TRADUCCION LIBRE DE DOMINGO CARRASCO Y EL AUTOR DE ESTE BLOG.
Para proporcionar a nuestros lectores
acceso oportuno a nuevo contenido, los documentos aceptados por el American
Journal of Tropical Medicine and Hygiene se publican en línea antes de la
publicación impresa. Los trabajos que han sido aceptados para publicación son
revisados por pares y editados en forma de copia, pero no incorporan todas
las correcciones ni constituyen las versiones finales que aparecerán en la
revista final, los trabajos corregidos se publicarán en línea junto con el
lanzamiento de la edición impresa. Este es un artículo de acceso abierto
distribuido bajo los términos de Creative Commons Attribution License, que
permite el uso, distribución y reproducción sin restricciones en cualquier
medio, siempre que el autor original y la fuente sean acreditados.
A.m. J. Trop. Medicina. Hyg. , 00 (0), 2020,
págs. 1-3
doi: 10.4269 / ajtmh.20-0234
Copyright © 2020 por la Sociedad
Americana de Medicina e Higiene Tropical
Leandro Tapia *
Instituto de Medicina Tropical y Salud Global, Universidad Iberoamericana, Santo Domingo, República Dominicana
El primer caso de la nueva enfermedad
por coronavirus (COVID-19) en la República Dominicana coincidió con un período
de crisis política. La desconfianza en las instituciones gubernamentales
dio forma a la fase crítica de la respuesta temprana. Al tener una débil
infraestructura de salud y la falta de confianza pública, el Ministerio de
Salud (MSP) comenzó la lucha contra COVID-19 de manera tardía. Dentro de
los 45 días del primer caso reportado, la crisis política y la agitación
causada por las "noticias falsas" han limitado la capacidad y éxito
de la respuesta del Ministerio de Salud a la pandemia.
era de 5,044 casos confirmados, con una tasa de mortalidad estimada del 4.8 por 100 (en base a 245 muertes registradas)1 .
La República Dominicana tomó medidas
para garantizar una respuesta a la crisis del COVID-19. Cuando la OMS
declaró su preocupación por el COVID-19 como una emergencia de salud pública
internacional 1, 2 , la República Dominicana no
tenía casos detectados. Cuando la OMS lo anunció como una pandemia, la
Republica Dominicana tenía solo 11 casos detectados, con aproximadamente 50
posibles casos identificados por vigilancia sindrómica. El presidente
anunció medidas nacionales de “toque de queda” solo 17 días después del primer
caso detectado, cuando existían 21 casos reportados y una muerte1 , mencionando las experiencias
de las zonas gravemente afectadas 3,4 .
Los ciudadanos desconfiaron de esta medida gubernamental, en el entendido
del impacto económico del bloqueo ante la baja carga de COVID-19 en ese
momento. La gente percibió una reacción exagerada por parte de las
autoridades. Este sentimiento y las acciones del gobierno condujo a
la detención de miles de civiles al violar el toque de queda. Con el
tiempo, en las redes sociales denunciaban cada vez más las explicaciones del
Ministerio de Salud sobre el por qué la curva epidemiológica aún no había
aplanado.
Durante la primera semana del brote, el Ministerio de Salud dio conferencias de prensa matutinas para mantener advertida a la comunidad sobre la epidemia. Estas más tarde evolucionarían para
no solo informar nuevos casos y
muertes, sino también para brindar recomendaciones al personal médico y al
público en general1 .
El Ministerio de Salud hizo una
fuerte inversión en anuncios en radio, redes sociales y televisión para
informar a la población sobre el mejor comportamiento preventivo y la
identificación de síntomas. También, el Ministerio de Salud publicó un
"Protocolo nacional para el Diagnóstico y Tratamiento para el
COVID-19 ”5 para asegurar la
estandarización de procedimientos para el diagnóstico, atención y prevención de
casos. Sin embargo, todas estas medidas no fueron suficientes para recuperar la
confianza del público y detener la rápida propagación de "noticias
falsas" en la población.
