I have received the following information from a good trusted friend, who researches everything before he writes.....
If you haven't already done so, I'd recommend getting a N95 - 100 pollen mask from Amazon with extra filters for the unforseeable future.....
Please note that I am not a doctor. I merely present here a summary of research articles and publicly available treatment protocols I have read.
Seek medical advice from a professional before acting on any information provided here.
This is my long post about COVID19 medications that I've been brooding over for a few days. Note that I wrote this before president Trump's unhelpful tweets.
There are medications that are widely used to treat COVID19. They are not talked about much outside the medical community but there are safe and effective options. If given early enough the meds can prevent hospitalisation and organ damage while getting patients back to health quickly. I will do a quick outline for each and then a more technical section further down.
Chloroquine is a prescription antimalaria drug with many decades of use that for some reason works for COVID19. All the side effects are known and it is quite safe at the lower and short doses needed to beat COVID19. It was the first treatment for most cases in china and is instrumental in keeping the death rate low. It is also very cheap so can be used early and repeatedly. It appears to be possible to use as a preventative so that life can go on as normal, especially for essential services personnel. The mechanism it works by is not yet known, but one theory is that it allows zinc to interfere with the viral replication process, so it is recommended to add a zinc supplement.
Hydroxychloroquine does the same as chloroquine but at lower doses and has less side effects. It is now the preferred option.
Kaletra is an antiviral drug combination used for HIV treatment. It has a stunning effect on COVID19, but is quite expensive at around $1000 per course. It can have serious side effects and is often not well tolerated. But it has been used for a while and is quite safe.
Remdesivir is a new antiviral developed for the ebola crisis, but didn't do so well for that purpose. It is however the top candidate for COVID19 treatment as it seems it can cure even severe cases in a matter of a few days. It has passed early clinical trials, but there has not been any large scale monitoring of side effects. It is the main focus as a future treatment option and research is being expedited by the WHO.
Favipiravir is an experimental antiviral that has shown good effect against COVID19. It was developed for influenza and is stockpiled by the japanese government for influenza oubreaks. It seems to be difficult to find on the open market.
Quercetin is a natural substance that has attracted a lot of interest because it has the same effect on zinc as (hydroxy)chloroquine. So if the zinc theory is right then this could be useful. It is cheap, natural and healthy. And suddenly very popular.
There are other antivirals that work, but most are not very effective.
Paracetamol is recommended to control high fevers. Low fevers are likely good for fighting the disease, so paracetamol should not be used unless fever is above 39 and rising. Fevers over 40 are dangerous.
Many herbal preparations are claimed to reduce symptoms and the chinese swear by them. For young people with expected mild cases this might be an acceptable option, but it should not be relied on for older people or high risk groups. Some chinese herbs are potent immune suppressants that can reduce the severity of the inflammation, but this carries similar risks to steroids, except milder.
The flu vaccine ensures you don't get the flu at the same time as COVID19, so this is a priority recommendation by the WHO.
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Be cautious with these remedies:
This list is obviously not complete, but here are some standouts.
One herbal product that should probably be avoided is Elderberry. This is known to help in some infections, but it works by releasing cytokines. Since the deadly pneumonia of COVID19 is largely caused by cytokines taking elderberry would make this worse.
Some chinese herbal preparations recommended for COVID19 are based on suppressing cytokine release. This will reduce symptoms, but may actually promote the growth of the virus to prolong the illness or make certain aspects worse. It carries the same risk as steroids in that regard. However some chinese herbs have been shown to lower infection rates, so might be suitable as a preventative. Taking the right ones at the right time is key.
Steroidal antiinflammatories are great at reducing inflammation but have been shown to make COVID19 worse. Examples of this are asthma preventer inhalers or oral cortisone type meds. The WHO recommends not to use these until the very late stage in recovery.
Aspirin and nurofen are non-steroidal antiinflammatories often used to treat pain and fever. However there is some concern that they might make COVID19 worse by the same process as steroidal antiinflammatories. Paracetamol does not have this problem and is good for reducing fever.
Hot air treatment (I won't even describe this) is mentioned as a way to cure COVID19, but this is based on data derived from throat and nasal infections. The process can not possible work for a lung infection without doing serious damage to the tissue.
