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Clinical Omissions in COVID-19

      Dr. McCullough and colleagues propose a flexible treatment algorithm that can evolve to meet our emerging clinical understanding of different coronaviral strains appearing in different places around the globe.
      • McCullough PA
      • Kelly RJ
      • Ruocco G
      • et al.
      Pathophysiological basis and rationale for early outpatient treatment of SARS-CoV-2 (COVID-19) infection.
      It may even defeat some annual varieties of influenza A and B that seem to have “disappeared” as a seasonal cause of death in some countries. However, there are still many outstanding questions in this pandemic.
      Recurrent involuntary coughing and high ventilatory pressures may both stretch injured pulmonary nerves, releasing large volumes of cytokines (IL-1 beta, IL-6, and IL-10 are well-known “neural” cytokines
      • Han H
      • Ma Q
      • Li C
      • et al.
      Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors.
      ,
      • Bösmüller H
      • Traxler S
      • Bitzer M
      • et al.
      The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation.
      ), with a variety of pathophysiological consequences. Denervation of pulmonary arteriolar endothelia may also activate clotting cascades similar to the coagulopathy that appears in some obstetric syndromes, including preeclampsia. Yet, to my knowledge, there are no published studies of the pulmonary arteriolar nerves in COVID lung.
      • Bösmüller H
      • Traxler S
      • Bitzer M
      • et al.
      The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation.
      Erecting the misplaced barrier of a placebo-controlled, randomized controlled trial as a prerequisite for the use of cheap, safe, and effective oral prophylaxis, including hydroxychloroquine and ivermectin, and, declaring that unproven vaccines “are the only way out of a pandemic” betrays a misunderstanding of medical “evidence” that may derive from political or corporate, rather than clinical, judgment.
      • Vincent MJ
      • Bergeron E
      • Benjannet S
      • et al.
      Chloroquine is a potent inhibitor of SARS coronavirus infection and spread.
      ,

      Fareed GC, Jacobs MM, Pompan DC. The Desert Review. Open letter to Dr. Anthony Fauci regarding the use of hydroxychloroquine for treating COVID-19. Available at:https://www.thedesertreview.com/opinion/columnists/open-letter-to-dr-anthony-fauci-regarding-the-use-of-hydroxychloroquine-for-treating-covid-19/article_31d37842-dd8f-11ea-80b5-bf80983bc072.html. Accessed January 19, 2021.

      An adaptive algorithm seems a better approach.

      References

        • McCullough PA
        • Kelly RJ
        • Ruocco G
        • et al.
        Pathophysiological basis and rationale for early outpatient treatment of SARS-CoV-2 (COVID-19) infection.
        Am J Med. 2021; 134: 16-22
        • Han H
        • Ma Q
        • Li C
        • et al.
        Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors.
        Emerg Microbes Infect. 2020; 9: 1123-1130
        • Bösmüller H
        • Traxler S
        • Bitzer M
        • et al.
        The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation.
        Virchows Arch. 2020; 477: 349-357
        • Vincent MJ
        • Bergeron E
        • Benjannet S
        • et al.
        Chloroquine is a potent inhibitor of SARS coronavirus infection and spread.
        Virol J. 2005; 2: 69
      1. Fareed GC, Jacobs MM, Pompan DC. The Desert Review. Open letter to Dr. Anthony Fauci regarding the use of hydroxychloroquine for treating COVID-19. Available at:https://www.thedesertreview.com/opinion/columnists/open-letter-to-dr-anthony-fauci-regarding-the-use-of-hydroxychloroquine-for-treating-covid-19/article_31d37842-dd8f-11ea-80b5-bf80983bc072.html. Accessed January 19, 2021.