Why Remdesivir Doesn’t Work And The Benefits of Early Therapeutics

Why Remdesivir Doesn’t Work And The Benefits of Early Therapeutics

On July 16th, 2021, Web MD published an article titled, “Large Remdesivir Study Finds No Survival Covid-19 Benefit”. The study was conducted by the VA, which showed no changes in survivability in VA patients that had Covid-19, with and without the use of remdesivir. There are other studies that have the same conclusion going back to 2020. Yet the latest update from the NIH on July 8th, 2021, states that remdesivir is the only drug approved by the FDA for the treatment of Covid-19.

The question is, why doesn’t remdesivir work?

One of the main reasons that it doesn’t work, is that it is given too late in the disease process. By the time a Covid-19 patient meets the criteria for admission to the hospital, there is a decrease in oxygenation due to a massive amount of inflammation in the lungs. By this point, viral replication is complete (see diagram 1 below). All antivirals depend on some form of viral replication to be effective. If there isn’t any, or very little viral replication, antivirals are not effective.

As is seen in the diagram above, by the time pulmonary symptoms are noted by patients with Covid-19, viral replication has stopped. Improvement of pulmonary symptoms due to Covid-19 was most likely due to the concomitant use of corticosteroids during the hospitalization, thereby reducing inflammation.

Besides being given too late in the disease process, another drawback to remdesivir is that it must be administered intravenously. It would be nearly impossible to administer this drug in an outpatient setting for five days in a row.

For antiviral therapy to be effective in Covid-19, it needs to be given earlier on in the disease process, before this abnormal cytokine storm, or as I like to view it, a cytokine explosion occurs. By giving antivirals early, we can contain that cytokine explosion before it can cause end organ damage (see diagram 2 below).

As can be seen, antiviral therapy is more effective when used while viral replication is occurring, once the patient begins to be symptomatic very early in the disease process. There are many drugs out there that can be effective in minimizing viral replication so that the cytokine explosion doesn’t occur. As discussed in my article “Covid-19 and HIV” several of my HIV patients had minimal symptoms with Covid-19, most likely due to decreased viral replication associated with their HIV medications. As a matter of fact, there are many medications out there that are effective against Covid-19, (see diagram 3 below).

In the United States, it is well known that we are not a healthy population. Approximately 75% of our elderly population have multiple chronic conditions, or MCC’s, which means that they have more than one chronic condition. There are obesity and metabolic syndrome epidemics in this country that have exacerbated the Covid-19 pandemic. With all of these risk factors to contend with, it is necessary for us to use early therapeutics to stay ahead of Covid-19. In January of 2021, Dr. Peter McCullough, MD and colleagues published an article stratifying treatment options based on risk factors which has helped significantly in treating patients early and avoiding hospitalizations (see diagram 4 below).

Ironically several medications contained in this flow chart are not recommended by the NIH in the treatment of Covid-19. They include doxycycline, azithromycin and hydroxychloroquine. Also not recommended in early treatment of Covid-19, is systemic steroids such as prednisone.

Favipiravir is an oral antiviral that has been used to treat viral infections such as Ebola, rabies and Lassa Fever. It inhibits RNA dependent, RNA polymerase and has been used in Russia and India. Unfortunately favipiravir has not been considered to be tested in clinical trials here in the United States for Covid-19.

Doxycycline has the ability to reduce viral replication, cellular damage and inflammation. Used in conjunction with a medrol dose pack, I am able to keep over 90% of my patients who come down with Covid-19 out of the hospital. All of these patients have MCC’s.

Azithromycin is another antibiotic with antiviral properties. It reduces the endosomal transfer of virons. It also has anti-inflammatory properties, as does hydroxychloroquine. The antimalarial drug hydroxychloroquine also has antiviral properties. Not only does it inhibit endosomal transfer of virons, but it interferes with RNA polymerase activity by helping zinc transfer intracellularly.

Prior to all the controversy involving hydroxychloroquine, I successfully used it along with azithromycin in treating patients early on in the pandemic. Again these were patients with MCC’s. Many of the studies that dismissed this combination stating that it didn’t work, was due to the fact that it was given late in the disease process. Theses medications in any number of combinations can work if given early during active viral replication.

