Excellence in Early Outpatient Treatment versus Therapeutic Nihilism

This is the second part of our Essential Educational Travel for Messrs Legault and Trudeau, respectively prime ministers of Québec and Canada. It brings us to California, where those politicians could learn from some of the very best when it comes to early outpatient treatment, as a means not only to save many lives but also to nearly eliminate the need for any hospitalization for COVID-19. The analysis is not Canada or Quebec-centric, and is actually applicable to many other jurisdictions, in Europe especially, where therapeutic nihilism is also widely practiced.

Picture: Dr Brian Tyson and his team at the All Valley Urgent Care medical practice in El Centro, California, // French version also available.

Now that our Canadian politicians are familiar with both prophylaxis for high risk individuals and with how to squash outbreaks in nursing homes, it’s time to educate them about the best practices for the outpatient treatment of COVID-19. This is something they both heard about, but probably badly advised, they ignored it. There were petitions circulating, and other initiatives, including the submission of of a comprehensive report by the undersigned, both at the provincial and at the federal level, early in the pandemic, calling for outpatient treatment. They were ignored, and no attempt was really made to even try such outpatient treatment in Québec and in Canada – with only a short-lived experience in New-Brunswick. So a bit of explanation is warranted.

Introducing the concept of therapeutic nihilism

Professor McCullough, MD, from Texas, who has an impressive set of publications about COVID-19 therapeutics and policies, summarizes very well the “strategy” adopted in Canada and unfortunately too many other countries, as “therapeutic nihilism.” He wrote, in a landmark article co-authored with 56 other prominent medical doctors from all over the world: “In countries where therapeutic nihilism is prevalent, patients endure escalating symptoms and without early treatment can succumb to delayed in-hospital care and death.” 

https://rcm.imrpress.com/EN/10.31083/j.rcm.2020.04.264

Therapeutic nihilism is exactly the strategy adopted by Canada, its territories and provinces, including Quebec. If you get COVID-19, you are asked to stay home, to isolate, and to wait. Maybe your immune system and general health, largely dictated by your age, enable you to overcome the disease. You are lucky then. You get over COVID-19 within a few days, and you may even avoid long-term symptoms such as chronic fatigue or headaches. But maybe not. Maybe your condition worsens. There are symptoms, such as the loss of smell or taste, that indicate you may not be among the lucky ones. At some point, you may have difficulties breathing. That means the disease is already creating havoc, but you don’t realize it. Actually, your oxygen saturation level may already be dangerously low, but you don’t know it, because of a now well-documented phenomenon of “happy hypoxia.” And of course, you have not even been told to monitor your oxygen saturation, with an oximeter device that just cost around US$30.

The period of time during which you are mandated to stay home, without any treatment, can last 1 or 2 weeks, sometimes less, sometimes more. For medical doctors who know the disease, it’s described as the viral replication phase of COVID-19, and it’s now abundantly clear from the science and therapeutic experience all over the world, that it’s during this phase that the disease is the most easy to treat, to cure. One of the most prominent authors of the above article, Professor Thomas Borody from Australia, actually declared back in August: “We Know it’s Curable; It’s Easier than Treating the Flu.” But to be so curable and easier than treating the flu, COVID-19, needs to be treated early, within days after the first symptoms, during the viral replication phase of the disease. When governments such as those of Canada and Quebec prevent such treatment to take place, they actually practice therapeutic nihilism, probably without even being aware of it.

The practice of therapeutic nihilism has devastating consequences. First, as previously mentioned, some 80% of the deaths in Canada occurred in nursing homes, where only contagion control measures were, and are still taken, to attempt curbing new infections. The elderly in nursing homes are the first victims of the therapeutic nihilism imposed by the authorities, as the ill-conceived strategy is applicable to both the general population living at home, and the older folks, living in aged care facilities, nursing homes, etc. Already back in April, some medical doctors treated nursing homes residents successfully with early therapeutic protocols. One of them is Dr Robin Armstrong, who presented his experience in one of our webinars. The result was a considerable reduction in contagion and mortality. Today, there are even more effective therapeutic protocols for nursing homes, and yet, they remain denied to the residents. Families and residents alike are usually unaware that such therapeutic solutions exist, so they are brought to accept the often fatal outcome, without any protest. At the very minimum, from available studies based on actual experiences with treatments in nursing homes, with very old residents, 50% of the deaths could have been, and could be avoided. Actually, it’s likely much more than that, especially if prophylaxis is being associated with early treatment.

