MESSAGE
| DATE | 2020-05-03 |
| FROM | Ruben Safir
|
| SUBJECT | Subject: [Hangout - NYLXS] Blood Clots in the lungs - Wuhan-19
|
https://www.onlinelibrary.wiley.com/doi/epdf/10.1111/jth.14828
Tissue Plasminogen Activator (tPA) Treatment for COVID‐19 Associated
Acute Respiratory Distress Syndrome (ARDS): A Case Series
Janice Wang Negin Hajizadeh Ernest E. Moore Robert C. McIntyre Peter
K Moore Livia A. Veress Michael B. Yaffe Hunter B. Moore Christopher
D. Barrett
First published:08 April 2020 https://doi.org/10.1111/jth.14828Citations: 5
This article has been accepted for publication and undergone full peer
review but has not been through the copyediting, typesetting, pagination
and proofreading process, which may lead to differences between this
version and the Version of Record. Please cite this article as
doi:10.1111/jth.14828
PDFTOOLS SHARE
Abstract
A hallmark of severe COVID‐19 is coagulopathy, with 71.4% of patients
who die of COVID‐19 meeting ISTH criteria for disseminated intravascular
coagulation (DIC) while only 0.6% of patients who survive meet these
criteria (1). Additionally, it has become clear that this is not a
bleeding diathesis but rather a predominantly pro‐thrombotic DIC with
high venous thromboembolism rates, elevated D‐dimer levels, high
fibrinogen levels in concert with low anti‐thrombin levels, and
pulmonary congestion with microvascular thrombosis and occlusion on
pathology in addition to mounting experience with high rates of central
line thrombosis and vascular occlusive events (e.g. ischemic limbs,
strokes, etc.) observed by those who care for critically ill COVID‐19
patients (1‐7). There is evidence in both animals and humans that
fibrinolytic therapy in Acute Lung Injury and ARDS improves survival,
which also points to fibrin deposition in the pulmonary microvasculature
as a contributory cause of ARDS and would be expected to be seen in
patients with ARDS and concomitant diagnoses of DIC on their laboratory
values such as what is observed in more than 70% of those who die of
COVID‐19 (8‐10).
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Tissue Plasminogen Activator (tPA) Treatment for COVID-19 Associated Acute
e
Respiratory Distress Syndrome (ARDS): A Case Series
lc Janice Wang MD1*; Negin Hajizadeh MD, MPD1*; Ernest E. Moore MD2,3;
Robert C.
McIntyre MD3; Peter K Moore MD4; Livia A. Veress MD5; and Michael B.
Yaffe MD;
it PhD6,7; Hunter B. Moore MD, PhD†3 and Christopher D. Barrett MD†6,7
r1. Feinstein Institutes for Medical Research, Northwell Health,
Manhasset, NY USA
A Denver, 2. Ernest CO E USA
Moore Shock Trauma Center at Denver Health, Department of Surgery,
3. Department of Surgery, University of Colorado Denver, Aurora, CO USA
d 4. Department of Medicine, University of Colorado Denver, Aurora, CO USA
5. Department of Pediatrics, Pulmonary Medicine, University of Colorado
Denver, Aurora,
e Colorado, USA
t 6. Koch Institute for Integrative Cancer Research, Center for
Precision Cancer Medicine,
p Departments Technology, Cambridge of Biological MA, USA
Engineering and Biology, Massachusetts Institute of
e 7. Surgery, Division Beth of Acute Israel Deaconess Care Surgery,
Medical Trauma Center, and Surgical Harvard Medical Critical Care,
School, Department Boston, MA
of
c USA
cA This differences through article the between has copyediting, been
this accepted version typesetting, for and publication the pagination
Version and and of undergone Record. proofreading Please full peer
process, cite review this which article but has may as doi:
not lead been
to
10.1111/JTH.14828
This article is protected by copyright. All rights reserved
To whom correspondence should be addressed: E-mail:
hunter.moore-at-ucdenver.edu
e
or cdbarret-at-mit.edu, Ph: 617-452-2103, Fax: 617-452-2978
l * denotes co-first authors
c † denotes co-corresponding authors
it Keywords: COVID-19; Acute Respiratory Distress Syndrome (ARDS); Tissue
r Plasminogen Activator (tPA); Fibrinolysis; Case Report
A both Conflicts coagulation/fibrinolysis of Interest: CDB, diagnostics
HBM, EEM, and and therapeutic MBY have fibrinolytics, patents pending
and are related passive
to
co-founders and holds stock options in Thrombo Therapeutics, Inc. HBM
and EEM have
d received grant support from Haemonetics and Instrumentation
Laboratories. MBY has
previously received a gift of Alteplase (tPA) from Genentech, and owns
stock options as
e a co-founder of Merrimack Pharmaceuticals. LAV has received grant
support from
t Genentech. JW, NH, RCM, and PKM having nothing to disclose.
