It should be in the land that was founded on the Word--time we remember. Please heed the words of this Doctor.
Letter from a Doctor to Help In These Trying Times of Covid-19:(If you would like to have a doctor speak to your club or group...please contact doctor at end of this letter. Thank you)
We have an unprecedented opportunity to help our patients and friends in preventing and effectively treating COVID-19. This is a critical time for us in medicine. You may not be aware that the American Association of Physicians and Surgeons is suing the FDA for making hydroxychloroquine (HCQ) unavailable to physicians and pharmacies.a Why are they suing to make this medication available? I believe that it is because they did the research that I have done and have come to the same conclusion: We need an effective early prehospital treatment or we cannot prevail against this virus. We have that treatment. It is hydroxychloroquin, which if given early in combination with zinc, in appropriate doses, HCQ is safe and highly effective for prophylaxis and treatment of COVID-19.
In fact, if hydroxychloroquine were used universally in the US for prophylaxis and treatment, the death rate could possibly be reduced from 1500 deaths a day to as little as 100 per day! This pandemic could come to a screeching halt and life could return to normal, not the new normal. Business and schools could reopen and we could prevent the worst depression in history, a depression that will kill many more than this pandemic.b
The website c19study.com is a compendium of all the studies that have been done to date, with a short explanation of the results. As of December 4, there are 192 studies, 126 of which are peer reviewed, the vast majority showing that hydroxychloroquine is safe and very effective. They estimated that 754,769 lives have been been lost worldwide by not using hydroxychloroquine and chloroquine.
Studies that support the use of HCQ report reduction in hospitalization by up to 80% and a reduction in mortality up to 80%.1,2 See also the studies below and others at c19study.com and breggin.com/coronavirus-resource-center/.
In addition, HCQ when given prophylactically for at least 6 weeks prior to exposure reduces the risk of contracting the virus by up to 80%.3 You can do the math. If HCQ was used universally in the US for prophylaxis, within 6 weeks there would be 80% less cases. And if the 20% that get sick have an 80% reduced chance of dying, then we end up with little or no pandemic.
How did I come to this conclusion since there are so many conflicting studies and information on HCQ? As most of you may not have time to review all these studies, please allow me to outline some of the highlights of the research that I have done that helped me to clear up the confusion.
First, it is important to understand the mechanism of action of hydroxychloroquine.4 It works in at least 6 ways to help defeat this virus. I will mention only two. First, it binds to the spike protein on the virus which prevents it’s attachment to the ACE 2 receptor on human cells. This prevents the viral RNA insertion into the cells in order to replicate. Since it can not attach, our T cells are then able to destroy the virus. This then, as I understand it, destroys the virus and provides T cell immunity to prevent future infection with the same virus. This is why it works well for prophylaxis and creates immunity at the same time.
Second, it is a zinc ionophore which, as you know, facilitates zinc transport into our cells. The zinc inhibits RNA dependent RNA polymerase thus inhibiting viral replication. That is why HCQ is much more effective when given with zinc.
Understanding these mechanisms of action helps to make sense of the numerous studies on HCQ, some showing benefit and others not. These are the clarifying principles:
Now let me ask, why did the WHO, FDA and many state medical and pharmaceutical boards impede the use of HCQ? Why in some states (not in Alabama) is a doctor’s license in jeopardy if he or she prescribed HCQ for COVID? Why are many pharmacies refusing to fill prescriptions for HCQ for COVID? Here in Huntsville, I have had pharmacies refuse to fill prescriptions. Hospitals have made it hard and in some cases impossible to order HCQ for a patient, even when a patient requests it. Why did this happen especially when many initial observational and retrospective studies were showing very good results with HCQ? Why are websites being taken down and Facebook and Google removing information positive about HCQ?