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A second devastating consequence of therapeutic nihilism is the crisis in hospitals. Without early treatment, a comprehensive study on 4,536 people who tested positive for COVID-19 showed that 21.1% of them required hospitalization. This represents a considerable risk of hospitalization, especially for those at higher risk, typically over the age of 60 with one or several comorbidities. Note here that in Canada, there are no publicly available data about the proportion fo those tested who get hospitalized. It’s probably lower than 20%, not because of better care, but because the elderly sick with COVID-19 are typically not transferred to hospital and are left to die, untreated, in the nursing homes.

Now, what’s the risk of being transferred in case you benefit from early outpatient treatment. On the basis of the real-world experiences of two medical practices in the US, it’s found to be reduced by at least 80%, probably much more in fact, as we discuss below This is what comes out of the academic studies done about the medical practices of Dr Zev Zelenko in New York and Dr Brian Procter in Texas. These MDs were among the few who implemented early ambulatory treatment for COVID-19 from the beginning of the pandemic. Their results are very similar: a considerable reduction in the need for hospitalization. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7587171/

Imagine today if there were 5 times or even fewer people hospitalized for COVID-19 in Canada. Imagine today if there were 5 times or even fewer transfers to the ICU for COVID-19. This is what would happen with early ambulatory treatment for the disease. But the authorities have decided otherwise, and instead they practice therapeutic nihilism, which is responsible for the crisis in the hospitals and ICUs. Today, it’s the failed governmental response to the virus, and not the virus, and even less the population, that should be blamed for the crisis in hospitals. Yet, politicians blame the population, that is being imposed extremely strict yet ineffective lockdown measures. And now, the politicians also blame the international travellers, presented as the new scapegoats. As we analyzed in this blog, the testing measures for international travellers are pretty ineffective, and for many destinations, the risk of getting COVID is much lower than in Canada, especially during the very long winter, when contagion is highly active … 

Learning about the best therapeutic practices for the early ambulatory treatment of COVID-19

Now that the concept of therapeutic nihilism, and its devastating consequences, has been explained, it’s time to look at the other side of the coin, namely, the best therapeutic practices for the early ambulatory treatment of COVID-19. This is where the third stage of this essential educational trips kicks in. The idea here is for our politicians to learn first hand from medical doctors who have successfully treated thousands of COVID-19 patients and this brings us to California. There, a small medical practice, run by Dr Brian Tyson, in El Centro, not far from the Mexican border, has treated nearly 4,000 COVID-19 patients, confirmed positive, as outpatients, through the prescription of drugs, and in rare cases oxygen, to be taken at home. Those receive treatment typically include high risk people, with diseases such as diabetes, and from hispanic ethnicity, that has been found to be more affected by the disease.

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We previously conducted a comprehensive interview with Dr Tyson, when he had reached the 1,700 outpatients benchmark, and where he explained in detail the diagnosis, treatment and follow-up provided to his patients. We also welcomed Dr Tyson as a surprise guest in our webinar with Professor Peter McCullough, who just had caught COVID-19 himself, and received therapeutic advice from Dr Tyson during the webinar. Professor McCullough actually recovered from the disease swiftly, even if he is close to age 60 and suffers from a significant comorbidity. Actually Dr Tyson had also caught COVID-19 recently, so both doctors exchanged about their respective therapeutic protocols. Professor McCullough was back into running within a week of developing the first symptoms of the disease. Dr Tyson also had recovered from it swiftly.

During our webinar, Professor McCullough commented on the ambulatory treatment practices of Dr Tyson. For Dr. McCullough, this is the “package of care” delivered by Dr Tyson – comprising a rapid initial diagnosis, determination of treatment, monitoring of the patient taking their treatment at home, and prescription if necessary, of additional medication or even oxygen – which explains the quality of the results obtained with early treatment, taken at home, without hospitalization. The details of the treatment depend on the patients and the MDs involved. There is no one size fits all. Yet, the algorithm developed by Professor McCullough and the already mentioned impressive international group of medical professionals from all over the world, summarizes the approach.

https://rcm.imrpress.com/EN/10.31083/j.rcm.2020.04.264

All the medical doctors who know about early outpatient treatment agree. The earlier you treat, the better. Most effective treatments are started within days of the first symptoms, when the infected person is still at home, or in a nursing home in the case of the elderly. This is known since April, and it’s astounding that 9 months later, the very contrary remains practiced in many jurisdictions. More recently, the motus is also that, the more agressive you treat early, the better.  Aggressive treatment in this case does not mean an hospitalization, but rather being pro-active for any complications. Here is an example. Aspirin, as a blood thinner, was not typically prescribed from the beginning. But now it’s more likely to be the case with these general practitioners who know how to treat the disease. Another example is the use of multiple drugs. Several medical doctors will now combine hydroxychloroquine-based and ivermectin-based treatments, as they act in a different manner on the infection, and combined, they typically fasten the recovery time.