El protocolo nacional para
el diagnóstico y tratamiento de COVID-19 especifica que todas las estrategias
de prevención se centran en técnicas de aislamiento, uso de equipo de
protección personal y distanciamiento social y que los tratamientos se centren
en el alivio sintomático. Sin evidencia local para terapias efectivas, el
público en general y los medios de comunicación han buscado a nivel
internacional experiencias con diversos tratamientos. En los medios de
comunicación están circulando informaciones sobre muchos estudios de
tratamientos experimentales para COVID-19, incluido lopinavir/ritonavi 6, hidroxicloroquina7, tocilizumab,8 e ivermectina, 9 a pesar de que estos
estudios son preliminares y muestran resultados mixtos. Los informes que
circulan en la República Dominicana muestran que los médicos están
prescribiendo tratamientos y profilaxis con
regímenes como la hidroxicloroquina más azitromicina,
tocilizumab10 o ivermectina11, todos basados en informes de
noticias en lugar de la dirección del Ministerio de Salud Pública. Estas
prescripciones prácticas, sin consecuencias para los prescriptores, se debe a
la falta de confianza en las instituciones públicas y la falta de regulación
por parte del Ministerio de Salud. Hasta mediados de abril, en la
República Dominicana no hay ensayos clínicos registrados para el tratamiento
COVID-19, lo que podría explicar el uso de tratamientos experimentales,
surgiendo la pregunta: ¿qué institución dominicana regula las acciones de los
médicos que se desvían de las pautas de evidencias?
. Este estado de cosas ha destacado dos graves déficits del sistema de salud de la República Dominicana. Primero, los medios sensacionalistas pueden influir en las opiniones del personal médico alejado de la evidencia práctica. Segundo, con una cultura de automedicación y falta de necesidades de sus pacientes? ¿Qué pueden los médicos hacen cuando el sistema no garantiza su amparo al no proporcionar equipos para la necesaria protección personal de salud? Las respuestas a estas preguntas no están claras, pero lo seguro es que el primer paso para recuperar el control de la respuesta contra el brote de COVID-19 depende del compromiso de la gente.
Con una creciente desconfianza en las instituciones públicas, los académicos en las ciencias de la salud deben guiar la narrativa de COVID-19 al identificar los desafíos que enfrentan las personas y al actuar como expertos desinteresados para resolverlos. Los académicos también necesitan denunciar públicamente a los infractores y responsabilizarlos con evidencia científica El trabajo de un investigador médico ha cambiado. Ahora, necesitamos comunicarnos y traducir la literatura científica actual en términos que pueda ser entendida y accesible, beneficiándose de un mayor interés del público. Además, necesitamos sentirnos comprometidos con las soluciones. Se deben asumir las diferentes plataformas de redes sociales e intentar silenciar a esas personas mal informadas que ayudan a difundir "noticias falsas" que inspiran a clínicos, para deshacernos de los medios sensacionalistas, y más bien buscar respuestas dentro de la comunidad científica.
El personal médico debe instar a las autoridades a ampliar las estrategias preventivas, como el distanciamiento social, y mantener las regulaciones del Ministerio de Salud con respecto al uso y abuso de medicamentos. Los jóvenes investigadores y líderes emergentes tienen la oportunidad de aprovecha el momento y proponer soluciones. Todas estas sugerencias parecen obvias, pero con un sistema
que no apoya a los profesionales que
se basan en la evidencia, pueden surgir dificultades. Como un médico
recién iniciado en la carrera, a menudo me pregunto ¿qué pasa cuando un
paciente llega a mi consultorio y se va sin entender por qué la clave para
prevenir una infección respiratoria es el distanciamiento social y el lavado de
manos?, ¿cuándo ha leído algo diferente en línea?, ¿qué sucede cuando un
paciente se va sin remedio, después de prescribirle un tratamiento sintomático
y aislamiento en el hogar, cuando esperaba un tratamiento específico que
escuchó en las noticias?, ¿qué pasa cuando ese paciente encuentra sus
esperanzas satisfechas por otro médico, que ofrece algún tratamiento
experimental no regulado?, ¿qué pasa cuando mi reputación sufre
porque los pacientes prefieren un tratamiento probado para la atención basada
en evidencia? En realidad, nosotros no podemos controlar las acciones de
cada paciente, pero tenemos que luchar, porque si no lo hacemos, las
"noticias falsas" triunfarán sobre la ciencia.
Recibido el 1 de abril de 2020.
Aceptado para su publicación el 22 de abril de 2020.
Publicado en línea el 29 de abril de
2020. Agradecimientos: Agradezco a Robert Paulino-Ramírez por su
minuciosidad revisando los manuscritos. Los cargos de publicación de
este artículo fueron eliminados debido a la pandemia en curso de COVID-19.
