- Registrado
- 1 de Mar, 2020
I'm not a doctor, but I'm going to try my best to describe what's going on here, based on my digs.What would you do if you were a doctor with a patient in the ER 11 days into Covid?
Ideally, early and proactive outpatient treatment should begin the very moment that symptoms appear. But let's presume that the subject is in poor health and has been symptomatic for over a week, like in your scenario. The onset of COVID-19 hyperinflammation is when someone is about 8 to 11 days post-symptomatic, or about two weeks after initial exposure. Some come into the ER feeling a little funny, with O2 sat around 93%. Others have their lips turning blue and their SpO2 is in the area of 77% and dropping rapidly. When they take their blood and start doing tests, they see an exhausted adaptive immune system and over-activated innate immune system (lymphopenia and neutrophilia) coupled with elevated inflammatory and oxidative markers, but also signs of abnormal clotting. Some older patients with pre-existing clotting disorders come into the ER with COVID-19 and their D-dimer is like 2,000 to 20,000 ng/ml. Twenty-goddamn thousand. Yes, COVID-19 can cause blood clots bad enough to trigger strokes, heart attacks, PE, and even cut off blood supply to the extremities, in some instances.
The patient is beginning to show the clinical signs of severe viral sepsis and endothelial dysfunction, trending towards ARDS, respiratory failure, and death. Normally, when someone comes into the hospital with bacterial sepsis, the standard treatment is antibiotics, but COVID-19 sepsis is not like bacterial sepsis. The causative agent is a virus that has profoundly deranged many key biochemical pathways in the body, suppressing endogenous antioxidant enzyme activity and directly activating the innate immune system. As a result, the patient's immune system is now attacking their body with an over-exuberant immune response.
By this point, the virus is already gone, so antivirals don't work. If I intubate the patient and pump them full of corticosteroids, as appears to be customary with COVID-19, I risk causing additional oxidative damage to their lungs (a.k.a. VILI). The ROS would then trigger steroid insensitivity by attacking glucocorticoid receptors, leading to steroid rebound and more inflammatory damage. And yet, the patient is critically deoxygenated and it's only a matter of time before they're a brain dead vegetable. Also, the entire time, I will be fighting an uphill battle of coagulopathy by futilely using anticoagulants, alternating between too little and too much, risking clots one moment, hemorrhages the next.
That's how COVID-19 patients are currently treated.
If it were my choice, I would postpone invasive ventilation as long as possible, and provide a cocktail of:
- Vitamin D (antioxidant and calcium moderator; never hurts to try, and most people are deficient anyway)
- Intravenous NAC and glycine (profoundly antioxidant)
- Intravenous Vitamin C (antioxidant)
- Selenium (antioxidant)
- Melatonin (anti-inflammatory and antioxidant)
- Methylene blue (antioxidant)
- Inhaled Budesonide (anti-inflammatory)
- Inhaled Montelukast (antioxidant)
- Colchicine (antioxidant)
- Amlodipine (antioxidant)
- Deferoxamine (iron chelator)
- Fluvoxamine (SSRI that's also an antioxidant)
- Famotidine (antihistamine that's also an antioxidant)
- Diphenhydramine (antihistamine that's also an antioxidant)
- Quercetin, Resveratrol, and Apocynin (more antioxidants)
- Aspirin (mild anticoagulant)
The virus is mostly gone by the time the patient is 8 days post-symptomatic. Antivirals are useless by that point and may do more harm than good. Ivermectin, HCQ, Kaletra, and Remdesivir are all basically useless by that point. Ivermectin may have some immunomodulatory/redox modulation properties that the others don't have, but it seems too subtle to be of much benefit.
The ideal time to take antivirals is actually immediately after suspected exposure, continuing until symptoms appear and discontinuing at around day 7/8. The controversy about what antivirals to dose people with past day 8 is basically pointless bickering that does absolutely nothing for the patients. The pro-antiviral and anti-antiviral sides are both caught up on a red herring. They should really be talking about immunomodulatory drugs and antioxidants.
I should add, the first phase of treatment would also include non-invasive ventilation.