p Author Contribution Statement: JW, NH and CDB prepared the manuscript with
e critical input and revisions from EEM, RCM, PKM, LAV, MBY, and HBM.
c INTRODUCTION
c of COVID-19 A hallmark meeting of severe ISTH criteria COVID-19 for
disseminated is coagulopathy, intravascular with 71.4% coagulation of
patients (DIC)
who die
A while only 0.6% of patients who survive meet these criteria (1).
Additionally, it has
This article is protected by copyright. All rights reserved
become clear that this is not a bleeding diathesis but rather a
predominantly pro-
e
thrombotic DIC with high venous thromboembolism rates, elevated D-dimer
levels, high
l fibrinogen levels in concert with low anti-thrombin levels, and
pulmonary congestion with
c microvascular thrombosis and occlusion on pathology in addition to
mounting
experience with high rates of central line thrombosis and vascular
occlusive events (e.g.
it ischemic limbs, strokes, etc.) observed by those who care for
critically ill COVID-19
r patients (1-7). There is evidence in both animals and humans that
fibrinolytic therapyAcute Lung Injury and ARDS improves survival, which
also points to fibrin deposition in
A the expected pulmonary to bemicrovasculature seen in patients with as
a ARDS contributory and concomitant cause of ARDS diagnoses and would of
DIC be
on their
in
laboratory values such as what is observed in more than 70% of those who
die of
d COVID-19 (8-10). The following are 3 case reports of using tissue
plasminogen
activator (t-PA) in critically ill, mechanically ventilated COVID-19
positive patients with
e ARDS where extracorporeal membrane oxygenation (ECMO) capabilities,
staffing and
t resources are extremely limited as a result of the current COVID-19
pandemic.
p Case 1
e mellitus, 75 and year-old coronary male artery with disease a history
presented of hypertension, to the hospital hyperlipidemia, with 1 week
type of 2 cough,
diabetes
c fatigue and fevers. Vital signs on presentation were T 38.5° Celsius,
HR 87 bpm, BP
c 133/78 glass opacities mm Hg,with RR 22, peripheral SpO2 91% and
basilar on room predominance; air. CT chest revealed COVID-19 bilateral
testing ground
was
A positive. Hydroxychloroquine and azithromycin were started and given
for five days. His
This article is protected by copyright. All rights reserved
oxygen requirement increased from 4 – 6 LPM O2 supplementation on day of
admission
e
(DOA) to 100% FiO2 on a non-rebreather mask (NRB) by day 3, with oxygen
saturation
l (SpO2) improving from 85% to 91% with positioning in the awake prone
position.
c Unfortunately, his severe hypoxemia persisted and he was intubated on
hospital day
(HD) 6 at which time his PaO2/FiO2 (P/F) ratio was 73. His FiO2 requirements
it remained >60% despite maximal ventilatory strategies, his D-dimer
levels were
r consistently > 50,000 ng/ml for the four days following his intubation
and his fibrinogen
levels ranged between 375 to 541 mg/dl. On HD 8 his P/F ratio ranged
between 140 to
A 240 therapy and(CRRT); he became that anuric combined for which with
persistently he was initiated elevated on continuous D-dimer, the renal
decision replacement
was
made to administer tPA (Alteplase) 25mg intravenously over 2 hours,
followed by a
d 25mg tPA infusion over the subsequent 22 hours. The patient tolerated
tPA therapy
without bleeding or any other apparent complication. Eleven hours into
his tPA infusion
e his P/F ratio had improved to 408, a 2-fold improvement from pre-tPA.
