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.
“Spending the 90s”, as he used to affirm, Prof. Dr. Gustavo Zubieta-Castillo,
has left this physical world on Sep17, 2015 leaving behind: everything he used, personally created, his thoughts, his questioning attitude, his severe criticism of what he considered wrong or misleading, his inquisitive mind, his courage and tenacity, his kind and generous attitude, his extraordinary teaching abilities, his visionary inteliigence, his defense of life at high altitude, his poems, his capturing literary production, his paintings in oleo, his discipline, his tolerance with arrogance, and even his own organism.
A member of the Bolivian Academy of Sciences, Bolivian Literature Academy, yet simple and friendly. He was the organizer of the First World Congress on High Altitude Medicine and Physiology that started in La Paz, Bolivia and moved on to Cusco, Peru – Matsumoto, Japan – Arica, Chile, Barcelona, Spain, Xining, China & Lhasa, Tibet and many other cities – countries that we lost track of.
In Bangalore, India he was named with the generous sponsor of Dr. Thuppil Venkatesh, the “lead man of India” at the Saint John’s University the Parvatha Guru (Mountain Guru) a unique distinction that he was proud of.
We constructed the Chacaltaya Pyramid (glass) Laboratory at 5300m (the highest in the world).
Natalia Zubieta, his granddaughter created and founded the High Altitude Museum in Oct 20, 2010 (the first in the world). He strongly supported it and felt very proud of her being the director.
He was the leader that crystallized the highest soccer (football) game played on the summit of Mount Sajama (6542m) proving that sports at that high altitude was possible, denoting the extraordinary capacity of the Aymaras, thereby defending Bolivia to play the world cups in its own grounds in La Paz (3600m).
His original and unique views on what was called Chronic Mountain Sickness, a term he proposed be discarded and be rather expressed as PolyErythroCythemia (as a more precise symptomatic description of multiple pathologies in the hypoxic environment of high altitude, was a subject of controversy but of his absolute certainty based on his over 50 years of physician at high altitude. He opposed the obsolete concept of reducing the red blood cells with archaic treatments such as phlebotomy or the use of toxic drugs such as Phenylhydrazine, an OMS proscribed drug. He interrupted its use saving thousands of Polycythemia patients from a guaranteed fatal outcome. He often considered this his most outstanding feat.
He created the “Triple Hypoxia Syndrome” an essential description to explain momentary decrease of PaO2 in Polyerythrocythemic patients.
His concepts of hypoxia gave rise to the formulation of the High Altitude Adaptation Formula.
Upon arrival to La Paz, from a sea level trip, in spite of the fatigue, he would insist that tests be performed on ourselves to observe adaptation. This gave rise to the paper “Adaptation to high altitude through hematocrit changes”.
As a young professor of physiology at Universidad Mayor de San Andres, in La Paz, he performed isolated heart perfusions in dogs and proved that heart surgery could be successfully carried out at high altitude.
He also affirmed back in 1964 that the hearts at high altitude were more resistant than at sea level. This visionary observation is currently subject of innumerable papers of the favorable effects of hypoxic exposure on heart function.
Following the observation of the low levels of PaO2 in patients with PolyErythrocythemia at high altitude, the soccer game on Mount Sajama (6542m), the fetal PaO2, he formulated the theory that man can adapt to live at the summit of Mount Everest. His last conference on this was given this February 2015 at the Conference Internacional de Medicina de Altura (CIMA) in Puno, Peru in a joint effort of the Peruvian Medical and Bolivian Medical Colleges. He was awarded distinctions that he much enjoyed. Thank you to all those that recognized his talents.
El uso instintivo de Miguel de Cervantes Saavedra de la curva normal de Gauss
He wrote a unique article entitled “The mathematics in the structure of Literature”, showing how Miguel De Cervantes description of Don Quijote and Sancho Panza were extremes in a Gauss curve. Several of his books on essays are a delight to read (in Spanish).
We jointly created the First High Altitude Pathology course in La Paz, Bolivia. We then went on to create the Congress on the Effect of Hypoxia on Diseases at high altitude that later evolved to be, held every two years, uo to the V Chronic Hypoxia Symposium. We then went on to create the International Society of Chronic Hypoxia (ISCH) with several colleagues attending the II Chronic Hypoxia Symposium. The Wilderness and Environmental Medicine Journal kindly published our abstracts, for which we are most profoundly grateful.
One of the most interesting achievements, was his concept that in regards to Chronic Mountain Sickness, it was unacceptable to talk about loss of adaptation. He strongly affirmed: “there is no loss of adaptation!!”.
Consequently he wrote:
” The organic systems of human beings and all other species tend to adapt to any environmental change and circumstance within an optimal period of time, and never tend towards regression which would inevitably lead to death”.
In fact we had a dissenting point of view in the International Consensus for the Definition of High Altitude Diseases, that eventually stopped the use of the term “loss of adaptation”.
We created the “Science, Honor and Truth” award and a medal which says “defeating hypoxia”. The most distinguished scientists that truly follow these forgotten concepts are awarded every two years
.
We wrote the first book published in English in Bolivia called “High Altitude Pathology at 12000 ft”. It was dedicated to: “Those of short breath at high altitude”.
Our research and publications, never received one sole grant (being them nonexistent in Bolivia), and all science was produced with our own funds acquired at the High Altitude Pulmonary and Pathology Institute (the first altitude clinic in the world, founded 45 years ago), from treating our patients. This became his contribution to the well-being of the residents of high altitude. In order to carry out such feats, we constructed our own equipment using very basic and inexpensive materials, writing our own software, and giving all our time and effort with satisfaction thereby having “the Joy of seeing the light” as our dear friend and outstanding physiologist Poul-Erik Paulev affirmed. We jointly created the Poul-Erik High Altitude Diving Laboratory in his honor and we developed high altitude diving tables.
His publications are cited in many papers around the globe and have recently shot up in the number of downloads and views are available at ResearchGate. Don’t miss them, they are historic.
He had an absolute certainty that after he left, he would receive recognition for his work and for his theories of which he never doubted. That is left to be seen if he was right!
Thank you father, mentor, professor, wise mountain Guru for having left us a legacy, and a school of thought that Natalia, Rafaela, (my two daughters), Lucrecia my wife, Nancy. Luis and Rosayda (my brother and sisters), Clotilde (my mother, his attentive and unconditional supporter and lifetime companion), Joyce, Andrei, Gustavo, Katia, Luis Andres and Sebastian, (his other grandchildren) and even his first grandson Thomas Andrew Jenkins will spread and continue.
Prof. Dr. Gustavo Zubieta-Calleja
High Altitude Pulmonary and Pathology Institute IPPA
Photo from Wikipedia
Revisiting the original theory by Prof. Dr. Gustavo Zubieta-Castillo that it is possible for man to adapt to live even on the highest mountain on planet Earth: Mt. Everest, please find below links to:
1) The original paper as published in the Fiziol. Journal 2003, 49:3, pg. 110-117
