A highly respected physician and professor of medicine at Bangladesh Medical College (BMC) has been using a combination of two cheap, easily available drugs to treat patients suffering from COVID-19 with great success in reducing the viral load and restricting the severity of disease.

Apparently 98 percent of Covid-19 patients get cured with the combined use of anti-parasitic drug Ivermectin and antibiotic Doxycycline within 4-14 days, said Dr Tarek Alam, the renowned doctor who has been leading a team of BMC physicians in a study during the course of treating patients at the hospital attached to BMC.

They recently reported tremendous success with the two-drug combination treatment against the virus during its study that started on April 15 last.

"What we've found is that it's better to use the two drugs as soon as possible after a person is tested positive or symptom is seen," Dr Alam said in an interview with our sister newsagency UNB.

"We used the drugs within 5-6 days on all patients (and almost all got cured). Actually it needs to conduct further study whether these (drugs) will be effective in case of use after the time," he said, adding that so far the drugs have been used on "some 400-500 Covid patients" since April.

But only "4-5 patients" having diabetes and heart problems or who delayed in getting the treatment needed the kind of critical care only provided by hospitals through their Intensive Care Unit (ICU). And two patients died despite being administered with Remdesivir and plasma therapy. "Our 98 percent patients got cured," he went on.

That may not sound like much against a virus that in Bangladesh is struggling to kill 2 percent of the patients it infects, but here is the nuance: when Dr Alam says 'cured', he means cured on the drugs alone, and without needing ICU support. If the numbers reported from his study were to hold, that would present a dramatic reduction in the pressure being placed on health systems.

Worldwide, the percentage of patients needing ICU support of course varies from country to country, across health systems, and even among regions within countries. In Italy during the early part of the outbreak up to 12% of all positive cases required ICU admission, a startling figure that may be traced to its older population. In New York on the other hand, hospital sources estimated 1 in 5 of the total hospitalisations (itself around 20%) needed ICU support at some point, so that would mean around 4%. In China, a study of the first 44,000 patients showed 5% needed critical care.

If that 4-5% number could be reduced to 2 percent, that would free up at least twice the number of ICU beds available. Or seen another way, require half the number of ICU beds as they did, or less. If his numbers hold.

Hidden wonders of a 'lice-killer'

It becomes pertinent to ask how Dr Alam happened to arrive at the prescription that eventually was taken up for a clinical trial by ICDDR, B, that is now ongoing. Particularly given how even some in the scientific community were dismissive of its potential.

One is reminded of a virologist attached to a national institute of repute, who literally exited the panel of a tv program reporting the earliest results from Dr Alam's team with the implication that discussing any therapeutic outside antivirals was a waste of time.

If the virologist had hung around, what he could've learnt from Dr Alam (who eventually managed to connect to the program), the professor of medicine, may have transformed his view of a drug that most Bangladeshis know from adolescence as a lice-killer.

In fact, Ivermectin "proposes many potentials effects to treat a range of diseases, with its antimicrobial, antiviral, and anti-cancer properties as a wonder drug," according to a paper published just last month in The Journal of Antibiotics.

Also last month, the journal Antiviral Research reported the findings of the first in vitro (in cell culture) study that showed Ivermectin inhibits the replication of SARS-CoV-2, the causative agent of COVID-19.

"Ivermectin, an FDA-approved anti-parasitic previously shown to have broad-spectrum anti-viral activity in vitro, is an inhibitor of the causative virus (SARS-CoV-2), with a single addition to Vero-hSLAM cells 2 hours post infection with SARS-CoV-2 able to effect ~5000-fold reduction in viral RNA at 48 hours," the authors report, the potency corresponding with the effect on the viral load reported by Dr Alam's team from PCR test results on their patients.

The viral load is a measure of virus particles present in an infected person. With most viruses, higher viral loads are associated with worse outcomes.

Dr Alam, also Head of the BMC Medicine Department, said his team had primarily applied the two drugs on 60 patients during their observation before they came to the media. "All the 60 patients were tested for Covid-19 negative within 4-14 days. They did not need admission in hospital or go to ICU," he said.

Noting that the two drugs have been available for many years at cheap prices in Bangladesh, Dr Alam asked the people not to use the medicines arbitrarily, or without a prescription from a physician.

He said many people have taken the combination by now, prescribed by doctors who spoke to Dr Alam observed its effectiveness. "But none should intake these medicines unless she or he is tested positive for Covid-19 or without prescription of a physician," he added.

The noted medicine professor said it is better for the patients to go to hospital before the condition deteriorates seriously and not waste time in taking treatment at home. The use of antiviral drugs is not enough to get cured of this disease in many cases and many more medicines are needed, he added.

He suggested the elderly patients or other patients having comorbidities like diabetes or hypertension must be admitted into hospital without fear or delay, as the doctors and nurses now know what needs to be done in such cases.

"There is no accommodation problem (for Covid-19 patients) in the hospitals. All doctors now know what they should do in case of Covid-19 patients," he said, adding that the government has managed enough hospital beds and oxygen by and large.

Dr Alam said his team started the study on its own, and now seek permission from the regulatory Bangladesh Medical and Research Council (BMRC) for the clinical trials in this regard. The ICDDR, B trial is expected to conclude next month.

To end, it may not surprise you anymore to learn that in 2015, Dr William C. Campbell of Ireland and Japanese researcher Satoshi Omura were awarded the Nobel Prize in Medicine for the discovery of Ivermectin. It is strongly held that they would have shared it with a third scientist, indeed the head of the research team at Merck (where Dr Campbell also worked) that developed the drug, had he not passed away, since the Nobel is not given posthumously. That man was Bangladeshi scientist Dr Mohammad A. Aziz.