Covid-19 News

Quote from Navid

Key points:

- people are getting out of breath due to low oxygen, and suffering hypoxic collapse and organ failure to death

- this isn't like pneumonia, I can confirm having seen imaging on CT q/ bilateral findings ground glass opacities which is novel

- this disease seems to affect ability of Iron binding to heme

- Hydroxychloroquine protects hemoglobin in malaria, and seems to affect the same here

- oxygen, not ventilator appears to be best direction here [there is some complexity there and a professional will have to seek out advice for all of this]

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Obviously, I disagree vehemently with this person on many things but this should be about observation and data and not persons. The above video, in my opinion has merit (and I am a physician though not involved with patient care). I can't speak to the details of treating ARDS vs COVID-19 because I have neither ICU nor pulmonology experience. But Dr. Kyle-Sidell's observations seem valid and if so, urgently need attention. Some of the comments to the video are lamentable but others also make sense like the one that leads to this: https://medium.com/@gunthersch…d19-patients-35190f47988a apparently by a non physician researcher.

The thing is, it is fine to post a video (this one had over half a million views) but hopefully he has also gone to some valuable contacts like his consultants at the hospital or maybe a senior physician he met during residency or fellowship. What is obviously needed here are studies! I hope Dr. Kyle-Sidell is working on having someone or a group do those studies. I expect them to take time and be difficult. Anyway, very interesting. Thanks Navid

Quote from Navid

oxygen, not ventilator appears to be best direction here

corroborates Ratjer

"Avoided intubation at all cost even if requiring 100% FiO2. All of them have improved."

So... no intubation,, no mechanical ventilator

just CPAP with nasalprongs at max O2 delivery,,

how fast will the ICU staff uptake be?

Quote from RobertBryant

So... no intubation,, no mechanical ventilator

just CPAP with nasalprongs at max O2 delivery,,

how fast will the ICU staff uptake be?

A couple of quick niggles. How can it be widely adopted without at least one proper study? Maybe ICU doctors will try it out of desperation but with just the video, who knows? It's hard to keep calm on a sinking ship but if you want to survive, it's worth it to stop and think before you act.

Second, I don't remember where but I recall seeing a recommendation against CPAP as well as ventilators, PEEP, etc. So yes, 100% oxygen at high flow but for as short a time as possible before flow reduction. Pure oxygen at high flow irritates lungs. And probably by mask. Nasal prongs aren't that great unless the patient is alert enough to know to breathe through his/her nose. Finger tip oximetry will tell how effective this is.

Shane D. Go ahead and get infected! Just make sure you take our Z-pak Anti Bat as soon as you have symptoms. Or maybe before. Then we should marshal a large population of volunteers who are waiting to return to work to expose themselves to the virus on purpose! This I think is what is happening anyway in Haiti, Papua New Guinea, Sub-Saharan African states, India, Bangladesh, S East Asia, Venezuela, Tajikistan and Greece - all counties with endemic malaria or recently eradicated malaria where the population has access to anti-malarial chloroquine, hydroxychloroquine or other quinine analogues like mefloquine or primaquine. Iran is an exception with very high death rates - they have malaria in swamp regions in the south, but all medicines here are in desperate short supply because of US sanctions. Check the Worldometer statistics they can't all be fiddled like China or N Korea. <0.5 deaths per million population. Seems to work without azithromycin and most diets should supply sufficient Zn. Could add a shot of Ivermectin too? Oh I know I'll do it first and let you know how I get on!

Or alternatively Mass Drug Administration or Mass Fever Therapy to all the care homes in the UK now, immediately, there is a mass outbreak in 2000 care homes! They are all dying. The government, WHO and NHS are doing what exactly? Quibbling over statistics? A ten-fold increase in deaths in care homes in the UK due to no testing and no PPE hazmat type protection. 'like lambs to the slaughter' 'Developing very rapidly and a very dangerous situation'. Still no anti virus therapy available here. At least you have Trump doing something about it in the US. Hate to say it but he will save your nation while ours sinks because of blatant negligence.

The care sector workers think it's because of austerity cuts over the last ten years. Sure stupidity (I won't mention Boris's final solution to the care crisis made in their election manifesto again!). And nobody can get universal credit - what exactly was wrong with the old system anyway? It didn't force enough people back to work, did it? Make them all starve a bit first? Thanks IDS!

Quote from Alan Smith

Let us hope it is no more than stupidity.

