COVID-19, Fluoroquinolones and the Long Haulers

We knew it was inevitable. With COVID-19 viral infections on the rise in many places of the world, the much touted ‘second wave’ of the COVID-19 pandemic has proven itself a reality, especially in some areas.  Regardless of your opinion on COVID-19, one thing is abundantly clear, it is a real boon for the pharmaceutical industry.

While the contentious political debate rages around various aspects of COVID-19, one fact has become apparent, many patients with COVID-19 , especially those who develop infections or are at risk for developing co-infections, are being given Fluoroquinolone antibiotics (1).

Fluoroquinolone Use

Statistics are showing on average that seriously ill adult patients with COVID-19 are being prescribed antibiotics between 87-94% of the time.  Depending on the country, Fluoroquinolone antibiotic usage varies around the globe from 50% to 92% (1).   Preliminary observations show that levofloxacin, ciprofloxacin, and moxifloxacin seem to be the Fluoroquinolones of choice when they are used.

This usage has market analysts predicting increased sales, with the generic levofloxacin tablets market expecting tremendous growth in the very near future (2).

Steroids

If the risk of receiving a Fluoroquinolone antibiotic alone wasn’t great enough, another fact surrounding COVID-19 is that a majority of COVID patients are given some form of strong steroid therapy to combat the devastating inflammation that COVID is so known for causing (3).

It has been found that dexamethasone and other corticosteroid drugs are effective treatments for treating from of COVID-19 inflammation in patients, especially those who are severely ill.  Also, the severely ill demographic would also likely need antibiotic therapy (4).

The Proverbial Oil and Water

Anecdotally, we (the Fluoroquinolone community) have known for decades that Fluoroquinolones and steroids do not mix.  Many severely impacted individuals were damaged by combinations of these drugs and, at the very least, many individuals had their adverse event amplified by the addition of a steroid to the mix.    

The ‘official’ medical opinion regarding Fluoroquinolone and steroid concomitant use remains dubious.  Some authorities see it as a dangerous combination (5), while others hold to plausible deniability and believe that a potential interaction between Fluoroquinolones and steroids may be unlikely, making them more apt to prescribe the combination (6).

Despite the disagreement in modern medicine as to the danger of using Fluoroquinolones and steroids in clinical use, the truth is that many individuals have been and are being treated with these possible lethal combinations. Now, due to COVID-19, they are being used together on a regular basis, especially in those with moderate to severe cases of COVID-19 (3).   

That brings me to my central point, and one that directly affects the Fluoroquinolone community.

While the whole world is focused on COVID-19 mortality, survival rates, mask usage and vaccines, there is an entire element of the COVID-19 illness that is missing from the discussion sphere. 

The “Long Haulers”

The medical landscape is already littered with the people who have adverse events to the Fluoroquinolones. They are the “walking wounded” as I call them.   As we know, Fluoroquinolone victims permeate other chronic illness communities such as fibromyalgia, chronic fatigue/ME, mitochondrial diseases and so on. I have found that, in these communities, a large subset has had exposure to Fluoroquinolones.   Some of them have connected the dots and made the connection, while many others remain clueless buying into the medical paradigms that deny the Fluoroquinolones are the instigators of their adverse health symptoms.     

Now we have long-haul COVID-19 added to the mix. 

In a scenario so familiar with individuals damaged by Fluoroquinolones, Long Haulers are being ignored amongst all the ‘noise’ that is being generated by the political clamor in the world.  Long haulers are defined as people who are experiencing extended post-viral sequelae. Sequelae is pathological condition resulting from a disease, injury, therapy, or other trauma.

Post-viral Sequelae

Post-viral sequelae are nothing new.  It accounts for a large portion of people in health communities such as mitochondrial, fibromyalgia, chronic fatigue and many more.  

For many, the problem has always been, “what is the root cause?”  Was it the illness itself, a toxic pharmaceutical treatment, or a combination of the two that cause the chronic illness?

Many COVID-19 patients, even people who were never sick enough to go to a hospital, much less lie in an ICU bed with a ventilator, are reporting a laundry list of ill-defined symptoms that I would include under the umbrella of mitochondrial dysfunction.  Long Haulers are reporting neuropsychiatric symptoms such as brain fog, numbed limbs, exhaustion, fumbling for words, depression, anxiety, and PTSD. Still others are reporting symptoms including headaches, dizziness, lingering loss of smell or taste, and deep cognitive impairment.

