Dr. Fernando Valerio: About Catracho
Dr. Fernando Valerio joined us from Honduras to introduce us to World Council for Health Coalition Partner, Catracho.
Dr. Valerio is Co-Director of the Critical Care Unit of Hospital CEMESA in San Pedro Sula, Honduras and is a member of the Honduras COVID 19 Physician Task Force.
The Catracho Platform (Platforma Catracho) is a non-profit organization comprised of health professionals who are on the front lines in the battle against Covid-19 that are committed to Honduran society. Catracho provides recommendations on the management of Covid-19 and integrates information based on scientific evidence and the best experiences of professionals.
This is an edited segment from the weekly live General Assembly meeting on February 14, 2022.
The full General Assembly Meeting is available in our multimedia library.
Here’s what WCH members, staff, and coalition partners are saying about Dr. Valerio’s presentation:
“Wow! This is absolutely incredible.” -Karen McKenna
“Thanks for that – we had a very similar experience in Zimbabwe. We use Azithromycin and Doxycycline interchangeably.” -Jackie Stone
Dr. Fernando Valerio === [00:00:00] Dr. Tess Lawrie: I’m very pleased to welcome Dr. Fernando Valerio from Catracho in Honduras, Dr. ~, uh,~ Dr. Valeria is a co-director of the critical care unit of the hospital semester in San Pedro, Sula, Honduras. He is a member of the Honduras COVID-19 physician task force, and he’s an ABIM certified in internal medicine and critical care medicine. And I can say that I know Dr Valeria’s work because he and his colleagues in Honduras were [00:01:00] one of the first teams in the world to be recommending and using ivermectin based protocols. So a warm welcome to you, Dr. Valeria, you have the floor for 15 minutes. Dr. Fernando Valerio: Thanks for the invitation. Can you hear me? Dr. Tess Lawrie: Yes. Dr. Fernando Valerio: Thank you, I will share my screen. Yeah. ~So, um, ~This is the team of Catracho. ~You know, ~We started,~ um,~ treating patients in March 2020. We first saw patients in the ICU ~and, ~and we started following the guidelines of the international organizations. And we noticed that we were failing and most ~of our, ~of our patients were dying following these guidance. So around April 23rd, 2020, we decided to start doing some,~ um,~ changes. We started giving some medications to try to recover our patients and send them home. So we made an [00:02:00] acronym with the first letter of the medications we were using. And Catracho is the nickname of the Hondurian people where we live and C is for colchicine, A is for anti-inflammatories for the use of corticosteroids, T is for Tocilizumab, R is for Ivermectin, A for the therapeutic anticoagulation. The other C in March was hydroxychloroquine. But after the,~ um,~ all the media started attacking hydroxychloroquine and,~ uh,~ fear for that, our patient had, we started using a chroma, a chronometer. We started doing the treatment as fast and,~ uh, as, ~as the patient arrived to the ~emergency room ~emergency room. We heard from New York city that patients intubated were dying. And we, we replicate that, that,~ uh,~ observation by seeing our patients, how were they dying? So we started using high flow oxygen and asking patients to protonate [00:03:00] improve oxygenation. So that’s why that’s, what Catracho means for also is the nickname of a Hondurian general that was very resilient in the war against other countries here in central America. So this is part of our team, my partner, Oscar Diaz and Dr. Miguel Sierra from Texas,~ uh,~ from Victoria, Texas. We,~ uh,~ made these~ uh,~ protocol together and we started noticing that patients were surviving. Let me see if I can. So today I’m going to tell you about the impact of this multifaceted treatment in the case fatality rate of COVID-19 in Honduras. So Honduras is a very small country, it is a very underserved and understaffed. ~It is, ~it is two hours away from Florida by plane and a little less than three hours from Texas has,~ uh,~ has we, were ~we, ~we were not ready for a pandemic and we weren’t, we are not ready honestly,~ to,~ to take care of our own [00:04:00] people without the pandemic, because we had very little resources. We wrote this opinion letter to the in INNOVARE journal of the University of Technology of Honduras is about the,~ uh,~ scarce beds per inhabitants that we had before the pandemic. We just had a little bit of a 600, 5,600 