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Hydroxychloroquine + Azithromycin therapy at a higher dose improved survival by nearly 200% in ventilated COVID patients


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Hydroxychloroquine + Azithromycin therapy at a higher dose improved survival by nearly 200% in ventilated COVID patients

Treatment options have been limited in the ongoing coronavirus disease 2019 (COVID-19) pandemic. Earlier optimism regarding immunomodulatory drugs such as azithromycin (AZM) and hydroxychloroquine (HCQ) seemed to be undermined by results of large interventional trials.

 

However, a fascinating new study posted to the medRxiv* preprint server (not peer-reviewed*), suggests that such disappointment may have been both premature and unwarranted, based on a re-analysis of over 250 patients on invasive mechanical ventilation (IMV) during the first two months of the pandemic.

 

Using computational modeling, the use of weight-adjusted HCQ and AZM appears to be associated with a more than 100% increase in survival, without a clear correlation with ECG abnormalities.

 

Study details

In this study, based on a subset of critically ill COVID-19 patients, consisting of patients who required intubation and IMV, data from the medical records were analyzed using several novel methods. This included not only the vital signs and laboratory values but the therapeutic methods.

 

The study was carried out on patients at Saint Barnabas Medical Center, New Jersey, with just over 1% having been clinically diagnosed to have COVID-19. Of the 255 patients, almost 80% died during the study period. Seven patients were transferred to another hospital on the ventilator, mostly after day 40 of hospitalization.

 

Parameters were broadly comparable between survivors and non-survivors, except that all patients with an active malignancy, dementia, chronic obstructive pulmonary disease, and stroke failed to survive. However, sex, race, presentation severity, and blood type had no association with survival chances.

 

A pre-print version of the research paper is available on the medRxiv* server. A preprint is a version of a scholarly or scientific paper that precedes formal peer review and publication in a peer-reviewed scholarly or scientific journal.

Laboratory markers

Laboratory markers of inflammation, such as Ferritin, D-dimer, Lactate Dehydrogenase (LDH), and C-reactive protein (CRP), were above average in almost every patient (96%). While all parameters, except the LDH, were equivalent in survivors and non-survivors, three patients had D-dimer values above 69,000 ng/mL. LDH values were higher in non-survivors by almost 30%.

 

The increase in these parameters over time was characteristically steeper in patients who did not survive.

Clinical complications

More than three in four non-survivors developed acute kidney injury (AKI), of which a tenth received renal replacement therapy (RRT). Of this latter group, a fifth survived.

 

Almost 60% of patients were intubated within three days of hospitalization. The time to intubation did not predict survival, but intubation beyond day 15 was associated with survival in only 1 of 16 patients.

 

More than 90% of the patients in this cohort had high blood glucose levels above 140 mg/dL, peak at >200 mg/dL, without corticosteroid therapy. Although none were known to be diabetics, most probably had impaired glucose tolerance before they acquired SARS-CoV-2.

 

This prevalence is higher than in most other studies, probably because the researchers looked actively for hyperglycemia

Obesity

While half of the patients were obese, and 30% were overweight, the older patients were significantly heavier. That is, 74% of those above 60 were obese, vs 37% of those below this age.

 

The mean body weight was approximately 90 kg, but unlike most antibiotic clinical trials, the range of body weight was extensive. The heaviest patient thus weighed approximately seven times more than the lightest.

 

Notably, blood glucose levels or obesity did not predict a good clinical outcome.

Therapeutic drugs

The chief therapeutic classes included steroids, tocilizumab, convalescent plasma, hydroxychloroquine, and azithromycin.

 

Corticosteroids, when given at 6 mg or more, reduced the mortality risk 1.4 times. Meanwhile, the interleukin-6 receptor blocker) tocilizumab had two-fold lower mortality.

 

Convalescent plasma (CP) was used only from week 4, in a fifth of the patients, mostly younger than those who did not receive it. The survival of the group which received CP was almost doubled from CP non-users.

 

HCQ was used in 94% of patients within 48 hours of emergency room arrival, while >55% received 2,000-3,000 mg, cumulatively. Of this number, approximately 63% also received AZM. This combination fell out of favor over the study period based on external recommendations.

Effect of HCQ/AZM on mortality

With every log increase in the cumulative dose of HCQ, the mortality rate fell by 1.12 times, such that at 3 g HCQ, survival odds rose by 2.5 times.