All these drugs can be used safely, but with all medications there are adverse reactions that need to be noted and should be avoided in certain groups. It is well known that azithromycin and hydroxychloroquine together can prolong the QT interval and may trigger a dangerous arrhythmia known as torsades de pointe – it occurs less than 1% of the time. I do not use hydroxychloroquine either with or without azithromycin in patients with known heart disease, especially those with arrhythmias. Doxycycline is well tolerated, but can not be used in pregnant women and cautiously in women of child bearing years considering pregnancy.

Ivermectin is an antiparasitic macrolide with both antiviral and anti-inflammatory properties. Prior to the pandemic, I was using ivermectin for refractory chronic skin ulcers, both systemically and topically. The best work out there right now came from the American Journal of Therapeutics published in May of this year. Ivermectin appears to be beneficial for prophylaxis, early treatment, late treatment and in post Covid patients. I know clinicians who are using ivermectin in all four phases of the disease successfully and I’ve have started incorporating it my practice in battling Covid-19.

Pulmicort is an asthma inhaler that contains budesonide, a corticosteroid which some clinicians are using as an early therapeutic, with or without other adjuncts. Clinical trials are being conducted using Pulmicort. There is some concern in using inhalation therapy because it may exacerbate spread of the virus.

Supplements also play an important role, not only in combating Covid-19, but other respiratory viruses. It is amazing the number of patients I see with vitamin deficiencies. Vitamins A, C and D all have anti-inflammatory properties and Vitamin C is a powerful antioxidant. Zinc helps in decreasing viral replication. Quercetin is an immunomodulator that has been shown to have antioxidant, anti-inflammatory and antihistamine properties and is being used as an adjunct in early treatment of Covid-19. These supplements alone will not prevent Covid-19, but do help in potentially minimizing its effects and act as important support of early therapeutics.

The United States is a diverse population with many chronic conditions – a one-size fits-all approach to this pandemic has not worked, and will not work. As of August 18th, 2021, the CDC has announced that people that received the vaccine early on, are now at risk of severe disease and are urged to get a booster when eligible. We will not be able to vaccinate our way out of this pandemic because of animal resivoirs for the virus. As people struggle with this new surge, many are asking what can be done to avoid hospitalizations. Fortunately more clinicians are beginning to use early therapeutics. As this pandemic continues to evolve, we will need to have more tools in the toolbox, not less.

References for diagrams:
1) EVMS Critical Care Covid-19 Management Protocol: Paul Marik, MD https://www.evms.edu/covid-19/medical_information_resources/
2) Pathophysiological Basis and Rationale for Early OutpatientTreatment of SARS-Cov-2 (Covid-19) Infection. https://doi.org/10.1016/j.amjmed.2020.07.003

By | 2021-08-25T02:16:14-04:00 August 25th, 2021|Infectious Disease|

About the Author:

I am a passionate blogger, author, speaker and 3X Board Certified MD in Infectious Disease, Internal & Sleep Medicine. I currently am an infectious disease physician in Atlanta, GA for Infectious Disease Consultants.

84 Comments

  1. shorten url October 27, 2021 at 3:58 pm - Reply

    Wow, incredible blog layout! How lengthy have you ever been blogging for? you make blogging glance easy. The full look of your website is wonderful, as smartly as the content material!!

  2. Bradleynearm October 31, 2021 at 12:13 am - Reply

    ivermectin 5 http://stromectolivermectin19.online# ivermectin 4
    stromectol 12mg

  3. JohnnieGuill October 31, 2021 at 8:57 pm - Reply

    ivermectin 6 ivermectin 1 topical cream – ivermectin buy online

  4. JohnnieGuill November 1, 2021 at 1:28 pm - Reply

    ivermectin 3mg ivermectin for sale – ivermectin 50 mg

  5. shorten link for twitter November 2, 2021 at 6:42 am - Reply

    Wow, awesome weblog layout! How lengthy have you been blogging for? you make blogging glance easy. The whole look of your web site is magnificent, as well as the content hitman

  6. Quantum Healing Hypnosys Technique November 3, 2021 at 8:06 pm - Reply

    I really appreciate this post. I’ve been looking everywhere for this! Thank goodness I found it on Bing. You’ve made my day! Thank you again! soyos