Following
t completion of the tPA infusion, a heparin infusion was started at 10
units/kg/hour withp PTT There goal was of a60-80. concern One for hour
fluid into overload his heparin and pulmonary infusion, his edema P/F
ratio given worsened he was 1 to liter
136.
e positive efforts to on remove his fluid volume balance via for CRRT
the prior were 24 complicated hours and by remained the development
anuric on CRRT, of rapid but
atrial
c fibrillation and hypotension which made it difficult to achieve a
negative fluid balance.
c His phenylephrine, vasopressor and requirements vasopressin).
increased At 48 hours from post-tPA one to three his (norepinephrine,
P/F was 188-250, similar to
A his pre-tPA status. His fibrinogen levels remained similar at 351
mg/dl and his D-dimer
a
This article is protected by copyright. All rights reserved
had decreased to 16,678 ng/ml. Unfortunately, by HD 11 the patients
continued to
e
descend into multiple organ failure with refractory hypotension
secondary to arrhythmia
l and superimposed bacterial infection. He was made DNR and expired
shortly after.
cCase 2
it 59 year-old female with a history of hypertension presented to an
outside hospital
r after two days of rhinorrhea, cough, myalgias, and headaches. Vital
signs from her
initial presentation at the outside hospital are not available. CT chest
demonstrated
A bibasilar Hydroxychloroquine predominantly and ground azithromycin
glass opacities were initiated. and COVID-19 Her oxygen testing requirement
was positive.
progressed over two days from nasal cannula O2 supplementation to 100%
NRB withd PaO2 of 137. On HD 4 she required intubation for hypoxemic
respiratory failure and
was transferred to our hospital. She required one vasopressor for
hemodynamic support
e and chemical paralysis in addition to sedation. Her P/F ratio was 82
supine and
t improved to the 130’s in the prone position. On return to supine
position her P/F ratio
p to dropped 20,293 back ng/ml toby asHD low 9 as with 90. a On
fibrinogen HD 6 her level D-dimer of 939 was mg/dl. 545After ng/ml 4 and
days this of being
increased
e (Alteplase) intubated and was 2 administered days in the prone as a
position 25mg intravenous with no durable bolus improvements, over 2
hours, followed IV tPA
by a
c 25mg tPA infusion over the subsequent 22 hours. The patient tolerated
tPA therapy and
c was At 4 hours transitioned after completing to heparin tPA therapy
her (as P/F in was Case 135 1) (prone without position) any bleeding
which was complications.
similar to
A pre- tPA, but by 12 hours after completing tPA her P/F ratio had
improved to 150 (prone
a
This article is protected by copyright. All rights reserved
position) with D-dimer increased to 40,490 ng/ml. By 38 hours after
completing the tPA
e
infusion the patient continued to improve and was placed back in the
supine position
l where the P/F ratio was now 135, a 50% improvement in supine position
P/F ratio
c compared to the P/F of 90 in the supine position three days earlier.
it Case 3
r 49 year-old male with no known medical history presented with 6 days
of cough,
progressive dyspnea, fever, and myalgias. Vital signs on presentation
were T 36.5°
A Emergency Celsius, HRDepartment 133 bpm, BP and 115/74 improved mm Hg,
to 90% RR of on 24. 100% SpO2 FiO2 was via 40% NRB, onhowever room air given
in the
increased tachypnea he was intubated and required one vasopressor for
hemodynamic
d support, sedation and chemical paralysis. A CT chest was performed and
revealed
bibasilar ground glass opacities. Positive end-expiratory pressure
(PEEP) of 20 was
e initially used, however he developed pneumopericardium and thus his
PEEP was
t reduced. Hydroxychloroquine and azithromycin were started as well as
heparin drip for
p HD suspicion 2 had of reduced venous to thromboembolism. 17,301 ng/ml.