Most natural flu remedies like oregano oil and sipping hot tea will only kill the virus in the mouth and nose area but will not protect the lungs. So at best they will delay infection until a virus droplet is inhaled deep enough. Tea however also has mild immune boosting and antiviral effects.
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What are the dangerous symptoms and who is at highest risk?
For most young people COVID19 will be no worse than a flu or even less. They may not even get symptoms, which means they will spread it around their families and friends without even knowing.
The death rate for under 50s is just 0.2% and is mostly comprised of cancer or immuno-compromised patients. No one under 10 has died.
80% of all infected will not require hospitalisation. However 20% will need hospital and will likely spend at least some time on a ventilator. If you're young and healthy this might be just a few days, but older patients might require ventilation for several weeks. The average age of needing a ventilator is in the low 50s, but ranges from the 20s upwards. Survival depends on the availability of ventilators. The numbers are hard to track down, but Australia probably has about 15,000 ventilator beds. Once that capacity is reached doctors will have to prioritise which patients get ventilators. This is usually done based on expected life years (young people) and expected time spent on ventilator (young people need less time to recover). That means oldies may miss out if the hospital system is overloaded. This is what happened in northern Italy where lack of ventilators caused a death rate of 7%. And this is why #flattenthecurve is so important. Treating the disease early means that your chances of developing pneumonia are reduced.
There are a number of conditions that affect the outcome of COVID19 infections. One of these is diabetes or even prediabetes. There is a direct correlation between HbA1c (long term blood sugar indicator) and severity of disease. Other comorbidities are cardiovascular disease, hypertension, cancer, and lung conditions. These can increase risk of death between 6 fold and 13 fold. But the greatest risk factor is age. Risk of death in the 50s is just 1.3% while it is 15% in the 80s.
But death is not the only problem. The more severe the disease the more likely it causes a permanent lung condition. So avoiding the need for hospital seems to be an important goal. One of the greatest concern is fibrosis of the liver which can cause permanent reduction in lung capacity. This has been observed not just in older patients, but at any age group that had a severe response. The problem is that viral replication causes cell death as the new viruses emerge from their hijacked cells. Once you have enough damage in one location the immune system start attacking the healthy cells nearby via cytokines and an irreversible cascade starts. It is no longer the virus doing the damage, but the immune system. The stronger the immune system the faster the damage. The idea is to intervene early before this ratio of dead cells happens.
Blood type appears to relate to death rate in a preliminary study. Type A fares considerably worse while type 0 does considerably better than average.
To understand how treatment works you need to understand how the virus works. It is generally inhaled or introduced to the face via lung aerosols (droplets coming from the mouth). The virus will then enter a cell of the lining of your mouth, nose, or lungs where it will hijack the cells and force it to produce copies of itself. In a matter of hours the cell will produce about 4000 such copies. When the cell is exhausted the new viruses will break out of the cell, usually rupturing it in the process. That's one cell dead. These 4000 new viruses will then start the process over and repeat this every few hours, killing thousands of cells each time. Once enough cells are dead the immune system mounts an overproportional attack and kills everything nearby via cytokine inflammation. This is because it knows the virus is lurking hidden in healthy looking cells so it is mounting a preemptive strike. In the process it causes far more damage than the virus itself. And healthy immune systems are often the worst affected. Intervening with viral replication at the first stage means you only have to kill one cell and it's contents. A few hours later it is 4000. A few hours after that it is 16 million. And so on. With each replication the drug needs to so much more work. By the time you feel symptoms you are already 1 to 14 days into this cycle, so every hour counts.
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The drug details.
Many countries have banned the export of these drugs so that their national stockpile is not affected during the upcoming crisis. That leaves often very questionable overseas sources and buyers need to be cautious about importing drugs that may not be what they claim to be.
Remdesivir is the main drug promoted by the WHO for COVID19. It was developed to treat ebola, but wasn't as effective as other drugs for that. Remdesivir causes severe gastrointestinal problems and elevated liver enzyme values but appears highly effective at curing even the most severe cases of COVID19. Fatally ill patients appear to be cured within 48h. It is given by an intravenuous drip. The dose is 200mg by IV on the first day, followed by 100mg IV for 9 to 13 days.
