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link)
As you may be aware, health-care providers across the country and around the world have reported great success in using Hydroxychloroquine + Zinc + Azithromycin (the “HCQ cocktail”) to treat COVID-19. According to these physicians and researchers, the key to success is to use the HCQ cocktail within the first seven days after onset of COVID-19 symptoms.
Nevertheless, ever since President Trump endorsed Hydroxychloroquine (HCQ), its use has become a highly politicized and controversial matter. The opposition to HCQ started with Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases. At the same press conference that the president first expressed hope about using HCQ to treat COVID-19, Dr. Fauci challenged its effectiveness and stated that he would not take it outside the confines of a clinical trial.
Since then the opposition to HCQ has increased even to the point where it is almost impossible to find physicians willing to prescribe it and pharmacies willing to provide it.
Three practicing physicians have published the following
“Open letter to Dr. Anthony Fauci regarding the use of Hydroxychloroquine for treating COVID-19.” It is a devastating written cross-examination of Dr. Fauci that contains much valuable life-saving information and squarely addresses the needless deaths that have occurred due to the opposition to the HCQ cocktail.
Comments
https://bbc.com/news/53601027
https://nature.com/articles/s41419-020-2721-8
Would it not have been easier for you to direct these folks to the off-topic M* forum where 294 posts have been devoted to this subject, including your repost of norbi's article?
While Trump himself was the one who politicized the matter, you might want to read what the FDA had to say.
https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-revokes-emergency-use-authorization-chloroquine-and
And, as Carlos told you:
"Most of them (doctors) will not prescribe it since they follow science. However, if you shop long enough you will find someone, like the infamous DNA Texas doctor that will do it."
https://www.washingtonpost.com/technology/2020/07/28/stella-immanuel-hydroxychloroquine-video-trump-americas-frontline-doctors/
Since Dr. Risch published in The American Journal of Epidemiology look there first to see the responses to his work. Links are on the right side of the page.
There's at least one more positive paper from a US source out there from the Henry Ford health system, and published in The International Journal of Infectious Diseases.
I haven't read it yet. This will be going on for a while. Probably years.
Now the question I ask myself is "I wonder what Dr. Risch, and the Docs from Henry Ford, think about the science behind global warming?" Would anyone change their mind if they said it was the real deal?
https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or
https://www.fda.gov/media/138946/download
Thank you for the link.
there are two retrospective (= not scientifically so strong, ... but it's a plague) studies the last couple days which look promising, so perhaps new attention will be turned toward hcq in combos
see todaro initial post for this thread
https://twitter.com/JamesTodaroMD/status/1299005625507209217
otoh this systemic / meta review (also not as strong as desirable) is a counter:
https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30505-X/fulltext
The Hydroxychlorquine (HCQ) controversy all over the internet shows a lack of understanding of how decisions about the use of potentially harmful medical treatments need to be made, using data from Randomized Controlled Trials (RCT).
Glasziou PP. A deluge of poor quality research is sabotaging an effective evidence based response. BMJ. 2020;369 m1847.
https://www.bmj.com/content/369/bmj.m1847
As of today, I found five RCT of HCQ available. Four are published after peer review. None demonstrates a benefit to HCQ in hospitalized or outpatients, or exposed people and it can be harmful and deadly. All of these studies show significant side effects.
https://www.nejm.org/doi/full/10.1056/NEJMoa2019014
https://www.nejm.org/doi/full/10.1056/NEJMoa2016638
https://www.recoverytrial.net/news/statement-from-the-chief-investigators-of-the-randomised-evaluation-of-covid-19-therapy-recovery-trial-on-hydroxychloroquine-5-june-2020-no-clinical-benefit-from-use-of-hydroxychloroquine-in-hospitalised-patients-with-covid-19
https://www.bmj.com/content/369/bmj.m1849.full
https://pubmed.ncbi.nlm.nih.gov/32674126/
Anyone who wants to find these studies in the future just needs to go to "PUBMED" (the NIH database )
https://pubmed.ncbi.nlm.nih.gov
and search " covid randomized controlled trial hydroxychloroquine" Today there are 68 references, most of them protocols stating that a new trial is underway but not finished. Read a couple of these protocols to see how science is done to protect patients and provide effective treatments.
https://pubmed.ncbi.nlm.nih.gov/?term=covid randomised controlled trial hydroxychloroquine
I am amazed that a reputable journal published Risch's paper, and the criticism later published shows why. One of the five studies (in addition to the Trump favorite from Italy that was later deemed "Fully irresponsible" by the same journal that published it) Risch uses is the worst excuse for "science" I have ever seen. He quotes a letter from a family practitioner in New York who says he gave over a thousand patients HCQ and Azthromycin and Zinc if they had shortness of breath, cough, diarrhea or muscle aches (no definitions). These symptoms told him that they could have Covid. He claims it is effective because only two people died. There is no data on any of the patients, methods, or how he determined that only two people died.
https://docs.google.com/document/d/1pjgHlqI-ZuKOziN3txQsN5zz62v3K043pR3DdhEmcos
Yet Risch claims that this study shows a benefit to HCQ because fewer people died than the expected 20% Covid deaths seen in Connecticut. He doesn't mention that 70% of CT Covid deaths were in nursing homes and the family practitioner had no nursing home patients.