The big clamp down occurred when a study was published May 22 on line by both the NEJM and the Lancet.6 The study by Mehra, et al, claimed to be a multinational registry analysis of 96,032 patients from 39 countries. The study claimed mortality in the control 9.3%, HCQ 18.0%, HCQ plus macrolide 23.8%, chloroquine 16.4%, chloroquine plus macrolide 22.2%. Immediately observant doctors and scientists questioned how Surgisphere, a company with only 11 employees, could accumulate data from 39 countries in this short of time. When hospitals in Australia and Africa started reporting that they had never given data to Surgisphere, it became obvious that the data was completely or in large part fabricated. Surgisphere immediately retracted the study on June 4 and they refused to give data to anyone. It was fictitious.7,8
Why did Surgisphere fabricate a study to discredit hydroxychloroquine, shortly after President Trump had announced on May 18 that he was taking it, and why did the NEJM and the Lancet publish it without peer review? On May 24, 2020 Philippe Douste-Blazy, Cardiology MD, Former France Health Minister and 2017 candidate for Director of WHO, former Under-Secretary-General of the United Nations, revealed that in a recent 2020 Chattam House closed door meeting, both the editors of the Lancet and the New England Journal of Medicine stated their concerns about the criminal pressures of BigPharma on their publications. Things are so bad that it is not science any longer.9,10
The fall out from this fraudulent Lancet/NEJM study was immediate. The WHO recommended HCQ studies be stopped and thousands were. Good randomized controlled studies were discontinued. They also recommended against the use of HCQ. The FDA then came out against the use of HCQ and removed the emergency use authorization. Even though the study was retracted in both journals within 2 weeks, these restrictions have not been removed. Many physicians continue to be unsure of the safety of HCQ and so are not using it.
One day after the Lancet study by Surgisphere was retracted on June 4, the Recovery trial results were announced on June 5, followed shortly thereafter by the Solidarity trial, and Remap COVID trial. These studies were heralded as exceptionally good data since they were large randomized trials. The problem with the data, overlooked by most, is that these studies all used toxic doses of HCQ, 2 to 2-1/2 times the known safe dose.11 The studies claim to show no benefit. It is a miracle that they did not show harm. Why these toxic doses were chosen was either terrible lack of judgement or malicious intent to discredit HCQ. I believe that it was intentional and even criminal, using improper doses that killed patients.
Let me illustrate. What if a study on ibuprofen was undertaken using 2000mg four times daily instead of the known upper limit safe dose of 800mg four times daily? The study would show that it was either harmful or ineffective. That is exactly what these studies did, intentionally or unintentionally. Given that we know the safe dose of ibuprofen, the only apparent reason for using a toxic dose is to intentionally skew the data. I think we would all agree that such a dose of ibuprofen would be criminal.
Because of these three studies, appropriate studies that were using correct doses of HCQ were stopped such as the NIH ORCHID study12 and the hydroxychloroquine and lopinavir/ritonavir treatment arm of a WHO study13, that could have shown benefit of HCQ in large randomized trials.
It is not possible to go through all of the studies on HCQ. The most effective way is to review the description of the studies on c19study.com. You will note that there are far more studies showing benefit of HCQ than there are negative studies. You will also note that in the negative studies HCQ was given too late, in toxic doses, or only to the sickest of the patients. In some, it was given only at the end of life.
I believe that we can agree that Hydroxychloroquine is safe when used in doses known for decades to be safe for rheumatologic conditions. That dose is 200mg BID, after a loading dose of 400mg BID on day one. Many of you may have been discouraged from using HCQ because of studies that showed that it was either harmful or ineffective. As you review the studies below and those on the websites that I have mentioned, I think you will feel comfortable using the medication. At the end of this letter I have included 3 protocols for the safe use of HCQ, one for pre-exposure prophylaxis, one for post-exposure prophylaxis, and one for treatment of active infection with COVID. I think that you will agree that these treatment protocols are safe and well designed, because they use multiple weapons that have been shown to be effective against the virus. That would explain why my friend, Dr. Stella Immanuel, has treated over 350 COVID patients, including those in their 80s and one in her 90s with comorbidities and has had no deaths and only 2 hospitalizations. The key is early, safe treatment.
