Dr. Harish Moorjani, Infectious Disease Specialist is currently at the frontline in New York's Epicenter. He shares his personal story in the #medicalwarzone that he is currently facing. He also discusses about the latest evidence on the combination therapy of Hydroxychloroquine and Azithromycin in treating COVID 19. Does this hold promise for COVID 19? Dr. Moorjani shares his clinical pearls and the latest in the United States Epicenter for COVID 19. For any questions or further contact, please email: SecretsOfSurvivalMedicine@gmail.com.
0:247 - Dr. Moorjani shares his "war zone" experience in treating patients with COVID 19 in New Rochelle, New York with Dr. Rashid. New York is the Epicenter for COVID 19 in the USA.
1:26 - Dr. Rashid introduces the episode, "A Delicate Balance" that doctors and healthcare providers are facing the controversial issue of treating COVID 19 with Hydroxychloroquine and Azithromycin without solid clinical evidence through randomized clinical trials.
4:24 - New Governor Andrew Cuomo expresses solemnly the high death rate New York is facing especially those that are more vulnerable to the novel Coronavirus 2019. Dr. Rashid explains the public health crisis that the healthcare system New York is facing due to COVID 19.
5:59 - Dr. Moorjani shares exclusive clinical pearls with his experience in treating COVID 19. In his anecdotal evidence, he shares that early treatment of COVID 19 with Hydroxychloroquine and Azithromycin was found to be successful. Dr. Moorjani goes into further detail about the physiology and pharmacology of why the combination may work in decreasing the viral load of COVID 19.
10:44 - Dr. Rashid explains the history of Chloroquine and Hydroxychloroquine from World War 2 in treating malaria. Dr. Rashid shares the recent research results from Marseille, France. It was found when both Hydroxychloroquine and Azithromycin are used together, there is a significant decrease in the COVID 19 viral load.
11:38 - US President Trump praises the the use of Hydroxychloroquine calling it a "tremendous breakthrough".
12:07 - Dr. Rashid explains how doctors are facing "A Delicate Balance" between clear scientific evidence vs. anecdotal evidence.
14:05 - Dr. Moorjani shares the controversial aspects of Hydroxychloroquine and Azithromycin. He shares his further information about the dosing and time of intervention in treating patients with COVID 19. He shares his thoughts on the French study as well as the studies performed in South Korea and Taiwan. Side effects of the combination are discussed into further detail.
25:38 - Dr. Rashid shares that "A Delicate Balance" is experienced from the medical and economical level that Americans and the world is currently experiencing with regards to social distancing and currently being in lockdown.
27:50 - Dr. Rashid concludes the episode and shares contact information for the show.
"And I've never seen anything like it. I now characterize it as a war zone."
"It's frightening. It's disturbing that amount of loss."
"In honor of the first responders and health care workers, the iconic Empire State Building will glow red heart beat lights during this pandemic."
"Testing has become rapid, the turnaround time is less than 24 hours."
"Once the symptoms start, you have five to six days to intervene."
"They recover fast, they go home, they're afebrile, and they can go back to their normal life after they have tested negative...."
"This could be a tremendous breakthrough, tremendous breakthrough."
"The delicate balance is between giving a promising drug with the hope that it will be effective from anecdotal evidence versus clear scientific evidence from randomized clinical trials that assures drug effectiveness."
"The dosing of Hydroxychlooquine and Zithromax is something that's controversial. What we are doing is a dose of 800 to 1200 mg loading on day 1 of Hydroxychloroquine and then 400 day after that."
"If the QT interval is more than 500 we are either not initiating this or we are stopping the protocol if the patient is on it."
"Zithromax we finish the 5 day course."
"I think in our own opinion, right now in the early stages, very good success rates with this intervention protocol that we have."
"Hydroxychloroquine does have cardiac toxicity."
"So a clinical trial to understand the nuances of this intervention is absolutely necessary. And so I applaud Governor Cuomo for launching the trial on a statewide basis for trying to address and answer some of these questions."
"Doctors and scientists rapidly racing around the globe are faced with giving treatment that has promise, but not enough scientific data. It is a delicate balance that they face. And at the same token, we all are facing this."
"In many ways, life and death has always been a delicate balance."
"We will succeed and that success will belong to every one of us."