 

When given together with AZM, the benefit was still more significant. Chances of survival increased further. Among those who received both > 3g HCQ and >1g AZM, almost half survived, compared to one in seven (16%) among patients who received one of these drugs at the same dosages.

 

Number of patients by Date of Admission and breakdown by treatment with HCQ/AZM, HCQ alone or no HCQ therapy. Shown are the number of patients in the Cohort by admission date, from March 12 – May 1, 2020. HCQ therapy for each patient is demonstrated by use of color. Blue means the patient received HCQ and AZM therapy together, Gold, HCQ therapy without AZM, and Red, the patient did not receive HCQ.
 
Number of patients by Date of Admission and breakdown by treatment with HCQ/AZM, HCQ alone or no HCQ therapy. Shown are the number of patients in the Cohort by admission date, from March 12 – May 1, 2020. HCQ therapy for each patient is demonstrated by use of color. Blue means the patient received HCQ and AZM therapy together, Gold, HCQ therapy without AZM, and Red, the patient did not receive HCQ.
 

 

This means a 32% absolute difference in survival, or a relative improvement in survival odds of 200%, with the combination of HCQ/AZM at this dosage. This far exceeds the survival benefit cited in any study of any intervention so far.

When HCQ/AZM was given at lower dosages, the risk of death was over three times higher relative to the above combination and dosage regimen.

 

When the cohort was divided into patients who received >3g HCQ/>1g AZM and those who did not, overall, the absolute chances of survival were 23% higher for the first group. The 17% survival in the second group would have increased to 39% with the former treatment, predicted the researchers.

This indicates that treatment with >3g HCQ/>1g AZM was associated with a more than 130% increase in survival rate compared to any other standard therapy.

Weight-adjusted cumulative dosage

The researchers also found that when adjusted for weight, the cumulative dose would have a still greater effect. In fact, the average treatment effect (difference in mean survival, in this case) shows a steep increase between 40-50 mg/kg to peak at 46% for a dose of 82 mg/kg.

 

Thus, patients receiving HCQ above 80 mg/kg of HCQ with >1g AZM had 14 times higher survival odds compared to those who did not. If HCQ dosage was fixed at >3g, the odds of survival were 7 times higher, or less than half of that achieved with the weight-adjusted cumulative dosage.

The fact that weight-adjusted cumulative dose has an even greater effect on survival than cumulative HCQ dose is strong confirmation of the causal relationship between this treatment and improvement in survival rate.”

Age was another major factor since those older than 60 were five times more likely to succumb than younger patients. Hyperlipidemia was the single comorbidity linked to approximately four times higher odds of death.

 

Interestingly, there was no correlation between the cumulative dose of HCQ (or AZM) and the occurrence of QTc prolongation. In fact, the QT interval began to fall during the period when the cumulative dose of HCQ increased. None of the patients showed torsades de pointes.

What are the implications?

These findings indicate that a steeply rising ferritin, D-dimer and LDH over time predict poor survival, the rate of rise being several times greater for non-survivors. This should be validated to help provide a better prognosis for COVID-19 patients.

 

The extensive range of obesity among critically ill patients indicates that weight-adjusted dosage is critical in achieving the correct therapeutic levels. Moreover, AZM is an independent contributor to improved survival.

 

Most importantly, this is the first clinical study to demonstrate the remarkable benefit of using cumulative doses of HCQ>3g/AZM>1g, compared to those not treated with this combination.

 

Why did such a large effect miss observation? For one thing, HCQ produces its benefit by cumulative effects on the target cells, which is weight-dependent. The failure to treat patients with weight-adjusted doses leads to ineffective treatment and outcomes biased towards lighter patients.

 

HCQ is both safe and tolerable at higher doses, as shown in studies of rheumatoid arthritis or lupus. Such high doses for such long durations have not been used to treat COVID-19.

 

The earlier studies claiming prolongation of the QTc duration with HCQ in COVID-19 treatment are shown to be flawed. Indeed, available data suggests that this finding is due to the underlying illness itself.

The investigators also point out: “On April 24, 2020, the FDA issued a warning about the possible effects of low HCQ on QTc interval (47). Since 2010, the FDA has approved over 150 clinical trials, which include HCQ treatment. The FDA did and does not require monitoring for cardiotoxicity. In each of these trials, the total HCQ dose and expected tissue levels are markedly higher than used or seen in Covid patients. This discrepancy lacks logic or explanation.”

