Standardized Covid Treatment Protocols?

[eytonxav]

I am curious if there is a standardized protocol or accepted best practices for treating Covid across the country or is every hospital doing it differently? It seems there are some effective therapeutics, but are some infected getting nothing at all and just being sent home or end up in a hospital bed and placed on a ventilator and why isn't this being reported in the news? That said, I am sure there are different levels of severity based on an individuals health and the stage of the disease, but still I would assume there would be a uniform approach for treating cases.

 

[sengsational]

There's only one FDA approved treatment, it's ineffective, but it's manufacturer threaded the needle and "proved" it can reduce disease duration: remdesivir.

There are some treatments that have emergency use authorization: https://www.fda.gov/emergency-prepa...mework/emergency-use-authorization#coviddrugs

 

[eytonxav]

There's only one FDA approved treatment, it's ineffective, but it's manufacturer threaded the needle and "proved" it can reduce disease duration: remdesivir.

There are some treatments that have emergency use authorization: https://www.fda.gov/emergency-prepa...mework/emergency-use-authorization#coviddrugs

Yes, but many hospitals do other things like IV drips of vitamin C, zinc, steroids, etc. What are the best practices across the country? If there are none, this seems like a huge opportunity to fill in the gaps.

 

[Popeye]

MATH+ Protocol

This is the one I have heard about. They have strong opinions to say the least and say timing is key. This is an interesting read.

https://www.evms.edu/media/evms_pub...cine/EVMS_Critical_Care_COVID-19_Protocol.pdf

The systematic failure of critical care systems to adopt corticosteroid therapy (early in this pandemic) resulted from the published recommendations against corticosteroids use by the World Health Organization (as recent as May 27th 2020) [282,283]. This recommendation was then perpetuated by the Centers for Disease Control and Prevention (CDC), the American Thoracic Society (ATS), Infectious Diseases Association of America (IDSA) amongst others. A publication 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.[121,284] Their erroneous recommendation to avoid corticosteroids in the treatment of COVID-19 has led to the development of myriad organ failures which have overwhelmed critical care systems across the world and led to excess deaths. The recently published results of the RECOVERY- DEXAMETHASONE study provide definitive and unambiguous evidence of the lifesaving benefits of corticosteroids and strong validation of the MATH + protocol. I

 

[eytonxav]

I have also heard of the importance of blood thinners.

 

[pacergal]

I am not sure about home care, but I have read a lot about the hospital treatment protocol:
MATH+
https://covid19criticalcare.com

 

[audreyh1]

This is the one I have heard about. They have strong opinions to say the least and say timing is key. This is an interesting read.

https://www.evms.edu/media/evms_pub...cine/EVMS_Critical_Care_COVID-19_Protocol.pdf

Wow, I had now idea that corticosteroids were strongly discouraged for treatment early on.

Mortality rate of those hospitalized has been cut by 4. It’s probably a mix of factors including somewhat younger cohort, more effective treatment, and perhaps also people not waiting until they have trouble breathing to go to the hospital.

 

[sengsational]

A lot of what hospitals do now is seat of the pants stuff. In my non-medical opinion, the best thing in a hospital's arsenal are LWMH and prednisolone. But the battle has gone badly if one finds themselves needing those immune disregulation stage remedies. The problem tends to be that the hospital misses the opportunity to treat in the viral replication stage because people stay home and suffer through that stage. That's an opportunity missed in many cases. So not to hijack too bad, but a PSA is to be prepared to do a virtual visit upon the very earliest symptom.

 

[eytonxav]

Wow, I had now idea that corticosteroids were strongly discouraged for treatment early on.

Mortality rate of those hospitalized has been cut by 4. It’s probably a mix of factors including somewhat younger cohort, more effective treatment, and perhaps also people not waiting until they have trouble breathing to go to the hospital.

In the early pulmonary stage steroids are highly recommended.

 

[audreyh1]

A major confusion early on was Silent Hypoxia. It took a while for medical professionals to realize that people could have dangerously low blood oxygen, yet not feel shortness of breath.

That’s when I realized that monitoring blood oxygen levels would be critical and got an oximeter.

Also, it took a while to appreciate the clotting that could occur.

 

[NW-Bound]

Whatever it is that hospitals are doing now, the death rate is a lot lower than it was originally.

Or could it be that recent batches of patients are the young and daring who have a better odd of survival, while old and weak folks have learned to be hermits to save themselves?

What are the latest statistics on this?

 

[Freedom56]

I speak to my brother quite often (he is a doctor - Radiology Nuclear Medicine). He told me the treatment depends on the patient's overall health, symptoms, and what the imaging of the lungs and vital organs indicated. Dexamethasone is the most widely prescribed for those experiencing breathing problems and is widely available. Despite the lower mortality rates, they are finding that a large number of patients that recover are suffering longer term symptoms due to damage caused to the heart, lungs, and kidneys.

 

[Sunset]

Whatever it is that hospitals are doing now, the death rate is a lot lower than it was originally.

Or could it be that recent batches of patients are the young and daring who have a better odd of survival, while old and weak folks have learned to be hermits to save themselves?

What are the latest statistics on this?

