Bronco Forum - Full Size Ford Bronco Forum banner

641 - 646 of 646 Posts

·
Premium Member
Joined
·
468 Posts
Doctors reply to the recent observational, ahem, study, on Medscape.

Dr. Beatrice Aime Celian| General Practice1 hour ago

Since the beginning everytime I prayed about COVID-19, God made me understood the treatment is something simple, I thought of aspirin, but rejected it because they were saying aspirin and NSAID should be avoided.
Based on newest discovery about the COVID-19, intravascular coagulation, activation of the inflamatory system, a simple treatment with our old drug ASPIRIN should be effective to treat COVID-19
It is antiifllammatory, anticoagulant and antipyretic. Are they conducting any study on Aspirin ?

Flag
LikeReply


Dr. Beatrice Aime Celian| General Practice1 hour ago

Millions of people are taking hydroxychloroquine for RA and Lupus or chloroquine for prevention or treatment of malaria worldwide. If chloroquine is so dangerous why there is not report of fatalities which would lead to stop using it? Or is the association with COVID-19 that increases the risks?
I have no disclosure.

Flag
1LikeReply

Bill Rhoades| Other Healthcare Provider1 day ago

Friday morning April 24th, US COVID fatalities crossed the 50K mark. Later that same day, the FDA essentially banned outpatient prescribing of HCQ for early stage disease, apparently based largely on results of a retrospective study on critically ill ICU patients at a VA hospital.
Interestingly, their ruling still allows for HCQ use in critically ill ICU patients that appear to be harmed by this therapy, while forbidden in healthier early stage patients, where HCQ has a remarkably benign safety record & initially promising results as a therapeutic.
We’re now 30 days past this curious ruling and US fatalities are approaching 100K, still without a single outpatient therapeutic available to doctors or patients. If the fullness of time shows early/outpatient HCQ was in fact the “Best Medicine” we’ll have in 2020, I can’t help but wonder if there is any recourse that might apply for what would essentially be the greatest medical blunder of all time.
We live in interesting times!


Dr. Richard Free| General Practice9 hours ago

An interesting age related element in the pathophysiologic puzzle of COVID19 that could be complicating elders and nursing home residents is adiponectin and IL-18 (interleukin). These have both been identified as accurate biomarkers for underlying Metabolic Syndrome (IL-18 better than adiponectin) and are both associated with complications in elder influenza infections.

There is a consistent over representation of comorbid obesity, presumed visceral obesity, hypertension, diabetes, abnormal glucose in complicated COVID 19. These are ALL elements of Syndrome X or Metabolic Syndrome and suggest both COVID19 and seasonal Influenza may have manageable “host factor” targets like adiponectin and IL-18. Further, these complications of influenza are in vaccinated individuals and suggest poor immune responses in elders may not be the only explanation.

Hypertension, obesity, insulin resistance can also be biomarkers for aging as well. Interestingly, several countries including US, Italy, and China, do not identify COPD as a very prevalent comorbidity along with current smoking. If anything current smoking and COPD are “under represented” compared to the community levels of smoking and COPD and contrast with the “over represented” metabolic syndrome profile, and presumed adiponectin/IL-18 signaling pathways.

Flag
3LikeReply


Maurice Baker| Other Healthcare Provider15 hours ago

It seems there is considerable discussion of many good candidate study details in a flawed study which somehow ignores the basic critical necessary central contribution that zinc plays in the use of this ionophore to treat Covid-19.
Flag
5LikeReply

Dr. Olga Goodman| Rheumatology19 hours ago

A lot of people just reading provocative headline and titles but not looking for raw data.
"Controls" has 7.7% mechanically ventilated but CQ/ HCQ arm ~23%.

Till middle April, mortality rate for ventilated patients was close to 80-90%.

Flag
10LikeReply

Dr. Italo Santos| Cardiology, General14 hours ago
@Dr. Olga Goodman - the study report the Mechanical Ventilation as an outcome. But they did not report the time from treatment onset to mechanical ventilation. Maybe a lot of patientes, specially in december/january, was in an invasive ventilatory support when started the drug.