beds in the total hospital public hospital system with 4,093 public hospital bed, and a little bit over 1500 in the social security system. Just 0.4 hospital bes for every 100,000 inhabitants, 9.5 hospital beds for 10 in 100,000 inhabitants, just 125 critical care beds for 9 million people, six physicians for every 10,000 inhabitants and just 18 ICU adult ICU physicians and 27 pediatric [00:05:00] ICU physicians. And,~ uh,~ on the graph of the right, you can see the comparison of another population of 9 million people like New York city. Where they, where have 1600 critical, critical care specialists and more than 4,000 ICU beds. So no, we were not ready for a pandemic whatsoever. So we decided to change gears and decided to start treating early. And what we did is we created a protocol where we started giving,~ uh,~ medications that were cheap, that were safe. And ~as, ~as soon as the patient started having symptoms, so we created an early response,~ uh,~ medical kit called ~mice ~MAIZ in Spanish is four. M is a mouthwash. And I’ll give you the details in the next slide. A is azithromycin. I is Ivermectin. Z is zinc, and you could also give hydroxychloroquine in the first days of the pandemic. If the patient [00:06:00] didn’t do better after day seven, in the pulmonary phase, we would add anticoagulation rivaroxaban or apixaban. We would add colchicine and we would start doing,~ uh,~ we, we started giving steroids on a dose of one mineral per kg. And if the patient would go to the hospital or to the ICU, we will do a triage protocol. So we started calling people using the media. We gave more than 200,~ uh,~ Zoom meetings to, to train physicians over Honduras especially in the rural areas. And we would present ~our, ~our findings, our observations in, in, in very important TV shows and in Honduras. So this is what happened. ~We, we, ~we presented these,~ uh,~ research,~ uh,~ first,~ uh,~ plus one. And we noticed that by blocking the reproduction of the virus with medication like ivermectin hydroxychloroquine and azithromycin, we can detain [00:07:00] the inflammation. But if then, if the inflammation would go,~ um,~ we’ll continue. We can block the inflammasome, which is like a turbine to produce inflammation. Also give steroids. Give~ uh,~ therapeutic anticoagulation for, to prevent further plotting. And we’ll ask the pages to oxygenate with high flow system, which are easier to use and to train physicians on the front field. And we’ll ask the patient to prone. And what we saw is that we decrease the days of hospital stay for our patients and around 6.9 days. And also ~we, ~we saw a very important trend to decrease mortality. We had our first 30 patient, 30 patient had a mortality around 40% of the ICU, and we dropped that to 14%. In the univariate analysis that had a very significant key value of 0.01, now we’re in a multivariate analysis we didn’t see such a difference, [00:08:00] but eh, ~w w ~we didn’t want to collect more data. Or at that point, we wanted to just spread the word and tell the world that ivermectin was working, especially when you add it to a protocol to help patients in the ICU. So if this was working in ICU, we decided a early treatment protocol. So we would give,~ um,~ in the outpatient,~ uh,~ treatment, we’ll give a mouthwash that had a very low dose of high sodium hypochlorite and ~hydrogen, ~hydrogen peroxide. We would give ivermectin a hundred microns per kg with a full stomach for five days. We’ll give sink 50 minutes, twice per day for 10 days. And if the patient didn’t do better, as I said, we will get started giving prednisone 1 million per kg per day for seven days. We’ll start colchicine twice per day for seven days. And we’ll give a population like rivaroxaban 20 milliliters per day or Apixaban,~ um, uh, ~five millimetres twice per day. And what happened? We made a team with [00:09:00] a researcher from Texas a and M and our case fatality rate first dropped from 17% then ~from, ~from one, when we started the CATRACHO protocol at the hospital, and then in a massive TV show, we presented the treatments. And after that, the seven day fatality rate continue dropping. And it continued dropping significantly. So when we did a kaiser analysis before our intervention and after our own intervention, the case fatality rate dropped from 14.5 being one of the highest of the world. We were in the top 30 country with the highest case fatality rate, and we were the second and the third highest