1. Hydroxychloroquine (HCQ) Update
It is my observation that there is now a broad consensus in the practicing medical community that, while it is not perfect, HCQ IS EFFECTIVE. I have written numerous Facebook posts in this regard with references: primarily a placebo-controlled study from China, and the study of 1000 patients by world-renowned infectious disease specialist Didier Raoult MD, PhD of Marseille France.
In addition, doctors from numerous countries such as India and Jordan recommend its routine use for their COVID-19 patients based on the recommendations of their medical experts. The noted New Jersey infectious disease specialist Stephen Smith firmly believes in it and has said so repeatedly in the media. And I just got off the phone with one of the most accomplished infectious disease specialists in Chicago who said there is no question that it works and that all the doctors in their large group feel the same way. This doctor also bemoaned the politicization of hydroxychloroquine use: that the advocacy of hydroxychloroquine is now synonymized with the advocacy of President Trump. Politics has no place in the practice of medicine. It Is inexcusable to oppose a life-saving drug because President Trump supports it.
In a recent development, Dr. Vladimír Zelenko from Orange County New Jersey has found that all 500 of his patients with respiratory symptoms treated early with a combination of hydroxychloroquine, Azithramycin, and Zinc recovered without hospitalization or respirator use; and there were no fatalities. Nor were there significant side effects, cardiac or otherwise, from drug usage.
I should also point out that any physician is free to prescribe hydroxychloroquine for COVID-19. I read that pharmacists are not allowed to fill the drug for COVID-19 since it is an off-label indication. This is not true. There may be state prohibitions still in place as there were in New York and Michigan, but not Illinois. But any physician is free to prescribe it and pharmacists are not prevented by the FDA from filling these prescriptions because it is an off-label use.
2. Remdesivir
This Ebola drug which blocks interleukin six has shown promise but to my knowledge, it is not clear either from studies or overwhelming anecdotal evidence that it is clearly effective.
3. Actemra
This is another drug that blocks interleukin six, seeking to mitigate cytokine storm. Again there is promising preliminary evidence but no definitive studies nor overwhelming anecdotal evidence of efficacy to my knowledge.
4. Plasma Treatment
The plasma of recovered infected COVID-19 patients has been shown to be an effective treatment for other patients currently ill with the virus from many fronts around the world as well as in the United States at the Mayo Clinic and elsewhere. One of the best reports has come from China. It has been clear for weeks that the treatment is effective, and there was much precedent for this kind of treatment going back 100 years or more, including saving lives in the Spanish flu epidemic 100 years ago. It is a mystery to me why plasma treatment is not more widespread now.
5. Should We be Wearing Face Masks?
I do, and I think it is advisable. I clean and re-cycle my face masks. Here are instructions on how this can be done. They seem to hold up well. I clean the mask at night and do not wear it again for several days. Alcohol and hydrogen peroxide are effective, but ammonia is not. UV light is best but generally not available. Be warned that this is a controversial practice and some advocate against it. I use a simple normally re-usable surgical face mask, not the ND 95. But in a time of shortage, I feel it is important to stretch out my usage of supplies so that others can be supplied
6. Respirators/Proning
Some now think respirators increase mortality. This is controversial, but if I were ill I would try to get by without one as long as safe. Lying prone, “proning” has also been shown to be helpful. So far essentially everyone who has needed a respirator has had one, and it appears that will continue.
7. Outdoor Exercise
Congregating in a group is bad and should not be done. Solitary outdoor exercise, walking-running-biking is good and should be done. The Spanish flu taught us this. People were healthier when they got outdoors. Exercise in and of itself is health-giving and modulates the immune response which may also be helpful for COVID-19. There is no excuse for politicians telling people not to exercise outdoors in a SOLITARY DISTANCED fashion.
8. Testing
Is the key to reopening the economy. Happily, President Trump is aggressively cutting red tape to make testing widely available quickly.
9. Does Reinfection Occur
COVID-19 infection imparts immunity in general. I have seen this questioned recently but I know of no evidence that COVID-19 reinfection occurs. The best interpretations I have seen are that the cases of reinfection are most likely due to inaccurate tests. Many from China in particular have been shown to be defective.
10. The Vaccine
This has turned out to be quite controversial. What is clear is that it will be a long time before it is widely available and proven and that waiting for a vaccine to reopen society is not an option. It is my opinion that we will be able to open up the economy as treatments are proven so that a diagnosis of COVID-19 can hopefully have its fatality rate reduced to or near to that of influenza.
11. The Worst is Behind Us
There is now consensus that this is true. With continued vigilance, it should also be the case that our health system should be able to handle the ongoing COVID-19 burden. The real fear has always been inadequate health care capacity so that some would die needlessly. These dangers appear to have been averted. Although continued precautions are still necessary.
DOES REINFECTION OCCUR: COVID-19 infection imparts immunity in general. I have seen this questioned recently but I know of no evidence that COVID-19 reinfection occurs. The best interpretations I have seen are that the cases of reinfection are most likely due to inaccurate tests. Many from China in particular have been shown to be defective. (REF)
12. Your Rights
As I wrote last week you, the patient, have the right to be involved in decisions regarding your health and you should exercise that right. Whether it is about hydroxychloroquine, another drug, whether to be turned prone or put on a respirator or not – your course of care should be the result of a shared dialogue with your physician.
13. The Future
The key in my opinion is refining treatment. It is clear that many treatments are at least somewhat effective. If we are able to refine treatment so that COVID-19 is no more deadly than a traditional flu for most citizens, which I believe is possible, then if a new wave occurs the implications would be far less grave. We would need to protect the most vulnerable, but not shut down society for the rest. If they did become ill it is hoped that early intervention with refined treatment would preclude the need for the drastic measures we have had to take at present.