His On P/F HD ratio 1 was his D-dimer 120 in the was prone 33,228
position, ng/ml and and in
on
e the tPA supine (Alteplase) position was his administered P/F ratio
ranged similarly from to 72-90. as in Cases His heparin 1 and 2, drip
with was the held heparin and IV
drip
c resuming immediately after completion of the tPA infusion. His supine
P/F improved
c from increase. 72-90 There pre-tPA were to no a P/F bleeding of 125
complications. by 3 hours after After completion tPA, his D-dimer of
tPA, a increased 38-73%
from
A 17,301 ng/ml to 37,215 ng/ml and his fibrinogen decreased from 874
mg/dl (pre-tPA)to
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544 mg/dl (35 hours post-tPA). By 33-hours after completing the tPA
infusion his P/F
e
ratio declined to 71 and the patient was placed back in the prone
position with recovery
l to a P/F ratio of 118.
cDISCUSSION
it In summary, we now report 3 cases of off-label intravenous
administration of tPA
r (Alteplase) for patients with COVID-19 suffering from ARDS and
respiratory failure. In
A improvements all 3 cases the ranging patients from demonstrated a 38%
improvement an initial improvement (Case 3) to a in ~100% their P/F
improvement
ratio, with
(Case 1). The observed improvements were transient and lost over time in
all 3 patients
after completion of their tPA infusion. In the study by Hardaway et al
using fibrinolytic
d therapy in ARDS, they re-dosed the fibrinolytic agent in patients who
had transient
e There responses is also such precedent as were for observed using much
here, larger which bolus led to doses more of durable tPA and responses
doing so (8).
while
t patients remain on a therapeutic heparin drip, such as in sub-massive
pulmonary
p heparin embolism drip where has been the use shown of a 100mg to be
highly bolus effective of tPA (Alteplase) in reducing while mortality on
a and therapeutic
only
e increases bleeding risk by 1.2% (11). Such an approach using larger
bolus-dose tPA
c the (50mg suspected or 100mg pulmonary bolus) without microvascular
holding anticoagulation thrombosis underlying in order COVID-19 to
prevent ARDS recurrence (7) is
of
c worthy of further consideration and study, and while the mortality in
COVID-19 ARDS is
exceptionally high the risks of tPA must still be carefully considered
given the ~1% risk
A of catastrophic bleeding from tPA in non-stroke patients (11,12).
Formal studies are
This article is protected by copyright. All rights reserved
needed to determine whether the observations in these cases were the
result of tPA
e
therapy or the result of unrelated/random effects, and (if effective)
to determine the
l optimal dosing regimen of tPA with or without therapeutic
anticoagulation in COVID-19
c ARDS to include whether a re-dosing protocol is needed if the benefits
are transient.
i REFERENCES
tr 1.
N. Tang, D. Li, X. Wang, Z. Sun, Abnormal coagulation parameters are
associated with
A poor (2020).
prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost,
2.
H. Han et al., Prominent changes in blood coagulation of patients with
SARS-CoV-2
d 3.
e 4.
tp 5.
ec 6.
c 7.
AThis articleinfection. Clin Chem Lab Med, (2020).
D. Wang et al., Clinical Characteristics of 138 Hospitalized Patients
With 2019 Novel
Coronavirus-Infected Pneumonia in Wuhan, China. JAMA, (2020).
X. Yang et al., Clinical course and outcomes of critically ill patients
with SARS-CoV-2
pneumonia in Wuhan, China: a single-centered, retrospective,
observational study.
Lancet Respir Med, (2020).
T. Li, H. Lu, W. Zhang, Clinical observation and management of COVID-19
patients.
Emerg Microbes Infect 9, 687-690 (2020).
J.F. Xu, L. Wang, L. Zhao et al, Risk assessment of venous
thromboembolism and
bleeding in COVID-19 patients. Respiratory Research (under review).
W. Luo, H. Yu, J. Gou et al, Clinical pathology of critical patient with
novel coronavirus
pneumonia (COVID-19). Preprints (not peer reviewed). Posted 9 March 2020.
is protected by copyright. All rights reserved
8.
e
l 9.
cit 10.
r 11.
A 12.
detpeccAThis articleR. M. Hardaway et al., Prevention of adult
respiratory distress syndrome with
plasminogen activator in pigs. Crit Care Med 18, 1413-1418 (1990).
K. A. Stringer, B. M. Hybertson, O. J. Cho, Z. Cohen, J. E. Repine,
Tissue plasminogen
activator (tPA) inhibits interleukin-1 induced acute lung leak. Free
Radic Biol Med 25,
184-188 (1998).
