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Covid-19 Prophylaxis

Reload

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Rex,
This drug regimen appears to decrease viral load/RNA replication. If the individual infected with Covid-19 spends less time building antibodies while infected (5 days and done due to the medications), can one postulate that they are more likely to become reinfected due to a lack of antibody formation? I keep reading how those infected and recovered may become the bullet proof few that will be able to care for the newly infected w/o concern for PPE use. I question the validity of this, especially as Covid-19 mutates.
 

Rogue

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I know I used to almost always get sick getting off and going

How about extra virgin olive oil? Or whole olives.
A good olive oil is an essential , and if you can keep some sort of it in your diet, you will reap some of its MANY benefits.
However, if you are looking at natures wide spectrum ANTI-VIRAL ,OLE desrves a closer look at this is where oleuropein and hydroxytyrosol, that have antiviral, antibacterial, anti-inflammatory and antioxidant properties are found in highest concentrations.

Not suggesting it to a cure, but certainly amunition you can use in this battle.
Not medical advise.
 

Rex Feral

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Rex,
This drug regimen appears to decrease viral load/RNA replication. If the individual infected with Covid-19 spends less time building antibodies while infected (5 days and done due to the medications), can one postulate that they are more likely to become reinfected due to a lack of antibody formation? I keep reading how those infected and recovered may become the bullet proof few that will be able to care for the newly infected w/o concern for PPE use. I question the validity of this, especially as Covid-19 mutates.
Yes, generally the sicker you become the more robust and long lasting the immune response. But we simply don't know for certain about this virus. We really don't know much about reinfection with coronaviruses in general. This is one hypothesis as to why we can continually be reinfected with the 4 coronaviruses that cause the common cold despite the fact that we all have antibodies. It simply doesn't make us sick enough to illicit a robust enough immune response to protect us from reinfection. Or could be the antibodies are not particularly useful in preventing reinfection. The common cold coronaviruses look almost exactly the same as they did 30 years ago, they have not mutated significantly unlike the flu. MERS and SARS we know very little about reinfection.

You can't change PPE use that's just crazy. Some estimates now place those without symptoms as high as 60%. You can't test these people every day. You could be reinfected and not know it, spreading disease to patients. Also you could receive of huge "dose" of the virus with no PPE which could be enough to overwhelm whatever defenses you may have. N95 masks are no better at preventing infection than surgical masks as we see with the flu. Only people performing procedures that cause aerosolization, like intubation, need N95. While you have complete fucking morons like Rich Gaspari walking around the grocery store with an N95 mask, posting pictures on IG of him wearing it upside down. The complete fools stole all the masks and hoarded the same way the same complete fools hoarded all the toilet paper. Now people are locking them up so the people who actually need them for procedures may actually have what they need. Back on topic, general consensus is that infection should confer protection from reinfection for a period of time. The sicker you become the longer this period should be. But no one knows for certain.

Rex.
 

Rex Feral

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Copy and paste from my email..........

An online meeting was held last evening with Dr. Wen Hong Zhang discussing the China experience with COVID-19.

There were ~7000 attendees, mostly from the United States.

The following are notes provided to me (I was not on the call):

-Predicted number of cases in Shanghai with exponential growth was calculated to be nearly one million by March 1, but social distancing avoided this.

-Cases went down to zero or near zero by late-Feb, and there is now a small second wave from imported cases.

-Key to mitigating spread in Shanghai was doing diagnostic COVID test on every suspected case.

-All patients with positive COVID PCR were admitted to a designated COVID hospital regardless of their level of illness.

-Coinfection was very common with other respiratory bacteria and common cold viruses, and >50% patients were positive for a co-infection with a respiratory organism.

-False negative rate of COVID PCR even with two serial swabs was 10-30%! Next Generation Sequencing for COVID was used as the gold standard.

-RSV, Mycoplasma and Parainfluenza virus also caused similar bilateral CT findings to COVID. Molecular diagnostics was needed, and even two negative PCRs, for suspected cases on CT - they sent Next Gen Sequencing, a PCR to National Lab, a 3rd local PCR, and local PCR in another swab location (e.g. anal) (e.g. sent all 4) before they would r/o COVID.

-Mean incubation was 6.4 days, and patients were quarantined mean 5.5 days from symptom onset, with this approach the "curve" was 1 month in duration.

-Hydroxychloroquine is in a multicenter RCT in China and will be published "very soon".

-LDH and D-Dimer was associated with development of ARDS.

-He felt there is a narrow window between positive CT findings and deterioration to ARDS, where corticosteroids have been helpful and further studies are required to investigate this.