Flag
2LikeReply


David Dewar| Other Healthcare Provider20 hours ago

At this point it would take too long to run an RCT. Which needs to happen long term. However, we can’t discount the anecdotal experience of all the front line providers in Europe that have found some benefit from HCQ. Covid19 and HCQ will both take lives.
Flag
4LikeReply


Dr. Nicholas Bachynsky| Internal Medicine22 hours ago



Some common sense thinking: If OHchloroquine was truly effective we would certainly know by now. Novartis is actually doing a 3 arm, double blind study that should put this issue to rest once and for all.
On safety, there is no equivocation in my mind. Enough independent studies have shown that OHchloroquine does promote cardiac arrhythmias (starting w/ Q-T prolongation). Covid-19 itself has been shown to cause myocarditis and arrhythmic problems, increased mortality, The combination of both could either be additive or synergistic.
Why put your patients life at the risk after looking at actual odds ratio (relative risk) analysis to date?
BTW, safety of a drug for one condition/disease (malaria) does not equate for safety with Covid-19 (e.g., thalidomide for Leprosy, multiple myeloma is disastrous (malpractice) for insomnia in pregnant women).

Flag
2LikeReply


Robert Granett| Pharmacist19 hours ago


@Dr. Nicholas Bachynsky It's always benefit versus risk. Currently we do not have a truly definitive best practice answer for either. Dosing has not been standardized and adequately tested. Most trials are over dosing their patients. Additionally, most trials do not have combination zinc with HCQ. The only one I have seen is retrospective and single center out of NYU. Place in therapy should be early or as a prophylactic option and in combination with zinc. Respectfully disagree. Will see about the randomized prospective studies as Henry Ford should have data in the next 2 months. God Bless.
Flag
11LikeReply


Dr. Jimmy Chang| Family Medicine16 hours ago



@Dr. Nicholas Bachynsky That is the benefit of starting HCQ treatment early, and settle the disease, before it progresses and hurts the heart.
HCQ + Zinc should be started early, upon diagnosis, on the high-risk groups.
If Novartis only recruits patients in the advanced stage of COVID-19, then it adds the knowledge to the use of HCQ monotherapy in hospitalised ill patients only. The study still does not answer the effectivenss in early stage of the disease, especially in out-patient stage, and also as prophylactic treatment.

Flag
8LikeReply


Dr. Italo Santos| Cardiology, General13 hours ago


@Dr. Nicholas Bachynsky good question. In fact we don't have the truth about this. But I think all physicin around the world have seen a lot of patients treated with HxCQN during this pandemia - and almost all of them did not have arrythmia (sudden arryhtmic death). We have reports (Mathieu Million et al) about HxCQN safety in the COVID-19 scenario. But, your reasoning proceeds. Just as we have no final answer on the lack of effectiveness, we have no definete answer on safety. So, it will be based on physician judgment.
Flag
6LikeReply


Dr. Howard Gershon| Family Medicine23 hours ago



In my opinion this study published in Lancet was inferior to the Observational Study recently published in the NEJM -
Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19; May 7, 2020
DOI: 10.1056/NEJMoa2012410. At least the NEJM study controlled for differences in the inflammatory markers which included ferritin and CRP. As you would expect the cohort of patients who received HCQ treatment were more ill and had more elevated levels of ferritin and CRP and even after attempting to control for these differences the ferritin level in the treatment group was still more elevated than the statistically adjusted control group. Unfortunately the NEJM study didn’t resolve the debate as it showed no difference in outcome as measured by progression to ventilator or death for the HCQ treatment group compared to the control group. However, these observational studies don’t really help us to understand whether in vivo HCQ can inhibit the ability of the virus to infect cells and to replicate. If it doesn’t then its treatment value would be limited because there are other more targeted anti-inflammatory therapies, like the IL-6 antagonist tocilizumab, to suppress a hyperactive immune system and a cytokine storm.

Flag
4LikeReply

Bill Rhoades| Other Healthcare Provider22 hours ago



@Dr. Howard Gershon
If we consider the theoretical benefit of HCQ as similar to the Tamiflu model (inhibiting exponential viral replication early in the disease process) it is easy to see where most all of the HCQ trials fail to show a good result.
80% of COVID patients resolve their disease without any treatment at all, so to avoid this confounding factor clinical trials are limited to those who are already progressing beyond early stage disease.
By the time one gets enrolled in a trial & treatment is initiated, these patients may be well past the point of benefit from the med. It will be interesting to see how the few outpatient & prophylaxis trials now underway pan out. In malaria country, the standard of care is prophylaxis & early treatment. It may be if we wish to keep another 100K fatalities from accumulating over the next few months, the malaria model (HCQ for everyone in areas of high risk) may be our only way out. This may sound extreme, but in malaria country the population has adopted to this quite well. You either treat and live, or deal with the casualties.

