Q: I've heard about this drug called remdesivir - if I have COVID-19, can it be used for my treatment?

On July 28, Health Canada authorized the antiviral drug remdesivir for the treatment of adult and adolescent patients in Canada with severe COVID-19 symptoms such as pneumonia. Remdesivir is the first drug that Health Canada has authorized for the treatment of COVID-19. Earlier this year, on May 1, the US Food and Drug Administration (FDA) announced that it had issued Emergency Use Authorization (EUA) for the use of remdesivir in treating COVID-19. According to Health Canada, their expedited review of the "... available safety, efficacy, and quality data [determines] that the drug’s benefits outweigh its risks when used for the authorized indication [of treating COVID-19 symptoms]". 

There have been numerous clinical trials that include remdesivir though experts caution that "additional well-designed studies will be necessary to bolster the evidence for using remdesivir in patients with COVID-19". They further state that "the evidence that we have so far seen suggests that if remdesivir is effective its effects are small." Whether remdesivir reduces overall mortality is still unknown and further data is needed before this conclusion may be drawn. 

(Source: CEBM - COVID-19 Clinical Trials Report Card: Remdesivir and Emergency Use Authorization of remdesivir by the US Food and Drug Administration) 

In late June, the widely and cheaply available steroid drug dexamethasone was being touted as the latest treatment for COVID-19 to reduce mortality rates due to a preliminary study from the University of Oxford. Since then, countries such as Japan have approved dexamethasone as a potential treatment, and the UK's National Health Service (NIH) has since added it to their treatment guidelines for COVID-19. 

However, it's not a drug that is recommended to be taken for the prevention of COVID-19 - furthermore, the NIH cautions that it should only be used as a treatment for severely ill patients who require ventilation or require supplemental oxygen. The WHO is in the process of updating their treatment guidelines regarding dexamethasone, and the Public Health Agency of Canada has not yet included it in their guidance on treatments. While experts have indeed found a plausible mechanism of action against SARS-CoV-2, however, the experience of dexamethasone in COVID-19 patients is still very limited, and more clinical results are required to increase confidence.   

(Sources: CEBM - Dexamethasone  |  NIH - Corticosteroids (Including Dexamethasone)) 

In recent months, social media posts like this video of a US physician demonstrating "proper techniques" to disinfect their groceries and takeout (including washing produce in soap) have gone viral. Since then, the CDC has found that around 1 in 3 surveyed American adults are engaging in "high-risk" activities to prevent COVID-19, including washing their food products directly with bleach or soap. The McGill Office for Science and Society further points out that these practices can lead to accidental poisoning, since cleaning products like soap and bleach are not formulated to be safely ingested. Furthermore, the Canadian Food Inspection Agency notes that currently there is no evidence that food is a likely source of transmission of the coronavirus. Health Canada recommends practicing safe food handling and preparation, like washing hands with soap and warm water before and after handling food for 20 seconds, and washing produce under running water (not with soap, chlorine, or other chemicals).

While there is currently no evidence to suggest that disinfecting food packaging of any sort prevents the spread of COVID-19, the Government of Canada does recommend regularly cleaning and disinfecting surfaces. The World Health Organization further suggests that you thoroughly wash your hands before and after shopping, and again after unpacking and storing your shopping.

(Source: iHealthFacts - Does disinfecting food packaging prevent the spread of COVID-19?) 

Many governments including the City of Toronto have recently implemented mandatory mask-wearing when in public, indoor settings. This has led to concerns on social media over the safety of mask-wearing, with viral Facebook posts claiming that masks deprive the wearer of enough oxygen, or that people's immune systems weaken as they wear masks. Numerous fact checking sites citing scientific experts have since debunked these claims. According to the World Health Organization, there is no evidence that prolonged use of medical/surgical masks causes carbon dioxide (CO2) intoxication nor oxygen deficiency (hypoxia). While the Public Health Agency of Canada advises that certain individuals should be cautious when wearing masks - such as those with breathing difficulties or who are unable to remove the coverings without assistance - they also recommend adherence to mask-wearing in situations when physical distancing is not possible. 

(Source: World Health Organization | iHealthFacts - Does wearing a face-mask by people who are not sick prevent COVID-19 infection? | Image source: Photo by Julian Wan on Unsplash) 

The World Health Organization has reported positive cases of COVID-19 in cats and dogs who were in close contact with humans infected with COVID-19. While the World Organization for Animal Health and several other veterinary associations state that there is currently no evidence that COVID-19 may spread from pets to humans, they do advise that pets are at risk for contracting the disease if they are in close contact with infected humans. Though these cases are rare, they recommend that people infected with COVID-19 minimize contact with their pets whenever possible. 

(Source: iHealthFacts - Do pets spread COVID-19?) 

There are claims on social media that hot or humid weather can reduce the risk of contracting COVID-19. However, there is little conclusive evidence that sunlight or warmer weather can prevent or treat COVID-19. The WHO states that even countries with hot/humid weather have reported cases of COVID-19. Though there are some recent studies that suggest that weather conditions may influence the transmission of COVID-19, with cool and dry conditions appearing to boost the spread, the impact of weather is still considered minimal by experts. It's also important to keep in mind that other preventative measures, including physical distancing and handwashing, have also contributed to slowing down the transmission rate. 

