Hydroxychloroquine-Azithromycin and COVID-19

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  #31  
Old 03-29-2020, 06:32 AM
Lindsyburnsy Lindsyburnsy is offline
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Please don't take any of these possible cures until YOUR doctor prescribes it. Taking any drug can have adverse reactions based on other meds a person is taking, their current health issues and dosages. Even when FDA approved drugs are used, take a look at all of the class action lawsuits out there because it was found out later that the drug caused other negative outcomes. For now, protect our healthcare workers with needed masks, gowns, shields and get ventilators to the hospitals. Stay home and wash your hands.
  #32  
Old 03-29-2020, 06:46 AM
davem4616 davem4616 is offline
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Originally Posted by GoodLife View Post
I shot 69 last week, 5 birdies 2 bogies, 32 putts. Had 2 holes in one last year.

There's a reason lots of Drs prescribing these drugs and conducting trials, it's not because they are stupid.

69 nice...what do you normally shoot when you play 18?

I had a good round last week too...came close to shooting par...that darn hole with the windmill is always a toughie for me and once again I lost my ball on the 18th to that whale that's just sitting there
  #33  
Old 03-29-2020, 07:34 AM
Lady.Sumter Lady.Sumter is offline
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Default Novel Coronavirus 19

[QUOTE=GoodLife;1735057]New observational study by French DR Raoult shows good results,



Thank you for forwarding the on line study..It provided reassurance and medical break through ...reading this article instilled hopeful prognosis!!😊..indeed good news!!
  #34  
Old 03-29-2020, 07:35 AM
jacksonbrown jacksonbrown is offline
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From Jim Sinclair's Mineset

Michigan’s Governor Is Practicing Medicine Without A License

This is beyond an overreach. The action by this Politician.…Whitmer….is putting the citizens of Michigan in harms way….it is disgusting and DANGEROUS !

I have reviewed a number of studies….the first of which from 2005….yes 2005…revealed chloroquine was found to have suppressed the SARS Virus….a kissing cousin ( no social distancing with that virus) to the current Corona Virus.

In addition, a series of studies and case reports from China, Italy, Poland and France have shown Hydroxychloroquine to be effective against the current Corona Virus. Specifically, a study from Marseilles, France revealed a combination of Hdroxychloroquine plus Zithromycin ( Zpack) within 6 days debilitated the Corona Virus. This was a small population studied but the experience of those in the field in a number of countries including the United States have confirmed those results. In fact, the FDA has fast tracked a study on this combination of medications. That is a very rare action taken by the FDA and speaks to the positive data they have accumulated on the treatment.

Enter ” FAKE Doc” Whitmer…… she has threatened REAL Docs and Pharmacists in Michigan with punitive actions if they use this potential life saving combination for a patient…. I kid you not. This is beyond unconscionable ! By her ignorant and Despicable totalitarian actions she has put thousands of Michigan citizens and health care providers in harm’s way. This is an egregious example of politics at it’s worst!

She ran on “Fixing the damn roads”….. she needs to stick with the “damn roads” and QUIT practicing medicine without a license! Thousands of people have been put in Harm’s way and providers who are already over worked and stressed to the max do not need a political HACK DICTATING punitive actions against them as they battle for people’s lives.

Dave Janda M.D.
  #35  
Old 03-29-2020, 07:51 AM
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Originally Posted by GoodLife View Post
New observational study by French DR Raoult shows good results,

Note: This is not the same as a clinical trial but is good news

Clinical and microbiological effect of a combination of hydroxychloroquine and
azithromycin in 80 COVID-19 patients with at least a six-day follow up: an
observational study

Abstract

We need an effective treatment to cure COVID-19 patients and to decrease the virus carriage duration. In 80 in-patients receiving a combination of hydroxychloroquine and azithromycin we noted a clinical improvement in all but one 86 year-old patient who died, and one 74 yearold patient still in intensive care unit. A rapid fall of nasopharyngeal viral load tested by qPCR was noted, with 83% negative at Day7, and 93% at Day8. Virus cultures from patient respiratory samples were negative in 97.5% patients at Day5. This allowed patients to rapidly de discharge from highly contagious wards with a mean length of stay of five days. We believe other teams should urgently evaluate this cost-effective therapeutic strategy, to both avoid the spread of the disease and treat patients as soon as possible before severe respiratory
irreversible complications take hold.

https://www.mediterranee-infection.c...ID-IHU-2-1.pdf
Terrific if it works!
I read this morning a long letter on Facebook from an ER doctor in New Orleans to a friend who is a retired professor from a nursing school. It’s tough going if you don’t have a medical background, but in short, this doctor says that they are giving hydroxychloroquine and azithromycin to everyone, and it doesn’t seem to be helping. Also, he says that worldwide, 84% of those who are put on ventilators die rather than getting better! In that case, a shortage of ventilators hardly matters. Might as well die. (But I prefer to keep my distance.)