-Approximately 5% of patients will need ICU level care, and mortality depends on availability of ICU.

-How to protect medical personnel - China protocol:

1) Standardized process in terms of patient care areas and flow.

2) PPE - double-layer gloves, double-layer shoe covers, isolation gown, masks, goggles, etc. "The most important is to cover the head"

3) Positive pressure masks - for aerosol generating procedures.



Q&A:

-Time window until infection and test positive? 3d by PCR, and 7d by Serological.

-Who did you test? They abandoned risk factor criteria quickly and just tested anyone with symptoms.

-What is the best test? PCR is better than Antibody test for sensitivity. But the Antibody test is helpful, as PCR can have false negative by week 3. Antibody test is helpful to see the overall population prevalence in terms of patients with mild or no symptoms.

-Does viral RNA degradation of samples happen? Tests are done within 4 hours in China, or frozen at -20C otherwise there is increased false negative.

-What is risk for pregnant women? These cases were mild, and no severe/intubated cases were seen so far in Shanghai (no Wuhan data presented).

-What is the underlying medical conditions that are high risk? Heart disease do the worst - the virus causes myocarditis as well.

-What percentage of patients have antibodies? Every recovered patient tested have found to have antibodies on testing but it is unclear if these are actually protective.

-What is the dosage for hydroxychloroquine? 400mg bid x1d, 400mg po qd. They did not treat with azithromycin due to hepatotoxicity observed.

-What is the risk to health care workers? There were none of his colleagues who went to Wuhan to help that became infected with COVID, and this is attributed to PPE.

-What is the outcome of COVID survivors? Lung fibrosis is definitely less than SARS and most patients had a good long-term outcome.

Rex.
 

Reload

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-What percentage of patients have antibodies? Every recovered patient tested have found to have antibodies on testing but it is unclear if these are actually protective.
Thank you for the info Rex. The above leads me to believe there will be a Covid-20, 21, 22...just like influenza moving forward.
 

muscle96ss

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Thank you for the info Rex. The above leads me to believe there will be a Covid-20, 21, 22...just like influenza moving forward.
Time will tell, but there were some doctors commenting on this on tv 2 days ago and they were saying that they haven't seen much mutation yet and theorized that based on its structure they aren't sure that it will mutate much. I didn't quite understand the medical explanation. Perhaps others with a better understanding could explain this issue further and what to expect.
 
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maldorf

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Copy and paste from my email..........

An online meeting was held last evening with Dr. Wen Hong Zhang discussing the China experience with COVID-19.

There were ~7000 attendees, mostly from the United States.

The following are notes provided to me (I was not on the call):

-Predicted number of cases in Shanghai with exponential growth was calculated to be nearly one million by March 1, but social distancing avoided this.

-Cases went down to zero or near zero by late-Feb, and there is now a small second wave from imported cases.

-Key to mitigating spread in Shanghai was doing diagnostic COVID test on every suspected case.

-All patients with positive COVID PCR were admitted to a designated COVID hospital regardless of their level of illness.

-Coinfection was very common with other respiratory bacteria and common cold viruses, and >50% patients were positive for a co-infection with a respiratory organism.

-False negative rate of COVID PCR even with two serial swabs was 10-30%! Next Generation Sequencing for COVID was used as the gold standard.

-RSV, Mycoplasma and Parainfluenza virus also caused similar bilateral CT findings to COVID. Molecular diagnostics was needed, and even two negative PCRs, for suspected cases on CT - they sent Next Gen Sequencing, a PCR to National Lab, a 3rd local PCR, and local PCR in another swab location (e.g. anal) (e.g. sent all 4) before they would r/o COVID.

-Mean incubation was 6.4 days, and patients were quarantined mean 5.5 days from symptom onset, with this approach the "curve" was 1 month in duration.

-Hydroxychloroquine is in a multicenter RCT in China and will be published "very soon".

-LDH and D-Dimer was associated with development of ARDS.

-He felt there is a narrow window between positive CT findings and deterioration to ARDS, where corticosteroids have been helpful and further studies are required to investigate this.

-Approximately 5% of patients will need ICU level care, and mortality depends on availability of ICU.

-How to protect medical personnel - China protocol:

1) Standardized process in terms of patient care areas and flow.

2) PPE - double-layer gloves, double-layer shoe covers, isolation gown, masks, goggles, etc. "The most important is to cover the head"

3) Positive pressure masks - for aerosol generating procedures.



Q&A:

-Time window until infection and test positive? 3d by PCR, and 7d by Serological.

-Who did you test? They abandoned risk factor criteria quickly and just tested anyone with symptoms.

