- Jun 6, 2007
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Everyone has to tell all these medical professionals, pharmaceutical industry supporters and just naysayers to "hold your horses" in writing off "hydroxychloroquine" (HCL)as having a role as a therapeutic for Covid 19 patients. In the last week or so you have the JAMA Study from Brazil, the Veterans Hospital Study and the French 181 patient study all coming out with negative conclusions about chloroquine or hydroxychloroquine and you have tons of people in the media that want the issue closed, that HCL should not be an approved treatment option. Responsible people say no, no, no we have to look more carefully here, these studies are not dispositive about this drug at all; the big red flag about all these studies is that the demographics of the patients in the study is their old which makes them bad candidates for the drug based on how it works. HCL has a long history of use it is used as a treatment for diseases like lupus and rheumatoid arthritis. These diseases involve a person's immune system going haywire and attacking good tissues within the body for lupus it can be many parts of the body attacked for rheumatoid arthritis it is the joints of the body. In the broadest sense the way that hydroxychloroquine works is that it suppresses or dials down part of a persons immune system since in these diseases the immune system is causing the problem suppressing it provides relief to people with these diseases. The fact that HCL suppresses part of the immune system should be a big concern to clinical doctors considering using it and people that design studies to determine the efficacy and safety of the drug because the way the disease Covid 19 works is that it attacks the lungs and in order for medical science to bring about a healing for such a person medical care has to aid such a person in using their immune system to combat, defeat and keep defeated this disease. The reason why the demographic group of older patients should be a concern is that this group's immune system is weaker to begin with, medical science labels this medical condition "immunosenescence" plus older people tend to have separate diseases which involve or cause a weakened or compromised immune system. It should strike people as very risky giving patients medicine to suppress a "weakened" immune system when the plan is that person's immune system is the means to defeat the virus!
Unfortunately, the full details on how hydroxychloroquine works within the body isn't clearly known! The following analysis I offer as a helpful analysis based on the science known. The SARS Cov 2 virus, the virus behind Covid 19, specifically attacks the little air sacs (aveolar) in the lungs, there is millions of aveolar in the lungs, it specifically attacks the aveolar II cell in the air sac which is principally responsible for producing a fluid which creates a membrane barrier between the capillaries and the air sacs the place where the transfer of oxygen to the blood supply is facilitated. How the Cov 2 virus actually brings about fatality is that it kills enough of these alveolor II cells in the air sac which causes the membrane to fail and fluid from the capillaries to fill the air sac thus the oxygen to blood transfer is shut down and the patient dies from lack of oxygen. Now how the human immune system operates in a broad general sense is that you have two different kinds of defenses you have these immune system cells in lymph nodes which are strategically located tissue throughout the body then you have this other line of defense where you have immune system cells dispersed throughout the body. You have three general types of immune system cells you have these cells that do phagocytosis (phago -greek meaning to eat & Latin cyto meaning hollow vessel [cell]) eat or breakdown cells - macrophages, neutrophil and T cells another type of immune system cell sends signals to other immune cells to bring them to the fight -dendritic cells and then you have antibody creating cells - B (body) cells. The important thing to know is that T cells and B Cells reside in the lymph nodes and macrophages, neutrophil and dendritic cells are dispersed throughout the body one further thing to note is that the aveolar itself has macrophages that reside there.
