COVID-19 medical discussion

[Anastasis 23461]

10 minutes ago, Bevo said:

Interesting, but way too small of a sample size. In the conclusions, they did a pretty good job of summarizing the shortcomings of their own study.

It should also be pointed out that fluvoxamine has some unique pharmacological properties distinct from other common antidepressants.  In some of the data I have seen, BH/MH diagnoses generally and antidepressant use has pinged as independent risk factors for COVID, so there is a lot going on here to be unpacked. There may be some unique aspects with fluvoxamine, or it may be a totally spurious finding.  

[Anastasis 23461]

PFE submits their EUA request to FDA this morning. Advisory committee meetings scheduled for Dec 8, 9, 10. Authorization should be shortly behind. 

[LurkingHorn 1066]

Stupid question, but why are they waiting 2.5 weeks to have the advisory committee meet? Is that prep time or something? Seems like they would want to get this going ASAP. 

[Bevo 13566]

9 minutes ago, LurkingHorn said:

Stupid question, but why are they waiting 2.5 weeks to have the advisory committee meet? Is that prep time or something? Seems like they would want to get this going ASAP. 

They need to review all the data before the meeting. Same thing in business - the decision is pretty much made before the meeting ever happens. Plus Thanksgiving which adds a week to the timeline.

Edited November 20, 2020 by Bevo

[Brisketexan 105066]

1 hour ago, Bevo said:

They need to review all the data before the meeting. Same thing in business - the decision is pretty much made before the meeting ever happens. Plus Thanksgiving which adds a week to the timeline.

We didn't delay shit in WWII because of T-giving and Christmas.  I think they can work through the holiday on this one.

[Bevo 13566]

10 minutes ago, Brisketexan said:

We didn't delay shit in WWII because of T-giving and Christmas.  I think they can work through the holiday on this one.

Who are you, Armybrat?

[InkaUtexas 25862]

3 minutes ago, Bevo said:

Who are you, Armybrat?

Nah, would have used the Crimean War as his reference  

[htown85 159]

Who is jumping on this and who is waiting it out?

[kevwun 15764]

I will happily get the vaccine as soon as I can.

[Homercles 10205]

I’m going to take both, one in each arm.  Straight from the freezer too, don’t want to risk them going bad first.  

[Anastasis 23461]

3 hours ago, LurkingHorn said:

Stupid question, but why are they waiting 2.5 weeks to have the advisory committee meet? Is that prep time or something? Seems like they would want to get this going ASAP. 

I believe that there is a two week notice period required. But you really want to give the AdComm attendees a chance to review every fucking decimal point of the clinical data before they come together. 

[Pato del Muerto 52485]

2 hours ago, Brisketexan said:

We didn't delay shit in WWII because of T-giving and Christmas.  I think they can work through the holiday on this one.

There was the Christmas truce of WWI though

[XYZ 2154]

44 minutes ago, htown85 said:

Who is jumping on this and who is waiting it out?

Jumping on what?

[InkaUtexas 25862]

1 hour ago, htown85 said:

Who is jumping on this and who is waiting it out?

I will jump in. Tried to be on trials but they had enough volunteers. 

 

[InkaUtexas 25862]

53 minutes ago, Homercles said:

I’m going to take both, one in each arm.  Straight from the freezer too, don’t want to risk them going bad first.  

Ever have the frozen Hemoglobin shot? Fucker sucked.

[Bevo 13566]

16 minutes ago, InkaUtexas said:

Ever have the frozen Hemoglobin shot? Fucker sucked.

Sure it was a shot? Should have been a clue when they asked you to drop your drawers.

[pearlandhorn 3269]

1 hour ago, htown85 said:

Who is jumping on this and who is waiting it out?

Definitely getting it as soon as possible.  I'm curious as to if all oil & gas employees are considered essential workers though.  That'll move me up 2 months versus the common folk.

[dcar00 14153]

3 hours ago, InkaUtexas said:

Ever have the frozen Hemoglobin shot? Fucker sucked.

Is that something you can order at Touche's on 6th?

[Liquor and Poker 3659]

2 hours ago, dcar00 said:

Is that something you can order at Touche's on 6th?

I always got kamikazes

[washparkhorn 9939]

Is there a plan for boosting these numbers? Shaming doesn't seem to work. Is there a plan to only allow those with the vaccine to participate in certain desirable activities (flying, hotels, resorts, conferences, in-restaurant dining, . . .)?

Quote

 

Americans are more likely to say they’d get vaccinated against the coronavirus than they have been in nearly three months, but willingness remains driven largely by political leaning.

Fifty-three percent of adults now say they would get a coronavirus vaccine if one became available, according to a new Morning Consult poll, a slight uptick from 49 percent the first week of November and the highest level since late August, amid both a surge in infections that’s threatening to overwhelm health systems and a flurry of promising vaccine developments.