Governor Andrew Cuomo - New York's High Death Rate
Empire State Building - Heartbeat Lights
Hydroxychloroquine And Azithromycin Physiology And Pharmacology
First Research Study Results From Marseille, France
US President Trump - Remarks On Hydroxychloroquine
NIAID Dr. Anthony Fauci - Hydroxychloroquine's Anecdotal Evidence Vs. Clinical Trials
Side Effects Of Hydroxychloroquine And Azithromycin For COVID 19
Second Research Study Results From Marseille, France
The Economic Toll Americans Face With Lockdown
Queen Elizabeth II - Message Of Hope
Email: secretsofsurvivalmedicine@gmail.com
Dr. Susan Rashid's Facebook - Susan Rashid
Dr. Susan Rashid's Twitter - @SecretsSOS
Dr. Susan Rashid's Instagram –@Rashid.Susan767
Dr. Susan Rashid's Linkedin - Susan Rashid
AAF Creative Zen ("mini Ted Talk" of South Florida) Instagram - @Choose954
Dr. Susan Rashid reports no relevant financial disclosures. Rashid Media Productions report no relevant financial disclosures.
Moorjani, H., Rashid, S. “5: A Delicate Balance." Secrets of Survival (S.O.S.) - An Informative And Historical Podcast - The Capstone Project for the Media and Medicine Program At Harvard Medical School, Produced With Rashid Media Productions. https://secrets-of-survival-s-o-s.simplecast.com/episodes/inside-the-warzone. Originally Published on April 8, 2020. Currently Under Construction with the Media and Medicine Program At Harvard Medical School.
-Copyright 2023 Rashid Media Productions, All Rights Reserved.
Dr. Susan Rashid: [00:00:00.08] How are you doing?
Dr. Harish Moorjani: [00:00:02.47] Good morning, Susan. Thank you for hosting this podcast.
Dr. Harish Moorjani: [00:00:06.21] So we're exhausted mentally and physically being on the front lines for the last two weeks in the middle of this epidemic, pandemic, that's evolved in New York and specifically in Westchester County. So at this point of time, directly seeing and managing and treating patients at two community hospitals in Westchester County, which are jam-packed with COVID 19 patients. So just to give you an idea, I have seen more than 200 different patients over the last two and a half to three weeks at these two hospitals. And it's been it's it's it's a very, very tiring process both mentally and physically for one. And I've seen, I think, the entire spectrum of this disease in the last and a half, two and a half to two weeks. It's been a pretty remarkable experience.
Dr. Harish Moorjani: [00:00:59.55] And I've never seen anything like it. I now characterize it as a war zone.
Buried Secrets Piano Background Music: [00:01:04.3-1:26.00]
Dr. Susan Rashid: [00:01:05.41] Yeah.
Dr. Harish Moorjani: [00:01:05.41] And I think of myself as a war veteran. (chuckle)
Dr. Susan Rashid: [00:01:06.15] Yeah.
Dr. Harish Moorjani: [00:01:06.15] Strange, I never thought as a doctor I would be in a war zone in my own country where I live and practice.
Dr. Susan Rashid: [00:01:26.68] My conversation this week with Dr. Moorjani was a harrowing one. The chilling truth with what he faced and continues to face with COVID 19, was striking, Dr. Moorjani is an Infectious Disease specialist and is currently at the frontline in Westchester County, New York. New York is currently the Epicenter for COVID 19 in the U.S., Westchester County is about 25 miles away from New York City. New York City and its surrounding areas are known for its fabulous fashion, beautiful Broadway shows, delicious food. The city never sleeps. These days, it's eerily silent, only the sounds of ambulances are heard. None of us know when this pandemic will end. What we do know is we are all eager for solutions. Recently, there have been numerous discussions about the use of #Hydroxychloroquine and #Chloroquine in treating COVID 19. They have ranged from enthusiastic to worrisome. As the pandemic continues and the number of deaths continues to rise, the situation continues to remain challenging. Join me on my conversation with Dr. Moorjani as he shares his clinical experience, clinical pearls and his firsthand experience in using #Hydroxychloroquine for treatment of COVID 19. I'm Dr. Susan Rashid your host for Secrets Of Survival (S.O.S).
Mysterious Way Music: [00:03:02.78] Mysterious Way Theme Background Music Playing Starts Playing At 00:03:02.78 and ends on 00:04:07.83
Dr. Harish Moorjani: [00:04:07.83] So that's the situation and the disease is still evolving.