In this startling study, the investigators carefully re-examined the data, showing that among critically ill COVID-19 patients on IMV, less than 4% “walk out of hospital.” In contrast, the survival benefit of combined HCQ/AZM at a cumulative dosage of >80 mg/kg and >1g, respectively, is shown to be both clear and significant.

 

The safety at such doses is obvious, since survival is increased by almost 130% in this very high-risk population. Moreover, it appears that AZM is an important component of this therapy in terms of mortality reduction.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

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43 minutes ago, Markinsa said:

Hydroxychloroquine + Azithromycin therapy at a higher dose improved survival by nearly 200% in ventilated COVID patients

Dr. Liji Thomas, MDBy Dr. Liji Thomas, MDJun 2 2021

Treatment options have been limited in the ongoing coronavirus disease 2019 (COVID-19) pandemic. Earlier optimism regarding immunomodulatory drugs such as azithromycin (AZM) and hydroxychloroquine (HCQ) seemed to be undermined by results of large interventional trials.

 

However, a fascinating new study posted to the medRxiv* preprint server (not peer-reviewed*), suggests that such disappointment may have been both premature and unwarranted, based on a re-analysis of over 250 patients on invasive mechanical ventilation (IMV) during the first two months of the pandemic.

 

Using computational modeling, the use of weight-adjusted HCQ and AZM appears to be associated with a more than 100% increase in survival, without a clear correlation with ECG abnormalities.

 

Study details

In this study, based on a subset of critically ill COVID-19 patients, consisting of patients who required intubation and IMV, data from the medical records were analyzed using several novel methods. This included not only the vital signs and laboratory values but the therapeutic methods.

 

The study was carried out on patients at Saint Barnabas Medical Center, New Jersey, with just over 1% having been clinically diagnosed to have COVID-19. Of the 255 patients, almost 80% died during the study period. Seven patients were transferred to another hospital on the ventilator, mostly after day 40 of hospitalization.

 

Parameters were broadly comparable between survivors and non-survivors, except that all patients with an active malignancy, dementia, chronic obstructive pulmonary disease, and stroke failed to survive. However, sex, race, presentation severity, and blood type had no association with survival chances.

 

A pre-print version of the research paper is available on the medRxiv* server. A preprint is a version of a scholarly or scientific paper that precedes formal peer review and publication in a peer-reviewed scholarly or scientific journal.

Laboratory markers

Laboratory markers of inflammation, such as Ferritin, D-dimer, Lactate Dehydrogenase (LDH), and C-reactive protein (CRP), were above average in almost every patient (96%). While all parameters, except the LDH, were equivalent in survivors and non-survivors, three patients had D-dimer values above 69,000 ng/mL. LDH values were higher in non-survivors by almost 30%.

 

The increase in these parameters over time was characteristically steeper in patients who did not survive.

Clinical complications

More than three in four non-survivors developed acute kidney injury (AKI), of which a tenth received renal replacement therapy (RRT). Of this latter group, a fifth survived.

 

Almost 60% of patients were intubated within three days of hospitalization. The time to intubation did not predict survival, but intubation beyond day 15 was associated with survival in only 1 of 16 patients.

 

More than 90% of the patients in this cohort had high blood glucose levels above 140 mg/dL, peak at >200 mg/dL, without corticosteroid therapy. Although none were known to be diabetics, most probably had impaired glucose tolerance before they acquired SARS-CoV-2.

 

This prevalence is higher than in most other studies, probably because the researchers looked actively for hyperglycemia

Obesity

While half of the patients were obese, and 30% were overweight, the older patients were significantly heavier. That is, 74% of those above 60 were obese, vs 37% of those below this age.

 

The mean body weight was approximately 90 kg, but unlike most antibiotic clinical trials, the range of body weight was extensive. The heaviest patient thus weighed approximately seven times more than the lightest.

 

Notably, blood glucose levels or obesity did not predict a good clinical outcome.

Therapeutic drugs

The chief therapeutic classes included steroids, tocilizumab, convalescent plasma, hydroxychloroquine, and azithromycin.

 

Corticosteroids, when given at 6 mg or more, reduced the mortality risk 1.4 times. Meanwhile, the interleukin-6 receptor blocker) tocilizumab had two-fold lower mortality.

 

Convalescent plasma (CP) was used only from week 4, in a fifth of the patients, mostly younger than those who did not receive it. The survival of the group which received CP was almost doubled from CP non-users.

