While the world continues to develop COVID-19 vaccine, coronavirus cases are treated according to protocols developed in every single country. However, not everyone is pleased with the treatment. Both in Kyrgyzstan and Kazakhstan there are cases when patients refuse treatment.
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Kyrgyzstan: compulsory treatment
A 61-year-old resident of Naryn, Orozbek Makenaliev, arrived at Kyrgyzstan on March 15 after four months of missionary work in Pakistan. At that time, this country was not considered by Kyrgyzstan as an epidemiologically unsafe country, so he had to fill in the questionnaire at the airport. According to him, no one has informed him of special rules of movement.
The old man visited his son in Bishkek and left home in four days. Two days later, the passengers of the same flight were known to have the symptoms of COVID-19.
“I had no symptoms, I felt very well, but, according to doctors, the test showed I had the disease in a mild form. They administered treatment, but after I took tablets I had a suffocating feeling. They gave me water and paracetamol and I felt better. Next day I refused to take them,” Makenaliev said in his video statement.
Antivirus therapy was administered to his 60-year-old wife, who was placed under observation together with the son and their daughter-in-law. However, the treatment, according to the daughter, almost nearly resulted in death of the woman.
“When she was hospitalised, she had good results and no complaints. On the second day of treatment, she received oxygen therapy and could not drink, eat, get out of bed. But she didn’t refuse treatment despite her getting worse. She believed she would be cured, she would become better. She took 4 tablets a day, as prescribed. She refused them on the fifth day when her condition became critical and she couldn’t swallow them,” her daughter Nurgiza Makenalieva said.
Soon doctors managed to improve the health of the woman and she no longer needed oxygen therapy.
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A few days before that, Orozbek Makenaliev posted a video online and asked whether his family members and he have a right to refuse treatment that worsened his health. The regional interior affairs department reported they opened a criminal case on “Violation of health requirements”.
The police categorically rejected the connection between these two events, referring to the allegedly repeated violations of the sanitary epidemiological regime and the appeal to them by local doctors.
As in the whole world, in Kyrgyzstan, COVID-19 treatment is based on the experience of China, Italy and the USA. Doctors are guided by the second version of the interim clinical guide developed by the working group of specialists of the Ministry of Health. In the absence of evidence-based medicine, doctors are trying to adapt drugs already used in diseases caused by viruses similar in behaviour and already known to science.
The combined antiretroviral drug lopinavir + ritonavir is used to combat HIV infection. According to the head of the council of physicians of the Ministry of Health on the fight against coronavirus Talant Soronbaev, it is used in severe stages of COVID-19. The list of drugs recommended for use by the Ministry of Health also contains a drug designed to fight malaria – hydroxychloroquine, which is widely tested at this stage in the fight against pandemic in many countries of the world.
However, according to the expert of evidence-based medicine Bermet Baryktabasova, studies on the effectiveness of lopinavir, ritonavir and arbidol in the fight against coronavirus were discontinued either due to lack of effect or increased mortality rate.
“80% of people do not become infected with it [coronavirus] at all, due to immunity. 9 to 20% become infected in a mild form or the disease is asymptomatic. And only a small part is seriously ill and people die due to immunodeficiency. And if a person with dubious test is treated with extremely toxic drugs, this usually leads to the most unpredictable consequences,” Baryktabasova said.
According to her, she has data when patients even of a mild form nearly died. And what was the real reason for the death of five patients at this moment in Kyrgyzstan – coronavirus or empirical treatment, most likely we will not know, the expert said.
“In Suzak, asymptomatic patients were prescribed antiviral therapy and their condition worsened. One young man nearly died. They administered him an urgent detoxification. These patients would have easily suffered the disease, if not for this aggressive intervention. And this is deeply hidden information, although it is written in all WHO documents that research results should be available to the general public,” Baryktabasova said.
A Kazakhstani Alina Dzhanzakoa caught the virus on the plane. The girl and her friend came to Almaty from Tbilisi via Minsk. The next day she developed throat irritation, burning heart, and cough. She called the ambulance and she was delivered to the infectious diseases hospital. At two at night, she was confirmed coronavirus.
