JAMA table 1, comparing efficacy of masks
(This isn’t medical advice, since it would be unethical to treat people I can’t examine and follow. But this may be a good list of recommendations for discussion.
If I were in charge of the public health response to COVID-19, I would implement the following:
1. Let physicians practice medicine!
Stop the political, weaponised threats censorship, and cancelling!
Pharmacy Boards should never get between a doctor and patient except in matters of life and death or illegal practice. Politicians, State Medical Boards and our House of Medicine professional organizations should defend our legal practice of medicine rather than threatening physicians and changing the rules during a pandemic.
2. Encourage shared information & fact-checking among physicians as part of our missions of education & transparency.
3. Suggest voluntary use of masks in public places or self-isolation for those worried about their vulnerability
. Traditionally, we quarantine the sick and at-risk and new-comers, not the healthy or people in place with a low risk of exposure.
JAMA review of masks, August 2020
4. Where a high percentage of the local population tests positive, local authorities should consider – and have the ethical responsibility to – impose higher isolation measures like masks and public distancing. The threshold for mandates must be locally determined with public input, and explained – clearly, frequently.
This means you, anti-maskers!
5. Stress that surgical procedure masks are nearly as effective as N95 masks, blocking nearly as much aerosols and viral particles for both wearer and those around us. Medical providers and those with a high risk of prolonged close contact need fitted N95 masks, the rest of us don’t.
Single layer cut-up T-shirts and homemade masks, balaclavas or bandannas, aren’t very effective protection at all, either for the wearer or the people around us. N95 Masks with single valves are a money-maker, but not nearly as effective as surgical masks, even with an added filter layer.
5. Educate the elderly & vulnerable about extra infection-avoiding and -control precautions, advising self-imposed near-quarantine for the most vulnerable of them.
6. Recommend Vitamin D & zinc over the counter supplements, possibly Vitamin C – which are harmless to virtually everyone, if not beneficial, to everyone.
7. Make Rapid tests for in-home testing available at nominal, sliding scale cost, on demand and at first symptoms or exposure. (This may be a place for donations by crowd funding.) Back up positives with the PCR tests, quarantine all rapid positives until cleared by PCR.
8. Begin early prophylaxis with hydroxychloroquine/zinc and/or inhaled steroids for the willing & likely exposed.
10. Open the schools, let the kids be kids on the playground. Utilize younger teachers and aides in the classroom. Supervision & protection for vulnerable teachers & students can be achieved as necessary with distance learning measures.
11. Make sure we have lots of Hydroxychloroquine/ azythromycin/ zinc/ vitamin D to begin at the first symptoms (I know the literature is mixed, but every article or study that I’ve seen it’s all flawed, see below**).
12. For both of my homes, in Texas, USA and in the British Virgin Islands, we should open the borders to anyone willing to quarantine in a government-secured location for 14 days & planning to stay at least 30 days (maintaining strict isolation & infection control precautions).
And, the most risky proposal of all...
10. I’d sanction the Chinese government-connected businesses and confiscate their assets to pay for it.
** I follow the literature as best as I can: every single peer-reviewed study is flawed. However the anecdotal evidence for some protocols is very strong. If necessary to avoid politics, let the controlled trials continue but let willing physicians continue our ethical off-label prescription. We could just pretend we’re giving malaria prophylaxis, if it makes you feel better.
Hydroxychloroquine: 400 mg. twice on day one 200 mg twice on day two, then 200 mg. Twice a day every 4 days
Treatment dosing (always allowing treating physicians who prescribe determine need & frequency of alternate doses & monitoring)
This isn’t a prescription!
Hydroxychloroquine: 400 mg. twice on day one then 200 mg. twice a day for either 5 or 10 days;
Azithromycin: 250 mg. tablet, 2 on day one, 1 on day 2 to 5;
Budesonide: unit dose via hand held inhaler or nebulizer twice a day. (I’m looking for references for this one. )
Zinc 150 mg. to 250 mg. a day indefinitely. (Best evidence for lozenges or syrup multiple times a day. See references.)
Vitamin D, 1000 IU a day, up to 4000 IU is safe
Vitamin C, No set dose, but extra will be excreted in the urine or feces, can cause diarrhea.
