I will be your Covid guinea pig. As a front line provider in the COVID-19 fight, I will be receiving I messenger RNA vaccine tommorrow. Let me know if I grow third eye in the middle of my forehead or a tail Or anything else weird.
I believe the end of this thing is in sight. The vaccines are rolling out. Natural herd immunity is approaching. Bamlanivimab has been working great! (Eli Lilly’s single antibody). Regeneron’s antibody cocktail with two antibodies is coming out. Ivermectin looks very promising to both prevent and treat the disease (We have used it to treat scabies and worms in adults, children, and animals for years). Vitamin D3, Vitamin C, Zinc, Pepcid, steroids such as dexamethasone, Remdesivir, and Possibly azithromycin (An antibiotic but seems to have antiviral activity as well) i’ll have shown some activity against the virus.
I feel more like an astronaut at work than a doctor. N95s, Goggles, gloves, gown, caps, Face shield. It is fatiguing just to wear it all day. Donning, doffing, decontaminating, and disposing of personal protective equipment Is more intense than we normally do for surgery. I UV and ozone decontaminate my phone, stethoscope and other reusable equipment continuously. You have to yell to be heard through your masks. I’m ready for this to be over. Looks like it will be soon!
Everybody stay safe and have Happy holidays!
Update: New England Journal of Medicine published positive data on Regeneron’s Drugs Casirivimab and Imdevimab as well as Lilly’s Bamlanivimab. These are the antibody drugs I had mentioned in the previous post. They seem to be highly effective. Many patients recover within 24 hours of administration. They’re given IV right now.
Azar is saying that the drugs should be used, not left sitting on a shelf. I would take these myself if I had COVID-19. The new strain of COVID-19 in Great Britain Is very similar to the existing strain here. It is felt that the existing therapies will be affective against it as well. As far as we know it’s not in the US yet.
Thanks for the updates, Fred. I try to stay on top of this, but there is so much to sort through, in the general media. It’s great that you provide the bottom line on the treatments, etc…
Could I get a link on the monoclonal antibody paper?
Last I checked, all we have are Emergency Use Authorizations from Phase II trials.
Previous data on Bamlanivimab shows it doesn’t appear to be particularly effective so I’m interested in contradictory reports.
I believe that none of the monoclonal antibodies have passed a Phase III trial and a couple of them actually failed their Phase III trials (to great disappointment and consternation), so I’m really interested in this.
I have personally seen it worked very well. I have numerous people within 24 hours showing greatly decrease symptoms. I’m out of town and don’t have my computer (using my phone). I can send information on the papers when I get home. Our biggest problem with the Antibodies is that we don’t have enough. Strangely, we can only give it to out patients, not if they’re hospitalized. They can’t be Requiring oxygen because of Covid19 . They have to meet today criteria for inclusion such as age over 65 not on oxygen, over 55 with co- morbidity with diabetes, renal failure, heart disease, immune suppression and more strict criteria for younger patients.
Even respectable medical journals have published bad information. Examples are New England Journal of Medicine and the Lancet, Two of the most respected journals out there, have published total garbage and not reviewed it. They both admitted to this and hopefully learned their lesson.
We have been given a lot of wrong information. I don’t blame the original investigators for not knowing. It’s a very unique disease. But they told us originally it was not transmissible from person to person. That changed to it’s highly contagious. We were told originally that masks don’t help. Then we were told we must wear a mask. Sometimes I feel like we’re flying by the seat of our pants I need to use our best judgment at the moment. Time will reveal the truth.
By the way, if you take ivermectin, make sure it is OK for human consumption. Don’t take your dogs heartguard. It contains another ingredient it is not safe for people. If your doctor writes you a prescription, Use one of those discount cards like good RX or that other one that Martin Sheen does the commercials for (I can’t remember the name right now) it should be about $10. I’m not advising you to do it. Just throwing the information out there for your review.
Fred Martin
Below is a link describing outpatient use of the antibodies.
