aggiegolfer03 said:

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So what is being done for patients who show enough symptoms to present a flu like illness, enough that they'd normally end up at their family doctor?

Because as you said, I would think THAT would be the time for seeing improved outcomes from HCL treatment.

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For me if they are positive for COVID-19 we are having the discussion via a video visit about the risks and benefits of trying the treatment. If they have risk factors for possible severe disease and they have not yet been tested I will give them the option of treatment as long as there is no known complications to treatment.

I had a lady last week who has many risk factors obesity, DM type 2, HTN, Hyperlipidemia, and COPD. However, she had a slightly prolonged QT on her last physical in Sept 2019. I told her I was nervous about treating her but she wanted to be treated. I faxed her EKG to the cardiologist I use and we discussed the case. He said the Z-pak is actually more prone to QT prolongation and arrhythmia then the HCQ so we decided to treat her with HCQ/Doxycycline and she is doing fine.

I do think we as primary care doctors have got to be aggressive at treating this early so we don't have as many admissions to the hospital. If you don't want to use HCQ such as a healthy 30 y/o you appears to have possible COVID. There risk of hospitalization is low but I still tell them to take Zinc 50mg per day, Quercetin 1g 2 po BID, Vitamin C 500mg to 1g per day and melatonin 10mg at night.

I am not alone with this thinking. Here is a link to a critical care doctor recommending similar supplements. He also recommends Vitamin D which I am hesitant to recommend unless you are deficient since Vitamin D can increase some cytokines. Which is normally great for protection from infection but since this disease does it's damage with cytokine storm I am not using it unless someone is low to start with.
https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf

I am using these supplements in small doses for prevention also.

DadHammer said:

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Do you have a web link for a video visit apt if my wife or I get sick? We definitely want to use the HCQ and Zpac.

Both healthy and do ekg yearly during our health exams. Also we are doing your recommended vitamin dosing you just listed. Both well over 40 yrs old.

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www.drcoates.net

You should contact your primary care physician and you can see what his or her stance is also. But if not I would be happy to treat you.

74Ag1 said:

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When does an unproven drug that works become proven?

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We don't know it works yet, that's the point. Right now all we have are a lot of anecdotal reports both that it works and that it doesn't.

As others have pointed out though, there are quite a few pre-print articles circulating that are awaiting peer review and nearly all are showing no statistical benefit.

Strawman

74Ag1 said:

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Infection_Ag11 said:

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74Ag1 said:

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When does an unproven drug that works become proven?

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We don't know it works yet, that's the point. Right now all we have are a lot of anecdotal reports both that it works and that it doesn't.

As others have pointed out though, there are quite a few pre-print articles circulating that are awaiting peer review and nearly all are showing no statistical benefit.

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So do you prescribe it if it shows no benefit?
Maybe you should Stop using it if you don't think it works.

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Again, we don't know if it has benefit or not yet. I'm more selective than many, but yes I'm prescribing it. I don't know if it works or not but I am maintaining a healthy degree of skepticism.

I will say that, based on the mechanism proposed and the known effects of HCQ, the chance of statistically significant benefit seems somewhat unlikely. My anecdotal sense (no more valid than any other) is that I haven't seen it provide much benefit in my patients. On the flip side, the IL-6 inhibitors do anecdotally seem to help quite a bit in moderate to severe disease.

Infection_Ag11 said:

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74Ag1 said:

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When does an unproven drug that works become proven?

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We don't know it works yet, that's the point. Right now all we have are a lot of anecdotal reports both that it works and that it doesn't.

As others have pointed out though, there are quite a few pre-print articles circulating that are awaiting peer review and nearly all are showing no statistical benefit.

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Curious if those studies are skewing more to sicker patients. The initial push was to use this in hospitals. Would make sense if not working at more advanced stages.

My concern is that it may be effective in keeping cases out of the hospital if started early and we aren't studying it enough for that purpose.

HouAggie2007 said:

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Strawman

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The science itself takes a back seat to other concerns for many people.

Moxley said:

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Infection_Ag11 said:

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74Ag1 said:

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When does an unproven drug that works become proven?

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We don't know it works yet, that's the point. Right now all we have are a lot of anecdotal reports both that it works and that it doesn't.

As others have pointed out though, there are quite a few pre-print articles circulating that are awaiting peer review and nearly all are showing no statistical benefit.

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Curious if those studies are skewing more to sicker patients. The initial push was to use this in hospitals. Would make sense if not working at more advanced stages.

My concern is that it may be effective in keeping cases out of the hospital if started early and we aren't studying it enough for that purpose.

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It will be looked at every which way imaginable before it's over.

"For Charles Vavruska, it was nothing short of a miracle cure.

Days after the 53-year-old City Council staffer arrived at New York Presbyterian-Queens hospital barely able to breathe and tested positive for COVID-19, doctors started him on the controversial drug cocktail of hydroxychloroquine, an anti-malarial, and azithromycin, an antibiotic.

Although Vavruska said he felt almost immediately better, he wishes the urgent-care doctor he went to see in the early days of his flu-like symptoms in mid-March could have prescribed a similar treatment before he grew progressively worse and ended up in a hospital room, hooked up to an oxygen tank and fighting for his life."


https://www.google.com/amp/s/nypost.com/2020/04/11/doctors-pols-urge-use-of-miracle-coronavirus-drug-cocktail/amp/

74Ag1 said:

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"Days after the 53-year-old City Council staffer arrived at New York Presbyterian-Queens hospital barely able to breathe and tested positive for COVID-19, doctors started him on the controversial drug cocktail of hydroxychloroquine, an anti-malarial, and azithromycin, an antibiotic.