“ A former ER nurse in New Orleans shared this post from an MD regarding the front lines of treatment of COVID 19.

"I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all."”
  #36  
Old 03-29-2020, 08:03 AM
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Default Mylan

Quote:
Originally Posted by GoodLife View Post
Mylan (NASDAQ:MYL) has restarted production of its hydroxychloroquine sulfate tablets at its West Virginia manufacturing facility as a potential treatment for COVID-19, the disease caused by the new coronavirus. The company plans to have product available by mid-April and thinks it can ramp up to 50 million tablets, which could treat more than 1.5 million people.

Mylan Ramps Up Production of Hydroxychloroquine as a Potential COVID-19 Treatment | The Motley Fool

2 Companies to Boost Production of Hydroxychloroquine to Fight CCP Virus

2 Companies to Boost Production of Hydroxychloroquine to Fight CCP Virus
If Mylan is making this drug it will $2,000.00 a dose vs $20.00 from anyone else. Don't forget what happened with the Epipen. Joe Manchin's daughter owns Mylan and the EpiPens went from $100.00 to $600.00 when the Manchin family took control.
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  #37  
Old 03-29-2020, 08:04 AM
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Originally Posted by clyde t View Post
If Mylan is making this drug it will $2,000.00 a dose vs $20.00 from anyone else. Don't forget what happened with the Epipen. Joe Manchin's daughter owns Mylan and the EpiPens went from $100.00 to $600.00 when the Manchin family took control.



Of course.
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  #38  
Old 03-29-2020, 08:18 AM
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Originally Posted by clyde t View Post
If Mylan is making this drug it will $2,000.00 a dose vs $20.00 from anyone else. Don't forget what happened with the Epipen. Joe Manchin's daughter owns Mylan and the EpiPens went from $100.00 to $600.00 when the Manchin family took control.
Lots of companies make hydroxychloroquine/plaquenil, its been in use for 70 years and is made all over the world. Costs less than a dollar per pill. Stop spreading nonsense.
  #39  
Old 03-29-2020, 08:33 AM
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Terrific if it works!
I read this morning a long letter on Facebook from an ER doctor in New Orleans to a friend who is a retired professor from a nursing school. It’s tough going if you don’t have a medical background, but in short, this doctor says that they are giving hydroxychloroquine and azithromycin to everyone, and it doesn’t seem to be helping. Also, he says that worldwide, 84% of those who are put on ventilators die rather than getting better! In that case, a shortage of ventilators hardly matters. Might as well die. (But I prefer to keep my distance.)

“ A former ER nurse in New Orleans shared this post from an MD regarding the front lines of treatment of COVID 19.

"I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all."”
Excellent but very scary information. Especially about withholding fluids. We cannot appreciate the people on the front lines enough. Dear God, protect all of us.
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  #40  
Old 03-29-2020, 08:47 AM
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Originally Posted by davem4616 View Post
69 nice...what do you normally shoot when you play 18?

I had a good round last week too...came close to shooting par...that darn hole with the windmill is always a toughie for me and once again I lost my ball on the 18th to that whale that's just sitting there
Normal scores for me are low/mid 70s, been playing since I was 5 but don't break par as often as in the past, also don't play from the tips anymore. That 69 was 1 less than my age, one of the hardest things to do in golf. Youngest guy to shoot his age or better was Bob Hamilton who carded a 59 at age 59. Sam Snead shot 67-66 on PGA tour at age 67 in Quad cities open. There was a guy at my club age 93 that regularly shot mid 70s, unfortunately he recently had leg amputated due to diabetes.
  #41  
Old 03-29-2020, 09:21 AM
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I have been on hydroxychloroquine to treat my lupus for 18 years. I know the next time I try to refill it I likely will have difficulty finding it. I would gladly give it up to save someone else. Without it my lupus will likely no longer be in remission but it likely won’t kill me anytime soon. I will have to simply deal with it if and when the situation arises
  #42  
Old 03-29-2020, 02:26 PM
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Nothing like a long term 2 day observational study (MD says I think it works...ergo it works)!

As for me, I trust Fauci. He is the gold standard.
  #43  
Old 03-29-2020, 02:38 PM
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Nothing like a long term 2 day observational study (MD says I think it works...ergo it works)!

As for me, I trust Fauci. He is the gold standard.
Just out of idle curiosity....why is Fauci the gold standard?
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  #44  
Old 03-29-2020, 05:42 PM
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A couple of videos by Doctors talking about how these medicines work on coronavirus

COVID-19 Update 8: Zinc and chloroquine for the treatment of COVID-19? - YouTube

Coronavirus Epidemic Update 34: US Cases Surge, Chloroquine & Zinc Treatment Combo, Italy Lockdown - YouTube
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