I hope none of us would get on an airplane if it's safety to fly had not been rigorously and scientifically tested. We should use the same standards for our health care especially in a pandemic.
tyvm
did you take a look at the Todaro links?
indeed from the results
“Patients receiving HCQ were more likely younger, men and had higher levels of C-reactive protein and less likely had ischemic heart disease, cancer or stages 3a or greater chronic kidney disease (Table 1). Patients receiving HCQ more likely received another drug for COVID-19 treatment (78.4%; lopinavir/ritonavir or darunavir/cobicistat, remdesevir, tocilizumab or sarilumab, corticosteroids), in comparison with non-HCQ patients (46.3%; P<0.0001;
41% of non HCQ pts are categorized as Severe pneumonia vs 13% of HCQ, although it is not clear if this was on admission or at anytime during hospitalization.
( This is why a prospective randomized trial is so important. the groups have to be similar. Corticosteroids are the only treatment that clearly has a major benefit in severe Covid)
“ However, the observed associations should be considered with caution, as the observational design of our study does not allow to fully excluding the possibility of residual confounders. Large randomized clinical trials in well-defined geographical and socio-economic conditions and in well-characterized COVID-19 patients, should evaluate the role of HCQ before any firm conclusion can be reached regarding a potential benefit of this drug in patients with COVID-19.”
The July 23 NEJM study I linked to above 2019104 was a RCT in hospitalized patients with moderate Covid that found no difference. I dont want to sound biased but NEJM is far more scientifically rigorous journal than European J Int Med, and probably the reason the RCT was published there. It is a better study.
Remdesevir's benefit in severe covid does not qualify as major, I suppose (so far as is known now).
*Hydroxychloroquine not effective as postexposure prophylaxis for COVID-19 (June 2020)
Clinical trials are evaluating postexposure prophylaxis to prevent COVID-19. Hydroxychloroquine was a primary candidate, but available data suggest it is not effective in preventing infection. In a placebo-controlled, double-blind trial of 821 individuals with occupational or household exposure to SARS-CoV-2, hydroxychloroquine administered within four days did not reduce the rate of PCR-confirmed COVID-19 or symptoms consistent with COVID-19 over the subsequent 14 days compared with placebo (12 versus 14 percent) [1]. A number of limitations reduce confidence in the findings. Nevertheless, we recommend that hydroxychloroquine not be used for post-exposure prophylaxis to prevent COVID-19 outside of a clinical trial. (See "Coronavirus disease 2019 (COVID-19): Epidemiology, virology, and prevention", section on 'Post-exposure prophylaxis'.)
WHO recommendations on mask wearing in the community in the context of COVID-19 (April 2020)
National recommendations on community use of face masks in the context of the COVID-19 pandemic vary across countries. In June 2020, the World Health Organization updated its recommendations to encourage individuals in areas with substantial community transmission of SARS-CoV-2 to wear a mask in public settings where social distancing is difficult to achieve [1]. Clinicians should emphasize that wearing a mask does not diminish the importance of other preventive measures, such as social distancing and hand hygiene (including before and after handling the mask). In the United States, recommendations from the Centers for Disease Control and Prevention on wearing masks in the community are similar [2]. (See "Coronavirus disease 2019 (COVID-19): Epidemiology, virology, and prevention", section on 'Personal preventive measures'.)*
Imho
Uptodate is the source I trust the most. Nonbiased, heavily back up science/data, 80s% of health care providers rely on this source. For c19, it is a virus, so far nothing seem to work, just support care and maybe plasmas transfusions reserved for sickest patients. Even the new wonderful extremely expensive drug demisivor (they must spentt a fortune wine and dine the WHO team becayse it still listed as an effectivedrug-) recent articles also find these drugs non-functional... the realities are once you have a dying patients you may need to throw a kitchen sink at this patient to prevent deaths
We work in an institution that teach many new medical personnels/residents/ students, from chart reviews they dont use hcq as first line - data are weak.