Although Vavruska said he felt almost immediately better, he wishes the urgent-care doctor he went to see in the early days of his flu-like symptoms in mid-March could have prescribed a similar treatment before he grew progressively worse and ended up in a hospital room, hooked up to an oxygen tank and fighting for his life."


https://www.google.com/amp/s/nypost.com/2020/04/11/doctors-pols-urge-use-of-miracle-coronavirus-drug-cocktail/amp/

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Again, it's just an anecdote. There's no evidence here at all. We have no idea what would have happened had he received no treatment at all or treatment much sooner.

I got it you don't like it
It's akin to a sugar pill

74Ag1 said:

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I got it you don't like it
It's akin to a sugar pill

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As I've said many times before, I genuinely hope it works. To hope otherwise would be irrational for someone in my line of work. I do not however have a preconception for which I'm trying to cherry-pick data to fit. This is because my motivation for hoping it works isn't political, I'm not trying to score points and "beat" the other team. I want something I can give to patients and know there is evidence that it will consistently offer benefit.

I don't know what your motivation for wanting it to work is, but we should probably get that out of the way now. If this is only about beating the liberals, then we really have nothing else to discuss. In that case you aren't here to learn and I have bigger concerns than which political team wins. If you genuinely believe that constitutes evidence however, I'm only trying to temper your misguided enthusiasm by assuring you it does not.

Have a good evening

To all of the doctors posting here:

Please ignore the snarky and complaining posters who criticize without understanding. Most of us are extremely grateful to get an insider view of what is going on with the disease and understand that we are a long ways away from mastering it.

Thank you very much for your postings.

Treated with hydroxychloroquine and the azithromycin.

https://www.msn.com/en-us/health/medical/coronavirus-update-102-year-old-woman-defies-odds-to-beat-covid-19-doctor-calls-recovery-miraculous/ar-BB12ugyu

Today's update! Happy Easter to everyone!

https://www.facebook.com/1998386763777604/posts/2667205700229037/?sfnsn=mo

DadHammer said:

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All I know is most Dr around the world are using it and say it is working. You need to read his study on over 1000 patients with great results.

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Most are using it, but to say most are saying it works is very misleading. The anecdotal reports are very much a mixed bag.

No offense, but this is anecdote on top of anecdote. If you are establishing this as your case, then it's up to you to bring the citation. You can't offload "look it up" onto those with whom you seem to disagree.

DadHammer said:

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There was a worldwide poll that says they do. Not me saying it so not being misleading. Look it up.

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No there isn't. I know the poll you think you are citing; however, the results are actually that 37% picked HCQ out of a list of medications as the most effective. 32% Said that "nothing" was the most effective treatment. Nevertheless, this is not how treatment efficacy is determined.

DadHammer said:

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There was a worldwide poll that says they do. Not me saying it so not being misleading. Look it up.

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That's not accurate, unless there's a large international poll I'm unaware of. One large poll showed 65% of physicians polled would use it or are using it (saying nothing about whether they felt it worked) and in another it got the most votes from a list of therapies when asked what they felt was the most effective therapy (33% if I recall correctly).

Neither of those could be reasonably be taken to mean "most physicians say it is working".

Interesting piece:

Quote:

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In 2005, an article was published in Virology Journal titled "Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. The eight authors were associated with the Centers for Disease Control and Montreal's Clinical Research Institute. The study described in the article was conducted in the wake of the SARS epidemic:

Quote:

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Severe acute respiratory syndrome (SARS) is caused by a newly discovered coronavirus (SARS-CoV). No effective prophylactic or post-exposure therapy is currently available.

We report, however, that chloroquine has strong antiviral effects on SARS-CoV infection of primate cells. These inhibitory effects are observed when the cells are treated with the drug either before or after exposure to the virus, suggesting both prophylactic and therapeutic advantage. In addition to the well-known functions of chloroquine such as elevations of endosomal pH, the drug appears to interfere with terminal glycosylation of the cellular receptor, angiotensin-converting enzyme 2. This may negatively influence the virus-receptor binding and abrogate the infection, with further ramifications by the elevation of vesicular pH, resulting in the inhibition of infection and spread of SARS CoV at clinically admissible concentrations.

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Like COVID-19, SARS was a coronavirus. The article concluded:

Quote:

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Chloroquine is effective in preventing the spread of SARS CoV in cell culture. Favorable inhibition of virus spread was observed when the cells were either treated with chloroquine prior to or after SARS CoV infection. In addition, the indirect immunofluorescence assay described herein represents a simple and rapid method for screening SARS-CoV antiviral compounds.

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Note that this study found chloroquine to be effective prophylactically, as well as as a treatment. The drug should have been on CDC's radar from the beginning.

The site from which I linked to the 2005 study also quoted this comment on an InstaPundit post:

Quote:

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As most know, the media/Democrat politicians/FDA want the use of the hydroxychloroquine/azithromycin/zinc combination to be restricted until late in the course of the infection, when the patient's infection is well-advanced. As a physician, this baffles me. I can't think of a single infectious condition bacterial, fungal, or viral where the best medical treatment is to delay the use of a anti-bacterial, anti-fungal, or anti-viral until the infection is far advanced.

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