Quote:

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Besides, a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 32) compared with the control group (54.8%, 17 of 32)."

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Part of me suspects that treatment group is made up of CCP officials and the control is made up of...well...others.

jeffdjohnson said:

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74OA said:

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When do you think we can expect to start hearing official results from the hydrochloroquine treatment observational tests being conducted in New York hospitals?

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Here is a new study posted yesterday (from China so YMMV).

https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2

"But for TTCR, the body temperature recovery time and the cough remission time were significantly shortened in the HCQ treatment group. Besides, a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 32) compared with the control group (54.8%, 17 of 32)."

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Thanks for posting! That is more encouraging news!

Squadron7 said:

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Quote:

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Besides, a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 32) compared with the control group (54.8%, 17 of 32)."

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Part of me suspects that treatment group is made up of CCP officials and the control is made up of...well...others.

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Only part of you?

Hell, I'd be willing to be a roll of toilet paper that's the way it worked!

First of all, I am just a hayseed dermatologist but from reading the above two posts it solidifies to me what we should be doing and I believe probably are actually doing on the ground.

Plaquenil/azithromycin/zinc cocktail should be used broadly on less sick folks because it works better than when they get sick. You want to prevent the cytokine storm with these meds, not treat them with that cocktail once the storm occurs.

I think we need a cheap, fast antibody test even more than the initial test which obviously could be negative one day and positive the next. Once we can ID who has antibodies, we can use their antibodies for treatment in more severe cases. And our numbers would get much more accurate. Might explain why the numbers seem so low in California also.

And I am almost 65 years old and am well aware of potential side effects especially the aforementioned Toursade de pointes. Have actually studied extensively plaquenil side effects due to my using it a lot. For this length of treatment I feel very, very comfortable with giving the three med cocktail fairly indiscriminately. As with all meds, benefits vs risk. I always think what I would do for me and my family and I would not hesitate to give the three drug treatment even in my daughter who has had three open heart surgeries if they showed symptoms of Coronavirus. In fact, I would be pissed if the docs would not treat them until they started showing severe symptoms which makes no sense. Not only have you missed the window, but now you are giving meds that probably will not work.

Anyway, the bottom line is widespread use of three drug cocktail in non critical patients and widespread antibody tests so the plasma can be used for sicker people. And we get a better idea of numbers.

Those are the delaying tactics until we get a vaccine.

First we need a faster testing process so we can get patients confirmed positive BEFORE they're outside the window of effective treatment of these drugs.

But with all due respect the reality is that we do not have the test readily available at this time. So I am advocating treating all those who show symptoms consistent with Coronavirus. So you may completely obviate folks going on to severe cases. I think the benefits outweigh the risks for the recommended treatment time period even if you treat numerous non corona virus cases.

Maybe get an EKG prior to treatment or counseling if history of cardiac arrhythmias. I know if I or my family members had early symptoms I would not wait on an EKG to treat.

And edited to add that I think the testing has been dramatically overblown. I could test negative one hour and positive the next, especially if I am seeing patients. The cynic in me tells me the fixation on testing is political in nature but I will not go down that rabbit hole.

The key to diagnosis, as with almost all medical diseases, is still clinical.

There isn't enough hydroxychloroquine to treat everyone who presents with URI symptoms in the state with it. Especially after the recent hoarding. It just isn't an option. Much like testing every person, it is a supply issue.

Badace52 said:

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There isn't enough hydroxychloroquine to treat everyone who presents with URI symptoms in the state with it. Especially after the recent hoarding. It just isn't an option. Much like testing every person, it is a supply issue.

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I so admire what you and the other front line docs are doing on here and actually kind of miss the rush. I hear you loud and clear. But my point is to use the available meds on maybe high risk folks BEFORE they crash.

And imho, I would much prefer a cranking up of med supplies rather than test supplies. But as I said, I am only a hayseed pimple popper. My days at the Ben Taub ER are far behind me.

