Live Webinar for Long Hauler Patients with Drs. Patterson, Parikh and Yogendra (2021-02-18)

[-] stereomatch | 2 points | Feb 19 2021 09:01:12

Dr Yo hosts Dr Bruce Patterson and three long hauler advocacy groups.

Dr Bruce Patterson has created a test to quantify long hauler syndrome so it can be recognized as a real thing and not psycho-somatic and thrown under the rug by physicians.

He has teamed up with Dr Yo and have created:

https://www.longhaulers.com

where long haulers have signed up for testing and for updates, as physicians join their network. The list of physicians is increasing, but since many are using telemedicine ie online for examining and prescribing, even if you don't have a local doctor, you may be able to get an assessment. The process also involves getting testing labs on board, so patients can get tested locally.

From what I have seen, they seem to prescribe ivermectin, Maraviroc, leronlimab and a few other medicines like fluvoxamine, depending on the results of the spectrum of test results.

The webinar seems a bit low energy by the end though.

[-] Haitchpeasauce | 2 points | Feb 19 2021 09:09:05

Leronlimab is hard to get though, because it had no EUA and long haulers typically aren't hospitalised. Fluvoxamine is a very interesting new entrant into the COVID-19 scene. As an SSRI I am a bit cautious about it.

[-] stereomatch | 2 points | Feb 19 2021 09:22:10

Although I am getting more confident about what an early treatment should look like, I am still not fully grasping the long hauler equation - for treatment of long haulers who never got early treatment, or who didn't get steroids whether early or late even.

And I am unsure about what the prognosis is for long hauler symptoms developing after a month or two (as some are reporting over at r/covidlonghaulers) - and what the chances are of perfectly early treatment treated patients who recover wonderfully.

I don't have the data from the cases I know to say (ie it has not been long enough) - my guess they would be all ok and not have issues, and so far been the case. But you never know.

This is why I am leaning to just like aspirin for a month even after recovery, to do same for ivermectin ie take it every weekend for 3 weeks even after recovery. A possibly side effects is it may cover for the remote possibility of "viral persistence" that some are raising for long haulers (though case is not fully convincing - it still looks majority like a dysregulation immune response, or continuing irritants).

I am not sure if there is a handle on how fast the viral debris clearance is, or should be.

Since the early treatment cases who were treated early ie in day 8 with steroids don't seem to have a relapse soon after, that suggests the viral debris irritant may be gone by 2 weeks after day 8.

But since an early treatment protocol gives steroids at day 8, there may a remote possibility of viral escape due to arrival of steroids at day 8 - for that reason low dose or weekly ivermectin may have a role to reduce even the rare cases of long hauler that MIGHT occur with early treatment, ie to plug a possibly escape route for viral persistence.

[-] Haitchpeasauce | 2 points | Feb 19 2021 13:12:49

I follow your reasoning, really good points. Let's start by saying we're both in speculation mode here discussing a situation driven by a lot of variables. I also lack the medical background that might clear up some of the questions I raise below.

In terms of recovering wonderfully, it's clear that more time of replication and higher quantity of virus is going to cause more widespread damage and more antigen present in the body. Both of these will cause greater macrophage recruitment, more T helper activity, which drive the chronic symptoms and immune dysregulation. This is why the right interventions given early will have the best outcomes.

Delayed chronic symptom onset I hadn't heard of before and this is an interesting problem. What could explain this? It almost sounds like an autoimmune disease. Do we know whether these people were rechallenged by the virus? How extensive was the damage to their lungs, airways and endothelia? Lingering virus cannot be ruled out either.

Viral persistence. This is a topic requiring a lot of exploration. One thought that pops to mind is, if someone with COVID-19 develops typical pneumonia such that the alveoli are damaged and accumulating infected fluid, how long does it take for the damage to heal and for the material to clear? Could this be a source of lingering virus? Are there also immune privileged sites where the virus can hide?