C. Liu et al., Meta-Analysis of Preclinical Studies of Fibrinolytic
Therapy for Acute
Lung Injury. Front Immunol 9, 1898 (2018).
S. Konstantinides et al., Heparin plus alteplase compared with heparin
alone in patients
with submassive pulmonary embolism. N Engl J Med 347, 1143-1150 (2002).
investigators G. An international randomized trial comparing four
thrombolytic strategies
for acute myocardial infarction. N Engl J Med. 1993;329(10):673-82.
is protected by copyright. All rights reserved
This article is protected by copyright. All rights reserved
On 4/29/20 1:25 PM, Keren Ahava wrote:
>
> iPhone
> Both of your remarks and questions are very good.
>
> I agree with you about the heparin.
> My daughter was put on heparin preventatively at the beginning of her pregnancy which was just about when corona started. It’s merely coincidence that she got pregnant at this terrible time; however she’s fine and so is the pregnancy progressing, thank God!!!
> As for the streptokinase you’re absolutely correct about that too of course you know that.
> Hospitals that did this study here in New York looked at their own patient population between those that were already on blood thinners before they got sick and those who got sick and had no blood thinners and progressed to getting extremely ill quickly.
> Your position on streptokinase is correct is that it is the clot buster however jumping to that particular medication wouldn’t be necessary if everybody who were over a certain age just took a baby aspirin or any blood thinner that’s not at a high dose prophylactically.
> This could only be possible if studies were done watching the clotting times of patients who are admitted with corona during their stay in deciding whether or not they are at the beginning of the disease where they still have no clots formed or in the middle of the disease where they already have clots and then streptokinase would be considered.
>
> I wish I could tell you the hospital where this is being done in New York but unfortunately the physicians there are order to be close lipped.
>
> All the positions sign a disclosure and they’re not allowed to talk.
>
> Think all the great minds need to put our heads together and start thinking of a way to present this in a thoughtful and mindful way that will not threaten other practitioners who haven’t gotten it right.
>
> I have a great disdain for Dr. Fauci who hasn’t practiced medicine in over 20 years and he was basically at this point and academician who’s out of touch with what’s going on in the field. He vacillates back-and-forth about how to deal with this and basically he’s the one who’s making the decision whether or not things will open up and how patients are being treated and with what protocols.
>
> If you have any other thoughts send them along.
>
>> On Apr 29, 2020, at 10:58 AM, Ruben Safir wrote:
>>
>> On 4/29/20 9:59 AM, Carolinedliny wrote:
>>> I don't know that everything here is accurate, I talk to my colleagues
>>> in the ICU and they tell me they are putting pts on heparin drips, they
>>> are using 100% oxygen, and/or high flow o2 in an attempt to prevent
>>> hypoxia/desat without using mechanical ventilation
>>>
>>
>> I'm not certain that these two things are inconsistant. First of all,
>> Heparin is not a Thrombolytic, so it is nto going to break clots down,
>> but prevents growth of new clots. That would be consitant with what
>> Keren is saying. However, real clot busters, for pulmonary embolism,
>> streptokinase and friends, are they being used at all. The granularity
>> is being SEEN on the xrays.
>>
>> Regardless, why are shut down? My college at St Barnabas has been
>> begrudging this from the beginning, rightfully so, and he is at ground
>> zero of this virus in the Bronx.
>>
>>
>>>
>>> -----Original Message-----
>>> From: Ruben Safir
>>> To: Karen Perilman ; Hangout ; Liz
>>> Moore
>>> Sent: Wed, Apr 29, 2020 2:53 am
>>> Subject: Re: good thing they are rushing (the vaccines)
>>>
>>>
>>> One more thing... the women who some might think uses capital letters is
>>> a Nurse Anesthesiaologist who spent good part of her life working with
>>> Doctors without Boarders... threating patients and populations in Africa.
>>>
>>> Karen, meet, Rick. Rick, meet Karen.
>>>
>>> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>>> Side note to Liz -
>>> I've been told today that Pharmacists aren't experts on vaccinations so
>>> our opinion doesn't hold much weight....
