Updates in CV: Preparing for a New Phase—Part II

You. It's great to be back with everybody once again. So we're going to start doing now is talking about therapies, therapeutics, how do we treat this thing and looking at some of the research behind that as well as I want to start making a transition our minds to a more holistic approach to this disease. What is functional medicine, integrative medicine, which now everybody knows what this is, includes all kinds of therapies like vitamin C, like repurposing previous medications. So we need to start retooling our thinking about this as we enter society, as we see things. So what I'm going to do is review some of the numbers real quickly and then go into these therapies. This will be a several part series. I want to go through different parts of this just so we can understand more clearly. Again, I'm trying to educate everybody so as they read news articles, as they talk with friends, they'll just be more educated and able to evaluate what's actually going on better. I think that is a super important thing. So, so looking at this graph, for example, of total cases in the world, this will never go down, it'll always go up because there will always be more people getting this. And so just looking at this graph makes you think, wow, we're in a pretty bad place. But if you look at the actual cases in the world, this is just looking at the United States versus Spain versus the world, you'll see there's 3.4 million cases in the world right now, 1.1 of which are in the United States. That's another theme you're going to see. You're going to see cases grouping in locations. The United States represents one third of all world cases. And that's a recurrent theme you'll see in the United States, you'll see New York City or New York State, I'm sorry, representing one third roughly of the cases in the United States and within New York State, New York City representing roughly one third. So you're going to see recurrent themes of population centers, you know, where people are crammed together, subways, you know, et cetera, et cetera, et cetera. So we need to get a little bit of grasp on these. And we also need to realize that Peru down here at the bottom with 40,000 cases, in the Netherlands with 39, roughly 40,000 cases, are not the same city or not the same country. I'm sorry, the Netherlands has almost 5,000 deaths versus the Peru 1,000. There's going to be differences in these cultures. Peru is later on in the Netherlands. Peru is also a more moderate climate. So we need to start looking at things and getting a little better grasp some of these numbers because they're kind of being used against us and kind of sort of away. Australia is an interesting case. They're in the Southern hemisphere. We need to watch them closely because they are entering their fall. And so I'd expect to see peaks starting as they enter their fall, but looks like they've crushed it pretty well. Same same applies to New Zealand, who again, is in a different hemisphere. If we look at the United States versus Europe, what we see is that the United States is diverging. Even though we represent one third of all cases in the world. Look, we're actually doing better than Europe as a whole. And that's another thing. We have to compare the United States with Europe as a whole, not with England, not with Germany, because population wise, we are about the same as far as differences. Each one of our states almost functions like a different country. Our Italy being New York, our Lombardy being New York City. But you see, we're actually doing pretty good compared to Europe. But you can also see they are ahead of us. They are ahead of us by about 10, 15 days on the progression of the disease. We've looked at this before and I just kind of like to remind us that this is how this thing progresses and moves. And we are now seeing it switching to the southern hemisphere. So I click these buttons, things are a little slow. Again, this is a different graphic representation of case distribution throughout the world. You look at this blue right here, the United States, again, 33.1% of all cases in the world are in the United States. So we also are the biggest tester to date in the world. So we're going to see that over representation. It could be because we're testing more. We need to just have these things in mind. If you, you look at the daily cases worldwide, it actually is leveling off. Okay, so worldwide, we've had a leveling happen. Again, one third of the cases are in the United States. If you look at Sweden, which has not closed, which actually never really closed down per se, they didn't have a peak. They've had a steady, a steady dribble, so to speak. And they'll see that. And it's going to kind of flatten down later out here, probably mid to late summer, as they actually hit herd immunity. Switzerland, a little different, different country, but again, things are calming down. Uk, it's kind of looking sort of like Sweden. And if you remember, they didn't close down initially, then closed down. So their, their graph is probably more likely going to align with Sweden's than say Italy. You know, Italy actually is curving down as well. And then as we move on, looking at the United States, similar thing. There's 1.1 million cases in the United States, 315,000 of which are New Jersey. So again, this one to three divide and the same thing with cases with New York City. So again, these are all different areas. You can't look at Indiana and Ohio, which have roughly the same amount of cases and the same amount of deaths, and then say, well, they should file the exact same policies as New