Journal of the American Medical Association review. Published August 11, 2020. (Free, with Tables)
CDC recommendation on cloth masks:
John’s Hopkins recommendation:
Journal article on treatment for the common cold: https://www.acpjournals.org/doi/10.7326/0003-4819-125-2-199607150-00001
Unpublished, non-peer reviewed: https://www.researchgate.net/publication/47794995_Zn_Inhibits_Coronavirus_and_Arterivirus_RNA_Polymerase_Activity_In_Vitro_and_Zinc_Ionophores_Block_the_Replication_of_These_Viruses_in_Cell_Culture
International Journal of Infectious Diseases (Henry Ford or Ashad report):
On synergistic effect of hydroxychloroquine plus steroids:
Description of study in progress on treatment for loss of smell in patients without severe symptoms:
Vitamin C safety:
Note: comments are off. Please comment on my Facebook page, Beverly Nuckols.
Edited 31/08/20 12:30 for mis-spellchecked word. BBN
Dr. Scott W. Atlas, former Chief of Neuroradiology at Stanford University Medical Center, current Senior Fellow at Stanford’s Hoover Institute, author, and public health policy consultant was added to the White House COVID-19 task force this week. Unfortunately, he and his appointment have already become a political target by some.
Far from being unqualified, or someone who “clearly wouldn’t know science if it kicked him in the atlas” (see above link – I refuse to give clicks to the original source or the ignorant woman who spoke those words), Dr. Atlas speaks common sense, science-based truth, as in this video from 23 June, 2020 interview with Peter Robinson of the Hoover Institute’s. “Uncommon Knowledge.”
In fact, Dr. Atlas states what I’ve been saying since I heard about the virus outbreak in Italy, while attending Carnivale parades just a few miles away in
Carnivale float, Nice France, depicting Chinese labor in Fashion industry.
Nice, France: the reaction by governments and fearful people has been just as bad if not worse than the results of the infection itself.
The initial lockdown was correct, but we have new data – and new models – every day. Yet, we are still acting as though the early models were accurate.
Worse, instead of “flattening the curve,” the call is to conquer or eliminate the virus “at all costs.” The latter has never happened and will never happen with a Coronavirus. There is the possible exception of the elimination of smallpox, a much more deadly disease, at the cost of egregious human rights violations and even deaths.
I’m surprised that anyone would attack Dr. Atlas or his qualifications. Before you dismiss him, please listen to his testimony and critique the facts rather than the source.
14 minute interview with Houston TV reporter.
She’s a warrior, all right! Worth your time!
I would like to see some data, but lots of other doctors report the same results, and I’d like to see some of their patient information, too. (Ages, other meds, vitals, timing, symptoms.)
She does say wear a mask if you can’t be on prophylaxis and to make other people comfortable. I would call her regimen a “treatment” rather than a “cure.”
But the biggest fuss has been about Dr. Immanuel’s religious beliefs. I’ve heard Baptist, Assembly of God, even Church of Christ preachers say much the same about the hidden powers in the world. Maybe not the origins, but their existence and, as Jesus Himself said, the need for prayer and fasting to deal with them.
I’ve been told that her religious views are a distraction and counter-productive for the Medical issues and “science.” But Dr. Immanuel doesn’t even bring up her religion until she’s questioned in this interview and didn’t bring it up at all in DC.
The detractors don’t understand the cultural background and how many Christians – across the spectrum from those who believe in the indwelling of the Holy Spirit to those who only remember the story of St. Michael – will recognize the theme.
Were you triggered by the religious views of Nigerian born and trained, Texas licensed and practicing, Dr. Stella Immanuel?
Not only is she a passionate, powerful, and persuasive speaker and a professional black woman who committed the sin of going against the grain on an unreasonably politicized medical treatment. Worse: she was praised by President Trump. So, she had to be put under the political microscope.
There was a video of a press conference held on the steps of the Supreme Court in Washington, DC by a group called “Front Line Doctors.” The group spoke in favor of Hydroxychloroquine therapy for treatment of COVID-19 an included a Congressman from North Carolina and 15 to 20 doctors. Virtually all of the various online video tech hosts keep censoring the video, removing it almost as soon as it’s posted.
After reading about the censorship of the video, I was able to access a site and watch about 10 minutes before called away from my phone. When I came back, the video had been removed.
The five docs I originally heard (& possibly the 10 to others who were lost to censorship) spoke about their experience and preferences for treatment. Were any of the other docs the object of deep background scrutiny?
