By Joel Mandaza
A clash of methods has emanated in Zimbabwe’s medical field over treatment regimens being used to manage symptoms.
Covid-19 does not have a cure, and physicians are administering medicines meant to handle the resultant discomfort as well as pain.
Mild symptoms and asymptomatic cases, which make the majority of the infections have been relatively easier to deal with, as some have been recovering based on traditional herbs, paracetamol and other rudimentary medication.
The bone of contention has been in managing cases with severe symptoms in which breathing and inflammation are said to be challenges.
Some doctors have been using Ivermectin and Nanosilver in treating patients, while others have been describing the intervention as abominable.
Ordinarily Ivermectin, (which was first introduced as veterinary medicine), has been converted for human treatment used to treat parasitic roundworm infections.
Nanosilver is a multi-use, an antibacterial and antimicrobial whose use is still very much under study, though it is considered safe for human contact.
In Zimbabwe, Dr Jackie Stone, has been the most notable proponent of Ivermectin and Nanosilver.
In a video, which went viral in December last year, Dr Stone said;
“[Nebulised] Nanosilver is a complementary medicine, registered in South Africa… Is it safe? Extremely safe- we’ve given 20 times the concentration we’re giving you to rats and there are no side effects on the rats… What have you got to lose? Not a lot… Silver you can’t overdose.”
On Ivermectin, she said the nature of the crisis requires physicians to prioritise saving lives over administrative concerns.
“[the] Government directive that in absence of anything else we can use what we like’: implying that it is reasonable to use veterinary ivermectin products in humans.
There are 35 clinical trials, not a single one shows it doesn’t work, every single one shows it does work’, ‘Ivermectin is very hard to overdose,” said Dr Stone.
These suggestions, created excitement in the medical sector and to keen, desperate Zimbabwean citizens as the death toll rose.
However, Dr Stone’s suggestion, struck the ire of head of Professor Rashida Ferrand who leads Parirenyatwa’s Covid-19 department.
Professor Ferrand argues that when someone tests positive for Covid-19, if they are showing mild symptoms the only treatment they need is for managing the fever.
“I am afraid I have to repeat myself, Ivermectin, Hydroxychloroquine, Azithromycin, Doxycycline and Silver nebulization should not be used to treat Covid-19,” wrote Professor Ferrand on her Twitter, on January 16.
Not only did she end there, she sought the interventions of the authorities on the matter.
Professor Ferrand wrote a letter to the Medical and Dental Professional Council of Zimbabwe seeking Dr Stone’s censure.
Writing to the Medical and Dental Professional Council of Zimbabwe Registrar Josephine Mwakutuya
“We are writing to register a serious complaint against Dr Jackie Stone, who is a registered medical practitioner in Zimbabwe. We have grave concerns about her practice and probity.
Dr Stone is currently practising in Harare and is advocating a worrying combination of therapy for patients with SARS-CoV-2 infection and COVID19,” wrote Professor Ferrand in her charged letter.
Professor Ferrand called for Dr Stone’s censure
“Dr Stone seems to be taking advantage of her patients’ anxiety and vulnerable situation to promote panic and utilisation of a non-evidence-based treatment regime. Her actions have engendered a widespread belief that the health system is withholding treatment from communities. In particular, we believe she is not acting with integrity or honesty. She is not holding herself accountable for professional and personal behaviours, and she is not taking responsibility for the stewardship of her position of authority, mindful of her impact on others,” wrote Professor Ferrand.
She added; “We call for an urgent review of her actions and of her fitness to practice in Zimbabwe. We strongly believe she has transgressed the strong code of conduct that the medical profession is bound to, and is potentially putting her patients at risk of harm.”
Some even questioned Dr Stone’s qualifications, as the debate raged.
In a statement, issued in apparent response to Professor Ferrand`s letter, the Medical and Dental Practitioners Council of Zimbabwe said Ivermectin should not be dispensed to treat Covid-19.
“We would like to set the record straight that: Ivermectin is an old drug that is used to treat parasitic infections and is not currently registered by the Medicines Control Authority of Zimbabwe (MCAZ) for the treatment of Covid-19 patients in Zimbabwe and elsewhere in the world,” the statutory body said.
In another statement, they warned Zimbabweans against listening to Dr Stone saying she is illegally practising in Zimbabwe as she is not licensed.
However, investigations by Open Parly, showed the Dr Stone is indeed registered with the Medical and Dental Practitioners Council of Zimbabwe under Registration Number 802444.
Dr Stone’s latest license renewal was done on January 21 2021, under receipt number 74855.