[00:00:04:24.66 - 00:05:21.99]
New York Governor Andrew Cuomo Press Conference Speech On Monday April 6, 2020
Virus Pandemic Music [00:04:44.52] Virus Pandemic Music Background Music Theme Playing [00:004:44.52 - 00:05:21.99]
New York Governor Andrew Cuomo: [00:04:24.66]It's frightening. It's disturbing that amount of loss. The undeniable truth here is that this #virus is a deadly enemy and we will lose and we are losing people who are vulnerable to the virus.
Dr. Susan Rashid: [00:04:44.52] #Governor Andrew Cuomo Of New York, along with the first responders and health care providers, such as Dr. Moorjani, are battling with the chaotic surge of patients needing medical care for COVID 19 deaths. This public health crisis has placed an enormous stress on our health care system and is being tested to the max. In honor of the first responders and health care workers, the iconic #Empire State Building will glow red heart beat lights during this #pandemic.
Dr. Susan Rashid: [00:05:21.99] Once again, I commend you for your courage and your bravery and being at the front line during this pandemic and your experience, I'm sure is it's going to be with you for life and it's going to be enriching for all the other doctors and clinicians that are bracing for this pandemic that will hit their community at any time.
Dr. Susan Rashid: [00:05:43.5] So let's go ahead and why don't you go ahead and share with us the clinical pearls in regards to diagnosing and managing the patient with COVID 19. And then we can go to the outpatient setting and the hospital setting.
Dr. Harish Moorjani: [00:05:59.94] Ok. So, from a diagnosis perspective, we are very, we've moved forward quite a lot. We now have testing available at the hospital level, at the outpatient level, at a drive-thru to level.
Dr. Susan Rashid: [00:06:12.74] Hmm-hmm.
Dr. Harish Moorjani: [00:06:13.59] And in Westchester County. And it's truly available for those that are symptomatic and are under the care of a provider. So #testing, and, testing has also become very rapid. The turnaround times have now become less than 24 hours.
Dr. Susan Rashid: [00:06:28.83] Ok.
Dr. Harish Moorjani: [00:06:28.83] And so that has helped us diagnose people, treat people and do #quarantine and isolation as needed in an attempt to slow down this epidemic. So that's one part of it. The other part of it is that there are treatment and the clinical pearls, from our very early experience over the last three weeks treating more than 200 patients so it's pretty clear to me that early treatment in the first five to six days of symptoms.
Dr. Susan Rashid: [00:06:59.28] (Hmm-hmm)
Dr. Harish Moorjani: [00:06:59.28] Once the symptoms start, you have five to six days to intervene. And that's when the virus has just attacked the human body. It's sitting in the oropharyngeal mucosa, it's multiplying there, and it's spreading, trying to spread to the lungs. It may or may not have. Some people progress faster. Some people progress slower. But on average, the median, median, time after the patient is symptomatic is about four to five days, six days before it gets into the lungs.
Dr. Harish Moorjani: [00:07:28.92] And that, I think, is the key time to intervene. If you intervene at that time in that setting, and if you start the patients on this combination of #Hydroxychloroquine and Zithromax, in our anecdotal experience, which we have not yet tabulated them and put together and analyzed yet, but early experience suggests that people treated early in that symptomatic phase of the first four or five days, do very, very well. They recover fast, they go home, they're afebrile, and they can go back to their normal life after they have tested negative with negative PCR's, or if they're asymptomatic three days without fever, they can go back to work with the mask if they can, if they have to go out or they can work from home. But most importantly, their health starts to improve. They don't get, you know, a washed out so to say from this virus, and this, infection. And they can go about their life. So that's one part.
Dr. Susan Rashid: [00:08:26.37] Hmm-hmm.
Dr. Harish Moorjani: [00:08:27.12] Patients who presented late into the illness and who are started on treatment, whether it's #Hydroxychloroquine, #Zithromax, combination or whatever else the people are doing, I think don't do as well. And the ones that are actually doing very poorly, who are getting ventilated, and then the very low death rate that we are seeing are the ones who are elderly with co-moderated illnesses and who present very late into the illness. So out of the 200 plus patients, we have seen three deaths, these are only hospitalized 200 plus patients. There's more than four to five hundred patients that have not even admitted and we have sent home without any treatment. We have not seen, at least in the first three weeks, any of those patients doing poorly. Some have relapsed and come back and have been treated, but they've all been released. So it's interesting to see that this disease wreaks havoc in those who are older and those who are weak and frail. And so it's important to understand, I think this this is a very important clinical pearl. Patients who are vented, so currently I think seven patients on a ventilator in the ICU and this is know a 120 bed hospital, one of the community hospitals I go too.
