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A modest proposal for COVID-19 response (Or, I’m not King, but)

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.

REFERENCES

** 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.
Prophylaxis dosing:
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.

References

Journal of the American Medical Association review. Published August 11, 2020. (Free, with Tables)

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2769443?guestAccessKey=53b2b8ec-df1a-4ca4-88ce-abf6c4fa470c&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=081120

CDC recommendation on cloth masks:

https://wwwnc.cdc.gov/eid/article/26/10/20-0948_article

John’s Hopkins recommendation:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-face-masks-what-you-need-to-know

Zinc:

https://www.uchealth.org/today/zinc-could-help-diminish-extent-of-covid-19/

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

Hydroxychloroquine/azithromycin protocols

International Journal of Infectious Diseases (Henry Ford or Ashad report):

https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext

https://www.ijidonline.com/article/S1201-9712(20)30600-7/fulltext

On synergistic effect of hydroxychloroquine plus steroids:

https://www.ijidonline.com/article/S1201-9712(20)30613-5/fulltext

Budesonide

Description of study in progress on treatment for loss of smell in patients without severe symptoms:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370627/

Vitamin C safety:

https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/vitamin-c/faq-20058030#:~:text=For%20adults%2C%20the%20recommended%20daily,Nausea

Note: comments are off. Please comment on my Facebook page, Beverly Nuckols.

Edited 31/08/20 12:30 for mis-spellchecked word. BBN

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