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Government gives up on chloroquine-prescribing app, for now

. Jan 21, 2021
app covid brazilian government Photo: Dean Drobot/Shutterstock

The Brazilian Health Ministry has decided to temporarily take down a government app designed to help doctors and patients navigate the early stages of coronavirus infections, launched less than a week ago. In many ways, the short-lived algorithm epitomized the way the Jair Bolsonaro administration tackled the pandemic. That is, it was an ineffective tool predicated on prescribing unproven treatments against Covid-19.

The app — named TrateCOV or, “Treat Covid” — consisted of a broad triage assessment with a number of questions regarding symptoms and potential exposure to people with confirmed coronavirus diagnoses. Once doctors or patients filled in all of their relevant details, the app would provide treatment suggestions based on the “coronavirus risk level” denoted from the answers.

</p> <p>The issue with the platform, experts say, is that it continuously provided recommendations for the use of antibiotics, chloroquine, ivermectin, and other drugs, regardless of the reported symptoms. Suggested treatment for fevers and coughs did not differ from those for <a href="https://twitter.com/marivarella/status/1351718496657436674">trivial symptoms</a> such as diarrhea, nausea, or the combination of fatigue and headaches that come with a typical hangover.&nbsp;</p> <p>In fact, for any combination of two symptoms, TrateCOV would recommend treatment of chloroquine, even if the individual in question had not left their home or had any contact with infected persons in the two weeks prior to diagnosis.</p> <p>&#8220;The TrateCOV platform was launched as a pilot project and was not officially in operation, only being used as a simulator. However, the system was hacked and improperly used —&nbsp;which has led to its momentaneous removal,&#8221; said the Health Ministry, in a statement.</p> <p>Earlier in the week, however, the department claimed that TrateCOV suggested diagnoses based on a points system that adheres to &#8220;rigorous clinical criteria.&#8221;</p> <h2>App suggested one-size-fits-all treatment</h2> <p>TrateCOV is the brainchild of Mayra Pinheiro, a senior official within the Health Ministry and one of the staunchest defenders of the use of chloroquine within the government. She unsuccessfully ran for a Senate seat in 2018 for the libertarian party Novo, and was named as head of the Health Education and Labor Secretariat at the beginning of the Bolsonaro administration.</p> <p>Her app provided no distinction in its drug recommendations based on age, weight, height, or symptoms. Almost all hypothetical patients — from newborns to senior citizens — are advised to take chloroquine, hydroxychloroquine, and ivermectin. In some cases, the suggested doses are so high that they could be fatal.</p> <p>Physician Pedro Opará, for instance, inserted details for a hypothetical patient who is obese, and suffers from high blood pressure, diabetes, heart failure, and kidney failure. Mr. Opará specified that the imaginary individual was suffering from a loss of taste and smell for two days.</p> <p>&#8220;Look at what the app recommends: a complete kit of hydroxychloroquine, ivermectin, and even a corticosteroid,&#8221; he wrote on Twitter. &#8220;He is 63 years old and has various diseases such as high blood pressure and diabetes, as well as heart disease and kidney failure. Even if this &#8216;Covid kit&#8217; worked (which it doesn&#8217;t), these diseases would be contraindications for its use.&#8221;</p> <p>Members of <strong>The Brazilian Report</strong> staff also filled out the medical questionnaire, using fictitious names and widely diverse ages and symptoms. The results were always the same, prescribing chloroquine, hydroxychloroquine, and ivermectin. One fictitious patient was recommended this Covid cocktail despite only suffering from mild back pain.</p> <p>On Mr. Bolsonaro&#8217;s request — he has long touted chloroquine as a potential &#8220;<a href="https://brazilian.report/podcast/2020/05/27/chloroquine-bolsonaros-miracle-cure-for-covid-19-podcast/">miracle cure</a>&#8221; for Covid-19 — the Army manufactured over 3.2 million chloroquine pills last year. As of December, it had only been able to distribute less than 500,000 units.</p> <h2>Chloroquine &#8220;bug&#8221; is actually a feature</h2> <p>Web designer Joselito Júnior — who participated in a group that investigated the source code behind the TrateCOV app — affirmed that the platform&#8217;s algorithm was taken from a template on REDCap, a web application for building online surveys. &#8220;It is a normal code template, but this part about chloroquine was added later,&#8221; he says. &#8220;Of course it was put there on purpose. It&#8217;s intentional, it was a choice.&#8221;</p> <p>The programmer explains that the app attributes a score to measure each patient&#8217;s risk. As soon as this figure exceeds six, the platform will automatically recommend treatment with the federal government&#8217;s &#8220;Covid kit.&#8221; In order to reach a score of six, only mild symptoms are required.</p> <p>&#8220;The app doesn&#8217;t account for age, weight, nothing. It will always recommend this list of medications. We observed that only weight and height are taken into consideration for determining dosage, but the recommendation for these drugs remains,&#8221; adds Joselito Júnior.</p> <h2>&#8220;Rigorous clinical criteria&#8221;</h2> <p>The platform&#8217;s short trial period happened in Manaus, where the local health system has collapsed amid a <a href="https://brazilian.report/society/2021/01/06/manaus-biggest-amazon-city-back-in-coronavirus-chaos/">violent second coronavirus wave</a>. Over 340 health professionals signed up to use the app. The Health Ministry expressed its intent to expand the project to other cities.</p> <p>Contradicting the claim that TrateCOV was only operating on a trial basis, doctors who did not wish to prescribe the medication recommended by the app had to provide a justification, with options such as &#8220;patient refusal,&#8221; &#8220;medical contraindication,&#8221; or &#8220;lack of medication.&#8221;</p> <p>One day after Health Minister Eduardo Pazuello and his team visited Manaus, the Office of Federal Prosecution in Amazonas opened a civil inquiry to investigate whether the Health Ministry was negligent in aiding the region and recommending unproven coronavirus treatments.</p> <p>On Wednesday, Congressman Marcelo Freixo filed a request in court for TrateCOV to be taken down. The Federal Council of Medicine <a href="https://oglobo.globo.com/sociedade/coronavirus/conselho-federal-de-medicina-pede-que-ministerio-da-saude-retire-imediatamente-do-ar-aplicativo-tratecov-24848735">followed suit</a> on Thursday, demanding the platform be deactivated.</p> <hr class="wp-block-separator"/> <p><em>Additional reporting by Débora Álvares.</em>

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Renato Alves

Renato Alves is a Brazilian journalist who has worked for Correio Braziliense and Crusoé.

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