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This was originally published here, in French (link).
We provide this translation for your convenience. Practical aspects may differ where you live.



Coronavirus, HIV, ARVs, intermittence...(17)

Coronavirus: We do the math

Graphic update by worldometers and Southern France Morning Post.

01/06/20: Self-medication, risks and medical failure

Karine Lacombe: premium non nocere, secondo nulla fare: that's my kitchen Latin! First do no harm and second do nothing! Well... What do we need old-fashioned precepts in the 21st century? If she was really in the premium no-no, Karine Lacombre, self-proclaimed HIV expert, and furiously insignificant, she would have jumped in the Intermittence train. Que neni.

Cardiac ? The double punishment We understand that the people most at risk of succumbing are the very old and/or the cardiac. Raoult tells us that thanks to HCQ/AT, there is no mortality under 70 years old (except for 1). So, in the arms of the valiant Raoult, only very old patients, mostly cardiac, died. These are the ones who would have benefited the most from a miracle treatment... However, they are probably the ones who were excluded from the treatment (...in order not to harm, as Karine Lacombe would say...): by excluding them from the treatment, they were probably condemned to die from COVID, rather than from QT prolongation or even torsade de pointes, which certainly sometimes killed, but not that much... The prolongation of QT, or even torsade de pointe, is not, far from it, a death sentence. We do not yet have the analysis of the control group at the IHU. We will see...

Angiotensin blockers (sartans): a predictable pharmaceutical risk, a deleterious prescription... They act by lowering blood pressure, hence the indication in arterial hypertension. In patients with systolic heart failure, they reduce the symptoms and the risk of cardiac accidents and are therefore an alternative to conversion enzyme inhibitors. Given the affinity of SARS-CoV-2 for Angiotensin, the existence of alternatives to Sartans, and their moderate usefulness, one may ask the question: should patients on Sartans be taken off their treatment, even temporarily, for the duration of the epidemic? The precious Lorgeril had this thought about COVID: 'There are many questions about ACE inhibitors and sartans; it would be better to stop them as a precaution and limit ourselves (for hypertension) to diuretics and beta-blockers...'.

02/06/20: Factor X and childhood immunity

The health crisis in France has left its mark...in Asia...Often cited as an example of excellence in its health system, the emperor was naked! Hence the opposite question... Why so few cases in Vietnam, and in Asia, home first? Everyone has their own explanation for what is known as the X factor (favorable). The question of the mortality of the elderly, in particular those on Satan sartans, will be all the more interesting as the WHO has published a very surprising opinion: that the ingestion of these molecules should not be stopped. Would hypertension be a risk factor for SARS-CoV-2? Covid-19 penetrates through the angiotensin 2 converting enzyme receptor. Hence the hypothesis raised that high blood pressure would worsen the infection. If so, should ACE inhibitors and sartans be stopped?

The WHO's argument is specious... In fact, there are 2 indications for sartans, serious cardiac pathology and common hypertension. Normally, in the first indication, which is rare, stopping the drug is harmful. In the second, temporary discontinuation, with possible substitution by an alternative, is not at all of the same gravity: 2 indications, with 2 distinct benefit/risk assessments (keeping in mind that the COVID risk is very high in patients on sartans). 2 groups, 2 potential decisions. The WHO takes the argument from one to apply it to the other. This reminds us of the phantom over-risk of START where the risk observed in countries with a high prevalence of tuberculosis is applied to you, which is idiotic, it should be remembered, especially for Molina, who has been a champion of it. Here is the WHO opinion COVID-19 and the use of angiotensin-converting enzyme inhibitors and receptor blockers, which concludes: 'There is low-certainty evidence that patients on long-term treatment with ACE inhibitors or ARBs are not at increased risk of malignant COVID-19'. So much for talking about nothing. Evidence that is considered inconclusive is not evidence... FRHTA, a promotional site targeting hypertensives, goes further, finding arguments in favor of taking sartans: 'anti-hypertensive treatments including a sartan or an ACE inhibitor should be continued during the COVID-19 epidemic because they may provide additional protection in case of a severe form of coronavirus infection'. The European Society of Cardiology quickly hammered home the point and recommended that ACE inhibitors or sartans should not be taken unless there are 'severe symptoms or sepsis'. I am as suspicious of the SEC as I am of the EACS (you know... Molina, Raffi...)... They are all false noses!