I disagree with some of the claims made in the video, especially the use of the word “cure” (rather than treatment) and with the opposition to the routine use of face masks to decrease exposure and viral load.
Dr. Immanuel only talked about her clinical experience. She spoke about successfully treating patients with Hydroxychloroquine for malaria in Nigeria and, along with zinc and Zithromax (azythromycin), as treatment for COVID-19 in her practice in Texas.
Ignoring the fact that the WHO resumed
trials of Hydroxychloroquine June 3, the policy that masks were not helpful was promoted by both the WHO and CDC just a couple of months ago. Are the old documents from these organizations being removed from servers?
From what I understand, Dr. Immanuel is a preacher in addition to being a doctor. The things I’ve read about her sermons seem bizarre to me, but they remind me of a certain Chicago minister who had a few bizarre beliefs about HIV/AIDS, the US, and roosting chickens.
Nigeria has a different folklore tradition than mine in Texas; with a background of animalism and spirits, instead of our Greek mythology and Judeo-Christian history.
Cultural explanations and practices for disease have evolved, but traditions and habits persist: in the West, we knock on wood or throw salt over our left shoulder to chase off the “evil humours” that were the explanation for something that couldn’t be seen before microscopes.
I trained in South Texas, where I learned to ask about and counsel on the curanduras’ advice and practices. Curanduras still tell mamas to put pennies on baby’s umbilical cord to ensure an “innie”belly button and to place raw eggs under the bed to draw away sickness. Never was able to do as well with devotees of homeopathy & “adjustments” for asthma and “subluxation” or the irrational opposition to vaccinations.
I’ve had my medical and political credibility questioned because I’m a Christian. In contrast, I try to be respectful of people of different ideologies, evaluating their actual knowledge of science and practice of medicine, no matter what I think about their religion.
Would the theories of the origins of disease have been familiar to people from Dr. Immanuel’s culture? More importantly, does she understand and practice medicine according to the germ theory and current science?
There are no PROVEN therapies for COVID-19! Hydroxychloroquine/zinc/azithromycin is no more “unproven” than any other. It’s “unproven” that HCQ is unsafe.
(As of Midnight, 30 July, the video was available at https://www.bitchute.com/video/09K3kIwzeewO/?fbclid=IwAnR2E-LChNhpqOktcV4GPeT0ZS79cdf1tjdlnfNSlpGNWMCW6vVYYnHLCbjU so I was able to watch the rest of the docs.I am impressed especially by Dr. Joseph Ladapo, beginning at minute 33.)
Traditional germ theory explains the deaths & spike in COVID-19 cases in the US better than any political accusations going around. But, some politicians do carry real blame, however denied:
“”You had this political conspiracy theory that the deaths in nursing homes were preventable,” said Mr. Cuomo.””
At a press conference today, New York Governor Andrew Cuomo insisted that his March order requiring NH’s to accept COVID positive patients from the hospital didn’t cause deaths – in spite of the fact that it’s estimated that those orders caused more than 6300 such transfers.
Click to view the percentage of death in NH by State
The problem with the spread of disease has been a lack of common infection control where it counts: in the care of the most vulnerable in nursing homes (“NH” ) and hospitals, as well as the failure to protect healthcare workers who come into close contact with the vulnerable and infected — and who travel between facilities & the community.
The first reported
US case led to an outbreak in a Washington State nursing home and the local hospital. It began after a traveler returned from China – while that country still denied person-to-person spread – and sought treatment at the hospital. Employees carried it between facilities and into the community.
In spite of this history, New York
& New Jersey
governors each ordered nursing homes to accept COVID positive patients from the hospital & the Minnesota Department of Health insisted
that hospitals discharge positive patients back to NH’s that weren’t prepared. It’s estimated that 1/4 of NY NH workers contracted the disease between March and June.
NY didn’t mandate NH testing until mid-May. NJ required testing by May 26th!
” gives more details about the lack of anticipation about the NH risk in a July 6 article
The cycle of poor infection control in facilities caring for the vulnerable elderly – with inadequate protection for residents, employees, & their contacts – spread the virus.
Wear a mask if you, too, are at risk or will spend time with someone who is. Wash your hands! But, please don’t politicize this disease.
The “Right to Life” means the negative right not to be killed by intentional acts. It’s not the right to force others to invest our life, liberty or property other than the duty to intervene against infringement. This is a basic negative right, not a positive right.