Flag
9LikeReply

Dr. James Calero| Cardiology, General22 hours ago


@BILL Rhoades @Dr. Howard Gershon It would seem appropriate to use HCQ prophylactically as opposed to using this medication on intubated patients who perhaps may not benefit from this drug.
Flag
9LikeReply


Robert Granett| Pharmacist19 hours ago


@BILL Rhoades @Dr. Howard Gershon India just authorized and is supporting use as prophylaxis in high risk front line workers. Additionally, Henry Ford Hospital in Michigan is completing a 3,000 person prospective study to be completed in the next 2-3 months.
Flag
7LikeReply


Dr. jose figueroa| Oncology, Medical1 day ago



Nothing wrong with this study, except that it goes against the preconceived opinions some persons had of the effectiveness of this combination in treating covid-19. I would recommend those that continue believing in this therapy to place their patients in the ongoing studies for prophylaxis and treatment of covid-19: with these medications. The plural of anecdotal observation is not evidence.

Do the science and be ready to accept the results even if they go against our preconceived Opinions. That’s how medicine is done.

Flag
4LikeReply

Robert Granett| Pharmacist19 hours ago


@Dr. jose figueroa Most know that HCQ is not effective as a salvage therapy agent. It should be given as early as possible or as prophylaxis and ideally with zinc.
Flag
6LikeReply


Dr. Jimmy Chang| Family Medicine16 hours ago



@Dr. jose figueroa 9/5000 vs 0/5000 prophylactically, and 0/200 prophylactically, does this sound good to explore further?
I presumed 'preconceived' means 'believe blindly', vs those who are blind to see the success stories outside USA because of the failure.

Flag
4LikeReply


Alice Perry| Other Healthcare Provider1 day ago



The information in your article is rather obsolete. Hydroxychloroquine is noted better for a prophylaxis and early in the disease.
I also read your lengthy article regarding the difference in San Francisco and New York and the handling of preparation for the pandemic-San Francisco the better example. But one thing to note is that San Francisco has the highest percentage of the LGTBQ community. Many of those individuals are most likely on a prophylaxis viral medication for HIV. It seems prudent to study that population as to how many if any have been infected. Perhaps that has something to do with the lower infection rate. Maybe an antiviral, particularly for those most at risk, is the way go to combat this disease.

Flag
7LikeReply

Dr. jose figueroa| Oncology, Medical1 day ago


@Alice Perry Do the study and publish it.
Flag
4LikeReply


Dr. William E. Thomas| Surgery, General1 day ago


Medscape, did you not print my statement about that Lancet article because of what reason? There was no bad words in it (I made a professional statement but I guess the truth hurts) but I guess it had too much truth in it. Is that it????
Flag
7LikeReply


j bartlett| Other Healthcare Provider1 day ago



Dr. Seheult over at MedCram goes into extraordinary depth on the mechanism of HDCQ as a zinc ionophore and the effect of zinc on Replicase dependent RNA as well as things like Remdesivir.

Dispassionate examination of things in an academic, teaching style...which in addition to being an ICU respiratory guy, he is.

You can find on U-tube, but they're starting to censor. You can, however, sign up on the main MedCram site for FREE and have access to the entire covid collection and a forum. He was WAY out in front on this going back into January.

Episodes of importance: 11, 34, 32, 71.

Flag
9LikeReply


Dr. William E. Thomas| Surgery, General1 day ago



MEDSCAPE, how can you allow such an article be printed in “MEDSCAPE” about the effects of Hydroxychloroquine not being effective in treatment of Covid-19 when many studies have shown that it is effective. This article from Lancet has already been shown nationally to be politically twisted toward the “left’s” political agenda. This study says 100000 patients but is from a collection that was worldwide and no controlled studies such as the symptoms, stage of the disease when treated and dose of the drug.
I am a Vietnam Veteran MD who was one of millions of GI’s who received Chloroquine for Malaria prophylaxis and no studies were ever published that I know of about deaths caused by this Chloroquine and I’m sure if there had been deaths associated with this drug then everyone would have known about it. So I think that THAT STUPID ARTICLE about deaths caused by that hydroxychloroquine drug is ridiculous!
Medscape I thought was a legitimate source of medical information but now I’m thinking about deleting my App of Medscape.
Wm. THOMAS MD

Flag
17LikeReply


Marirene Salazar| Physician Assistant1 day ago


Medscape has lost all credibility in pieces like this in my opinion
Flag
13LikeReply