The Raoult Bomb: children were immune The benign Coronaviruses circulate every year, undetected, because without symptoms, in our toddlers. Who thus preserved a certain immunity. Enough for us to ask ourselves the question: what good will it do to vaccinate immunized populations? From there to find that the famous factor X, in Asians, was a pre-exposure to the benign coronavirus... We will see. The Raoult bomb is here: #LancetGate. The Nickel Pieds make science.

03/06/20: Self-Medication and the Failure of Medicine

Harvey A. Risch's article: Early outpatient treatment of symptomatic high-risk Covid-19 patients should be expanded immediately as a key to the pandemic crisis, is a good analysis of the current decision-making landscape. In the side effects section, it is noted that cardiac rhythm disturbances are rare and even when they occur they do not expose to a significant or immediate fatal risk. As this is a short treatment, prior screening by ECG is unnecessary. Thousands of screenings are needed to avoid a single death (in this case, it is necessary to reason in NTT - Number to treat). The number of ECGs to be performed to avoid even one death is enormous: it is impracticable and useless in a context of widespread generalization, which is obviously desirable.

You have been sold fear upon fear. In the light of the figures put forward, the warnings of Miss Lacombe, appear for what they are: a total perversion of medical thought.

A chain of incapacitated people: doctors could not prescribe, pharmacists could not deliver, logisticians could not supply, importers could not transport: it's like masks... Useless until we had them, they then became mandatory

A vaccine for immunized people !!?? Really??? There is an amusing theory that the immunity due to the BCG vaccination, abandoned in our country, still practiced in Asia, would be this X factor, the one that makes the difference between the West and the East... You have been (in-)voluntarily infected by a benign pathogen and here you are, immune, defeated, against a new and malignant pathogen... In a way, it is true... An indirect immunity... Why not ? It's the principle of BCG. That's also the reason why I only get the flu shot once in a while. So the idea is not stupid in principle. Except that if we follow what Raoult says, this secondary immunity has been conferred by benign coronaviruses, which have circulated widely, under the radar, in the past years. Kids from 5 to 10 years old have (not) seen many of them. At the mature age, this immunity decreases to be null in the old ages. (This is why the idea of vaccinating the elderly against the flu, without vaccinating the active carriers, the little ones we like to kiss, is so strange...). So we have locked up by force some little ones full of energy to spare, and we are going to want to vaccinate them by force!???

04/06/20: The foxes and the rabbits cry Robert MAY

We're going through a bad patch... Those who are familiar with the Leibowitchian pen may have had some difficulty in understanding the repeated allusion to rabbits, foxes and the forest. In simple cases, the evolution of populations can be modeled: this is the case of rabbits and lynx in Hudson Bay. The animal skins follow cycles: the years with rabbits, the foxes reproduce, the following year, they exterminate the rabbits, so they have nothing to eat, so no offspring, and the following year the rabbits are abundant, etc. This prey-predator model can be found in many fields.

As for the 2-body physics, it is quite easily solved through a 2-component Lokta-Volterra. As with the 3-body problem, the mathematics of a 3-component Lokta Voltera is difficult to access. However, the CD4/CD8 system is a dual and constrained system (because CD4 + CD8 = 70%). For rabbits, foxes, this constraint is the forest... We would like to understand the dynamics of the CD4 and CD8 populations, because the non-reconstitution of CD4 is a concern for some patients. A simple(simplistic?) version is to say that CD4 does not come back well, sometimes, because the forest is destroyed. This is the Leibowitchian metamorphosis. It is Lokta-Volterra with 2 populations and one constraint (CD4, CD8 and lymphoid tissue). The points of divergence between Leibo and Charles-Edouard are not numerous, and there, you have one. Anyway... I have points of difference with everyone, including myself... I know how to live in good understanding with the divergent ones.

Sir Robert May, baron of Oxford, aquitted us at 84 years(see Nature). Robert MAY made the first resolution of the Lokta-Volterra at 3 populations... If we know how to do, we can do. Leibo, him, he did not know, therefore he did not make. His metaphor is pretty and unusable. The Charles-Edouard, she knows how to do (thanks to R. MAY), therefore she does, and her metaphor brings more. One day, I will explain... Beyond the theoretical resolution of the 3 populations system, R. May has contributed a lot to the understanding of systems whose appearance is complex, even random, and the underlying equation is disconcertingly simple.

But to find the system of simple laws, underlying an observation which does not seem to make any tail nor head, it is a trade. The dynamics of complex systems is unintelligible to those who have not acquired the basic mathematical concepts. So, this is not the object here... My metaphor is CD4, CD8 and ... and ... and ... Well, I'll keep that to myself. But once we understand, and as Sonigo says 'biologists do not understand anything'The world is illuminated in a different way.