  7. Rodneysix November 4, 2021 at 2:54 am - Reply

    online pharmacy 365 canada pharmacy safedrg – walmart online pharmacy

  8. Rodneysix November 4, 2021 at 6:46 pm - Reply

    generic drugs india order online buy prescriptions from india pharmacy – buy prescriptions from india pharmacy

  9. Rodneysix November 5, 2021 at 11:13 am - Reply

    trusted india online pharmacies buy medication online from india – buy medication online from india

  10. Rodneysix November 6, 2021 at 4:51 am - Reply

    meds online without doctor prescription buy prescription drugs without doctor – legal to buy prescription drugs from canada

  11. Rodneysix November 6, 2021 at 10:05 pm - Reply

    buy prescription drugs without doctor pet antibiotics without vet prescription – meds online without doctor prescription

  12. Rodneysix November 7, 2021 at 2:05 pm - Reply

    prescription drugs online canadian drug – canadian drugs

  13. Rodneysix November 8, 2021 at 7:42 am - Reply

    cheap generic drugs from india best online international pharmacies india – buy medication online from india

  14. Dunkinrunsonyou.com November 8, 2021 at 8:29 pm - Reply

    I write often and I greatly respect your web content. This fantastic write-up has absolutely actually peaked my attention. I am going to book mark your internet site and keep looking for new information concerning once a week. I opted in for your RSS feed too.

  15. Your internet site is very crucial to your clients. All the bests with regard to creating, thanks with regard to the numerous subjects.

  16. Clintonfus November 10, 2021 at 4:51 am - Reply

    prednisone generic brand name prednisone for sale 5mg – 50 mg prednisone tablet

  17. Clintonfus November 10, 2021 at 9:10 pm - Reply

    hydroxychloroquine-o-sulfate generic plaquenil online – plaquenil singapore

  18. Clintonfus November 11, 2021 at 2:03 pm - Reply

    prednisone 20mg price in india prednisone – prednisone buy cheap

  19. Clintonfus November 12, 2021 at 8:02 am - Reply

    cost of plaquenil in canada plaquenil – hydroxychloroquine covid-19

  20. Clintonfus November 13, 2021 at 1:54 am - Reply

    medicine prednisone 10mg prednisone for sale – can you buy prednisone in canada

  21. Tntdrama activate fire tv November 13, 2021 at 1:05 pm - Reply

    Hey there would you mind letting me know which webhost you’re working with? I’ve loaded your blog in 3 completely different internet browsers and I must say this blog loads a lot quicker then most. Can you suggest a good hosting provider at a honest price? Many thanks, I appreciate it!

  22. Clintonfus November 13, 2021 at 7:24 pm - Reply

    ivermectin over the counter stromectol 3mg tablets – ivermectin drug

  23. Davidnaw November 14, 2021 at 8:38 am - Reply

    cialis generic alternative whats better cialis viagra or levitra

  24. Davidnaw November 15, 2021 at 12:42 am - Reply

    cialis pay with paypal cialis free trial canada

  25. JerryAmuct November 16, 2021 at 6:22 am - Reply

    stromectol order online ivermectin tablets

  26. Visit November 16, 2021 at 4:31 pm - Reply

    Awesome blog! Is your theme custom made or did you download it from somewhere? A design like yours with a few simple tweeks would really make my blog jump out. Please let me know where you got your theme. Cheers

  27. JerryAmuct November 16, 2021 at 10:07 pm - Reply

    stromectol drug ivermectin cream 1%

  28. getchaseslate.com November 17, 2021 at 2:00 pm - Reply

    I love your blog.. very nice colors & theme. Did you create this website yourself or did you hire someone to do it for you? Plz respond as I’m looking to create my own blog and would like to know where u got this from. thank you

  29. Andrepam November 18, 2021 at 12:31 am - Reply

    how long does viagra last viagra without doctor prescription

  30. Andrepam November 18, 2021 at 3:47 pm - Reply

    order viagra online 100 mg viagra lowest price

  31. Tntdrama com/activate November 18, 2021 at 5:39 pm - Reply

    Thanks so much for giving everyone remarkably remarkable possiblity to discover important secrets from this site. It’s always so superb and jam-packed with a great time for me and my office fellow workers to visit your site no less than three times a week to find out the fresh guides you will have. And definitely, I am always happy with your awesome strategies you give. Some two points in this article are unequivocally the most beneficial we have all had.

