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1/ Highlights from Sermo survey of 6,227 verified physicians on COVID-19 treatment.

- Besides analgesics, HCQ & AZ are most used drugs
- HCQ chosen as MOST effective therapy
- Most common HCQ regimen: 400mg twice daily (day 1), then 400mg daily x 5 days

public-cdn.sermo.com/covid19/c8/be4…
2/ US vs International approach

Outside US: HCQ is used equally for mild to severe cases of COVID-19

In US: HCQ is most commonly used for high risk/severe cases

51% of US physicians believe most effective therapy is “nothing”

vs

4% in China, 16% in Italy/Spain, 29% in Europe
3/ Studies show anti-virals are MOST EFFECTIVE if administered as post-exposure prophylaxis or within first 48 hrs of symptoms (e.g. Tamiflu, Zanamivir, Peramivir, Zinc, Rimantadine, Amantadine).

I suspect HCQ in the treatment of COVID-19 is no different. Early treatment is key.
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More from @JamesTodaroMD see all

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James Todaro, MD
@JamesTodaroMD
1/ Summary of HCQ + AZ UPDATED STUDY by @raoult_didier

N = 80 patients w/ COVID-19
Average age 52 yo (29% over 60 yo)
11.2% diabetes
7.5% heart disease
10% respiratory disease
16.3% hypertension

All patients treated with HCQ (10 days) + AZ (5 days).

mediterranee-infection.com/wp-content/upl…
2/ Patient presentations:

- 54% presented with pneumonia
- 15% febrile
- 5% asymptomatic
- Onset of symptoms to start of treatment = 4.9 days
- Screening EKG done before treatment and on day 2 (treatment not started/discontinued if QTc > 500ms)
3/ Results (post-treatment):

- Virus cultures neg in 97.5% of patients on day 5
- 93% neg PCR on day 8
- Time from treatment to discharge = 4.1 days (criteria for discharge clinical appearance or PCR CT ≥34)
- One death (86 yo) & one still in ICU (74 yo)
- Mortality rate = 1.2%
Read 8 tweets
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James Todaro, MD
@JamesTodaroMD
1/ I've aggregated several studies and their findings about the potential interactions between CHLOROQUINE + AZITHROMYCIN with a focus on cardiac outcomes.

This is very important given this potential combination therapy in the treatment of #COVID19 #coronavirus
2/ Efficacy & safety of azithromycin-chloroquine in pregnant women. Kimani et al.

Summary: Randomized, Phase 3 trial showing no drug related deaths in 1446 pregnant women treated with 620mg chloroquine and 1000mg azithromycin daily for 3 days.

ncbi.nlm.nih.gov/pmc/articles/P…
3/ Pharmacokinetic interaction between azithromycin & chloroquine. Cook et al.

Summary: Randomized, Phase 1 trial showing no clinically relevant pharmacokinetic interaction in 24 subjects receiving 500-1000mg CQ & 1000mg AZM daily for 3 days.

ajtmh.org/docserver/full…
Read 7 tweets
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James Todaro, MD
@JamesTodaroMD
1/ Here is my summary of the relevant points from the breaking open-label clinical trial on the use of hydroxychloroquine (HCQ) and azithromycin in the treatment of COVID-19 by Didier Raoult, MD/PhD. @DiderRaoult
2/ Trial included 36 adult patients, 26 received HCQ & 16 controls. Six out of 42 patients meeting inclusion criteria lost to follow up. (All from treatment group: 3 transferred to ICU, 1 death, 1 left hospital, 1 stopped HCQ bc nausea. No control patients lost to follow-up.)
3/ HCQ-treated patients average age 51.2 yrs vs control patients average age of 37.3 yrs. Six patients receiving HCQ received azithromycin on day 1 (unclear how certain patients were selected to receive azithromycin).
Read 6 tweets

Related threads

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liz gerard
@gameoldgirl
Brace, brace! Long #covid19 #journalism thread afoot.