Meanwhile, 23 percent of adults said they would not get vaccinated and another 23 percent didn’t know or had no opinion, according to the survey, which was conducted Nov. 19-23 among 2,200 adults and has a margin of error of 2 percentage points.

 

https://morningconsult.com/2020/11/24/coronavirus-vaccines-slight-uptick-willingness/

Ideally, people would trust their medical providers, but many do not have one. And some don't trust them anyway. 

[Captainant 27635]

13 minutes ago, washparkhorn said:

Ideally, people would trust their medical providers, but many do not have one. And some don't trust them anyway. 

After how they've set my dad up to do nothing but waste away to a degenerative disease while covering only the most bare minimum of mitigating physical and occupational therapies to slow his descent into nothingness... Yeah, fuck for-profit insurance and medical care. It's nothing but a corporate tax on health. They don't give a shit about their customers, they only want to make sure their shareholders get a >1% increase over last quarter.

[XYZ 2154]

On 11/20/2020 at 12:46 PM, InkaUtexas said:

Ever have the frozen Hemoglobin shot? Fucker sucked.

Had one as a kid and it sucked.

[triplehorn 2664]

This is a nice study for ivermectin.  

A randomized, double-blind, placebo-controlled, multicenter, phase 2 clinical trial designed at five hospitals measuring mortality in those treated after requiring hospitalization:

Tables in the article show there were 4 ivermectin treatment arms stratified by dosing regimen, two of which amounted to a single oral dose of ivermectin at either 0.2mg/Kg or 0.4mg/Kg.  No deaths recorded in either of those two groups either.  Other studies have shown additional benefits when ivermectin is taken in early flu stage of illness at very substantially reducing need for hospitalization, or death.  The 0.4mg/Kg arm also supports safety across a broad dose range.

With 80,000 Americans hospitalized today with covid, and well over 100k new cases daily, the kind of benefit as seen above with a 'one and done' oral dose of a med that can be taken at any time or at any stage of the illness that is inexpensive and safe would be welcome right now.  A single dose that could be administered rapidly at the time of clinical presentation with a positive test, or presumptive positive with symptoms would simplify everything - minimize time to tx, improve compliance, improve outcomes etc. 

 Compendium of international ivermectin studies to date.

I haven't heard any news that our national health officials have gotten around to studying it.  

 

[washparkhorn 9939]

3 hours ago, Captainant said:

After how they've set my dad up to do nothing but waste away to a degenerative disease while covering only the most bare minimum of mitigating physical and occupational therapies to slow his descent into nothingness... Yeah, fuck for-profit insurance and medical care. It's nothing but a corporate tax on health. They don't give a shit about their customers, they only want to make sure their shareholders get a >1% increase over last quarter.

So sorry to hear about your dad. It doesn't have to be that way. 

[wild_turkey 3159]

After how they've set my dad up to do nothing but waste away to a degenerative disease while covering only the most bare minimum of mitigating physical and occupational therapies to slow his descent into nothingness... Yeah, fuck for-profit insurance and medical care. It's nothing but a corporate tax on health. They don't give a shit about their customers, they only want to make sure their shareholders get a >1% increase over last quarter.

Who is the “they” you are referring to?

[naija 2854]

Does anyone believe that whatever hospital you work for/at, isn't going to require everyone get vaccinated as soon as it becomes available? Don't think opting in or out is going to be much of an issue

[Captainant 27635]

2 hours ago, wild_turkey said:

Who is the “they” you are referring to?

For profit health insurance and medical providers. As is pretty clear in the quoted text, I thought. 

[naija 2854]

I guess medical providers should work for free

[Anastasis 23461]

Captainant will be queued up in the COVID-19 vaccination line brought to him by Pfizer in literally previously incomprehensible time frames, simultaneously  whining about the for profit medical industry with absolutely so sense of self awareness.   

[Captainant 27635]

7 minutes ago, naija said:

I guess medical providers should work for free

Not for profit != Not paying your people. 

The difference is that in for profit systems, shareholders get paid out based on the fees and premiums you pay in. In a non profit system, any excess money (is supposed to) be invested back into improving standard of care and availability of treatment. 

Edited November 26, 2020 by Captainant

[dcar00 14153]

1 minute ago, Anastasis said:

Captainant will be queued up in the COVID-19 vaccination line brought to him by Pfizer in literally previously incomprehensible time frames, simultaneously  whining about the for profit medical industry with absolutely so sense of self awareness.   

dude, moderna and pfizer didn't build that!  

[Captainant 27635]

2 minutes ago, Anastasis said:

Captainant will be queued up in the COVID-19 vaccination line brought to him by Pfizer in literally previously incomprehensible time frames, simultaneously  whining about the for profit medical industry with absolutely so sense of self awareness.   