Jersey, which has 10, almost 10, 15 fold more cases, as well as multiple more deaths, almost 25 fold more deaths than Ohio and Indiana. We need to have an individualized approach to this whole thing. Looking at the United States, I'll move this over here a little bit. We see we're kind of coming down on the back end of things right now. It's May 2nd. On May 2nd, that's where that line right there is. We're seeing the same kind of phenomena happen with other states. This is New York again, they are coming down. We all should be familiar with this. California, the biggest state in the country with 39 million people look and never really even got close to capacity. Florida and California look very similar, but Florida is the oldest as far as population state in the country. And then Georgia, looking a little different. And finally where I live, Virginia, we're not seeing a massive change or flux and what is going on with this. So let's kind of switch over here now and start talking about some treatments. So what we're going to do is I'm going to talk about our way forward. We've talked about this before, public policy. That's what's happening right now with our politicians, our representatives trying to figure out what we're going to do going forward. Prevention I've already talked about, we've discussed in our COVID 19 survival guide, which is available on our website. And we'll be coming back around to this in a later session. Treatments. Look at all the treatments. Hydroxychloroquine, chloroquine, remdesivir, lopinavir, ACE inhibitors, etovoquone, which is another anti parasitic. There's a big list of things right here. I'm not going to discuss all these, but I do want to focus on some of the big, the big ones just to help us understand what is actually going on with these therapies. Because there's been a lot reinterpretation of data, misrepresentation of data. So let's kind of review a few of these just to kind of help wrap our brains around. And as always, I will have the articles for these below. I'm putting them all together. There's lots of articles for, for those of you who want the data. You can click on them below and feel free to read. But I'm going to summarize these here. So the first thing to remember with remdesivir, which has been the news a lot this past week, it's the only medication that actually has a randomized double blind placebo controlled trial to apply to it. That's a big thing. When we talk about all the other medications, there are no RTCs, which is the gold standard. And those take years and years to get. It's amazing we've gotten one out this quickly. With remdesivir, which is a repurposed drug. It was actually originally studied with some of the other coronaviruses and now we repurposed it. It is an ATP analog. So it actually looks like ATP, which is the major source of energy in our body. And by tricking the cell, it stops viral transcription. So there are two major studies. The first one was in Lancet. That came out. That was one of the original studies that came out about a month or so ago. And I think Gilead is the company making it. And their stocks plummeted when the Lancet trial came out saying there was no big difference between using remdesivir and other drugs. Just this past week, another study came out and they actually had to stop the study in the United States early because it works so well in clinical research. When you're watching a study, if you actually see the data points diverge to the extent that, you know this is a good treatment and the endpoint, death or whatnot, is a really significant endpoint because of ethical reasons, you will stop a study early. And that's actually what they did with this one. Because the P value, which is the probability that this happened by chance alone, was so low, less than 0.05, which means greater than a 95% chance that the results were actually real. That's the statistical analysis we use with this. They stopped the study. But what did the study actually show? Well, showed the time to recovery and the people given the medication, it was a difference between 11 days versus 15 days. So people got better four days quicker. You saw a quicker reduction in the viral load in the people's Bloodstreams mortality is the, is for me, that's the big endpoint. You know, four days difference, you know, it's important, but death is a more important endpoint. And you saw an 8% mortality versus 11.6%. Now that is not a huge difference. It's an absolute risk reduction of 3.6%. Now what does that mean? In this study that they were looking at 11, about 11% of people died that were used standard of care. And with the remdesivir only 8% of people died. Now if you do a statistical, you know, this is what happens in statistics. You change things around. That's a relative risk reduction of 32%. So you can say the risk reduction was 32% relatively, because the difference between 8% and 11% is a 32% difference. But the absolute was 3.6%. What's, what's the point of that? This is not a home run. This is not game over. This is not, we don't need to study more stuff. This is the answer. This is something that will help. You have to be in the hospital to get it. So you have to be sick enough to get to the hospital, but it's not a game changer. Hydroxychloroquine. There's been a lot of stuff out about hydroxychloroquine. Does it help? Does it not help? You know, I'm gonna briefly review these studies. The links are attached below as well. But hydroxychloroquine, we're not quite sure how it works. It can work through the lysosomes, which are the part of our cells which kill viruses and get things in there and just basically make lots