4. Medical interventions and exit strategy.
COVID-19 is a new disease and new information is emerging every day about the most promising approaches to treat it. Many clinical trials are underway and their results are being analyzed. The pandemic situation seriously complicates these clinical studies, but it is probable that effective antiviral molecules will eventually be identified among the candidates studied: hydroxychloroquine, remdesivir, ivermectin, interferons, macrolides, zinc (cation), and vitamin C in high doses intravenously, for example.
The pandemic situation led to an antiviral intervention that was too late for most patients, only severe cases were admitted to hospital, a time when antivirals no longer made a difference. However, a number of general practitioners have developed approaches that appear to be beneficial to their suspected COVID-19 patients, even if it is under conditions that do not meet the demands of a medicine based on strict evidence, given the urgency of the situation.
I propose that instead of prohibiting any treatment of COVID-19 cases by general practitioners, such as for example the prohibition of hydroxychloroquine outside the hospital context at the start of the pandemic, we allow these doctors the freedom to prescribe what their experience and conscience dictate and in informed consent with the patient, with a monitoring framework at the national level so that the results are usable. The side effects of these drugs are well understood and controlled. This approach will reduce the pressure on the hospital system and thus facilitate coming out of the lockdown.
4.1 Medical interventions: hydroxychloroquine + azithromycin + Zinc.
Dr. Raoult proposed a controversial treatment. Studies that use this treatment too late can only conclude that it is ineffective, and the others lack control. However, a study in Brazil on 636 symptomatic outpatients tested the combination of hydroxychloroquine and azithromycin: 412 started treatment and the 224 who refused it were used as a control group. The need for hospitalization was 1.9% for the treated and 5.4% for the control group; for those who started treatment before, instead of after, seven days since the onset of symptoms, these figures were 1.17 and 3.2% (p
4.2 Medical procedures: azithromycin or other macrolide + Zinc.
Doctors in northern France have used azithromycin, or another macrolide, + Zinc due to the unavailability of hydroxychloroquine, with good results that have yet to be validated more rigorously. Zinc interferes with viral replication and azithromycin, an antibiotic, has intrinsic antiviral activity that may be linked to its mitochondrial toxicity. Indeed, viral replication depends on the inhibition of apoptosis and the stress of the mitochondria can promote this apoptosis, and therefore the elimination of infected cells. It is also possible that the effect of the replication of the virus in the lungs influences the flora, the microbiome, present in the lungs and that antibiotics prevent the emergence of harmful strains. Whatever the mechanism, the effect of macrolides and Zinc led to a clear clinical improvement, the main limitation of these studies is that the cases were presumed COVID-19, unconfirmed.
4.3 Medical procedures: ivermectin.
Ivermectin causes an influx of chlorine ion and thus exerts a broad anti-parasitic action. Ivermectin treats onchocerciasis (river blindness), a public health problem in Africa, as well as lymphatic filariasis. In vitro, ivermectin very effectively suppresses the replication of SARS-CoV-2 with a single dose yurl.com/ya4vmnhz.
The Malagasy government has announced very good results based on plants, artemisia and ravensara, (one of which contains arteminisin, which, like hydroxychloroquine, is an antimalarial treatment).
5. Conclusions
5.1 We cannot count on collective immunity.
It seems clear that collective immunity cannot be relied upon to counter the spread of COVID-19 when the individual level of antibody is often low and when a high level of antibody is associated with an exacerbation of the disease.
5.2 The dominant mode of transmission of COVID-19 is by aerosol.
One cannot conceive of a serious lockdown exit strategy that does not accept this reality.
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