Oh you mean the vaccine that was funded by the German government and their nationalized healthcare system?

[Anastasis 23461]

1 minute ago, Captainant said:

Oh you mean the vaccine that was funded by the German government and their nationalized healthcare system?

What a joke. I guess PFE was just jerking off in the corner. 

[Anastasis 23461]

5 minutes ago, dcar00 said:

dude, moderna and pfizer didn't build that!  

Hey, these clinical trials and regulatory submissions just run themselves, don't you know. You just throw tax payer money at them and poof, magic happens. 

[dcar00 14153]

2 minutes ago, Anastasis said:

Hey, these clinical trials and regulatory submissions just run themselves, don't you know. You just throw tax payer money at them and poof, magic happens. 

pfft, taxpayer money.  don't ya know, govt solves everything, just print the money and hand it to them.  preferably 20's in metal suitcases 

[Captainant 27635]

8 minutes ago, dcar00 said:

pfft, taxpayer money.  don't ya know, govt solves everything, just print the money and hand it to them.  preferably 20's in metal suitcases 

Lol you seemed pretty happy with the government shelling out 3 TRILLION to corporate America over the next 10 years, not sure why you can't stand to see people get healthcare that doesn't financially ruin them

[dcar00 14153]

24 minutes ago, Captainant said:

Lol you seemed pretty happy with the government shelling out 3 TRILLION to corporate America over the next 10 years, not sure why you can't stand to see people get healthcare that doesn't financially ruin them

now you are just making shit up.  which is par for the course with you.  how big can you make the strawman?

[triplehorn 2664]

Ivermectin y'all. 

A national call to action just wrapped outside of UMMC in Houston.  Fast forward to the presentation start at about 12 min in.  A mountain of overwhelming data has emerged since NIH last updated its covid recommendations at the end of August.  It works prophylactically (think use in any frontline person), it's works after exposure and in early phase, and helps in critical hospitalized patients.  There is also emerging evidence it significantly helps resolve prolonged symptoms of "long Covid".  It's a bridge to vaccines which won't be available and deliverable at meaningful amounts globally for months.  You're on the clock, Dr. Fauci, including anyone else in a position to effect change for patients or people who ignores this information.

Quote

  

 

 

[washparkhorn 9939]

28 minutes ago, triplehorn said:

Ivermectin y'all. 

A national call to action just wrapped outside of UMMC in Houston.  Fast forward to the presentation start at about 12 min in.  A mountain of overwhelming data has emerged since NIH last updated its covid recommendations at the end of August.  It works prophylactically (think use in any frontline person), it's works after exposure and in early phase, and helps in critical hospitalized patients.  There is also emerging evidence it significantly helps resolve prolonged symptoms of "long Covid".  It's a bridge to vaccines which won't be available and deliverable at meaningful amounts globally for months.  You're on the clock, Dr. Fauci, including anyone else in a position to effect change for patients or people who ignores this information.

 

Interesting.

What is your nutshell version of why anti-parasite medication is effective against Covid? What is the mechanism in play when a person takes Ivermectin? Thanks.

Edited December 4, 2020 by washparkhorn

[triplehorn 2664]

26 minutes ago, washparkhorn said:

Interesting.

What is your nutshell version of why anti-parasite medication is effective against Covid? What is the mechanism in play when a person takes Ivermectin? Thanks.

It's a common theme that medications often have multiple, often initially unknown, mechanisms of action leading to different applications (think everyday off-label use as seen for every 1 in 5 scripts written) , and perhaps equally as common that we can't explain or define the exact molecular pathways involved, particularly when a process is complex and dynamic like immune system function.  But you don't have to know the exact mechanism for it to warrant use as is commonly the case in medicine.  You need observable, measurable, and consistently reproducible beneficial results.  And when a treatment effect is greater than 50% effective, sound observational studies reflecting that size of a treatment effect are just as valid as RCT's, and are more ethical in this context. 

The treatment effects of ivermectin on covid are much greater than 50% compared to treating with nothing (current NIH recommendation) and in several cases are an order of magnitude greater.  When you translate the size of these treatment effects to US numbers of cases, active hospitalizations, and deaths, we're talking about a treatment effect that could immediately relieve our bursting health care system by opening up hospital and ICU beds, and save literally tens of thousands of US lives in the next two months alone.

[washparkhorn 9939]

Thank you.  

Is this essentially correct: 

• We have a substance that kills parasites but may also kill or slow the COVID virus.
• That substance is a medication, already approved by the FDA for treatment of parasites. 
• Time is of the essence in preventing greater illness/death from the virus as we wait for the widespread rollout of vaccines.

