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Single Dose Treatment May Reduce the Necessity for Ventilation in COVID-19 Patients

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By Eddie Fatakhov, M.D.

With an appropriate primary focus being on the treatment options for currently infected COVID-19 patients, the question still lingers as to if there are any additional potential preventative treatments, outside of social distancing and quarantine, that may be used by healthcare professionals on the frontlines and people considered in the high-risk category that have yet to contract the virus.  

The public has been made aware of the anti-malaria drug, hydroxychloroquine, being used in hospitalized patients as a potential treatment.  While those trials are unfolding and a vaccine actively in the works, prevention is still a major concern for those who are healthy but in contact with confirmed cases and for the population that is high-risk but has remained virus-free for now.   

As this pandemic rapidly evolves throughout the world, researchers and physicians are aggressively looking into the reasons why certain COVID-19 infected patients are rapidly declining and how this could possibly be prevented.  Recent research has suggested that COVID-19 is starting as a viral infection in the upper respiratory system.  As it progresses, it is migrating to the lower respiratory system – resulting in mechanical ventilation of a vast number of patients. 

Hospitals are flooded and being forced to allocate ventilators to the sickest of the sick.  The mechanisms of action by hydroxychloroquine could possibly hinder the virus from moving from the upper to lower respiratory tract – in turn making mechanical ventilation less likely to be a necessity. 

Hydroxychloroquine has shown to accumulate in highest concentrations in the liver, adrenal and lung tissue in rodent trials.  Determination of a drug’s potency needed to induce the desired response, also known as the EC50 value, is key to the potential effectiveness of a drug.  Physiological-based pharmacokinetic models (PBPK) have been implemented to simulate the concentrations of hydroxychloroquine in the body. 

The results suggest that a single dose of 800mg of hydroxychloroquine may provide a lung tissue concentration that is greater than twenty times the required EC50 values necessary to inhibit COVID-19 in the lungs.  A single dose of 200mg of hydroxychloroquine has a half-life of 22 days, meaning that half of the administered dose remains in the system at day 22.  This evidence would lead to the potential of greatly reducing COVID-19 induced lung damage.  This lung damage leads to increased necessity of mechanical ventilation.   

If proven to be effective, this would not stop one from contracting the virus itself.  It would potentially stop the virus from progressing to such deadly states with possibly as little as one dose taken every three weeks.  Further research is needed to continue to validate these findings but provides hope for those who are battling this virus on the frontline that there may be a protective option available in coming days.   

Eddie Fatakhov, M.D., is a Board-Certified Physician, Nutritionist and Best-Selling Author.

References:  

Concordia Pharmaceuticals Inc. (2015). Plaquenil® hydroxychloroquine sulfate tablets, USP.

Tansan, S. (n.d.). A possible role for single dose hydroxychloroquine for prevention of lethal coronavirus infection.

 Yao, X., Ye, F., Zhang, M., Cui, C., Huang, B., Niu, P., Liu, X., Zhao, L., Dong, E., Song, C., Zhan, S., Lu, R., Li, H., Tan, W., & Liu, D. (2020). In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, ciaa237. Advance online publication. 

Yimin, W., Nygard, G. A., Ellertson, S. L., & Khalil, S. K. W. (1995). Stereoselective disposition of hydroxychloroquine and its metabolites in rats.

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