“Covid-19 is a viral, inflammatory and a clotting disease. In a way, the virus can be described as a terrorist that incites the body to overreact…”
Dr Darrell DeMello is a doctor with 30years of experience, having graduated from one of India’s premier medical colleges (St John’s Medical College, Bangalore – M.B.B.S/ Physician in Medicine and Surgery) in the early 1980s. Dr DeMello has developed effective treatment protocols which span all stages of the disease and include measures to prevent long-haul Covid. In this interview, he tells us about his successful Covid treatment protocols and the enabling environment in India.
* How did you first become involved with the treatment of Covid?
I got involved with Covid as from January 2020, jumping into it thinking that this could be a huge thing. I learned as much as I could about the disease, developed comprehensive treatment protocols and the standard operating procedures (SOPs) that go with the treatments. I came up with the idea that Covid-19 is a viral, inflammatory and a clotting disease. In a way, the virus can be described as a terrorist that incites the body to overreact. The super overdrive of the body’s immune response system then sets off the tsunami known as the cytokine storm. That tsunami sets off clotting. So basically, you’ve got to look to block the clotting. From 1 May 2020 I started treating Covid as a hyper-inflammatory disease-causing clotting.
* What is your basic early treatment protocol?
It starts with a three-drug regimen, using anti-viral, anti-inflammatory, and anticlotting drugs. I use an antiviral drug called Ivermectin to prevent the replication of the virus; it’s fantastic at denying a certain key element that the virus needs to replicate. Ivermectin became my drug of choice, based on the paper that the Royal Melbourne Hospital and Monash University released and that said that one dose reduces the viral load by 99.8%in 24 hours. (The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 invitro – https://pubmed.ncbi.nlm.nih.gov/32251768/). Generically produced Ivermectin is very low cost. I give a four-dose regimen over two days on an empty stomach. After the dose of Ivermectin, my theory has been that there’s no live virus in the person, and I allow my patients to come out and mix with the family 24 hours after the last dose.
The second is an anti-inflammatory drug called Colchicine prescribed mainly to reduce the inflammation in the body – the infamous cytokine storm. I call Colchicine my fire retardant; it’s fantastic at reducing the inflammation, so there’s no overdrive, no super overdrive. Anybody who’s taken Colchicine will realise that this drug really works well to calm the body down. Colchicine is easy to administer, generally well tolerated at a low dose, and inexpensive, so you calm the body down and stop that over inflammatory response, the additional extra super overdrive of the immune response system, such that you most likely won’t set up the clotting.
However, to prevent clotting, I still give an anti-clotting drug. I started off using aspirin in my first 200 cases. But, as we went into the second week, I saw that the platelet count bounced back to very high levels. Platelets are blood cells that bind together when they recognise damaged blood vessels. This clotting stops us from bleeding. However, excess clotting can be dangerous leading to pathologies such as heart attacks and strokes.
I ended up picking the brains of a very well-known cardiologist Ragavendra Baliga (Professor of Internal Medicine/Cardiology at The Ohio State University Wexner Medical Centre) and shared with him the idea that I wanted to use Clopidogrel (in the US it’s called Plavix) as my anti-clotting drug – he agreed that it was an excellent idea. And since case number 200 we started using this three-drug regimen. We have successfully treated over 10,000 Covid patients, 50,000 family members and provided prophylaxis to another 16,000 people. Most patients can be managed very well as long as you start as early as possible. Until now I’ve had something like 66 admissions and 21deaths, and it’s been a fantastic success at all stages, although of course anyone death is a tragedy.
It’s such a very simple and replicable process. I generally do not need to use steroids, though I do use them and various other drugs in serious cases. The precise regime depends on the individual and the stage of treatment. I also manage post-Covid treatment to ensure that nobody becomes a long hauler. The good news is that my regime, which was developed during the first wave, works fantastically well with all the variants, including Delta. I see no reason why it should not work effectively with Omicron.
Whether a patient is fully vaccinated, partially vaccinated, or unvaccinated, once you have Covid you are a Covid patient, and I will treat you as such as early as possible. I have seen so many types of variants which I recognise from the symptomatology, and my treatments have worked with all variants of the disease, facilitated thanks to technology, telemedicine, which I have recourse to in 90% of the cases treated. Patients get in touch remotely, obtain a diagnosis, and an appropriate treatment is advised within three or four minutes.
* Is it solely a drug regime or do you recommend other practices during the course of the disease?
I do have strict rules for the patient to follow during the course of the disease. It’s a 14-day disease and during this time I want people to only eat certain foods, in particular soft foods, which are well-cooked and soft dahl (lentils) and rice. I recommend a lot of soups with yellow pumpkin soup, yogurt, besides taking in a lot of fluids. The diet is plant-based as animal products are a challenge to the digestive system, although I do allow eggs. I also give high dose vitamin D as tablets or as injections. I may also give iron injections.
My protocols include tracking blood oxygen saturation levels (using a pulse oximeter) and taking temperature and pulse rate three or four times a day.
Mobilisation is especially important on the days eight, nine, and ten if blood oxygen levels are low. I make patients walk, sometimes during the whole night. In certain instances, I’ve told people that if you want to live you are not going to sleep tonight. You need to move until your blood oxygen levels improve. And most patients have succeeded. If you can move correctly, it slows down the clotting process. It’s not just the drugs, it’s also the mobility of the patient that makes a difference. There’s a whole bunch of things that go into making sure you have success with patients. My appeal to everyone is to treat this as a clotting, not as an interstitial lung disease. Because at the end of the day you’ve got to stop the clotting or the patient’s going to die.
* How is this getting implemented at the ground level?
I’ve been running a sustenance campaign to help three large companies continue to work. With that mandate certain plans were put into place from August – September of last year to build up people’s immunity over time. I tell everybody to get their vitamin D up to above 60 nanograms per millilitre (ng/mL) so that when you get Covid you won’t even know you had Covid. And of course, if people do get sick, I treat them. We carry out either monthly or quarterly screening where we do a Covid antibody test, and those who actually get sick are treated with the therapy that I described earlier. That way, we get them back to work asap.
One of our clients is a hotel business, and they haven’t had a Covid case since July of last year till April of this year. The other two companies in the financial sector, have continued operating uninterrupted.
*Is there anything about India that has facilitated your work?
We are very lucky in India in that we have a wide range of drugs available, and we have a lot of flexibility in terms of what we can prescribe. There is also a lot of emphasis on clinical judgement. Many other countries do not have the availability of drugs that we have in India for various reasons.
In India we have been very successful in preventing long haul Covid because nobody is left behind and everybody is treated with drugs here. People are not just given paracetamol and vitamins and told to wait until they get breathless before more aggressive treatment is prescribed. Yes, there have been deaths in India, but compared to many other countries, the death rate has been negligible.
*Any advice for Mauritius as the country navigates its way through Covid?
There are essentially five pillars of Covid management — lifestyle changes to minimise people’s vulnerability, non-pharmaceutical measures such as lockdowns, social distancing and mask wearing, initial in-home treatment, in-hospital treatment, and vaccines. It appears that Mauritius has been doing well in terms of non-pharmaceutical measures and vaccines, but not so well in addressing the other pillars. To truly get on top of the pandemic, it will be necessary to pursue all avenues.
I am sure that our treatment protocols and training, either in person or remotely or through a combination of both, can help turn around the Covid situation. A Return to Work Programme can be rolled out with the assistance of the Mauritian government.
* Published in print edition on 7 December 2021
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