 

[triplehorn 2664]

17 minutes ago, washparkhorn said:

Thank you.  

Is this essentially correct: 

• We have a substance that kills parasites but may also kill or slow the COVID virus.
• That substance is a medication, already approved by the FDA for treatment of parasites. 
• Time is of the essence in preventing greater illness/death from the virus as we wait for the widespread rollout of vaccines.

 

Watch the physicians' call to action I linked just above.  They really cover it all. 

But yes, that is essentially correct.  Ivermectin also is thought to have an immune modulating effect or effect on inflammation which may account for growing observations that it improves condition in patients with ongoing 'long covid'.  They mention this from the podium.

Yes, ivermectin is 40 years FDA approved and was the basis for a Nobel Prize in medicine in 2015.  It's very well tolerated and very safe.  Drug to drug interactions are minimal though Dr. Marik above mentions graft rejection med cylosporin as one to watch in a small subset of people with an organ transplant.  It's very effective and commonly used against scabies without FDA approval for that application.  Standard stuff.  Same dose range of ivermectin is used in covid as is used for other conditions, with some variations in frequency and duration for covid.  The live conference above gives all the numbers including frequency and duration of dosing in different contexts.  Anyone who listens to what those physicians present can tell whether or not they speak the truth and are impassioned to immediately help divert from a tragically worse path of human suffering and death.

[triplehorn 2664]

I appreciate the ceaseless effort and contributions of Dr. Peter McCullough in Dallas.  He's expertly fluent in science, research, and medicine and his personal contributions in medical research and literature are prolific.  His comments starting around the 30-31' mark on major pandemic bungles are so important to understand, learn from, and accept for future use to guide decision making for globally better outcomes the next time.  Heavy truth bombs in there throughout

 

 

Edited December 8, 2020 by triplehorn
grmma

[Pimphand 5733]

On 3/19/2020 at 10:04 PM, Anastasis said:

A pretty broad review, with information on dosing etc.

https://www.idstewardship.com/coronavirus-covid-19-resources-pharmacists/

 

Created: 14 March 2020

Last updated: 18 March 2020 PM

Many pharmacists across the world are working hard to keep up with therapeutic options for coronavirus / SARS-CoV-2 / COVID-19. This webpage was created to provide insights and resources for pharmacists helping to manage this pandemic. Take note that updates to the page will be made periodically as permitted and the content here may not be completely up-to-date as the situation is evolving quickly. Also beware that much of the data identified below is of relatively poor quality in terms of utility for determining what should be done in clinical practice.

Additionally, there are many potential COVID-19 therapies, I list several at the bottom, but do not discuss them in depth. Some of these can potentially lessen the cytokine storm associated with COVID-19 and help with managing acute respiratory distress syndrome (ARDS).

MOST IMPORTANTLY: Thus far no antiviral drug has been proven to work against COVID-19 in humans, although many randomized controlled trials are ongoing. Inclusion in this webpage is not an endorsement for use of any of these drugs for COVID-19.

If you have a resource that is helpful and reliable, but not posted here, send it to me: IDstewardship@gmail.com or @IDstewardship on Twitter.

General COVID-19 Resources

• CDC information for healthcare professionals
• CDC clinical care information for healthcare professionals
• CDC COVID-19 cases in the U.S webpage
• UK Government COVID-19 guidance for healthcare professionals
• Johns Hopkins Coronavirus Tracker
• WHO COVID-19 Clinical Management Document
• University of Liverpool COVID-19 resources (drug interactions, information for patients with difficulty swallowing)
  • **THIS IS AN EXCELLENT RESOURCE**
  • University of Liverpool page on COVID-19 patients with difficulty swallowing
• ClinicalTrials.gov search page
• Internet Book of Critical Care (IBCC) COVID-19 Review
  • **THIS IS AN EXCELLENT RESOURCE**

Institutional & Society COVID-19 Treatment Guidelines

• Italian Society of Infectious Diseases and Tropical Diseases COVID-19 Guideline
  • Published in Italian
  • Tweet with link to google.doc that has the document translated into English
• Chinese Government’s New Coronavirus Pneumonia Diagnosis and Treatment Plan (Trial Version 7)
  • Published in Chinese
  • Translated into English
• University of Michigan: Inpatient Guidance for Diagnosis and Treatment of COVID-19 in Adults & Children
• University of Washington Resources (includes Treatment Guideline)
  • University of Washington Emergency Medicine ED/ICU COVID-19 Guide
     