Mayo clinic says that they are seeing a number of cases of people who report long-term fatigue, headaches, vertigo (and), interestingly enough, difficulties with cognition, hair loss, cardiac and cardio-respiratory fitness concerns, and gastrointestinal issues.

Dr. Gregory Poland, Mayo Clinic’s COVID expert says “I think what we’re going to find out is that a large portion ― not all, but a large portion of that ― is likely to relate to the significant cellular-level damage that this virus can cause,” referring to those who are asymptomatic or have mild cases of COVID-19.

“I think it’s an argument for why we take this disease so seriously,” says Dr. Poland. “People who are thinking, especially young people: ‘(It’s a) mild disease, you know. I might not even have any symptoms, and I’m over it.’ Whoa. The data is suggesting otherwise. There’s evidence of myocardial damage, cardiomyopathy, arrhythmias, decreased ejection fractions, pulmonary scarring and strokes.”

“We’re going to see more and more of the longer-term consequences come out, and we’re going to need to study those as vigorously as we did the acute symptoms. Catalog them, understand them and then do clinical trials to figure out how best to treat them,” says Dr. Poland (7).

Whether you believe COVID-19 is a serious health threat to society or not, one thing we all can agree on is that there is no long-term health information available.  We do not have the luxury of historical data. Will those who seemingly had no initial reaction to the virus, come down with something serious, months or years down the road?  Only time will tell.

What is the percentage rate of those experiencing extended post-viral sequelae?  Well, in contrast, to more than 90% of flu patients who recover fully within two weeks, only 65% COVID-19 are recovering fully in the same time frame. That means that 35% of all patients not hospitalized are not returning to normal quickly and many are complaining of lingering symptoms, some indefinitely.

It wasn’t until late July that the US Centers for Disease Control published a paper recognizing that as many as one-third of coronavirus patients not sick enough to be admitted to the hospital don’t fully recover (8).

It does appear that SAR-COV2 hits the mitochondria hard, but let’s get back to the Fluoroquinolones.

Complexity

Now before someone accuses me of being Chicken Little or at the very least looking at the world through rose colored glasses, I will be the first to admit that not every person who gets COVID is prescribed a Fluoroquinolone.  So no, I don’t see Fluoroquinolones under every rock.  But the truth is that many are being prescribed Fluoroquinolones, so much so that market analysts are expecting an increase in Fluoroquinolone manufacturing.   Also, as I mentioned earlier, many COVID patients are also being prescribed a steroid as a common adjunct.

Most of my readers know that once the Fluoroquinolone enters the mix, the complications of diagnosing go up exponentially.   After being exposed to a Fluoroquinolone, no one really knows if the post-viral sequelae are being cause by, or at least influenced by, the Fluoroquinolone that was tossed into the mix.  One thing is for certain, you can never rule it out, ever. 

They’re Here

Although I have not had many contacts from post COVID patients, I have had a few.  I am anticipating that this will go up in the future as more and more individuals are given a combination of drugs to battle COVID that included a Fluoroquinolone, and possibly a steroid as well.   

Additionally, I’m afraid, that this will be another area where the Fluoroquinolones fall through the cracks in the medical system, where they will get a pass.  They will cause their damage and then hide, remaining blameless while the medical authorities look in another direction. After all, who would suspect a commonly prescribed antibiotic that has been around for decades, that has a wonderful safety record, as causing any lingering problems? (Sarcasm)

Conclusion

These are truly challenging times we live in.   I hope it never becomes reality, but the chances are good that one of our loved ones could be faced with the potential for antibiotic use to treat COVID. During times of crisis most people don’t think of questioning the treatment regimen.   If you haven’t, do your loved ones a favor and let them know that there are usually safer options if they are ever faced with this choice.  

During a recent COVID study the authors observed that administration of antibiotics, especially multiple antibiotics, did not seem to change the disease outcome, so they recommended the rational use of antibiotics (1).

Again, if antibiotic use is necessary, there are generally safer alternatives than the Fluoroquinolones.   The risk/rewards and any other concerns should be discussed with the treating doctor so as to choose the safest treatment for the particular situation.

Stay safe everyone.