There’s a huge difference between personal responsibility in avoiding a risk to yourself and actively causing harm to someone else. Self-defense rather than selfish demands, using only appropriate force on others.
You know, the old “your right to swing your fist ends at my nose!” (Especially Appropriate in this case.)
*You* take the actions *you* believe are responsible. Only frequent places/businesses that require masks if you want, do the work necessary to maintain the social distancing you are comfortable with. Don’t force everyone else to do your work for you.
Even after all this time, bad explanations – fake news and myths – are being spread in Social media about COVID-19.
One of the more pernicious is the accusation that the hypoxia caused by COVID-19 isn’t due to pneumonia or ARDS. Oh, no, instead, there’s a “secret, ” new mechanism for the morbidity and mortality caused by COVID-19. The theory is based on the fact that one of the complications in the sickest COVID-19 patients, as well as earlier SARS1 and MERS patients, is increased coagulation that causes lots of tiny blood clots in the tiniest blood vessels in all the organs if the body. We’ve known for quite a while that viruses cause inflammation, causing the body to inappropriately produce antibodies against proteins called phospholipids. These antibodies attack the platelets and red blood cells, causing blood clots.
Last night I was referred to what my Facebook friend, a non-physician, called “one of the more detailed links” on the research. I would hate to see the others.
Right at the top of the page is this disclaimer: “”Anyone can publish on Medium per our Policies, but we don’t fact-check every story. For more info about the coronavirus, see cdc.gov.'” Good advice.
The author the blog post isn’t identified except by a pseudonym and avatar. While he does admit that he’s not a doctor, we aren’t given a real name, much less a profession or qualifications and clicking on the avatar yeilds no information. There’s not even a link or citation for the origin of the “scientific” quote upon which he bases his entire premise.
(In contrast, a quick Google search, “Coronavirus red blood cell iron,” yeilds an article,“Debunking the hemoglobin story,”
by a man who not only gives his name, he also describes his credentials, a seven (7) year MD/Ph.D program in hematology. He tells us he is writing with two other, *named,* Ph.Ds. Dr. Armdahl is worth reading for more detail than I give, here.)
The pseudonymous author has a brand new explanation for the hypoxia due to COVID-19: the virus supposedly breaks iron free from the hemoglobin molecule in red blood cells (RBC), poisoning the cells so they can’t carry oxygen. That is proposed as the cause of hypoxia, low oxygen, that leads to the need for increased oxygen and ventilation, as well a being responsible for the damage to organs other than the lungs.
The first author describes the virus “attacking” the red blood cell (RBC) with a “glycoprotein ” produced by the virus. He’s apparently unaware that the RBC does not have a nucleus or the cellular apparatus to produce proteins, much less copies of viruses. That’s a dead end for that virus particle and for any virus that does work that doesn’t enable reproduction.
Further, where is the evidence that these glycoproteins exist in the blood or bone marrow (where RBCs are produced) in concentrations that are significant? Where are the measurements of these mythical glycoproteins , any free iron or the RBCs containing free iron?
Why would there be a “secret?” ***What would be the purpose of the medical community ignoring a valid explanation of the etiology for morbidity and mortality due to SARS-CoV-2? *** The hematologists would be all over this.
The pseudonymous writer isn’t happy with promoting fake physiology and function of the RBC. He also displays his ignorance of the fact that we’ve known at keast since 2007 that the proper treatment for ARDS is low, not high, tidal volume ventilation. More important still, are personalized ventilator settings. More information, here.
If I may make a suggestion, when you come across a story that interests you and that seems new and significant – especially if it’s outside your area if expertise – don’t just share it. I suggest that you do a search looking for evidence that it’s false, as well as evidence that it’s true. Test the story!
Here in the small Nation of the British Virgin Islands, we’ve delayed, but we haven’t “beaten,” or completely avoided, the disease caused by the novel, or new, Coronavirus, COVID-19. Everyone who hasn’t yet been infected is still at risk. A lot of us will eventually catch the virus if and when we once again interact with the world at all.
If you want to learn about the current state of the science, this video is excellent by a fantastic teacher.
The Nation has done an excellent job of blunting the effect of the disease, beginning with closing all ports of entry to everyone except residents, back in March, followed by a 6 day “lockdown” with an in-home curfew at night and limitedbusiness and shopping.
