In these trying times, ideas on dealing with CoVid-19 in the medical field are mandatory, from any part of the planet. This Pandemia will change, without doubt, the way we scientists deal with population emergency situations in the near future. As a physician working at high altitude, several novel ideas arise, that may aid in the life-saving management of such critical situations. As such, allow me to propose the following:
I suggested that patients with Coronavirus detected at airports or other points of entry should be taken to isolated areas outside cities where vacant buildings ought to be adapted for intensive care (or containers with sunroofs). They should not at all be taken to city or town hospitals as, particularly in a country with limited resources, as they would overwhelm existing intensive care units and thereby displace all work with routine critically ill patients. In addition, it would become a nucleus that spreads the disease to the otherwise healthy population. The areas should be surrounded by open space, with security and the sterilization techniques mentioned in the 3rd point should be applied.
Furthermore, In the city of La Paz, Bolivia (3100-4100m) establishing these modified buildings in the Altiplano (High Plateau) at 4,100 meters above sea level would indeed be beneficial as ultraviolet radiation is relatively high and can help as a natural bio-sterilization resource. Furthermore, the Intensive Care Units (ICUs) should have roofs to let sunlight come through.
The recent good news is that Dr. Augusto Ittig an intensive care specialist in Jujuy, Argentina has established his Coronavirus isolation and intensive care treatment, following theses guidelines.
2) I originally mentioned that there was an exponential growth of this Pandemia. Actually, it is a Hyper-Exponential, since it does not follow the regular exponential progression (y = A * Bx) but rather, in CoVid-19, 1 patient in a closed environment full of people can infect 50 or more in one shot from the very beginning.
3) The management of intensive care units has to be modified. As mentioned in the above interview, the Covid-19 is like a nuclear attack. It could actually be termed a BIO-NUCLEUS ATTACK. Viruses are targeting our nuclear cell areas, in search of self-reproduction, as is well known. Hence, the protection suits for the medical personnel should be full-body impermeable overalls leaving only the face exposed. Goggles, face masks and gloves should, of course, be worn. Upon exiting the Intensive Care Unit, the personnel should pass through a mandatory shower with plenty of soap or other disinfectants, followed by hot drying air for the whole body. This can help reduce significantly the viral transmission. This is similar to radioactive contamination, and it could be termed BIO-ACTIVE CONTAMINATION and we physicians need to evolve urgently to these new 21st-century health safeguarding strategies. After all, we all have the obligation of saving the lives of the courageous intensive care physicians and para-medical personnel that can end up giving their lives in order to save others.
4) Finally, those that actually survive the severe complications with lung (and heart tissue) sequelae will have pulmonary (and perhaps myocardial) fibrosis that will give rise to a pulmonary (and perhaps to some degree, cardiac) insufficiency with resulting complications at a later date. If those patients remain at high altitude, they will present Chronic Mountain Sickness (Poli-erythro-cythemia), as a compensatory mechanism in order to provide sufficient oxygen transport to the tissues. At high altitude, if properly understood, it can be adequately managed.
It has been observed by several groups that Hydroxychloroquine has some effectiveness in the treatment of severe CoVid-19 cases. In-vitro, it has been shown to inhibit the SARS-CoV-2 virus[1,2,3]. The American government has announced that Hydroxychloroquine will be approved by the FDA, ASAP today (March 19, 2020).
We are aware that full studies have to be carried out but, there is no time.
The hospitals are being overflowed, the intensive care units are insufficient, medical resources are running out, even in the first-world countries! People are losing their lives at an alarming rate and the crucial ones turn out to be those of the medical personnel, doctors, nurses, and all those working in the hospitals. The whole planet is shutting down. The world economy is suffering the consequences and above all, it is taking away thousands of human lives.
When you board a plane, prior to departure, you are always told that if there is an emergency related to cabin decompression in-flight, one fundamental advice is:
If you are with a child, please put on the oxygen mask yourself first before putting the child’s mask on. This is a fundamental life-saving procedure since if the loss of consciousness hits the mother or father first then, for certain, not only will the parents lose their lives but also the child.
In a similar manner, if the doctors, nurses and medical personnel fall sick with the Coronavirus, then the patients will also succumb (thousands and maybe tens or hundreds of thousands).
Due to the emergency situation that the whole planet is suffering and particularly the medical and paramedical personnel with this extreme Pandemia, it is essential to consider prevention strategies.
Consequently, we suggest that all medical staff and support teams in hospitals consider start taking Hydroxychloroquine as a preventive strategy, once per week, while studies are being carried out. This is based on the effect of hydroxychloroquine taken to reduce malaria-risk significantly. It is not a perfect solution but it is what is available. The dosage, side-effects, contraindications are available from IAMAT[4]. The long term use of this drug in several other pathologies is well known and apparently well tolerated. We are aware of the criticism that can arise from this. However, today, this world is in a critical emergency situation and the Coronavirus is implacable, unmerciful, selfish and cruel. And we, as physicians from all around the world, have the obligation to help with innovative ideas born from our extensive experience.
