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calendar   Friday - May 29, 2020

Fighting The Good Fight

Dr. Zelenko prepares for the final battle.

I have been preparing for the final battle in this war. The major counteroffensive is beginning. The whole world will hear us and be turned upside down.

Just released today, this 20 page medical document might be one of the nukes he’s planning to drop.

Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis
Abstract:
More than 1.6 million Americans have been infected with SARS-CoV-2 and >10 times that number carry antibodies to it. High-risk patients presenting with progressing symptomatic disease have only hospitalization treatment with its high mortality. An outpatient treatment that prevents hospitalization is desperately needed. Two candidate medications have been widely discussed: remdesivir, and hydroxychloroquine+azithromycin. Remdesivir has shown mild effectiveness in hospitalized inpatients, but no trials have been registered in outpatients. Hydroxychloroquine+azithromycin has been widely misrepresented in both clinical reports and public media, and outpatient trials results are not expected until September. Early outpatient illness is very different than later hospitalized florid disease and the treatments differ. Evidence about use of hydroxychloroquine alone, or of hydroxychloroquine+azithromycin in inpatients, is irrelevant concerning efficacy of the pair in early high-risk outpatient disease. Five studies, including two controlled clinical trials, have demonstrated significant major outpatient treatment efficacy. Hydroxychloroquine+azithromycin has been used as standard-of-care in more than 300,000 older adults with multicomorbidities, with estimated proportion diagnosed with cardiac arrhythmias attributable to the medications 47/100,000 users, of which estimated mortality is <20%, 9/100,000 users, compared to the 10,000 Americans now dying each week. These medications need to be widely available and promoted immediately for physicians to prescribe.

I read the whole thing. You have to open the .pdf link at the above site to get to it.

Pointed out in this paper is the deeper truth that while Dr. Zelenko may have seen 1456 patients that were symptomatically declared to have COVID, he actually used his HCQ treatment plan on “only” 405 of them. The rest were so mildly ill that they didn’t merit treatment.

Here are a few parts I found noteworthy. The original document is unedited, tending towards run-on sentences and a rather high level of insider terminology and acronyms. Well duh, it’s a medical research paper, not a news story in USA Today.

[ on the MSM pushed fear of HCQ causing irregular heartbeats therefore heart attack danger!! ] This arrhythmia issue is a real, physiologically measurable effect of the use of these combined medications (HCQ+AZ), but fatal arrhythmia outcomes are so rare that they are of much lesser clinical significance than the hospitalization and mortality that the drugs prevent.  This fact is also clear from the lack of any cardiac arrhythmia events or arrhythmia mortality noted in the 405 Zelenko patients or the 1061 Marseilles patients or the 412 Brazil patients.Patients were not enrolled in these studies if they had known histories of QTc prolongation.  History of cardiac arrhythmia or other possible contraindications for use of HCQ orAZ or doxycycline is a normal part of workup and clinical judgement in physicianchoice to use these medicationsand how to monitor the patients

....

[ the Oxford study looked at more than 600,000 patients who had taken HCQ over the years ] The maintenance HCQ dose in the Oxford study patients, 200 mg/day, gives as large or larger plasma drug levels as five days of HCQ at 400 mg/day, the recommended dose for outpatient Covid-19.  These very small numbers of arrhythmias, as well as the null results in this very large empirical study should therefore put to rest the anxieties about population excess mortality of HCQ+AZ outpatient use, either from cardiac arrhythmias, or as mortality from all causes.

This discussion thus shows that the FDA, NIH and cardiology society warnings about cardiac arrhythmia adverse events, while appropriate for theoretical and physiological considerations about use of these medications, are not borne out in mortality in real-world usage of them. Treatment-failure mortality will be much higher, but even that pales in comparison to the lives saved. 

It would therefore be incumbent upon all three organizations to reevaluate their positions as soon as possible.  It is unclear why the FDA, NIH and cardiology societies made their recommendations about HCQ+AZ use now, when the Oxford study (41, 42) analyzed 323,122 users of HCQ+AZ compared to 351,956 users of HCQ+amoxicillin, i.e., that the combination of HCQ+AZ has been in widespread standard-of-care use in the US and elsewhere for decades, use comparable to HCQ+amoxicillin as if it just involved an alternate antibiotic choice, this use predominantly in older adults with multiple comorbidities, with no such strident warnings about the use given during that time. 

I note that since doxycycline is believed to cause even fewer cardiac arrhythmias than AZ, in patients where that is a concern(43), the long-term care-facility evidence suggests that HCQ+doxycycline likely will work about as well.

...

The extrapolation from laboratory theory to empirical use also seems to underlie resistance to the idea that combined HCQ regimens could work for early outpatient use.

...

The clash in scientific worldviews is that basic and clinical scientists seem to feel that biological and drug-development evidence for medication use in non-human and non-outpatient contexts can be extrapolated to recommendations for outpatient use without benefit of RCT [ randomized controlled trial; ie “official” and not anecdotal ] evidence but don’t accept epidemiologic evidence without RCTs, whereas epidemiologists have had career experience with laboratory and animal evidence that did not hold up under epidemiologic study, but do reason by including all types of epidemiologic study designs and derive causal conclusions in the standard way following Hill’s Aspects (26) on the basis of strong totality of evidence, sometimes even without RCT evidence.  There are contexts where each approach is valid.

...