Stupidity appears clearer in times of crisis. Also, it appears clear how inadequate the leadership of too many leading countries is nowadays, which is a limit of democracy, and calls for robust Constitutions to set prerequisites of and counterpowers to Presidents and Prime Ministers. I let you guess which countries I hint to.

My country Italy sure could have done better in this crisis but I saw no blatantly stupid actions once things started going rough (a list of idiotic things occurred earlier but easy to judge in the aftermath). Out of sheer luck we have a Prime Minister who is not a politician but a University Professor, chosen a couple years ago as a compromise figure to lead the coalition between the 5-star Movement and the Northern League. His background naturally leads him by education to value expertise and take informed decisions, which is a blessing in these circumstances. He was not elected but nominated, which can only occur in a Parliamentary democracy.

I cannot even think of the disaster we would have faced with a government led by an ignorant fascist as the leader of the Northern League who has a very large electoral consensus, but luckily was stupid enough to commit political suicide by sinking his own government when he was vice-premier only to be replaced by a new coalition without him. And I cannot think of the disaster we would have faced with a government led by an ignorant amateur as the 5-Stars leader, currently Minister of Foreign Affairs, leader of a conspiration-theorist, anti-vaccine confused party of goodwill clueless people.

Quote from JedRothwell

That is incorrect. With 21st century medical technology, a large fraction of the dead will be elderly people.

@Jed: You just repeat what I said in the post but first say it's incorrect... May be your mind is somewhat troubled...

Quote from seven_of_twenty

ETA: human dosing info (0.2 mg in a single dose seems right) https://www.rxlist.com/stromectol-drug.htm#description That means for a 150 pound person, appx 70kg, the dose is 14 mg (15 mg would be 5 tablets. The tablets are 3 mg each and sold in blister packs of 20. Cost per pack is around $150. There may be supply chain problems. Veterinary versions have been used in desperate circumstances, I read while browsing.

There is more than enough veterinary Ivermectin available. USA/Switzerland the two biggest pharma mafia countries did ban Ivermectin & Praziquantel for human use because of the cancer preventing benefits that impact the big pharma benefits...

But all cattle USA/Switzerland gets at least a yearly dose... Ask for the horse version as its safe at least here in Europe. Usually sold 8 tablets for 2x 800kg horse. The dosage for horses is the same as for humans thus you simple can cut the tables or use a scale.

There are side effects. Ivermectin affects callus (hard skin). It makes it softer and do not touch the eyes!! I think it could have some positive side effects as it allows to increase sensitive of callus... If you plan to go to sauna you will feel the pains (heat) in your feet.

And please to tell you local politicians about the true death rate among people younger than 65! that is well below 0.1% I do upload the full data set it as the mafia certainly will make it disappear soon.

Kanton Wadt statistik.pdf

Navid Agreed, reposting this in the light of the clinical evidence for HCQ protecting haemoglobin from SARS Cov-19

COVID-19: Attacks the 1-Beta Chain of Hemoglobin and ...

chemrxiv.org › articles › COVID-19_Disease_ORF8_and_Surface_Glyc...

2 days ago - COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism.

The results showed the ORF8 and surface glycoprotein could bind to the porphyrin, respectively. At the same time, orf1ab, ORF10, and ORF3a proteins could coordinate attack the heme on the 1-beta chain of hemoglobin to dissociate the iron to form the porphyrin. The attack will cause less and less hemoglobin that can carry oxygen and carbon dioxide. The lung cells have extremely intense poisoning and inflammatory due to the inability to exchange carbon dioxide and oxygen frequently, which eventually results in ground-glass-like lung images. The mechanism also interfered with the normal heme anabolic pathway of the human body, is expected to result in human disease. According to the validation analysis of these finds, chloroquine could prevent orf1ab, ORF3a, and ORF10 to attack the heme to form the porphyrin, and inhibit the binding of ORF8 and surface glycoproteins to porphyrins to a certain extent, effectively relieve the symptoms of respiratory distress

This is not as speculative as at first glance - chloroquine kills the Plasmodium malaria parasite in RBC's by blocking its heme polymerase thus allowing toxic levels of heme to build up inside its digestive vacuole, by binding to heme groups thus preventing polymerization to less toxic hemozoin crystals. So this binding of chloroquine or hydroxychloroquine to the heme group of hemoglobin (as they also suggest from their molecular docking study) would prevent the attack and associated poisoning and inflammation.

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Quote from andrea.s

Stupidity appears clearer in times of crisis.

