Speyside
6 years ago
Mittens, I hope and pray you are right. But people are hoarding medications that probably won't work. People with Lupus need hydocloroquin. They can't find it, this is a tragedy.
tonygraz
6 years ago
Did Spey win this 500 ?
USNGunner
6 years ago

Gunner I get that, on an individual level, many of us are prepared as best we can. I am talking on a governmental, national level.

Speyside wrote:




If you're relying on the .gov to "save" you? Hell, you've lost already. They can't stop anything. Period.

The corruption and lack of actual, functional accountability runs way too deep. Look at their latest response. If it weren't so fucquing sad it would be laughable.

The individual level is the only thing that WILL work. Nobody is responsible for you and yours but you. Folks need to pay attention and accept personal responsibility.

A little more self reliance, self-determination, and awareness would go a long damned way in this country.
Pudding Mittens
6 years ago

Al, this is a wake up call for the world. The world wasn't prepared. The world has acted to slowly. The world needs to learn from this and plan a world wide step by step procedure for a pandemic. Fortunatly the morbidity rate is low, about 1/2 %, possibly lower. What if a pandemic occurs with a 30% morbidity rate?

Speyside wrote:


Some of the bird flus have horrifying fatality rates. H5N1 for example is 60%.

Right now, they're able to jump from bird to human, barely. This is why poultry farmers handling birds daily can catch it, but even then, very very rarely.

Once the farmer has it though, he becomes symptomatic very very quickly (cueing everyone else to isolate him and stay away) and he also dies very quickly, both of which sharply limit human-to-human spread, and most of the bird flus suck at doing human-to-human jumps anyway, or are incapable of them entirely. So generally the farmer dies, but that's it.

If one of them ever mutates and develops a long pre-sympomatic shedding period and gets really good at exponential human-to-human spreading, well then gentlemen, it was nice knowing you all.
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teedubbya
6 years ago
updated info all footnoted... the foots are not linked here but I can get any of them. This is pulled from a much larger set of practice protocols.

Investigational agents — A number of investigational agents are being explored for antiviral treatment of COVID-19, and enrollment in clinical trials should be discussed with patients or their proxies. A registry of international clinical trials can be found on the WHO website and at clinicaltrials.gov.

Certain investigational agents have been described in observational series or are being used anecdotally based on in vitro or extrapolated evidence. It is important to acknowledge that there are no controlled data supporting the use of any of these agents, and their efficacy for COVID-19 is unknown.

●Remdesivir – Several randomized trials are underway to evaluate the efficacy of remdesivir for moderate or severe COVID-19 [95]. Remdesivir is a novel nucleotide analogue that has activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro and related coronaviruses (including SARS and MERS-CoV) both in vitro and in animal studies [96,97]. The compassionate use of remdesivir through an investigational new drug application was described in a case report of one of the first patients with COVID-19 in the United States [98]. Any clinical impact of remdesivir on COVID-19 remains unknown.

●Chloroquine/hydroxychloroquine – Both chloroquine and hydroxychloroquine have been reported to inhibit SARS-CoV-2 in vitro, although hydroxychloroquine appears to have more potent antiviral activity [99].

Use of chloroquine is included in treatment guidelines from China's National Health Commission and was reportedly associated with reduced progression of disease and decreased duration of symptoms [100,101]. However, primary data supporting these claims have not been published [102].

Other published clinical data on either of these agents are limited. In an open-label study of 36 patients with COVID-19, use of hydroxychloroquine (200 mg three times per day for 10 days) was associated with a higher rate of undetectable SARS-CoV-2 RNA on nasopharyngeal specimens at day 6 compared with no specific treatment (70 versus 12.5 percent) [103]. In this study, the use of azithromycin in combination with hydroxychloroquine appeared to have additional benefit, but there are methodologic concerns about the control groups for the study, and the biologic basis for using azithromycin in this setting is unclear. (See "Azithromycin (systemic): Drug information".)