As of January 22nd, Dr Brian Tyson provided an update to the author. He had 3600 treated patients (i.e. COVID-19 positive patients with symptoms), 5 hospitalizations and 1 death. It appears that the person who died did not complete the early treatment and was transferred an hospital and an ICU. It was a patient in his late 60s with comorbidities. Dr Tyson has treated many patients in their 60s and 70s, and even older ones. So this was one very unfortunate case where the early outpatient treatment did not work as a safety net. With 5 hospitalizations for 3600 deaths, this is not even 1% of those outpatients who needed hospitalization. And much less than 1 out of 1,000 patients died. If you look at the studies about the practices of Dr Zelenko and Dr Procter, during the first wave of the pandemic, they achieved already a reduction in the risk of hospitalization exceeding 80%. But here, it looks like this is brought to much higher level, exceeding 99%, in the practice of Dr Tyson. 

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It’s really important to fully understand the implications of this. Here is a small medical team, in a small medical practice in El Centro, California, that was able to considerably reduce the need for hospitalization. This team, instead of practicing the outpatient therapeutic nihilism so dear to the Canadian and other authorities, implement the best therapeutic practices, actually they practice excellence in outpatient treatment of symptomatic COVID-19 confirmed patients. And they deliver a considerable reduction in the need for hospitalization. The precise data estimate are not yet available, but hundreds of hospitalizations were avoided, hundreds of advanced forms of the disease, and many associated deaths, were avoided, thanks to the excellent package of care provided. In Quebec and Canada, which seem to live very isolated from the world despite excellent Internet, the hope is now placed in colchicine, which would deliver about a 20% in hospitalizations. As we discussed in a recent article, if administered alone, as it seems to be the new idea of the authorities, that would just reduce by about 20% hospitalizations, while the package of care, implemented by Dr Tyson and his team, deliver a reduction in the risk of hospitalization that exceeds 80% is actually close to 100%. So an excellent place to learn about the best practices for outpatient treatment clearly is at Dr Tyson’s All Valley Urgent Care in El Centro, California. Both politicians are most welcome to spend all the time needed to educate themselves about how one successfully treats COVID-19 on an outpatient basis, with barely any need to send anybody to the hospital! 

Another amazing medical doctor whom the two politicians should absolutely meet is Dr George Fareed, from the nearby city of Brawley. Dr George Fareed is a Harvard Medical School graduate with 50 years of medical experience (yes you read well – 50 years of experience and still practicing!). Presently, he works both as an hospitalist and as general practitioner, and is therefore able to educate our politicians about the critical importance to avoid hospitalization. Moreover, Dr George Fareed has direct experience in intervening with therapeutics in a nursing home where there was a major outbreak. It was a form of early treatment, that probably helped avoid many deaths, and a visit of this nursing home, the staff, the residents and the administrators could also be organized. As discussed in the first part of this article, there are now excellent therapeutic solutions both for the prophylaxis and early treatment of COVID-19 in nursing homes. Actually, Dr George Fareed developed a comprehensive prophylaxis and early treatment protocol for nursing homes facing infections and outbreaks, and he will be honoured to present this protocol to our politicians. Again, let’s repeat it, with the vast majority of deaths in Canada occurring in nursing homes, and the ineffectiveness of non-therapeutic approaches, as implemented by the authorities, it is of the uttermost importance to introduce prophylaxis and early treatment protocol to dramatically curb infections, deaths and outbreaks, and the associated tragedy in nursing homes.

Now, for the journey in the plane, here are mandatory videos for our politicians to watch, so that they can best prepare for their California stopover: our interview with Dr Brian Tyson, and our webinar with Professor Peter McCullough, where Dr Tyson is doing a surprise appearance for the Q&As.

And here is the prophylaxis and early treatment protocol of Dr George Fareed, as well as the webinar he did with Dr Robin Armstrong about how to prevent infections and outbreaks in nursing homes.

The fourth part of this essential educational travel will bring us to the Dominican Republic, where the focus will be on public policy, on good governance.