Corona Therapies

Although the media may believe they are performing a service to American society, their wall-to-wall, 24/7 coverage of the COVID-19 virus pandemic is doing the opposite.  They are actually providing a disservice by generating fear and panic in a population that has been indoctrinated by the media.  It is George Orwell’s society where the media tells you what to believe and how you should react.  When you are no longer able to think for yourself, it is only a matter of time when that helplessness leads to panic.  The media has focused on the virus’ contagious nature and relative high mortality in older, vulnerable populations.  Where was this histrionic reporting during past influenza epidemics?  My own personal belief is that this has been blown out of proportion due to the media’s extreme hatred for President Trump.  It seems more than a coincidence that this crisis appeared on the scene after other attempts to remove Trump from office failed.  With an upcoming presidential election the Dems are hoping a crashing economy from a medical crisis will result in his defeat.  The Dems answer to Trump, Joe Biden, is a medical crisis in itself.  The scientific community is apolitical and has already shown progress toward a vaccine that is now in human trials.  The FDA approval process is an arduous one, and that is to protect the American public.  It will most likely be a year or more before the vaccine has cleared all the necessary steps to be widely distributed.

Lessons learned from experience with COVID-19 in China and South Korea have made several discoveries.  1) Corticosteroids should be avoided as they may prolong viral shedding.  2) Bronchodilators are best administered by metered dose inhalers rather than nebulizers which may spread the virus.  3)  Antibiotics are best avoided unless there is a clear indication for them.  4)  Co-infection with influenza is unlikely, but co-infection with SARS-CoV-2 may contribute to pneumonia.  5)  People who die from COVID-19 are those who require ventilator support and die from ARDS (acute respiratory distress syndrome).  6)  Infection can occur in children but is generally not as severe as that seen in adults.  A case of neonatal COVID-19 infection was reported in China but is probably not transmitted from mother to fetus.  7)  Several combinations of anti-virals have been tried with mixed results and toxicity.  8) Chloroquine, used in preventing and treating malaria, has shown anti-viral activity to the coronavirus.  It does have a risk for hepatic damage and could be problematic in patients with CHF, recent MI, G6PD deficiency, epilepsy, or porphyria.  The recommended treatment of mild, moderate or severe disease is a dose of 500 mg PO twice daily for 10 days.  A combination of chloroquine and remdesivir was shown to be effective against the newly emerged novel coronavirus (2019-nCoV).  9)  Hydroxychloroquine inhibits the virus in much the same way as chloroquine and is better tolerated in most cases.  It is also 3X  more potent therefore the course of treatment is shorter.  The dosage studied was 400 mg twice a day on day 1 then 200 mg twice a day for 4 more days.

Tocilizumab is an interleukin-6 (IL-6) inhibitor that could be beneficial in patients with extensive lung involvement and those with elevated IL-6 levels.  Tocilizumab suppresses the immune system and should be avoided in patients known to have other serious infections such as tuberculosis.  Some have suggested that ACE-inhibitors(ACEIs)  and angiotensin-receptor blockers (ARBs) could increase the severity and transmissibility of COVID-19 infection as a result of greater expression of ACE2 receptors.  French researchers have suggested that NSAIDS such as ibuprofen be avoided for potentially making infections worse and for impairing renal function.  Both ACEIs/ARBs & NSAIDs are known to impair renal function at times when patients may become volume depleted and hypotensive.  It would not be unusual for an individual to become both volume depleted and hypotensive in severe COVID-19 infections.  Fluids are often administered judiciously in the sickest patients due to the increased likelihood of ARDS and fluid accumulation in the lungs.  The virus results in lymphopenia and experience has shown that COVID-19 diagnosis and treatment may be guided by the surveillance of neutrophil-lymphocyte-ratio and lymphocyte subsets over the course of the disease.

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