Wading into the debate on Ivermectin, Zimbabwe College of Public Health Physicians (ZCPHP) President Dr Pamela Magande said there is no sufficient evidence justifying the use of Ivermectin to treat Covid-19.
“Ivermectin is currently only licensed for veterinary use in Zimbabwe. It is NOT in our national treatment guidelines for Covid-19 or in the Essential Drugs List of Zimbabwe (EDLIZ),” Dr Magande said.
At this point, it nearly appeared forgone that Dr Stone and others who were prescribing Ivermectin had jumped the broom.
Some thought they were likely to face disciplinary action, but a communique from senior doctors swung the pendulum back in motion, reopening what many had seen as an open and shut case.
Despite the Medical and Dental Practitioners Council of Zimbabwe having reprimanded Dr Stone, there were still more twists to the tale as senior doctors urged authorities to reconsider the hard stance on Ivermectin.
A group of senior doctors, including Lazarus Chitambo, Dr Johannes Marisa, Dr Ingrid Landman and Dr Portia Musonza on behalf of the College of Primary Care Physicians of Zimbabwe wrote to the Ministry of Health and Child Care appealing to their conscience on the use of Ivermectin.
In the letter, they admitted to using the drug in their management of Covid-19.
“Since August 2020 we have adopted the use of both Ivermectin and Nanosilver solution and have found this combination to be a game changer in terms of the management of our patients.
….After the first wave when numbers were low it was less obvious just how successful this regimen can be but when the second wave hit in mid-December we found that using this protocol was extremely effective. We use far less oxygen, far fewer patients progress and in fact some practitioners estimate that they have a less than 1,5 percent mortality using this combination,” the doctors said.
They asked the government what stands to be lost in allowing them to use Ivermectin as the evidence of its efficacy is being put to test by academics and researchers.
In the same breath, they took time to retaliate, on behalf of Dr Stone whom they tacitly admitted to be working with, in her disagreement with Professor Ferrand.
“Prof Ferrand and the public health physicians (who do not contest the safety of Ivermectin if used on prescription and under a doctor’s care) have stated that we must wait for the next 4-12 weeks until more data is out and only then be allowed to use it. They say that ‘if the data shows they are wrong and it is effective then they will be the first to adopt it and change their stance’. We too earnestly await the upcoming trials and (if the data shows we are wrong and it is ineffective then we will be the first to apologize to our patients for effectively treating them with a placebo that may have given them some GIT side effects)
The difference will be the patients who will most certainly die in the next 12 weeks if this medication is withdrawn and no amount of apologies from the public health physicians will bring them back for their families. We as doctors believe this to be against everything we stand for and do not want this on our conscience,” senior doctors said.
It appears those in favour of the use of Ivermectin have gained ground as the Medicines Control Authority of Zimbabwe (MCAZ) who are the most important voice in the Ivermectin discourse have made a determination on the matter.
In a memo seen by Open Parly, on January 24, MCAZ wrote to the Ministry of Health and Child Care saying they are authorizing the importation of Ivermectin to be used, in the interest of saving lives.
“Zimbabwe can develop its own national protocols for the administration of investigational products like Ivermectin under a controlled and structured environment such that we avoid wanton and indiscriminate prescribing and dispensing of these products which could expose members of the public to potentially unsafe doses and substandard and counterfeit products,” read the MCAZ letter.
The suggestion and request was well received by the Ministry of Health and Child Care as they acceded to the suggestion.
Responding to the MCAZ response, on January 26, the Acting Permanent Secretary in the Ministry of Health and Child Care Dr Robert Mudyiradima, admitted the need for flexibility in handling and managing the ever-changing Covid-19 situation.
“In these difficult times of Covid-19 treatment, we have to be careful to protect, we have to be careful to protect the patients as well as not to deny them effective treatment regiments,” Dr Mudyiradima said.
The jury is still out on whether or not Ivermectin helps in treating Covid-19 but authorities have decided to err on the side of preserving, by opting to try out what doctors say have been working.
Some practitioners have remained adamant they will not administer Ivermectin until conclusive research is done, despite the country having given the green light.
The Ivermectin debate, is however, not unique to Zimbabwe, in South Africa, Dr Naseeba Kathrade from Durban has come out guns blazing against South Africa Health Products Regulatory Authority saying their refusal for the open use of Ivermectin is fueling the black market.
She and 700 other doctors have since written to South Africa`s President Cyril Ramaphosa seeking an audience to state their case on why Ivermectin could be useful in the country. Get more Covid-19 Stats from CovidZW.info #WhereAreOurVaccinesZW #OpenCovidContracts
Investigative: Inside Zimbabwe’s Ivermectin fight
