Hello, wonderful Surak readers. I hope you are enjoying your Thanksgiving. Leave some turkey for the Kraken.
I just received an e-mail from a doctor friend of mine. He graduated from an internationally known medical school, and taught there some time ago.
My friend is a free-thinker, rather libertarian, and an advocate for patient freedom. He forwarded a great protocol to help you prepare in case you get coronavirus. This protocol was published by the American Academy of Physicians and Surgeons. It has information that will help you get around the evil governors who are forbidding patients from getting the healthcare they need. I recommend downloading and printing out the first link, a short pdf from the AAPS, and watching the second link, a 15-minute video from a doctor at Baylor University Hospital. Here is my friend’s message.
This email provides information for those who wish to explore the possibility of avoiding COVID hospitalization by treating COVID early and aggressively at home.
I believe that the approach discussed below, if implemented on scale, would greatly reduce the frequency with which high-risk individuals, if infected with COVID, are hospitalized, enter the ICU, or die. I myself intend to follow a variant of this approach if I develop COVID. However, this is a personal decision that each person must make for him- or herself, or on a family basis, according to their unique circumstances and level of “buy in” to the approach.
Three notes, by way of preface:
1. The approach discussed here is intended for “high-risk” individuals — not for relatively young and healthy persons. The risk of a bad COVID outcome increases gradually with age and the extent of preexisting illness, and there is no hard-and-fast line between low-risk and high-risk individuals. However, most would define “high-risk” as persons older than age 50, 55, or 60, or persons of any age who have a serious underlying health condition. Examples of such conditions include: obesity, cardiovascular disease (for example, heart disease or hypertension), lung or kidney disease, diabetes, cancer, significant sleep apnea, and immunosuppression.
2. In what follows, I refer to “physicians” and “doctors” but make little mention of independently functioning nurse practitioners or PA’s. Please mentally substitute “clinicians” for my “physicians” as you read, if you happen to see an independently functioning non-physician prescriber, or if you are one yourself.
3. Home treatment is also referred to as “outpatient” or “ambulatory” treatment. The three terms can be used interchangeably.
Home Guide and Accompanying Videos
Here is a link to a newly published, 26-page guide to home (outpatient) treatment. The guide embodies a protocol advocated by a group of physicians and researchers in the US and Italy led by Peter McCullough, M.D., M.P.H., Vice Chief of Medicine at Baylor University Medical Center at Dallas. The target audience for the guide is laypersons (non-medically trained persons who are at risk for COVID) but will be a useful introduction for physicians a well: https://aapsonline.org/CovidPatientTreatmentGuide.pdf
Next is a 15-minute video of Dr. McCullough, in which he informally discusses the approach presented in the guide. The video is user-friendly and intended for those with no special medical background, but it also will provide a good, brief introduction for physicians who wish to make a “first pass” at the approach. You may wish to watch this video before reading the guide. https://rumble.com/vay2vx-dr.-mccullough-explains-treatment-protocol.html
Next is a detailed webinar given by Dr. McCullough, for those who wish to better understand the protocol advocated in the guide and introductory video. Physicians who treat outpatients will certainly want to watch this detailed video: https://www.youtube.com/watch?v=C5u5GuErjcA&feature=emb_logo
The treatment approach advocated in the guide and webinar is a modified version of an approach first published in the American Journal of Medicine; I include the link for those who wish to see the peer-reviewed source of the protocol: https://www.amjmed.com/article/S0002-9343(20)30673-2/fulltext
How to Obtain Medications for Home Treatment
The above-linked guide advocates for working with your regular physician to implement the protocol. It also suggests that if your physician is not willing to implement the approach, you should seek another physician who is willing to do so.
However, I am aware that some people are finding that their physicians are not willing to implement a home-based approach, and that it is difficult to find a new physician quickly. If you are a high-risk person who wishes to obtain treatment (either because you are currently ill, or because you want to keep medications “in the fridge” so you can treat rapidly if you develop COVID symptoms) but are unable to do so with the assistance of your regular physician, this website provides an option: https://speakwithanmd.com
There may be other, similar web-based options, but that is the one I am aware of. (If you know of any others, please let me know the details.) Here’s how it works: for a fee of $59.95, paid online by credit card, you fill out an online form and will be scheduled for a telemedicine call with one of their affiliated MD’s or nurse practitioners. If this clinician decides to prescribe for you, you can then have medications shipped to you by UPS from their affiliated pharmacy. All medications must be paid for out of pocket; their pharmacy does not accept medicare or any other form of insurance. The cost for a typical package of COVID medications of the sort discussed in the protocol is in the range of $150-200.
If you proceed via this route, you should make clear in the on-line form, and during the consultation, what your objective is, and explain why you are at elevated risk for a bad COVID outcome (age, health conditions, etc.). In my experience, their clinicians are very open to considering prescribing for high-risk persons who are (1) currently acutely ill with COVID, or (2) wish to obtain medications while healthy so they can immediately begin treatment if they become infected, or (3) wish to consider prophylaxis with ongoing, low-dose hydroxychloroquine, and also wish to keep a supply of the full suite of medications on hand should they nonetheless become infected.
If you are currently ill with COVID, you should make that fact clear, so that you will be prioritized, although my understanding is that after submitting the form you are, in any case, likely to receive a phone call within an hour or two. (They also have a phone number listed at the website). Likewise, you should emphasize that you are currently ill when you speak with their pharmacy, as they will then expedite the order and offer (for an additional fee) to ship the medications to you by overnight delivery, which you should take advantage of.
For those who wish to better understand the rationale for home treatment, a number of additional, excellent videos are available.
