It was very interesting seeing suspected COVID pts. We actually had 2 yesterday. The striking thing was that each complained of severe fatigue rather than respiratory symptoms, yet each has pneumonia on chest CT. Neither had much of a cough. Unfortunately, neither's test result is back yet, so I don't know for sure if they have COVID-19 or not.
But you have to practice Medicine, you just can't read about it. One of the pts is doing very poorly and now on a ventilator and he is less than 50 yo.
On the positive front, the data are really in, but I am confident that hydroxychloroquine (HCQ) and chloroquine work against this virus. China, South Korea, Australia and now France are reporting efficacy. These drugs are for malaria and HCQ is also for Lupus or Rheumatoid Arthritis. They are well-tolerated, but do interact negatively with some medications, such as anti-depressants.
Japan is reporting that their flu drug, favipiravir, also works against COVID-19. Favipiravir is not available in the US yet, but my guess is it will be very soon.
I am very confident that we are turning the tide.
I said early on that delaying this thing as much as possible would give us insight into new therapies. I think we may really have some now. We still are waiting for the raw data, however.
This is good news Dr. Steve. Thanks for taking the time to share.
Yes, I did.
Update:
The 45 yo pt who had a respiratory arrest went to the ICU and was on a ventilator We continued him hydroxychloroquine (HCQ). Patients, who have pneumonia severe enough to cause a respiratory arrest, don't do well and IF they get better, they do so over a period of weeks. By yesterday, this pt was much improved. This morning, he was extubated, meaning he is now breathing on his own. That kind of dramatic improvement I have rarely seen.
The second pt, had less severe disease. For the first 3 days in the hospital, he was not on HCQ and continued to spike fevers to 102. On Day 3, I started him on HCQ and the fever went away within 24 hours.
Now, these two cases are examples of ANECDOTAL data.
Back to the first pt, that recovery was remarkable. Again, it anecdotal, but still impressive. Worse, we don’t have the tests results back for either pt. The second pt’s test was sent on 3/15 or 6 days. He is going home today without confirmation of the diagnosis. I would be very surprised, however, if either pt tested negative for COVID-19.
Hello Dr. Steve, I hope you are well. Did you prescribe these two patients HCQ? I don't believe there is any FDA regulation preventing you from doing so.
I am getting more than a little annoyed. Two days ago, THE New England Journal of Medicine published data from China on the effect of Kaletra (lopinavir/ritonavir) on COVID-19. In 2003, Hong Kong researchers showed the Kaletra plus another drug, ribavirin, improved outcomes in SARS patients. In this COVID-19 trial, ribavirin wasn't used and THE New England Journal did not say why. THE New England Journal also did not mention the fact that China also tested chloroquine, stated that chloroquine works against COVID-19, is using chloroquine as the drug of choice for COVID-19, and has not published those data, which are over 4 weeks old.
It is time for those data to be published. THE NEJM included an editorial commentary, which seemed intentionally, poorly done. Given the poor job done by NEJM's editorial board, you have to wonder about their motivation. Regardless, it is time for China's chloroquine data to be released.