Social media posts claim that doctors who do not treat hospitalized COVID-19 patients with a combination of ivermectin, hydroxychloroquine and several other drugs are guilty of malpractice if the sick person dies. This is false; health agencies and experts advise against several of the treatments listed, and legal experts say that for this reason the claim does not describe malpractice.
"In 2021, if someone gets admitted to the hospital with #COVID19 -- and dies -- without having been treated with some combination of Vitamin D, zinc, IVM, HCQ, steroids, Azithromycin and blood thinners -- they didn't die from COVID; they died from malpractice. #FactsNotFear," says a September 26, 2021 tweet from an account said to belong to a doctor.
Screenshot of a tweet taken on October 22, 2021
More examples of the post -- part of a trend of inaccurate information circulating online about how to prevent and treat COVID-19 -- appeared on Instagram here and here.
Hydroxychloroquine, abbreviated in the posts as "HCQ," is an anti-malarial drug that was favored by former president Donald Trump as a Covid-19 treatment, despite no strong evidence of real-world efficacy.
The US Food and Drug Administration (FDA) revoked the Emergency Use Authorization for using hydroxychloroquine to treat hospitalized Covid-19 patients in June 2020, citing safety issues including "serious heart rhythm problems... blood and lymph system disorders, kidney injuries, and liver problems and failure."
And the National Institutes of Health (NIH) "recommends against the use of chloroquine or hydroxychloroquine and/or azithromycin for the treatment of Covid-19 in hospitalized patients and in nonhospitalized patients," according to the agency website.
Anti-parasitic drug ivermectin -- "IVM" in the social media posts -- showed promise in early lab settings but has so far failed to translate into real-world success, as judged by its lack of clear efficacy in trials.
The NIH Covid-19 treatment guidelines say there is not enough evidence "either for or against the use of ivermectin for the treatment of Covid-19" until clear results become available from rigorous trials.
Ivermectin is approved by the FDA to treat people with certain conditions caused by parasitic worms, but the agency has warned against using it for Covid-19.
A physician confirmed that scientific findings do not support treating hospitalized Covid-19 patients with a combination of vitamin D, zinc, ivermectin, hydroxychloroquine, steroids, azithromycin and blood thinners, and that doing so may actually harm the patient.
Texas A&M College of Medicine's Robert Carpenter said: "I am aware of no reliable scientific data showing a benefit of taking these agents individually or clustered as described above in prevention or 'curing' of Covid-19. In fact, taking these agents in combination with other chronic medications can be quite dangerous."
He noted that the medicines listed in the post are safe and effective at "helping patients overcome the diseases for which their medical providers intended their use" and "Vitamin D and zinc supplements when taken in approved doses can be essential to helping individuals maintain health."
But "most of the agents promoted in the original social media post can cause significant harm when taken in unrecommended forms, or at elevated dosages, or for prolonged periods of time outside the advice of a one's qualified health care team," Carpenter said.
The NIH Covid-19 Treatment Guidelines Panel says there is not enough evidence for it to recommend for or against the use of zinc or Vitamin D to treat Covid-19, and that it advises against taking more supplemental zinc than the recommended dietary allowance to prevent the disease.
Some corticosteroids -- a type of anti-inflammatory drug commonly referred to as steroids -- are recommended for certain Covid-19 patients, the NIH panel says, depending on patient severity and other factors.
And a large clinical trial found that "full-dose blood thinners" helped moderately ill Covid-19 patients, but not severely ill ones, the NIH said. A separate study found the antibiotic azithromycin no more effective than a placebo in preventing Covid-19 symptons.
Carpenter said the best way to prevent severe Covid-19 illness, hospitalization and death is to get a Covid-19 vaccine, which "have been proven to be safe and are extremely effective at preventing clinically significant Covid-19."
"The science is solid," he said.
Malpractice
Loyola University School of Law professor Nadia Sawicki, who specializes in health law, said that a physician has legally "committed malpractice if their treatment of a patient does not conform to the customary practices in the medical community as a whole."
"Unless a significant community of physicians and hospitals treating Covid patients routinely rely on this combination of treatments as the standard of care, failing to provide those treatments would not constitute malpractice," she said.
Health law professor Leslie Wolf said that nuance, including taking into account the patient's condition, is also key to determining if malpractice has been committed.
Although "recommendations of expert bodies" such as the NIH are helpful, they are not necessarily "determinative, as there can be more than one reasonable approach."
Boston University School of Law professor Christopher Robertson said that the since the treatments described by the posts are not the standard of care, "physicians have no legal obligation to provide them."
In fact, the opposite could be true. "Because these treatments are not typically used by mainstream physicians or supported by the scientific literature, if a physician... uses them and it leads to a bad outcome, the physician may well face malpractice liability or professional discipline from their licensure agency," he said.
AFP Fact Check has debunked more than 1,100 false or misleading claims about Covid-19 here.