1) Interview with Brian Tyson, M.D., in California. As of the date of this interview (October 2, 2020), Dr. Tyson reports having treated 1,700 COVID-positive patients, with no deaths, using a three-agent regimen of hydroxychloroquine, azithromycin (or doxycycline), and the nutritional supplement zinc. To my knowledge, he has treated more COVID outpatients patients than anyone else in the U.S. https://covexit.com/interview-with-brian-tyson-md-from-california-a-pioneer-of-outpatient-treatment-for-covid-19/
2) Harvey Risch, M.D., Ph.D. — Yale University School of Public Health – two-part interview by a highly credentialed and outspoken M.D. and mathematical epidemiologist:
At the end of the second video, Dr. Risch mentions that the home-based treatment approach can be thought of as an appropriate (some, including Dr. Risch, would argue absolutely necessary) concomitant to the selective-protection approach to immediate societal opening advocated in the Great Barrington Declaration.
3) The next video has two parts. The first part (up to about the 46-minute mark) is another webinar with Peter McCullough, which substantially (but not completely) recapitulates the one linked above. The second part of the video (starting at the 46-minute mark) is a discussion and Q&A between Dr. McCullough and Dr. Tyson. This second part is instructive and may be of interest even to those who don’t want to watch the first 46 minutes. During the course of their discussion, both doctors reveal that they are currently infected with COVID and are treating themselves with the same protocol they prescribe for their patients: https://covexit.com/outpatient-early-treatment-algorithm-for-covid-19-a-webinar-with-dr-peter-a-mccullough/
4) Finally, here is a webinar on the treatment and prophylaxis of COVID in nursing homes — Drs. Armstrong (Texas) & Fareed (California), describe their personal experiences using hydroxychloroquine and other medications and supplements in nursing homes. The doctor’s begin their presentations about 12 minutes into the video: https://covexit.com/prophylaxis-early-treatment-in-nursing-homes-a-webinar-with-dr-robin-armstrong-and-dr-george-fareed/
I’ll close with comments about a few things that are not explicit in most of the above information; these may be useful for high-risk persons who are trying to determine whether they are likely to have COVID and whether they should consider initiating treatment.
The viral (“PCR”) test for COVID, while useful, is much less than 100 percent reliable. In particular, it has a high rate of false negatives (that is, when infected persons give a test result of “negative.”). Given this high frequency of false negatives, a single negative test result should never be used to rule out COVID in a person who has a history, signs, and symptoms consistent with COVID. Even two consecutive negative tests may (depending when testing is done, relative to the onset of symptoms) rule out COVID with less than a 90 percent level of confidence. Beyond this, some labs take days to return a result on these tests, which will delay your treatment.
For these reasons, the diagnosis of COVID should be considered primarily a *clinical* diagnosis (based on history, signs, and symptoms) rather than a laboratory diagnosis (based on a test result). This clinical diagnosis can be made by phone or other telemedicine venue, especially if you have access to a thermometer. You also probably can diagnose yourself, based on well-known signs and symptoms, which are listed in the home-treatment guide. There is thus no need, on onset of signs and symptoms, to run out and get a PCR test if doing so is inconvenient or uncomfortable for you, or if doing so will put you or others at risk of infection.
Note that this clinical diagnosis will not be fully reliable — you may have the flu or some other acute illness — but if you have relevant signs and symptoms, there really is no way to be sure you do not have COVID short of obtaining multiple negative PCR tests — which, as a practical matter, is not feasible in most circumstances.
Accordingly, the optimal way to implement a home-based COVID treatment plan appears to be: (1) define signs and symptoms as best you and/or your doctor can, (2) make a *presumptive* diagnosis of COVID, if the signs and symptoms point in this direction, and (3) initiate home treatment and plan to continue it for the full duration recommended in the protocol. Note also (4) that nothing in the protocol should prevent you from being seen personally by your physician, or going to an emergency room, if such seems warranted.
It is important to understand that an oxygen saturation level (“SaO2”) lower than about 94 percent likely points to lung involvement. It is useful to own a pulse oximeter and take a few measurements across several days while you are healthy — so you know your starting point, which is your “baseline”. (These non-invasive finger-tip devices can be purchased inexpensively via Amazon or the drug store.) Then, if you are elderly and at especially high risk, you may wish to check your oxygen levels periodically. This is especially important in people over age 80 who may have been exposed, as elderly persons may not have, or readily recognize, other early signs and symptoms of COVID. In fact, some nursing homes, where the risk of exposure is high, have implemented routine, thrice-daily oxygen checks of all their clients. If your normal baseline is, say, 96 percent, and you are in your eighties or in poor health, and you subsequently get a pulse-oximetry reading of, say, 92 or 93 percent, it may be wise to presume that you have COVID and to immediately treat accordingly, even if you have no other signs or symptoms.
At the same time, be aware that pulse oximeters are not absolutely reliable or consistent across readings. Your baseline on two different pulse oximeters may differ by a percentage point or two, and you may get that degree of variation even on the same device on two consecutive readings. Still, any marked deviation should be taken seriously and, in an elderly or debilitated person might reasonably be taken as presumptive evidence of COVID, regardless of other indications of disease.
Finally, note that your baseline oxygen saturation level will depend somewhat on your age and prior lung health. Most persons have a baseline between 95 and 100 percent, with young healthy people being at the high end of that range, and those with chronic obstructive pulmonary disease (COPD) may have baselines as low as the high 80s — so be sure to take your baseline level into account when trying to assess for COVID.
Those are my current (11.25.2020), personal views, offered for consideration. They are not intended as either definitive guidance or “medical advice.” (end of friend’s message)