Dirección del autor: Leandro Tapia,
Instituto de Medicina Tropical y Salud Global, Universidad Iberoamericana,
Santo Domingo, Dominicana República, correo electrónico: l.tapia@prof.unibe.edu.do .
Este es un artículo de acceso abierto
distribuido bajo los términos del Licencia Creative Commons Attribution (CC-BY), que
permite uso restringido, distribución y reproducción en cualquier medio,
siempre que El autor original y la fuente sean acreditados.
REFERENCES
1. General
Directorate of Epidemiology, Ministry of Health, 2020. COVID-19 Special
Bulletins . Available at: https://www.msp.gob.do/web/?page_id=6682. Accessed March 26, 2020.
2. World
Health Organization, 2020. Coronavirus Disease (COVID-19) - Events as
they Happen . Available at: https: // www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen. Accessed April 7, 2020.
3. Lau H,
Khosrawipour V, Kocbach P, Mikolajczyk A, Schubert J, Bania J, Khosrawipour T,
2020. The positive impact of lockdown in Wuhan on containing the COVID-19
outbreak in China. J Trav Med . Available at : https://doi.org/10.1093/jtm/taaa037 .
4. Sj ¨odin
H, Wilder-Smith A, Osman S, Farooq Z, Rockl ¨ov J, 2020. Only strict quarantine
measures can curb the coronavirus disease (COVID-19) outbreak in Italy,
2020. Euro Surveill 25:2000 280.
5. Ministry
of Public Health and Social Assistance, 2020. Protocol for the
Diagnosis and Treatment of Coronavirus (COVID-19).vol. 1. 1st
ed. Santo Domingo, Dominican Republic: Minis-Public Health and Social
Assistance Term.
6. Cao B,
Wang Y, Wen D, Liu W, Wang J, Fan G, Ruan L, Song B, Cai Y, Wei M, Li X, 2020.
A trial of lopinavir-ritonavir in adults hos-pitalized with severe
COVID-19. N Eng J Med . Available at: https://doi.org/10.1056/NEJMoa2001282 .
7. Cortegiani A, Ingoglia G, Ippolito
M, Giarratano A, Einav S, 2020. A systematic
review on the efficacy and safety of chloroquine for the treatment of
COVID-19. J Critical Care. Available at: https: //doi.org/10.1016/j.jcrc.2020.03.005 .
8. Xu X et
al., 2020. Effective treatment of severe COVID-19 patients with
tocilizumab. ChinaXiv . 2020 Feb 14; 202003 (00026): v1.
9. Caly L,
Druce JD, Catton MG, Jans DA, Wagstaff KM, 2020. The FDA-approved drug
Ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral
Res 178: 104787.
10.
Pantale´on D, 2020. Treatment Takes Five Out of Care Intensive. List' ı n
Journal . Available at: https://listindiario.com/la-republica / 2020/03/28/610777 /
treatment-take-out-five-intensive-care .
11. Ponce M,
2020. Medication Helps 150 with COVID-19 in Puerto Plata
center. Caribbean. Available at: https: //www.elcaribe.com.do/2020/04/20/medicamento-ayuda-a-150-with-covid-19-in-the-center-of-puerto-plata
/ .
12. Bello Romero A, 2020. Patients with Lupus and Arthritis Live Frightened by Shortage of their Medicines. The D´ ı a . Available
at: https://eldia.com.do/patientes-que-padecen-lupus-y-arthritis-they
live-scared-by-shortage-of-their-medications / .
13. CDN,
2020. Teacher Suffering From Lupus Aide Stop Shopping Plaquinol as Preventive
of COVID-19. CDN . Available at: https://cdn.com.do/2020/03/27/maestra-que-sufre-de-lupus-ask-to-stop-buying-plaquinol-as-preventive-fromcovid-19 / .
14. Ramırez
J, 2020. Hygiene Products Deplete on Demand Before Coronavirus. List' ı n
Journal . Available at: https: // listindiario.com / economy / 2020/03/10/607578 /
hygiene-products-se-deplete-on-demand-before-coronavirus .
15. Z101 FM,
2020. The Medical Recipe of Z. The Medical Recipe Z . Santo
Domingo, Dominican Republic. Available at: https://omny.fm/shows/la-receta-m-dica/23-03-2020-programa-complete .
16.