guys fatality rate of,~ uh,~ of the patients of America. And we drop it to 2.4. And that had a p-value basically of zero. Which is 2.2 times 10 minus 16 ~of, ~of the 10 square. ~Uh, ~We were very pleased to see that and we decided to go forward to make [00:10:00] another analysis, and we requested another scientist to help us find out if the ____ was doing the change and not only the treatments, because we didn’t have enough ICU or hospital beds. So we knew that the change was done on the fields on the early stages of the disease. So Dr. and Dr. Lee Zeng from- Dr. Antis, the head of family practice medicine Texas A&M and Dr. Lee Zeng is a mathematician from, from University of Texas A&M did this analysis, which was actually, was really clever. I think, I don’t know, I’m not very happy with randomized controlled trials ~in the, in the setting, ~in the setting of a pandemic. So we did this analysis, Dr. Zeng help us out to analyze what happened when we did the changes. So in, on May ~of, of, ~of,~ uh,~ 2020, our case fatality rate [00:11:00] dropped, and it did not drop in the Mexican population, ~which is, ~which is a country nearby with the same ~ethics, ~ethics, and culture. And it dropped under a, the lower limit control. These too hard control studies uses a statistical process control analysis that sets an upper level control and a lower level control. Just like a lot of,~ uh,~ industry is due to make recalls to their cell phones or to their cars, for instance. So ~at the, ~at the same day, the case fatality rate of Mexico did not change. And we did in Honduras. So by around June, we, our hospital system was about to collapse. We have patients all over. We didn’t have enough beds. So we requested government to distribute, to go house by house, using medical brigades,~ to,~ to treat patients with our, these [00:12:00] mice get, you can see the picture on the left upper corner of the screen. ~Well, ~To send them to, to start them on steroids after day seven and anticoagulation, and then the case fatality rate on average in the world was around 5%. And what happened despite our cases where increases increasing our case fatality rate dropped again in June of 2020. So this is a comparison of this on the left. We see the case fatality,~ uh, um, ~Eh, record of all the month of 2020, we drop it from 10.1 all the way to 2.4. And just before November, after being hit by last four hurricanes, our case fatality was around 1.6. And after November, after we recover all the patients that were having severe plottings that were case fatality rate was probably the lowest of all Latin [00:13:00] America; of 1.5. And having said that, I would strongly believe it was ~very, very, ~very, it was probably lower than 1.5 because we never had enough testing. Testing was done on just the sickest patients of the hospital in the hospitals or eh, or those that had the money or the availability to go in and get the tests. But I’m very, I believe with the case that I had to drain was very likely lower than that and how we did compared to other countries with a stronger,~ um,~ healthcare system. If we compared to Italy, Mexico, and the United States, we were doing a lot better in June of 2020. So this is my presentation of Catracho, I hope you liked it. I’m open for questions. Thank you so much. Dr. Mark Trozzi: Thank you so much, Dr. Valerio. ~Um, ~Really nice to hear such a good thing happening, especially [00:14:00] coming from Canada, where the treatments have been blocked,~ uh,~ doctors prescribing proper treatment have had their licenses suspended, et cetera,~ and,~ and all this, as we perceive to herd the population into the dangerous injections. ~So, uh, ~One question is,~ um,~ with you being,~ um,~ able and doing such a great job of administering proper treatment to the population. And therefore I would imagine also with very little sickness achieving great herd immunity. ~Uh, ~How did that, what was the impact of that in terms of protecting the population against the dangerous injections ~have, ~have the population been predominantly protected against being injected? Dr. Fernando Valerio: Not really, ~you know, ~we had a lot of- after 2020, there was a big debate, uh, between doctors. Some were not believers of ivermectin because big journals were not,~ um,~ showing data and treatments where we’re helping and there’s as any ~like, ~like every country around the world, there’s a lot of politics. And [00:15:00] the,~ um,~ union of