>>>
>>> Just for reference, I point out the paper that Liz and I wrong on
>>> http://www.brooklyn-living.com/
>>>
>>> to continue on this thread...
>>>
>>> On to Karen...
>>>
>>>> On 4/28/20 8:09 PM, Karen Perilman wrote:
>>>> 
>>>> Ruben,
>>>> It’s been a long time since we spoke,
>>>
>>> That is your fault! I periodically send you email :)
>>>
>>>> And I must tell you, this message you sent came as a surprise,
>>>
>>> Call me when you have time 718-715-1771
>>>
>>>>
>>>> First of all, the patients that were first largely infected in Europe,
>>> Italy and Spain were knee jerk treated with intubation and ventilation.
>>>> I say knee jerk, because never before had they seen so many people
>>> with the same symptoms in mass like this.
>>>>
>>>> Never mind the Chinese allowed 5 million INFECTED people to leave
>>> China up to Jan 20th and go to work in Italy and Spain, the fashion center.
>>>> How do i know, because my daughter is the head senior designer for
>>> women in Spain for the company Zara. They have so many Chinese working
>>> there, and their industry is in the HUB of China.
>>>>
>>>> And in October 18-19th the International militaries all met in Wuhan
>>> for the WUhan games for 100 COUNTRIES. ANd when the games were over,
>>> all those 100 countries became infected.....
>>>>
>>>> Now, go back to where we were....
>>>> All these people presenting with Shortness of breath we MISDIAGNOSED
>>> FROM THE GET GO.
>>>> WHy do I say this, because maybe you forgot I am an anesthetist.
>>>
>>>
>>> I haven't forgotten anything. Are you in New York now?
>>>
>>>> The presentation of SOB was way off the standards of evaluation for SOB.
>>>> The Corona is a virus that spread thru droplets as does EVERY OTHER VIRUS.
>>>> But we never reacted like this before.
>>>
>>> I say this until I am blue in the face. We have NEVER reacted like this
>>> to even Small Pox!!
>>>
>>>
>>>> Here is why we shouldn’t have.
>>>> I spoke with the head oncologist at a NY Cancer hospital....
>>>> I also spoke with the head neurologist at Northwell Hospitals and all
>>> of us said the same thing.
>>>>
>>>
>>> We've been working with St Barbaus and they just said the same thing in
>>> the NY Post today,,
>>>
>>>> The SOB from Corona patients was unlike a person with pneumonia or ARDS.
>>>> Patients were talking and even on the phones, and showing low Puse OX
>>> readings.
>>>> In Italy they didn’t have the time to asses as they were
>>> barraged with patients,
>>>> They ran out of ventilators when that was ACTUALLY what was killing
>>> people.
>>>> Sick lungs under PEEP and ventilation only causes more problems and
>>> patients vaso constrict and organs shut down, and FAST, especially in
>>> the elderly.
>>>
>>> This I didn't know and I don't understand. The ICU is packed in the
>>> Bronx with people on vents undergoing ID evaluation. In the end, there
>>> is not much I can do for them other than take the states and track
>>> infection. Infection contol on the floors is the biggest problem we have.
>>>
>>>>
>>>> But in the US, NO ONE took the time to look at the reason people were
>>> SOB and they ASSUMED it was a viral infection, Corona.....
>>>>
>>>> BIG MISTAKE!
>>>> Now, looking back, we know now, that after autopsies, the patients
>>> lungs and bodies were filled with CLOTS!!!
>>>
>>> Bilateral Granularity on the Xrays. We don't even need testing for
>>> this. It is a presumptive diagnosis already.
>>>
>>> The patients were actually acting like someone with pulmonary embolism.
>>> The clots killed people with heart attacks and Strokes!!!!
>>>>
>>>> So where did this information take the doctors who were in the know.
>>>> In NY and the UK, they started realizing that the patients who were on
>>> blood thinners and anti inflammatories had NO clots and they were mildly
>>> sick and got better.
>>>
>>>> Those patients, in particular were Cancer patients who as you know are
>>> compromised immunologically.
>>>>
>>>
>>> I have data clearly showing me that pts on Chemo and with advanced
>>> cancer don't survive this. They won't even ventolate those patients at
>>> this point. So please explain this further.