Incarnation D, 2020. Scarcity of Masks and Others Continues Prevention
Products. The Caribbean . Available at: https://www.elcaribe.com.do/2020/03/31/continua-escasez-de-masks-and-other-prevention-products
/. COVID-19 AND FAKE NEWS IN THE DOMINICAN REPUBLIC
ARTICULO ORIGINAL EN INGLES
Novel Coronavirus Disease (COVID-19) and Fake News in the Dominican
Republic
In order to
provide our readers with timely access to new content, papers accepted by the
American Journal of Tropical Medicine and Hygiene are posted online ahead of
print publication. Papers that have been accepted for publication are
peer-reviewed and copy edited but do not incorporate all corrections or
constitute the final versions that will appear in the Journal. Final, corrected
papers will be published online concurrent with the release of the print issue.
This is an
open-access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.
Am. J. Trop.
Med. Hyg., 00(0), 2020, pp. 1–3 doi:10.4269/ajtmh.20-0234 Copyright ©
2020 by The American Society of Tropical Medicine and Hygiene. Perspective
Piece
Novel Coronavirus Disease (COVID-19) and Fake News in the Dominican
Republic
Leandro Tapia*
Instituto de Medicina Tropical
& Salud Global, Universidad Iberoamericana, Santo Domingo, Dominican
Republic
Abstract. The
first case of novel coronavirus disease (COVID-19) in the Dominican Republic
coincided with a period of political crisis. Distrust in governmental
institutions shaped the critical phase of early response. Having a weak public
health infrastructure and a lack of public trust, the Ministry of Health (MoH)
began the fight against COVID-19 with a losing streak. Within 45 days of the
first reported case, the political crisis and turmoil caused by “fake news” are
limiting the capacity and success of the MoH response to the pandemic.
The introduction of novel coronavirus disease (COVID-19) into the Dominican Republic was very untimely; the first case occurred during a chaotic period of political instability. After a failed election on February 15, 2020, distrust in public institutions rose due to a lack of clear explanation of the electoral crisis. This led to a month-long mass protest by thousands of people across the island-nation. The first confirmed case of COVID-19 occurred on February 29, 2020 in a traveler. During the next days, the Ministry of Health (MoH) announced the decision to enhance surveillance for COVID-19 and the designation of specific isolation centers across the country. Fifteen days after the first case was detected, the first diagnosis of autochthonous COVID-19 was confirmed. Six weeks after the first case was announced, the total burden of COVID-19 was 5,044 confirmed cases, with an estimated 4.8% mortality rate (based on 245 studied deaths).1
The Dominican
Republic took measures to ensure early response to the COVID-19 crisis. When
the WHO declared COVID-19 as a Public Health Emergency of International
Concern,2 the Dominican Republic had no detected cases. When the WHO announced
it as a pandemic, the Dominican Republic had only 11 detected cases, with about
50 possible cases identified by syndromic surveillance.1,2 Nighttime national
lockdown measures were announced by the president just 17 days after the first
detected case, at a time of 21 reported cases and one death,1 citing the
experiences of previously affected areas.3,4 Citizens became wary of this
measure, considering the extent of the economic impact of the lockdown and the
low COVID-19 burden at the time. The general impression suggested an apparent
overreaction by the authorities. This sentiment and government enforcement led
to the detainment of thousands of civilians for breaking the curfew. Over time,
social media increasingly denounced explanations by the MoH on why the epidemic
curve had not yet flattened.
During
the first week of the outbreak, the MoH gave morning press conferences to
maintain official communication on the epidemic. These later evolved to not
only report new cases and deaths but also provide recommendations for medical
personnel and the general public.1
The
MoH invested heavily on radio, social media, and television announcements
to inform the population about the best preventive behaviors and symptoms
identification. Also, the MoH released a “National Protocol for the Diagnosis
and Treatment for COVID-19”5 to ensure standardization of procedures for the
diagnosis, care, and prevention of cases. However, all of these swift measures
were not enough to regain the public’s trust and to stop the rapid spreading of
“fake news” through the population.
