re: Coronavirus Disease 2019 (COVID-19) ***W.H.O. DECLARES A GLOBAL PANDEMIC***

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I’ve always suspected that if it was going to work it would have to be started early in the infection (but that’s just my guess), because it’s effectiveness is based on its ability to slow the virus from spreading throughout your body from cell to cell

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This seems to be a common train of thought

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Most patients I see take 400mg daily for years without toxicity. The long term toxicity is not what worries doctors. Hydroxychloroquine can have an effect on the heart That isn’t necessarily a toxicity. Azithromycin can have the same effect. Combined with the fact that it is believed that the virus can effect the heart tissue in some patients. Doctors are worried about that triple threat and are wondering if they would do more harm than good by mass prescribing to patients in which 99% would recover anyway.

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Physicians should consider potential side effects and drug-drug interactions whenever they give any drug, and that's no different here. But that doesn't mean that we can't use chloroquine/hydroxychloroquine broadly for treatment of a pandemic virus if the risk-reward ratio is deemed acceptable. If these drugs lower the viral load as quickly and effectively as early studies have reported, they can potentially play an important role in lowering not only disease morbidity/mortality, but also the rate of spread which would "flatten the curve". All of that would mitigate other, potentially even more serious risks, such as supply chain disruptions and critical shortages, not to mention other economic disruptions, which may pose a bigger threat to public health than the virus itself.

Chloroquine/hydroxychloroquine have been used for 70 years, given to hundreds of millions of patients worldwide, some long term, some short term, with virtually every comorbid condition in the books and has a very good track record for safety. It has been sold over the counter, without a prescription, in various places around the world. And based on news reports, it is being used widely around the world for Covid-19, with several countries having stockpiled the drug and/or halted exports.

If QT prolongation related arrhythmia is a concern, patients can get a preliminary EKG, which is very cheap and easy to do, and if they're considered at risk then monotherapy (without azithromycin) could be used or other anti-viral therapy can be tried. But right now, in the throes of an rapidly spiking epidemic, I would say that an already approved drug with a long history of safe/extremely widespread use and some early evidence of efficacy is a potential godsend and should be given every chance to succeed, in an expedited manner. Particularly so when other options to stem this outbreak (drugs or economic shutdown) are unproven, limited and/or very risky themselves. Based on preliminary data I've seen, if I came down with symptoms and had a prompt positive test, I'd want the drug immediately. I suspect that world "leaders" and the rich and powerful already have their supply in storage or have already taken the drug.

I'm an attorney. The partners are all working from home. When I asked if I could do the same, I was told, "oh no. You are just as safe at the office as you are at home." You'd think a lawyer would see the faulty logic in that statement.

I agree with everything you said as well

I was only pointing out why doctors haven’t endorsed it to be used by everyone. Part of the problem is this...

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If QT prolongation induced arrhythmia is a concern, patients can get a preliminary EKG

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It’s not feasible to do a preliminary EKG in everyone. We are trying to keep these patients out of offices to slow the spread. But if it truly is effective this may have to change. Maybe EKGs at the testing sites once we get the rapid tests rolled out?

Normally if a patient will be placed on plaquenil they have a screening EKG before. Which does make the drug very safe. Without the EKG it’s more of a gamble (although very small)

It should be coming though right? They started using the meds I think Tuesday of LAST week. That said, are they using them on all hospitalized patients? Or just those super severe cases?

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Dallas County extends coronavirus stay-at-home order until May 20

Dallas County commissioners on Friday gave Judge Clay Jenkins the authority to keep in place the state’s first stay-at-home order until May 20, after a tense two-hour meeting punctuated by debates over hospital readiness, the cost of the coronavirus pandemic and how best to help the region’s most vulnerable.

The extension comes 24 days after Dallas County announced its first confirmed case of COVID-19, the disease caused by the new coronavirus, that has quickly spread around the globe infecting more than 1 million people.

“We are working with the health care community and the business community to put together the best way to save as many lives as possible,” Dallas County Judge Clay Jenkins said, rebuffing concerns from his fellow commissioners who pushed for changes to the order that would undo some of the restrictions. “We have to back our health care heroes.”

Since the state has largely adopted the rules first put in place by Dallas, the 4-1 vote changes little for the public.

But it likely makes Dallas County the state’s first and only municipality to extend the restrictions until May. Harris County, which includes Houston, has only prolonged its order until April 30, which mirrors the state.

Ultimately, Dallas County’s order was slightly amended to instruct Jenkins to find innovative ways to provide services to the community that does not increase the spread of the virus.

As of Thursday, Dallas County recorded more than 800 confirmed cases of COVID-19 — 17 have died from complications with the disease. The number of people confirmed in Dallas County is second only in the Lone Star State to Harris.

Commissioner John Wiley Price, a Democrat who represents southern Dallas, voted against the plan because he said the restrictions were “choking” his constituents. He urged during the meeting to open up pawn shops in order to help people get access to much-needed cash.

“An X-Box will feed a family for a couple of days,” he said, adding later, “I have to get some relief for my community.”

After weeks of deferring to local governments, Texas Gov. Greg Abbott on Tuesday put in place a statewide order limiting only “essential” work and errands. Abbott has wrestled with how to manage the pandemic that has spread through half the state — the second largest in the nation — while a vocal minority of Republicans and rural voters view it an urban issue. He attempted this week to distance his decision from the rhetoric “stay-at-home” embraced by Democratic leaders in urban centers such as Dallas, Harris and Travis counties.

Jenkins, however, warmly embraced the governor’s decision, going so far as to say the state had adopted his rules.

Dallasites who don’t work an “essential” job must continue to stay at home except to grocery shop, visit the doctor or pick up medicine.

The county, like many other local governments, is continuing its own orders so it can establish more granular rules and policies. For instance, the county has already established guidelines for construction workers. Rules for grocery stores and box stores such as Walmart and Target are expected.

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LINK

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Personally I usually don’t worry much about qt prolongation unless they are on other medicines that also prolong qt, have low magnesium, or some kind of structural heart abnormality. Your average patient will be fine taking an otc magnesium supplement once or twice a day with the hydroxychloroquine; no baseline ekg needed.

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The problem is the combination of Hydroxyxchloroquine + Azithromycin.
We are seeing a much higher frequency of prolonged QTc with the two.

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You guys are missing my point.

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well it wasn't very clear

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I'm saying we should end social distancing sooner than later.

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as long as business are back open, I don't really care if the government still recommends people to continue social distancing the rest of the year

at that point its up to the individual

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we should end social distancing sooner than later.

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Why?