Source: BBC Mundo
Honduras had one of the highest coronavirus case fatality rates in Latin America. In April, one in 10 officially infected people did not survive.
But in recent weeks the country managed to reduce that proportion to less than half.
Over the Sula valley, which brings together large cities in the north and concentrates around 80% of deaths from covid-19 throughout the country, the Honduran government recognized last month that the figures at that time were “alarming” and presaged “worst”.
“San Pedro Sula [the industrial city of the country] could become the Guayaquil of Central America,” the Honduran doctor Carlos Umaña then alerted, comparing it with the Ecuadorian municipality, one of the most severely affected by the coronavirus in the region.
But the situation in the second largest city in Honduras and the national epicenter of covid-19 changed to the point that, on May 17 and 18, the two main Sampedian hospitals did not report any deaths from the disease.
And although infections in the country continue to rise (3,100 cases and 151 deaths until this May 20), the government believes that the increase in the recovery rate (more than 11%) is linked to the implementation of a made-in Honduras strategy that combines drugs and techniques to deal with the virus at an earlier stage.
Its objective is to prevent patients from requiring intensive care, especially worrying for a weak health system whose maximum capacity to care for patients in this area is only 150 among more than nine million inhabitants.
The Honduran doctor Miguel Sierra-Hoffman was the one who devised this strategy in Texas, United States.
He did so after observing how after the death in Europe of many patients with covid-19 there were inflammatory and hypercoagulation infections that could end in cases of thrombosis and that, in his opinion, demonstrated that a change in approach to treatment was necessary.
Catracho – as Hondurans are colloquially called – is the name chosen for this method whose name was an acrostic made up of the names (in English) of its main components.
These are medications such as colchicine, anti-inflammatories, tocilizumab, ivermectin, blood thinners, and hydroxychloroquine.
The latter drug was under study by the World Health Organization (WHO), until it temporarily suspended clinical trials after a report linking it to an increased risk of death and heart disease.
Honduras, on the other hand, continues to include it in its treatment, considering that the positive results in the country support its use.
In addition, the Catracho method includes techniques such as administration of high-flow oxygen and pronation (lying the patient face down) in order to avoid infections and the need to be intubated.
“We didn’t really change any medications, we just started giving them from the first day of admission. Instead of giving the steroids on day six or 12, when people were already drowning, we gave them at the beginning,” Sierra-Hoffman explains to the BBC. World.
After applying it in an experimental group in the five hospitals near Victoria County where he works, the recovered people increased as those who needed intensive care decreased, so Catracho was administered to all patients.
That was when, alerted by the high lethality of that time in his native country, worked with a group of Honduran colleagues to further investigate the method Catracho that, today, and was implemented in three of the largest hospitals in San Pedro Sula.
Results in Honduras
According to Óscar Dí a z, head of Intensive Care at the Honduran Social Security Institute (IHSS) in this city and part of the research group, the results after its launch are clear.
“In four weeks, we halved intensive care mortality at the IHSS and cut the average hospital stay from 16 days to about six or seven today,” he tells BBC Mundo.
According to the doctors, between the second and third day of admission a gradual improvement is already observed in most cases.
“They started to improve without getting to intensive care, and if they did, they were much fewer days than the first (patients). In mid-April there was a drop in mortality, it was impressive,” the BBC’s medical director tells BBC Mundo. IHSS at the national level, Bessy Alvarado, who does not doubt “based on the evidence” that this evolution is a direct consequence of the Catracho method.
After observing the first results, the health authorities of the Honduran government decided to accept Catracho as a clinical trial and to approve its execution.
According to Honduran Vice Minister of Health, Nery Cerrato, “Critically ill patients successfully left the hospital. And for us, it was in response to the treatment applied and that has allowed the intensive care units to not collapse.”
“Catracho could be the most important contribution to a disease of which no one had the precise knowledge , ” he said in an interview with BBC Mundo.
The questioned hydroxychloroquine
When asked about its opinion on this Honduran strategy, the WHO recalls that to date, no drug has been shown to be safe and effective in treating coronavirus.