of hydrogen peroxide and free radicals to kill stuff. Or is a zinc ironophore to get zinc in the cells. And zinc helps modulate the immune system. Not 100% sure with hydroxychloro. And the thing to remember about this is there is no RTC currently. So you can't definitively say it helps and you can't definitely say it doesn't help. So those are, those both are true because we do not have an RTC yet. And with an RTC like we have with remdesivir, typically what happens, you get one of these, it gets published, then other groups try to replicate that. And that's the key is you want to be able to replicate whatever happens in the United States to England, to Italy, to other countries. You want to replicate what happens in California to New York. And if you can't, then you can't say this therapy is something we can universally use. So we're gonna have to replicate the remdesivir diet in the United States. But it's already being given orphan status to be used. Well, that just. But the point of that with the hydroxychloroquine is, you know, we can't say it doesn't work, and we can't say it does work because we don't have that rtc. Now, there are three initial studies in March in China, in France, and in China again showing positive data that chloroquine and then hydroxychloroquine actually helped significantly. Most of you all remember the French study back in March 20, showing the combination of hydroxychloroquine with azithromycin had a pretty big response. And then the physician in New York proper started city started using it, and that was going viral. Then we had A negative study, March 24 in Shanghai showed no difference. Then another negative study in France. They were trying to verify the initial study, the initial March 20th study, and it failed. The issue with this thing, there was no control group. Now, that's important because a control group is your group. You used to make. This is our. This is our norm. There was no group to compare with. So that negative study wasn't super helpful. The one that came out this past week that changed all the news was this VA study looking at hydroxychloroquine showing it actually was harmful, that you saw more deaths with hydroxychloroquine and hydroxychloroquine plus azithromycin. But there's a couple things to think about with this VA study. First of all, it was a retrospective study. It was just looking back at what people have been given and looking at outcomes. It wasn't an active study trying to see if this drug would work. It was just looking back for markers to see if it might or might not work. So that's. Retrospective studies are not as powerful and reliable as randomized trials are. The other thing is, this was an older VA group. This was a sicker group of people. The VA tends to have an older, sicker population exposed to more chemicals in the past, military service, et cetera. And they saw a higher death in the hydroxychloroquine and even the higher death in the hydroxychloroquine plus, plus the azithro thing. But these were not the same groups. They were different groups, and they were sicker groups as well. So interesting information. It makes us pause A little bit as far as the therapy for this, but it does not absolutely say, hey, it doesn't work. So we're going to next time around talk about convalescent plasma and some other medication treatments. But as we kind of go through this, what I want people to think about is what does this mean going forward for you? Because the goal is to keep us out of the hospital and keep us safe. This is a chart I'll probably referring back to more and more as far as the course of COVID 19. And there's three phases of COVID 19. Phase one is the infection phase. That's where, you know, whoever is getting it. No one knows. That includes the 50% of people that have no symptoms. That includes the exposure to the population in general. Okay. Just when this thing's floating around there. Phase two is the, is the, is the 80, 20 split. That's the 80% of people who get exposed to this and get better. That's where you. Someone got sick during January and February. They got lost their notes, their smell, got g upset, they had some respiratory problems for four weeks. Maybe it also including that 50% of people with no symptoms, these people got better. The 20% are those who need some kind of hospital care and move on to the hospital. That's the phase three. If you go into the hospital, you're sicker, you've got more stuff going on. And of that group about right now, the mortality rates in the United States are much better. We're looking at probably 0.6%. But of mortality in all. But of this 20%, about 5% that gets in the hospital actually need some kind of hospital ventilation. I'm sorry, some kind of intensive care which will include potentially ventilation of the ventilated group. Mortality is terrible. So with some of this data, our goal is to say how can we get more people to go towards the left? Is there anything we can do this 80% of people that have immune success, can we bump that up to 85% so that instead of 20% of people going to the hospital, it's only 3, 15%. Are there ways to boost our immune system? And the answer to that is yes. And we're going to talk about that later as we go through this series to talk about oxidative stress and the new theories behind COVID 19 infection and actually why we see what we're seeing with it, which also gives us more treatment modalities and things we can do for it. Hopefully this was helpful. If it was, please share with friends and family. We're going to be doing this series to help retool our thinking. 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