Covid-19 Prophylaxis

[superbigd]

Been doing some reading, apparently there’s some concern regarding heart health when you combine the zpack with hcq. Should I drop the zpack?

 

[maldorf]

Been doing some reading, apparently there’s some concern regarding heart health when you combine the zpack with hcq. Should I drop the zpack?

I dont think its a problem for someone with a healthy heart. I think the Z pack alone can cause rhythm problems for some folks, like me.

 

[maldorf]

FDA warns azithromycin "Z-pack" antibiotics could lead to deadly heart rhythms for some

Patients at risk are those with slower than normal heart rate, or taking certain drugs to treat arrhythmias

www.cbsnews.com

The FDA is warning the public that the pills can cause abnormal changes in the heart's electrical activity that may lead to a fatal heart rhythm. Not everyone is at risk. Patients with known risk factors such as existing QT interval prolongation, low blood levels of potassium or magnesium, a slower than normal heart rate, or those who use certain drugs to treat abnormal heart rhythms, or arrhythmias face the greatest risk.

Docs in the past before my heart attack prescribed it to me a lot and it works well! They don't prescribe it for me now since my heart is atfu.

 

[pickapeck]

Been doing some reading, apparently there’s some concern regarding heart health when you combine the zpack with hcq. Should I drop the zpack?

I would not drop it. the course is short. I would look for primary publication to see if the claim is supported by data reported. Given the hit pieces on the combination I would be verty suspicious of such claims especially since RA and SLE and malaria patients have been using it for 65 years. HCQ can cause an elongated QT wave interval but not much evidence of threatening arrhythmia in healthy individuals.

 

[muscle96ss]

Here in AZ. Just got diagnosed with COVID and got prescribed hcq + zpack. Will update you guys more. Currently on day 4 and just started medication today

Don't forget the Zinc!!

 

[superbigd]

Yup! Using the zicam sublingual zinc lozenges. Day 7 and I feel no different then day 4 when I started the meds. Sore throat and little to no energy. Other side effects like cough and hard time
Breathing are not effecting me

 

[maldorf]

Yup! Using the zicam sublingual zinc lozenges. Day 7 and I feel no different then day 4 when I started the meds. Sore throat and little to no energy. Other side effects like cough and hard time
Breathing are not effecting me

Glad to hear you are doing OK. One possibility is the drugs are keeping the infection suppressed enough that your symptoms aren't worse.

 

[pickapeck]

I don't know how much zinc is in zicam sublingual zinc lozenges but I would be taking 200 mg a day.

 

[superbigd]

What type of zinc and where from?

 

[pickapeck]

What type of zinc and where from?

Zinc picholinat or zinc gluconate should be fine. Do not take 200 mg for months on end. 50 mg/d is a good supplement dose but to get your ceoncentratin up 200 mg/d should suffice.

 

[danieltx]

Metformin may lower coronavirus death risk for women - https://www.msn.com/en-us/health/me...ing-coronavirus-deaths/ar-BB15SwFZ?li=BBnbfcL

Metformin, a low-cost diabetes drug that has been dubbed a "miracle" because of its potential anti-aging properties, could also play a role in preventing the worst effects of the coronavirus, according to a preprint study from the University of Minnesota.

The study, which was one of the largest observational studies of coronavirus risk factors so far, found that obesity and diabetes were two big risks for COVID-19-related death, the Minnesota Star Tribune reported.

But they also observed that metformin may lower death risk from the virus between 21% and 24% among women who already took the drug to to help with their diabetes and blood sugar levels.

Lead study author Dr. Christopher Tignanelli told the Star Tribune that people shouldn't seek out metformin as a virus cure, but that his team's findings open new avenues for non-vaccine solutions for infectious diseases like COVID-19, the disease caused by the coronavirus.

Tignanelli said metformin may help with COVID-19 infections because it reduces inflammation and lessens the body's immune system response. In some cases, people with COVID-19 have an overreactive immune response to the virus, which can result in death.

