triplehorn

Japanese flu drug 'clearly effective' in treating coronavirus, says China Any hopeful news is welcome. This might be useful as part of a cocktail. Also keeping an eye out for any treatment responsive meds that extrapolate to having prophylactic properties.

I'm an optimist even when it's beyond shitty. You push hard and find the best solutions even when you know there are limits to what you can do. You can't necessarily anticipate when you do strike a surprise breakthrough. For example, right now re chloroquine phosphate and hydroxychloroquine, I think a regimen of prophylactic use or immediate use upon a positive test before severe complications arise could be a major boost to mitigation hiding in plain sight. Most of the Chinese, SoKo, and Italian reports related to initiating it after people have complicated pneumonia. And if by chance we find there's an application in that context, we direct available supplies first to our health care providers on the front line for them to take.

Spain 100 ---> 10,000 in 2 weeks. If we were at about 4000-5000 over last 48 hours when we started piecemeal shutdowns, ----> likely minimum 500,000 2 weeks from now, ~50k hospitalized. US has 46k ICU beds total.

I’m not talking evidence based, ie controlled studies. It will involve recording data and searching for correlations and using week to week shared observations of treatments and outcomes as a guide. A number of clinical papers are now emerging from China that we should be looking at closely. After their coronavirus blizzard in Jan/Feb they now have some valuable information coming out. Realize also that even though their rate of new cases dropped in early Feb, they have still been stuck managing 10’s thousands of unrecovered patients over the last month. So the learning curve is still steep right now even for China.

I think over the next 6 weeks or so we’re also going to see an emerging medical consensus on best recommendations and practices for preventing and managing acute cases. Specifically I expect significant progress in determining when and how to use various med cocktails. This also should involve international data and results sharing. If we can blunt the morbidity and mortality significantly, then preventing infection doesn’t have to necessitate crippling societal closures and distancing. There will be a trend towards a compromise similar to the one we have with influenza.

Think of swallowing a zinc supplement tablet vs using a zinc throat lozenge as similar to taking an oral steroid vs. getting a localized steroid injection. In some cases you want the zinc (or steroid) to target a limited area quickly and don't need it to hit the whole body. Normally we think of hitting a virus in the throat where it's attacking. This coronavirus is infecting cells that bear the ACE2 receptor, and we know that's not limited to the respiratory tract. Publications are already showing this virus attacking gut lining and causing limited nausea, vomiting, and diarrhea in about half the cases in one report out of China. Those symptoms reportedly happen at the start and then respiratory symptoms follow in shortly after. JMO, supplementing with oral zinc is probably best as a pre-emptive measure you should do well before you get infected. It needs some time to distribute and equilibrate throughout your entire body and then find its way inside healthy cells. Getting into cells, which is where it is thought to help shut down viral replication, is the rate limiting step (zinc has a positive electrical charge and cell membrane is lipid, i.e "oil and water"). But if you take oral zinc over days in advance, in principle you will slowly drive up or at least optimize intracellular zinc concentration throughout your body, which is the goal. In vitro studies have shown that Chloroquine in a zinc ionophore. That means Chloroquine grabs zinc. Chloroquine crosses the cell membrane far more easily than zinc alone. So Chloroquine is thought to carry zinc into cells and quickly increase zinc levels inside cells to have an antiviral effect. Again, no controlled human studies to demonstrate this. China and other countries are reporting positive results. Here's an article about a guy in NJ with covid who contacted Chinese docs in China to tell his US docs how to help. They gave him choroquine: New Jersey patient James Cai recovering from coronavirus If you have chloroquine on hand, you may not even need to supplement with zinc as typical zinc levels in people are adequate to boost intracellular zinc levels with addition of choroquine.

The sooner we understand the dimensions of this bug well enough to significantly reduce morbidity and mortality in the minority of people who have a complicated course, the sooner we can return to normalcy while acknowledging that there will always be some risk factors we can't modify, like old age. At that point, the risks could more resemble the risks of getting influenza. I suppose it's conceivable we already have the tools to accomplish that, we just don't yet have an integrated medical consensus for diagnosis and treatment of the full spectrum of the illness and complications. It's also conceivable we could make major progress there well before a widely used vaccine is available.

A good lay explanation of the role of an overactive immune system aka cytokine storm, how it relates to coronavirus, and existing interventions: How doctors can potentially significantly reduce the number of deaths from Covid-19 We already have medicines for treating cytokine storm syndrome, the immune response that’s killing many who die of Covid-19. The link that disappeared above (which was not a scientific article) mentioned something about an autoimmune component with this coronavirus involving antibodies against the covid surface "S" spike which also cross-react with a similar antigen on the surface of healthy cells. I haven't seen anything to substantiate that.

Acutely mentally ill and addicts kicking are going to be having a hell of a time with this. Should be easier to spot though.

this would we most welcome if true:

your're on your own. do more. not my problem.

----> "There, doctors diagnosed him with the flu and prescribed him Tamiflu, the steroid prednisone and codeine cough syrup. Heaven Frilot said her husband immediately started taking the medications, but he got worse. When his nightly fevers wouldn’t break, though he was alternating Tylenol and Advil, he called the doctor back. He was prescribed both Immunosuppressive steroids and NSAIDS. Potentially a dire double whammy on top of Covid-19 infection.

