Introduction

The coronavirus disease 2019 (COVID-19) pandemic has provoked an enormous impact around the world (Ali, 2020) and Mexico has been one of the most affected countries; in fact, the true impact in Mexico has probably been underestimated (Ibarra-Nava et al., 2020). Several risk factors associated with severity and mortality of the disease have been reported in the literature. Among them are age >55 years, multiple pre-existing comorbidities, hypoxia. Specific computed tomography findings are indicative of extensive lung involvement, and diverse laboratory test abnormalities and biomarkers of end-organ dysfunction are present (Gallo-Marin et al., 2021).

Until now, the US Food and Drug administration (FDA) has authorized the antiviral drug remdesivir and two combinations of monoclonal antibodies for emergency use in certain patients. In addition, several vaccines are available, three of which (Pfizer-BioNTech, Moderna and Johnson & Johnson) have been approved by the FDA. Furthermore, baricitinib has been approved in Japan (Mouffak et al., 2021). Despite available drugs, therapeutics for the prevention and treatment of COVID-19 are still in great need.

Fear, anxiety and even paranoia can proliferate during a pandemic, all of which can lead to emotional and less than rational responses, such as self-medication (Freckelton, 2020). In addition of these, the ‘infodemic’, which refers to an excess of information (both true and false) that makes it difficult for people to access reliable sources and obtain valid guidance when it becomes most necessary for decision-making (Garcia-Saisó et al., 2021), could contribute to self-medication with medicinal drugs or other products that have no confirmed efficacy, worsening the situation (OPS, 2020).

Considering the risks that implied in self-medication, the objective of this study was to determine the prevalence of self-medication for the prevention of COVID19 in a sample of university students of northeast Mexico during 2021.

Methods

An anonymous survey composed of two sections was used: the first section collects information regarding age and gender; the second section collects information through open questions about the use of preventive treatments, type of treatment used, whether a relative has used preventive treatments and, other aspects about COVID self-prescription. The data of the survey are available as a supplementary file at https://doi.org/10.6084/m9.figshare.20205353.v1.

Due to COVID19 pandemic restrictions throughout Mexico, a convenience sampling was performed; the survey was applied online and was available for three months in the FORMS platform from February to April 2021. Students from the Universidad Autónoma de Nuevo León were invited through the social networks Facebook and Instagram. Responses were grouped by gender and the differences was tested with the chi-square test. A p-value <0.05 was considered significant. The data that support the findings of this study are available at https://figshare.com/articles/dataset/Data_Self-prescription_for_covid_prevention_Mexico_ 2021/16799773.

Results

A total of 284 students completed the survey; 66% of them correspond to females. (Table I). Twenty percent of all individuals reported to self-medicate with the intention of preventing COVID19. In this respect, there was no significant difference by gender (22.5% vs 16.5% for females and males respectively; p= 0.24). On the other hand, 34.5% of participants reported having a family member that used preventive treatment for COVID19; no significant difference was observed by gender (p= 0.13).

Among those who reported self-medication, the main products reported as a preventive treatment for COVID19 were: vitamins (mainly C and D) 53.9%, medicinal drugs (mainly paracetamol/AINES) 17.1%, herbal products 10.5%, other unspecified 7.9%, alcoholic beverage 6.6% and, chlorine dioxide 3.9%. This pattern was observed in both genders and no significant differences were observed between them (Table II).

Discussion

Self-medication for COVID-19 has been the object of few studies, with a prevalence ranging from <4% to 88% in the general population; this high variability could reflex specific factors of each country which merit more research (Quicho-Lopez et al., 2021). In this work, the prevalence of self-medication in students of UANL, for prevention of COVID19 was higher (23%) than reported for the general population of other countries, such as Poland, Saudi Arabia, and India, where the prevalence was 11.3% (Makowska et al, 2020), 22.1% (Alyami et al., 2020), and 16.3% (Azhar et al., 2021), respectively. Several factors reported in the literature could be responsible for the high prevalence found in this study, such as long waiting time in healthcare facilities, difficulty in obtaining physicians’ appointments, an insufficient amount of available beds/space in healthcare facilities, insufficient stock of essential medicines, and delay in attention (Parulekar et al., 2016). In addition, the fear and fake news misinformation regarding treatments and miracle cures on the web and social networks also could have contributed to this result (OPS, 2020).

Concerning the most common products used for the prevention of COVID-19 (vitamins 53.9%), similar results have been reported in the general population of Saudi Arabia (Alyami et al., 2020) and Bangladesh (Ahmed et al., 2020). On the other hand, medicinal drugs such as acetaminophen and NSAIDs, which were the second most common in this study, have been reported in the literature to be self-medicated mainly for COVID-19 symptomatic treatment of fever (Ahmed et al., 2020) not for prevention of the infection. Herbal products also have been found to be self-medicated for the prevention or treatment of COVID-19 in other studies (Villena-Tejada et al., 2021).

Considering that the population studied has a high education level, the use of chlorine dioxide (3.9%) as a preventive product for COVID-19 is worrying. It is possible that their use is higher in less educated individuals and, the general population of Peru has been reported its use in 8% of individuals (Soriano-Moreno et al., 2021). This compound is not safe for humans, due to its observed thyroid suppression, DNA damage and neurotoxicity in several animal models; alarmingly, it has been consumed to treat COVID-19 in many Latin-American countries, including Mexico (Mostajo-Radji, 2021).

Although responsible self-medication could empower individuals to take control of their wellness in general, it could produce other undesirable consequences such as polypharmacy, adverse effects, drug interactions, antibiotic resistance, incorrect diagnosis and, increased drug expenses (Malik et al., 2020)

To face self-medication implies combating misinformation by academics and authorities at all levels, since it is a potential source for the use of miracle cures. In addition to this, in the case of Mexico and other developing countries, the empowerment of community pharmacist’s role should be promoted by health authorities, since they could contribute to combating misinformation and irresponsible self-medication.