>>>
>>> BTW - the virus attacks clotting factors, and causes prolong PT times,
>>> but frankly, that is common with cytosine storms, so I am not convinced
>>> of that data.
>>>
>>>> They tested the patients clotting times and saw the proof in the blood.
>>>> Waiting for a vaccine to kill a virus that will be obsolete in a year
>>> is ridiculous when we know how to treat the patients NOW.
>>>>
>>>> If someone presents to the ER with SOB, they should have been assessed
>>> to rule out for clots.
>>>>
>>>> A retro study, and a study that moves forward should be done immediately,
>>>> BUT because the cure for the clots is CHEAP, no one is going to
>>> recommend ASPIRIN or Azithromycin because they won’t be able to
>>> make MONEY.
>>>>
>>>
>>> This has been a recurring problem. It is almost like they are purposely
>>> misusing Hydroxychloroquin, which can only work in the early phase of
>>> the disease, in order to make way for other thearpies, and those
>>> therapies, Remdesivir, Kaletra, Nitazoxanide, Tocilizumab, etc. All of
>>> them cost over $2K per treatment. My friend Maya, who is a PharmD, she
>>> was big on this point. They are not acting in a way that is consistant
>>> with a disease that shuts down civilization. They are telling us we are
>>> in moral danger and the numbers don't bare it out and they aren't acting
>>> like it is that serious.
>>>
>>>> The mayor NY and the governor are 100% assholes.
>>>> We have NEVER quarantined in the history of illness HEALTHY PEOPLE!!
>>>> Sick people yes, and they should be isolated at home.
>>>
>>> It is unbelievable. Never in my lifetime could I have ever imagined this.
>>>
>>>
>>>> If you go to any NY hospital now in the city, if you show ANY signs
>>> of SOB you are intubated and you DIE!!!! They do not resuscitate anyone
>>> suspected of corona!!
>>>> That’s insane..... If the reason people are dying are the
>>> clots, they NO ONE should be intubated and they should emergently be
>>> give blood thinners.
>>>>
>>>> The elderly are being treated like disposable spoilers of this virus.
>>> They die alone and it’s criminal.
>>>>
>>>
>>> How do you then prevent an anurism..
>>>
>>>
>>>> I will not fall for the BS of waiting for a vaccine, because patients
>>> being treated right now with the new paradigm are surviving and getting
>>> better quicker.
>>>>
>>>> No patient population compares to the cancer patients who were found
>>> to be Safe from the extreme sickness of Corona because so many of their
>>> patients were on blood thinners.
>>>> The evidence is there.
>>>> Even the Young patients that died, died from Strokes.!!!
>>>> No one is talking about the patients that contracted corona who were
>>> described as “healthy†who SMOKE; it is a joke. Smokers are
>>> NOT healthy, not if they smoke anything, pot, vaping or cigarettes.
>>>> I see people on the streets with masks and gloves SMOKING and
>>> it’s a joke.
>>>> THey are blowing Corona and adding to the contaminating of all of us.
>>>> I see people wearing masks and gloves throwing them in the streets,
>>> not using them properly, and I tell them, will all this costuming, they
>>> would never be allowed in the ICU to work because they have no idea how
>>> to used sterile masks and gloves.
>>>>
>>>> If you want to be mad, get mad with the medical system in NY fueled by
>>> political idiots that want to see the economy fail, so they can blame
>>> politics.
>>>> Even Fauci, that “Statistician†is out of the loop. He
>>> hasn’t practiced medicine in 20 yrs!! And he is nothing but an
>>> accountant for the numbers that other people give him.
>>>>
>>>> THis is BS, I don’t give a shit about politics...
>>>> I do care that we are being used for this political experiment.
>>>
>>>
>>> 100%
>>>
>>>
>>>> The economy should have NEVER been shut down.
>>>
>>>
>>> A strong economy is our leading weapon to fight the disease.
>>>
>>>
>>>> It’s laughable that all the markets and stores that are open
>>> are crowded and no one has stopped shopping.
>>>>
>>>> Maybe they should try putting the voter machines in Target or Walmart.....
