From my experience anecdotally I don't know. So far no deaths at my hospital with the cocktail. Time will tell.

No deaths at all at our hospital. Yet. ID is anti azithromycin because of QT concerns. I think this is BS. I have Rx'd a ton of azithro in my career and never have seen QT issues.

IMO your ID shouldn't be anti-Zithromax because of QT concerns. That should fall to you (ICU) or Cards. Daily EKG's are fine although I believe some institutions are measuring off tele strips to minimize exposure to the staff doing the EKG's.

Good Luck. Keep your mortality at zero!

Marcus Aurelius said:

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No deaths at all at our hospital. Yet. ID is anti aziithromycin because of QT concerns. I think this is BS. I have Rx'd a ton of azithro in my career and never have seen QT issues.

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I agree completely! Until recently when lawyers found out about it pharmacies never even mentioned the QT prolongation!

This feels like a fly on the wall moment to me. I'm fascinated by the conversations that are taking place here.

I respect the heck out of you guys and what you are dealing with.

Far more curious if it lessons length of stay, need for vent/ICU, and helps keep outpatient folks out. Treatment that does this will get us back to normal faster.

Odd that zinc is left out. Or are they assuming most folks already have high enough levels of zinc in their system?

What do inventory levels look like for this drug? Are we able to rapidly produce it in the States? Will we have enough?

Palovic said:

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Marcus-just for baseline knowledge, does your groups cocktail include zinc sulfate?

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Yes. All on zinc as well.

For full disclosure - HCQ prolongs the QT interval. Hypothetically the macrolide azithromycin can as well. Hence the concern about synergy among some MDs. But IMO that is what a daily EKG is for!!! Also I have seen some docs concerned about liver injury and azithromycin.

I have Rx'd a metric ton of azithromycin in my career. Side effects in zero patients. Literally.

Marcus Aurelius said:

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It's on shelves. It will diminish. Why I pray Trump orders military re-tooling of big Pharma to make hydrochloroquine and redesimivir.

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Not sure you need "military retooling". Everyone in the industry is doing whatever they can to beat this. The company I work for is gearing up one of our contract pharma production facilities in the US for making remdesivir.

I posted this comment on another forum a few weeks ago but I will restate it here as most medical and science personnel already know this, the debate about whether HCQ is effective with AZI and zinc is still ongoing, but the point is moot if we cannot effectively test and prescribe the said treatment early on in the infection to drastically reduce early inflammation in the lungs that have patients coming to ER needing vents day 1.

My belief (full disclaimer) is that the cocktail Dr. Marcus is referring to will prove to be an effective cocktail (not 100%) through the widespread studies that are ongoing. An anti-viral treatment is much more important than the vaccine in my opinion as it will be more than likely that this strain will change season to season and you will get about the same protection as you get with the flu on any vaccine. (Please note that I have no more evidence other than hearing many other medical professionals saying the same thing with no evidence)

Diagnosis and timing of treatment is everything here.

Palovic said:

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I posted this comment on another forum a few weeks ago but I will restate it here as most medical and science personnel already know this, the debate about whether HCQ is effective with AZI and zinc is still ongoing, but the point is moot if we cannot effectively test and prescribe the said treatment early on in the infection to drastically reduce early inflammation in the lungs that have patients coming to ER needing vents day 1.

My belief (full disclaimer) is that the cocktail Dr. Marcus is referring to will prove to be an effective cocktail (not 100%) through the widespread studies that are ongoing. An anti-viral treatment is much more important than the vaccine in my opinion as it will be more than likely that this strain will change season to season and you will get about the same protection as you get with the flu on any vaccine. (Please note that I have no more evidence other than hearing many other medical professionals saying the same thing with no evidence)

Diagnosis and timing of treatment is everything here.

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When a vaccine is developed it will target a stable portion of the virus and should not need reformulation yearly. Flu vaccine is the only crappy vaccine that was developed to target a shifty part of a virus and hopefully we will have better flu vaccine soon.

Palovic said:

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I posted this comment on another forum a few weeks ago but I will restate it here as most medical and science personnel already know this, the debate about whether HCQ is effective with AZI and zinc is still ongoing, but the point is moot if we cannot effectively test and prescribe the said treatment early on in the infection to drastically reduce early inflammation in the lungs that have patients coming to ER needing vents day 1.