 

HCQ was used in 94% of patients within 48 hours of emergency room arrival, while >55% received 2,000-3,000 mg, cumulatively. Of this number, approximately 63% also received AZM. This combination fell out of favor over the study period based on external recommendations.

Effect of HCQ/AZM on mortality

With every log increase in the cumulative dose of HCQ, the mortality rate fell by 1.12 times, such that at 3 g HCQ, survival odds rose by 2.5 times.

 

When given together with AZM, the benefit was still more significant. Chances of survival increased further. Among those who received both > 3g HCQ and >1g AZM, almost half survived, compared to one in seven (16%) among patients who received one of these drugs at the same dosages.

 

Number of patients by Date of Admission and breakdown by treatment with HCQ/AZM, HCQ alone or no HCQ therapy. Shown are the number of patients in the Cohort by admission date, from March 12 – May 1, 2020. HCQ therapy for each patient is demonstrated by use of color. Blue means the patient received HCQ and AZM therapy together, Gold, HCQ therapy without AZM, and Red, the patient did not receive HCQ.
 
Number of patients by Date of Admission and breakdown by treatment with HCQ/AZM, HCQ alone or no HCQ therapy. Shown are the number of patients in the Cohort by admission date, from March 12 – May 1, 2020. HCQ therapy for each patient is demonstrated by use of color. Blue means the patient received HCQ and AZM therapy together, Gold, HCQ therapy without AZM, and Red, the patient did not receive HCQ.
 

 

This means a 32% absolute difference in survival, or a relative improvement in survival odds of 200%, with the combination of HCQ/AZM at this dosage. This far exceeds the survival benefit cited in any study of any intervention so far.

When HCQ/AZM was given at lower dosages, the risk of death was over three times higher relative to the above combination and dosage regimen.

 

When the cohort was divided into patients who received >3g HCQ/>1g AZM and those who did not, overall, the absolute chances of survival were 23% higher for the first group. The 17% survival in the second group would have increased to 39% with the former treatment, predicted the researchers.

This indicates that treatment with >3g HCQ/>1g AZM was associated with a more than 130% increase in survival rate compared to any other standard therapy.

Weight-adjusted cumulative dosage

The researchers also found that when adjusted for weight, the cumulative dose would have a still greater effect. In fact, the average treatment effect (difference in mean survival, in this case) shows a steep increase between 40-50 mg/kg to peak at 46% for a dose of 82 mg/kg.

 

Thus, patients receiving HCQ above 80 mg/kg of HCQ with >1g AZM had 14 times higher survival odds compared to those who did not. If HCQ dosage was fixed at >3g, the odds of survival were 7 times higher, or less than half of that achieved with the weight-adjusted cumulative dosage.

The fact that weight-adjusted cumulative dose has an even greater effect on survival than cumulative HCQ dose is strong confirmation of the causal relationship between this treatment and improvement in survival rate.”

Age was another major factor since those older than 60 were five times more likely to succumb than younger patients. Hyperlipidemia was the single comorbidity linked to approximately four times higher odds of death.

 

Interestingly, there was no correlation between the cumulative dose of HCQ (or AZM) and the occurrence of QTc prolongation. In fact, the QT interval began to fall during the period when the cumulative dose of HCQ increased. None of the patients showed torsades de pointes.

What are the implications?

These findings indicate that a steeply rising ferritin, D-dimer and LDH over time predict poor survival, the rate of rise being several times greater for non-survivors. This should be validated to help provide a better prognosis for COVID-19 patients.

 

The extensive range of obesity among critically ill patients indicates that weight-adjusted dosage is critical in achieving the correct therapeutic levels. Moreover, AZM is an independent contributor to improved survival.

 

Most importantly, this is the first clinical study to demonstrate the remarkable benefit of using cumulative doses of HCQ>3g/AZM>1g, compared to those not treated with this combination.

 

Why did such a large effect miss observation? For one thing, HCQ produces its benefit by cumulative effects on the target cells, which is weight-dependent. The failure to treat patients with weight-adjusted doses leads to ineffective treatment and outcomes biased towards lighter patients.

 

HCQ is both safe and tolerable at higher doses, as shown in studies of rheumatoid arthritis or lupus. Such high doses for such long durations have not been used to treat COVID-19.