The national protocol for the diagnosis and treatment of COVID-19 specifies that all prevention strategies focus on isolation techniques, use of personal protective equipment, and social distancing, and that treatments focus on symp-tomatic relief. Without local evidence for effective therapies, the general public and news outlets have looked internationally to seek experience with various treatments. Media outlets are circulating information on many studies of experimental treatments for COVID-19, including lopinavir/ ritonavir,6 hydroxychloroquine,7 tocilizumab,8 and ivermectin,9 even though these studies are preliminary and show mixed results. Reports in the Dominican Republic have emerged showing that doctors are prescribing treatments and prophylaxis with regimens such as hydroxychloroquine plus azithromycin, tocilizumab,10 or ivermectin,11 all based on news reports rather than MoH direction. These prescription practices, without consequences for prescribers, demonstrate a lack of trust in public institutions and lack of regulation by the MoH. Up to mid-April, no clinical trial for COVID-19 treatment has been registered in the Dominican Republic which could explain the use of experimental treatments, begging the question: Which Dominican institution regulates the actions of doctors that skew away from evidence-based guidelines?
Massive
media bombardment regarding alternative COVID-19 treatments and increased
numbers of doctors prescribing these treatments have led people to storm
pharmacies and buy stocks of available drugs such as hydroxychloroquine.10
Thus, thousands of systemic lupus erythematosus (SLE) and rheumatoid arthritis
(RA) patients are unable to access their treatment because of nationwide
shortages.12 Social media posts from SLE and RA patients are frequently
soliciting people to sell or donate hydroxychloroquine, which was purchased for
COVID-19 prophylaxis.13 This state of affairs has highlighted two severe
deficits of the Dominican Republic’s health system. First, sensationalist media
can sway the opinions of medical personnel away from evidence-based
practices. Second, with a culture of self-medication and lack of
governmental regulation of drug use, drugs are purchased by clients without a
prescription, and so without medical supervision.
Public speculation in the country, as in many parts of the world, has led to grocery shortages. Supermarkets and grocery stores have experienced scarcity of antibacterial gels, antibacterial wipes, detergents, and toilet paper.14 Rumors of the benefits of tonic water, for which quinine is an ingredient, led people to storm grocery stores in search of this product, which quickly became scarce.15 Shortages have not been limited to groceries. Pharmacies are experiencing shortages of essential items such as isopropyl alcohol, latex gloves, and medical-grade masks. Medical personnel have reported a lack of protective gear in hospital settings, including sites designated by the MoH as COVID-19 response sites, due to market shortages and inflation of costs, limiting hospital purchases.16 Overall, preventive actions against COVID-19 are a possibility only for those with adequate resources, not those at highest risk.
With the high
stakes of the fight against the COVID-19 pandemic, what can a government
without apparent regulatory capacity and public trust do to fight against it?
What can medical practitioners in low-income settings do, when the system is
rigged against their patients’ needs? What can medical practitioners do when
the system cannot ensure their protection by providing necessary personal protective
equipment? Answers to these questions are unclear, but what is clear is that
the first step to regaining control of the response against the COVID-19
outbreak depends on the people’s engagement.
With increasing distrust in public institutions, health science academics should guide the COVID-19 narrative by identifying challenges faced by the people and acting as disinterested experts to solve them. Academics also need to publicly denounce wrongdoers and hold them accountable with scientific evidence. The job of a medical researcher has changed. Now, we need to communicate with the public and translate the current scientific literature into terms that can be understood and accessible, benefiting from the public’s increased interest. Furthermore, we need to become engaged in the solutions. Academics should take on the different social media platforms and attempt to silence those misinformed individuals helping to spread “fake news” by inspiring clinicians to ditch sensationalist media, and rather to search for answers within the scientific community.
Medical personnel have to urge the authorities to scale-up preventive strategies, such as social distancing, and to up-hold MoH regulations regarding drug use and misuse. Young researchers and emerging leaders have the opportunity to seize the moment and propose solutions. All of these suggestions seem obvious, but with a system that will not back up evidence-driven professionals, difficulties can arise. As an early-career medical doctor, I often wonder what happens when a patient comes to my office and leaves without understanding why the key to preventing a respiratory infection is social distancing and handwashing, when he has read something different online? What happens when a patient leaves hopeless, after I prescribed symptomatic treatment and home isolation, when he expected a specific treatment he heard about on the news? What happens when that patient finds his hopes satisfied by another doctor, who offers some unregulated
experimental treatment? What happens when my reputation suffers because patients prefer an un-proven treatment to evidence-based care? In reality, we cannot control the actions of every patient, but we have to fight on, for if we do not, the “fake news” will triumph over science.
Received
April 1, 2020. Accepted for publication April 22, 2020.
Published
online April 29, 2020.
Acknowledgments:
I thank Robert Paulino-Ramirez for thoroughly reviewing the manuscripts.
Publication charges for this article were waived due to the ongoing pandemic of
COVID-19.
