Monday, May 18, 2020

Equal Time

A team of front-line docs and specialists formed a "consortium that recommends changing how Covid-19 patients are treated.  The "Front Line Covid-19 Critical Care Consortium" argues the "severe inflammation (in the lungs) sparked by the coronavirus, not the virus itself, that kills the patient.  Inflammation causes a new variety of acute respiratory disease syndrome (ARDS), which damages the lungs."  However, the WHO opposes their recommendations.

Hence the doctors recommend immediately treating the patient in the following manner:

“If you can administer ascorbic acid (Vitamin C) and corticosteroids intravenously starting in the Emergency Room and every 6 hours thereafter while in the hospital, the mortality rate of this disease and the need for mechanical ventilators will likely be greatly reduced,” says Dr. Pierre Kory, the Medical Director of the Trauma and Life Support Center and Chief of the Critical Care Service at the University of Wisconsin in Madison.

The Consortium claims positive results:

The typical treatment for ARDS is to put patients on a mechanical ventilator, but Dr. Paul E.Marik, of the Eastern Virginia Medical School, says that should be the very last resort. Of the 7 COVID-19 patients Dr. Marik has treated with this protocol in the ICU, all survived....

Of the 24 seriously ill COVID-19 patients that Dr. Joseph Varon has treated with this protocol in Houston’s United Memorial Medical Center, ALL survived. The experts all emphasize that early intervention is critical in preventing the deterioration and death that has been described across the world once patients enter the ICU. After observing minimal improvements or recoveries in the first of New York’s Northwell Health Care system’s many dozens of patients, Northwell’s critical care specialists found that by changing their therapeutic strategy towards initiating the combination of high-dose ascorbic acid and corticosteroids earlier in the disease course, the need for mechanical ventilation has been greatly reduced.

The WHO opposes the proposed therapy.  Dr. Marik published in a subsequent memo:

The systematic failure of critical care systems to adopt corticosteroid therapy resulted from the published recommendations against corticosteroids use by the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the American Thoracic Society (ATS) amongst others. A very recent publication by the Society of Critical Care Medicine and authored one of the members of the Front Line COVID-19 Critical Care (FLCCC) group (UM), identified the errors made by these organizations in their analyses of corticosteroid studies based on the findings of the SARS and H1N1 pandemics. Their erroneous recommendation to avoid corticosteroids in the treatment of COVID- 19 has led to the evelopment of myriad organ failures which have overwhelmed critical care systems across the world.
The WHO states on its website:

The current interim guidance from WHO on clinical management of severe acute respiratory infection when COVID-19 infection is suspected advises against the use of corticosteroids unless indicated for another reason.

This guidance is based on several systematic reviews that cite lack of effectiveness and possible harm from routine treatment with corticosteroids for viral pneumonia or acute respiratory distress syndrome.
 Will it work? Stay tuned.  The memo and suggested protocol are posted below. 

* The Consortium is:

1. Dr. Umberto Meduri, M.D., Professor of Medicine, Division of Pulmonary Critical Care & Sleep Medicine, University of Tennessee
2. Dr. Jose Iglesias, M.D., Dept. of Nephrology & Critical Care, Seton Hall
3. Dr. Keith Berkowitz, M.D., Dept. of Internal Medicine at Lenox Hill Hospital, NY
4. Dr. Howard Kornfeld, M.D., President of Pharmacology Policy Institute,   American Board of Emergency Medicine
5. Dr. Pierre Kory, M.D., Critical Care Service Chief, University of Wisconsin School of Medicine
6. Dr. Paul Marik, M.D., Chief of Pulmonary & Critical Care Medicine, Easter Virginia Medical School
7. Dr. Fred Wagshul, M.D., Pulmonologist & Medical Director of Lung Center at Wright State University School of Medicine


Anonymous said...

The longer physicians treat Covid19, they discover how to treat it better. I trust front-line physicians far more than administrators at the WHO on this. As much as the USA feds have bungled it...the WHO knew about it earlier than they led on and far more people have ended up dead because of the way it’s been handled by paper pushers.

Just look at cloth masks. Initial reports: WHO- not needed. CDC follows that recommendation. Lo and behold, places where it didn’t rampage (New Zealand, Austria, South Korea) mandated them early. And now that it’s a political statement, many here don’t want to wear one, and it’s just prolonging the situation.

Anonymous said...

Corticosteriods are very dangerous. They suppress the immune system, soften the bones, cause blindness, weight gain and kidney damage. And, we all should know the dangers of steroids.

So, the question becomes which is worse? Dying later with a long term painful and life alternating side effects or the risk of dying while on a ventilator but having fewer long term side effects if it works? And, that's just the cortisones. You know what the steroids do.

Maybe the ascorbic acid counteracts the side effects of cortisones and steroids. Maybe a blast of the latter has fewer adverse effects. That would be a great discovery.

I hope there is long term follow-up in place.

