The COVID 19 Donut Hole by Angela Rieck

Watching the President and other high-risk patients recover quickly from COVID-19 made me fear the virus less, until a friend of mine contracted COVID 19.

She was probably exposed when she volunteered to be a poll worker for the election.  Proof of the adage: “No good deed goes unpunished.”

She became infected despite wearing a mask and washing her hands frequently. After testing positive, she was contacted by Florida contact tracing, and then…nothing.  She began to experience worsening symptoms; but there were no treatments available to prevent her from declining.

The President and other VIPs were given treatments that are not available to us because of the limited supply of these medications i.

As her condition deteriorated, she continued to search for treatment; but the only guidelines were to self-quarantine and contact her doctor.  Like most of us, she did not have access to a doctor who specialized in COVID 19 treatment.

She had fallen into the COVID 19 “donut hole.”  Experiencing worsening symptoms but not sick enough to be hospitalized.  A terrifying place to be.

COVID 19 research has focused on developing vaccines, treatments for the critically ill, and prevention, but there is less research on stopping the virus at the early stages to prevent those infected from becoming gravely ill.

There are some experimental treatments for these early stages.  Early studies demonstrated that monoclonal antibody treatment (that President Trump received) can be effective when symptoms first appear.  Unlike vaccines, which enable us to develop our own immunity by exposing us to the virus, monoclonal antibodies are laboratory made proteins that target COVID 19. The FDA approved Regeneron’s monoclonal antibody drug, but only 80,000 doses will be available by end of November with a maximum of 200,000 by the first week of January.  Currently 165,000 people are infected with COVID 19 per day.

Other studies are assessing the effectiveness of anti-virals (such as Remdesivir) and convalescent plasma (which is receiving plasma from COVID 19 survivors) on early stages of the disease. Both can be expensive (Remdesivir is over $3K). Other experimental treatments for early stages are off-label uses of Ivermectin (an anti-parasite drug used for river blindness and to prevent heartworm in dogs) and fluvoxamine (an anti-depressant); both with anti-viral properties.  But there is limited research, so these treatments have not been approved by the FDA. In fact, the FDA strongly discourages users from being treated with Ivermectin because studies have only been done in a test tube.

Doctors risk malpractice lawsuits prescribing them.

My friend in the COVID-19 “Donut Hole” was getting sicker.  As her condition worsened, she desperately sought help. Was there a treatment to stop the virus now to avoid hospitalization?  All she could do was hope that her oxygen levels would stop dropping.

Utilizing every connection she could find, she eventually discovered a doctor who was willing to prescribe experimental drugs.

Ivermectin proved to be a miracle drug for her, within 24 hours her symptoms dramatically improved. But she wondered, why was it so hard to get? Why was it so difficult to get treatment until a patient became critically ill?

So we are in a perfect Catch-22.  There is no approved treatment until you are gravely ill.  There are some treatments that MIGHT prevent this severe manifestation of the virus, but because there is inadequate research to prove their effectiveness, it is hard to find a prescriber.

She now knows that she will recover, but she can’t shake the uncertainty, fear,  and anger.

She learned how desperately we need to explore medicines to stop the virus in the early stages. Preventing patients from becoming critically ill would benefit patients and health care workers, alike.  But for now, luck and prayer are all that we have.

Science is coming to our rescue with vaccines, we are in the home stretch, and we can only be grateful for these brilliant minds who have worked tirelessly to save us as well as the health care workers who have risked their lives to treat us.

But we have months to go until we all can be vaccinated.  Until then, a deadly virus lurks in the microscopic shadows.

For those interested:  There is a site where you can participate in research studies of early treatments. (Qualification: You must be at high risk and have tested positive within 6 days.) But remember, you may end up being in the placebo group.  The link is here.

Angela Rieck, a Caroline County native, received her PhD in Mathematical Psychology from the University of Maryland and worked as a scientist at Bell Labs, and other high-tech companies in New Jersey before retiring as a corporate executive. Angela and her dogs divide their time between St Michaels and Key West Florida. Her daughter lives and works in New York City.