Jane Orient, MD — Dec. 12, 2020
I hope a loved one is not incarcerated, but all of us need to be concerned about prison health, for humanitarian reasons and also because prisons are breeding grounds for contagious diseases.
The Pfizer vaccine for COVID-19 is expected to arrive in hundreds of sites next week under an Emergency use Authorization (EUA) from the Food and Drug Administration. In Arizona, it will be administered, by appointment only, in centralized drive-thru locations (“pods”) to persons on the 1A allocation list. That includes healthcare workers and nursing home residents—not prisoners.
More than half the inmates at the Arizona State Prison Complex in Yuma test positive for COVID. Staff are getting certified to administer vaccine, when it becomes available, but the vaccine is already too late for more than half. The not-yet-positive inmates are housed separately and required to wear cloth masks when outside their cells. But inside or outside their cells, they are breathing the same air.
Orofecal spread of coronavirus is possible. Virus lives in the GI tract and wastewater for days or weeks. Virus has been isolated from restroom exhaust fans. In one study of environmental contamination, the air sampler had to be quarantined twice despite wearing full protective gear. If virus is aerosolized from flushing toilets, the prison mask policy will be of limited value.
So, what can we do to protect both prisoners and staff? A disproportionate number are minorities, the population most severely affected by the disease.
On Dec 8, the Senate held a second hearing about early treatment for COVID. While none of the witnesses said anything related to politics, or anything critical about vaccination or public health mitigation measures, Sen. Chuck Schumer (D-N.Y.) attacked the hearing, Chairman Ron Johnson (R-Wis.), and witnesses as being political, “anti-science,” and “anti-vaxx”—before a word was said.
There is apparently an Anti-Early-Treatment movement, which confuses being pro-treatment with being “anti-vaxx.” It has specifically discouraged use of hydroxychloroquine (HCQ), but official guidance from the National Institutes of Health (NIH) recommends no treatment for outpatients—except for the recent addition of mostly unavailable new monoclonal antibodies.
In contrast to official therapeutic nihilism, testimony at the hearing provided great hope about ivermectin, which has been called “a miracle drug,” having saved millions from terrible parasitic diseases in Africa and other developing areas. In more than 30 studies completed to date, all studies show effectiveness for COVID-19 in early and late disease and for pre-exposure and post-exposure prophylaxis (PrEP and PEP in HIV/AIDS parlance), as the graphic below shows.
There have been no large-scale randomized controlled trials (RCTs) for use in COVID-19 because of difficulty in obtaining funding. The research money goes to novel drugs and vaccines with huge profit potential. But safety has been shown with nearly 4 billion doses taken by humans since 1981.
Prisoners could be offered the choice to take one dose of ivermectin today and a follow-up dose in perhaps a week. Or they can wait to get infected soon and vaccinated whenever.
If you would like to discuss these issues, contact me at janeorientmd@gmail.com or (520) 323-3110.
Jane M. Orient, M.D., Executive Director, Association of American Physicians and Surgeons
