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#325469 - 05/10/20 01:00 AM Re: Medications that might help against SARS-CoV-2 [Re: GreatNewsTonight]
pondering_it_all Offline
veteran

Registered: 02/27/06
Posts: 10347
Loc: North San Diego County
Much more likely they offer an assistance program so the uninsured poor don't have to pay much. But insurance companies get it for the negotiated discount price of $5000. Retails at $8000, which Medicare has to pay.

As for giving 140,000 treatments away, that's them getting a whole bunch of drug trials for free! If it works in some situations (which I bet it does) they have about 300 million more potential customers in the US alone. Not to mention the rest of the world.

There is also the distinct possibility that a Covid-19 attack aborted with an antiviral would not get you IgG antibodies. So you could catch it again, and be a repeat customer.

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#325580 - 05/11/20 09:25 PM Re: Medications that might help against SARS-CoV-2 [Re: GreatNewsTonight]
pondering_it_all Offline
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Registered: 02/27/06
Posts: 10347
Loc: North San Diego County
A bit of encouraging news: Seems like NAC (n-acetylcystein) might be useful for treating very sick Covid-19 patients in the ICU. This is not an antiviral, it's an antioxidant and a pretty sophisticated clot-buster. The biochemistry is pretty complex. If you are into that stuff, you can watch Medcram #69 on Youtube for the pathways and tons of journal paper references.

Basically, Covid-19 makes a nasty critter called super-oxide which can cause endothelial disruption. Cells in your blood vessel walls that are normally covered by endothelium then release something called VWF. That forms long polymer chains that help bind platelets into clots. The clots are what causes most Covid-19 deaths.

NAC can help reduce super-oxide to OH- and water, and it can break up VWF polymers. In fact, some of those papers actually talk about using NAC to bust clots from other pathologies. This is not very helpful during the virus replication phase. It does nothing to slow that down. But it's nice if doctors have a drug that they can use for critical patients besides heparin. There is a clinical trial underway that uses NAC in exactly this way. Oh, and adverse reactions are so far rare or non-existent.

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#325583 - 05/11/20 10:59 PM Re: Medications that might help against SARS-CoV-2 [Re: pondering_it_all]
GreatNewsTonight Offline
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Registered: 04/27/20
Posts: 264
Originally Posted By: pondering_it_all
A bit of encouraging news: Seems like NAC (n-acetylcystein) might be useful for treating very sick Covid-19 patients in the ICU. This is not an antiviral, it's an antioxidant and a pretty sophisticated clot-buster. The biochemistry is pretty complex. If you are into that stuff, you can watch Medcram #69 on Youtube for the pathways and tons of journal paper references.

Basically, Covid-19 makes a nasty critter called super-oxide which can cause endothelial disruption. Cells in your blood vessel walls that are normally covered by endothelium then release something called VWF. That forms long polymer chains that help bind platelets into clots. The clots are what causes most Covid-19 deaths.

NAC can help reduce super-oxide to OH- and water, and it can break up VWF polymers. In fact, some of those papers actually talk about using NAC to bust clots from other pathologies. This is not very helpful during the virus replication phase. It does nothing to slow that down. But it's nice if doctors have a drug that they can use for critical patients besides heparin. There is a clinical trial underway that uses NAC in exactly this way. Oh, and adverse reactions are so far rare or non-existent.


Yes, NAC is a very interesting drug.

I started today the Eastern Virgina Medical School protocol that you diffused here, for me and for my wife (got the tablets and capsules from Amazon), and I sent the information to my son, my daughter, and my brothers and sisters. Thanks for that very helpful protocol.

By the way, I don't know in what thread you posted the link to the protocol. Would you repost here? It belongs here.


Edited by GreatNewsTonight (05/12/20 12:56 AM)
_________________________
Please take COVID-19 seriously; don't panic but don't deny it; practice social distancing (stay 6ft from people); wash your hands a lot, don't touch your face, don't gather with too many people, so that you help us contain it.

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#325621 - 05/12/20 10:49 PM Re: Medications that might help against SARS-CoV-2 [Re: GreatNewsTonight]
GreatNewsTonight Offline
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Registered: 04/27/20
Posts: 264
Anticoagulation seems to be key to survival. At Mount Sinai Hospital in New York, critical patients on ventilators had a drop in mortality from 62.7% to 29.1% when they got heparin.

https://www.mdedge.com/cardiology/articl...20to%20survival

Another treatment seems to have helped in a small trial: a triple antiviral combination.

https://www.mdedge.com/familymedicine/ar...20to%20survival


Edited by GreatNewsTonight (05/12/20 10:50 PM)
_________________________
Please take COVID-19 seriously; don't panic but don't deny it; practice social distancing (stay 6ft from people); wash your hands a lot, don't touch your face, don't gather with too many people, so that you help us contain it.

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#325623 - 05/12/20 11:14 PM Re: Medications that might help against SARS-CoV-2 [Re: GreatNewsTonight]
GreatNewsTonight Offline
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Registered: 04/27/20
Posts: 264
Two more nails in the coffin of hydroxychloroquine for COVID-19:

https://www.cnn.com/2020/05/11/health/hy...s=1589278084735

This shows once more that Dr. Donald J. Trump should not be dispensing medical advice.
_________________________
Please take COVID-19 seriously; don't panic but don't deny it; practice social distancing (stay 6ft from people); wash your hands a lot, don't touch your face, don't gather with too many people, so that you help us contain it.