Despite the limited clinical data, given the relative safety of short-term use of hydroxychloroquine, the lack of known effective interventions, and the in vitro antiviral activity, some clinicians think it is reasonable to use hydroxychloroquine (or chloroquine) in hospitalized patients with severe or risk for severe infection if they are not eligible for other clinical trials. The possibility of drug toxicity (including QTc prolongation and retinal toxicity) should be considered prior to using hydroxychloroquine, particularly in individuals who may be more susceptible to these effects. Optimal dosing is uncertain; various regimens are being used, including 400 mg twice daily on day 1 then daily for five days, 400 mg twice daily on day 1 then 200 mg twice daily for four days, and 600 mg twice daily on day 1 then 400 mg daily for four days [104].

●Tocilizumab – Treatment guidelines from China's National Health Commission include the IL-6 inhibitor tocilizumab for patients with severe COVID-19 and elevated IL-6 levels; the agent is being evaluated in a clinical trial [105].

●Lopinavir-ritonavir – Lopinavir-ritonavir appears to have little to no role in the treatment of SARS-CoV-2 infection. This combined protease inhibitor, which has primarily been used for HIV infection, has in vitro activity against the SARS-CoV [106] and appears to have some activity against MERS-CoV in animal studies [107]. However, there was no difference in time to clinical improvement or mortality at 28 days in a randomized trial of 199 patients with severe COVID-19 given lopinavir-ritonavir (400/100 mg) twice daily for 14 days in addition to standard care versus those who received standard of care alone [108].

Other interventions of interest but with limited or no clinical data include interferon beta and convalescent serum.
victor809
6 years ago
Interesting. Not necessarily hopeful yet... the Remdesivir sounds interesting... that's the same mechanism as the very functional HepC cure, and some HIV drugs....
teedubbya
6 years ago
I wish I could paste the link or the whole schpeel. It is an excellent well documented source meant to give treatment guidelines and protocols on pretty much everything..... its updated continually
Pudding Mittens
6 years ago

the biologic basis for using azithromycin in this setting is unclear.

teedubbya wrote:



I assume they're referring to the general rule "it's an antibiotic so it can't work against a virus only bacteria" however as I note above, azithromycin appears to be something of an odd, special case among antibiotics.

It's been observed to kill several virii (Zika, Ebola, etc.) in-vitro, and prescribing doctors have noticed for years that it seems to help significantly with viral infections (not just with secondary bacterial infections).

How (the mechanism) is not known, but it's been abundantly noticed over the years. It may be why it's so effective (at least in some places and according to some studies) when combined with hydroxychloroquine.

Great info by the way, thanks for the paste!

As to the question of why hydroxychloroquine + azithromycin works amazingly well in some places, and not at all in other places, I'm starting to wonder if the effect is much more precisely dosage-dependent than are the effect magnitudes of typical medications. Just look at the dosage range being used in the field in that paste above, the dosages are all over the map.

With many drugs, if you give a patient 200mg a day instead of 300mg..... or for another example, maybe 500mg instead of 600mg..... the outcome is pretty much the same. This particular 2-drug combo may be much more highly sensitive to dosage differences however... for example, 600mg a day may cure fully while 400mg does nothing (just to pull numbers out of my ass).

It would explain the wild differences in effectiveness, because the different sites are usually using different doses. It may be simply that small dosage differences cause very large outcome differences.

Gonna be interesting to see what the real answers end up being, months or years from now.
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teedubbya
6 years ago
^ dunno. I trust them though.

Found this interesting. SOmeone was asking me about UV the other day... cant remember who.

Strategies for PPE shortages — Limited availability of personal protective equipment (PPE) has complicated medical care of patients with suspected or documented COVID-19 (and other transmissible conditions) worldwide.

In the United States, the CDC offers guidance on optimizing the supply of PPE when sudden increases in patient volume threaten a facility's PPE capacity [114]. Strategies include canceling non-urgent procedures or visits that would warrant use of PPE, prioritizing the use of certain PPE for the highest risk situations, and cautious extended or limited reuse of PPE.

There has also been interest in decontamination of PPE for reuse, in particular for N95 respirators. Decontamination with ultraviolet (UV) light was evaluated in the context of the H1N1 influenza pandemic; in experimental models, UV irradiation was observed to reduce H1N1 influenza viability on N95 respirator surfaces at doses below the threshold observed to impair the integrity of the respirator [115-117]. Coronaviruses can also be inactivated by UV irradiation, but comparable studies have not been performed with SARS-CoV-2, and the dose needed to inactivate the virus on a respirator surface is unknown. Nebraska Medicine has implemented a protocol for UV irradiation of N95 respirators in the context of the COVID-19 pandemic based on the dose generally needed to inactivate other single-stranded RNA viruses on surfaces [118].