-What is the best test? PCR is better than Antibody test for sensitivity. But the Antibody test is helpful, as PCR can have false negative by week 3. Antibody test is helpful to see the overall population prevalence in terms of patients with mild or no symptoms.

-Does viral RNA degradation of samples happen? Tests are done within 4 hours in China, or frozen at -20C otherwise there is increased false negative.

-What is risk for pregnant women? These cases were mild, and no severe/intubated cases were seen so far in Shanghai (no Wuhan data presented).

-What is the underlying medical conditions that are high risk? Heart disease do the worst - the virus causes myocarditis as well.

-What percentage of patients have antibodies? Every recovered patient tested have found to have antibodies on testing but it is unclear if these are actually protective.

-What is the dosage for hydroxychloroquine? 400mg bid x1d, 400mg po qd. They did not treat with azithromycin due to hepatotoxicity observed.

-What is the risk to health care workers? There were none of his colleagues who went to Wuhan to help that became infected with COVID, and this is attributed to PPE.

-What is the outcome of COVID survivors? Lung fibrosis is definitely less than SARS and most patients had a good long-term outcome.

Rex.

My greatest fear "-What is the underlying medical conditions that are high risk? Heart disease do the worst - the virus causes myocarditis as well." I was afraid of that. Ive got asthma too.
 

Cinder

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Dosages for PEP (post exposure) for HIV aren't higher than PrEP (prevention) dosages for HIV.
They just give you Truvada at the same dosage as PrEP and and in another HIV drug called esentrace or something (don't remember spelling)
 

Rex Feral

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Dosages for PEP (post exposure) for HIV aren't higher than PrEP (prevention) dosages for HIV.
They just give you Truvada at the same dosage as PrEP and and in another HIV drug called esentrace or something (don't remember spelling)
They add a drug = higher anti-viral dose.

Rex.
 

Rex Feral

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Dosages for PEP (post exposure) for HIV aren't higher than PrEP (prevention) dosages for HIV.
They just give you Truvada at the same dosage as PrEP and and in another HIV drug called esentrace or something (don't remember spelling)
Nomenclature explanation. TRUVADA for PrEP® is a trademark of Gilead. It means pre-exposure prophylaxis to HIV. I'm assuming they chose the small "r" for the reasons you state, to highlight that is for prevention aka prophylaxis. Now PrEP means you are on Truvada or Descovy. Until last year when Descovy was approved it meant only TRUVADA for PrEP® This term is probably what, 10 years old or less. Whenever Truvada was approved for pre-exposure prophylaxis. Many decades before that we had pre-exposure prophylaxis for other indications like malaria and influenza. We abbreviated it PREP or PreP to highlight that it was pre-exposure. Given that PREP and PReP were already commonly used medical abbreviations I imagine there may have been some problems trademarking them but I'm not a patent attorney so I don't really know but generally, it is hard to patent terms commonly in use. So they chose PrEP. So now if you say PREP or PReP it means pre-exposure prophylaxis for any pathogen other than HIV. If you say PrEP it means pre-exposure prophylaxis to HIV as this term or abbreviation was not in use prior to Gilead patenting. But younger people and clinicians often only know pre-exposure prophylaxis because of HIV or PrEP. So now the terms are generally interchangeable as they all mean pre-exposure prophylaxis. But to speak of PrEP when discussing Covid-19 prophylaxis would be technically incorrect. If I mentioned HIV in passing and used the term PReP, well only someone trying to be a smartass would not understand what I mean. Also if I say the dose is higher for PEP - notice there is no patent for that as these are treatment doses - only someone trying to be a smartass would try to argue that adding another anti-viral medication is not an increase in dose. How many people here understand that when you add Anadrol to your cycle of T and Deca that you are increasing your dose? Everyone, smartass.

Rex.
 

muscle96ss

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A NY Doctor shared his Hydroxy Chloroquine/Azithromycin results.
200mg 2x daily Hydroxy Chloroquine
500mg 1x daily Azithromycin
220mg 1x daily Zinc sulfate

350 patients
• Breathing restored 3-4 hours
• Zero deaths
• Zero hospitalizations
• Zero intubations https://t.co/b2ZGqd4jF7
( )
How late into having the virus can this be administered and still be effective. In other words, once it gets to the point where you are hospitalized, will this be this still be effective(assuming that the treatment actually works as the medical community is theorizing)? And if it does work once the symptoms have gotten out of hand; why aren't they using it more in NY for the serious patients. It would seem like they could possibly avoid the need of so many ventilators and many deaths if they were more proactive in using this protocol.
 