Dr. Susan Rashid: [00:09:49.41] Hmm-hmm.
Dr. Harish Moorjani: [00:09:49.41] So our ventilator rate is a little bit low compared to what other people in New York City are reporting. And I think that's because we've been very aggressive at treating people with #Hydroxychloroquine and Azithromycin combination. The moment they arrive in the ER and they are admitted, they are started on this protocol.
Dr. Susan Rashid: [00:10:09.61] Ok.
Dr. Harish Moorjani: [00:10:09.61] We're not waiting, waiting, to see progression. We are not waiting to see, you know, worsening infiltrates. So our protocol from the very beginning has been very different. We started early. We had enough supply of Hydroxychloroquine way before anybody else was thinking or treating. And I think it has, it has sort of given us a little bit of a different experience. We are in the process of tabulating all this data, analyzing it, and then hoping to share it with everybody else. And we hope that my impressions are validated by the data analysis that will occur.
Viral Pandemic Music: [00:10:44.73] (Viral Pandemic Music Soundtrack In Background Starts At 10:44, Ends At 12:41)
Dr. Susan Rashid: [00:10:45.48] #Chloroquine, which is chemically similar to #Hydroxychloroquine, has been used to treat Malaria since World War 2. These anti-malarial drugs can be used to prevent and treat Malaria. These medications are also used to treat autoimmune diseases such as Lupus and Rheumatoid Arthritis. Recently, French researchers released promising results in treating COVID 19, which will appear in the International Journal of Anti-Microbial Agents. The study performed an open label non randomized clinical trial with the sample size of 20 patients affected by COVID 19. The study had found a significant reduction of the COVID 19 viral load when a combination of Hydroxychloroquine is used with Azithromycin. [00:11:37.04]
US President Donald Trump White House Coronavirus Task Force Press Conference Speech On March 19, 2020
US President Donald Trump: [00:11:38.73] And I think it's going to be very exciting. I think it could be a game changer and maybe not, and maybe not. But I think it could be based on what I see, it could be a #game changer. Very powerful, they're very powerful. We believe these therapeutics and others under evaluation right now will be able to provide relief to many Americans. We really hope that's going to be this could be a #tremendous breakthrough, tremendous breakthrough. [00:12:05.91]
Dr. Susan Rashid: [00:12:07.77] #U.S. President Trump has praised the use of both anti-malarial drugs in combating COVID 19. Due to the current public health crisis The FDA has issued on Sunday, March 29, 2020, an emergency authorization for experimental coronavirus treatments using Chloroquine and Hydroxychloroquine. The FDA is currently conducting clinical trials in New York with the use of anti-malarial drugs in combating COVID 19. Clinical trials are imperative to validate drug effectiveness.
Dr. Susan Rashid: [00:12:41.37] Doctors are facing a delicate balance when providing anti-malarial drugs for treatment. The delicate balance is between giving a promising drug with the hope that it will be effective from anecdotal evidence versus clear scientific evidence from randomized clinical trials that assures drug effectiveness.
Dr. Susan Rashid: [00:13:02.94] Dr. Anthony Fauci, who is the director of the National Institute of Allergy and Infectious Disease and currently a member of the White House Corona Virus Task Force, shares his expertise advice regarding the use of anti-malarial drugs for treatment of COVID 19.
NIAID Director Dr. Anthony Fauci Speaking At White House Coronavirus Task Force Press Conference On March 21, 2020
NIAID Director Dr. Anthony Fauci: [00:13:21.34] So when you have approved drugs that physicians have the option and a decision between the physician and the patient are you going to use a drug that someone says from an anecdotal standpoint, not completely proven, but might have some effect? There are those who lean to the point of giving hope and saying give that person the option of having access to that drug. And then you have the other group, which is my job as a scientist, to say my job is to ultimately prove without a doubt that a #drug is not only safe, but that it actually works. Those two things are really not incompatible. When you think about that, particularly when you're in an arena where you don't have anything that's proven.