Again, I salute all the docs, nurses, NPs, PAs, orderlies, clerical staff, pharmacists, all the folks working their tails off with no thought other than to save as many lives as possible.

beerad12man said:

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He said "zinc", not 'zing".....

maroonbeansnrice said:

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Badace52 said:

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There isn't enough hydroxychloroquine to treat everyone who presents with URI symptoms in the state with it. Especially after the recent hoarding. It just isn't an option. Much like testing every person, it is a supply issue.

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I asked this a while back, and I didn't see an answer, but does atovaquone-proguanil possibly have some of the same (assumed) positive effects of hydroxychloroquine?

Is the hydroxychloroquine working in combination with zinc because it is a zinc ionophore or is it some other mechanism that is helpful? If it is because it is a Zn ionophore, is proguanil as well? Proguanil is the go to anti-malaria these days and it seems there should be a lot of doses of it around?

Would appreciate a professional opinion.

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If you are looking for an option for a Zinc Ionophore, look into implementing Quercetin along with Zn and green tea. All are readily available over the counter

You are 100% correct. That was a stress induced, moment of weakness, made worse with wine. I sincerely apologize to everyone. Won't happen again. Need to be mentally tougher. Everyone stay safe, wash your hands, and gigem.

Doug Ross said:

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You are 100% correct. That was a stress induced, moment of weakness, made worse with wine. I sincerely apologize to everyone. Won't happen again. Need to be mentally tougher. Everyone stay safe, wash your hands, and gigem.

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I don't think anyone could fault you from being on edge. These are trying times especially in your line of work.

dermdoc said:

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First of all, I am just a hayseed dermatologist but from reading the above two posts it solidifies to me what we should be doing and I believe probably are actually doing on the ground.

Plaquenil/azithromycin/zinc cocktail should be used broadly on less sick folks because it works better than when they get sick. You want to prevent the cytokine storm with these meds, not treat them with that cocktail once the storm occurs.

I think we need a cheap, fast antibody test even more than the initial test which obviously could be negative one day and positive the next. Once we can ID who has antibodies, we can use their antibodies for treatment in more severe cases. And our numbers would get much more accurate. Might explain why the numbers seem so low in California also.

And I am almost 65 years old and am well aware of potential side effects especially the aforementioned Toursade de pointes. Have actually studied extensively plaquenil side effects due to my using it a lot. For this length of treatment I feel very, very comfortable with giving the three med cocktail fairly indiscriminately. As with all meds, benefits vs risk. I always think what I would do for me and my family and I would not hesitate to give the three drug treatment even in my daughter who has had three open heart surgeries if they showed symptoms of Coronavirus. In fact, I would be pissed if the docs would not treat them until they started showing severe symptoms which makes no sense. Not only have you missed the window, but now you are giving meds that probably will not work.

Anyway, the bottom line is widespread use of three drug cocktail in non critical patients and widespread antibody tests so the plasma can be used for sicker people. And we get a better idea of numbers.

Those are the delaying tactics until we get a vaccine.

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Well said dermdoc!!

I agree 100% and knowing that while it does have potential side effects they are minimal compared to the effects of COVID-19. I plan to offer it to all of my patients who test positive. I even have contacted two compounding pharmacies about making it for my patients (COVID-19 positive and autoimmune patients) in case the supply runs low. Now the trick is to get quicker testing done. I am currently awaiting results on 3 of them. We need to get same day or at worst next day results we can people start as soon as possible. I believe in doing anything and everything to keep my patients out of the hospital.

I am angered by the governments in Nevada and New York making laws prohibiting doctors from prescribing it because it is "not FDA approved"! Doctors prescribe medications off label which means not FDA approved everyday. I don't even think it is legal to prohibit off label use. What do they plan on telling the families of the deceased patients 6 months from now if we find out it is effective?

However, I think we need to make sure the patient is positive or you have a very high index of suspicion before prescribing as to not use up our supply of these medications.

dermdoc said:

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But with all due respect the reality is that we do not have the test readily available at this time. So I am advocating treating all those who show symptoms consistent with Coronavirus. So you may completely obviate folks going on to severe cases. I think the benefits outweigh the risks for the recommended treatment time period even if you treat numerous non corona virus cases.