In 6 months - few years we may know more
1) I read several links but non talks about all 3 = Hydroxychloroquine + Zinc + Azithromycin (the “HCQ cocktail”) to treat COVID-19
2) The “HCQ cocktail” is only effective in the early days. When the situation gets worse, it's too late. It sounds as the “HCQ cocktail” may be an option before you get to the hospital
3) The daily death count is at the high and in the last several weeks about the same (link). Looks like the only real solution is washing hand + social distancing but not medical. Maybe it's that easy but still difficult to explain how Thailand+Vietnam with population of 70+95 millions and living very closely have hardly any deaths. Total deaths from the start Thailand=58. Vietnam=32.
(link)Some answers: "While there is more to learn about the disease and deaths, some experts speculate that Vietnam’s extremely low obesity rate, combined with its young population (the median age in Vietnam is 30.5, only 6.9 percent of the population is over 65, and the median COVID-19 patient age is 29),23 have contributed to better COVID-19 outcomes"
But Japan with pop=125 million had only 1235 death have median age of 48 while US is at 38 but US is by far the highest (link)
4) When to Go to the ER
Go to the hospital if you experience symptoms of any life-threatening illnesses, not just for symptoms of coronavirus.
Symptoms of a Medical Emergency
Symptoms that may indicate a life-threatening emergency include:
Difficulty breathing, shortness of breath
Chest or upper abdominal pain or pressure
Fainting, sudden dizziness or weakness
Changes in vision
Confusion or changes in mental status
Any sudden or severe pain
Uncontrolled bleeding
Severe or persistent vomiting or diarrhea
Coughing or vomiting blood
Difficulty speaking
If everybody will follow the above the ER would not be able to handle it.
Example: I'm older than 60 and healthy. 2 weeks ago I get severe headache on the weekend and it doesn't go away within hours. I contact my Dr, he tells me to go to the ER. After 1 day I tell my wife let's think what has changed in the last several days, she reminded me that I saw the dentist, and he filled a cavity, and she remembers that it may affect the sinusitis. Right away I start taking a simple decongestant and feel better. I called the dentist on Monday, he prescribed antibiotic, problem solved.
Glad you have access to UPTODATE.COM I have relied on it for years for accurate, scientific based answers to almost all medical questions. It is expensive though, as Elsevier bought it and raised the price considerably. One of the advantages is you can share articles with anyone, and give them a one month free trial
@FD100
1) Not much data on Zinc. Lots of speculation, but people have advocated Zinc for almost every disease know to man for years without much data. Almost all of the articles are in the nutritional literature or in obscure and probably unreliable journals. I thought the big retrospective trial in NYC hospitals included it but no. I did find this one. Pretty small and not much help
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375307/
2) As I said before I do not think there is any data on HCQ that supports using it in any situation. Young people probably will not be harmed but older patients can get fatal cardiac arrhythmia, especially with Zithromycin. Unfortunately people who do need it for Lupus and Rheumatoid Arthritis have had a lot of trouble getting it thanks to this unscientific hoopla.
3) There are lots of countries whose response is far far better than the US with 25% of the cases and 4% of the worlds population.
Even now, there are immediate steps that the government can take to shut down local outbreaks. The Chinese have learned this recently in Beijing
https://jamanetwork.com/journals/jama/fullarticle/2769930?resultClick=1
4) the symptoms you list should prompt an immediate call for medical care, Covid or not. Unfortunately, primary care has been destroyed by low reimbursement, electronic medical records and ridiculous medical student debt so most people do not have a primary care internist like me to call day or night. After 40 years there was not a lot I couldn't handle on the phone with a good history, but patients still went to the ER anyway without calling me first
One thing that has not gotten much attention is "Not everything is Covid".
My brother in law's brother developed fever cough aches. Hospital told him "you got Covid don't come here". He got worse, went to Covid clinic had two neg tests CT scan and told he had regular pneumonia. Routine antibiotics didnt' help.
Finally admitted, three more neg Covid tests IV antibiotics. Still getting worse Oxygen dropping and he asked MD if it could be related to feral cats he fed at home. BINGO he had murine Typhus, which is endemic in Galveston where he lives carried by cat fleas. But everybody assumed he had covid so didn't ask the important questions.
The guy in Dallas who died of Ebola was victim of the same lack of comprehensive approach. The nurse actually documented his West African origins, but MD never saw it (nor did he notice his accent was not Texan, I guess) because it was buried in the electronic medical record along with his sexual preference, gender identity, reams of insurance junk and everything else hospitals have to document now to get paid.
My own primary care doctor for 30 years, considered by many surveys of SF doctors to be one of the best primary care guys in the city, also retired because of the reasons that you've mentioned. My present primary care is pathetic- just another "go to the emergency room" robot in the Sutter system.
Uptodate is pricy now for sure, but everyone here should be aware, if not already, of the various Harvard health newsletters (https://www.health.harvard.edu/newsletters), plus Mayoclinic and Webmd and Healthline.
https://www.refseek.com/directory/health_medical.html
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