Dr. Harish Moorjani: [00:14:05.51] The dosing of #Hydroxychloroquine and #Zithromax is something that's controversial. What we are doing is a dose of 800 to twelve hundred milligrams loading on day one of Hydroxychloroquine and then 400 a day after that. It's 200 B.I.D. For five more days. So a total duration of 6 days. Zithromax, is of course, 500 mg IV loading and then 250 a day for the next four days so a total of 5 days of Zithromax. We are monitoring the QT interval. If the QT interval is more than 500 we are either not initiating this critical or we are stopping the protocol if the patient is on it. So far, we have not had to do this in more than 100 odd patients that we have put on this treatment protocol with Hydroxychloroquine and Zithromax.
Dr. Susan Rashid: [00:14:54.9] Beautiful doctor. Thank you. I think the only thing that I just wanted to ask about the protocol was in the very beginning, who gets admitted, because it looks like who gets it admitted gets to start the protocol. What are the criteria basically for someone to be admitted? Because you're not admitting based on whether they're #COVID 19 positive. You're admitting based on other criteria. Would you share that? Like how would one patient get admited versus the other one not getting admitted?
Dr. Harish Moorjani: [00:15:25.54] Ok, so we offer admission to anybody above the age of 60. Anybody with A-a gradient more than 40. Anybody that has evidence of any other organ failure other than the lungs. Anybody that has comorbid illnesses that are associated with poor prognostic signs. And anybody that has returned to the ER after being sent back saying that they are progressively worse, so progressive illness. So it's a clinical judgment. It's not a hard and fast rule. And the only thing is we offer treatment to everybody that is admitted. We don't say we are going to watch you. We offer it. And ninety nine point nine percent of the patients I can tell you, there's only one patient who has said, no, she wants to think about the Plaquenil out of the 200 plus that we have offered it to. And then, and then, we start and then we already have more than, you know, 100 plus patients that have finished this protocol, which is what I referred to earlier on in the podcast.
Dr. Susan Rashid: [00:16:30.51] So, Doctor, the ones that get discharged home, do they get a prescription for #Chloroquine or #Hydroxychloroquine with the ZPAK to take it home? Is that something that's?
Dr. Harish Moorjani: [00:16:46.94] So that's a, yeah, so that's a great question, though. What we are doing is we have a six day protocol for Hydroxychloroquine, but that's only for inpatient use. Once the patient is deemed stable for discharge whether it's one day, two days, three days, 4 days, 5 days, or 6 days, they go home to finish just the five day course of #Azithromycin. We are not finishing the course of #Hydroxychloroquine on an outpatient basis. And the rationale for that is very simple. Once the patient has improved and is going home, that immune system is the one that's going to clear that virus from everywhere. #Hydroxychloroquine, the purpose of giving #Hydroxychloroquine, is to reduce the initial attack on the human body in the lungs by this virus. So if #Hydroxychloroquine works and it stops the virus from multiplying, it allows the immune system to gain the upper hand. Once the immune system has gained an upper hand, I think the value of #Hydroxylchloroquine is minimal. So we're using inpatient #Hydroxychloroquine. So we are using oral and we are using NG tubes in ventilated patients
Dr. Susan Rashid: [00:18:02.6] Ok.
Dr. Harish Moorjani: [00:18:02.6] enteracally. #Zithromax we finish the 5 day course, 500mg loading, in four days, even if the patient goes home, we do give them a prescription to finish the five day course of #Zithromax. We believe that #Zithromax does not have direct effect on the virus. We believe the effect of #Zithromax is probably on down regulation of the receptors that the virus attaches to.
Dr. Susan Rashid: [00:18:25.63] Ok
Dr. Harish Moorjani: [00:18:25.63] And that is why I think the combination of #Hydroxylchloroquine and #Zithromax works. This is by no means science. This is just my personal opinion. This still needs to be validated, studied, to see how exactly this combination of #Hydroxychloroquine and #Zithromax works. We know how #Hydroxychloroquine works, but we don't know what the nuances of that are.