General Notes

• Coronavirus 2019 (aka SARS-CoV-2) causes a diseases called COVID-19
• Corticosteroids are not recommended as part of treatment for COVID-19 unless other indications exist
  • They may prolong viral shedding
  • One recent article did recommend to consider a short course of glucocorticoids
• Nebulized bronchodilators may risk spread of the virus, in general meter dose inhalers (MDIs) are preferred
  • RE: Transmission of Corona Virus by Nebulizer- a serious, underappreciated risk!
• Antibiotics are generally NOT recommended
  • Pharmacotherapeutics for the New Coronavirus Pneumonia
• Co-infection with influenza and COVID-19 is expected to be unlikely, but possible
  • Co-infection with SARS-CoV-2 and Influenza A Virus in Patient with Pneumonia, China
• Lymphopenia is a common component of initial COVID-19 presentation
  • Clinical Characteristics of Coronavirus Disease 2019 in China
• COVID-19 does not appear to increase procalcitonin, but does appear to increase CRP
  • Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China
  • Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore
• Empiric neuraminidase (NMD) inhibitor therapy may be reasonable during flu season, but I am unable to identify any data to support NMD inhibitor use for COVID-19
  • Inhibition of SARS Coronavirus Infection In Vitro with Clinically Approved Antiviral Drugs
• People who die from COVID-19 usually have ARDS, beware the fluids may exacerbate this so aggressive fluid support is not generally appropriate
• COVID-19 commonly causes troponin elevations
• Patients with mild disease may not require hospitalization, but they may worsen with progression to lower respiratory tract disease
  • Risk factors for progression include: older age and underlying chronic medical conditions such as lung disease, cancer, heart failure, cerebrovascular disease, renal disease, liver disease, diabetes, immunocompromising conditions, and pregnancy
  • Infection in pediatrics may not be as common or severe, but it is possible
    • A case report of neonatal COVID-19 infection in China
    • Laboratory Abnormalities in Children With Novel Coronavirus Disease 2019

Remdesivir Resources & Notes

• Remdesivir (GS-5734, RDV) is not FDA-approved and is available for investigational use only
  • Is a nucleotide analog antiviral
  • Has activity against Ebola virus, MERS, and SARS
  • Has drug-drug interactions via the liver, so would not be expected to be given with LPV/r
    • Guidance I received from Gilead was that once remdesivir is initiated, any experimental anti-COVID-19 therapies must be ceased
  • Available intravenous only
    • Study dose in adults: RDV 200 mg loading dose on day 1 is given, followed by 100 mg iv once-daily maintenance doses for 9 days
      • Review study protocols here
• In preparing to request investigational remdesivir, collecting the following information ahead of time may be helpful:
  • Prescriber name, address, email, and phone number associated with the treatment center
  • Professional designation (ie, MD) or qualifications of requester including medical license number
  • Institution/ hospital name, address, email, and phone number
  • Shipping information (including pharmacy hours)
  • Patient case information, including previous or current treatments and clinical status
• There are many exclusion criteria for remdesivir
  • Gilead website including key inclusion & exclusion criteria for remdesivir
• Remdesivir clinical trials
• Email to contact Gilead compassionate use: compassionateaccess@gilead.com

Lopinavir/ritonavir (Kaletra, LPV/r) Resources & Notes

• Data suggests LPV/r should not be used mono therapy for severe COVID-19
  • A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19
• LPV/r may be effective when used in combination with other drugs versus COVID-19, but more data on this is needed
• Beware drug-drug interactions as ritonavir is a CYP enzyme inhibitor (will increase levels of other drugs)
• Consider avoiding for patients with liver or cardiac disease
• LPV/r comes in an oral solution, but it may not be available during times of high demand, so people may consider crushing the capsules
  • Pharmacokinetics of Lopinavir/Ritonavir Crushed versus Whole Tablets in Children
    • Crushing LPV/r can reduce the AUC by 50%
    • Increasing the LPV/r dose by 50% to compensate would mean a considerable amount of ritonavir, which may cause considerable drug-drug interactions
      • Cushing LPV/r has shown to reduce exposure to both lopinavir and ritonavir, so the increase in ritonavir may not be clinically relevant
  • From a colleague (paraphrased):
    • We may be able to use information from venetoclax (Venclexta), which like LPV/r has a film coated tablet
      • For venetoclax we dissolve the tablet into a slurry in a syringe to reduce the risk of losing drug in a crusher or amber vial. It can take up to 20 mins (per patient report) to get the drug to dissolve. The ICU nurses have not had issues with getting ventoclax surry down NG tubes, but floor nurses did report issues (potential it was not administered immediately?). We also did the tablet slurry in a syringe to reduce exposure to compounding staff.
      • This approach can avoid the use of preservatives
        • This briefing includes  information on making a pediatric venetoclax solution, notes avoiding preservatives and potential issues with stability
      • Stability data is lacking, consider immediate use
        • From the above referenced article: “Disruption of the extrude matrix environment may adversely impact this formulation affect. The crushing of the pill leaves part of the drug(s) on the walls of the container or crushing device, and the transfer of the crushed substance to the food or liquid for mixing may also generate loss of the active drug.”
• The dose and duration I have seen recommended is LPV/r 400-100 mg BID x14 days
• The University of Michigan COVID-19 guidance document recommends:
  • Adult dosing: 400 mg-100 mg PO BID
  • Pediatric dosing:
    • 14 days to 6 months old: lopinavir component 16 mg/kg PO BID
    • 6 months to 18 years:
      • 15-25 kg: 200 mg-50 mg PO BID
      • 26-35 kg: 300 mg-75 mg PO BID
      • >35 kg: 400 mg-100 mg PO BID
• LPV/r oral solution has a high alcohol content and tastes terrible, which can be an issue for children in particular
• Consider HIV testing prior to initiating therapy
• Some clinicians are combing LPV/r with ribavirin
• Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore
  • Includes 5 patients treated with LPV/r for COVID-19
  • None died
  • 3 of 5 developed abnormal liver test results
• There are pre-SARS-CoV-2 publications supporting activity of LPV/r versus SARS
  • Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings
  • Treatment of severe acute respiratory syndrome with lopinavir/ritonavir: a multicentre retrospective matched cohort study
• Kaletra Package Insert (tablet & oral solution)