Now what science knows is that the way hydroxychloroquine works is that it blocks the activation of dendritic cells so if a Covid 19 patient is taking HCL their dendritic cells when they come across a corona virus in the aveolar aren't being activated so they aren't going to the lymph nodes and bringing T cells to the fight between the Cov 2 virus and Aveolar II cells. So for these patients on HCL their principle defense is the macrophages and the Aveolar II cells themselves and too a lesser extent neutrophil cells. There is authority in the medical profession that concludes that in older people their macrophages don't work as well as when they were younger and specifically one area where they don't work as well is in breaking down lipids there is a lot of lipids in cells cell walls are mostly lipids so if lipid structures aren't being broken down in these air sacs it could be a problem in clogging up transfer of oxygen to the capillaries in the air sacs this is actually a recognized medical condition called "pulmonary alveolar proteinosis". Another concern would be that macrophages have the ability thru the proteins and chemical they shed to call neutrophil, phagocytic cells, to the fight and neutrophil cells are better killers of microorganisms than macrophages because neutrophils have a mixture of granules within them and these granules contain a wide variety of enzymes that break down structures of and within microorganisms. Moreover, another defense mechanism of the human body is that when they are fighting pathogens and the fight is not going well immune cells send signals to cells under attack and those cells under attack send signals to themselves to kill themselves to protect healthy parts of the body. The point here is that if HCL is used on a Covid 19 patient that is older or has a weakened immune system what you have is a person in the aveolar in their lungs fighting these viruses with weakened macrophages so the macrophages are fighting less effectively and being less effective at calling other immune system cells to the fight and combine that with aveolar II cells killing themselves as a defense mechanism besides being killed by the virus, these cells vital to preventing the lungs air sacs from filling up with fluid, it should be no surprise that such patients at a high rate have poor health outcomes - these types of patients are not good candidates for HCL use - the studies on this drug should be enrolling only good candidates this way America and the world can learn if the drug has safety and efficacious value for the Covid 19 disease!
The American public needs to hear more of the other side on these studies. For the JAMA Brazilian study it involved chloroquine (CL) not hydroxychloroquine, HCL is what is primarily being used in America today. CL permeates the blood stream more easily than HCL so it has higher toxicity. In this study they used dosages of either 600 mg twice a day for five days or 450 mg two times for the first day with 450 mg for the following four days; this is over dosage for lupus and for RA the recommendation for such diseases is 200 mg to 400 mg per day. The study had a small sample size only 81 persons, the mean age of the enrolled patients was 51 and amongst the study population there was forty reported diseases, diseases that would indicate the person in that status had a weakened immune system whether one enrolled patient had two or more of such diseases it is not clear from the report. For the Veterans Hospital Study, it was a study of medical records. Although there was 368 patients in the study the median age of people in the study was between the age of 68 - 70. Amongst the patient population there was 457 diseases that would indicate the holder of the disease had a weakened immune system again it is not clear how many patients had multiple such diseases. Moreover, since it was a study of medical records one needs to factor in that those patients that got HCL were sicker from Covid 19 compared to those patients that did not get HCL which necessitate drawing the conclusion that to a significant degree the study was not fully fair because the patients getting HCL were sicker that fact could have in part been the cause for the disparity in outcomes not fully the drug HCL. For the French Study, amongst the 181 patients the median age was 60 years old. The dosage was high it was 600 mg of HCL per day and patients chosen for the study were a sicker demographic of Covid 19 patients you had to be a patient that needed to be on oxygen when admitted to the hospital to be eligible for the study. It was noteworthy the outcome 2.8% of the HCL patients died within the first seven days, but, a higher 4.6% of no-HCL patients died in that time period. What I think most Americans want here is just fair studies done we hear of stories where people were in seriously declining health from Covid 19 and were put on HCL and within forty-eight hours their medical condition significantly improved. Could it be that HCL was "not" responsible for the healing or it could be that it was a beneficial therapeutic we just want to know the truth please those in authority make the system work correctly here, it is literally a matter of life or death that is at stake!
Unfortunately, the full details on how hydroxychloroquine works within the body isn't clearly known! The following analysis I offer as a helpful analysis based on the science known. The SARS Cov 2 virus, the virus behind Covid 19, specifically attacks the little air sacs (aveolar) in the lungs, there is millions of aveolar in the lungs, it specifically attacks the aveolar II cell in the air sac which is principally responsible for producing a fluid which creates a membrane barrier between the capillaries and the air sacs the place where the transfer of oxygen to the blood supply is facilitated. How the Cov 2 virus actually brings about fatality is that it kills enough of these alveolor II cells in the air sac which causes the membrane to fail and fluid from the capillaries to fill the air sac thus the oxygen to blood transfer is shut down and the patient dies from lack of oxygen. Now how the human immune system operates in a broad general sense is that you have two different kinds of defenses you have these immune system cells in lymph nodes which are strategically located tissue throughout the body then you have this other line of defense where you have immune system cells dispersed throughout the body. You have three general types of immune system cells you have these cells that do phagocytosis (phago -greek meaning to eat & Latin cyto meaning hollow vessel [cell]) eat or breakdown cells - macrophages, neutrophil and T cells another type of immune system cell sends signals to other immune cells to bring them to the fight -dendritic cells and then you have antibody creating cells - B (body) cells. The important thing to know is that T cells and B Cells reside in the lymph nodes and macrophages, neutrophil and dendritic cells are dispersed throughout the body one further thing to note is that the aveolar itself has macrophages that reside there.