  32. startwatch.own.tv/activate roku November 18, 2021 at 8:39 pm - Reply

    Today, I went to the beach with my kids. I found a sea shell and gave it to my 4 year old daughter and said “You can hear the ocean if you put this to your ear.” She put the shell to her ear and screamed. There was a hermit crab inside and it pinched her ear. She never wants to go back! LoL I know this is totally off topic but I had to tell someone!

  33. Click here November 19, 2021 at 5:09 pm - Reply

    I am really loving the theme/design of your website. Do you ever run into any internet browser compatibility issues? A handful of my blog visitors have complained about my blog not working correctly in Explorer but looks great in Opera. Do you have any ideas to help fix this problem?

  34. Indigo apply invitation number November 19, 2021 at 8:55 pm - Reply

    I am really loving the theme/design of your blog. Do you ever run into any internet browser compatibility problems? A small number of my blog audience have complained about my site not operating correctly in Explorer but looks great in Safari. Do you have any tips to help fix this issue?

  35. Tntdrama on roku November 20, 2021 at 3:18 am - Reply

    Hey would you mind letting me know which web host you’re using? I’ve loaded your blog in 3 different internet browsers and I must say this blog loads a lot faster then most. Can you recommend a good internet hosting provider at a fair price? Cheers, I appreciate it!

  36. Visit November 20, 2021 at 8:01 am - Reply

    Thanks so much for giving everyone an extremely memorable chance to read critical reviews from this site. It is usually so useful and packed with amusement for me personally and my office fellow workers to search your site really 3 times a week to read through the newest tips you have. Of course, we are actually fulfilled with your brilliant inspiring ideas you give. Some 2 facts on this page are ultimately the most efficient we’ve had.

  37. Mytjx.com login November 20, 2021 at 8:13 am - Reply

    You actually make it seem so easy with your presentation but I find this topic to be really something which I think I would never understand. It seems too complicated and extremely broad for me. I’m looking forward for your next post, I will try to get the hang of it!

  38. Andrepam November 20, 2021 at 9:56 pm - Reply

    viagra without doctor prescription viagra coupons

  39. jetbluemastercard activate November 21, 2021 at 12:21 pm - Reply

    We’re a group of volunteers and starting a new scheme in our community. Your web site provided us with valuable information to work on. You’ve done a formidable job and our whole community will be grateful to you.

  40. Andrepam November 21, 2021 at 3:37 pm - Reply

    can i take cialis with daxpoteine cialis free trial canada

  41. Andrepam November 22, 2021 at 5:56 am - Reply

    cheapest generic cialis online online pharmacy cialis comparison

  42. watchown.tv/activate November 22, 2021 at 6:34 pm - Reply

    Wow! Thank you! I continually needed to write on my blog something like that. Can I implement a fragment of your post to my site?

  43. paramountnetwork com activate November 22, 2021 at 10:12 pm - Reply

    Hmm it looks like your site ate my first comment (it was super long) so I guess I’ll just sum it up what I had written and say, I’m thoroughly enjoying your blog. I too am an aspiring blog blogger but I’m still new to everything. Do you have any recommendations for beginner blog writers? I’d genuinely appreciate it.

  44. Andrepam November 22, 2021 at 10:22 pm - Reply

    100mg viagra without a doctor prescription viagra online

  45. Visit November 22, 2021 at 10:29 pm - Reply

    Hi! I’ve been following your web site for a long time now and finally got the bravery to go ahead and give you a shout out from Humble Texas! Just wanted to mention keep up the excellent job!

  46. Val Treml November 22, 2021 at 10:30 pm - Reply

    How do you make the navbar in blogger come back?

  47. Best Dating Site November 23, 2021 at 5:32 am - Reply

    nuebqq12

  48. Andrepam November 23, 2021 at 2:45 pm - Reply

    cialis online from canada cheap cialis generic online

  49. usbankrewardscard.com activate November 23, 2021 at 10:28 pm - Reply

    I would like to voice my gratitude for your generosity in support of women who really need help with this one matter. Your real dedication to getting the solution all over has been exceedingly functional and has all the time permitted folks like me to reach their desired goals. Your own insightful tips and hints indicates a whole lot a person like me and extremely more to my office workers. Thanks a ton; from all of us.