Chloroquine Resources & Notes

• Chloroquine is best known for it’s use versus malaria, but apparently has activity versus some coronaviruses
• Beware liver toxicity
• Consider avoiding in patients with heart failure, recent myocardial infarction, G6PD deficiency, epilepsy, or porphyria
• Oral tablets can be crushed, but it is not preferable
  • A chloroquine oral syrup may be available for purchase
  • Stability of Alprazolam, Chloroquine Phosphate, Cisapride, Enalapril Maleate, and Hydralazine Hydrochloride in Extemporaneously Compounded Oral Liquids
    • Found chloroquine phosphate 15 mg/mL was  stable in extemporaneously compounded oral liquids for 60 days at 5 and 25 degrees C
• Expert Consensus on Chloroquine Phosphate for the Treatment of Novel Coronavirus Pneumonia
  • Recommends chloroquine 500 mg PO BID x10 days for treatment of COVID-19 pneumonia of mild, moderate, or severe disease
• Breakthrough: Chloroquine Phosphate Has Shown Apparent Efficacy in Treatment of COVID-19 Associated Pneumonia in Clinical Studies
  • These authors reported that information from a news briefing stated more than 100 patients given chloroquine phosphate did better than the control patients when it came to exacerbation of pneumonia, improving lung imaging findings, and promoting a virus-negative conversion, and shortening the disease.
• Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro
  • Favorable findings on activity of chloroquine and remdesivir versus SARS-CoV-2
• Screening of an FDA-approved Compound Library Identifies Four Small-Molecule Inhibitors of Middle East Respiratory Syndrome Coronavirus Replication in Cell Culture
  • Suggests chloroquine may be a therapeutic option
• New Insights on the Antiviral Effects of Chloroquine Against Coronavirus: What to Expect for COVID-19?
  • Discusses chloroquine’s potential mechanisms against SARS-CoV-2
• Chloroquine Package Insert

Hydroxychloroquine (Plaquenil) Resources & Notes

• Hydroxychloroquine is generally better tolerated than chloroquine and has the same mechanism of action
• On crushing hydroxychloroquine tablets:
  • Stability of Extemporaneously Prepared Hydroxychloroquine Sulfate 25-mg/mL Suspensions in Plastic Bottles and Syringes
    • Describes preparation of hydroxychloroquine sulfate and concludes it is stable for at least 90 days in Medisca Oral Mix or Oral Mix SF suspension media at 25°C and 4°C
  • Hydroxychloroquine suspension instructions:
    • Nationwide Children’s Pharmacy
    • Stanford Children’s Recipe (screenshot in a Tweet)
  • Nuffield Orthopaedic Centre NHS Trust and Oxfordshire Primary Care Trust Shared Care Protocol and Information for GPs
    • Recommends dispersing tablets in water after crushing
  • This article is referenced in some references, but I cannot find a link to it:
    • Pesko LJ. Compounding: Hydroxychloroquine. Am Druggist. 1993; 207-257.
• In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
  • This study found that hydroxychloroquine was 3x more potent than chloroquine phosphate in vitro
  • The study recommends hydroxychloroquine 400 mg BID load, then 200 mg BID for 4 days
    • Note this is a shorter course than the 10 day chloroquine course noted above
• The University of Michigan COVID-19 guidance document recommends:
  • Adult dosing: 600 mg PO BID x2 doses (load), then 200 mg PO TID
  • Pediatric dosing (<18 years): 10 mg/kg (max: 600 mg/dose) PO BID x2 (load), then 3 mg/kg PO TID (max: 200 mg/dose)
• Plaquenil (hydroxychloroquine) Package Insert

