COVID19 Outpatient Treatment Protocols

The HCQ cocktail, including Hydroxychloroquine, azithromycin, and zinc, costs about $20 total; IV remdesivir costs about $3000 and is usually given at least 5 times, for hospitalized patients only.

“It is inhumane to tell a patient who has tested positive that they cannot even try a drug that’s been around for 65 years. It is unconscionable.”

Senator Ron Johnson

Senator Peters (D), the minority party leader for this committee, disagrees strongly to the use of any oral medications to treat COVID19. According to him (and his one witness), the “expert” organizations have determined the HCQ cocktail is ineffective and therefore should not be used.

Sen Peters is so against treating COVID19 patients with any oral protocols that he has introduced legislation to create a COVID19 Misinformation and Disinformation Task Force.

Sen Peters brought as his expert witness Dr. Jha, Dean of Public Health at Brown University who stated that when potential treatment protocols surface, he reads the literature and asks himself if he’s missing the boat. Then he goes to the experts, and in his opinion, the scientific consensus is very clear that the HCQ protocol is not effective – so he would not treat a patient with it.

Senator Johnson asked Dr. Jha if he sees patients. He said yes, he see patients at the VA. When asked if he has treated any COVID19 patients. He answered “no”.

That’s it. That’s the expert for the argument of not treating patients with outpatient protocols.

Senator Johnson on the other hand, brought several experts – doctors who actually do treat COVID19 patients and have successfully done so with HCQ and other medications as a complete protocol for both outpatients and inpatients (when appropriate).

Dr. Peter McCullough, Vice Chief of Medicine at Baylor University, also oversees cardiology training, education, and research for Baylor Health Care System. He stated he is in regular communication with doctors treating COVID19 around the world.

Dr. Mccullogh’s viewpoint is that this pandemic should be viewed as having four pillars:

The vast majority of government efforts have been focus on contagion control. It is obvious this has not stopped the problem.

Early Home Treatment: The ONLY treatment protocol for infected individuals is to stay home for two weeks. We have opportunity for early ambulatory treatment – and that’s what the hearing was about.

What we have learned about this virus is that there is an early viral revocation phase, followed by destructive immune activation and then blood clotting from thrombosis.

Dr. Mccullogh has summarized a proven approach to home treatment. This has been published in the American Journal of Medicine (link below).

Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection – Dr. McCullough

These principles could be deployed in a layered and escalating manner depending on clinical manifestations of COVID-19-like illness and confirmed infection:

1. Reduction of reinoculation

Fresh air & fans, or air purification

2. Combination antiviral therapy with the goal to reduce the rate of viral replication.”

• Zinc “is a known inhibitor of coronavirus replication and clinical trials of zinc lozenges in the common cold have demonstrated reductions in the duration and or severity of symptoms. Zinc lozenges can be taken 5 times per day for 5 days minimum.”
• Antimalarials – “Hydroxychloroquine (HCQ) is an antimalarial/anti-inflammatory drug that impairs endosomal transfer of virions within human cells. HCQ is also a zinc ionophore that conveys zinc intracellularly to block the SARS-CoV-2 RNA-dependent RNA polymerase, which is the core enzyme of the virus replication. A typical HCQ regimen is 200 mg bid for 5 days and extended to 30 days for continued symptoms.”
• Antibiotics that have “multiple intracellular effects that may reduce viral replication, cellular damage, and expression of inflammatory factors” (Azithromycin or Doxycycline). “French studies are demonstrating markedly reduced durations of viral shedding, fewer hospitalizations, and reduced mortality of antibiotics in combination with HCQ as compared to those untreated.”

3. Immunomodulation

“The manifestations of COVID-19 that prompt hospitalization and that may well lead to multiorgan system failure are attributed to a cytokine storm. Some of the first respiratory findings are nasal congestion, cough, and wheezing. These features are due to excess inflammation and cytokine activation. Early use of corticosteroids is a rational intervention for patients with COVID-19 with these features as they would be in acute asthma or reactive airways disease.”

4. Antiplatelet/antithrombotic therapy

Studies “support the notion that endothelial injury and thrombosis play a role oxygen desaturation, a cardinal reason for hospitalization and supportive care. Based on this pathophysiologic rationale, aspirin 81 mg daily can be administered as an initial antiplatelet and anti-inflammatory agent.”

5. Delivery of Oxygen and Monitoring

“A significant component of safe outpatient management is maintenance of arterial oxygen saturation on room air or prescribed home oxygen under direct supervision by daily telemedicine.”

Doctors and scientist all over the world are using these outpatient treatments with great success.

The US currently has over 800 deaths per million population due to COVID19.

India has less than 100 per million – they are treating at home with the above mentioned multi-drug program.

In Greece, the at home multi-drug program is the first line defense – they have less than 200 per million.

More than 30 countries are using an oral version of remdesivir, which has also proven to be effective for treating outpatients, however we reserve use via IV for patient who hospitalized.

Dr George Fareed – Pioneer Med Center Medical Director, trained at Harvard stated if a patient comes into his hospital with mild respiratory symptoms, he doesn’t immediately put them on IV remdesivir, he prescribes the multi-drug cocktail. He also discussed the importance of what he calls real world studies.

Randomized Control Trials (RCT) strictly evaluate the effectiveness of a specific treatment with selective test subjects. In a RCT, everyone gets the same therapies, but in the real world, doctors can shift and adjust as necessary.

Non-randomized control studies, aka real world study, are every bit as reliable as RCTs. Dr. Fareed asked 2 doctors to have their patients participate in a NRCT over a six week period using the HCQ cocktail.

• Doctor 1 treated 400 patients with no deaths.
• Doctor 2 treated 180 patients with 1 death (this patient died of an unrelated heart attack two weeks after being seen, treatment was finished but covid was included on his death certificate).

“In the art of medicine, you take what has been proven to be effective and you modify it, you listen to other doctors who are having success and add or make changes to improve what is already working.”

Dr. Fareed

Right to Try

The Right to Try bill allows patients and doctors the right to try medications that have gone through the first two stages of FDA approval so it’s known to be safe, but hasn’t gotten through the final efficacy approval, for conditions where no other treatment is available.

HCQ is a fully approved drug and has been safely used to treat malaria, lupus, rheumatoid arthritis and other conditions for 65 years. It is one of the safest and cheapest drugs available.

And yet doctors who have had the courage to try to treat their patients with HCQ have been scorned and worse.

The vaccine will not be available to the public for months and is not expected to reach the full population for a year. In the meantime, Senator Johnson is advocating to allow doctors to treat patients compassionately with a proven drug so they don’t progress into hospitalization or death.

It is unconscionable that we are demanding restrictions that significantly affect businesses and individuals to an extreme detriment, but we are not even willing to try proven at home treatment protocols.