My belief (full disclaimer) is that the cocktail Dr. Marcus is referring to will prove to be an effective cocktail (not 100%) through the widespread studies that are ongoing. An anti-viral treatment is much more important than the vaccine in my opinion as it will be more than likely that this strain will change season to season and you will get about the same protection as you get with the flu on any vaccine. (Please note that I have no more evidence other than hearing many other medical professionals saying the same thing with no evidence)

Diagnosis and timing of treatment is everything here.

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The genetic data suggest the opposite. Genetic sequencing shows about 2 mutations per month in CoV2 which is similar for influenza, but CoV2 has a genome of twice the size, meaning the mutation rate is lower.

Additionally, only some portions of the genetic sequence are relevant to immunity, as only a few proteins are on the outside, particularly spike (s) and nucleocapsid (n) proteins. SAR-CoV derived B and T cells recognize epitopes of the s and n proteins that are thus far highly conserved in CoV2, with no changes to these regions observed in all 120 sequenced CoV2 genomes. Also, SARS-CoV derived mouse polyclonal antibodies are effective at binding to SARS-CoV2 s protein.

As a CoV and CoV2 are both bat viruses, the similarities may not surprising. But CoV jumped from animals in 2003 and CoV2 jumped nearly 20 years later, meaning the two diverged at least that long ago and we have a minimum of 17 years of accumulated mutations without significant changes to these immune recognized epitopes, which suggest a lot of genetic stability.

That is all good news for a vaccine, although depending on how long the immune response lasts in a person, it might require a booster periodically, maybe more like tetanus vaccine than flu vaccine.

See biochemag agrees with me with much more biochemical details haha

BiochemAg97 said:

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Palovic said:

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I posted this comment on another forum a few weeks ago but I will restate it here as most medical and science personnel already know this, the debate about whether HCQ is effective with AZI and zinc is still ongoing, but the point is moot if we cannot effectively test and prescribe the said treatment early on in the infection to drastically reduce early inflammation in the lungs that have patients coming to ER needing vents day 1.

My belief (full disclaimer) is that the cocktail Dr. Marcus is referring to will prove to be an effective cocktail (not 100%) through the widespread studies that are ongoing. An anti-viral treatment is much more important than the vaccine in my opinion as it will be more than likely that this strain will change season to season and you will get about the same protection as you get with the flu on any vaccine. (Please note that I have no more evidence other than hearing many other medical professionals saying the same thing with no evidence)

Diagnosis and timing of treatment is everything here.

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The genetic data suggest the opposite. Genetic sequencing shows about 2 mutations per month in CoV2 which is similar for influenza, but CoV2 has a genome of twice the size, meaning the mutation rate is lower.

Additionally, only some portions of the genetic sequence are relevant to immunity, as only a few proteins are on the outside, particularly spike (s) and nucleocapsid (n) proteins. SAR-CoV derived B and T cells recognize epitopes of the s and n proteins that are thus far highly conserved in CoV2, with no changes to these regions observed in all 120 sequenced CoV2 genomes. Also, SARS-CoV derived mouse polyclonal antibodies are effective at binding to SARS-CoV2 s protein.

As a CoV and CoV2 are both bat viruses, the similarities may not surprising. But CoV jumped from animals in 2003 and CoV2 jumped nearly 20 years later, meaning the two diverged at least that long ago and we have a minimum of 17 years of accumulated mutations without significant changes to these immune recognized epitopes, which suggest a lot of genetic stability.

That is all good news for a vaccine, although depending on how long the immune response lasts in a person, it might require a booster periodically, maybe more like tetanus vaccine than flu vaccine.

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Great information and the science is sound and please don't take my comments as dismissing the need for an effective vaccine. The issue I see in this scenario is time. We may eventually get to an effective vaccine at some point in the future which will relegate this virus to a step above the flu in regards to seriousness but still very controllable.

Today and in the future until the vaccine is completed and tested, the anti-viral treatment is paramount which is how I should have stated my previous comments.

We still learn more about the virus on a daily basis but the good news is that we have some of the smartest people in the world from a variety of specialties looking at this problem in unprecedented numbers in our lifetime and with instant access to that information. This access alone is remarkable and the information we get daily across the world from the front lines, medical labs, and even patients will truly formulate how to better react going forward as a connected society.

2020 COVID QTC Guidance is an exceptional guide from mayo Clinic EP. Our network is using the algorithm, shown as Figure 1 Page 19, as a reference to our providers. (If I knew how to pull that figure out to post it separately I would.) Our PDF version is the bottom half of diagram that has to do with QT prolongation only for non trial eligible patients.

Regardless, it's worth printing.

Good Luck!