Show Notes
With Professor Colleen AldousCritical appraisal of multidrug therapy in the ambulatorymanagement of patients with COVID-19 and hypoxemiaPart II: Causal inference using the Bradford Hill criteriaUploaded 13-04-25https://www.jstage.jst.go.jp/article/antibiotics/78/1/78_35/_pdf/-char/enWe continue the critical appraisal of three published case series of 119 COVID-19 patients with hypoxemia, treated in the United States, Zimbabwe, and Nigeria with similar ivermectin-based multidrug treatments, to assess the available evidence supporting a causal relationship between treatment and reduction in hospitalizations and mortality. A narrative review was conducted to assess the Bradford Hill criteria for a causal association. We used a previously proposed refinement of the Bradford Hill criteria that reorganized them into three categories of direct, mechanistic, andparallel evidence. The efficacy of the two most aggressive ivermectin-basedmultidrug protocols is supported by the Bradford Hill criteria for temporality,strength of association, biological gradient, biological plausibility, coherence, consistency, and analogy. The causal relation between the treatment of hypoxemic COVID-19 patients using these protocols and the reduction in hospitalizations and mortality is supported as an inference to the best explanation.Critical appraisal of multidrug therapy in the ambulatorymanagement of patients with COVID-19 and hypoxemiaPart I. Evidence supporting the strength of associationhttps://faculty.utrgv.edu/eleftherios.gkioulekas/papers/032-c19-ivm-oxygen.pdfOn March 11, 2020, Coronavirus Disease 2019 (COVID-19), the disease caused by the Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2), was declared a pandemic by the World Health Organization (WHO) [1]. Worldwide, 768,187,096 confirmed cases of COVID-19 and 6,945,714 deaths have been reported to the WHO as of June 21 2023, amounting to an average Case Fatality Rate (CFR) of 0.9% [2]. During 2020, while several governments and public health agencies were focused on contagion control and in-hospital patient care, several medical doctors from all around the world innovated and discovered early outpatient multidrug treatments using several repurposed medications in combination [3–15]. In the United States, several independent efforts coalesced into the formulation of a sequenced multidrug protocol [10, Fig. 3] (hereafter, McCullough protocol), which is based on the pathophysiological understanding of COVID-19 as a triphasic illness with three overlapping phases: (1) viral proliferation; (2) hyperinflammatory cytokine storm (COVID-19 pneumonia); and (3) thrombosis. McCullough’s protocol proposed a combination antiviral therapy for treating the viral proliferation phase, immunomodulators for treating the cytokine storm, and antiplatelet agents and antithrombotics for handling the thrombotic stage, based on risk stratification and how the disease presents in each individual patient. Thus, the McCullough protocol is an algorithmic treatment using sequenced multiple drugs in combination and customized to the individual patient and their response to treatment; no single drug is necessary nor sufficient to achieve treatment efficacy towards reducing hospitalizations and deaths. A recently published update of the McCullough protocol [16, Fig. 3] introduced some adjustments including virucidal nasal washes and oral gargles [17–24]. A large case series of 869 high-risk patients [25, 26], who were treated using an early version of the McCullough protocol, has been compared against population-level and historical controls [27], showing the existence of efficacy with respect to the reduction of mortality and hospitalizations, which is also resilient with respect to random selection bias, provided that patients are treated early enough within the first 3 to 5 days from the onset of illnes Learn more about your ad choices. Visit megaphone.fm/adchoices
More from Dr. John Campbell
the medical people I interact with at the hospital are far more optimistic than I've seen them since this all began in April last year
Our world in dataUploaded 11-06-23https://ourworldindata.orghttps://ourworldindata.org/grapher/excess-mortality-p-scores-average-baselinehttps://ourworldindata.org/excess-mortality-covidExcess mortality is a term used in epidemiology and public health that refers to the number of deaths from all causes during a crisis above and beyond what we would have expected to see under ‘normal’ conditionsExcess deaths = Reported deaths – Expected deathshttps://ourworldindata.org/excess-mortality-covid#excess-mortality-our-data-sourcesThe Human Mortality Database is maintained by a team of researchers based at the University of California, Berkeley, USA and the Max Planck Institute for Demographic Research in Rostock, Germany. Learn more about your ad choices. Visit megaphone.fm/adchoices Learn more about your ad choices. Visit megaphone.fm/adchoices
