The COVID-19 pandemic has been reminiscent of the early HIV epidemic in a number of ways. For some, cases of pneumonia appear. And though at first the cause is unknown, it turns out to be a newly identified virus. Fear and panic abound. The federal response in the U.S. is slow and inadequate. The death toll mounts. Of course, what took several years to unfold when the AIDS epidemic was first recognized in 1981 took only weeks to unfold when the COVID-19 pandemic began in December 2019. As with the AIDS epidemic then, researchers the world over now are frantically searching for treatments against COVID-19. Also, as in the early days of AIDS, doctors and patients alike have turned to alternative therapies to treat COVID-19 in the absence of any scientifically proven drugs approved by the Food and Drug Administration (FDA).
When the COVID-19 pandemic first appeared, widespread fear, panic, and lack of government response led to great confusion and many attempts to find alternative therapies, many of which were highly dubious. Not only has no treatment been approved by the FDA to treat COVID-19, some once-promising treatments, like the drugs hydroxychloroquine and chloroquine, have been warned against by medical experts and the FDA on the grounds that they can seriously injure or even kill some COVID-19 patients. In the absence of medical treatment, as we saw with the early AIDS crisis, people turn to alternative therapies—many of which have already been proposed and debunked in the course of the COVID-19 pandemic.
There is no single definition of alternative therapy. The Department of Veterans Affairs (VA) provides information about alternative and complementary therapies for HIV/AIDS on their website. The VA website says that such treatments are called “alternative” because they are outside the mainstream of Western medicine. The VA notes that such treatments may also be called complementary treatments, because they do not replace standard medical care, but work alongside standard treatments like antiviral drugs. This is a sensible way of defining alternative treatments in a context where a standard of medical care exists. It is a bit more difficult to accept that definition when there is no standard of care for a particular condition. In such cases, so-called alternative treatments may be the only game in town. Such was the case for HIV infection before the first antiviral drugs against HIV were developed, starting with AZT (marketed as Retrovir) in 1987. One could say the same about COVID-19 today, when only one drug, remdesivir, has been granted emergency authorization for use by the FDA, and no drugs have yet been granted outright FDA approval.
The term “alternative” can refer to a wide range of treatments—from products like herbs and other supplements to practices like acupuncture and yoga and pharmaceutical medications approved for other uses. For COVID-19 today, as for HIV/AIDS many years ago, some alternative treatments make more sense than others. While some have a basis in science and medicine—either Western or non-Western—some are quackery, others are scams, and some may be flat-out dangerous. The VA list of alternative therapies for HIV includes yoga, massage, acupuncture, aromatherapy, meditation, visualization, and herbal products. While the VA makes clear that alternative treatments are not a replacement for antiviral therapy or other medications prescribed by a medical professional, people with HIV may use these approaches to improve their general health and wellness, and in some cases to help deal with HIV-related symptoms or medication side effects.
In the months since COVID-19 came on the scene, many alternative treatments have been proposed. Many of these have to do with bizarre ideas about actual or alleged disinfectants. These have included home-brewed hand sanitizers using mixtures of rum, vodka, or vinegar with poisonous products such as bleach and fabric softener. So-called “coronavirus truthers” have claimed that inhaling a hydrogen peroxide solution through a nebulizer could prevent or cure COVID-19. Other debunked treatments for COVID-19 include saltwater, saunas, hand dryers, hair dryers, ultraviolet light, chlorine, high temperatures, boiled ginger—and even red soap, white handkerchiefs, and volcanic ash.
Other invalid claims about COVID-19 treatments have to do with drugs. For example, a drug marketplace on the dark web recently banned vendors who were promoting an alleged COVID-19 vaccine that contained a mix of cocaine, amphetamines, and nicotine. Earlier in the pandemic, a myth gained wide traction in France claiming that snorting cocaine would prevent COVID-19 by sterilizing nostrils. A YouTube video circulating in Sri Lanka falsely claimed that cannabis could boost immunity against COVID-19. A fake Fox News article promoted CBD oil as a COVID-19 treatment. In Brazil, the country hardest hit by COVID-19 throughout Latin America, fake news spread widely on social media about the effectiveness of an ether and chloroform blend known as “lança perfume” or “loló.” In Iran, over 700 people died after drinking methanol (wood alcohol) in the mistaken belief that it could cure COVID-19.
