Sunday, May 3, 2020

It is medically illogical to wait until someone is very sick before treating them

Here's the thing.  For the first week of clinical illness, disease is primarily in the respiratory tract, and viral titers are rising.  After a week, you start making detectable antibodies, and usually viral titers decline. But other processes are at work making you sick, especially an inappropriate immune response. And you are still dealing with damage that was caused by the virus.

While many things can go very wrong after that first week (heart failure, kidney failure, blood clots neurologic damage, etc.) the main killer is ARDS and inappropriate immune-mediated damage.  

ARDS has a mortality rate of about 40%, and nothing tried over decades has made much impact on that.  Likewise, there are no great treatments for kidney and heart failure, nor for most neurologic illness.  

It should be obvious that with a disease whose course evolves over time in the manner of COVID-19, you have to attack the virus hard and fast, rather than the mess it leaves in its wake.  That can only be done in the early stage.  Treatment trials need to enroll patients when they first become ill, rather than holding off.

If there is a shortage of hydroxychloroquine, for example, and that is the reason for waiting to treat, then the public needs to be told, and to be told what the plan is to ameliorate the shortage, if it turns out to be effective.  

We won't be able to identify a really good COVID drug unless we start using it early.  Why are our federal health agencies doing everything wrong?

5 comments:

MattM said...

It's pretty much a given that CV19 was a genetically engineered virus. The US is as much responsible as China, possibly others, for it's released from the Level 4 lab.
I'd be willing to bet my "Helicopter Money" that each virus has it's own viral fingerprint that would point to where it originated from...which country and lab. That's the info that is being kept the utmost secret for obvious reasons.
There is a very good possibility it was released at the Level 4 lab in Rome, Italy. Hence why Italy was one of the ground zero places.

MattM said...

I left my comment but someone didn't like what I said and it was deleted before it got posted.

Anonymous said...

Thank you for asking tough questions and providing information from your perspective Dr. Nass! I appreciate a professional with your education and experience addressing public health concerns in this open manner.

Diane,S said...

Thank you for all of your good work. At least once a day, I type your name into a search engine to check if there is a new blog entry.

But starting today, your name brings up no results for this page. I got here by using yandex.

olddochall said...

Dr. Nass
Also wondering why not the early treatment as you mentioned but why in many of the trails I have read they have not followed through with combination therapies in trials. Seeing that most patients having combination therapy of Hydroxychloroquine and Remdesivir have not been followed up with for outcome. Memory serves me correct it has been done with success in HIV and TB and is still used today.