Beginning about April 2, Government began enforcing a 24 hour in-home curfew, shutting business and forbidding residents from leaving our homes.
There have been 5 people with positive tests. 4 of them caught the disease in other countries and one person may have caught the disease from the last of those 4. The first 3 had mild cases and appear to be recovering.
Unfortunately, that last case was a woman whose disease was only discovered when she became very sick and had to be admitted to the hospital. She died the next day. One of her contacts has tested positive, but has mild symptoms. Unfortunately, not all of the people she might have interacted with have been identified and tested.
Hopefully, over the last 6 weeks, the BVI health department has had time to plan and prepare for multiple sick patients.
Even more: I hope that researchers around the world will come up with good treatments and discover why some patients get so sick so fast.
If there’s ever a vaccine, it’s years away There haven’t been any successful vaccines for other human strains of coronavirus.
It appears from some recent random testing in the US, that about 25% – 30% of an exposed population contracts the disease. Most either have no symptoms or mild symptoms. A small minority gets sick enough to be hospitalized, and a fraction of those end up in the ICU.
You may have heard about the high “case fatality rate,” reported anywhere from 0.01 to 10. Remember that this statistic only counts those who have been tested, predominantly those sick enough to be admitted to the hospital.
There is good news in addition to the fact that most infected people have mild or no symptoms: evidence that we have immunity after recovery comes from one of the treatments undergoing research: serum containing antibodies from the blood of recovered patients helps other people get well.
The scary part of the story is that the virus is very contagious, largely because people without symptoms can spread the disease. Medical personnel have been surprised by what appears to be the unprecedented, rapidity of the onset of Acute Respiratory Distress Syndrome (ARDS) in some patients, usually about day 12 to 14 of the symptoms. In a matter of a few hours, patients become very short of breath, requiring intubation. 80%- 90% of those intubated have died in the ICU.
The virus can also cause the body to produce proteins causing increased coagulation (the tendency for blood to clot). It also can directly infect the heart muscle and brain.
As our country opens up, and goes back to (relatively) more normal interaction, it’s important to remember that infected people may not have symptoms, but are still able to share the virus and spread the disease. They don’t know they have it and you certainly can’t tell by looking at them.
We will probably see our neighbors continue “social distancing” and wearing face masks when we leave our homes. And yes, inevitably, some of us will get sick.
Reality is teaching a hard reality lesson with COVID-19.
This video concerns the minority of COVID-19 patients who require intensive care and the less than 1 percent who die of the disease. The discussion about the course of the disease and treatment is possibly too technical and brutal for the general public, so watch the whole thing with care.
However, I’m hoping to spur conversations about end of life in light of the broader COVID-19 crisis and specific crisis events.
This is a tough, highly technical discussion between Dr. Zubin Damania, a blogger otherwise known as “ZDoggMD” and Barbara McClean, MN, RN, CCRN, NP-PC, an expert in Critical Care & Intensive Care medicine in an Atlanta, Georgia teaching hospital with over 100 ICU beds. The first few minutes show Barbara McClean as a compassionate caring practitioner and educator. I believe and trust what she says about the worst case (stressing, again: fortunately these are the minority!) outcomes with COVID-19.
If you want to get to the meat of the video, there’s a “philosophical discussion” about the very real, unique in this modern age, futility of CPR in COVID-19 patients whose hearts stop due to the disease at 35:00 to 41:00.
There’s also interesting information about Personal Protective Equipment (PPE) difficulty (not shortage, but the physical reality) at the segment 30:00 to 35:00 minutes.
COVID-19 is, as Ms. McLean says, an unpredictable, sometimes deadly disease. Currently, patients can go from minor symptoms to death due to respiratory failure and cardiac arrest in as little as 4 hours. There is very little success to date in attempts to resuscitate patients who “code,” whose hearts stop, while in distress due to the virus.
I can’t stress enough that we need to talk, we need to make decisions among our families and to understand that this disease takes some options, some autonomy we have come to assume are our rightful “choices,” completely off the table. This disease doesn’t care what we want.
I’m unable to turn comments back on for this post. Please post comments to my Facebook page and I will try to keep up with replies. Let’s keep this on the level of philosophy and medical ethics. I will delete political criticisms.
Let’s keep this on the level of philosophy and medical ethics. I will delete political criticisms.