Dr. Harish Moorjani: [00:18:46.73] So the other thing we are doing, is we are doing a loading dose of eight hundred to twelve hundred. And the twelve hundred doses given to people who have much severe disease, which we define with high A-a gradients and people with multifocal infiltrates. So people who have A-a ingredients of more than 100, people who have multi focal disease and require a non-rebreather mask or a C-PAP, they're the ones who are getting the twelve million unloading dose of #Hydroxychloroquine. And people who are obese, people who are more than 100 kilograms are getting #Hydroxychloroquine up and twelve hundred. This is based on a pharmacokinetic analysis of #Hydroxychloroquine epithelium fluid lining levels, which we looked at and we said this is what we're going to do. So you can see that, you know, there's a huge variation in various protocols in the various systems, healthcare systems that exist in New York. Which one is right? Nobody knows.
Dr. Susan Rashid: [00:19:47.71] Right.
Dr. Harish Moorjani: [00:19:48.02] But we have found, I think in our own opinion, right now in the early stages, very good sucess rates with this intervention protocol that we have.
Dr. Susan Rashid: [00:19:59.76] Ok so doctor the first day it could be between eight hundred to twelve hundred milligrams of #Hydroxychloroquine and then for the following, and that's the first day and then the following, is it five or six days that they just get the four hundred milligrams of #Hydroxychloroquine?
Dr. Harish Moorjani: [00:20:18.16] Five days.
Dr. Susan Rashid: [00:20:18.16] Five days total. So this is a....
Dr. Harish Moorjani: [00:20:18.16] Yeah.
Dr. Susan Rashid: [00:20:18.16] So this is a....
Dr. Harish Moorjani: [00:20:18.16] Five days.
Dr. Susan Rashid: [00:20:18.16] Ok.
Dr. Harish Moorjani: [00:20:18.16] A total of 6 days.
Dr. Susan Rashid: [00:20:18.16] A total of 6. Ok.
Dr. Harish Moorjani: [00:20:18.16] If they stay in the hospital, if they are discharged, they don't complete the six days.
Dr. Susan Rashid: [00:20:25.51] Ok. They just get a ZPak to go home. So....
Dr. Harish Moorjani: [00:20:29.6] That's correct.
Dr. Susan Rashid: [00:20:30.18] Why has there been this wave of excitement and success with various countries throughout the world using this to treat their patients? What is the chemical properties of the medication that is successful in combating the #COVID 19 virus?
Dr. Harish Moorjani: [00:20:50.09] So #Hydroxylchloroquine is Plaquenil, which has been used for years for treatment of Rheumatoid Arthritis and Lupus in various [00:21:00.0] different settings. #Hydroxychloroquine is also related to the drug #Chloroquine, which has been used as an anti-malarial.
Dr. Susan Rashid: [00:21:08.27] Hmm-hmm.
Dr. Harish Moorjani: [00:21:08.27] For many years before #Chloroquine resistance became worldwide. So, you know, there's been enough experience. It's available genetically. It's a compound that actually gets very good levels in the epithelial lining fluid where this virus most of this damage. So the Chinese experience with #Hydroxychloroquine and then the French experience and the South Korean experience all pointed to positive effects of treating patients with Hydroxychloroquine with Coronavirus pneumonia. [00:21:36.41]
Dr. Harish Moorjani: [00:21:39.68] But having said that, those are all at best anecdotal reports, this was not done in a clinical trial setting. It was not compared to other interventions. The French actually published a very small study of a couple of dozen people where people were given, a few patients were given Hydroxychloroquine and Azithromycin protocol and they had PCR testing done on a daily basis. And they showed that this combination of Hydroxychloroquine and Azithromycin cleared the PCR much more rapidly than with no treatment or with Hydroxychloroquine alone.
Dr. Harish Moorjani: [00:22:16.87] Now, that study was flawed because patients who went to the ICU and patients who refused treatment in between after having started were not included in that analysis. Having said that, you know, when you look at Hydroxychloroquine, it does stop the virus from multiplying, it stops the virus from getting into the ACE 2 receptor cell where it attaches to so it prevents that attachment, it prevents the internalization of the virus. So it does have viralcidal properties, at least on a cell culture. It's been shown it has levels that can be achieved in the lung, which are enough to suppress this virus from multiplying. Whether it actually works or not, nobody knows yet. But those studies are ongoing. And so that's Hydroxychloroquine. And then you have to, you have to then do pharmacokinetic modeling, which has been done to see how much dosing you have to give to get those suppressive levels, viralcidal levels, into the lung and kill this virus and allow the immune system to build up the wall so to say.
