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Hydroxychloroquine changes the pH at the cell surface making it more difficult to bind. It inhibits nucleus acid replication, virus assembly, virus protein glycosylation, virus particle transport is inhibited, it works in a dose dependent fashion up to

400 mg twice daily and may have even stronger effects as a pretreatment. Hydroxychoroquine has more potent antiviral activity than chloroquine.
Hydroxychloroquine is an immune modulator and can suppress the release of inflammatory cytokines like il6 and il10.

Losartan upregulates ACE2 and its anti fibribotic, anti thrombotic, anti inflammatory (decreases tgf-B). The resultant cytokine storm is suppressed if patients are on ARBs.
The upregulation of ACE2 by ARBs appears to attenuate the inflammatory response in animal models.

The virus appears to create excessive AT1R activation and after binding to ACE2 the viral binding down regulates ACE2. This results in excessive angiotensin production and increased lung injury due to angiotensin stimulated AT1R resulting in increased lung vascular permeability

and thereby lung injury.
Thus, higher ACE2 expression following ARB treatment leads to less injury by blocking the excessive angiotensin production and increasing the level of the vasodilator, angiotensin 1-7.
Consider losartan 25 mg po QD as a way to limit the cytokine storm

and resultant fibrosis as a pretreatment. Its highly recommended to give hydroxychloroquine 400 mg po bid x one day followed by 200 mg po bid x 4 days for someone who’s been exposed and for those who may have the disease
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This took me all of about 36 hours to figure out last Thursday after surgery. We need to stop pretending there’s no cure and focus on getting this medicine out to those who need it.

It’s absolutely insane that we are acting like there’s no treatment for this disease. It’s like having pneumonia and not giving patients penicillin or cipro. Instead we are told to stay home and watch them die a painful death on ECMO. Let’s be proactive and get the word out,

if we are going to save lives, we have the medication (hydroxychloroquine) to do it. To watch our media run our medical practices is crazy. THERES A MORAL OBLIGATION TO GET THE WORD OUT ON TREATMENT, NOT TOO STAY IN OUR HOUSES LIKE SCARED RABBITS. PLAQUENIL CURES THE DISEASE.

SPREAD THE WORD AND SPREAD THE WORD TO OUR MORALLY CONCIOUS BUT CLINICALLY IGNORANT ACADEMY. Let’s lead the way on educating the public, what are we afraid of, or are we slow readers.

Who benefits if the corona virus goes unchecked and thousands of patients need to be on ventilators in the ICU?? If we as physicians are unwilling to stand up for our patients and provide them the voice they need to obtain the medicines that are necessary to overcome this disease

then we have failed our Hippocratic oath. First, do no harm. How can we sit back and not clamor for our patients to have access to Plaquenil.

It’s insanity to say that our public health officials have determined that our patients need our disposable medical supplies to help

patients in the ICU.
NO, OUR PATIENTS NEED OUR HELP GETTING THE PLAQUENIL THEY NEED TO KEEP THEM OUT OF THE ICU. The EXISTENTIAL crisis is the failure to act in the best interests of our patients. Why in Gods name should we allow them to get to the ICU in the first place.

Everyone look in the mirror. It’s up to us to make this happen. How is this morally responsible. Why let our patients get super sick!!!

Please please retweet

Link to the nature article nature.com/articles/s4142…

Clinical trial for hydroxychloroquine clinicaltrials.gov/ct2/show/NCT04…

This is the Fox News tweet foxnews.com/world/world-he…

Here’s the nature article nature.com/articles/s4142…

Another nice link academic.oup.com/cid/advance-ar…