“In many countries, doctors are giving patients with covid-19 drugs that have not been approved to treat this disease,” which is considered “an unsuitable use ,” a WHO spokeswoman told BBC Mundo / OPS via email.
Hydroxychloroquine, part of this Catracho method and traditionally used to treat malaria and lupus, is one of those drugs.
This drug was in the study phase by the WHO along with three other drugs as part of an international clinical trial – of which Honduras is also part – to determine if it is effective against covid-19 and does not pose health risks.
However, the international organization announced on May 25 that it was temporarily suspending hydroxychloroquine tests for safety reasons.
Its CEO, Tedros Adhanom Ghebreyesus, cited a study published in the journal The Lancet that indicated a “higher death rate” for covid-19 patients who had taken this drug.
After knowing the WHO announcement, the Honduran government assured instead that hydroxychloroquine will continue to be part of the Catracho method, having verified “excellent results that the statistics reflect with the prompt improvement in the patients” who received the treatment.
Dr. Sierra-Hoffman denies that any of his patients has suffered from problems of this type and highlights that hydroxychloroquine was also included in the treatment of Costa Rica, one of the countries with the lowest covid-19 case fatality in Latin America.
Deputy Minister Cerrato says that the use of hydroxychlorquine for years to eliminate malaria in the country “had no complications”, but stresses that all patients are informed of the treatment that will be applied to obtain their consent beforehand.
“We consider that the clinical results support the continued use in the country (given that) there is no accepted treatment so far,” he says.
Fear and ignorance
Dr. Díaz insists that reducing the number of hospitalizations is crucial in Honduras, a country with “a fairly poor health system” and with insufficient number of beds since before the pandemic.
For this, the Catracho method is complemented by a first outpatient phase, called protocol Ma í z, and in which a patient with mild symptoms are advised to use sodium hypochlorite and take several medications to reduce viral load and try to avoid your income in a medical center.
That this treatment can be followed at home could help alleviate a problem detected in Honduras and that worries doctors: many people do not seek help for fear of being discriminated against for having covid-19.
According to the IHSS medical director, many of her most recent critical cases were patients who delayed going to the hospital and were already very serious.
“We are fighting ignorance and stigmatization. If you cough in public, you are left looking ugly here,” Carlos Umaña, president of the IHSS Medical Association in the country’s northwestern region , tells BBC Mundo .
“It is something that we have tried in information campaigns in local media, so that patients who arrive late and have serious infections, especially in the public system, seek treatment earlier before entering the phase of complications,” says Díez.
To this fear and misinformation they also attribute some incidents in which groups of residents tried to avoid the burial of coronavirus victims in their municipalities for fear of contagion.
The Ministry of Health assured that in some cases even the relatives themselves rejected the dead for fear of contagion, so it was the authorities who had to take care of the burial in the cemetery.
Deputy Minister Cerrato acknowledges that the government had not sufficiently informed about the security measures taken when moving the bodies, but he believes that these incidents will tend to disappear thanks to the awareness raised by local governments.
Regarding the low number of coronavirus tests carried out in Honduras (between 400 and 500 per day), Cerrato points to logistical problems such as the acquisition of kits that did not bring the complete equipment at the beginning of the crisis.
“This caused us a significant delay in an emergency situation like this,” he acknowledges.
But he assures that with the acquisition of new laboratories, the objective is to get to do a thousand tests a day. Dr. Díaz, however, believes that about 3,000 would be necessary.
“We are very concerned about the positivity rate of the tests, which is around 50%. The medical community asks that the country do more tests to see when the pandemic will peak,” says Umaña.
Diaz recalled that “the government is trying to reopen the economy through all the difficulties there, but it is difficult without real data on how many pe r Sonas have been infected” .
Regarding the Catracho method, its promoter Sierra-Hoffman assures that he would love it to be implemented also outside of Honduras and Texas, and he is sure that he has already received calls from doctors from Ecuador and Guatemala interested in his approach.
“With the use of this treatment we believe that we will continue to reduce lethality and that we will be able to provide the world with a treatment scheme, even amid the limitations of a country like ours,” concludes Vice Minister Cerrato.