Maybe get an EKG prior to treatment or counseling if history of cardiac arrhythmias. I know if I or my family members had early symptoms I would not wait on an EKG to treat.

And edited to add that I think the testing has been dramatically overblown. I could test negative one hour and positive the next, especially if I am seeing patients. The cynic in me tells me the fixation on testing is political in nature but I will not go down that rabbit hole.

The key to diagnosis, as with almost all medical diseases, is still clinical.

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I agree with you again! Don't give it to everyone but use it on the ones with a high index of clinical suspicion we need to be aggressive in treatment. Not colds or other common etiology of coughs, but patients with cough, fever, SOB, anosmia, body aches, no sneezing. You have 4 or more of the above symptoms and it is becoming very likely that you have COVID as long as you have a negative FLU test.

Badace52 said:

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There isn't enough hydroxychloroquine to treat everyone who presents with URI symptoms in the state with it. Especially after the recent hoarding. It just isn't an option. Much like testing every person, it is a supply issue.

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I agree but as primary care doctors we need to selective in who give to. Not just any URI but patients with a high index of suspicion like the ones I said in the previous post. Also make arrangements for YOUR patients. I personally called the two compounding pharmacies in my area and discussed this with them. They have ordered plenty of ingredients to compound the pills for a significant number of my patients if necessary.

If we are aggressive at the primary care level we can potentially make a huge impact in the amount of hospitalizations. Not just with medications but also with education. That is reason I began writing about this to my patients on a regular basis. If we all do this we can make a huge impact.

Wendy 1990 said:

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Don't most daily vitamins have enough zinc?

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Yes you only need a small amount Zinc if you eat a good diet. However, I suggest taking Quercetin and Green Tea as they are also Zinc ionophores so similar mechanism of action as hydroxychloroquine.

maroonbeansnrice said:

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Badace52 said:

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There isn't enough hydroxychloroquine to treat everyone who presents with URI symptoms in the state with it. Especially after the recent hoarding. It just isn't an option. Much like testing every person, it is a supply issue.

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I asked this a while back, and I didn't see an answer, but does atovaquone-proguanil possibly have some of the same (assumed) positive effects of hydroxychloroquine?

Is the hydroxychloroquine working in combination with zinc because it is a zinc ionophore or is it some other mechanism that is helpful? If it is because it is a Zn ionophore, is proguanil as well? Proguanil is the go to anti-malaria these days and it seems there should be a lot of doses of it around?

Would appreciate a professional opinion.

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Since Zinc inhibits replicase the enzyme used in viral replication, we believe being a zinc ionophore is the mechanism of action but that is not proven.

In response to Doug Ross apology:

100% class act in coming back with that response. I'm of the belief that we all mess up and we sometimes lose our cool. The true value of a person is their character when mistakes are made. You have my respect and many others for sure. Thanks doc for your service during this trying time and please stay safe and well.

Working together we can beat this virus, but ironically we must do it by being separate.

Doug Ross said:

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You are 100% correct. That was a stress induced, moment of weakness, made worse with wine. I sincerely apologize to everyone. Won't happen again. Need to be mentally tougher. Everyone stay safe, wash your hands, and gigem.

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Sorry for coming down on you. We're all frustrated, on edge, and scared.

Continued prayers for all of you fighting the fight.

This damn thing has us all stressed and not at our best

Doug Ross said:

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You are 100% correct. That was a stress induced, moment of weakness, made worse with wine. I sincerely apologize to everyone. Won't happen again. Need to be mentally tougher. Everyone stay safe, wash your hands, and gigem.

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If anyone says they haven't ever posted their frustrations on texags at some point they're probably a liar. I did find yours quite amusing. Noticing they were all around 3 a.m. I assumed you weren't in the best frame of mind. Hope it gets better sooner rather than later.