Dr. Stanley Harrison| Orthopaedic Surgery1 day ago



I m not an infectious disease specialist but it seems to me that first we said HCQ has not been evaluated with RCTs but now we accept an Observational study saying that it doesn’t work and causes complications
Furthermore the problem with Covid is that the severe cases leading to ventilator dependence and death are caused by the immune systems response to the virus. What does HCQ do, stop inflammation. The severe immune response and breakdown of the membrane responsible for O2 exchange leads to rapid deterioration and death.
So it seems to me that the anecdotal reports of rapid recovery after administration of HCQ tap into this anti inflammatory (immune system modulation) and THAT IS WHAT NEEDS TO BE STUDIED on the micro level
And RCT on the macro level.
Paying attention to viral load, clinical symptoms, at the time of
administration .
So the jury is still out

Flag
7LikeReply


Dr. Howard Gershon| Family Medicine1 day ago


The one thing I find missing in all of these recent HCQ studies is the measurement of viral load through time. Isn’t that what we are trying to assess? Shouldn’t the viral load for each patient have been measured before HCQ administration and measured through time to see if there is a difference between the treatment groups and the control groups. Outcomes like progression to ventilator or death can be caused by lots of confounding factors and these studies do try to account for the cohort differences using statistical methods. But the one variable not available to assess the differences in the patients at time of admission and the time to outcome is the viral load. So we still don’t know whether HCQ offers any benefit to reduce viral load in a statistically significant manner in comparison to a control group. If HCQ turns out to be reducing viral load compared to control then we need to better understand why these patients are progressing to ventilator or dying.
Flag
10LikeReply


Dr. Claudio Melloni| Anesthesiology1 day ago


THe italian experience(personal comments from many collegues working inside the public Hospitals and outside(MMGs) and up to now totalizing hundreds of thousand patients ,may be one million already,is that Hydroxicloroquine +LMWH (often at high doses,4000 *2))+azythromycin,vitamins and essential elements, administered as soon the first symptoms appear constitute the standard of cure.Hcq not useful in patients presenting late in the disease course,with pneumonia,sepsis,etc.As a matter of fact since the inception of the abovementioned regimen(+ lockdown,DPIs,social distancig) ICUs beds are now free, COVID hospitals closing,recoveries in the hundreds of thousands,quarantine stopped and life and work starting again as usual with attention to DPI,social distancing .Keeping our fingers crossed....CM.
Flag
16LikeReply

j bartlett| Other Healthcare Provider1 day ago


@Dr. Claudio Melloni Eastern Medical College of VA was evidently paying attention to the Italian experience.

https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf
Flag
4LikeReply


Dr. Michele Murburg| Psychiatry/Mental Health1 day ago



I agree with the comments pointing out the selection bias in the cited study and others, in which high doses of a QT prolonging drug with an extraordinarily long half life (in some cases along with a second QT prolonging drug) were seemingly administered too late in the course of CoVID-19, apparently without co-administration of zinc, which Hydroxychloroquine's putative zinc ionophore mechanism of action requires. (One would not expect Hydroychloroquine to work well or at all in zinc deficient patients, and one would expect very ill hospitalized patients, often NPO, to be increasingly deficient in zinc). And yes, if we gave Tamiflu, etc. only when influenza patients were already moribund, we would not be surprised to find our efforts at treatment unhelpful. It is certainly well documented that QT prolongation can occur with Hydroxychloroquine and Azithromycin, and QT prolongation does pose an increased risk of fatal arrhythmias.

That said, in psychiatry we have almost no drugs that do NOT prolong the QT interval, but we still have to treat most of our patients with such drugs at the minimum effective doses, with informed consent and monitoring, and avoidance of adding other QT prolonging drugs (requiring us to communicate with other specialists treating our patients for other conditions). We'd be in a terrible position trying to help our outpatients if we were admonished not to use reasonable doses of QT prolonging psychiatric drugs outside the hospital simply because overdoses of those same drugs can cause fatal arrhythmias. (That seems to be what is happening with Hydroxychloroquine, which has been safely used for well over half a century in outpatients with various diagnoses, and might be just as safe in early CoVID-19 treatment, especially if it turned out that only a few reasonable size loading doses needed to be given, which well might be the case given that its half life is 30-50 days!)