Metformin has also been shown to help with weight loss maintenance
Previous research suggests metformin is also helpful for long-term weight loss maintenance.

An April 2019 study published in the journal Annals of Internal Medicine found metformin could help people lose weight for the long term.

Researchers believe the drug — which is prescribed for pre-diabetics, diabetics, and off-label to people with PCOS — may also help patients who have lost large amounts of weight keep it off.

The study compared the effects of metformin versus diet and exercise for weight loss and weight loss maintenance.

"Taking a pill a day is a lot easier than going to diet and exercise for 15 years. Almost no one can achieve it," Dr. Kishore M. Gadde, the lead study author, previously told Insider.

 

[MonkeyBoy]

Here in AZ. Just got diagnosed with COVID and got prescribed hcq + zpack. Will update you guys more. Currently on day 4 and just started medication today

Did you feel sick or just felt like getting tested?

 

[superbigd]

Did you feel sick or just felt like getting tested?

I actually feel 100% fine now just wanted to get tested. Maybe a small cough here and there

 

[MonkeyBoy]

I actually feel 100% fine now just wanted to get tested. Maybe a small cough here and there

Glad you are ok!!!!

 

[superbigd]

Thanks fam!

 

[maldorf]

HCQ had statistically significant benefit in study.

"Our results do differ from some other studies," Dr. Marcus Zervos, who heads the hospital's infectious diseases unit, said at a news conference. "What we think was important in ours ... is that patients were treated early. For hydroxychloroquine to have a benefit, it needs to begin before the patients begin to suffer some of the severe immune reactions that patients can have with COVID."

Hydroxychloroquine helped save coronavirus patients, study shows; Trump campaign hails 'fantastic news'

Researchers at the Henry Ford Health System in Southeast Michigan have found that early administration of the drug hydroxychloroquine makes hospitalized patients substantially less likely to die -- a finding that conservatives say validates President Trump's early statements on the drug, even as...

www.foxnews.com

Many news outlets probably won't report on this.

 

[Rex Feral]

HCQ had statistically significant benefit in study.

"Our results do differ from some other studies," Dr. Marcus Zervos, who heads the hospital's infectious diseases unit, said at a news conference. "What we think was important in ours ... is that patients were treated early. For hydroxychloroquine to have a benefit, it needs to begin before the patients begin to suffer some of the severe immune reactions that patients can have with COVID."

Hydroxychloroquine helped save coronavirus patients, study shows; Trump campaign hails 'fantastic news'

Researchers at the Henry Ford Health System in Southeast Michigan have found that early administration of the drug hydroxychloroquine makes hospitalized patients substantially less likely to die -- a finding that conservatives say validates President Trump's early statements on the drug, even as...

www.foxnews.com

Many news outlets probably won't report on this.

Not much has changed since we started this thread almost 4 months ago. In the first post, I explained that if this was going to work it had to be given early preferably with symptom onset or prophylaxis for high risk groups. We knew the risk of arrhythmias was not a concern with such a short treatment duration. Yet we had to endure months of complete bullshit about torsades de pointes and poorly designed studies initiating treatment with people on their literal death beds to finally arrive at what we already knew due purely to politics. How many people died unnecessarily because they had a physician with political bias who could not think for themselves?

The only real new development is the use of PEEP on ventilators because they were following an ARDSnet protocol when all they needed was oxygen. I didn't read back yet to see if this was covered. The very same people who withheld HCQ blindly followed a ventilator protocol that killed people. The very same media who created a mass hysteria about lack of vents also reported that there was no evidence of efficacy for HCQ. The vents that we were so hysterical about running out of, which never happened, killed thousands upon thousands of people. I think there is zero doubt that political affiliation largely played a role in determining patient treatment for the first time I've ever seen. If you were unlucky enough to have a doctor who withheld HCQ/Zpak/Zn and blindly followed an ARDSnet vent protocol then they basically killed you. PEEP = Positive end expiratory pressure. I became very familiar with vent settings in my years in ICU. The physicians who were creative with treatment, meaning HCQ/Zpak/Zn as early as possible, high O2 w/ low PEEP and proning, saved a lot of lives. Those that withheld HCQ/Zpak/Zn and blindly followed ARDSnet protocol killed a lot of people. It's really sad to see that an inability for independent thought and/or political bias cost people their lives and that is 100% true with zero doubts. It's just of matter of how many at this point.