Chipper Jones78

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How late into having the virus can this be administered and still be effective. In other words, once it gets to the point where you are hospitalized, will this be this still be effective(assuming that the treatment actually works as the medical community is theorizing)? And if it does work once the symptoms have gotten out of hand; why aren't they using it more in NY for the serious patients. It would seem like they could possibly avoid the need of so many ventilators and many deaths if they were more proactive in using this protocol.
BUMP for the clever mind's to answer please.

Great questions muscle96

Stupid ? I'd assume this protocol of meds is not recommded if your not showing any symptoms?
 

Rex Feral

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How late into having the virus can this be administered and still be effective. In other words, once it gets to the point where you are hospitalized, will this be this still be effective(assuming that the treatment actually works as the medical community is theorizing)? And if it does work once the symptoms have gotten out of hand; why aren't they using it more in NY for the serious patients. It would seem like they could possibly avoid the need of so many ventilators and many deaths if they were more proactive in using this protocol.
This is an excellent point, 100% accurate and precisely why I posted this thread. You could count on one hand the number of threads I've started in the last 16 years or whatever. I had no evidence when I posted this last week to initiate therapy within 24-48h. As Rouge posted, they were mostly waiting until a person was in ICU to initiate therapy with mixed results. I tried to explain my rationale for this. Based on the history of how drugs work on viruses for pre-exposure prophylaxis and post-exposure prophylaxis. Then you saw Dr. Zelenko post his data/experience with treating as soon as symptoms arise. I'll post some other opinions from healthcare professionals on threads I am involved with just so that people see I am not the only one thinking this way. You've been able to extrapolate what many physicians still cannot. If you read some these articles, almost none of them take into account initiation of therapy vs symptom onset. I said last week that the reason for the mixed results was initiation of therapy vs symptom onset. Which basically means you should have it on hand for maximal efficacy. I could still be wrong but the advice does no harm and it's looking like I'm right more every day. I have a lot of experience in virology as well. I actually personally started the IV and administered the first drug for treatment of HIV in the US 2 1/2 years ago in a Phase I trial. I also ran a site for the largest PrEP trial ever in the US with over 400 patients. My point is, I don't just pull this shit out of my ass and it's really just common sense if you observe.

Dr. Tracey Lewis| Ophthalmology2 days ago

"I agree that evidence based medicine is what we need to work with and we must statistically analyze the data exactly how you recommend for truly meaningful results. One aspect I see being overlooked are some nationwide retrospective studies that could be performed right now by epidemiologists on data coming in from small community physicians who have been treating COVID19 early as outpatients with off label HCQ/Zithromax/zinc for the past few weeks. For example, there is a cohort from a primary care doc in an Hasidic Jewish community in NY (his patients refuse to obey social distancing) who is treating all his COVID19 positive patients with HCQ/Zithromax/zinc early (even with mild symptoms-no respiratory distress) and sending them home. He reports over 350 patients positive and zero hospitalizations. He has a large population of elderly. I don’t know if his data is real. I would love to see it analyzed.
Is there any reason why we can’t add retrospective studies now regarding timing of dosing and gather some data from what’s been done already in these small but plentiful cohorts? My reasoning- it appears the COVID19 virus (when severe) progresses in two phases. First is acute symptoms - fever, cough, chills, malaise. Then days (maybe a week) later - respiratory distress - progressing to ARDS - hospitalization, possible intubation/ventilation. Is the virus first infecting the oral/nasopharynx and then progressing to the lungs?

HCQ/Zithromax/zinc combo seems to have two mechanisms of action. 1)Prevents viral binding/replication in pulmonary tissue (via receptor blockade and endosomal acidification) and 2) interrupts cytokine storm during acute respiratory distress syndrome (ARDS). Could we be waiting too long after the COVID19 already has infected the lungs and caused pulmonary compromise? Currently the new studies in NY seem only to be looking at dosing patients when hospitalization occurs. By then, are we hitting only one arm of the drugs efficacy? The anti-inflammatory part? Could we decrease hospitalizations substantially if we treated earlier to prevent progressive pulmonary infection? We could use the drug combo early in all positive patients at high risk and send patients home (on holter monitoring to watch QT interval prolongation if necessary) of the retrospective data gathered now appears promising statistically.
We need these studies and it wouldn’t be too hard to gather them."