doctors who manage ~the, ~the Hondurian College~ uh,~ of Physicians were very anti-gun,~ uh,~ to, to govern to the government. So they started doing the rollover of vaccination and around 50% of the population’s been,~ uh,~ have received the vaccine and they, and there’s a huge call to, to vaccinate everyone. So unfortunately, despite our success and, but big pharma took over and, ~you know, ~most, some of these treatments are not being given to patients, but Dr. Tess Lawrie: Thanks. ~You, you, ~you,~ um,~ we lost you for a moment there,~ uh,~ Dr. Valerio,~ um,~ I think there are a couple more questions for you in the chat. Dr. Mark Trozzi: Sure. ~Uh, so, um, ~here’s one from a Dr. Jackie Stone, can use Doxycycline given that we are often concerned about malaria in Zimbabwe in the differential diagnosis, we may use doxycycline and Hydroxychloroquine and ivermectin in some patient before the roles, the results are back. So as regarding [00:16:00] your use of doxycycline and then,~ um, uh, ~she was commenting as well, we tend to use ivermectin with doxycycline, with Hydroxychloroquine, with azithromycin, as both Hydroxychloroquine and azithro concentrated in the Lysosome but as long as there is combination therapy and it is given early patients do well. Some have some information from Jackie Stone and the question about, are you using doxycycline there? Dr. Valerio? Dr. Fernando Valerio: Actually we did. We ran out of Azithromycin some days of the pandemic. ~So, ~And we receive information that Doxycycline was working. So we gave some Doxycycline as well, but that was in 2021. Dr. Mark Trozzi: And one other question,~ um,~ we’re not,~ uh,~ I’m not sure which type of,~ uh,~ the COVID injections are being administered there, but we’re wondering if,~ uh,~ perhaps what’s predominantly being used. Are they causing vaccine injuries? And are you using similar protocols,~ uh,~ to treat these vaccine injuries? Dr. Fernando Valerio: Yes, we are. We are we, the jabs that are being applied [00:17:00] here are Pfizer. Moderna, AstraZeneca. And we had some Sputnik vaccination, too. And for those that are injured by vaccination and go to some doctors that follow us, we treat them with ivermectin and sometimes with steroids. Dr. Tess Lawrie: Thanks. Very much. Dr. Mark Trozzi: Thanks very much. Dr. Tess Lawrie: Yeah. I have to say Dr. Lara it’s, ~you know, ~it’s just remarkable that your team and Honduras was doing this in 2020. And when you think of all the suffering, that’s been injured ~by the, ~by the people of the world over the last year,~ uh,~ with the inaction ~from, from, ~from other governments and health authorities, when you know that there was ~this, ~this,~ uh,~ protocol regimen that was working so well in your country, and I know other countries as well, like El Salvador, have been giving people,~ um,~ these at-home kits that they can use that include ivermectin and zinc and other things. ~Um, ~And,~ uh,~ and it’s just ~you know, ~remarkable that,~ um,~ you were doing it and nobody’s been listening and,~ uh, you know, and, ~and so much loss and suffering has occurred. It [00:18:00] just as a last question, is there any thing that your government? ~I mean, w ~Why, what is the difference between the action your government took,~ uh, and, and, ~in rolling out those,~ um, those, ~those kits to people, and what do you think made them do it ~and, ~and other countries not to do it? Dr. Fernando Valerio: ~Uh, ~Actually ~it was, it~ it was a combination of many things. One is that we were not prepared for our system was underserved, and we were desperate. Two they listened ~to, ~to the doctors on the front fields, because since we didn’t have enough critical care doctors and receiving patients at the critical care setting was the recommendation of the international agencies. They paid attention to us because our protocol with these medications was working in the ICU and in antivirals work, if they’re given early, not late early-~ so,~ Dr. Tess Lawrie: Oh, unfortunately we’ve lost you again, Dr. Valerio but thank you ~very, ~very much. ~You, ~You cut off there again. ~Um, so, uh, ~Thank you very much [00:19:00] for coming in and sharing that perspective and hopefully there are. Doctors people and other,~ um, uh, ~health professionals, as well as regulatory authority officials who might be tuned in today and would,~ uh,~ think very carefully about the importance of the information that you’ve shared. So thank you once more.