Favorite Covid pickup line; You can’t spell virus without U and I.

I hope you had a great weekend and are adjusting well to the new social order.  Try not to worry too much about finances.  We are all in this together and all affected to some degree.

I wanted to go over a few points about current medications we are hearing so much about.  I have been looking extensively in the literature regarding the use of Hydroxychloroquine (HCQ), Chloroquine (CQ), and Azithromycin (AZM).  These are all antibiotics and should have little antiviral activity.  Chloroquine (CQ) was originally used as an anti-malarial before malaria resistance to this drug emerged over most of the world.  Because of this early extensive usage a beneficial side effect of the drug was discovered.  CQ has the ability to suppress certain parts of the immune system.  Later a cousin to CQ called Hydroxychloroquine (HCQ) was developed.  It had a somewhat better side effect profile and subsequently became a mainstay in the rheumatoid (auto-immune) community to treat Lupus and other disorders.  Azithromycin (AZM) or Zithromax is a macrolide antibiotic known for its antibacterial effect as well as its anti-inflammatory effect.  At least some of the benefit of these drugs is attributed to blocking viral entry into cells and modulating the adverse immune consequences of infection.

Currently there are protocols in place from China, France, and Italy where HCQ and AZM were used in the treatment of hospitalized Covid pts.  Unfortunately there is no consensus and limited data that suggest these protocols are truly efficacious.  This does not mean that they did not work and they likely confer some benefit.  However, believe me if they were markedly beneficial we would not be questioning their use and the data a bit more clear cut.  Personally I think we will soon have effective treatments but I don’t think either of these drugs will make the all star list.  Instead wait for a targeted antiviral (already present and used in MERS) to ramp up production and move into clinical use.  Another issue is a common cardiac electrical conduction problem called a long QT syndrome which can be exacerbated by either drug (let alone the combination) that can lead to a deadly arrhythmia.

Regarding the use of anti-inflammatory drugs like ibuprofen, naproxen, and other NSAIDS there is conflicting information but it is thought that this class of drugs increases the number of receptors that the Covid virus can enter through.  So for right now just stick with Tylenol and remember that a fever does not need to be treated unless you have a history of febrile seizures which are usually a childhood phenomenon.  
We did a lot of work to refit the Clinic today and hope to wrap up tomorrow.  I will keep you posted on the details but we will resume normal operations here later this week.   

Second favorite Covid pickup line; Is that hand sanitizer in your pocket, or are you just happy to be within six feet of me?
Warm Regards,
Dr. Nick