Duke University Health System is using hydrogen peroxide vapor for N95 decontamination [119]. Hydrogen peroxide vapor has been observed to inactivate other single-stranded RNA viruses on environmental surfaces [120,121].

Equipment used for protection in other industries is also being explored as an alternative to standard health care PPE, such as elastometric half-mask respirators in place of N95 respirators [122].
delta1
6 years ago

If you're relying on the .gov to "save" you? Hell, you've lost already. They can't stop anything. Period.

The corruption and lack of actual, functional accountability runs way too deep. Look at their latest response. If it weren't so fucquing sad it would be laughable.

The individual level is the only thing that WILL work. Nobody is responsible for you and yours but you. Folks need to pay attention and accept personal responsibility.

A little more self reliance, self-determination, and awareness would go a long damned way in this country.

USNGunner wrote:



on some levels, I agree...but for this emergency, individualism will not work, because if one member of your small self reliant group gets sick, the entire group could become infected and succumb, especially if it doesn't have access to advanced medical facilities....
teedubbya
6 years ago
In the next hour or so it will kill more Americans than 911.
Pudding Mittens
6 years ago
.
BREAKING: FDA Issues Emergency Authorization for Hydroxychloroquine to be Prescribed to Coronavirus Patients

https://theduran.com/breaking-fda-issues-emergency-authorization-for-hydroxychloroquine-to-be-prescribed-to-coronavirus-patients/ 

Also, the "Dr. Z" I mentioned hearing about in a post above turns out to be Dr. Vladimir Zelenko, and he's treated 699 COVID-19 patients with 100% success using hydroxychloroquine, azithromycin and zinc sulfate:

https://techstartups.com/2020/03/28/dr-vladimir-zelenko-now-treated-699-coronavirus-patients-100-success-using-hydroxychloroquine-sulfate-zinc-z-pak-update/ 

Key quotes:

"Dr. Vladmir Zelenko shares the results of his latest study, which showed that out of his 699 patients treated, zero patients died, zero patients intubated, and four hospitalizations." .... Dr. Zelenko said he saw the symptom of shortness of breath resolved within four to six hours after treatment.


"There are many other success stories about hydroxychloroquine across the country. Last week, Dr. William Grace, an oncologist at Lenox Hill Hospital in New York City, said they’ve not had a single death in their hospital because of hydroxychloroquine. “Thanks to hydroxychloroquine, we have not had a death in our hospital,’ Dr. Grace said."


Go read the whole thing though.
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victor809
6 years ago
I saw the FDA release an hour ago or so.
No real new information in it, just "authorized" for use. They're already doing so.

As for the Dr. Zelenko stuff.... there's a LOT about what's in that which I simply cannot trust.
It's not a study... He calls it one. But really he's just treated a bunch of his patients with the drugs. There's zero controls... No results testing other than "shortness of breath after 4-6 hours".

I suspect that we'll find out after the fact that there's no impact at all from the drugs.
delta1
6 years ago
as long as it does no harm, shows positive outcomes and can be produced in large enough quantities to satisfy the needs of all the other non-COVID 19 patients who really need it, I welcome it...


maybe it'll prove to be the "biggest game changer in the history of medicine" Trump hoped it would be...
victor809
6 years ago

as long as it does no harm, shows positive outcomes and can be produced in large enough quantities to satisfy the needs of all the other non-COVID 19 patients who really need it, I welcome it...


maybe it'll prove to be the "biggest game changer in the history of medicine" Trump hoped it would be...

delta1 wrote:



maybe.
without our own pool of infected patients, a blinding protocol and PCR machine, we're just guessing.
teedubbya
6 years ago
The fda release was out earlier today. Doesn’t change anything g really.
delta1
6 years ago
#515 ^

we're gonna have ample opportunity to do that...the vaccine is at least 12 months away and nothing else seems to work with any degree of certainty...
teedubbya
6 years ago
It’s Desperation move that’s happening anyway.
delta1
6 years ago
if it was me or a family member on the ventilator, and they asked me if I'd like to try it....yep I would...
teedubbya
6 years ago
I’m not saying differently. I’d take a tick tac if it would work.
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