COVID-19: The Jury is OUT again on Hydroxychloroquine

The jury is out again on hydroxychloroquine (HCQ) and chloroquine (CQ) as a result of refusal of Surgisphere Corporation (the analyzing agency of the database elements presented in the paper) to divulge the full dataset, client contracts, and the full ISO audit report to peer review for analysis. The claim was that such transfer would violate client agreements and confidentiality requirements.
This retraction is appropriate in my view as the full scientific evaluation wasn't completed.
In spite of the retraction, the information and data didn't appear flawed to me and therefore I would hesitate in endorsing use of HCQ and CQ pending further elucidation of this quandary. 

Frustrating stuff.

D. Aldoori

[Retraction—Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet]
[COVID-19 Running Notes]

COVID-19: The Jury is Back on Hydroxychloroquine

At this time, I recommend against using chloroquine or hydroxychloroquine to prevent or treat COVID-19 infection. This recommendation is mostly based on the study published in the Lancet online, May 22, 2020.[1]

Included in this study were 96,032 hospitalized patients from 671 hospitals who were diagnosed with COVID-19 between Dec 20, 2019, and April 14, 2020 and met the inclusion criteria for said study. It was convincingly a large multinational real-world analysis.

The authors (who I agree with), did not observe any benefit of hydroxychloroquine or chloroquine (when used alone or in combination with a macrolide) on in-hospital outcomes, when initiated early after diagnosis of COVID-19. Each of the drug regimens of chloroquine or hydroxychloroquine alone or in combination with a macrolide was associated with an increased hazard for clinically significant occurrence of ventricular arrhythmias and increased risk of in-hospital death with COVID-19.[1]

[1]       M. R. Mehra, S. S. Desai, F. Ruschitzka, and A. N. Patel, “Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis,” Lancet, vol. 0, no. 0, 2020. Link to study.

Can the Surgical N95 Respirator Mask Halt the SARS-CoV-2 Virus?

How does the surgical N95 respirator mask by 3M stop the SARS-CoV-2 virus from accessing the airway passages of the wearer?

Coronavirus virions are spherical with diameters of approximately 125 nm. Where an ‘nm’, indicates a nanometer which is a billionth of a meter.

The indicated mask is documented to have a filter efficiency level of at least 95% against particulate aerosols free of oil and was tested against a 0.3 micron (0.0000003 meter) particle (mass median aerodynamic diameter). Where a micron is one millionth of a meter.

Given above facts where the virion (0.000000125 meter) is 2.4 times smaller than the mask’s preventive ‘entry’ capacity of 0.0000003 meter, one may wonder is it not going to go through?

Answer: viruses do not fly through the air all by themselves, rather they are carried in the aerosol particles expelled from the infected with or carrier person of the virus. This originates from the coughing or sneezing process. And since aerosols seem to average at 1.25 microns (0.00000125 meter), which is larger than the 0.3 micron above, therefore the virus conveying aerosol should be stopped by the mask.

Notably here, the aerosols with its virions lodge in the outside of the mask and therefore the wearer should avoid touching the outward surface of the mask.

COVID-19: Should I wear a protective mask? Masks for general public?

Question (TK): Hi there, what are your thoughts on the general public buying masks online to wear when shopping or going outside? I know there is a shortage of masks in hospitals, but it seems like there’s a surplus online, so I assume hospitals aren’t buying the ones I am finding. An example:

Amazon Link

Answer (Dhia Aldoori): I think it is a good idea for all to wear masks in public at this time, particularly when you are going to be in a place which may force too close person proximity, and always if you are sick with the possibility  people may come near you (especially  important in a closed environment).

That said, let us (health professionals) have first dibs on the really useful kind, the NIOSH N95 version by 3M which I couldn’t find on Amazon.  

The ones in the link are apparently abundant and will help prevent aerosol projection from a cougher and sneezer, and prevent a person from unconsciously hand-face touching. It won’t protect against incoming viruses. The other kind does, and isn’t currently very available to many caregivers.

Running Notes COVID-19

COVID-19: Using Anti-inflammatory Medications

At this time I am of the opinion that avoidance of NSAIDs for flu like symptoms is the way to go [non steroidal anti-inflammatory drugs are like ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac (Voltaren), meloxicam (Mobic), etc.]. Of course, that is if you even feel inclined to band-aid your symptoms. Barring an allergy or medical condition where it is contraindicated, I would go with acetaminophen (Tylenol). Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists.
The theory behind this is that NSAIDs may hinder the natural inflammation cascade of events otherwise needed to fight against viral infections. That said, even acetaminophen, has an antipyretic action which I am not sure I want to impede during this process. I change my stance if there is excessive fever making the patient uncomfortable or symptomatic (e.g. delirious).
I am more a fan of rest, hydrate, good nutrition (beef barley soup rocks) and stay warm. After you do the preceding, hydrate some more. 🙂

COVID-19: Running Notes (quick link above or click on my picture above)

Clicking on the quick link above or the link below within this post will take you to the diagram.

See "Black Box Warning" update for 4/3/20.
My COVID-19 Running Notes @ Diagrams.net

Depending on feedback I will answer questions within the updated diagram.