The Lancet Commission on lessons for the future from the COVID-19 pandemic Uploaded 16-09-2214th September 2022https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01585-9/fulltexthttps://covid19commission.orgWHO responseWHO acted too cautiously and too slowlySeveral important mattersTo warn about human transmissibility of the virusTo declare a Public Health Emergency of International ConcernTo support international travel protocols designed to slow the spread of the virus(This delay contributed to the spread of the virus and limited the possibilities for risk mitigation.)To endorse the public use of face masks as protective gearTo recognise the airborne transmission of the virus.(These delayed and vague recommendations from WHO continued until late April, 2021.) Just 1 example, after receiving an open letterFrom 238 scientists in July, 2020,asking the organisation to address airborne transmissionWHO did not change until April 30, 2021.Multiple failures of international cooperationToo many governments have failed to adhere to basic norms of institutional rationality and transparency, and the world's major powers have failed to collaborate to control the pandemic.Specific pointsLack of timely notification of the initial outbreak of COVID-19Costly delays in acknowledging the crucial airborne exposure pathway of SARS-CoV-2, and in implementing appropriate measures at national and global levels to slow the spread of the virus.Lack of coordination among countries regarding suppression strategiesFailure of governments to examine evidence and adopt best practices for controlling the pandemic,and managing economic and social spilloversShortfall of global funding for low-income and middle-income countries (LMICs)Failure to ensure adequate global supplies and equitable distribution of key commodities,protective gear, diagnostics, medicines, medical devices, and vaccinesLack of timely, accurate, systematic dataInfections, deaths, viral variants, health system responses, and indirect health consequencesAgain the report raised lab leak possibilityPoor enforcement of appropriate levels of biosafety regulations in the lead-up to the pandemic, raising the possibility of a laboratory-related outbreakFailure to combat systematic disinformationLack of global and national safety nets to protect populations experiencing vulnerability.As of May 31, 2022There were 6·9 million reported deaths and 17·2 million estimated deaths from COVID-19Institute for Health Metrics and Evaluationhttps://covid19.healthdata.org/global?view=cumulative-deaths&tab=trendThis staggering death toll is both a profound tragedy and a massive global failure at multiple levels. Sustainable development processSet back by several years, Deep underfinancing, Sustainable Development Goals and,aims of the Paris Climate Agreement. Previous publicationsLancet 2021https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02833-6/fulltextLancet Jan 2022https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02871-3/fulltexthttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01585-9/fulltext Learn more about your ad choices. Visit megaphone.fm/adchoices Learn more about your ad choices. Visit megaphone.fm/adchoices
Dr. Melissa McCann is a general practitioner in Queensland, Australia
Monkeypox virus, seldom reported outside African until now, Uploaded 27-07-22https://www.nejm.org/doi/full/10.1056/NEJMoa2207323?emp=marcom&utm_source=nejmlist&utm_medium=email&utm_campaign=aomev2&utm_content=version-a&ssotoken=U2FsdGVkX19dsxXEVZT5ggLZ3zieDxejeViMkwTigM4Q7ECfBTJmfTXUrKWkbZ3up0jDhhQjYR6OydzgkC%2F1LL8S5l7OuFDLsP2LiBwfKJ3ymNN4hp0Z%2FNASEYMuetIqeQIQ9ETL8BABCQut7e8xEQeWPlduFdyPMYgAugUePHtSEs5rFR%2BGWfFOCIPZs9Wb7aJf%2FyzhvvLSrzqDKmNt4Q%3D%3D&cid=DM1289135_Notable_Articles_Engaged&bid=1085207852Endemic in AfricaCases now worldwideMETHODSFormed an international collaborative group,international case series, presentation, clinical course, outcomes of PCR confirmed infectionsRESULTSWe report 528 infections diagnosed between April 27 to June 24, 2022Cases, 528, at 43 sites in 16 countries98% in gay or bisexual men, 75% were White, 41% had HIVmedian age 38Transmission suspected to have occurred through sexual activity95% of casesPresentation in this series95% rash (with 64% having less than 10 lesions)73% anogenital lesions41% had mucosal lesions(with 54 having a single genital lesion)Common systemic features preceding the rashfever (62%)lethargy (41%)myalgia (31%)headache (27%)lymphadenopathy (56%)Concomitant sexually transmitted infections109 of 377 (29%)Among the 23 people with a clear exposure historymedian incubation period, 7 days (range, 3 to 20)Monkeypox virus DNADetected in 29 of the 32 (in whom seminal fluid was analyzed)ManagementAntiviral treatment given to 5% of cases70 (13%) were hospitalizedMostly for pain managementsevere anorectal pain (21)soft-tissue superinfection (18)pharyngitis limiting oral intake (5)eye lesions (2)acute kidney injury (2)myocarditis (2)infection-control purposes (13)No deaths were reportedCONCLUSIONSMonkeypox manifested with a variety of dermatologic and systemic clinical findings. Need for rapid identification and diagnosis of cases to contain further community spread. Learn more about your ad choices. Visit megaphone.fm/adchoices Learn more about your ad choices. Visit megaphone.fm/adchoices