Caxton Opere - COVID-19: Physician Treatment Strategies

COVID-19:

PHYSICIAN TREATMENTSTRATEGIES

CAXTON OPERE, MD

COVID-19: PhysicianTreatment Strategies

Published by DivorcePrevention Inc.,

Frisco, TX

Copyright 2020 CaxtonOpere, MD

ISBN:978-1-952642-02-9

All Rights Reserved. Thisbook or parts of it thereof, may not be reproduced or stored in anyinformation retrieval system or network without the expressedpermission of the author and copyright owner.

DISCLAIMER

The information in thisbook is intended to inform healthcare professionals on a pandemicthat has affected millions around the world. By reading this book,you agree not to hold the author or publisher liable for anyinformation in the book. The author disclaims any liability,injury, loss or damage incurred as a direct or indirectconsequence, of the use and application of any of the contents ofthis book. The books is sold without any warranties of any kind,expressed or implied. You agree that you and not the author orcopyright holder, is responsible for any and all treatment orpatient management decisions you make. It is your responsibility tocheck and confirm any treatments and dosages on any off-label useof drugs. The author does not guarantee that any websites, urls,government websites, or links in the book will be functional at thetime the reader purchases this book. Offlabel and FDA authorizeddrugs may be mentioned and the healthcare professional should usesound clinical judgment in individualizing care to each patient.The accuracy of this work cannot be guaranteed and the contents ofthis book are to be used only as a guide and not as a substitutefor sound clinical judgment, training, experience or a replacementfor current treatment guidelines.

Acknowledgements

This book is dedicated toall the physicians and healthcare professionals at the frontlinesin the fight against Covid-19, to all those that have lost theirlives serving on the frontlines, the families theyve left behind,as well as those searching day and night through their astuteobservations and medical knowledge, for cutting edge scientificprinciples and solutions to human challenges in the medical fieldaround the world.

A portion of the proceedsfrom the sale of this book will be dedicated to Frisco FamilyServices.

TABLE OFCONTENTS

ACKNOWLEDGEMENTS

INTRODUCTION

1. Its Up To Us Doctors

2. Covid-19s Hangman

3. Epidemiology

4. Virology

5. Pathology

6. Clinical Features

7. Shortcomings of DiagnosticTests

8. Triage and TreatmentStratification

9. When To Treat

10. Treatment Options andStrategies

11. Understand What You AreTreating

12. Repurposing TherapeuticAgents

13. Perspectives, Politics,Profits

14. Patents, and People

15. Clinical Trial Basics

Introduction

Covid-19: PhysicianTreatment Strategies is for healthcareprofessionals particularly treating physicians and healthcarepractitioners in the frontlines of the Covid-19 pandemic. Covid-19: Remedies isthe non-physician companion book. The latter is free for nowat https://www.doctorcaxton.com and will be for a limited time. Both books contain timelessprinciples and information written as an urgent response to thefight against the Covid-19 pandemic from a practical, clinical,scientific perspective by a physician who sees and cares forpatients. As physicians, our knowledge base, training and abilityto respond quickly to crisis, create solutions and think from firstprinciples in solving any pressing clinical problem, is what willhelp us deal with the Covid-19 epidemic. That was why we learnt thebasic sciences before being ordained to write prescriptions!Everything we know, including our resilience, creativity andability to see each others viewpoints and integrate it intocreative lateral thinking outside the box is now being tested. Aswith all flawed systems during a crisis, the Covid-19 pandemic isexposing flaws entrenched deep within the entire global industrialsystems in both the developed and underdeveloped countries.Everything is being exposed in diverse fields of endeavorparticularly in education, business, computing, policy-making,disaster management and healthcare, with mixed positive andnegative effects. Some employers and business owners that would notlet forward-thinking employees work from home are glad they agreedto the demand. Employees are becoming more productive than before.Teachers are now forced to think ahead more critically and plantheir lectures and classes in order to increase student engagement,understanding and invariably retention of their material.Redundancy will be reduced in many industries while opportunitieswill not be viewed with complacency any longer. Family members willappreciate themselves better if theyre not suffering from mentalillness, and asides from abusive relationships that could intensifyduring isolation quarantine and lockups, most marriages shouldbecome more fulfilling. The only real challenge left that seemshard to decipher is the Center for Disease Control'srecommendations to practicing physicians. As of May 21, 2020. TheCDC still does not offer any real clinical gems for managingCovid-19 at this time. Their recommendations fail to reflect thedepth of knowledge and scope of therapeutic strategies that we needas clinicians in order to manage the Covid-19 pandemic. Onoccasion, you might get the feeling that some of theirrecommendations for health care professionals were written by thehead of a janitorial service for other janitors and not forpracticing physicians facing a pandemic thats taking lives in thethousands every day. For example, it was quite disappointing todiscover that while the FDA had approved HCQ for emergency use inCovid-19 infections, the CDC remains aloof, not hopeful or excited,regarding the use of the drug. On the contrary not only had FDAapproved HCQ for use in Covid-19, 6227 doctors surveyed in 30countries around the world by Sermo reported that for now, HCQ isstill the best drug we have to fight the infection. There are somany unanswered questions that the CDC should be able to help uswith but cant. For example, how do you stratify patients attriage? As a health care worker, what should you do after exposureto Covid-19? Does the CDC recommend exposure prophylaxis? Ifmanufactured drugs wont be available, what about proven remedieswith antiviral properties such as eucalyptus oil, citrus peelextract and ginger? Every time I visited the Health Care Professionals section onthe CDC.gov website before writing this book, I found it hard tobelieve that a physician wrote what I saw there, much less apracticing physician. The best I could glean from the CDC site wasnot to use steroids for ARDS, something weve known for decades. Bythe way, steroid use in late stages of ARDS has been shown to bebeneficial in several studies ( McIntyre etal. 2000 ) There was also some additionalinformation on the website about continuing the use of ACEinhibitors in Covid-19 patients with a history of congestive heartfailure (CHF). There is still no mention of a clear treatmentstrategy for Covid-19, at least not from a treating physiciansperspective dealing with proper triaging of asymptomatic patientspresenting to our ERs.

This book is for allphysicians, pharmacists, nurse practitioners, physician assistants,nurses and all those with prescriptive authority in the healthcarefield, direct patient care responsibilities or are involved in theeducation of such healthcare providers. I will use the wordphysician (s) or doctor (s) at different points in the book torefer to all healthcare professionals especially can prescribemedications and round on patients in the hospital setting. Thatincludes you.