>>>> Then we could vote out these morons that crashed our economy when the
>>> answer to save people was right under our noses.
>>>>
>>>>
>>>>
>>>>
>>>> Sent from my iPad
>>>>
>>>>> On Apr 28, 2020, at 5:46 PM, Ruben Safir >>> > wrote:
>>>>>
>>>>> 
>>>>> We wouldn't want to distribute anything until we are absolutely sure it
>>>>> is safe, because WTF!! 11K are already dead in NYC alone and 23million
>>>>> are on indefinite lockdown!
>>>>>
>>>>> Take your time boys. Make sure you get it right..
>>>>>
>>>>>
>>>>> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>>>>> Wall Street Journal today:
>>>>>
>>>>> Pfizer could start distributing a possible vaccine on an emergency basis
>>>>> in the fall if all testing proves successful.
>>>>> Photo: Sipa USA via AP
>>>>> By Jared S. Hopkins
>>>>> April 28, 2020 1:14 pm ET
>>>>>
>>>>> Pfizer Inc. PFE -1.10% said Tuesday it could have a coronavirus vaccine
>>>>> ready for use on an emergency basis in the fall if it proves to work
>>>>> safely in testing.
>>>>>
>>>>> Testing of the vaccine, which has already started in Germany, could
>>>>> start in the U.S. as early as next week if health regulators sign off,
>>>>> Pfizer Chief Executive Albert Bourla said in an interview. Results from
>>>>> the study could come as early as next month, Mr. Bourla said.
>>>>>
>>>>> Pfizer would need to do more testing to make sure the vaccine works
>>>>> safely. If all testing proves successful, Pfizer could start
>>>>> distributing the vaccine on an emergency basis in the fall and receive
>>>>> approval for widespread distribution by year’s end, Mr. Bourla
>>> said.
>>>>>
>>>>> “This is a crisis right now, and a solution is desperately
>>> needed by
>>>>> all,†Mr. Bourla said.
>>>>> --
>>>>> So many immigrant groups have swept through our town
>>>>> that Brooklyn, like Atlantis, reaches mythological
>>>>> proportions in the mind of the world - RI Safir 1998
>>>>> http://www.mrbrklyn.com
>>>>> DRM is THEFT - We are the STAKEHOLDERS - RI Safir 2002
>>>>>
>>>>> http://www.nylxs.com - Leadership Development
>>> in Free Software
>>>>> http://www.brooklyn-living.com
>>>>>
>>>>> Being so tracked is for FARM ANIMALS and extermination camps,
>>>>> but incompatible with living as a free human being. -RI Safir 2013
>>>
>>>
>>> --
>>> So many immigrant groups have swept through our town
>>> that Brooklyn, like Atlantis, reaches mythological
>>> proportions in the mind of the world - RI Safir 1998
>>> http://www.mrbrklyn.com
>>> DRM is THEFT - We are the STAKEHOLDERS - RI Safir 2002
>>>
>>> http://www.nylxs.com - Leadership Development in
>>> Free Software
>>> http://www.brooklyn-living.com
>>>
>>> Being so tracked is for FARM ANIMALS and extermination camps,
>>> but incompatible with living as a free human being. -RI Safir 2013
>>
>>
>> --
>> So many immigrant groups have swept through our town
>> that Brooklyn, like Atlantis, reaches mythological
>> proportions in the mind of the world - RI Safir 1998
>> http://www.mrbrklyn.com
>> DRM is THEFT - We are the STAKEHOLDERS - RI Safir 2002
>>
>> http://www.nylxs.com - Leadership Development in Free Software
>> http://www.brooklyn-living.com
>>
>> Being so tracked is for FARM ANIMALS and extermination camps,
>> but incompatible with living as a free human being. -RI Safir 2013
>
--
So many immigrant groups have swept through our town
that Brooklyn, like Atlantis, reaches mythological
proportions in the mind of the world - RI Safir 1998
http://www.mrbrklyn.com
DRM is THEFT - We are the STAKEHOLDERS - RI Safir 2002
http://www.nylxs.com - Leadership Development in Free Software
http://www.brooklyn-living.com
Being so tracked is for FARM ANIMALS and extermination camps,
but incompatible with living as a free human being. -RI Safir 2013
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