Latest Covid Treatment FAQ’s Orange County

ANNOUNCEMENT from CMO-

A woman calls a law firm,
“This is Schwartz, Schwartz, and Schwartz. How may I help you?”
“I would like to talk with Mr. Schwartz.”
“Oh sorry; he is in court all day.”

“OK, in that case let me speak to Mr. Schwartz.”
“Apologies. He is on vacation.”

“Then let me speak to Mr. Schwartz.” “Speaking!”

(With thanks to Henny Youngman.)

As this story illustrates, there are times you really don’t want to answer a question. But eventually, you have no other choice.

You have a sore throat. Cough. Maybe a fever. You test positive for Covid. You contact us and ask, “What can you give to treat it?”

A very legitimate question. But not so fun to answer.

Because it is frequently followed by a request for Hydroxychloroquine. Or Ivermectin. Or a Vitamin combination.
Lately, CoQ10 is a popular request.

You may be tempted to mimic the formula unsuccessfully used by
quarterback Aaron Rodgers. He declined to disclose his secret formula, but did state in an interview prior to his positive PCR he was taking a cocktail of Hydroxychloroquine, Ivermectin, CoQ10, zinc, Vitamin C, and D.

NONE of these treatments have been shown through ANY valid study to prevent or treat Covid. Hence Rodger’s recent Covid infection.

So what DOES prevent Covid?
Only one thing…a vaccine. And unlike vaccines we are used to, it has a relatively high failure rate. Their main advantage is they DO prevent severe cases, hospitalizations, and my personal favorite thing, to prevent-death.

And what DOES treat Covid? Well, none of those modalities mentioned above. Going into our third year of dealing with this virus, five therapies appear to have passed the tests of efficacy (working) and safety.

• 4 of the 5 have FDA authorization, either emergency or standard approval.
• 2 of the 5 are indicated only in hospitalized patients with severe cases.
• 1 of the 5 is not currently available, at least in Orange County.
• 1 of the 5 is very difficult to access, at least in Orange County.
• 0 of the 5 “cure” Covid; they all reduce symptoms, and risk of death.

Here they are:

1. Remdesivir and 2. Baricitinib.
They are only given in the hospital. They are very effective in reducing days in the hospital, days on high flow oxygen, chance of needing intubation, and of course risk of death. So, unless you are tucked into your hospital bed, 2 of the 5 are off the list.

3.  Paxlovid and Molnupiravir, oral outpatient anti-viral agents just approved by the FDA. So why not prescribe these to our patients calling?

• They are NOT to be used for prevention.
• They must be used within five days of symptoms starting, which is a very narrow window to get a positive test, which is also required.
• They are ONLY indicated in cases with a high likelihood of progressing to severe disease, hospitalization or death. Which limits to whom they can be prescribed.
• But the biggest issue–it simply isn’t available. We have called dozens of local pharmacies – nada. Some expect to not have it in common use until spring.

4.  Which leads us to the only other FDA approved (emergency use) treatment- Monoclonal Antibodies (MAB).

So far, they appear to be game changers. Safe, few side effects, and a very high success rate.

In fact, almost every case we have followed up on were improving. We do not specifically check for Omicron, but the MAB’s appear to be working in current strains we are seeing in Orange County.

And they are free, thanks to our federal government cutting a deal with Regeneron labs to supply the country with them. (A reasonable administration fee is allowed to be charged.)

Monoclonal antibodies are laboratory-produced molecules that act as substitute antibodies that can restore, enhance, or mimic the immune system’s attack on viruses–in this case Covid.

A fair analogy is vaccines have the SWAT team waiting for the Covid perpetrators and neutralize them on entering the nose–I mean house. With MAB’s the SWAT team rushes the house once the perps have already entered. Either way, antibodies are doing the work.

PDQ Urgent Care, in partnership with Infusion IV Hydration & Injection Therapy, in conjunction with Caduceus- has been approved to administer MAB’s and has given approximately 50 doses in the last few weeks. However, allocations are sparse, and we run out quickly. We never know if more allocations are coming, since it is in short supply nationwide.