Leibowitch has shown us how to take advantage of the entry into the Eclipse, but not how to exploit the exit from the Eclipse, which is possibly a key to eradication. The 1/7 is still pretty damn limiting, especially when, in light of the hundred or so patients who do it, there is almost no failure. So we don't go far enough. 4/7 is trivial, and we only limit ourselves to 1/7 because Leibowitch needed to keep his precursor patients on a leash.
Robert May allowed me to cross the Rubi-con, and here we are in a vast field of exploration, the 1/15 and beyond, whose limit is not known. Thanks Bob!

06/06/20: THE AFFAIRS: our enemies come out of the woodwork

If Polanski had some success with Dreyfus, a hackneyed story, there is no need to imagine the Holywoodian success of a BioPic Raoult. The line of demarcation between Pro and Anti HCQ/AT is exactly the same as the one between intermittence and continuous treatment. But how do we know who and who, and why does it matter? Many doctors talk about others in an eliptical way, so as not to fall under the 'justice' of the ordinal (corporatism too). In public, Leibo denounced the 'barons of the chairs', without naming them. So, when you are on the side of the patients, it is anxiety-provoking and unworkable. HCQ/AT served as a revelation and the 'Raoult' side drapes itself in Care, while the 'Lacombe' side claims to be Research. Nothing could be further from the truth: Lacombe/Lescure have no contribution to research, whereas Raoult, discoverer of the Mimivirus, for example , is another bigwig in research... Already the claim of the label is false, and the divide is real and on an unequivocal front lineOn the one hand, there are the non-affiliates, on the other hand, there are the Co-Labo. This is obviously important, because I maintain a list of experienced doctors in Intermittence, and, we can now name the enemy: the list of signatories of an anti-Raoult appeal, to make a long story short, is remarkable(it is here). So I completed my list of allied doctors with a list of anti-Raoult doctors. It's worth what it's worth, but it's good...

the nickel feet of French virology:

Raoult used the same expression as me... It's probably just a coincidence... Finally, I can see where the expression 'Limpimpim's father powder' comes from. You learn something new every day.

EHPAD: the anguish remains: While the Indian Journal of Medicine publishes the results of a study on anti-Covid prophylaxis with HCQ, our elders are at the exact same risk as 2 months ago: It is enough that it appears in an EHPAD and it is the hecatombe. However, we still haven't ruled on the prophylaxis of caregivers... The most rifdiculous in the case is the inclusion of Nivaquine in list 2... Nivaquine?! It's just the active ingredient of our great grandparents' quinine syrup. We are in full delirium!

Apparently, France Soir made a not too stupid cover. Read also this article

07/06/20: How to prepare for the next crisis

The only thing that is predictable is that it will come back... 17 years between the 2 SARS, with MERS in between: next time we'll be a little better prepared. List under construction: masks, alcohol and gel, PQ, Kleenex, thermometer, flour, Zinc, Azythromycin, Doxycycline, HCQ, Oximeter, taste kit, smell kit, cash, meds,

Prophylaxis or treatment? in the context of therapeutic reduction...

Supposed interactions between HCQ and common ARVs (in progress... 05/05)
Molecule	suspected effect
Abacavir	No corresponding record
Emtricitabine	No corresponding records
Lamivudine	No matching records
Tenofovir	No matching records
Efavirenz	The risk or severity of QTc prolongation may be increased when hydroxychloroquine is combined with efavirenz.
Etravirine	No corresponding records
Nevirapine	Nevirapine metabolism may be decreased when combined with hydroxychloroquine
Rilpivirine	Risk or severity of QTc prolongation may be increased when hydroxychloroquine is combined with Rilpivirine
Atazanavir	Risk or severity of QTc prolongation may be increased when hydroxychloroquine is combined with Atazanavir
Darunavir	No corresponding records
Fosamprenavir	No corresponding records
Lopinavir	Serum hydroxychloroquine concentration may be increased when combined with lopinavir.
Tipranavir	Tipranavir metabolism may be decreased when combined with hydroxychloroquine
Bictegravir	No corresponding records
Dolutegravir	No corresponding records
Elvegravir	No matching records
Raltegravir	No matching records
Cobicistat	No matching records
Ritonavir	Ritonavir serum concentration may be increased when combined with hydroxychloroquine
Maraviroc	No corresponding records
cave canem de rigueur this blog is not medical advice (especially since medicine has proven to be poor) source: drugbank