Tocilizumab (Actemra) Resources & Notes

• Tocilizumab is an inteurlukin-6 (IL-6) inhibitor that may be helpful for cytokine storm associated with severe COVID-19 disease
  • Cytokine storm may be a complicating factor for patients with severe COVID-19 disease
• Reserve for patients with severe disease who have failed other therapies, consider dose capping and limiting the number of doses
• Novel Coronavirus Pneumonia Diagnosis and Treatment Plan (Provisional 7th Edition) states:
  • For patients with extensive and bilateral lung disease and severely ill patients with elevated IL-6 levels, treatment with tocilizumab may be attempted
  • The initial dose should be 4-8mg/kg, with the recommended dosage being 400mg
  • Dilute with 0.9% saline to 100ml and infuse over the course of more than 1 hour
  • Repeat once after 12 hours (same dosage) if the response to the first dose was poor, mximum two cumulative doses
  • Single maximum dose is 800mg
  • Pay attention to allergic reactions
  • Prohibited in patients with active infections such as tuberculosis
• One article (not peer reviewed) reports on 20 patients with severe or critical COVID-19 disease treated with tocilizumab and having good outcomes
  • Effective Treatment of Severe COVID-19 Patients with Tocilizumab
• Concern exists that the long-term effects of this drug may predispose patients to future infections
  • Some providers are looking to IL-1 inhibitors for this reason
• This medication is very expensive
• Tocilizumab (Actemra) Package Insert

More COVID-19 Articles

• First 12 patients with coronavirus disease 2019 (COVID-19) in the United States
  • This is essentially a case series and given the limited amount of data here it is hard to take much away from it
• 2019-Novel Coronavirus (2019-nCoV): estimating the case fatality rate – a word of caution
  • Case fatality rate may vary by region
• Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China
  • Found older age is associated with death
• Detection of SARS-CoV-2 in Different Types of Clinical Specimens
  • Virus may be spread via feces and testing multiple sites of the body may be helpful
• Involving Antimicrobial Stewardship Programs in COVID-19 Response Efforts: All Hands on Deck
  • Discusses opportunities for antimicrobial stewardship programs to help out, including managing drug shortages, developing treatment guidelines, assisting with acquisition of investigational drugs, and monitoring
• On the origin and continuing evolution of SARS-CoV-2
  • This article discusses the L type and S type of SARS-CoV-2 and how the frequency of each may be shifting as the pandemic progresses
• Re: Preventing a covid-19 pandemic: ACE inhibitors as a potential risk factor for fatal Covid-19
  • This article suggests use of ACE-inhibitors (ACE-Is)/ angiotensin-receptor blockers (ARBs) may increase the risk for severe COVID-19 disease and increase transmissibility, due to increased expression of ACE2 receptor
    • However, this article suggests the opposite in that ARBs may be protective against COVID-19:
      • Angiotensin receptor blockers as tentative SARS‐CoV‐2 therapeutics
  • On the topic: Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?
    • This article suggests patients with cardiac diseases, hypertension, or diabetes, who are treated with ACE2-increasing drugs, are at higher risk for severe COVID-19 infection and, therefore, should be monitored for ACE2-modulating medications, such as ACE inhibitors or ARBs.
      • However, the European Society of Cardiology notes: “speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it.”
        • Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers
    • This article also notes that ibuprofen and thiazolidinediones can increase ACE2
      • On the topic: The French Minister suggested to avoid NSAIDs, take acetaminophen instead
        • Anti-inflammatories may aggravate Covid-19, France advises
      • Now there are multiple groups recommending against NSAIDs for patients with COVID-19
        • Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists
      • It is being reported as of March 16th, WHO is recommending to avoid ibuprofen for as a self-medication for COVID-19
• Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1
  • This article found SARS-CoV-2 (HCoV-19) could be found in aerosols up to 3 hours post-aerosolation, on cardboard up to 24 hours, and on plastic or stainless steel for 2-3 days
  • The inoculum required to cause infection is an important factor to consider when reading this article
• How will country-based mitigation measures influence the course of the COVID-19 epidemic?
  • This article has the famous figure showing how flattening the initial wave can help the healthcare systems cope with the influx of COVID-19 cases
• COVID-19: An Update on the Epidemiological, Clinical, Preventive and Therapeutic Evidence and Guidelines of Integrative Chinese-Western Medicine for the Management of 2019 Novel Coronavirus Disease