Hydroxychloroquine should not be used if the QTc is greater than 500msec. This is very rare and generally only occurs in patients on multiple QT prolonging medications. You will note that the protocol for treatment does include an EKG before treatment. Most of our EKG machines will calculate a QTc interval.
Successful use of HCQ has been widespread. Here are a few examples (references are noted at the end of this letter):
There are many other studies. Now that we know that it must be used early, with zinc, and following QTc interval in appropriate patients, we should get high cure rates, greater than 80%. What we should be focusing on is teaching all of our colleagues how to use it safely for prophylaxis and treatment.
A word about prophylaxis. It is effective! Six or more prophylactic doses of HCQ used by more than 1200 health care workers in India had a remarkably high (>80%) protective effect against SARS-CoV-2 infection.13 The dose was 400mg weekly after 400mg BID loading dose on day one.
One final word on HCQ. In countries where HCQ is used weekly for the prevention of malaria, the incidence and mortality from COVID-19 is one one-hundredth of what it is in developed countries that are not using HCQ even though the developed countries have more “advanced” medical treatment and better hospitals and ICUs.14 This fact alone should tell us a lot about the benefit of prophylactic HCQ. In addition a study of 1.8 billion people showed 74.9 % decrease in mortality in countries that used early HCQ treatment compared to those that didn’t.26
We have seen unprecedented attacks by media, internet, and “specialists”, many of whom are our physician colleagues, to discredit a drug that has been used safely for decades and now is being shown to reduce mortality by 50 to 80%. Because of fraudulent studies, faulty studies, and large randomized trials that could really demonstrate the benefit of HCQ have been discontinued. At the same time remdesivir is proclaimed to be the standard of care, even though studies show only non-clinically significant benefit on mortality!15,16 Why are we using a drug with minimal benefit when a medication with high benefit and low cost is available? I do not pretend to know who is behind this, but I do know that it is well orchestrated and vicious. Someone is apparently willing to sacrifice human life for their political or economic benefit.
In addition to HCQ, we have another medication that can be used to treat this virus. It is now just gaining momentum as studies are being completed and more physicians are using it. This medicine is Ivermectin, an anti-parasitic, that has potent antiviral properties. This is an incomplete list of it’s benefits:
We are in a battle with a serious viral infection. We can not let Big Pharma, the media, the government, or whoever is interfering with our ability to give effective prehospital treatment for COVID-19.
After you review this information and the additional studies on c19study.com, if you agree that hydroxychloroquine should be made available so that we physicians can use our best judgement to treat our patients, please email me your approval as soon as possible and you can join our efforts to make HCQ and Ivermectin available.
In the meantime, until we have HCQ and Ivermectin readily available, I have two suggestions:
1.Use what HCQ is available on your most ‘at risk’ patients.
2.Put the rest on Quercetin (Q), an OTC plant flavonol supplement.
Quercetin also attaches to the spike protein on the COVID-19 virus and is a zinc ionophore. It actually attaches to the spike protein with greater affinity than HCQ.17 It can be used in patients with prolonged QTc since it actually shortens QTc interval.18 The prophylactic dose is 500mg twice a day for as long as the pandemic lasts. It should be taken with Zinc 30-60mg, Vitamin C 1000mg, and Vitamin D 2000 iu or 3000 iu daily. It can increase Coumadin levels so INR should be followed in Coumadin patients. Quercetin probably is just as effective in preventing COVID as HCQ, but it has not been studied as extensively as HCQ. There are a number of studies ongoing, however.
Now that we know the safe and effective way to use HCQ, I believe that we should be disseminating this information as quickly as possible to all of our colleagues in the state. I hope that this information is helpful as we move forward to successfully treat patients, save lives, and end this pandemic. Again, I ask that you contact me if you are in agreement that HCQ should be made available so that we can do what we are trained to do - find the best treatments and provide them to our patients.
