Posted on 04/07/2020 6:51:15 AM PDT by Liberty7732
by Julio Gonzalez, M.D., J.D.
A controversy has arisen regarding the utility of using chloroquine or hydroxychloroquine with azithromycin in the prevention and treatment of COVID-19.
On the one hand, there are the purists who maintain that these medications ought not be employed until the proof of their benefits has been established. On the other, some advocate for the aggressive and immediate deployment of these medications. With these two very valid competing arguments proffered by sophisticated scientists and healthcare providers, the question for the rest of us mere mortals is what should we do?
The first step in addressing this question is to evaluate the state of the literature on the topic. An early indication that hydroxychloroquine or chloroquine in combination with azithromycin could be helpful in the treatment of CORVID-19 infection comes from a randomly controlled study from France involving 40 patients with early infection. All patients in the experimental group improved and did better than those in the placebo group, except for one who was 86 years old and received the medicines in an “advanced form” of the disease.
But the study suffered from its small size and lack of a peer review process.
Other studies seemed to support the French conclusion. In the laboratory, evidence demonstrates that chloroquine helps defeat the virus by increasing a cell’s internal pH and interfering with the penetration of the virus into the cell. Another study, this time out of China, showed the effectiveness of chloroquine and another medication, Remdesevir, against the SARS-CoV-2 virus (the COVID-19 virus) in Vero E6 cells taken from African green monkeys. Yet another preliminary study out of Wuhan showed that the time to clinical recovery, body temperature recovery time, and cough remission time were shorter in patients treated with hydroxychloroquine than in untreated controls.
There’s also experiential evidence suggesting that people who take chloroquine or hydroxychloroquine in low doses may be prevented from even developing the disease. Additionally, informally reported observations find that patients who regularly take these medications for other conditions such as lupus are generally not contracting COVID-19.
But conflicting scientific information has also emerged. One study suggests no benefit to the administration of hydroxychloroquine and azithromycin in patients with severe infection. The severe nature of the infections in these patients is notable, as it appears that the damage to the body goes beyond what an antibiotic can improve.
In light of all this emerging information regarding the potential benefits of administering the drugs it is tempting to conclude that we should treat all COVID-19 patients with these medications. But what about the potential harm? Here, there is extensive evidence of the safety of taking chloroquine and hydroxychloroquine. Yes, either medication can cause retinopathy and changes in heart electrophysiology, but these effects are exceedingly rare and take place in patients who consume the medication at higher doses and for much more protracted periods of time. In reality, the use of hydroxychloroquine or chloroquine in the recommended doses and projected administration times for COVID-19 is very safe.
So should we be taking chloroquine or hydroxychloroquine? Well, the answer actually comes in three packets.
• First, with the data available, those patients in respiratory failure ought definitely be treated with a regimen of chloroquine or hydroxychloroquine and azithromycin. They should also be placed on Remdesevir. These patients, of course, are generally being treated in the intensive care unit setting, and the optimal management controversy does not apply to the general public.
• Second, for those patients who are not in respiratory failure, but are nevertheless infected with COVID-19, the more proper approach is one of drug administration. Although treatment should be undertaken under physician supervision, there is little question that the balance between risk and benefit strongly lands in favor of benefit, especially when one considers the potential imminence of patient demise.
• Third, there is the question of preventive treatment or prophylaxis. Here again, there is a strong suggestion of benefit and a very remote risk of harm particularly when one considers the exceedingly low doses required for prevention. The conflict here lies in supply. Do we have enough chloroquine and hydroxychloroquine to meet the demands from such a broad swath of the population? Ideally, it would be preferable that everyone takes one of these medications, but in light of supply limitations, at the very least, those coming into frequent contact with COVID-19 patients and elderly persons should be on a prophylactic dose.
What about those on chronic regimens of these medications? Should they be kept from accessing chloroquine or hydroxychloroquine as many in the media claim is taking place? They shouldn’t. But even in light of temporary shortages, the prophylactic use of these medications should still be considered.
Let’s face it. We are looking at a massive pandemic that is devastating the national economy and able to take some victims with great haste. A short-term interruption of treatment on chronic patients is generally not going to result in their rapid demise, but the contraction of COVID-19 may. Here, urgency considerations definitely fall on the side of the COVID-19 patient and its prevention.