Having seen the effects in a relative who was given cortisones with steroids as treatment for early onset of arthritis before the side effects were understood, I'd choose " die now". You can live painfully a long time with broken bones turned to " mush" and blind and bloated and still die from suffocating in the end.

I suspect this is why WHO is not on board. They have more disciplines with different perspectives weighing in.

Kingfish said...

Serious question. Wouldn't arthritis be considered more of a chronic condition whereas the virus is more acute? One treatment with the drugs would be longer term while one is fairly short term in nature.

Anonymous said...

Corticosteroids for respiratory inflammation is a treatment usually limited to short term for acute problems versus how it was used for Chronic Inflammatory Conditions such as Arthritic Conditions and Pulmonary Conditions.

While I understand 8:58's concerns these types of regimes have been used for years. ARDS has been treated with ARDS, but the decision on Steroids was usually split. O2, Antibiotics, IV Hydration, Body positioning with getting the patient on their stomachs or use of RotoProne beds. There is also the use of inhaled medication such as Nitric Oxide and Albuterol. BP control with Levophed, the use of surfactant and sedation.

Anonymous said...

This is a homeland security conference call with doctors and some senators.
Skip to 48:38 to hear a that doctor speak who has been treating covid patients successfully with a series of meds including IV Vitamin C:

Albert Schweitzer said...

Surely the inappropriate use of steroids can have unfortunate consequences; they are powerful drugs.
But more importantly, they work. And in immediate situations, they work very well.
The physicians I know seem united in responding to those whores at WHO with neutral or negative response. Why in the world, after what we have just experienced, would we follow any advise from WHO? Few are stupid enough to do that. And the CDC and NIH are not mistake free, and should be continually questioned though their deviations from sense do not seem as malignant as the WHO.

More and more it seems that the wuhan chinese virus covid-19 causes such a rich immune response the response itself is the largest problem and the main cause of organ dysfunction and death.
The effects of hydroxychloroquine are apparently to mute the immune response; so do steroids. Vitamin D, Zinc, smoking (eyes, smoking!) all seem to have a statistical edge in preventing the damage.

No idea why vitamin C helps, or if it does, but it is relatively innocuous;like many vitamins just producing expensive urine.

You bet said...

We will have no opposing views, comrade. You will adhere to the party propaganda uh I mean prescribed guidelines. Do you need the Chinese brethren to reorient your position?

Anonymous said...

Before all of this started I have been using Multivitamins with additional C, E, D3, Zinc, CoQ10 and Turmeric (anti-inflammatory) and Magnesium for years. Also using baby aspirin daily secondary to multiple joint replacement for DVT prophylaxis. Did it stop me from contracting Covid. Have no damn idea, but figured what the hell.

Anonymous said...

@9:59, what do your physician friends hate so much about the WHO whores? Be specific please. Or are all your ”friends” actually Fox News guests?

Anonymous said...

KF, I appreciate your serious question.
And, also am glad for the serious comments made.

In the example, my relative's prescriptions were used for short periods of flare ups over the years in low dose pill form and never by IV. If the side effect is accumulative wouldn't it be possible that the reason is that it doesn't get flushed out of the body and a more concentrated dose would not either? The steroid shots were rare for acute pain from nerves being inflamed from pressure on the nerve.

I suspect the long term effects of rather a lot of drugs we take are not fully understood but we are seeing that anti-inflammatory drugs are seeming to have some long term consequences we should weigh carefully.

But, the bottom line is that we are reacting in crisis mode. Thinking outside the box is good and we need to explore these ideas with the understanding that many will not pan out. But, jumping to conclusions based on cases that may have resolved from the patient's own immune response, is premature and in this article, rather glaring to me...much like the early anecdotal reports of the drug our President is taking preventatively and the Abbot tests.

As for the President, he's been advised of the risks in advance, but patients in ER are in no position to make a choice especially about unknown consequences and all patients should be able to rely on their physicians to " do no harm" or at least tell them when there could be harm.

And, we see less caution on the part of humans who react to news like this and the Moderna by believing a cure will arrive quick enough to reduce their current risk.

I am hopeful that one or more of the many efforts will succeed, but if the past is any indication of the future, we shouldn't be cheering until the trials are further along. And, even when success is confirmed, delivery will present a whole new set of problems.

I would wish that all people, everywhere would wear masks ( we were told a half truth about not wearing masks because there weren't enough for doctors and hoarding would have been a given), keep hands and surfaces sanitized, and socially distance.

I'm seeing today in social media, Mississippi friends hugging a work associate in celebration of reopening, one shaking hands after winning a game, and one hugging visiting children and grands from out of town. None wore masks and I can only hope they had sanitized hands. None had been ill and recovered. None had been tested. I hope they'll all be fine. The odds are good, but if one gets sick and infects one that dies, that, to me, a lifetime horror I'd want to avoid. " I'm out of a job because I killed my boss" or " I killed grandma" or "my grandchild is suffering because I made them sick" seems pretty awful to me.

That's their choice. It's mine to no longer trust their judgement in the same way I did before.

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Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

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If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

This is definitely a Beaver production.

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