 

The earlier studies claiming prolongation of the QTc duration with HCQ in COVID-19 treatment are shown to be flawed. Indeed, available data suggests that this finding is due to the underlying illness itself.

The investigators also point out: “On April 24, 2020, the FDA issued a warning about the possible effects of low HCQ on QTc interval (47). Since 2010, the FDA has approved over 150 clinical trials, which include HCQ treatment. The FDA did and does not require monitoring for cardiotoxicity. In each of these trials, the total HCQ dose and expected tissue levels are markedly higher than used or seen in Covid patients. This discrepancy lacks logic or explanation.”

In this startling study, the investigators carefully re-examined the data, showing that among critically ill COVID-19 patients on IMV, less than 4% “walk out of hospital.” In contrast, the survival benefit of combined HCQ/AZM at a cumulative dosage of >80 mg/kg and >1g, respectively, is shown to be both clear and significant.

 

The safety at such doses is obvious, since survival is increased by almost 130% in this very high-risk population. Moreover, it appears that AZM is an important component of this therapy in terms of mortality reduction.

 

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Great news if it gets approved 

Edited by caddieman
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16 minutes ago, Markinsa said:

 

The question is, why would medicine already on the market for years, need to be approved and why were they rejected in the first place?

 

.

Because when Trump said this could possibly be a treatment for COVID and save millions of lives ... people like Caddie and Shabs started telling people if Trump said it, then it has to bad for you , remember when they were saying Trump was telling people to drink bleach , which he did not say !!!.. so many people died because of the people that wanted Trump to look bad .
Now we have Biden Destroyer of the United States , dispersing illegal COVID positive people all throughout the United States by Bus , Planes and Trains.  He’s a man of the clan !! He’s the racist 

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6 minutes ago, coorslite21 said:

Study's I am familiar with confirm this info......gentle ventilation was recommended for those who had been sick for a while....too much pressure damaged the lungs....

Some countries went to pure O2......with great success.... CL

Can you imagine how many people could have been saved ?

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Ivermictin and HCQ. Two old time viral meds that should have been used except the main stream media and medical people out to get Trump poo poo'd it costing lives in the process.

I believe those people should be tried for some degree of murder. 1 + year into this and with a political change it is all of a sudden O.K. to treat people with the stuff that was already approved. 

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4 minutes ago, nstoolman1 said:

Ivermictin and HCQ. Two old time viral meds that should have been used except the main stream media and medical people out to get Trump poo poo'd it costing lives in the process.

I believe those people should be tried for some degree of murder. 1 + year into this and with a political change it is all of a sudden O.K. to treat people with the stuff that was already approved. 

If Trump were to have any kind of victories with COVID be it a treatment, finding out the roots of where it came from ( get it ... ROOT) how they poo-Poo’d the Lab leak ... They wouldn’t have been able to steal the election

If everyone knew for sure it was a Lab leak .... who do you think ALL American’s would have wanted to hold China accountable .... Trump or Biden ?

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6 hours ago, Markinsa said:

 

The question is, why would medicine already on the market for years, need to be approved and why were they rejected in the first place?

 

.

Medicine is routinely found to have different applications than what it was intended. Viagra is ia perfect example. It was first intended for use in heart patients 

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41 minutes ago, caddieman said:

Medicine is routinely found to have different applications than what it was intended. Viagra is ia perfect example. It was first intended for use in heart patients 

It want not matter....Had Trump said low Dose Aspirin been good  for people with hearth issues it would have been wrong.....Soon according to some Viagra will have been deemed a Rocket Fuel intended for the Space Program and Never Meant for Human Consumption.....

 

Damned if they do and Damned with they don't but they will always figure one way or another to twist it.

 

Karsten

Edited by Karsten
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6 hours ago, coorslite21 said:

Study's I am familiar with confirm this info......gentle ventilation was recommended for those who had been sick for a while....too much pressure damaged the lungs....

Some countries went to pure O2......with great success.... CL

I agree, the treatment from the start was flawed, they had know idea what type of treatment to pursue and took the word of the CDC. Killed alot of people, put fear in the people.  Hundreds of Doctors knew of a treatment but the CDC prohibited.  Sad!!!

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7 hours ago, Markinsa said:

azithromycin (AZM)

 

If I'm not mistaken, AZM is a form of Penicillin.  I drug that I can not even touch without have an extremely severe allergic reaction. Any form of penicillin is fatal for me. And there are others with this allergy as well.   So I would never take this drug. And I would be very skeptical of any med the left handed government would recommend.  