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#325631 - 05/13/20 03:28 PM Re: Medications that might help against SARS-CoV-2 [Re: GreatNewsTonight]
GreatNewsTonight Offline
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Registered: 04/27/20
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Pfizer has announced that they expect to finish phases II and III of their vaccine's trials by October and get FDA approval by then, starting distribution immediately so that they will deliver 20 million doses by the end of the year (and hundreds of millions in 2021). This will be an absolute record, something I previously didn't think would be possible. Hopefully health care workers and first responders will be among the people given these 20 million (most likely politicians will get them too). Pfizer is outsourcing some of their regular medications production, to focus on making the vaccine. They are repurposing their biggest factory to manufacture the vaccine rather than their regular medications.

Moderna and Inovio are also starting phase II trials.

There is hope, after all.


Edited by GreatNewsTonight (05/13/20 03:29 PM)
_________________________
Please take COVID-19 seriously; don't panic but don't deny it; practice social distancing (stay 6ft from people); wash your hands a lot, don't touch your face, don't gather with too many people, so that you help us contain it.

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#325661 - 05/14/20 01:04 AM Re: Medications that might help against SARS-CoV-2 [Re: GreatNewsTonight]
pondering_it_all Offline
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Registered: 02/27/06
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Loc: North San Diego County
Those "two more nails in the coffin of hydroxychloroquine" are the same New England Journal article we discussed before. Not a real study, but data mining after the fact. Giving HCN to patients with a large viral load doesn't do anything: We already knew that. The reason they die more than the group that didn't get HCN is because they were sicker to begin with.

Here are some very recent publications from the Eastern Virginia Medical School, about treatment for Covid-19 at every phase.


Link to original post

They explain why HCN is only useful at the beginning, viral replication stage. That UCSF Grand Rounds I posted a link to also said that antivirals are not useful once people get really sick.

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#325663 - 05/14/20 01:19 AM Re: Medications that might help against SARS-CoV-2 [Re: pondering_it_all]
GreatNewsTonight Offline
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Registered: 04/27/20
Posts: 264
Originally Posted By: pondering_it_all
Those "two more nails in the coffin of hydroxychloroquine" are the same New England Journal article we discussed before. Not a real study, but data mining after the fact. Giving HCN to patients with a large viral load doesn't do anything: We already knew that. The reason they die more than the group that didn't get HCN is because they were sicker to begin with.

Here are some very recent publications from the Eastern Virginia Medical School, about treatment for Covid-19 at every phase.


Summary


Detail

They explain why HCN is only useful at the beginning, viral replication stage. That UCSF Grand Rounds I posted a link to also said that antivirals are not useful once people get really sick.


Well, I've said it many times but you aren't listening. Even when adjusted for severity of illness, the lack of advantage from HCQ remains.

You tried to repost the Eastern Virginia Medical School links but these aren't links. Redo, please.
_________________________
Please take COVID-19 seriously; don't panic but don't deny it; practice social distancing (stay 6ft from people); wash your hands a lot, don't touch your face, don't gather with too many people, so that you help us contain it.

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#325665 - 05/14/20 02:23 AM Re: Medications that might help against SARS-CoV-2 [Re: GreatNewsTonight]
pondering_it_all Offline
veteran

Registered: 02/27/06
Posts: 10347
Loc: North San Diego County
Quote:
adjusted for severity of illness, the lack of advantage from HCQ remains


That would be true if their "adjustment for severity of illness" was for a linear illness progression. But it looks like serious Covid-19 progression is almost two different illnesses. During the earlier virus replication phase, antivirals might have an effect. During the later predominately inflammation phase, antivirals have little effect. The amount of virus may actually be going down anyway, because of the immune system response. This phase is essentially an acute autoimmune disease. The important pathology is the attack on the endothelium and the resulting VWF clotting and thrombosis. That's why EVMS only uses HCN in the early phases, and then treats the inflammation phase with prednisolone and heparin and no more HCN or remdesivir.

So we have no new data. All we know is that it looks like HCN is useless in the latter phases.

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#325676 - 05/14/20 05:26 PM Re: Medications that might help against SARS-CoV-2 [Re: pondering_it_all]
GreatNewsTonight Offline
newbie

Registered: 04/27/20
Posts: 264
Originally Posted By: pondering_it_all
Quote:
adjusted for severity of illness, the lack of advantage from HCQ remains


That would be true if their "adjustment for severity of illness" was for a linear illness progression. But it looks like serious Covid-19 progression is almost two different illnesses. During the earlier virus replication phase, antivirals might have an effect. During the later predominately inflammation phase, antivirals have little effect. The amount of virus may actually be going down anyway, because of the immune system response. This phase is essentially an acute autoimmune disease. The important pathology is the attack on the endothelium and the resulting VWF clotting and thrombosis. That's why EVMS only uses HCN in the early phases, and then treats the inflammation phase with prednisolone and heparin and no more HCN or remdesivir.

So we have no new data. All we know is that it looks like HCN is useless in the latter phases.


The EVMS puts HCQ+AZ as OPTIONAL because there isn't enough data. It's an unproven hope at this point, and the hope has been fading more and more.

Studies so far haven't shown a benefit for HCQ in mild cases either. I strongly suspect that when all studies are in, including the Columbia University prophylaxis one is in (the quintessential one that hits the virus before replication), the conclusion will be that HCQ is not active against the SARS-CoV-2 at all, in any stage of the disease.

It's certainly active in-vitro... which accounts for very little, other than helping with hypothesis generation.

But it is looking more and more doubtful that HCQ helps in-vivo, for mild, moderate, or severe infections.
_________________________
Please take COVID-19 seriously; don't panic but don't deny it; practice social distancing (stay 6ft from people); wash your hands a lot, don't touch your face, don't gather with too many people, so that you help us contain it.

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