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Is this one-two punch set of treatment options the game changer?

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  • Tue, Mar 31, 2020 - 10:22pm

    #1
    denisgoddard

    denisgoddard

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    Is this one-two punch set of treatment options the game changer?

Hydroxychloroquine + Azithromycin is looking good, but only when used early on. It does’t help severe or critical cases at all:
https://www.sciencedirect.com/science/article/pii/S0399077X20300858

But, biologic agent Tocilizumab (rheumatoid arthritis medication) saves even severe COVID patients. As in, on Oxygen and/or intubated. Within 2 weeks, all are out of ICU. Study has been replicated multiple times, in the West:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext

It’s on the Wikipedia page now: https://en.wikipedia.org/wiki/Tocilizumab#COVID-19

Is this one-two punch set of treatment options the game changer? HCQ+Z-pack is cheap and plentiful, you give it the moment you get a positive test. If you don’t catch it till the patient is in a bad state, start the infusion of Actemra (trade name for Tocilizumab).

  • Wed, Apr 01, 2020 - 08:00am

    #2

    sand_puppy

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    Reply To: Is this one-two punch set of treatment options the game changer?

NYC ER and Intensive Care Doctors summarize their best practices for COVID care.  In Emergency Medicine News.

What’s Working for COVID-19 Patients
by Steven Johnson, DO and Dana Gottlieb, MD

Our large tertiary care ED in Queens, NY, usually sees more than 100,000 adults a year. As we write this, we have 458 COVID-19-likely or -positive [inpatient] patients, 111 of them on ventilators.

We have learned so much from treating COVID-19 patients in the emergency department, on the floor, and in the intensive care unit and by examining the available literature. We hope this summary will help with acute ED management….

Summary:

  • Keep ’em dry.  (No IV fluids, give lasix if BP normal).  Don’t hydrate to clear lactate, normalize Creatinine nor give usual fluid boluses.

  • Don’t intubate (even if look crappy) until CO2 is elevated and pH falls on ABG.

  • Both high flow nasal cannula AND non-rebreathing mask for oxygenation.  Position prone.

  • Yes on Vitamin C 1,500 mg IV, Thiamine, Mg, K+, azithromycin and hydroxychloroquine

  • Avoid Vancomycin, steroids (unless end stage ARDS).

  • Avoid CT Angiogram to rule out Pulmonary Emboli as contrast load especially harmful.

  • Give a first dose community acquired pneumonia antibiotics (rocephin & azithromycin) but will be discontinued if COVID pos and procalcitonin low.

  • Give anticoagulant Lovenox as microangiopathic kidney injury and DVT risk high.

  • Screen for markers of hyperinflammation / poor prognosis. (CRP, Ferritin, LDH, D-dimer, Neutrophil / Lymphocyte ratio.)

  • Discuss withholding ventilator care in patient where bad outcome is expected even with ventilator care.

  • Wed, Apr 01, 2020 - 08:26am

    #3

    dtrammel

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    Sandpuppy, does this mean no extra water?

Keep ’em dry.  (No IV fluids, give lasix if BP normal).  Don’t hydrate to clear lactate, normalize Creatinine nor give usual fluid boluses.

Does this mean you wouldn’t hydrate orally like we normally do for less severe fever or diarrhea? Or are they talking about IV hydration?

 

  • Wed, Apr 01, 2020 - 08:38am

    #4

    sand_puppy

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    Is this one-two punch set of treatment options the game changer?

dtrammel, that comment refers to IV hydration in sick people being admitted to the hospital.  Oral hydration while sick is always a good idea.

As people are sick they don’t feel like eating or drinking and almost alway arrive at the hospital dehydrated.  So oral fluids is good when sick.