Kaletra is a combination of Lopinavir and ritonavir. The former is an antiviral while the latter stops the metabolism of the former, keeping it in the system for longer. It has a history of being an effective HIV drug, but is often poorly tolerated so has been largely replaced by other drugs (which are not suitable for COVID19). Kaletra can cause serious, life-threatening side effects. These include liver problems, inflammation of the pancreas (pancreatitis), heart rhythm problems, severe allergic reactions, and life-threatening drug interactions. The sudden demand for kaletra is putting HIV patients at risk of not having access, so should only be used in absolute emergencies until stockpiles are secure. Not everyone needs kaletra. The unsubsidised price for kaletra is about $1000 per course and getting it is now very difficult. It is the preferred intervention for severe cases in the USA. It has been trialled in combination with chloroquine without any major problems. This means that patients can be on chloroquine as first line defence and only resort to kaletra if they don't respond well enough. Dosing information is a bit vague but seems to run along the same lines as for HIV treatment which is 400mg twice a day.
Chloroquine and Hydroxychloroquine are the most likely options for most people to obtain. The hydroxy version is safer and more effective but they pretty much do the same thing. No one really knows what that is though. There are 3 theories and all of them have merit. It may even act by more than one pathway.
1) it causes heme build up making the cell toxic to the virus
2) it acts as a zinc ionophore, allowing zinc to enter the cell and disrupt virus replication via inhibition of replicase
3) it stops the virus interfering with hemoglobin which it requires as a food source for replication.
Chloroquine is a 70 year old drug that has been researched a lot. It CAN have some nasty side effects but these mostly relate to very long term use or high doses. Keeping in mind this drug was often used for many consecutive years to prevent and treat malaria. Chloroquine was first used by the Chinese in their Wuhan outbreak and produced excellent results. They soon moved to hydroxychloroqine as this has a better safety profile and is more effective. This means there are a number of different dosing regimes for these drugs. Hydroxychloroquine is now official standard first line treatment for COVID19 in Poland. In other countries it is still administered as a trial drug even though it is given to vast numbers of patients. The trial drug status means patients need to agree to accept the risk.
For chloroquine the established protocol is 500mg twice a day for 5 to 10 days. This should ideally start as soon as symptoms appear, but is usually not started till testing has confirmed COVID19. Depending on testing method that can mean up to a 3 day delay. 3 days where the virus gets to proliferate and do damage. New testing methods will likely soon give near instant results, so this dilemma of when to start medicating may no longer be an issue.
For hydroxychloroquine the initially established protocol is 400mg twice a day for 5 to 10 days. It was then observed that after 3 days the serum levels were 3 times as high as for chloroquine, so that allowed for a reduction in the dosage to the newer protocol of 400mg twice a day for 1 day, followed by 200mg twice a day for another 4 to 9 days. This latter protocol might be especially valuable if there is a shortage of the medication or if the patient does not tolerate the medication well.
The latter protocol also opens the door for preventative dosing. One such proposed protocol is 400mg twice a day for the first day, followed by 200mg twice a day from then onwards. This is the same dose used for other conditions and is generally well tolerated in the medium term. I envisage that this is a protocol that could be used to keep essential services personnel (eg doctors and nurses) in active duty during the critical peak infection period we are facing. It could also keep the most vulnerable people virus free until a vaccine is available.
A small trial in France showed good results from hydroxychloroquine 200mg three times per day for 10 days, combined with the antibiotic Azithromycin 500mg on first day and 250mg for the remaining 9 days. The antibiotic was provided to stop bacterial superinfections and sped up the virus clearance rates substantially. This protocol uses dosing three time per day which was shown in previous trials to not be necessary as the serum levels stay quite steady throughout the day on double or even single doses, especially from day 3 onwards. Bacterial super infections should be rare if the hydroxychloroquine is given early enough to prevent inflammation of tissues, so this protocol might be a bit of a sledgehammer approach. But Azithromycin is also an antiviral and has been successfully used in treating Zika virus.
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Please note that I am well aware that the usual standards of research have not been met for ANY of these drugs. However field reports paint a very clear picture of effectiveness and they have been widely used in many countries. It's the best we have at this stage. That will change quickly and my dosing regime may change with it. Initial WHO trial data should be forthcoming in early April, with final results in august. They are unlikely to be of spectacular rigor, but will help to guide us through the next few difficult months. Better research is on the way.
Good luck to all.