Author’s address: Leandro Tapia,
Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana,
Santo Domingo, Dominican Republic, E-mail: l.tapia@prof.unibe.edu.do.
This is an
open-access article distributed under the terms of the Creative Commons
Attribution (CC-BY) License, which permits un-restricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.
REFERENCES
1. General
Directorate of Epidemiology, Ministry of Health, 2020. COVID-19 Special
Bulletins . Available at: https://www.msp.gob.do/web/?page_id=6682. Accessed March 26, 2020.
2. World
Health Organization, 2020. Coronavirus Disease (COVID-19) - Events as
they Happen . Available at: https: // www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen. Accessed April 7, 2020.
3. Lau H,
Khosrawipour V, Kocbach P, Mikolajczyk A, Schubert J, Bania J, Khosrawipour T,
2020. The positive impact of lockdown in Wuhan on containing the COVID-19
outbreak in China. J Trav Med . Available at : https://doi.org/10.1093/jtm/taaa037 .
4. Sj ¨odin
H, Wilder-Smith A, Osman S, Farooq Z, Rockl ¨ov J, 2020. Only strict quarantine
measures can curb the coronavirus disease (COVID-19) outbreak in Italy,
2020. Euro Surveill 25:2000 280.
5. Ministry
of Public Health and Social Assistance, 2020. Protocol for the
Diagnosis and Treatment of Coronavirus (COVID-19).vol. 1. 1st
ed. Santo Domingo, Dominican Republic: Minis-Public Health and Social
Assistance Term.
6. Cao B,
Wang Y, Wen D, Liu W, Wang J, Fan G, Ruan L, Song B, Cai Y, Wei M, Li X, 2020.
A trial of lopinavir-ritonavir in adults hos-pitalized with severe
COVID-19. N Eng J Med . Available at: https://doi.org/10.1056/NEJMoa2001282 .
7. Cortegiani A, Ingoglia G, Ippolito
M, Giarratano A, Einav S, 2020. A systematic
review on the efficacy and safety of chloroquine for the treatment of
COVID-19. J Critical Care. Available at: https: //doi.org/10.1016/j.jcrc.2020.03.005 .
8. Xu X et
al., 2020. Effective treatment of severe COVID-19 patients with
tocilizumab. ChinaXiv . 2020 Feb 14; 202003 (00026): v1.
9. Caly L,
Druce JD, Catton MG, Jans DA, Wagstaff KM, 2020. The FDA-approved drug Ivermectin
inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res 178: 104787.
10.
Pantale´on D, 2020. Treatment Takes Five Out of Care Intensive. List' ı n
Journal . Available at: https://listindiario.com/la-republica / 2020/03/28/610777 /
treatment-take-out-five-intensive-care .
11. Ponce M,
2020. Medication Helps 150 with COVID-19 in Puerto Plata
center. Caribbean. Available at: https: //www.elcaribe.com.do/2020/04/20/medicamento-ayuda-a-150-with-covid-19-in-the-center-of-puerto-plata
/ .
12. Bello Romero A, 2020. Patients with Lupus and Arthritis Live Frightened by Shortage of their Medicines. The D´ ı a . Available
at: https://eldia.com.do/patientes-que-padecen-lupus-y-arthritis-they
live-scared-by-shortage-of-their-medications / .
13. CDN,
2020. Teacher Suffering From Lupus Aide Stop Shopping Plaquinol as Preventive
of COVID-19. CDN . Available at: https://cdn.com.do/2020/03/27/maestra-que-sufre-de-lupus-ask-to-stop-buying-plaquinol-as-preventive-fromcovid-19 / .
14. Ramırez J, 2020.
Hygiene Products Deplete on Demand Before Coronavirus. List' ı n
Journal . Available at: https: // listindiario.com / economy / 2020/03/10/607578 / hygiene-products-se-deplete-on-demand-before-coronavirus
15. Z101 FM,
2020. The Medical Recipe of Z. The Medical Recipe Z . Santo
Domingo, Dominican Republic. Available at: https://omny.fm/shows/la-receta-m-dica/23-03-2020-programa-complete .
16.
Incarnation D, 2020. Scarcity of Masks and Others Continues Prevention
Products. The Caribbean . Available at: https://www.elcaribe.com.do/2020/03/31/continua-escasez-de-masks-and-other-prevention-products
/. COVID-19 AND FAKE
NEWS IN THE DOMINICAN REPUBLIC