The only thing I would add is to be very leary of any point of care antibody test. I have seen so many false positives on both FDA approved tests like ChemBio and unapproved FDA tests like Orient Gene as to render them completely useless. Some of the unapproved tests actually seem to be more accurate than the approved tests as we confirm by PCR swab and serum antibody (Ab). So, the point of care PCR swabs that use the Abbott machine seem to be quite accurate. False negatives are higher on serum PCRs, as high as 30%. When I say point of care (POC) that means a finger prick or a swab and you know the results by the time you leave. When I say serum that means a blood draw sent to a lab. So PCR serum has to be frozen immediately or very near and transported on dry ice otherwise the viral RNA degrades quickly. This is thought to be a major reason for the high % of false negs on serum PCR. A lot of offices and clinics simply don't transport on dry ice often enough to be compliant or are not used to freezing samples prior to transport. So if the swab is performed correctly then POC PCR is generally more accurate than serum PCR but should be near the same IF the sample is handled properly post draw. For Ab the only accurate test is the serum sent to Quest, LabCorp may do it as well I'm not sure I've only used Quest for this. I believe this test was developed at Mayo and is accurate for at least IgG though there a lot of questions for IgM. If someone told you that you were Ab pos on a POC test that's probably accurate 50% max at this point i.e. useless and you should have a blood draw if you really want to know. If you were sick and pos on PCR swab or serum it is probably right. If you were sick and had PCR serum neg you could be among the 30% and should also get a serum Ab test if you really want to confirm.

Rex.

 

[MyNameIsJeff]

I don't have a dog in this race since I haven't taken a position on HCQ thus far. Also, I'm a Trump supporter, hate the MSM, and believe that the early use of HCQ was justified given the anecdotal evidence and the great safety profile of HCQ.

But now that we have more evidence, it's time to reevaluate our assessment of HCQ, even if it turns out that in hind sight, we were wrong.

There's two types of studies, 1) observational studies and 2) randomized trials. The former are essentially useless, given the massive omitted variable bias arising from the fact that treatment is not allocated randomly, but correlates with (unobserved) patient characteristics and co-treatments, which both also influence disease outcomes. Consequently, there have been observational studies showing that HCQ does massive harm (hyped by the MSM), and also some showing HCQ to have massive benefits (hyped by right-wing media). The most recent study (**broken link removed**) mentioned by maldorf above is again an observational study with massive flaws.

So what are some of those issues?

First one is illustrated well by this quote from one of the authors:

"The combination of hydroxychloroquine plus azithromycin was reserved for selected patients with severe COVID-19 and with minimal cardiac risk factors," the team wrote.

Study finds hydroxychloroquine may have boosted survival, but other researchers have doubts

Hydroxychloroquine helped Covid-19 patients, a study in Detroit found.

edition.cnn.com

So to oversimplify a bit, you have 2 groups. A healthy group without cardiovascular risk factors, and an unhealthy group with cardiovascular risk factors. You only give HCQ to the healthy people and observe that their survival is higher than for the unhealthy group. But this outcome would have been the same if there had been no treatment at all! Sure, there are statistical techniques to try and control for the bias, but they are highly imperfect.

There are a couple of more issues. For example, the use of other medications was not constant across groups:

Finally, concomitant steroid use in patients receiving hydroxychloroquine was more than double the non-treated group. This is relevant considering the recent RECOVERY trial that showed a mortality benefit with dexamethasone.