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The government is not our friend. Except for the cases of allergic reactions these drugs are used for antiviral treatment. HQC and a metabolic steroid inhaled was found to be a wonderful treatment. But because Trump was pushing it along with many learned viroligists the media and others in the pocket of big pharma were against it. Drs overseas were treating patients with quinine. It is an anti viral medication. Ivermictin wth zinc was another. Do your research and then decide. 

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I wont quote many here as way too many are of the same mind set......No More BS from those would want to control the World.....

 

Swine Flu....Anyone remember that one....I do as it was one of the 1st Flu's that really knocked my what ever in the dirt.....I was alone and I knew I was going to die alone in from of the bathroom.....That was where I lived for 2 weeks.....I barely ate, barely drank....The beer was way to far away for me to crawl......Life was bad.

 

I later found out that after just 15 People Died from The H1N1 Swine Vax they stopped Immediately......

 

Fast forward I lived to fight another day some 12-15 years later I can't even catch a cold in the dead of winter.....Something to be said about Herd Immunity. I have since talked with 2-3 others that had Swine and had the same issues and now they can't or don't get sick after all these years.

 

I am a firm believer that God, Mother Nature and the Natural Way of Life is a far better plan than some test Vax for a trial Virus made by Bill Gates and Fauchi to kill off millions.....Besides, I will be standing and able to pull the Trigger and Reload to Stand up for what I knew as America and the American Way of Life.

 

I am not dead yet and I still have a lot of ammo that needs to be used before the Expiration date.......Let's get this party Started.

 

Karsten

 

 

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16 hours ago, Shelley said:

Because when Trump said this could possibly be a treatment for COVID and save millions of lives ... people like Caddie and Shabs started telling people if Trump said it, then it has to bad for you , remember when they were saying Trump was telling people to drink bleach , which he did not say !!!.. so many people died because of the people that wanted Trump to look bad .

 

Trump suggesting injecting disinfectant is on video, fact.....He made himself look bad, all on his own.  

 

GO RV, then BV

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8 minutes ago, Shabibilicious said:

 

Trump suggesting injecting disinfectant is on video, fact.....He made himself look bad, all on his own.  

 

GO RV, then BV

Shifty Shabs.... twist and contort to fit your narrative of hate anything Trump

people with common sense KNEW he didn’t literally mean inject, swallow or in any way use disinfectant !!!

Go play with your BAT CONSPIRACY 

GOOD OLE  DR FAUCI WAS EVEN WRONG ABOUT DISINFECTING EVERYTHING WE TOUCH !!!

 

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5 minutes ago, Shelley said:

Shifty Shabs.... twist and contort to fit your narrative of hate anything Trump

people with common sense KNEW he didn’t literally mean inject, swallow or in any way use disinfectant !!!

Go play with your BAT CONSPIRACY 

GOOD OLE  DR FAUCI WAS EVEN WRONG ABOUT DISINFECTING EVERYTHING WE TOUCH !!!

 

 

Except for those common sense Trump people who actually did ingest disinfectant because of Trump's irresponsible verbal meanderings and ended up dead.....and there's no need to scream, Shell.  ;)

 

Perhaps do yourself a favor next time and don't name drop me.....if you don't want a response.

 

GO RV, then BV

Edited by Shabibilicious
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7 minutes ago, Shabibilicious said:

 

Except for those common sense Trump people who actually did ingest disinfectant because of Trump's irresponsible verbal meanderings and ended up dead.....and there's no need to scream, Shell.  ;)

 

GO RV, then BV

I’m not screaming, I’m actually enjoying my morning in my open state 

having my coffee on my patio watching the boats go by with all their American flags flying high 

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8 minutes ago, nstoolman1 said:

Unless your state is asking for vaccine cards your state is wide open for everyone. 

 

Sort of that way....some places still require masks to enter the building for those unvaccinated, and it's not a HIPAA violation to ask folks....a person can lie I suppose, if that's the kind of person they are.

 

GO RV, then BV 

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16 hours ago, caddieman said:

Medicine is routinely found to have different applications than what it was intended. Viagra is ia perfect example. It was first intended for use in heart patients 

 

Both Azithromycin and Hyydroxychloroquine are antiviral medicines.  It would be safe to say the Doctors prescribing these medicines for the Hunan Virus would be prescribing them for their intended use.

 

.

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