With CoVID-19, we are dealing for the first time with a new and often devastating illness. We need to identify as soon as possible the right drugs, the right doses, and the right times to administer each in the evolving course of this illness. CoVID-19, at least in adults, can be seen as progressing through some or all of a number of clinical phases, most of which quite likely will end up benefitting from some form of discreet intervention (drugs being one class of intervention). For those interested, the Stanford U series of Grand Rounds on CoVID-19, especially the one discussing the pulmonary management of the ARDS with which it is often associated, are available on youtube and very illuminating. And the NIH guidelines and a number of recent articles describe some very nuanced treatment recommendations, including for patients with complications such as coagulopathy. However, except for specific pulmonary management, the current idea of staging CoVID seems mostly limited to differentiating between pre-hospitalized vs. hospitalized patients. Might it not help to conceptualize much more incrementally the phases of this illness overall, so that we can more easily figure out how to target interventions to best effect as a patient's clinical course progresses? Could we perhaps come up with some sort of staging (and maybe grading) system for the clinical management and research investigation of CoVID-19?

I hope our pulmonology and ID colleagues are already coming up with a much better paradigm than what I'm writing below (this is certainly not my field), but if they are, I haven't heard.

Just for purposes of starting a discussion, maybe we could think of the stages of CoVID-19 something like this:
-1 being exposed, but pre-positive for SARS-CoV-2, and pre-symptomatic; 0 being positive for virus but still presymptomatic; 1 showing mild URI symptoms only; 2 showing more severe URI symptoms and/or fever; 3 showing fever and cough but no ground glass on the pulmonary CT; 4 with clear X-ray, CT or ultrasound evidence of CoVID pneumonia; 5 with incipient ARDS but normal cytokines and no coagulopathy, and no PEEP or intubation; 6 with ARDS and high cytokines or coagulopathy, nasal 02 still sufficient; 7 with ARDS, elevated cytokines and evidence of coagulopathy, and/or in need of PEEP; 8 with secondary pulmonary infection and/or in need of intubation; 9 intubated, and with pulmonary edema, stroke, myocardial or renal involvement, and/ or in need of ECMO; 10 deceased. Maybe designating more stages, or subdividing some, would be necessary to take into account involvement of organs/tissues such as endothelium, kidney, heart and brain, and maybe grading each stage would also be helpful.

As best I can tell, the positive clinical reports on Hydroxychloroquine from US and foreign outpatient physicians, and the French prospective nonrandomized noncontrolled positive studies with good outcomes on hospitalized (for research treatment purposes) patients, co-administered zinc (and/or Azithromycin). and started the regimen somewhere between what we could think of as stage 0 and stage 4 as categorized by the above schema. Conversely, the negative (also not terribly well constructed) studies attempted to use Hydroxychloroquine, presumably without zinc, in what we might think of, using the above paradigm, as stages 5 and beyond, often well beyond. I think it would make sense that a drug such as Hydroxychloroquine, that mitigates early viral replication would not work as well once lungs and other organs are already overwhelmed with virus and very damaged. The same might be true of many antivirals. At any rate, using QT prolonging drugs in patients who already have a viral myocarditis would seem pretty dangerous.

Just a thought.









Flag
11LikeReply


Bill Rhoades| Other Healthcare Provider1 day ago



Pay no attention to that 2005 report: "Chloroquine is a potent inhibitor of SARS coronavirus infection and spread".
Chloroquine is a potent inhibitor of SARS coronavirus infection and spread
Pay no attention to the WHO monograph on: "the cardiotoxicity of antimalarials":
https://www.who.int/malaria/mpac/mpac-mar2017-erg-cardiotoxicity-report-session2.pdf
“Despite hundreds of millions of doses administered in the treatment of malaria, there have been no reports of sudden unexplained death associated with quinine, chloroquine or amodiaquine, although each drug causes QT/QTc interval prolongation.”
Big Pharma says this cheap generic is EVIL! (except tor the lupus & RA patients who take high doses of this med for decades on end with a remarkable safety record).



Flag
21LikeReply

Adeleye Erinle| Pharmacist11 hours ago


@BILL Rhoades AT last someone is paying attention. Big Pharma and cost happened to be a strong issue. It is still unimaginable that a virus that shuts down normal way of life could be destroyed by a cheap long known therapy
Flag
4LikeReply




Dr. Jimmy Chang| Family Medicine1 day ago



Again another malicious observational study, look at the design, methodology, ways things are presented etc.
So many countries are seeing positive results from HCQ, people are not blind okay.
If you have missed the progress of countries benefited from HCQ, now prospectively you can pay attention to Brazil's mortality rate two weeks from today; they just started treating even the mild cases.
Don't censor my comment again ya, Medscape.

