they become both less contagious…they shed less virus…and that the virus within them loses much of its ability to replicate, thus allowing the patient’s immune system to deal effectively with Covid.

This recent Review of the Literature by Zaidi et al[3] gives a complete summary of research to date as well as a highly detailed, technical description of exactly the ways in which the SARS- CoV-2 virus does what it does, and the precise mechanisms by which ivermectin interferes with viral activity, at several points in its activity.

Pierre Kory, who testified before the US Senate, begging the NIH at least to look at the data, was unequivocal:  “if you take ivermectin, you will not contract Covid, if you have contracted it and take ivermectin, you won’t spread it, and it won’t spread in your body, either.  You will recover.“ Although  Kory is a distinguished scientist, working with a group of distinguished scientists, with impeccable credentials, long experience with pandemics, and a man who has had idea after idea which was first ridiculed and then became the standard of practice in Covid, he was almost tearful in his presentation.  “I have seen more people die than almost anyone working in this pandemic.  I have watched them die when I knew there was a treatment that could save them, but cannot use it. I can’t do it anymore.”

Why can’t he use it?  Because the World Health Organisation, the CDC and NICE all advise against it.

No one should tell anyone else what they should think about this situation.  I invite the reader to do your own research and come to your own conclusions.

References

1. W Ritchie Russell, N. t. t. R. I. O. Paralytic Poliomyelitis, the Early Symptoms and the Effect of Physical Activity On the Course of the Disease. BMJ (1) (4602):465-71. 19 March 1949. https://doi.org/10.1136/bmj.1.4602.465 also
   Nancy Blake. Lost in Translation - The ME-Polio Connection and the Dangers of Exercise. 2016.  http://www.positivehealth.com/article/cfs-me-long-covid/lost-in-translation-the-me-polio-connection-and-the-dangers-of-exercise
2. Dr Melvin Ramsay. Myalgic Encephalomyelitis and Postviral Fatigue States: The saga of Royal Free disease. 1988. https://www.amazon.co.uk/Myalgic-Encephalomyelitis-Postviral-Fatigue-States/dp/0906923999
3. Zaidi, A.K., Dehgani-Mobaraki, P. The mechanisms of action of Ivermectin against SARS-CoV-2: An evidence-based clinical review article. J Antibiot.15 June 2021. https://doi.org/10.1038/s41429-021-00430-5

Further Information

Two trusted YouTube sources explaining Covid research can be found at  Dr Mobeen Syed and Dr John Campbell