Recently it was reported the entire Houston area would run out of MAB’s and unsure if they can get a new allocations soon. With no other proven therapies, demand is far ahead of supply.

(Conspiracy theorists: I have been unable to verify the head of Houston MAB distributions is a Dodger fan.)

To answer the many questions about receiving MAB, let’s skip the questions and go straight to the answers:

• To receive the MAB’s, you need to be referred by a PDQ provider. This is done via a video visit. Easiest way to do this is via the PDQ app, or live chat on the website at pdqurgentcareandmore.com. If they are closed, I suggest a Mouse Call, also available on the app or website.

• You also agree to a follow-up video visit a few days after the MAB infusion.

• (Advice- download the PDQ app. You can do all your Covid stuff anywhere your phone is via live chat. PDQ is then literally in your pocket.)

• You will need to be positive by either a PCR or Antigen test and present the test at the time of the infusion.

• You will need to be mildly to moderately ill, with a high likelihood that you may progress to a hospitalization. If you already have a severe case, you should go to the ER for possible admission to receive Options 1 and 2 above.

• If you have Covid but are relatively healthy and improving, you should not receive MAB’s.

• With supplies so limited, we are giving priority to our own loyal patients. It is not required to be a preexisting PDQ or Caduceus patient, however.

• Your costs for MAB’s are modest. The two video visits are billed to your insurance. If you do not have insurance, they are under $50. The infusion fee is paid at the time of administration and is NOT billed to insurance. It is currently around $200-300.

What if you qualify for MAB’s but cannot find it? Or you are sick, but do not meet the criteria for MAB’s? We have looked and found one other therapy to replace MAB’s if needed.

Enter Option 5- Fluvoxamine aka Luvox. This is actually a type of psychiatric medication, meant for OCD in the category of drugs known as “SSRI’s.”

Luvox acts by increasing levels of the brain chemical serotonin. In addition, the drug has other biological properties that could quell inflammation triggered by COVID-19.

Why is this different than the other off label drugs touted by social media?

Well, this one has actual peer reviewed studies to support it. Yes studies–as in multiple ones. Its main claim to Covid fame is it prevents the cytokine storm responsible for the severe double pneumonias, ARDS, ventilators, and even the “long hauler” symptoms. 
And the studies are not in obscure journals. It was given passing marks from both
JAMA and The Lancet.

It is not FDA approved, and at least one local pharmacy told us they will not fill prescriptions for it until it is. But it has been taken by millions of patients over the last 30 years with a good safety profile.

Since it is an off-label use, many physicians will be resistant to use it, given the drama of Plaquenil in 2020. But our Covid team will consider it if all other options hit a dead-end.

Again, you will need a positive Covid test, and a video visit. It is NOT for prevention, and only for higher risk patients.

That’s about it.

Five treatments with decent supporting data. But to review, only MAB’s are a realistic treatment to prevent hospitalizations and death.

Of course, having the antibodies ALREADY lying in wait for the dreaded spike protein is much preferred–and that means taking the vaccine, AND a booster OR check your antibody counts every 4-6 weeks as we have been advising. (Ok, nagging.)

In summary:

1. There is no treatment shown to prevent Covid
2. There are only five treatments showing respected data on treating Covid successfully.
3. Only one is a current viable option for outpatients- Monoclonal Antibodies. And they work.
4. Get vaccinated and boosted, or at least check a total antibody count regularly as your best bet to stay out of the hospital -or worse.
5. PDQ, in partnership with Infusion IV Hydration & Injection Therapy and Caduceus, is an approved site for MAB’s. Allocations are sparse and there is no guarantee they will continue.

Just ask Houston.

We began with Henny, let’s end with Henny.

A man goes to his doctor and says “Doctor, I have Covid and I’m afraid I am going to die!”
The doctor says, “Nonsense! You’ll live to be 80!”
“But I AM 80!” says the man.
“See? What did I tell you!!!!” 

Sincerely,

Gregg DeNicola MD Chief Medical Officer
Caduceus Medical Group