“They treated me with anti-viral drug. I stayed in the hospital for 23 days. Some people who knew I was infected wanted to burn me down, send to prison. Someone shared the link to my Instagram account on WhatsApp and wrote I was a girl from Pavlodar who was hiding from the authorities, came from the Maldives and was infecting people. People started to threaten and curse me,” Dzhanzakova said.
There is no medication to treat coronavirus infection effectively. Kazakhstan follows the WHO recommendations and experience of other countries. On April 1, the country updated the protocol of COVID-19 treatment approved by the Joint Commission of Medical Services Quality of the health ministry. Just like in Kyrgyzstan, the protocol contains anti-viral medications to treat HIV and malaria.
The resident of Atyrau, Murat Santemirov (not his real name), caught coronavirus from his colleague. The test was negative two times and after 24 hours coronavirus was confirmed.
“As soon as the test was positive, they started to administer to me with different HIV medications, and I got worse. Then I refused the treatment, otherwise I would have died. Later on, they administered vitamins and medications that boost immunity. I used to do sport before, don’t drink, maybe that’s why I tested negative in 12 days,” Santemirov said.
According to WHO, approximately 80 per cent of people recover without any specific treatment. Severe symptoms with development of respiratory distress occur approximately in every sixth cases of COVID-19. The most vulnerable group is people aged 65+ with chronic diseases and those who have such somatic diseases as arterial hypertension, heart and lung diseases, cancer or diabetes.
“The virus penetrates into cells and connects with the receptor of the angiotensin II-converting enzyme that is available on the surface of the lung cells. As we grow, the number of these receptors increases, and more viruses can contact them and penetrate into the cell. As the virus develops, it causes inflammation of cells and pneumonia. Therefore, the first to suffer from it are old people with chronic diseases,” infection disease doctor, Zhanar Kairulina, explained.
Nurbagi Kapasova is 82, yet she could overcome COVID-19. She caught coronavirus from her close relative and 10 people were placed under quarantine.
A week later, pains, dry cough and temperature developed. Chronic bronchitis and hypertension aggravated.
“I took mainly strong anti-virus medications but I felt very bad, ate little. Every day at five am the nurse came, administered injections and gave medications. To be honest, I thought I would never be discharged from the hospital. But my body turned out to be strong. We should have faith, I think,” Kapasova said.
Dinara Salim had coronavirus. She didn’t violate health requirements, she refused to be taken to the hospital for treatment.
“They administered various medications to me, including HIV medications. These medications are very strong and can do harm to the body. Therefore, I refused treatment and was treated at home. I took hot tea with honey, pork fat. In addition to the virus, I had double pneumonia. I think I wouldn’t survive at the hospital. The disease has gone now and I feel well,” Salim said.
Kazakhstan initiated four prejudicial inquiries for patients’ refusal of therapy and provision of information about contact persons. According to Yerlan Turgumbaev, minister of interior affairs of Kazakhstan, their actions fall into article 304 of the Criminal Code “Violation of sanitary rules or hygienic standards”. It provides for a fine, community work, restriction of liberty or imprisonment for up to two years.
Restricted human rights caused by COVID-19
At the end of March, a few countries of Eastern Europe and Baltics, Armenia, Georgia and Moldova notified the Secretary-General of the Council of Europe on the impairment of rights of their citizens as a coercive measure to fight the spread of COVID-19. It concerns mainly restriction of freedom of movement and ban on public gatherings.
A week later, 13 member states of the European Union warned the states of long-term violation of human rights and liberties under the pretext of fight against coronavirus pandemic.
As of early April, Russia was known to have at least seven criminal cases initiated mainly for the violation of sanitary and epidemiologic rules.
President of the Philippines Rodrigo Duterte permitted the police and the military to shoot lockdown protesters.
China instituted capital punishment in mid-February for the refusal of treatment, violation of self-isolation, visiting public places and transport by the infected people.
This article was prepared as part of the Giving Voice, Driving Change – from the Borderland to the Steppes Project.