Dr. Harish Moorjani: [00:23:23.17] Azithromycin does not have any direct viralcidal activity. Azithromycin as I said before possibly acts synergistically or addictively, by down regulating the ACE 2 receptor, which the virus users get into the cell, which it then destroys and causes havoc and damage at the organ system level. So that's the mechanism of action. I believe that remains to be elucidated. It remains to be studied, whether it pans out to be the truth, only time will tell.
Dr. Harish Moorjani: [00:23:49.83] The drugs do have side effects.
Dr. Susan Rashid: [00:23:53.18] Right.
Dr. Harish Moorjani: [00:23:53.18] Hydroxychloroquine does have cardiac toxicity. It can prolong the QT and people who have prolonged QT intervals can die of ventricular arrythmias. Cardiomyopathy and cardiac toxicity has been observed. Liver toxicity has been observed. The good thing is it's very rare. And we are monitoring for these toxicities and if we see evidence of these toxicities, we will stop these medications because then, the risk benefit analysis that goes on on a daily basis on more, sometimes two or three times a day basis. Then shifts to toward risk and we stop the medication. So a clinical trial to understand the nuances of this intervention is absolutely necessary. And so I applaud Governor Cuomo for launching the trial on a statewide basis for trying to address and answer some of these questions.
Dr. Susan Rashid: [00:24:45.45] Yes. And so it would be prudent that the cardiac monitoring is initiated if the patient is started on Hydroxychloroquine in a hospital setting. So thank you for sharing that, because both of these medications can prolong the QT interval.
Dr. Susan Rashid: [00:25:00.99] Are there any other side effects we need to be aware of with Hydroxy chloroquine besides the potential cardio, cardiac toxicity?
Dr. Harish Moorjani: [00:25:08.55] So aside from cardio toxicity and hepatotoxicity, occasionally you can get some GI side effects, but all those are relatively minor compared to those two big ones.
Dr. Susan Rashid: [00:25:19.32] The same team of French experts also performed a follow up observational study using a combination of Hydroxychloroquine and Azithromycin with a sample size of 80 patients affected by COVID 19. This study also showed promising results.
Buried Secrets Piano Background Music: [00:25:38.68] Buried Secrets Piano Background Music Playing (Starts At 25:38, Ends At 27:11)
Dr. Susan Rashid: [00:25:38.68] A luminous light of hope is instilled when you hear a glimmer of promise during these uncertain times. Doctors and scientists rapidly racing around the globe are faced with giving treatment that has promise, but not enough scientific data. It is a delicate balance that they face. And at the same token, we all are facing this. With the massive efforts in social distancing as a tool for mitigation, we sacrifice our economy. We relax our efforts in social distancing, we improve our economy, but we risk having another crisis with COVID 19 and we become even more vulnerable.
Dr. Susan Rashid: [00:26:21.78] In many ways, life and death has always been a delicate balance. One day all is well, and the next day it is the complete opposite. It makes you appreciate what is truly valuable in life. These are bleak, lonely days that have passed and we are bracing for more on the way. As worrisome as we all are of our health, our economy, our loved ones, one day this too shall pass. One day, we will have a wealth of information, knowledge, stories, and memories that will remain within us and we will be far superior because of it.
Her Majesty, Queen Elizabeth II addressing United Kingdom and the World regarding COVID 19 on Sunday April 5, 2020
Her Majesty, Queen Elizabeth II: [00:27:11.31] While we have faced challenges before, this one is different. This time we join with all nations across the globe in a common endeavor using the great advances of science and our intuitive compassion to heal. We will succeed and that success will belong to every one of us. We should take comfort that while we may have more still to endure, better days will return. We will be with our friends again. We will be with our families again. We will meet again.
Dr. Susan Rashid: [00:27:50.22] That is Her Majesty, the Queen, saying it the best, for the world to hear at exactly the right time during this crisis.
[00:27:58.8] (Mysterious Way Theme Background Song Playing Starts 27:58, Ends 29:05)
Dr. Susan Rashid: [00:27:58.8] I will have more coverage on [00:28:00.0] this ever evolving situation. For more information, please check out the episode notes, audio transcript, follow me. @SecretsSOS, and email me at SecretsOfSurvivalMedicine@gmail.com. I'm Dr. Susan Rashid, your host for Secrets Of Survival (S.O.S).
[00:28:19.22] Mysterious Way Theme Background Song Playing