However, it is not my point to say that remdesivir has little evidence to support its potential outpatient utility, only efficacy considerations that have not been addressed and that could lead to lack of efficacy under general use, but that HCQ+AZ has been directly studied in actual early high-risk outpatient use with all of its temporal considerations and found empirically to have sufficient epidemiologic evidence for its effective and safe employment that way, and that requiring delay of such general use until availability of additional RCT evidence is untenable because of the ongoing and projected continuing mortality. No studies of Covid-19 outpatient HCQ+AZ use have shown higher mortality with such use than without, cardiac arrhythmias included, thus there is no empirical downside to this combined medication use

...

HCQ+AZ has been standard-of-care treatment at the four New York University hospitals, where a recent study showed that adding zinc sulfate to this regimen significantly cut both intubation and mortality risks by almost half.

[ remember, any medicine works better earlier in the illness. To be intubated, you’ve got to be sick enough to be in the hospital, and then get even worse. So this is a Death’s Door kind of scenario. See her as well ]
...

But for the great majority, I conclude that HCQ+AZ and HCQ+doxycycline, preferably with zinc can be this outpatient treatment, at least until we find or add something better, whether that could be remdesivir or something else.  It is our obligation not to stand by, just “carefully watching,”as the old and infirm and inner city of us are killed by this disease and our economy is destroyed by it and we have nothing to offer except high-mortality hospital treatment.  We have a solution, imperfect, to attempt to deal with the disease.  We have to let physicians employing good clinical judgement use it and informed patients choose it.



Pretty amazing (not really) how NYU is just now finally seeing that zinc helps? WTF have you fools been??

PS - set up to fail? I read elsewhere today that the NIH suggested HCQ dosage is FIVE TIMES HIGHER than what Dr. Z and the international medical community has been doing. The likelihood of arrhythmia goes up as the HCQ dosage increases. 

The awareness of the pushback and paranoia against this treatment plan is gently mentioned in this paper. It is very apparent towards the end of one of the links I posted before about Dr. Z. And it is spelled out in no uncertain terms by the link I put up last week to WattsUpWithThat.  Ruin the world economy, let millions get sick, let millions die, all because a) OrangeManBad, and b) Global power grab by “elites” to push world Socialist tyranny.


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Somewhat related, somewhat sarcastic update: This same bunch of researchers at NYU Langone are going to try to prove a negative. They’ve got a big Official Study coming up, RCT and everything, in which they’ll try to prove whether HCQ works as a prophylactic. I want to see how that will work while being ethical. Sure, you could give half the subjects the drug, and half a vitamin pill, and then expose the whole bunch heavily ... which is the Nazi approach, and the worst No-No in medical research. “First do no harm”, right?

Clinical Trial Tests Efficacy of Common Antimalarial Drug to Prevent COVID-19 Infection

[ April 1, 2020. Coincidence, or April Fool’s stunt? ] < a href="https://nyulangone.org/news/clinical-trial-tests-efficacy-common-antimalarial-drug-prevent-covid-19-infection">YU Langone Health researchers are co-leading a major clinical trial to determine whether the common antimalarial medication hydroxychloroquine can help prevent 2019 coronavirus disease (COVID-19) infections. The drug, marketed as Plaquenil®, has attracted considerable media attention, but definitive evidence is lacking on whether it can thwart infections in people who have been exposed to the novel coronavirus known as SARS-CoV-2.

The new study, which is being led by the University of Washington Medical Center in Seattle in collaboration with NYU Langone, may help answer that question. “Currently, there is no proven way to prevent COVID-19 after being exposed,” says Anna Bershteyn, PhD, assistant professor in the Department of Population Health at NYU Langone and the study’s co-principal investigator. “If hydroxychloroquine provides protection, then it could be an essential tool for fighting this pandemic. If it doesn’t, then people should avoid unnecessary risks from taking the drug.”

Hydroxychloroquine, used widely against malaria since the 1950s, is effective against autoimmune diseases like lupus and rheumatoid arthritis as well. Past research has suggested that the same drug might block the SARS-CoV-2 virus from invading human cells in a lab setting. Other modeling studies have hinted at the drug’s potential to prevent an infection or reduce the length of time that people shed viral particles and remain infectious. But these hypotheses have not been specifically tested in humans.

To do so, the new study is enrolling 2,000 adult volunteers at 6 sites. Specifically, researchers are recruiting people who lack any COVID-19 symptoms but have been in close contact with others who have a confirmed or pending diagnosis. On a random basis, the trial participants will receive either hydroxychloroquine or a placebo pill (vitamin C) every day for two weeks. Each day during the 14-day period and then again on day 28, the participants will swab their nasal passages and send the samples to researchers so they can detect any new COVID-19 infections.

I have to wonder if zinc is part of the prophylactic approach too. Good luck finding 2,000 people willing to take a 50/50 risk on getting a placebo, knowing that they’ve been exposed to a virus that can kill them. Especially now that the virus is declining. Maybe the Nazi approach is the only way to be sure ... so that means this study isn’t going to happen. Oh wait: I gather if you give them a couple dollars it becomes a “challenge trial”, and that’s now ethical?? Crivens. Maybe next week it will be Ok to dose prisoners without telling them. Or maybe use those illegals that ICE is always corralling? WTF, if you’re flushing ethics down the toilet, might as well jiggle the handle a couple times to make sure.


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Posted by Drew458   United States  on 05/29/2020 at 12:08 PM   
Filed Under: • pandemic and epidemic diseasesPandemic Pandemonium •  
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