  50. Andrepam November 24, 2021 at 7:36 am - Reply

    hydroxychloroquine 200mg 60 tablets hydroxychloroquine 400

  51. trang 12bet 12BetNo1 November 24, 2021 at 12:49 pm - Reply

    Excellent blog here! Also your site loads up fast! What host are you using? Can I get your affiliate link to your host? I wish my website loaded up as fast as yours lol

  52. Andrepam November 25, 2021 at 12:14 am - Reply

    generic viagra cheap viagra

  53. DavidExism November 25, 2021 at 9:13 pm - Reply

    tamoxifen side effects forum nolvadex side effects – tamoxifen dose

  54. Slabway reviews November 26, 2021 at 2:40 am - Reply

    I am really enjoying the theme/design of your site. Do you ever run into any internet browser compatibility issues? A couple of my blog visitors have complained about my site not operating correctly in Explorer but looks great in Firefox. Do you have any advice to help fix this problem?

  55. Appreciating the dedication you put into your website and in depth information you offer. It’s great to come across a blog every once in a while that isn’t the same unwanted rehashed material. Great read! I’ve saved your site and I’m including your RSS feeds to my Google account.

  56. Joebak November 26, 2021 at 8:51 am - Reply
  57. Echelon Smart Treadmill Reviews November 26, 2021 at 12:28 pm - Reply

    Hello I am so excited I found your blog, I really found you by mistake, while I was researching on Aol for something else, Anyhow I am here now and would just like to say cheers for a incredible post and a all round entertaining blog (I also love the theme/design), I dont have time to look over it all at the minute but I have bookmarked it and also added your RSS feeds, so when I have time I will be back to read a great deal more, Please do keep up the fantastic job.

  58. DavidExism November 26, 2021 at 1:18 pm - Reply

    ventolin prescription canada ventolin generic – ventolin price usa

  59. Echelon Smart Treadmill Reviews November 26, 2021 at 2:11 pm - Reply

    I would like to voice my admiration for your kind-heartedness in support of those who actually need guidance on this question. Your real dedication to passing the message around had been exceptionally advantageous and have in every case helped associates much like me to get to their dreams. Your own invaluable facts entails a whole lot to me and somewhat more to my fellow workers. Thanks a lot; from all of us.

  60. Bluebird November 27, 2021 at 12:48 am - Reply

    I keep listening to the news speak about receiving boundless online grant applications so I have been looking around for the top site to get one. Could you advise me please, where could i get some?

  61. DavidExism November 27, 2021 at 4:09 am - Reply

    450 mg wellbutrin daily generic wellbutrin – generic wellbutrin online no rx

  62. Anker powerhouse 400 ii November 27, 2021 at 5:01 pm - Reply

    I am extremely impressed with your writing skills as well as with the layout on your blog. Is this a paid theme or did you customize it yourself? Either way keep up the excellent quality writing, it is rare to see a great blog like this one these days..

  63. Anker powerhouse 400 II review November 27, 2021 at 7:52 pm - Reply

    Hey There. I found your blog using msn. This is a very well written article. Ill be sure to bookmark it and come back to read more of your useful information. Thanks for the post. I will definitely return.

  64. DavidExism November 27, 2021 at 9:41 pm - Reply

    wellbutrin australia cost wellbutrin without prescription – wellbutrin 450 tablet

  65. DavidExism November 28, 2021 at 2:57 pm - Reply

    tamoxifen generic nolvadex price – what is tamoxifen used for

  66. DavidExism November 29, 2021 at 8:31 am - Reply

    order ventolin from canada no prescription ventolin over the counter – ventolin 200

  67. Best Dating App 2021 November 30, 2021 at 1:35 am - Reply

    ❤️ Alice want to meet you! Click Here: http://bit.do/fSJVK ❤️

  68. DavidExism November 30, 2021 at 2:45 am - Reply

    nolvadex price nolvadex – tamoxifen warning

  69. Peacock tv activate November 30, 2021 at 7:12 pm - Reply

    Wow, marvelous blog layout! How long have you been blogging for? you make blogging look easy. The overall look of your web site is wonderful, as well as the content!