The recommended initial dose could be 2 tablets orally for a total of 300mg or 400mg depending on the pharmaceutical presentation STAT, to be repeated every week if no symptoms appear provided there are no contraindications. If SARS-CoV-2 symptoms appear, a full daily dose will probably need to be administered along with the other medication. We cannot wait for full statistically proven studies. Nevertheless, the dosage and methods of administration can be modified with time. What is undeniable is that time is running out !!
The medical personnel should be prioritized. Particularly in a low resource country.
It is highly probable that this emergency life-saving strategy that we propose be considered for immediate execution in all medical personnel treating CoVid-19 hospitals around the world !!!
ESTRATEGIA URGENTE PREVENTIVA CON HIDROXICLOROQUINA PARA EL PERSONAL MEDICO ANTE EL COVID-19.
from: https://www.keckmedicine.org/coronavirus/
Queridos colegas:
Varios grupos han observado que la Hidroxicloroquina tiene cierta efectividad en el tratamiento de casos graves de CoVid-19. In vitro, se ha demostrado que inhibe el virus SARS-CoV-2 [1, 2, 3]. Hoy, 19 de Marzo de 2020, el gobierno estadounidense ha anunciado que la hidroxicloroquina será aprobada por la FDA lo antes posible.
Somos conscientes de que se deben realizar estudios completos, pero no hay tiempo.
Los hospitales se están desbordando, las unidades de cuidados intensivos son insuficientes, los recursos médicos se están agotando, ¡incluso en los países del primer mundo! Las personas están perdiendo la vida a un ritmo alarmante y los que están sufriendo contagios de manera preocupante resultan ser el personal médico, para-médico, enfermeras y todos los que trabajan en los hospitales. Todo el planeta se está paralizando. La economía mundial está sufriendo las consecuencias y sobre todo miles de vidas humanas se están perdiendo.
Cuando Ud. aborda un avión, antes del despegue, siempre le informan que si hay una descompresión de emergencia de la cabina en vuelo, un consejo fundamental es el siguiente:
Si Ud. está con un niño, póngase primero la máscara de oxígeno antes de ponersela al/la niño/a. Este procedimiento es fundamental para salvar vidas, ya que si la pérdida de conciencia golpea primero a la madre o al padre, entonces, con certeza, no solo perderán ellos la vida sino también el/la niño/a.
De manera similar, si los médicos, las enfermeras y el personal médico se enferman con el coronavirus, los pacientes también sucumbirán (miles y quizás decenas o cientos de miles).
Debido a la situación de emergencia que sufre todo el planeta y, en particular, el personal médico y paramédico de esta pandemia extrema, es esencial considerar estrategias de prevención.
En consecuencia, sugerimos que todo el personal médico y los equipos de apoyo en los hospitales consideren comenzar a tomar hidroxicloroquina como estrategia preventiva, una vez por semana, mientras se realizen estudios completos. Esto está basado en la metodología para reducir el riesgo de malaria significativamente. No es una solución perfecta, pero es lo que está disponible. La dosis, los efectos secundarios y las contraindicaciones están disponibles en IAMAT [4]. Tratamientos prolongados para otras patologías con este medicamento, aparentemente son bien tolerados. Somos conscientes de las críticas que pueden surgir de esto. Sin embargo, hoy, este mundo se encuentra en una situación crítica de emergencia y el Coronavirus es implacable, despiadado, egoísta y cruel.
La dosis inicial recomendada podría ser 2 tabletas de 300 mg por vía oral STAT, que se repetirá cada semana si no aparecen los síntomas. siempre que no hayan contraindicaciones. Si aparecieran los síntomas de SARS-CoV-2, probablemente será necesario administrar una dosis diaria completa junto con los otros medicamentos. No podemos esperar a estudios científicos completos estadísticamente comprobados sin embargo, las dosis e indicaciones se podrán mejorar a través del tiempo. Lo irrefutable es que el tiempo se acaba …
Se debe priorizar al personal médico. El tiempo dirá si esta estrategia deba expandirse a toda la población.
¡Es muy probable que esta estrategia de emergencia para salvar vidas que proponemos hoy, sea considerada para su ejecución inmediata en todo el personal médico que trata el Co-Vid-19 en los hospitales de todo el mundo!
Otras ideas fueron expresadasel 30 de Enero de 2020 y luego modificados el 17 de Marzo 2020. Para leerlas haga click aqui.
