COVID-19: Physician Treatment Strategies

By Caxton Opere, MD

What is the single most important thing you need to know about Covid-19 infection to be successful as a healthcare professional helping and saving patients? How should you triage and classify, admit or discharge patients? What type of mental models can be applied to the hydroxychloroquine debate so that the patient and the doctor win all the time? On what hypotheses is the 6-foot social distancing rule based and how useful is it? Are there any coronavirus patents? Can you learn about genetic engineering of viruses in less than 5 minutes? Were any human rights violated during Dr. Shi Zhengli's virus transmission experiments in Wuhan, China? You'll be able to decide this and much more after reading this book.

Written by an actively practicing physician for healthcare providers, COVID-19 PHYSICIAN TREATMENT STRATEGIES is for those seeking a thorough grasp of the multiple facets of Covid-19 infection that cuts through the noise in the media.

If you can't find what you're looking for at the CDC website as a healthcare professional, this is the book you need to read today.

• Language: English
• Publisher: Caxton Opere, MD
• Release date: May 28, 2020
• ISBN: 9781952642029

Caxton Opere, MD

Dr. Caxton Opere is a board certified internist, the world's #1 authority on the medical complications of divorce and 5-Minute Marriage Compatibility Tests with over 34 years of clinical experience. He is an international speaker and researcher, ordained minister and artist and has been interviewed coast to coast on the medical complications of divorce by the media including Fox Sports News and quoted by msnmoney.com on expensive weddings. He has published 18 books and hundreds of teaching programs on marriage, ministry, medicine including several videos on the Covid-19 pandemic.

Book preview

COVID-19:

PHYSICIAN TREATMENT STRATEGIES

CAXTON OPERE, MD

COVID-19: Physician Treatment Strategies

Published by Divorce Prevention Inc.,

Frisco, TX

Copyright © 2020 Caxton Opere, MD

ISBN: 978-1-952642-02-9

All Rights Reserved. This book or parts of it thereof, may not be reproduced or stored in any information retrieval system or network without the expressed permission of the author and copyright owner.

DISCLAIMER

The information in this book is intended to inform healthcare professionals on a pandemic that has affected millions around the world. By reading this book, you agree not to hold the author or publisher liable for any information in the book. The author disclaims any liability, injury, loss or damage incurred as a direct or indirect consequence, of the use and application of any of the contents of this book. The books is sold without any warranties of any kind, expressed or implied. You agree that you and not the author or copyright holder, is responsible for any and all treatment or patient management decisions you make. It is your responsibility to check and confirm any treatments and dosages on any off-label use of drugs. The author does not guarantee that any websites, url’s, government websites, or links in the book will be functional at the time the reader purchases this book. Off–label and FDA authorized drugs may be mentioned and the healthcare professional should use sound clinical judgment in individualizing care to each patient. The accuracy of this work cannot be guaranteed and the contents of this book are to be used only as a guide and not as a substitute for sound clinical judgment, training, experience or a replacement for current treatment guidelines.

Acknowledgements

This book is dedicated to all the physicians and healthcare professionals at the frontlines in the fight against Covid-19, to all those that have lost their lives serving on the frontlines, the families they’ve left behind, as well as those searching day and night through their astute observations and medical knowledge, for cutting edge scientific principles and solutions to human challenges in the medical field around the world.

A portion of the proceeds from the sale of this book will be dedicated to Frisco Family Services.

TABLE OF CONTENTS

ACKNOWLEDGEMENTS

INTRODUCTION

It’s Up To Us Doctors

Covid-19’s Hangman

Epidemiology

Virology

Pathology

Clinical Features

Shortcomings of Diagnostic Tests

Triage and Treatment Stratification

When To Treat

Treatment Options and Strategies

Understand What You Are Treating

Repurposing Therapeutic Agents

Perspectives, Politics, Profits

Patents, and People

Clinical Trial Basics

Introduction

Covid-19: Physician Treatment Strategies is for healthcare professionals particularly treating physicians and healthcare practitioners in the frontlines of the Covid-19 pandemic. Covid-19: Remedies is the non-physician companion book. The latter is free for now at https://www.doctorcaxton.com and will be for a limited time. Both books contain timeless principles and information written as an urgent response to the fight against the Covid-19 pandemic from a practical, clinical, scientific perspective by a physician who sees and cares for patients. As physicians, our knowledge base, training and ability to respond quickly to crisis, create solutions and think from first principles in solving any pressing clinical problem, is what will help us deal with the Covid-19 epidemic. That was why we learnt the basic sciences before being ordained to write prescriptions! Everything we know, including our resilience, creativity and ability to see each other’s viewpoints and integrate it into creative lateral thinking outside the box is now being tested. As with all flawed systems during a crisis, the Covid-19 pandemic is exposing flaws entrenched deep within the entire global industrial systems in both the developed and underdeveloped countries. Everything is being exposed in diverse fields of endeavor particularly in education, business, computing, policy-making, disaster management and healthcare, with mixed positive and negative effects. Some employers and business owners that would not let forward-thinking employees work from home are glad they agreed to the demand. Employees are becoming more productive than before. Teachers are now forced to think ahead more critically and plan their lectures and classes in order to increase student engagement, understanding and invariably retention of their material. Redundancy will be reduced in many industries while opportunities will not be viewed with complacency any longer. Family members will appreciate themselves better if they’re not suffering from mental illness, and asides from abusive relationships that could intensify during isolation quarantine and lockups, most marriages should become more fulfilling. The only real challenge left that seems hard to decipher is the Center for Disease Control's recommendations to practicing physicians. As of May 21, 2020. The CDC still does not offer any real clinical gems for managing Covid-19 at this time. Their recommendations fail to reflect the depth of knowledge and scope of therapeutic strategies that we need as clinicians in order to manage the Covid-19 pandemic. On occasion, you might get the feeling that some of their recommendations for health care professionals were written by the head of a janitorial service for other janitors and not for practicing physicians facing a pandemic that’s taking lives in the thousands every day. For example, it was quite disappointing to discover that while the FDA had approved HCQ for emergency use in Covid-19 infections, the CDC remains aloof, not hopeful or excited, regarding the use of the drug. On the contrary not only had FDA approved HCQ for use in Covid-19, 6227 doctors surveyed in 30 countries around the world by Sermo reported that for now, HCQ is still the best drug we have to fight the infection. There are so many unanswered questions that the CDC should be able to help us with but can’t. For example, how do you stratify patients at triage? As a health care worker, what should you do after exposure to Covid-19? Does the CDC recommend exposure prophylaxis? If manufactured drugs won’t be available, what about proven remedies with antiviral properties such as eucalyptus oil, citrus peel extract and ginger? Every time I visited the Health Care Professionals section on the CDC.gov website before writing this book, I found it hard to believe that a physician wrote what I saw there, much less a practicing physician. The best I could glean from the CDC site was not to use steroids for ARDS, something we’ve known for decades. By the way, steroid use in late stages of ARDS has been shown to be beneficial in several studies (McIntyre et al. 2000) There was also some additional information on the website about continuing the use of ACE inhibitors in Covid-19 patients with a history of congestive heart failure (CHF). There is still no mention of a clear treatment strategy for Covid-19, at least not from a treating physician’s perspective dealing with proper triaging of asymptomatic patients presenting to our ER’s.

