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Early Multidrug Outpatient Treatment of SARS-CoV-2 Infection (COVID-19) and Reduced Mortality Among Nursing Home Residents

Alexander et al., medRxiv, doi:10.1101/2021.01.28.21250706
Feb 2021  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 422 studies, used in 58 countries.
No treatment is 100% effective. Protocols combine treatments.
5,400+ studies for 118 treatments. c19hcq.org
Review of studies on treatment of COVID-19 for nursing home residents, concluding that there is a large >60% mortality risk reduction associated with multidrug treatment using two or more intracellular anti-infectives (HCQ and either AZM or DOXY) combined with other agents including corticosteroids, anti-thrombotics, and nutraceuticals. Authors note there is also recent focus on ivermectin and favorable evidence for bromhexine.
Alexander et al., 1 Feb 2021, preprint, 11 authors.
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Abstract: medRxiv preprint doi: https://doi.org/10.1101/2021.01.28.21250706; this version posted February 1, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. Early Multidrug Outpatient Treatment of SARS-CoV-2 Infection (COVID-19) and Reduced Mortality Among Nursing Home Residents Paul E Alexander MSc, PhD, Robin Armstrong, MD, George Fareed, MD, Kulvinder K. Gill, MD, John Lotus, BS, Ramin Oskoui, MD, Chad Prodromos, MD, Harvey A. Risch, MD, PhD, Howard C Tenenbaum, DDS, PhD, Craig M. Wax, DO, Peter A. McCullough, MD, MPH Paul E Alexander MSc PhD, McMaster University and GUIDE Research Methods Group, Hamilton, Ontario, Canada elias98_99@yahoo.com Robin Armstrong, MD, The Resort at Texas City Nursing Home, Texas City, TX, USA robarmstr@hotmail.com George Fareed, MD, Pioneers Health Center, Brawley, CA, USA gfareed@gmail.com Kulvinder K. Gill, MD, Concerned Ontario Doctors, Toronto, Ontario, Canada John Lotus, BS, The Foundation for Orthopaedics and Regenerative Medicine (FOReM), Chicago, IL, USA jlotus21@uchicago.edu Ramin Oskoui, MD, CEO, Foxhall Cardiology, PC, Washington, DC oskouimd@gmail.com Chad Podromomos, MD, The Foundation for Orthopaedics and Regenerative Medicine (FOReM), Chicago, IL USA chadprodromos@gmail.com Harvey A. Risch, MD, PhD, Yale School of Public Health, New Haven, CT USA harvey.risch@yale.edu Howard C. Tenenbaum DDS, Dip. Perio., PhD, FRCD(C) Centre for Advanced Dental Research and Care, Mount Sinai Hospital, and Faculties of Medicine and Dentistry, University of Toronto, Toronto, ON, Canada howard.tenenbaum@sinaihealth.ca Craig M. Wax, DO, Family Physician, Independent Physicians for Patient Independence, New Jersey, AAPS board of Directors physician1@comcast.net Peter A. McCullough, MD, MPH, Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA peteramccullough@gmail.com Address for Correspondence 1 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2021.01.28.21250706; this version posted February 1, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. Paul E Alexander MSc PhD, McMaster University and GUIDE Research Methods Group, Hamilton, Ontario, Canada elias98_99@yahoo.com Word Count 5546 Funding source(s): none related Conflict of interest statement for author and co-authors: nothing to disclose Authors had access to the data and wrote the manuscript Views and opinions expressed are only of the authors listed and not of their organizations of employment Running head: Early Multidrug Regimen for COVID-19 in Nursing Homes Acknowledgement: We thank Mr. Erik Sass, editor-in-chief of The Economic Standard for his oversight and input. Key words: SARS-CoV-2; COVID-19; nursing home; elderly; hospitalization; mortality; ambulatory treatment; anti-infective; anti-inflammatory; antiviral; corticosteroid; antiplatelet agent; anticoagulant 2 medRxiv preprint doi: https://doi.org/10.1101/2021.01.28.21250706; this version posted February..
