re: Mrs M is in Lane Hospital struggling with double Covid pneumonia.

NeonSunburst is correct- it has to be within that initial onset time.

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identified problems with those studies such as :

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studying hospitalized patients rather than early outpatient treatment.

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All the points are valid. Generalizing the purported ineffectiveness of treatment with plaquenil and ivermectin in the inpatient setting to lack of efficacy in the outpatient setting is not necessarily a direct or accurate translation.



But this particular thread is about a patient in the hospital. And she’s not in for a broken leg with a positive COVID test. She’s in the ICU on oxygen. There were several studies done, and I’ll admit it’s impossible to read them all and critique them appropriately, but I still do my damndest to do so. Many of these studies looked at hospitalized patients. The vast majority of those patients required oxygen. Whether they were in the ICU, on low or high flow, we would have to start naming studies and talking about the populations within them. But there wasn’t an “early in hospital” arm that did better with the meds. There wasn’t a line demarcating plain nasal cannula vs high-flow nasal cannula where the meds made a difference in one but not the other. There’s no arm or subset of a trial that shows benefit in the ventilated vs unventilated.


The post you replied to basically said, “the meds don’t seem to work in the hospital”
The reply from you seems to say, “but the studies were done in a hospital”


Unless I am missing something in your question.


It’s very correct to not generalize these thoughts to the outpatient setting, because there’s not a strong data subset that I’ve seen in that group at all. But when you get that subset, it doesn’t change that all the inpatient data shows a significant lack of efficacy, thus the statement

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There is no indication whatsoever that any of those are helpful treating advanced CV-19. None!

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would still be correct even if we DID go and find that it was 100% effective at preventing advanced disease.
It isn’t until a series of successful anecdotes or a trial shows efficacy that the current thought will change.



Anecdote time:
Early, we knew nothing. Watched some patients come in and do fairly poorly. Some did ok. Then the idea that plaquenil may work came up. Watched some patients come in and do fairly poorly. Some did ok. I didn’t find it impressive. I read anecdotes about it working wonders. Neither I, my partners, or any of my contacts that take care of hospital patients (mostly ICU and gen hospitalists) saw any defining characteristics like “seems to work Ok in patient with X but not Y.” Remdesivir came months later. I have posted it several times. But I saw a guy who was a few minutes away from dying get intubated (appropriately, that seems to be a whole different discussion in this thread. Intubation isn’t bad. Early in the pandemic, anecdotal data suggested better outcomes with early intubation which proved to be very false very quickly, and it hasn’t really been practiced by anyone I know of since about 4/2020). His liver and renal function were horrible. After about 3 days it improved enough that we were able to give remdesivir. And it was either 12 or 36 hours later that he was extubated. I was excited. I gave it to all my COVID patients that were in the hospital. But none of them made rapid, remarkable turnarounds after the first one. I chalk it up to wanting something to work and coincidence, sadly. My hospital tracks a few therapeutics retrospectively to see their impact. There are tons of flaws with this sort of process, and it is extremely subject to bias. But we were able to tease out that if you were early in the hospital on 2LNC or less, you may have a shorter stay. But otherwise, there wasn’t a big difference. And I don’t mean we had bad confidence intervals or high P values. The numbers were almost the same (attempted case-matched controls. Again. This happens tons of places for internal review and can sort of build a foundation and help to cement anecdotal data as being a bit more than that, but it isn’t worthy of publication on Mom’s refrigerator, much less JAMA/NEJM/the Lancet. But we start to shy away from it. Around that time, we discuss the MATH protocol and generally adopt it. Everyone gets ivermectin before leaving the ER, plaquenil, a couple antibiotics, steroids, all the vitamins before we ran into shortages. From the beginning there, I still didn’t see a big difference in outcomes (and around that time I and several others found that people that got intubated were less likely to recover for some reason. I went through about a 6m stretch where fewer people got intubated, but almost none of them came off once they went on. I only realized it when a CC friend of mine said, “can you remember the last person you got off the vent?” And I, indeed, couldn’t). After about 3-4 months of, again, not seeing a big difference following the protocol, I generally quit using it. There are good parts to it, but I’m certainly not sold on it being as effective as its proponents are suggesting, sadly. Most of us are back to sort of doing our own thing with our own quirks, but none of us really feel like we found any one thing that’s particularly effective (except for giving 12mg of decadron at once instead of splitting it up into BID dosing).



Again, that’s all inpatient stuff and has no parts about what appropriate early or at-home care is.

At this point you have been reaching out for days and likely weeks for help. Just be with Mrs. M. Devote all your time to her.

I wish you the best.

I have what may be a stupid question, but here it goes anyway...

Iirc, there was a thread on here that (I know...not the Lancet, so maybe more reputable) that linked a study to viagara use assisting those with breathing issues. One poster mentioned that the mechanism that’s makes viagara effective is different than that of acetaminophen or aspirin.

Sooooooo...

What are your thoughts on implementing this as part of a treatment protocol, and, for the OP, can this “treatment” be used for women?

To the OP, you and the missus are still in my prayers.

This physician organization (FLCCC) will help you find a physician to prescribe ivermectin. I believe they've even helped patient's families win court battles when hospitals have refused to administer the prescribed ivermectin.

LINK

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This physician organization (FLCCC) will help you find a physician to prescribe ivermectin. I believe they've even helped patient's families win court battles when hospitals have refused to administer the prescribed ivermectin.

LINK

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Call them, it can’t hurt. I pray your wife recovers.

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but I couldn't convince her to try anything at all.

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Damn shame on her part.

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In this case the scales tip way to the side of the vaccines.

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Last week 74% of the covid deaths in Louisiana were unvaxed. This in spite of the fact that about 60% of adults are vaccinated and over 90% of the obviously vulnerable. That means about 1/3 of the population is producing 74% of the deaths, and they are unvaccinated.

The scales are not “tipping” toward vaccines; they are radically in favor of vaccines for those who have never had covid.

Thanks for the response.

My follow up questions, can there be combo treatments such as aspirin / viagara?
Next, since viagara and cialis are different, are their effects (vasodilatory properties) different, or are they interchangeable? I ask because cialis, iirc, has a daily dosage.

Last but not least, what about over the counter anti-inflammatory items (Tumeric and / or Ceylon cinnamon...which can be taken daily with no know side effects)?

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Last week 74% of the covid deaths in Louisiana were unvaxed. This in spite of the fact that about 60% of adults are vaccinated and over 90% of the obviously vulnerable. That means about 1/3 of the population is producing 74% of the deaths, and they are unvaccinated. The scales are not “tipping” toward vaccines; they are radically in favor of vaccines for those who have never had covid.

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Your point is partially correct. You’re still largely blind to the baked-in idiocy of the statistics.