Now what science knows is that the way hydroxychloroquine works is that it blocks the activation of dendritic cells so if a Covid 19 patient is taking HCL their dendritic cells when they come across a corona virus in the aveolar aren't being activated so they aren't going to the lymph nodes and bringing T cells to the fight between the Cov 2 virus and Aveolar II cells. So for these patients on HCL their principle defense is the macrophages and the Aveolar II cells themselves and too a lesser extent neutrophil cells. There is authority in the medical profession that concludes that in older people their macrophages don't work as well as when they were younger and specifically one area where they don't work as well is in breaking down lipids there is a lot of lipids in cells cell walls are mostly lipids so if lipid structures aren't being broken down in these air sacs it could be a problem in clogging up transfer of oxygen to the capillaries in the air sacs this is actually a recognized medical condition called "pulmonary alveolar proteinosis". Another concern would be that macrophages have the ability thru the proteins and chemical they shed to call neutrophil, phagocytic cells, to the fight and neutrophil cells are better killers of microorganisms than macrophages because neutrophils have a mixture of granules within them and these granules contain a wide variety of enzymes that break down structures of and within microorganisms. Moreover, another defense mechanism of the human body is that when they are fighting pathogens and the fight is not going well immune cells send signals to cells under attack and those cells under attack send signals to themselves to kill themselves to protect healthy parts of the body. The point here is that if HCL is used on a Covid 19 patient that is older or has a weakened immune system what you have is a person in the aveolar in their lungs fighting these viruses with weakened macrophages so the macrophages are fighting less effectively and being less effective at calling other immune system cells to the fight and combine that with aveolar II cells killing themselves as a defense mechanism besides being killed by the virus, these cells vital to preventing the lungs air sacs from filling up with fluid, it should be no surprise that such patients at a high rate have poor health outcomes - these types of patients are not good candidates for HCL use - the studies on this drug should be enrolling only good candidates this way America and the world can learn if the drug has safety and efficacious value for the Covid 19 disease!
The American public needs to hear more of the other side on these studies. For the JAMA Brazilian study it involved chloroquine (CL) not hydroxychloroquine, HCL is what is primarily being used in America today. CL permeates the blood stream more easily than HCL so it has higher toxicity. In this study they used dosages of either 600 mg twice a day for five days or 450 mg two times for the first day with 450 mg for the following four days; this is over dosage for lupus and for RA the recommendation for such diseases is 200 mg to 400 mg per day. The study had a small sample size only 81 persons, the mean age of the enrolled patients was 51 and amongst the study population there was forty reported diseases, diseases that would indicate the person in that status had a weakened immune system whether one enrolled patient had two or more of such diseases it is not clear from the report. For the Veterans Hospital Study, it was a study of medical records. Although there was 368 patients in the study the median age of people in the study was between the age of 68 - 70. Amongst the patient population there was 457 diseases that would indicate the holder of the disease had a weakened immune system again it is not clear how many patients had multiple such diseases. Moreover, since it was a study of medical records one needs to factor in that those patients that got HCL were sicker from Covid 19 compared to those patients that did not get HCL which necessitate drawing the conclusion that to a significant degree the study was not fully fair because the patients getting HCL were sicker that fact could have in part been the cause for the disparity in outcomes not fully the drug HCL. For the French Study, amongst the 181 patients the median age was 60 years old. The dosage was high it was 600 mg of HCL per day and patients chosen for the study were a sicker demographic of Covid 19 patients you had to be a patient that needed to be on oxygen when admitted to the hospital to be eligible for the study. It was noteworthy the outcome 2.8% of the HCL patients died within the first seven days, but, a higher 4.6% of no-HCL patients died in that time period. What I think most Americans want here is just fair studies done we hear of stories where people were in seriously declining health from Covid 19 and were put on HCL and within forty-eight hours their medical condition significantly improved. Could it be that HCL was "not" responsible for the healing or it could be that it was a beneficial therapeutic we just want to know the truth please those in authority make the system work correctly here, it is literally a matter of life or death that is at stake!