This book is for all physicians, pharmacists, nurse practitioners, physician assistants, nurses and all those with prescriptive authority in the healthcare field, direct patient care responsibilities or are involved in the education of such healthcare providers. I will use the word physician (s) or doctor (s) at different points in the book to refer to all healthcare professionals especially can prescribe medications and round on patients in the hospital setting. That includes you.

The book might answer many of the questions running through your trained mind so you can at the least, even if no real cures are found for Covid-19, develop a system of thinking as well as strategies for triaging and treating patients with Covid-19 and perhaps other emerging infections.

Chapter 1

IT’S UP TO US DOCTORS

As a physician for over thirty years and board certified in internal medicine, I have always loved patient care and working on the frontlines. I love emergency rooms, hospitals and particularly the intensive care unit. So do many of my colleagues and healthcare professionals. I don’t know the details of the frustrations every healthcare professional is experiencing at work today, but I have firsthand knowledge of the pain many physicians experience as they practice medicine in 2020. It’s not that medicine is harder to practice but some changes have occurred that no matter how good you are, you end up a small fish in a big pond called the business of healthcare and have no voice.

Many doctors have been forced into unnecessary, unproductive, unrealistic work pathways that hinder the flow and expression of their abilities and effectiveness, autonomy, training and perhaps even talents. The very reason many chose the profession has been snatched out of their hands and the sense of accomplishment that previously accompanied the end of a doctor’s workday has been turned into a sigh. If you can get out of the hospital early enough, that brings a sigh of relief. Practicing seems ten times harder than residency training in many specialties. Often times that a physician escapes from the hospital in the late evening, he or she ends up logging on to the hospital patient portal at home to signoff, check something, or complete several electronic records late into the night. More than 50% of physicians in my calling as both an emergency medicine physician, internist and hospitalist are burnt out. That’s why at a time when the brilliant minds in medicine should be figuring out a treatment combination that would work against Covid-19, doctors and other healthcare professionals find themselves without decent information from the CDC and sometimes without appropriate personal protective equipment. Why won’t the CDC for example make it extremely clear, that while there is no treatment recommended, Covid-19 kills by cytokine storm and recommend that doctors to try and treat that storm at its early phases while more information is being collated? Is it because the real policy makers currently at the CDC have no clue about patient care? Their relative or absolute silence on cytokine storm management for weeks is almost deafening! As physicians, our creativity is stalled, our personalities stifled, our autonomy strangled and our endurance stretched beyond what is socially, physiologically, and mentally permissible. On top of that, we now go to work like soldiers going to Iraq, not sure if we’ll get infected by a disease or if we’ll survive the Covid-19 pandemic. We’ve been used and abused and when we really need to get a handle on what to do about Covid-19, the CDC section for healthcare professionals has barely any information. Physicians in the US are frustrated and this is reflected in the current burnout rates of US physicians and the thriving billion-dollar locum tenens business. Then Covid-19 strikes! The last published figures from the American Medical Association on burnout rates for physicians rose from just over 50% to almost 60% for frontline doctors. For example, in the AMA's January 31, 2017 report by Troy Parks, nearly 60 percent of surveyed emergency medicine physicians said they felt burnt out. The more recent January 21, 2020 AMA report on physician burnout by Sara Berg quietly skipped emergency medicine physicians in its survey on physician. Laughable! Today, few hospitals listen to their staff physicians for advise on better workflow and electronic health record expectations or design. Many hire ignorant or medically illiterate people with little or no clinical knowledge or actual patient care experience to assist in designing electronic health records for which they’ve paid ridiculous amounts. So physicians really cannot suggest anything useful or different because millions have already been paid for the electronic health system.

A physician who complained about lacking personal protective equipment was fired and when the news went viral, was offered his job back. Fortunately, he worked locums. If things continue this way, many doctors will quit practicing sooner than they’d love to. Doctors do work under very severe conditions in the US despite the available resources and often do so without complaining. Thanks to the extremely