Since we no longer hear of infections running rampant through nursing homes, I'd guess the age average has decreased in patients, accounting for a better survival rate.

 

[audreyh1]

As I mentioned above, average age of hospitalized patient is part of it. But I think also treatment has significantly improved, and patients are also seeking treatment earlier, not waiting until they have difficulty breathing before going to the hospital as was encouraged at one point before Silent Hypoxia was understood.

 

[eytonxav]

I am a bit surprised the CDC has not pushed a protocol like the one in Popeye's post. It just seems to me, some best practices for treatment should be espoused, even if some adjustments are needed based on individual patient circumstances.

 

[audreyh1]

Initially so many people were out on ventilators! And it was quite frightening - in NY they had only a 20% survival rate on a ventilator, could stay on for weeks, and then incredible rehabilitation required if they survived and got off. Truly horrific. Since then many medical centers have learned numerous ways of keeping COVID-19 patients off a ventilator while they recover from the disease.

 

[sengsational]

I think the mortality rate is affected less by the treatments, and more about what they have stopped doing, and also better timing of the few treatments, and also the population of hospitalized patients have probably gotten less severe over time. This is all my own speculation, but just to say that it's probably not much to do with the chain of understanding the root causes and implementing targeted protocols. Still early days. I believe there are quite a few studies underway that add various things to standard care. Those should be trickling out over the next months and years.

 

[spncity]

Anyone taking Ivermectin?

Anyone here taking Ivermectin for prevention?

Here you go - the I-MASK+ protocol. (from the people who brought you MATH+ Protocol for inpatients). See links for:

...Ivermectin info

...A protocol for prevention - and for early outpatient treatment

...Includes link for research on Ivermectin

All found here: https://covid19criticalcare.com/?fb...O9wxxNide0DkgyNf3BR0twp6xiIhZf-kgIQcBjQHraOdc

Video intro: https://vimeo.com/user113004012/rev...zgQm5ZjxXyagjINO-JSEG2ruJ2qhF2yjKdlbP2jd0rtxs

Dr. Paul Marik video:

IN THE COMMENTS BELOW THE VIDEO: "Great update, Dr. M. I think you meant, “safe up to two thousand mcg per kg” I think you mistakenly said 200. Thank you so much for this update. You are indeed saving the world when all of us spread this message." Dr. Paul Marik replies: "Yep you right. I was tired when I did that talk and made a few slips."

 

[spncity]

In addition to the I-MASK+ protocols above, Paul Marik, MD is the architect of the MATH+ Treatment Protocol. He updates his long paper and summary periodically. Here's the link:

https://www.evms.edu/covid-19/covid_care_for_clinicians/


(It was updated last week).


You can also search for his name on YouTube.

I heard him say in one of his lectures that if your pulse oximeter reading goes down to 94 or lower, you should head for the hospital.

 

[street]

The people I have known that have had it were given steroids and an antibiotic. They were sent home to quarantine.

 

[spncity]

Since we no longer hear of infections running rampant through nursing homes, I'd guess the age average has decreased in patients, accounting for a better survival rate.

By the middle of March, family member visits in nursing homes were being halted.

It was three more weeks before the CDC said that nursing home caregivers should be wearing masks...

Still, some nursing homes had few, if any, deaths. Others had many.

 

[gerntz]

As I mentioned above, average age of hospitalized patient is part of it. But I think also treatment has significantly improved, and patients are also seeking treatment earlier, not waiting until they have difficulty breathing before going to the hospital as was encouraged at one point before Silent Hypoxia was understood.

Yes.

 

[gerntz]

I am a bit surprised the CDC has not pushed a protocol like the one in Popeye's post. It just seems to me, some best practices for treatment should be espoused, even if some adjustments are needed based on individual patient circumstances.

I think docs do try to employ best practices. Just that there's no one agree practice.

 

[gerntz]

Article by Holman Jenkins in WSJ on Halloween estimates cumulative covid infections in USA in the 50-100M range regardless of confirmed cases - a biased metric. At this stage, no way for countries to contact trace & keep up. Stay safe.

 

[spncity]

Anyone here taking Ivermectin for prevention?

Here you go - the I-MASK+ protocol. (from the people who brought you MATH+ Protocol for inpatients). See links for:

...Ivermectin info

...A protocol for prevention - and for early outpatient treatment

...Includes link for research on Ivermectin

All found here: https://covid19criticalcare.com/?fb...O9wxxNide0DkgyNf3BR0twp6xiIhZf-kgIQcBjQHraOdc

Video intro: https://vimeo.com/user113004012/rev...zgQm5ZjxXyagjINO-JSEG2ruJ2qhF2yjKdlbP2jd0rtxs

Dr. Paul Marik video:

IN THE COMMENTS BELOW THE VIDEO: "Great update, Dr. M. I think you meant, “safe up to two thousand mcg per kg” I think you mistakenly said 200. Thank you so much for this update. You are indeed saving the world when all of us spread this message." Dr. Paul Marik replies: "Yep you right. I was tired when I did that talk and made a few slips."

One of the interesting things he talked about was that in Peru, the government issued hundreds of thousands of doses of Ivermectin. So while the spike in cases followed the curve of many other countries, the death rate did not.