In the end, these are prescription medications so the decisions for administration or not lie with the physician. Ultimately, each physician is going to have to make up his or her mind. However, although there is still some room for debate, the answer presently is falling on the side of administering rather than withholding these potentially life-saving medicines.
What he doesn’t mention is an adverse interaction possibly indicated between HCQ and Metformin.
A major concern of mine and it should be run to ground immediately.
If we would have fought WW2 like some intend on fighting this virus, we would be speaking German or Japanese today.
Compassionate use
A patient should be able to have their doc administer what looks to be our best hope
I wish he had mentioned zinc as well.
Going to point that out myself.
Every hack wants to get in on the game.
If you develop fever and a dry cough, you would be a fool not to take hydroxychloroquine/Zithromax even before you developed shortness of breath. Once you have demonstrable pneumonia, the effectiveness of the regimen diminishes greatly. That is why it will be so difficult to ascertain in retrospective studies the merit of the regimen. It will be difficult to ascertain just at what stage the patient was at when the regimen was started. That is why it is so harmful that these governors have put obstacles or prevented primary care physicians from using their best medical judgement and prescribing these drugs in a timely manner.
Key bullshit:
The severe nature of the infections in these patients is notable, as it appears that the damage to the body goes beyond what an antibiotic can improve.
If you are put on a ventilator, your chances of survival are only around 30%. I’d want to chance the medication.
Without zinc, the study is flawed
It took six months after Pearl Harbor to even get the situation semi-stabilized, and another six months to make losing seem less likely.
The genetic sequence of SARS-CoV-2 was published on January 9 of this very year.
The RCT that was done in Hubei China seemed to have been a valid protocol and was conclusive that HCQ reduced the Time to Critical Recovery (TTCR) and incidence of pneumonia in all the treated patients. It was a small cohort of 64 patients (32 in the drug arm and 32 in the placebo) but the results were statistically significant in that 85% of the treated patients showed a reduction in virus load after 5 days compared to only 54% of the untreated patients. No treated patients had to be hospitalized while 4 of the untreated were hospitalized and 1 died.
The contrary studies that I’ve seen were done on patients that were very sick with an overwhelming virus load. The key benefit may be realized by getting HCG early before the immune system is overloaded. Raoult in France cites this as why he considers doing RCTs on very sick people to be unethical. Observational studies can still be valid with a large enough sample to eliminate systemic biases but the analysis is not as conclusive as an RCT.
"But conflicting scientific information has also emerged. One study suggests no benefit to the administration of hydroxychloroquine and azithromycin in patients with severe infection. The severe nature of the infections in these patients is notable, as it appears that the damage to the body goes beyond what an antibiotic can improve."
These guys aren't "scientists", they're idiots!
From what I’ve read, the HCQ acts as an ‘ionophore’ that helps get the zinc into the cells and prevents the virus from replicating. Seems you need zinc to be ions to get into the cells and the HCQ does that. The azithromycin I guess, being an antibiotic, attacks secondary bacteria like pneumonia. Hard to research on google when all they want to talk about is Trump non-medical opinion and Trump has $3K in the drug company stock through a mutual fund in a trust. (He donates his $400K salary every year.) The news media is dead.
Every remedy,solution,helpful advice and directive etc is shut down by the left if it interferes with their crisis. The economy needs to be in flames and body bags filled! These scum are ghouls!
Yes, without Zinc, so what?
YOUTUBE Thousands of doctors agree hydroxychloroquine is best treatment for coronavirus patients
The Democrats led by Dr. Fauci are working overtime to shutdown Trump's MIRACLE DRUG COMBO. Democrat Governors in NY, Mich, and Nevada have made it illegal to use the drug combo.
By putting resistance to Trump's Drug Combination, the Democrats have guaranteed four more years. And if they are fully exposed, it will be a landslide in November.
Nanzi Pelosi will be on suicide watch. Her son made $millions in Ukraine as she probably did too. The RATS cannot afford to have investigations into their corruption in Ukraine and China.
Four more years guarantees investigations will be done.
Read previous post to this. It’s only a guess, but from what I’ve been reading, it seems like the HCQ main function is to help zinc get into cells and prevent the virus from replicating. But I’m no doctor, just what I’ve read.
Guessing is bad. The azithromycin has antiviral properties by increasing production of interferons and interferon-stimulated genes. That effect is a bad thing for the virus.
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