The timing of the steroids is a really good point you make. We can agree steroids given too early is a risk towards harm, allowing active virus to replicate unchecked. We know that by the time the immunological phase is taking over, active replicating virus is in *decline*, but is the active virus completely dealt with? I think this situation is playing a fine balance of risk vs reward. If used too late, the damage and immune dysreguation will have become extensive so the steroids become less helpful. If used too early, there will be more replicating virus and the steroid is simply throwing fuel on the fire.

So at the moment SpO2 is dropping, there is no way to know how much more severe a patient will become if no steroid is given and something must be done. A compromise is struck between developing a severe immunological disease and allowing some remaining virus to continue to replicate.

What role does Ivermectin play in all this? My opinion is Ivermectin's multiple mechanism of action as a virostatic agent as well as an immunomodulator make it a perfect compliment to corticosteroids. As you say, it plugs a gap. Patients most definitely should be upping their vitamins B, C and D to support the immune function in the lungs.

For long haulers, Ivermectin's biggest contribution could be in inhibiting NF-kB and STAT3, which drive various inflammatory pathways that have become chronic due to high VEGF, along with helping with any viral persistence.

Post-COVID prophylaxis using safe drugs (aspirin, ivermectin, steroids) and supplements (B, C, D, melatonin, fish oil) sounds like a sensible protocol that doctors should simply adopt. Everyone is different, and the damage may show no symptoms and be difficult to detect. We should just play it safe, or have people forgotten that COVID-19 is a serious disease?

What is obvious to me now is the stance of no early treatment is creating a nation of chronically sick people. SARS-CoV-2 is a fast replicating virus that excels at immune dysregulation. Letting viral load get out of hand is only inviting trouble. A patient may survive the infection, but the blaze has gutted the house. Why not put out the fire when it was small?

[-] stereomatch | 1 points | Feb 19 2021 17:10:42

Agree.

[-] stereomatch | 1 points | Feb 21 2021 04:46:10

So, our triad of great therapies so far has been Ivermectin, Maraviroc (which is a CCR5 inhibitor) and low dose steroids for at least two weeks, with seen improvement. The great thing with Ivermectin is it's been proposed as an antiviral, it's an immune modulator; we do think if there is persistent viral presence somewhere, and maybe even low levels of replication, then [Ivermectin] is doing some good work. Of course there is the patients who don't respond too, and we are expecting that. But I would say about 85-90% are responding to these combinations with Ivermectin.

Haitchpeasauce,

What kind of doses do they call "low dose steroids" - if I recall correctly from his (Dr Bruce Patterson) and others' videos - I think they are maybe referring to something like 5mg or lower prednisolone per day as a low dose. This is the prednisolone dose (ie 5mg or low dose) which, if one examines the literature, is considered a relatively safe dose that can be maintained for longer, ie many months, without too much ill effect.

NOTE: steroids can have a negative impact on bone health etc. (can lead to weakening/osteoporosis-like impact) if given for months. The types of doses used as lifesaver for covid19 in ICU are not as dangerous, as they are given for a short period, and for the fact that they are life savers. For early treatment (where steroids typically are given on day 8 to arrest a developing hyperinflammatory storm), and for preventing long hauler syndrome (where low dose steroids may be given with aspirin and ivermectin) - where 5mg prednisolone may be given for a week or more after post-recovery. These sorts of steroids doses are short-lived and would seem to be low risk - and esp compared to the higher risk syndromes they are trying to protect against.

However, my question is, if ivermectin is being given to a long hauler post-recovery, along with aspirin and low dose steroids short course, does it make sense to do the ivermectin doses separately (if their effect is postulated to be both immuno-modulatory as well as anti-viral) ie before the steroids, or in practice it may be difficult to time, and everything is just given together.

I say this because if for ivermectin - if one intent is as antiviral, to help clean out any remnants hidden in immuno-protected areas like brain (ivermectin won't reach ?) and testes etc. - then it would make sense to not give steroids just then.

