ice9 Profile picture
15 Nov, 8 tweets, 5 min read
Hospitals are getting full. There is still widespread practitioner ignorance about early treatment.

These are the antivirals proven to work in RCT against COVID-19 to date.

There are others that also look promising, but this is the short list.

Do with it what you will.
Addendum, as many replies mentioned other promising options that nonetheless still lack proper RCTs:



Each item on this list appears to have attainable EC90 based on pre-clinical data, and most have observational evidence in favor, but no RCT to date.
Also note the following options (not all of which are antivirals per se) are available OTC in at least some countries:

Among the OTC items, personally, I would place particular emphasis on aspirin.



Aspirin is not an antiviral in any sense against SARS-CoV-2. It is an antiplatelet drug. In high risk cases, limiting platelet activation is extremely important.
Dipyridamole is another antiplatelet drug with a different and broader mechanism of action. It may also have antiviral effects.

It performed quite well in a Chinese COVID-19 RCT. A larger U.S. RCT is being conducted by @YogenKanthi and @jasonsknight.

Interventions in moderate and severe cases, mostly non-antiviral, performing well in RCTs and controlled observational studies:



This table was meant for hospital cases. Think SpO2 on room air below 90%. Unfortunately, admission is no longer guaranteed.
It is very important to obtain medical evaluation and potentially hospital admission if SpO2 falls below 90-92%.

Buy a pulse oximeter. Keep it with your thermometer. Use it.



Please also watch for signs of pulmonary embolism, a medical emergency.

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More from @__ice9

17 Nov
Discussion of antiviral properties of acid sphingomyelinase inhibitors vs. SARS-CoV-2 and others.

Examples: fluoxetine, fluvoxamine, flupenthixol, clemastine, dicyclomine, etc.

en.wikipedia.org/wiki/FIASMA

May inhibit endosomal entry, as one effect.

Fluvoxamine succeeded in RCT.
Note that sufficient concentrations for antiviral effects are likely not attainable at tolerable clinical doses of some.

Fluvoxamine and fluoxetine have shown clinical benefit at ordinary doses.

Flupenthixol is not hittable.
Amitriptyline also works well for preventing SARS-CoV-2 infection, apparently.

cell.com/cell-reports-m…

Intriguing study design.

Volunteers were given amitriptyline, then epithelial cells were removed from their noses and inoculated with SARS-CoV-2. Infection was prevented. Image
Read 4 tweets
17 Nov
Please do not speculatively give linezolid or vancomycin as first-line monotherapy in literal first-glance triage protocols.

Some of us are awfully prone to getting MRSA SSTIs and would appreciate it if fallback antibiotics continue to actually work in the future.
At the very least, please recognize monotherapy as a key contributor to antibiotic resistance.

Add an antibiotic with an independent mechanism so the bacterial population cannot just evolve around it again.

True in more mundane situations as well.

dermatologytimes.com/view/antibioti…
Read 6 tweets
16 Nov
I am not sure how best to say this, but:

The increasingly likely possibility that SARS-CoV-2 arose from a systematic gain-of-function study on the emergence of human pathogens from wildlife reservoirs does not invalidate the implications of the study.

It affirms them.
Bat caves are truly dangerous places, at manifestly global and historic scale.

The viral genomes recombined by the EcoHealth grant were not artificial.

They came from the cave that killed the miners and tourist and yielded RaTG13, and others like it.

It is imperative for human interaction with bats to be sharply curtailed, by government policy if necessary.



If emulating the virome of a bat cave in the lab gave us SARS-CoV-2, then that is damning evidence that this can and will happen again.
Read 4 tweets
14 Nov
Latest ivermectin COVID-19 RCT:

Enormous mortality reduction in severe COVID-19: crude relative risk ratio is 0.1.

Also reduced mortality to zero in mild cases and led to faster viral clearance.

To date, every single study on ivermectin in COVID-19 has been highly successful. ImageImage
See e.g. this thread for more ivermectin studies:

Here is a large thread containing a number of additional ivermectin studies--

Read 4 tweets
13 Nov
Recent RCT demonstrates reduced viral load in patients treated with ivermectin.

papers.ssrn.com/sol3/papers.cf…

Along with the post-exposure prophylaxis trials, this further indicates genuine antiviral activity in vivo for ivermectin (not merely anti-inflammatory). ImageImage
See here for a few other relevant studies:

The only study in vitro for ivermectin against SARS-CoV-2 used Vero cells and did not pre-treat at all.



This made it difficult to infer much about the effect during an ongoing repository infection in humans. Initial estimates looked unhittable.
Read 4 tweets
4 Nov
Denmark orders military to kill all mink in the country after mutated, mink-passaged SARS-CoV-2 strain with supposedly poor antibody response (details pending) spreads back to humans.

Extensive prior culling was unsuccessful in halting mink infections.

bt.dk/politik/mette-…
Discussion among virologists trying to get more data--



So far, no further details.
Read 15 tweets

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