**broken link removed**

Also, the time from hospitalization until HCQ was given did not significantly differ between this and other studies, so the difference in timing cannot actually explain the differing findings. The exclusion 10% of the sample due to those patients not being discharged yet could also skew results. The finding that azithromycin alone is even more effective than HCQ is also highly dubious, and further indicates that omitted variable bias is driving the results regarding HCQ. There was also no addition of zinc supplements which proponents of HCQ claimed to be crucial when they criticized earlier studies.

So all in all, it is a terrible, useless observational study, just like the ones that came before and showed opposite results. The only type of study one can rely on are randomized trials. And the one randomized trial we have seen did not show statistically significant effects of HCQ treatment. You can criticize that study for being underpowered and argue that it actually does provide some evidence for HCQs effectiveness. But to claim victory (see Rex Feral above) because one of the very flawed observational studies is in line with your priors is disingenuous at best.

 

[Rex Feral]

I don't have a dog in this race since I haven't taken a position on HCQ thus far. Also, I'm a Trump supporter, hate the MSM, and believe that the early use of HCQ was justified given the anecdotal evidence and the great safety profile of HCQ.

But now that we have more evidence, it's time to reevaluate our assessment of HCQ, even if it turns out that in hind sight, we were wrong.

There's two types of studies, 1) observational studies and 2) randomized trials. The former are essentially useless, given the massive omitted variable bias arising from the fact that treatment is not allocated randomly, but correlates with (unobserved) patient characteristics and co-treatments, which both also influence disease outcomes. Consequently, there have been observational studies showing that HCQ does massive harm (hyped by the MSM), and also some showing HCQ to have massive benefits (hyped by right-wing media). The most recent study (**broken link removed**) mentioned by maldorf above is again an observational study with massive flaws.

So what are some of those issues?

First one is illustrated well by this quote from one of the authors:

Study finds hydroxychloroquine may have boosted survival, but other researchers have doubts

Hydroxychloroquine helped Covid-19 patients, a study in Detroit found.

edition.cnn.com

So to oversimplify a bit, you have 2 groups. A healthy group without cardiovascular risk factors, and an unhealthy group with cardiovascular risk factors. You only give HCQ to the healthy people and observe that their survival is higher than for the unhealthy group. But this outcome would have been the same if there had been no treatment at all! Sure, there are statistical techniques to try and control for the bias, but they are highly imperfect.

There are a couple of more issues. For example, the use of other medications was not constant across groups:


**broken link removed**

Also, the time from hospitalization until HCQ was given did not significantly differ between this and other studies, so the difference in timing cannot actually explain the differing findings. The exclusion 10% of the sample due to those patients not being discharged yet could also skew results. The finding that azithromycin alone is even more effective than HCQ is also highly dubious, and further indicates that omitted variable bias is driving the results regarding HCQ. There was also no addition of zinc supplements which proponents of HCQ claimed to be crucial when they criticized earlier studies.

So all in all, it is a terrible, useless observational study, just like the ones that came before and showed opposite results. The only type of study one can rely on are randomized trials. And the one randomized trial we have seen did not show statistically significant effects of HCQ treatment. You can criticize that study for being underpowered and argue that it actually does provide some evidence for HCQs effectiveness. But to claim victory (see Rex Feral above) because one of the very flawed observational studies is in line with your priors is disingenuous at best.

Do you have any personal experience with treating Covid patients with HCQ/Zpak/Zn and observing the response? I won't get into the many fallacies you posted, honestly not worth my time. Pretty sure I already know the answer to my question.

Rex.

 

[MyNameIsJeff]

Do you have any personal experience with treating Covid patients with HCQ/Zpak/Zn and observing the response? I won't get into the many fallacies you posted, honestly not worth my time. Pretty sure I already know the answer to my question.

Rex.

Have you not payed attention in med school? The part where they told you that you cannot rely on anecdotal evidence when assessing treatments? Do you understand what a counterfactual is, and how you lack it in your clinical practice?