List of Other Potential Therapies

• Probably the best place for a full list and ongoing studies related to these: clinicaltrials.gov
• Intravenous Immunoglobulin
• Thalidomide
• Fingolamid (FTY720)
• Carrimycin
• Bromhexine HCl
• Ecluzumab (Soliris)
• Bevacizumab (Avastin)
• Nitrous oxide gas
• Nitazoxanide
• Tiecoplanin
• ASC09F
• Xainping
• Ascorbic acid (vitamin C)
• Arbidol
  • Arbidol Combined With LPV/r Versus LPV/r Alone Against Corona Virus Disease 2019: a Retrospective Cohort Study
    • Supports LPV/r therapy but not LPV/r + arbidol therapy
• Darunavir/ cobicistat (Prezcobix)
• Danoprevir (Ganovo)
• Pirfrenidone (Esbriet)
• Ribavirin
  • Stability of Extemporaneous Oral Ribavirin Liquid Preparation
• Interferon alfa 2b
• Indomethacin
  • Indomethacin Has a Potent Antiviral Activity Against SARS Coronavirus
• Zinc
  • Zn²⁺ Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture
  • Chloroquine Is a Zinc Ionophore

Other COVID-19 Resource Centers

• IDSA COVID-19 Resource Center
• SCCM COVID-19 Resource Center
• ASM COVID-19 Resource Center
• The LANCET COVID-19 Resource Center
• CIDRAP COVID-19 Resource Center
• UW Medicine COVID-19 Resource Site
• UNMC COVID-19 Resource Center
  • UNMC COVID-19 Resources for Providers

More COVID-19 Webpages

• Contagion Live coronavirus page
• Shoreland travax coronavirus 2019 page
• FL DOH COVID-19 Tracking Map

Miscellaneous Things That May be Helpful

• UCSF COVID-19 Clinical Evaluation Guide (via Twitter)
• Medcram COVID-19 video update (includes discussion on Zinc)
• YouTube video from Italian MD Dr. Stefano Aliberti (March 17) providing insights on his experience
  • Related: On the Front Lines of Coronavirus: The Italian Response to covid-19
• Controversies in Hospital Infection Prevention article: COVID-19: Deep Thoughts and a Little Therapy

And Even More COVID-19 Literature

• Under the Epidemic Situation of COVID-19, Should Special Attention to Pregnant Women Be Given?
  • Provides considerations for pregnant patients
• Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy
  • Provides a summary of the response of the COVID-19 Lombardy ICU network and a forecast of estimated ICU demand over the coming weeks
• A Novel Approach for a Novel Pathogen: using a home assessment team to evaluate patients for 2019 novel coronavirus (SARS-CoV-2)
  • Describes an effective mechanism for testing outside of the healthcare setting
• A comparative study on the clinical features of COVID-19 pneumonia to other pneumonias
  • Suggests CT scan may be a reliable test for screening NCOVID-19 cases, liver function damage is more frequent in NCOVID-19 than NON-NCOVID-19 patients, and LDH as well as α-HBDH may be considerable markers for evaluation of NCOVID-19
• Dysregulation of immune response in patients with COVID-19 in Wuhan, China
  • Suggests surveillance of neutrophil-lymphocyte-ratio and lymphocyte subsets can be helpful in the early screening of critical illness, diagnosis and treatment of COVID-19

 

On 3/23/2020 at 2:41 AM, RayDog said:

ECGC is another proven zinc ionophore in vitro. Anything on that?  I actually have a bottle and drink green tea most mornings.

I read a dissertation by Dabbagh-Bazarbachi and he found it was a better ionophore than quercetin  but less effective than clioquinol. I have not read anything about studies with clioquinol against covid19 either. Clioquinol is readily available for topical use and has been used for treating cancer.

Pretty amazing that on page 2 in the apex of the maelstrom of panic all the answers you ever needed to cope with Covid were found right here at surlyhorns.com

[Gatorubet 30185]

On 12/4/2020 at 2:04 PM, triplehorn said:

Watch the physicians' call to action I linked just above.  They really cover it all. 

But yes, that is essentially correct.  Ivermectin also is thought to have an immune modulating effect or effect on inflammation which may account for growing observations that it improves condition in patients with ongoing 'long covid'.  They mention this from the podium.

Yes, ivermectin is 40 years FDA approved and was the basis for a Nobel Prize in medicine in 2015.  It's very well tolerated and very safe.  Drug to drug interactions are minimal though Dr. Marik above mentions graft rejection med cylosporin as one to watch in a small subset of people with an organ transplant.  It's very effective and commonly used against scabies without FDA approval for that application.  Standard stuff.  Same dose range of ivermectin is used in covid as is used for other conditions, with some variations in frequency and duration for covid.  The live conference above gives all the numbers including frequency and duration of dosing in different contexts.  Anyone who listens to what those physicians present can tell whether or not they speak the truth and are impassioned to immediately help divert from a tragically worse path of human suffering and death.  Also, this is as effective as ivermectin:

fify