But if ivermectin is also in a way even neutralising viral debris so it is less of a continuing irritant, then it wouldn't need to be timed. Though ivermectin may bind to spike protein fragments and a few other places on the virus debris fragments, I don't see how that could be a major role - since a real virus and it's resultant fragments would have so many antigens, or irritants ie every kink and molecular shape. But if it turns out that even viral spike protein fragments in the viral debris have some activity against ACE2 receptors ie they continue to clog them up, then ivermectin may have a role as continuing spike protein neutralizer perhaps (?), or not just spike protein but any other molecular shape in the viral debris that is a particular problem, that ivermectin just happens to neutralize.

This leads us to the other issue I have not seen much discussion on - what is the rate of elimination of viral debris typically ? The figures of 20 days after recovery being the time of highest risk for stroke according to some studies, and 1-2 months of steroids and anti-coagulants as recommended by medcram on youtube discussions (Dr Seheult) - these start to give an idea of "how long is the primary immune triggering by viral debris expected to continue".

The data that PCR tests can continue to test positive one month or more in some individuals (nasal swabs) - even though live virus is dead (as shown by Dr Paul Marik in his interviews, and in the MATH+ protocol) - is some indication that some debris somewhere is lasting for a month or more in some individuals.

The mechanistic effects of presence of viral debris as a direct physical irritant, that once removed may resolve issues, is borne out by Dr Paul Marik comments in the earlier Dr Been video where Dr Paul Marik said that if inflammatory explosion is not checked early it requires higher doses later, and can become hard to control/dampen even with very high dosage steroids - and he mentions that (and this is some cause-effect proof of the mechanistic impact of this viral debris) for the very few patients who did not respond to high dose steroids, they did plasma exchange (not to be confused with convalescent plasma) where they essentially filter out the viral debris - and this controlled the inflammatory reaction.

Dr Paul Marik and his MATH+/FLCCC group thus presents the clearest understanding of this virus, it's timeline and it's mechanisms - something that I have not found elsewhere, where the understanding is essentially a state of confusion.

So the parts still not clear are:

how fast does the body do viral debris clearance - can it be hastened - what practical steps by patients can accelerate clearance? (something as simple as drinking more, urinating more?)
live viral persistence in immuno-protected areas (ie areas that immune response does not get to - like the brain, testes etc.) - only now being addressed, as the early treatment phases are now being brought under control - and addressing long hauler syndrome becomes the new open frontier of inquiry

[-] Haitchpeasauce | 2 points | Feb 21 2021 14:18:44

Really good points, agreed these have not been addressed much at all. Part of the reason behind this is so little of the medical community accept Dr Marik's views. The likes of Dr Marik and Dr Patterson are well ahead of the curve.

I do not think Ivermectin neutralises viral debris, and what proportion of this debris could possibly bind to ACE2. Also not sure whether steroids would antagonise the benefits of Ivermectin with regards to lingering infection, there isn't data on this yet.

Given Dr Patterson's protocol uses Ivermectin in combination with steroid, I don't think there is an issue and don't see why there would be one. The priority is almost always to quell excessive inflammation, it's actually very important to sort this out in order for the body to be effective in clearing debris or fighting lingering virus. Once inflammation has settled, steroids should stop and other drugs and supplementation should continue.

I also do not know how long it takes for remnants of the virus to be cleared. If I recall this could be weeks but don't quote me on this. So purely thinking aloud and based on some very shaky memory, but I recall that COVID-19 produces so much virus and debris that it leads to bone marrow depletion (this of itself takes weeks/months to recover), and granulocytes were observed to be less mature because of the demands of their recruitment. These are less effective at phagocytosis, further hampering the cleanup, and apparently immature macrophages produce more inflammatory cytokines. It seems to me the main goal is to calm things down with steroids and give the immune system a chance to reset itself.

Low dose steroid I hear starts at 5mg. I have seen this used for my wife and my mother, for weeks and months. While quite safe it is not without its neurological effects and a gain in weight. Dr Mobeen has said he favours a pulse approach which typically is 5mg three times a day for 3 days (IIRC) and then tapered off. I think pulse style treatments have the benefit of giving the body a break and a chance to reassess whether symptoms return. In all cases the inflammation should be short term if treated well, there should be no concern about osteoporosis. This is more a concern for treating autoimmune disease where the steroid is given at higher levels for a long period.