Flag
20LikeReply

Dr. Mozammal Hossain| Cardiology, Nuclear1 day ago


please mention the countries that got benefitted
Flag
1LikeReply

Bill Rhoades| Other Healthcare Provider1 day ago



@Dr. Mozammal Hossain
Costa Rica is using HCQ on all symptomatic patients, with treatment often initiated before test results come back. Their case fatality rate? 0.86%. Not bad compared with what we're seeing in the USA.

Flag
11LikeReply


Spencer Stang| Psychologist12 hours ago



@BILL Rhoades @Dr. Mozammal Hossain I'll add to this. The attached spreadsheet shows 22 countries or states that use HC treatment relatively early, sometimes even prophylactically. The overall case fatality rate in these regions is 2.65%. The case fatality rate for countries/states that do not allow HC early is 9.81%. The results for places that are mixed (like the U.S., tends to fall between the two extremes).

Early HCZZ Treatment

If anybody has a strong hypothesis for this pattern of results other than HC treatment, I'd love to hear it. I keep hearing people say that if HC was having positive effects, we would know it by now. Looking at the worldwide pattern of data makes me think that maybe we do know it, we just aren't accepting it.

Flag
5LikeReply


Bill Rhoades| Other Healthcare Provider1 day ago



Friday morning April 24th, US COVID fatalities crossed the 50K mark. Later that same day, the FDA essentially banned outpatient prescribing of HCQ for early stage disease, apparently based largely on results of a retrospective study on critically ill ICU patients at a VA hospital.
Interestingly, their ruling still allows for HCQ use in critically ill ICU patients that appear to be harmed by this therapy, while forbidden in healthier early stage patients, where HCQ has a remarkably benign safety record & initially promising results as a therapeutic.
We’re now 30 days past this curious ruling and US fatalities are approaching 100K, still without a single outpatient therapeutic available to doctors or patients. If the fullness of time shows early/outpatient HCQ was in fact the “Best Medicine” we’ll have in 2020, I can’t help but wonder if there is any recourse that might apply for what would essentially be the greatest medical blunder of all time.
We live in interesting times!
 

·
Premium Member
Joined
·
468 Posts
Observational studies are a lower standard of evidence than experimental studies, are more prone to bias and confounding, and cannot be used to demonstrate causality. Observational studies can be either retrospective (using existing data) or prospective (collecting new data).

‘And if there are many physicians in the trenches who are using hydroxychloro for the treatment of COVID infections, maybe you can explain this conclusion from a recent study:

We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.’

This is an observational study full of bias. Anyone using this, ahem, bullshit study, doesn’t know how to identify the south end of a northbound jackass.
 

·
Registered
Joined
·
794 Posts
[MEDIA]
 

·
Registered
Joined
·
794 Posts

·
Premium Member
Joined
·
468 Posts
Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis
Harvey A Risch
American Journal of Epidemiology, kwaa093, Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis
Published:

27 May 2020

Abstract
More than 1.6 million Americans have been infected with SARS-CoV-2 and >10 times that number carry antibodies to it. High-risk patients presenting with progressing symptomatic disease have only hospitalization treatment with its high mortality. An outpatient treatment that prevents hospitalization is desperately needed. Two candidate medications have been widely discussed: remdesivir, and hydroxychloroquine+azithromycin. Remdesivir has shown mild effectiveness in hospitalized inpatients, but no trials have been registered in outpatients. Hydroxychloroquine+azithromycin has been widely misrepresented in both clinical reports and public media, and outpatient trials results are not expected until September. Early outpatient illness is very different than later hospitalized florid disease and the treatments differ. Evidence about use of hydroxychloroquine alone, or of hydroxychloroquine+azithromycin in inpatients, is irrelevant concerning efficacy of the pair in early high-risk outpatient disease. Five studies, including two controlled clinical trials, have demonstrated significant major outpatient treatment efficacy. Hydroxychloroquine+azithromycin has been used as standard-of-care in more than 300,000 older adults with multicomorbidities, with estimated proportion diagnosed with cardiac arrhythmias attributable to the medications 47/100,000 users, of which estimated mortality is <20%, 9/100,000 users, compared to the 10,000 Americans now dying each week. These medications need to be widely available and promoted immediately for physicians to prescribe.
Azithromycin, Covid-19, Doxycycline, Hydroxychloroquine, Remdesivir, SARS-CoV-2, Zinc
Topic:

Issue Section:
Special article
pdfPDF
This content is only available as a PDF.
 
641 - 646 of 646 Posts
Top