Yeah, it's only an initially observed association without any established cause and effect. But the world is adjusting on the fly right now. These kinds of timely initial observations can later prove to be extremely important. With cases over 65y/o, there are probably multiple contributing risk factors for bad complications/outcomes. Since risk factors are comparatively limited for young people, for this NSAID association to jump out in young people, it might be sharply narrowing the focus. It very well could be that not taking NSAIDS has a similar risk reducing effect for 65+ y/o though other risk factors may not be so easily overcome. For the immediate short term, I'd pass it along to avoid all NSAIDS unless a prescribing physician tells you the risks of not taking them outweigh the unknowns.

Bet any kids in Singapore school are all wearing masks.

Heads up that German and French docs apparently are seeing an association between taking NSAIDS and having a complicated course of Covid-19. This appears to be the case association particularly in the young people with the illness. So maybe avoid all NSAIDS (aspirin, ibuprofen, naproxen, etc.). Ask your prescriber first before stopping if you take it for prescribed purposes.

I don't like posting unofficial medical related stuff, but the NSAIDS/Covid-19 worsened course to complications association seems to be getting some traction. If you don't need to take them and are facing exposure (basically all of us) seems reasonable to consider avoiding them right now:

This appears on PubMed re Chloroquine for Covid-19

got it. i wasn't promoting it.

Re that “holding your breath for 10 sec” deal, I came across this (no idea if this is legitimate or not): From member of the Stanford hospital board. This is their feedback for now on Corona virus: The new Coronavirus may not show sign of infection for many days. How can one know if he/she is infected? By the time they have fever and/or cough and go to the hospital, the lung is usually 50% Fibrosis and it's too late. Taiwan experts provide a simple self-check that we can do every morning. Take a deep breath and hold your breath for more than 10 seconds. If you complete it successfully without coughing, without discomfort, stiffness or tightness, etc., it proves there is no Fibrosis in the lungs, basically indicates no infection. In critical time, please self-check every morning in an environment with clean air. Serious excellent advice by Japanese doctors treating COVID-19 cases: Everyone should ensure your mouth & throat are moist, never dry. Take a few sips of water every 15 minutes at least. Why? Even if the virus gets into your mouth, drinking water or other liquids will wash them down through your throat and into the stomach. Once there, your stomach acid will kill all the virus. If you don't drink enough water more regularly, the virus can enter your windpipe and into the lungs. That's very dangerous. Please send and share this with family and friends. Take care everyone and may the world recover from this Coronavirus soon." To the extent the above is accurate, it sounds like the pneumonia phase happens several days after the fever breaks and in part involves an immune response run amok where antibodies confuse lung tissue with virus and cause fibrosis. This doesn’t happen to everyone but is a main contributing reason people are hospitalized and need ventilation. So it stands to reason a lot of people WILL get and have Covid-19, but not the complicated pneumonia as demonstrated by passing the lung inhalation test. So don’t be misled and be in a position to potentially spread it. At least that’s how I read it. It could be the lung test fails earlier in the onset when fever starts, don’t know.

Related to the tweet just above about a possible association between NSAIDS and young patients w Covid-19 who need ICU level of care, I wonder how much that affects older patients who seem so vulnerable? I’d think on average more older folks would be taking aspirin, ibuprofen, naproxen etc. for general aches and pains from aging joints, not to mention aspirin for vascular protective purposes. NSAIDS May cause upregulation of ACE2 cell surface receptors ? That’s like making a can’t miss rapid hit target for a virus, and lots of targets for lots of viruses all at once - potentially a dangerous accelerant for the infection from the start. i have an allergy to NSAIDS, so maybe it cuts both ways for once.

I think they mean immunosuppressive steroids.

We're going to be hearing contradictory information and assertions that ultimately will be found to not be valid. So don't take anything to the bank. The comments to this contain some compelling thoughts: Sinclair again with more on Chloroquine and Covid-19 (mixed/contradictory). Also interesting info in the comments: The comment about Cloroquine being most effective in the early initial stages of Covid-19 infection caught my attention. It intuitively makes sense. If you can slow or disrupt the early viral replication, you give your own defenses a chance to really hobble it at the inception. Once complications form later, or the size of the infection becomes too large, chloroquine may not hurt and might still offer some help, but simply not be able to tip the scales nearly as much. Again still some clinical advocates speaking up. Also a French Chloroquine trial underway per comments.

...Florida's House Rep. Val Demings

Boosting your zinc will have an effect of increasing intracellular zinc, just not 1:1 equillibrium. Chloroquine in one study I saw referenced carries zinc across cell membrane to increase it about x10. It sounds like if a person takes chloroquine alone, the extracellular zinc that is already normally present without supplement might be enough to boost intracellular levels for a clinical benefit, but I don't know. also, the devastating immune response setting in 5-6 days after fever breaks is scary as hell. I'm day1-2 since last chills/sweats. Got my pcp on speed dial for that -umab if I go down.

^^^^ hugely important. This is how we keep people from getting on vents, dying, or even surviving but with lasting lung damage during this pandemic.