(Source: iHealthFacts - Can sunlight prevent or treat COVID-19?; Is the transmission of COVID-19 effected by hot or humid weather? and CEBM - Do weather conditions influence the transmission of the coronavirus (SARS-CoV-2)?) 

In late April, a French study investigating the role of nicotine in blocking the SARS-CoV-2 pathway caused speculation on social media that smoking may be used to prevent or lessen the symptoms of COVID-19. Irrespective of COVID-19, smoking can worsen the severity of respiratory diseases by impairing lung function, and the Chief Public Health Officer of Canada warns that smokers are a high-risk population for COVID-19. Though there are biologically plausible pathways where nicotine may impact the novel coronavirus, the WHO strongly recommends against tobacco smoking. While there are ongoing studies investigating the link between COVID-19 treatments and nicotine (which may be used in forms outside of cigarettes), the evidence is still extremely limited.  

(Source: iHealthFacts - Can smoking prevent infection or lessen the symptoms of COVID-19? and CEBM - The role of nicotine in COVID-19 infection) 

There is currently a lack of conclusive evidence indicating that the presence of antibodies (molecules made by our immune system in response to viruses) developed from a COVID-19 infection may provide immunity to re-infection of the novel coronavirus. In other words, even if you already had COVID-19, you may still be susceptible to getting the virus again. While there are studies testing for SARS-CoV-2 antibodies (the antibodies developed after COVID-19 infection), these studies are not designed to determine immunity to re-infection. 

(Source: iHealthFacts - If I've already had COVID-19 am I immune to re-infection?) 

While less common than fever, cough, and fatigue, evidence has emerged since late February that indicates loss of taste and/or smell are indeed reported symptoms in people with COVID-19. As such, many government agencies including the UK and the US have recently listed loss of taste and smell as symptoms of COVID-19 that should warn individuals to self-isolate. Do keep in mind, however, that much of the current evidence on these symptoms is of poor quality, and ongoing studies using symptom tracking are required to increase certainty. As it stands, loss of taste and smell also frequently occur with the common cold and other influenza and so there will likely be many who display these symptoms without having COVID-19. 

(Source: CEBM - Loss of smell and taste as symptoms of COVID-19: what does the evidence say?) 

The BCG vaccine is the most commonly used vaccine against tuberculosis worldwide. Myths have circulated that the BCG vaccine may protect against COVID-19, as there is a lower frequency of COVID-19 cases and mortalities in developing countries with universal BCG vaccination policies. There is evidence that BCG vaccination may prevent respiratory infections like pneumonia and influenza in children and the elderly. However, there is a lack of evidence that the BCG vaccine protects against COVID-19. More studies are currently underway. 

(Source: CEBM - Does BCG vaccination protect against acute respiratory infections and COVID-19? A rapid review of current evidence and iHealthFacts - Does the BCG (tuberculosis) Vaccine prevent infection or lessen the symptoms of COVID-19?; Image source: Syringe and Vaccine, by NIH (CC BY 2.0))

Bleach and other disinfectants may kill the coronavirus when sprayed on surfaces. There is NO evidence that injecting disinfectant prevents or treats COVID-19. Injecting, drinking, or inhaling bleach or any other disinfectant can be poisonous, and may result in brain injury, blood clots, kidney and liver damage, or even death. Bleach and disinfectant should be used carefully to disinfect surfaces only.

(Source: iHealthFacts - Does injecting disinfectant prevent or cure COVID-19)  |  Image source) 

Vitamin C is an essential nutrient that is naturally found in some vegetables and fruits, particularly oranges and other citrus fruits. While some individuals treat the common cold with vitamin C, there is little evidence to support its efficacy. There is currently no evidence that vitamin C is effective in the prevention or treatment of COVID-19. High doses especially may cause stomach upset and diarrhea. However, more research is underway to study the effects of using large doses of vitamin C to treat COVID-19, including a Canadian trial. 

(Source: iHealthfacts - Can large doses of vitamin C prevent or treat COVID-19?)

Vitamin D is produced naturally when you are exposed to sunlight.  While there is some evidence that points to vitamin D in helping to protect against respiratory tract infections, there are only clinical trials still being undertaken to see if vitamin D has a role in COVID-19 prevention or treatment.  There is currently no reliable evidence that vitamin D supplements can be used to prevent or treat symptoms of COVID-19.  

However, as many are staying indoors adhering to public health guidance, vitamin D levels may be lower than usual. As such, if a person cannot reach healthy levels of vitamin D through sun exposure and/or a healthy diet, some governments advise taking (no more than) the recommended levels of vitamin D supplements.

(Source: iHealthfacts - Does taking Vitamin D prevent or treat COVID-19? and CEBM -  Vitamin D: A rapid review of the evidence for treatment or prevention in COVID-19; photo source: image by DarkWorkX from Pixabay)