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.