  • Wed, Apr 01, 2020 - 09:28am

    #5

    Jim H

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    Why I keep posting about hydroxychloroquine

As the first poster made clear, this will only work well if given early on in the course of the disease.  The idea is to NOT end up on a ventilator.  Here is what I just published to my coworkers;

Team,  As I continue to gather information regarding potential treatments and supplements in the fight against Covid-19, I believe I have found something worth passing along.  As always, you should do your own research and come to your own conclusions.  I have an elderly mother in NY and from what I see, it’s really up to each individual to protect themselves and their own.. in many ways the system is set up against you.  What do I mean?

 

One senior citizen in my mother’s large townhouse retirement complex in NY has been diagnosed as positive – luckily my mother had had no contact with this woman for three weeks prior, though she is a friend.  Two days ago, the woman’s daughter had her taken to the hospital in an ambulance because her symptoms were worsening – and THEY TURNED HER BACK.  They would not admit her because she was not SICK ENOUGH.  She was not in full respiratory distress, and the hospital is already too full with patients who are sicker.  I have watched several new videos where MD’s are openly stating that your chances of coming off a ventilator, once on, are </= 50%.

 

We are trapped in a moment in time where much of the medical complex is stuck in this rut whereby there are no treatments that have been proven to work against this new, novel virus to the gold standard of a peer reviewed, placebo controlled, randomized study.  You and I though don’t have to be stuck in this rut.

 

I have been studying reports out of China, South Korea, France, India, etc. regarding the use of hydroxychloroquine, an off-patent drug used for malaria, against the virus.  The mode of action appears to be it’s acting as a Zinc ionophore.  The science is clear;  Once in the cell, Zinc can interfere with viral RNA transcription.. but it’s hard to get Zinc into the cell.   Some of the studies, one in particular done in France, show less than stellar results from this drug, and it’s now apparent why this is;  If you are already on a ventilator in ICU, you have already missed the opportunity for an early intervention.

 

Let’s go back to my mother’s friend – she was turned away because she was not sick enough.  There is a MD in NY named Dr. Zelenko who has taken it upon himself to develop his own protocol for using hydrochloroquine as EARLY intervention for presumptive cases of Covid-19, in individuals with high risk profiles (i.e. > 60, hypertension, etc).  In other words, the daughter of my mother’s friend should have taken her mother to Dr. Zelenko, who would have immediately started her on a three way cocktail of hydroxychloroquine, Zinc supplement, and Zithromax.  As of two days ago, out of 200 high risk patients being given the drugs, Zelenko had only two who had progressed to ventilators and none had died.  Dr. Zelenko is very clear on the fact that this has to be treated early, and hard, in order to give a person with a less than perfect immune system a better chance to beat it.  Here is the Zelenko protocol;

Hydroxychloroquine,  200mg, 2x daily for five days

Zinc (I think as sulfate),  220 mg, daily for five days

Zithromax,  500 mg, once per day for five days

 

Bottom line, until we hear of something better, if my mother gets sick I will demand her doctor start her immediately on this regimen.  If he won’t, I will find another Dr. who will.  This is a life or death decision, and information is power.  If you simply trust the medical system at this time, before a gold standard proven, “standard of care” is established, you may very well deny yourself or your loved one a chance to have this very safe cocktail of medications that are working well for Dr. Zelenko and his patients.  Again, it has to be prescribed as early in the course of the disease as possible, before serious lung damage sets in.

 

Dr. Zelenko interview #1:     https://www.youtube.com/watch?v=m3J_1B7kJbk

Dr. Zelenko interview #2:     https://www.youtube.com/watch?v=1TJdjhd_XG8

  • Wed, Apr 01, 2020 - 09:52am

    #6

    Jim H

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    Dr. Ban Truong in CA is following a protocol similar to Dr. Zelenko

In the attached video Dr. Ban Truong talks about his success with a very similar protocol – though he is using less Zinc – only 15 mg.

Amazingly, one one of his patients, who he had caught later in the disease cycle,  went into ICU, the responsible physician stopped the hydroxychloroquine because of concern over retinopathy.  Great.. .he will have a better chance of dying, but he sure won’t have retinopathy.  This is what we are up against folks, and why we need to take care of ourselves and stay out of the ICU.

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