Of course, in the early days of AIDS, there was no internet or social media on which to spread fake treatment news around the world. Moreover, as tragic a pandemic as AIDS would become, in the first year, it was not widely recognized and was confined to specific risk groups, including gay and bisexual men, injecting drug users, and people with hemophilia. By the end of 1981, the year AIDS was first identified, there were 337 cases reported in the U.S., and 130 deaths. By contrast, since the first cases of COVID-19 were identified in December 2019, over 8 million cases have been reported to the World Health Organization (WHO), with over 400,000 deaths reported. The pandemic has spread to every corner of the globe. The greater scale of the COVID-19 pandemic, compared with the early days of AIDS, seems to invite a much greater scale of fake news and treatment scams.
Today, while there are no drugs approved to treat COVID-19, standard care includes measures such as oxygen, ventilators, antibiotics, blood pressure medication, kidney dialysis, and life support, depending on the severity of the illness and the specific clinical presentation in any given patient. In the early days of HIV/AIDS, the only standard medical treatments available were for the treatment or prevention of some—not all—opportunistic infections (the diseases that attacked the immune system compromised by HIV infection and led to the onset of AIDS, and eventually to death, in most HIV-positive people).
Given the lack of standard medical treatments for AIDS-related opportunistic infections until 1996, alternative therapies abounded. One medical doctor closely associated with alternative treatments for HIV infection was Bernard Bihari, M.D., a neurologist and psychiatrist who was the head of addiction treatment in 1980s New York City. Bihari is most widely known for his discovery that naltrexone, a drug approved to treat heroin addiction in 1984, could also be used to boost levels of endorphins, hormones produced by the brain that boost the immune system. At the doses approved for treating heroin addiction, naltrexone caused unpleasant side effects like anxiety, depression, and irritability. But Bihari discovered that, at low doses, naltrexone continued to boost endorphins and also stabilized immune function, but did not cause the unpleasant side effects that occurred at higher doses. Patients with HIV and AIDS in his medical practice who took low-dose naltrexone did not increase their CD4 counts, but their CD4 counts stopped dropping, and their rates of opportunistic infections decreased (full disclosure: I was one of those patients).
Bihari also championed the use of other alternative treatments for AIDS—drugs that were FDA-approved for other uses, but had shown evidence of improving immune function in scientific studies. These included Antabuse (disulfiram), a drug used to treat alcoholism, and Tagamet (cimetidine), an antacid drug used to treat heartburn and peptic ulcers. In addition, Bihari advocated the use of high-dose Zovirax (acyclovir), an antiviral drug used to treat oral and genital herpes. Initially, Bihari prescribed Zovirax to protect against cytomegalovirus (CMV), a member of the herpes virus family and a major cause of opportunistic infections in people with AIDS. Later, however, evidence emerged that HIV uses herpes viruses to sneak into CD4 cells undetected by the immune system. Bihari, as well as other medical experts, believed that Zovirax, and later a related drug called Valtrex (valacyclovir), could help prevent this “upregulation” of HIV by herpes simplex virus and other herpes viruses.
With the introduction of triple-combination antiviral therapy against HIV (the “cocktail”) in 1996, controversial alternative treatments like naltrexone, Tagamet, Antabuse, and Valtrex were no longer needed to manage HIV infection or to slow or stop the progression to AIDS. After 1996, such drugs were seldom used to treat HIV. In most cases, it was never definitively proven whether these alternative treatments for HIV actually helped or not. As far as most people were concerned, it did not really matter: Scientifically proven, FDA-approved drugs were now available to treat HIV, and that was enough for most doctors and their patients.
Today, we are in just such a transitional place with COVID-19. Remember how enthusiastically President Trump touted hydroxychloroquine, an antimalarial drug that was turned to early in the pandemic as a coronavirus treatment? Now that the experimental drug remdesivir has shown some scientifically validated promise in at least one clinical trial, we hear much less talk about hydroxychloroquine and its cousin, chloroquine, an anti-inflammatory drug used to treat lupus. The day has not yet arrived, however, when safe and effective medications are approved to treat COVID-19 in a consistent and reliable manner. With any luck, and a lot of hard work by scientists and medical researchers, such drugs are just over the horizon. Until then, some people, at least, are likely to continue looking to alternative treatments, regardless of whether they are the real deal, social media hype, or outright fake news.