The bottom line is it seems that we need to get to the patient before they initiate an Inflammatory response to the virus. Once initiated, reducing viral load seems to be too late. It’s like sending the bomb squad after the bomb has gone off. It appears that is not the virus that kills you. It is your body’s over aggressive Inflammatory response to the virus that kills you. Cytokine storm etc. The same is true of the antivirals such as remdesivir. Early treatment seems to be important.
Recently in this country, we have had poor response to emergencies. We try to treat them as business as usual. Example: During Hurricane Katrina almost all of the emergency housing went on occupied while FEMA was busy doing inspections And trying to qualify the housing. Meanwhile hurricane victims were left homeless. I was at a hospital which was being evacuated for A hurricane to a sister hospital about 200 miles away. We had buses lined up to transfer patients. Most of them went empty. They refused to take patients with any medical problems. Remember we’re evacuating a hospital. Everybody has medical problems. It took all day, patients were transferred one by one by ambulance. The records were meticulously copied. Normal transfer protocols were used. They transferred the patients, their nurses, and several doctors to the hospital which was a member of the same corporate entity using the same computer system. But should’ve grab the patients charts, taking the patients doctors and nurses on the same buses and had several ambulances follow in the event have an emergency. On the receiving end we should’ve set up a remote location for the original hospital and continued all documentation as if we were in that same hospital. But that makes too much sense. We had our nurses taking care of other patients at the remote end. Nurses from the remote facility were taking care of our patients. Medications were getting changed, people were getting put into nursing homes 200 miles from their homes. Communication broke down. To top it off the hurricane never hit. It took a northern path. But it was a good learning experience. Many of the ambulance crew were from New York. They said they were grateful for the people that we sent to help them and they were returning the favor.
The same thing is happening with Covid. We are treating it as business as usual. We’re wanting completed placebo controlled randomized trials prior to initiating even low risk treatments. Meanwhile millions of people are dying. One of the studies I was reading stated that they considered death or worsening of the patient’s condition.
My interpretation on research of monoclonal antibodies, is that some are working, and some aren’t. Each have a different origin, as they are essentially distilled from a human, and so failure of one, doesn’t indicate a general failure of this type of treatment. Here’s a good starting point on JAMA for bamlamnivimab, which is from Eli Lilly
Day 2 post vaccine (Pfizer) And all is well. No symptoms at all. My arm is not even sore. I expected the kind of reaction you get from the flu shot, I’ve got nothing. My colleagues are saying the same thing.
Fred Martin
That’s the same information we are using. Same protocol. 700 mg over an hour and watch for an hour afterwards. It clearly reduces the viral load. The question is does this make the patient better. It seems to in the mild to moderate cases That have not entered the inflammatory stage.
Hi Fred: Isn’t it supposed to be the second dose that bites you?
I also found this video informative. The person being interviewed is from Eli Lilly, so they are obviously talking mostly about their product, but the underlying principles are the same. (I have no affiliation with them, it’s just what I’ve read and watched most recently)
This is the part that I have to caution people about–these treatments are NOT “low-risk”.
Dexamethasone? That seems to be genuinely useful when people are actually in bad shape. It’s worth risking any side effects.
Remember HCQ? It seems to make outcomes worse.
Remdesivir? Damages liver and kidney functions.
Yes, used correctly, these are useful drugs. The problem with Covid-19 is that most people recover from it naturally. So, your treatment has to be extremely safe as you are giving it up front to many people who in the end “wouldn’t need it.” If your treatment has significant side effects, it’s really easy to do more harm than good for the 90% of the people who wouldn’t have needed it. That’s why there are all the qualifiers on when and who to give these monoclonal antibodies to.
Even your vaccine with EUAs went through a lot more scrutiny for low-probability events than you might expect. The Australian vaccine trial was halted because people were getting false-positive tests for HIV and a rollout would hose our ability to screen the blood supplies. An earlier trial in England was also interrupted when some low-probability immune system events were observed.