Conclusion

In the year 2021, an important percentage of students of the Universidad Autonoma de Nuevo León, Mexico. reports to have self-medicated to prevent COVID-19. The main product used was vitamins.

References

Ahmed I, Hasan M, Akter R, Sarkar BK, Rahman M, Sarker MS, Samad MA (2020) Behavioral preventive measures and the use of medicines and herbal products among the public in response to Covid-19 in Bangladesh: A cross-sectional study. PloS One 15(12). E0243796. https://doi.org/10.1371/JOURNAL.PONE.0243706

Ali I (2020) COVID-19: Are we ready for the second wave? Disast. Med. Publ. Health Prepar. 14(5): e16-e18. https://doi.org/10.1017/DMP.2020.149

Alyami HS, Orabi MAA, Aldhabbah FM, Alturki HN, Aburas WI, Alfayez AI, Alharbi AS, Almasouud RA, Alsuhaibani NA (2020) Knowledge about COVID-19 and beliefs about and use of herbal products during the COVID-19 pandemic: A cross-sectional study in Saudi Arabia. Saudi Pharm. J. 28(11): 1326-1332. https://doi.org/10.1016/J.JSPS.2020.08.023

Azhar H, Tauseef A, Usman T, Azhar Y, Ahmed M, Umer K, Shoaib M. (2021). Prevalence, attitude and knowledge of self-medication during Covid-19 disease pandemic. Pakistan J. Med. Health Sci. 15(5): 902-905. https://doi.org/10.53350/PJMHS21155902

Freckelton QCI (2020) COVID-19: Fear, quackery, false representations and the law. Int. J. Law Psychiatry 72:101611. https://doi.org/10.1016/j.ijlp.2020.101611

Gallo-Marin B, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, Salzar-Mather TP, Dumenco L, Savaria MC, Aun SN, Flanigan T, Michelow IC (2021) Predictors of COVID-19 severity: A literature review. Rev. Med. Virol. 31(1): 1-10. https://doi.org/10.1002/RMV.2146

García-Saisó S, Marti M, Brooks I, Curioso W H, González D, Malek V, Mejia-Medina F, Radix C, Otzoy D, Zacarias S, Pereira-Dos-Santos E, D´Agostino M (2021) The COVID-19 Infodemic. Rev. Panamer. Salud Públ. 45: e56. https://doi.org/10.26633/RPSP.2021.56

Ibarra-Nava I, Cárdenas-De La Garza JA, Ruiz-Lozano RE, Salazar-Montalvo RG (2020) Mexico and the COVID-19 response. Disast. Med. Publ. Health Prepar. 14(4): E17-E18. https://doi.org/10.1017/DMP.2020.260

Makowska M, Boguszewski R, Nowakowski M, Podkowińska M (2020) Self-medication-related behaviors and Poland’s COVID-19 lockdown. Int. J. Environ. Res. Publ. Health 17(22): 8344. https://doi.org/10.3390/IJERPH17228344

Malik M, Tahir MJ, Jabbar R, Ahmed A, Hussain R (2020) Self-medication during Covid-19 pandemic: challenges and opportunities. Drugs Therapy Perspect. 36(12): 565-567. https://doi.org/10.1007/S40267-020-00785-Z

Mostajo-Radji MA (2021) Pseudoscience in the times of crisis: How and why chlorine dioxide consumption became popular in Latin America during the COVID-19 pandemic. Front. Polit. Sci. 3: 621370. https://doi.org/10.3389/FPOS.2021.621370

Mouffak S, Shubbar Q, Salch E, El-Awady (2021) Recent advances in management of COVI-19: A review. Biomed. Pharmacother. 143: 112107. https://doi.org/10.1016/j.biopha.2021.112107

Parulekar M, Mekoth N, Ramesh CM, Parulekar A (2016) Self-medication in developing countries: A systematic review. J. Pharm. Technol. Res. Manag. 4: 103-127. https://doi.org/10.15415/JPTRM.2016.42007

Quincho-Lopez A, Benites-Ibarra CA, Hilario-Gomez MM, Quijano-Escate R, Taype-Rondan A (2021) Self-medication practices to prevent or manage COVID-19: A systematic review. PLoS One 16(11): e0259317. doi: 10.1371/journal.pone.0259317

Soriano-Moreno DR, Fernandez-Guzman D, Ccami-Bernal F, Rojas-Miliano C, Nieto-Gutierrez W (2021) Factors associated with the consumption of chlorine dioxide to prevent and treat COVID-19 in the Peruvian population: a cross-sectional study. BMC Publ. Health. 21(2109): 1-10. https://doi.org/10.1186/S12889-021-12191-9

OPS (2020) Entender la Infodemia y la Desinformación en la Lucha Contra la COVID-19. Herramientas de Conocimiento. Organización Panamericana de la Salud. Washington, DC, EEUU. 6 pp. https://iris.paho.org/bitstream/handle/10665.2/52053/Factsheet.Infodemic_ spa.pdf?sequence=16

Villena-Tejada M, Vera-Ferchau I, Cardona-Rivero A, Zamalloa-Cornejo R, Quispe-Florez M, Frisancho-Triveño Z, Yañez JA (2021) Use of medicinal plants for COVID-19 prevention and respiratory symptom treatment during the pandemic in Cusco, Peru: A cross-sectional survey. PLoS ONE, 16(9). https://doi.org/10.1371/JOURNAL.PONE.0257165.

Notas de autor

omar.gonzlaezst@uanl.edu.mx