David Calderwood, MD
COVID-19 PRE-EXPOSURE PROPHYLAXIS
Hydroxychloroquine 400mg BID day one
Then 400mg each week for 3 months
Then 400mg every 2 weeks until pandemic ends
Daily- Zinc 30-60mg
Vitamin C 1-2 gms
Vitamin D3 2000 iu
COVID-19 POST-EXPOSURE PROPYLAXIS
Hydroxycholoroquine 400mg BID day one
Then 200mg days 2-5
Then 400mg weekly for 3 months
Then 400mg every other week until pandemic ends
Daily- Zinc 30-60mg
Vitamin C 1-2 gm
Vitamin D3 2000 iu
This is a small sampling of some of the studies on c19study.com:
fatality rate in patients. No cardiac toxicity in 1061 patients
Studies that have shown no benefit are given in toxic doses, given too late, given to the sickest patients, or given without zinc.
Effective for treatment.
1. April 20, 2020. French study. 1061 COVID Hospitalized patients 98.7% cure rate
2. April 23, 2020. Chinese study. Fatalities are 18.8% (9/48) in HCQ group, 47.4% (238/502)
in the NHCQ group (P<0.001) . Significantly reduced inflammatory cytokine IL-6
fatality rate in patients. No cardiac toxicity in 1061 patients.
4. May 27, 2020. Marseille, France retrospective study. Treatment with HCQ-AZ was
associated with a decreased risk of transfer to ICU or death (Hazard ratio (HR) 0.18 0.11-
0.27), decreased risk of hospitalization ≥10 days (odds ratios 95% CI 0.38 0.27-0.54) and
shorter duration of viral shedding (time to negative PCR: HR 1.29 1.17-1.42).
5. New York Sudy. 4 of 141 treated patients (2.8%) were hospitalized, which was significantly
less (p<0.001) compared with 58 of 377 untreated patients (15.4%) (odds ratio 0.16, 95% CI
0.06-0.5). Therefore, the odds of hospitalization of treated patients were 84% less than in the
untreated group. One patient (0.7%) died in the treatment group versus 13 patients (3.5%) in
the untreated group (odds ratio 0.2, 95% CI 0.03-1.5; p=0.16).
6. Sao Paulo, Brazil telemedicine treatment with HCQ and azithromycin. Need for and
hospitalization was 1.9% in the treatment group and 5.4% in the control group (2.8 times
greater) number needed to treat was 28 (NNT = 28). In those who started treatment before
versus after the seventh day of symptoms, the need for hospitalization was 1.17% and 3.2%,
8. July 10, 2020 Milan Italy study shows 66% reduced mortality.
9. July 1, 2020. Henry Ford study. 50% reduction in mortality with HCQ alone, 24% with
HCQ plus azithromycin. Doses of meds varied and unknown, but still showed benefit.
Even more effective with zinc.
NYU Grooman School of Medicine. 1.5 time more effective when given with zinc
Effective for prophylaxis.
3. Bulgarian study. 92.7% reduction of infection in health care worker with HCQ propylaxis
Post exposure prophylaxis.
significant) but was started too late
Ivermectin prophylaxis- 3 RCT and 5 OCT all positive (4 in PEER review)
2. Shouman et al. 304 Close contacts of COVID patients. 91.3% reduction in developing COVID in Ivermectin treated compared to controls.
3. Carvallo et al. 1195 Health professionals RCT, 788 Ivermectin and 407 no treatment. 0% infections in the Ivermectin and 58% in no treatment
4. Alam et al. RCT. 118 HCW. 12 mg Iver monthly vs none. 90.6% decrease in developing COVID
2. Meta-analysis. Total 35 studies with 10,336 patients (17 RCT with 2528 patients)
Early treatment 84% improvement
Late treatment 39% improvement
Prophylasis 90% improvement
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