All the vaccines are being watched like a hawk so we don’t get a repeat of swine flu vaccine fiasco.
Thanks for taking the vaccine as well as being a first responder. I would have happily been one of the first people to volunteer to get the vaccine after the first responders. Sadly, I got my immunity the hard way via community spread so now I’m at the bottom of the priority list. And I worked my ass off to NOT give Covid-19 to anybody else in my household when I did (quarantine in a single room, mask on 24/7, etc.)
I’m absolutely on the side of science and medicine, and the vaccines coming out are an absolute triumph of modern molecular biology. If, back in June, you’d told people that the efficacy of these things would be 95%+ at rollout, everybody would have laughed at you. Yet, here we are rolling these out and that’s what the numbers are.
However, I’m on the side of science and medicine even when it tells me “hold yer horses”. And that seems to be where the monoclonal antibodies are, right now. They’re interesting and might be useful if we can get the timing and patients right.
The low risk treatment I was referring to was ivermectin. I will include below some information from the FLCCC. The antibodies are currently being given to high-risk patients in the early stages of the disease. Low risk patients are just being told to quarantine without specific treatment. Believe me I had trepidations about taking the vaccine. I felt the risk was mostly to me personally. I’m trying to protect my family and my patients. I have a 93-year-old living with me.
I still have no side effects of the vaccine. Will have to see after the second dose.
Here’s the conference from the FLCCC meeting in Houston. Very interesting.
I jumped in on the Moderna vaccine clinical trial months ago. Well, they injected me with something, I don’t know what, it could have been a vaccine.
50%/50% placebo/vaccine. The Moderna vaccine’s early data showed it was very safe and 94.5% effective and has since come on the market under EU. I got an “it’s complicated” letter last week from the trial coordinator. With the vaccine on the market, it’s potentially unethical to leave people hanging who got placebo. So, they might call back the placebo people for the actual vaccine.
Yep I definitely saw that stuff on Ivermectin. It’s hard to say if it’s of any value, but its safety profile is alright.
Danny,
It seems that they should have broken the blinded portion of the study by now. Even so, studies have been halted when there is an overwhelming advantage or disadvantage to one arm of the study. Thanks for volunteering so early. You made it possible for the vaccine to hit the market. It is no surprise that you stepped up to the plate, as you do so on a regular basis at Hackerspace. I hope you got the real deal and are immune by now.
There is more at stake than just the Covid vaccine. Messenger RNA vaccines or a major innovation. As much as people complain about new and potentially dangerous technology, it is like the Borg, resistance is futile. It is coming whether we like it or not.
In the words of Elon musk, now that we can produce a custom piece of Messenger RNA, disease is a matter software. The implications are enormous. I recognize The dangers involved, but I feel the implications for the future are unlimited. Quite literally, your actions Enrolling in that study will change the future of Disease itself.
Fred Martin
More positive results for antibodies.
Regeneron‘s antibody cocktail REGN-CUV2 Shows new promising results in hospitalized patients. Patients who are hospitalized and do not show a good antibody response naturally died at three times the rate of those who were producing antibodies. In the ongoing studies, these seronegative patient had a good response to the anybody cocktail. Death rate and rates of intubation dropped approximately 22% when compared to placebo. The virus levels dropped dramatically. There seems to be another missing piece of the puzzle.
These are preliminary results of an ongoing study. I believe the key is seronegative hospitalized patients. The studies for Bamlanivimab I believe we’re done on all comers And not stratified in this way. I wonder how it would perform under similar Stratification. It’s all just food for thought call in understanding the mechanism
Fred R. Martin
Vaxart is getting ready to release their phase I human trials of an ORAL vaccine! Looks good so far. Take a pill, no refrigeration needed. Could be sent in the mail for distribution. Targets not just the S protein (spike) That has been mutating, but the N protein (nucleus). Still a long ways off, but something very different.