(1)
 @paulconnew1 @BrianCathcart @peterjukes @zelo_street @pguk10 @stevenjbarnett @Byline_Media
After yesterday’s plain wrong #covid19 headline, the Telegraph seems to be doubling down on the idea that flu remains more dangerous. This time it cites research from @lshtm to produce the headline below.
(2)
We are learning to become familiar with the R factor – the number of people a sufferer of any disease is likely to infect. The consensus seems to be that unchecked, #covid19 has an R factor of around 2.6.
(3)
Read 22 tweets
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Bryan Broderick, MD
@BBroderickMD
1/21 After caring for patients in the ICU with #COVID for the last week, the time seems right for a #pulmonology #tweetorial on #Proning or #PronePositioning

@sanjayvdesai @OslerResidency @JHUPCCMFellows @CPSolvers @thecurbsiders @cardionerds @tony_breu @david_furfaro @chadhoc
2/ Let’s begin with a question: how does prone positioning improve oxygenation in patients with severe Acute Respiratory Distress Syndrome (ARDS)?
3/ First, some history. Prone positioning was first proposed in the 1970’s as a method to improve gas exchange in resp. failure and has long been shown to improve Pa/FiO2 in mechanically ventilated patients with severe ARDS.

ncbi.nlm.nih.gov/pubmed/?term=1…
ncbi.nlm.nih.gov/pubmed/3383620
Read 21 tweets
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COVID19
@V2019N
*New* @TheLancet : We suggest that patients w/ cardiac diseases, hypertension, or diabetes, who are treated with ACE2-increasing drugs, at higher risk for severe #COVIDー19 infection & therefore, should be monitored for ACE2-modulating medications, such as ACE inhibitors or ARBs
The most distinctive comorbidities of 32 non-survivors from a group of 52 ICU patients w/ #COVIDー19 were cerebrovascular diseases (22%) & diabetes (22%).
thelancet.com/journals/lanre…
Another study 173 had severe disease w/comorbidities of htn (23·7%), diabetes mellitus (16·2%), coronary heart diseases (5·8%), & cerebrovascular disease (2·3%). Third study of 140 patients who were admitted to hospital with COVID-19, 30% had hypertension & 12% had diabetes.
Read 3 tweets
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Chicago Community Bond Fund
@ChiBondFund
This is a thread about why it is absolutely essential that we get people out of jails, prisons, & immigration detention during the #COVIDー19 pandemic. It will include information & demands for how to #StopCOVID19inJails .

The health of people inside & all of us depends on it.
This piece by @premaldharia explains how #COVIDー19 could spark a humanitarian crisis inside prisons and jails. slate.com/news-and-polit… #StopCOVID19inJails
Jails and prisons are the perfect incubators for #COVIDー19. Health care in these facilities is often abysmal. This article from @nhbaptiste explains what jails and prisons should be doing to improve access to healthcare. motherjones.com/politics/2020/… #StopCOVID19inJails
Read 34 tweets
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Tom Folan
@tomfolanmd
Clarification: The patchy opacities involving the upper, mid, and lower lung zones bilaterally are ground glass opacities, and do NOT represent necrosis.

This is extensive disease present, and #COVIDー19 can result in chronic lung injury to include fibrosis if not death first.
The following case study illustrates a case from China in a 46 year old male with ground glass opacities involving the bilateral lower lobes (A,B), with 2 day follow up imaging (C, D) with more extensive opacities, now involving right upper lobe as well as bilateral lower lobes.
Comparison of clinical and radiographic features of SARs, MERs, and COVID-19

#COVIDー19
Read 5 tweets
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🏴Alpha Intel🏴
@theAlphaIntel
A detailed thread on the #coronavirus drugs and vaccines in development
This will be updated accordingly
Gilead Sciences
Approach: Treatment
Stage: Phase 3

Gilead’s remdesivir, an intravenous treatment, has already been used to treat one infected patient in the U.S. and will soon be deployed in a pair of large, late-stage studies in Asia.
Later this month, Gilead will recruit about 1,000 patients diagnosed with the coronavirus to determine whether multiple doses of remdesivir can reverse the infection. The primary goals are reducing fever and helping patients get out of the hospital within two weeks.
Read 33 tweets

Trending hashtags

#coronavirus #COVID19france #COVID19 #WHO #Proning #coviditaly #covid19 #OMS #CommunismKills #Covid_19 #Shanghai #Liban #Lebanon #US #Blockchain #QuédateEnCasa #EtatsUnis #coronavirusuk #Europe #2019nCov #Afghanistan #Karnataka #Canada #Yémen #COVID2019

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