DOI record: { "DOI": "10.1101/2021.01.28.21250706", "URL": "http://dx.doi.org/10.1101/2021.01.28.21250706", "abstract": "<jats:title>Abstract</jats:title><jats:p>The outbreak of COVID-19 from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world with tremendous morbidity and mortality in the elderly. In-hospital treatment addresses the multifaceted nature of the illness including viral replication, cytokine storm, and endothelial injury with thrombosis. We identified nine reports of early treatment outcomes in COVID-19 nursing home patients. Multi-drug therapy including hydroxychloroquine with one or more anti-infectives, corticosteroids, and antithrombotic agents can be extended to seniors in the nursing home setting without hospitalization. Data from nine studies found multidrug regimens relying on the use of hydroxychloroquine as well as other agents including doxycycline were associated with a statistically significant and &gt;60% reductions in mortality. Going forward, we theorize and based on the evidence, that early empiric treatment for the elderly with COVID-19 in the nursing home setting (or similar congregated settings with elderly residents/patients) has a genuine probability of success and acceptable safety. This group remains our highest at-risk group and warrants acute treatment focus that will prevent the development and/or worsening of problems associated with COVID-19, most particularly isolation, hospitalization, and death. In fact, with the rapidity and severity of SARS-CoV-2 outbreaks in nursing homes, in-center treatment of patients with acute COVID-19 is possibly the most rational and importantly <jats:italic>feasible</jats:italic> strategy to reduce the risks of hospitalization and death. If the approach remains ‘wait-and-see’ and elderly high-risk patients in such congregated nursing room type settings are allowed to worsen with no early treatment, they may be too sick and fragile to benefit from in-hospital therapeutics and are at risk for pulmonary failure, life-ending micro-thrombi of the lungs, kidneys etc. We put forth the notion that the most important factor in this regard, is making available early therapeutic intervention as described here. These drugs include and under supervision by skilled doctors, combination/sequenced ivermectin, hydroxychloroquine, colchicine, azithromycin, doxycycline, bromhexine hydrochloride, and favipiravir (outside the US), along with inhaled steroids such as budesonide and oral steroids including dexamethasone and prednisone, and anti-thrombotic anti-clotting drugs such as heparin). As the clinical trials data on treatments for COVID-19 mature, this early treatment therapeutic option deserves serious, urgent, and sober consideration by the medical establishment and respective decision-makers.</jats:p>", "accepted": { "date-parts": [ [ 2021, 2, 1 ] ] }, "author": [ { "affiliation": [], "family": "Alexander", "given": "Paul E", "sequence": "first" }, { "affiliation": [], "family": "Armstrong", "given": "Robin", "sequence": "additional" }, { "affiliation": [], "family": "Fareed", "given": "George", "sequence": "additional" }, { "affiliation": [], "family": "Gill", "given": "Kulvinder K.", "sequence": "additional" }, { "affiliation": [], "family": "Lotus", "given": "John", "sequence": "additional" }, { "affiliation": [], "family": "Oskoui", "given": "Ramin", "sequence": "additional" }, { "affiliation": [], "family": "Prodromos", "given": "Chad", "sequence": "additional" }, { "affiliation": [], "family": "Risch", "given": "Harvey A.", "sequence": "additional" }, { "affiliation": [], "family": "Tenenbaum", "given": "Howard C", "sequence": "additional" }, { "affiliation": [], "family": "Wax", "given": "Craig M.", "sequence": "additional" }, { "affiliation": [], "family": "McCullough", "given": "Peter A.", "sequence": "additional" } ], "container-title": [], "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2021, 2, 1 ] ], "date-time": "2021-02-01T18:50:45Z", "timestamp": 1612205445000 }, "deposited": { "date-parts": [ [ 2021, 12, 15 ] ], "date-time": "2021-12-15T15:06:52Z", "timestamp": 1639580812000 }, "group-title": "Infectious Diseases (except HIV/AIDS)", "indexed": { "date-parts": [ [ 2024, 3, 1 ] ], "date-time": "2024-03-01T23:31:52Z", "timestamp": 1709335912437 }, "institution": [ { "name": "medRxiv" } ], "is-referenced-by-count": 0, "issued": { "date-parts": [ [ 2021, 2, 1 ] ] }, "link": [ { "URL": "https://syndication.highwire.org/content/doi/10.1101/2021.01.28.21250706", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "246", "original-title": [], "posted": { "date-parts": [ [ 2021, 2, 1 ] ] }, "prefix": "10.1101", "published": { "date-parts": [ [ 2021, 2, 1 ] ] }, "publisher": "Cold Spring Harbor Laboratory", "reference": [ { "DOI": "10.1111/jgs.16477", "doi-asserted-by": "publisher", "key": "2021020402200908000_2021.01.28.21250706v1.1" }, { "key": "2021020402200908000_2021.01.28.21250706v1.2", "unstructured": "Centers for Disease Control and Prevention (CDC). 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