  70. Click here November 30, 2021 at 9:27 pm - Reply

    I really like your blog.. very nice colors & theme. Did you create this website yourself or did you hire someone to do it for you? Plz answer back as I’m looking to construct my own blog and would like to find out where u got this from. appreciate it

  71. amex.us/magnetrsvp December 1, 2021 at 12:44 am - Reply

    I would like to express appreciation to this writer just for bailing me out of such a setting. Just after scouting through the online world and getting proposals which were not beneficial, I assumed my entire life was over. Existing without the approaches to the difficulties you’ve fixed through the article is a critical case, as well as ones which might have in a wrong way affected my entire career if I hadn’t encountered your web site. Your primary competence and kindness in taking care of every item was vital. I am not sure what I would’ve done if I hadn’t come upon such a thing like this. I am able to at this time relish my future. Thanks very much for the professional and result oriented help. I won’t think twice to recommend your blog post to anybody who needs to have guide about this situation.

  72. shortening alternative December 1, 2021 at 9:19 am - Reply

    Wow, incredible weblog format! How lengthy have you been blogging for? you made running a blog look easy. The total glance of your site is great, as neatly as the content!

  73. click here December 1, 2021 at 8:50 pm - Reply

    It’s a shame you don’t have a donate button! I’d without a doubt donate to this fantastic blog! I guess for now i’ll settle for book-marking and adding your RSS feed to my Google account. I look forward to brand new updates and will talk about this site with my Facebook group. Talk soon!

  74. mercurycards.com/activate today December 2, 2021 at 2:32 am - Reply

    I truly wanted to make a small remark in order to appreciate you for all the magnificent facts you are placing on this website. My prolonged internet research has at the end of the day been compensated with excellent facts and techniques to share with my family and friends. I ‘d admit that we visitors actually are unquestionably fortunate to be in a perfect website with so many wonderful professionals with great tips. I feel extremely blessed to have come across your web pages and look forward to so many more enjoyable moments reading here. Thank you once again for everything.

  75. click here December 2, 2021 at 7:03 am - Reply

    Great post however , I was wondering if you could write a litte more on this subject? I’d be very grateful if you could elaborate a little bit more. Kudos!

  76. Visit December 3, 2021 at 2:12 am - Reply

    There is obviously a lot to realize about this. I believe you made certain nice points in features also.

  77. Disney plus begin December 3, 2021 at 3:44 am - Reply

    I wish to express my appreciation to this writer just for rescuing me from this particular scenario. After exploring throughout the online world and seeing views which are not powerful, I assumed my life was well over. Being alive without the presence of strategies to the issues you have sorted out as a result of the posting is a critical case, as well as the ones that could have in a wrong way affected my career if I hadn’t noticed the blog. That ability and kindness in touching all areas was priceless. I am not sure what I would’ve done if I had not come upon such a stuff like this. I can also now relish my future. Thanks a lot so much for your high quality and result oriented help. I won’t hesitate to recommend your blog to anybody who will need assistance on this topic.

  78. Paramountnetwork activate December 3, 2021 at 4:59 am - Reply

    Fantastic beat ! I would like to apprentice while you amend your web site, how can i subscribe for a blog site? The account aided me a acceptable deal. I had been tiny bit acquainted of this your broadcast provided bright clear concept

  79. DonaldNoigh December 3, 2021 at 5:55 am - Reply

    cipro cheap online generic drugs generic drugs online lasix cheap generic drugs from canada

  80. DonaldNoigh December 3, 2021 at 10:51 pm - Reply

    cytotec cheap generic drugs from india cheap online generic drugs cipro cheap generic ed pills

  81. www.bluebird.com December 4, 2021 at 3:09 pm - Reply

    I just couldn’t depart your website prior to suggesting that I really enjoyed the standard info a person provide for your visitors? Is gonna be back often in order to check up on new posts

  82. DonaldNoigh December 4, 2021 at 3:57 pm - Reply

    lasix buy generic drugs online cheap generic ed pills prednisone buy generic drugs online

  83. bluebird.com/activate card December 4, 2021 at 7:34 pm - Reply

    magnificent points altogether, you simply gained a brand new reader. What would you suggest in regards to your post that you made some days ago? Any positive?

Leave A Comment

Join 10,000 Subscribers
AND GET DR. PUGLIESE'S LATEST CONTENT IN YOUR INBOX

SUBSCRIBE 
Your information will never be shared
close-link
Sign up and receive the latest blog posts & take back your health!
Subscribe
Subscribe
close-image