Dr. Jason Maude| Emergency Medicine

"I understand from the recent experience at hospitals in Paris that now give hydroxychloroquine routinely, is that it doesn't work when given in the late stages of the disease progression - I assume the other organs have started to deteriorate - but it does work extremely well when given in the early stages. In fact, they report a threefold increase in patient throughput with stories of severely ill elderly patients actually recovering in a few days. If we look at the study you cite with the knowledge that the drug is very unlikely to work in those patients who need to go to ICU, how would the numbers look then?
At this stage, there seems to be enough from the various studies, the fact that Belgium and France are now recommending the drug for treatment and that the clinicians there all want to take for preventative purposes, the fact that the Indian Medical Research Council recommends it for preventative use and finally a growing body of anecdotal evidence that it works, to administer it to patients early on.
There has been a lot of criticism of the studies but even the authors would probably not describe them as robust but simply done to help their colleagues around the world learn as soon as possible what appears to be working. This really is the time to listen and learn from others about what works and not wait for the perfect RCT."

Rex.
 

Rex Feral

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BUMP for the clever mind's to answer please.

Great questions muscle96

Stupid ? I'd assume this protocol of meds is not recommded if your not showing any symptoms?
The title of the thread is prophylaxis and includes the protocol for prophylaxis in the first post.

Rex.
 

Knight9

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Hey buddy..it's been a while and I hope you are well. This pandemic has me somewhere in the area of relatively calm and full out freaking out and everywhere in between. Partly for myself and friends but more so to my folks who are in their 70s and I see often. I went to honeybee and they are not allowing the sale of HCQ due to the national emergency unless you had a script or can prove you have a pre existing condition. I'm looking elsewhere.

Z-pak shouldnt be hard to come by.

My other question is if one is to take 220mg zinc sulfate daily...and I have zinc picolinate on hand, what dose of Zinc picolinate would be appropriate to equate to the 220mg sulfate dose?

It's great to see a sponsor offering up zpak and HCQ but forgive me for being weary of the quality control and contents of the black market even though its touted as pharm grade. In a situation like this, it's just a lot tougher to take that kind of gamble.

Thanks for your time Rex and thanks for the great info you are sharing with us.

Simply because that's what's available as a prescription for zinc deficiency. Brand name is Orazinc 220. Basically it's been around forever. It's just not worth it to big pharma to put a bunch of different zinc salts on the market. There is no picolinate Rx and he's not going to send people out to buy a nutritional supplement OTC. I believe his only better choice is Galzin, zinc acetate. But Galzin is an approved med for Wilson's disease, not typically used for regular zinc deficiency, and is therefore probably not particularly common in pharmacies. Whereas zinc sulfate is cheap and ubiquitous.

Rex.
 

Reload

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I may be able to help you with your zinc question Knight9. I started looking for zinc sulfate online and everyone was sold out which got me questioning why zinc sulfate 220mg to begin with? That lead to many articles on the different types of zinc and their absorption abilities. I believe what's important is the total mg's of "elemental zinc" in these different zinc supplements to this drug regimen. They all have variable percentages. Zinc sulfate is about 23% so has about 50mg of elemental zinc in each 220mg tab.

*In my reading it appears that zinc picolinate has the best absorption of all the different types of zinc and releases approximately 20% elemental zinc. Zinc picolinate typically comes in 50mg capsules/tabs so each tab theoretically releases 10mg of elemental zinc. So one can infer that to get the 50mg of elemental zinc you would have to take 5 tablets/capsules of zinc picolinate daily to equal the elemental zinc in 220mg of zinc sulfate.
 

Knight9

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I may be able to help you with your zinc question Knight9. I started looking for zinc sulfate online and everyone was sold out which got me questioning why zinc sulfate 220mg to begin with? That lead to many articles on the different types of zinc and their absorption abilities. I believe what's important is the total mg's of "elemental zinc" in these different zinc supplements to this drug regimen. They all have variable percentages. Zinc sulfate is about 23% so has about 50mg of elemental zinc in each 220mg tab.

*In my reading it appears that zinc picolinate has the best absorption of all the different types of zinc and releases approximately 20% elemental zinc. Zinc picolinate typically comes in 50mg capsules/tabs so each tab theoretically releases 10mg of elemental zinc. So one can infer that to get the 50mg of elemental zinc you would have to take 5 tablets/capsules of zinc picolinate daily to equal the elemental zinc in 220mg of zinc sulfate.
Thx..so 250mg zinc picolinate? That seems high and potentially toxic and will throw copper levels off soon enough. Rex or anyone else?
 

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IMO Chris Masterjohn, PhD is in the top-tier of intelligent minds when it comes to nutritional sciences. Maybe I'm being partial due to he taught nutritional sciences at my alma mater, UofI.





"1:42:25 Supplementation of zinc (What form? Citrate, acetate, gluconate, picolinate, oxide? What dose? When to take it?)"
 

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