[...]

My country Italy sure could have done better in this crisis but I saw no blatantly stupid actions once things started going rough (a list of idiotic things occurred earlier but easy to judge in the aftermath).

I was kind of rough to the Northern League and 5-Star leaders in Italy.

To be fair I will report the number one stupid action of this crisis, whose credit goes to the leader of the Democratic party that replaced the Northern league in the governing coalition, and governor of Latium, the region including Rome, and as such in charge of the region's Healthcare.

On Feb 27 he traveled from Rome to Milan to publicly celebrate in a crowded cocktail party the Mayor's decision not to lock down activities in Milan. He tweeted his vicinity to Milan, the need not to panic and commented "we must defeat the virus following science". On Feb 27 there were 650 cases and 17 deaths and a 30% daily growth of both, the vast majority in Milan's region Lombardy, and zero active cases in Rome (3 cases from abroad had recovered). One week later he was diagnosed positive in Rome.

.........whole blood transfusions from SARS Cov-2 recovered patients before they leave hospital may save the lives of critically ill patients still in the ICU, replenish healthy red blood cells at the same time receiving the necessary antibodies. Administer some Z-pak Anti Bat (Iv) [we added ivermectin] for good measure to protect the replenished blood cells and knock out the virus at the same time!

An interesting read about the confusion over using ventilators and low oxygen. Seems like Doctors are still trying to make sense of it. Perhaps a bunch of ventilators are currently being manufactured that won’t end up being used.

https://wgntv.com/news/coronav…verused-doctors-weigh-in/

Quote from Alan Smith

andrea.s

We try to keep politics out of this place, always- politics in general is hard to escape when discussing the pandemic, but naming and shaming politicians is not part of this forum's briif- even when they deserve it.

You are right Alan, I got carried away. Will refrain in the future. Let me know if I should remove the posts - though at least I did balance the picture with the last post. "Par condicio" they call it - if only they could level out a little higher.

Re drugs:

Ivermectin is one of very many drugs that show activity against COVID in vitro. I guess it would be nice to know whether that concentration is what typical (found safe) doses give. One would hope so. In that case it passes the first hurdle and can move to human trials (in any case I note these are being done).

It has better chances than HCQ of being a wonder drug since as far as I know we do not yet have any trial results: the mixed HCQ results make it clear that it best this is useful, at worst irrelevant.

The anecdotal evidence shown here for Ivermectin is even worse than that posted for HCQ, but it is worse no information rather than worse bad information.

However, as a medium-term treatment for COVID, assuming equal efficacy, HCQ would be vastly preferred to Ivermectin because it can be produced more cheaply in larger quantities.

Luckily we will have the first set of proper trial results for various things by the end of April, not long to wait now.

Shane D. Don't consider going for herd immunity without the full Z-pak Anti Bat (Iv). This is no placebo, without it we at our age will become seriously ill, possibly with long term consequences. Not a decision to be taken lightly. But as you say if it is inevitable anyway such an exposure with the antidote already in our system would be akin to a mild dose similar to the effects of a vaccination and would be far better than enduring the COVID-19 several months or years later when we would be more vulnerable. Easy enough to pick up the infection, help out in a care home for a few weeks, then self isolate. The HCQ shortage must still be due to people in the know stockpiling, but the increased supply by Teva, Bayer and others should filter through soon hopefully. Azithromycin has other analogues like clarithromycin which could have similar effect, no studies testing either these or indeed other analogues of CQ such as mefloquine or primoquine or other anti-malarials like proguanil which is often prescribed with CQ (and is an analogue of metformin) have even been suggested in vitro or in vivo. So it's very early days in searching for the best anti viral treatment, Z-pak Anti Bat (iV) is a quick fix in time better treatments without side effects will hopefully be developed. There is little time to wait though.

Quote from RobertBryant

corroborates Ratjer

"Avoided intubation at all cost even if requiring 100% FiO2. All of them have improved."

So... no intubation,, no mechanical ventilator

just CPAP with nasalprongs at max O2 delivery,,

There was a report on NHK of some researchers doing a lightning fast development project of a machine somewhere between a CPAP and a ventilator. The patient does not need to be sedated, but it pushes and pulls the air. It looked like a helmet to me. They said this is needed because ventilators do not work well with this disease. Elsewhere I read that 80% of patients who go on ventilators end up dying.

Sorry, but I do not recall who is working on it, or any other details. Maybe someone else has heard of it?