Some doctors are questioning the way ventilators are being used for people with serious cases of COVID-19. Why? More data shows a high death rate for patients treated under current ventilator practices.

At the same time, these doctors are saying their patients behave more like they have high altitude sickness than a viral infection. They talk about two different types of COVID-19 patients with differing severe lung problems.

While some patients respond to treatment as expected, doctors also describe patients whose lungs seem relatively fine, but who still can't get enough oxygen into their blood. These patients may make up the majority with severe infections.

This is why some are asking other doctors to consider changing how they treat some people in severe condition from COVID-19.

This conflict in treatment approaches shows in real time how doctors are adjusting their tactics against a novel and dangerous infection.

And it shows the persistence and diligence necessary to shift the medical establishment's practices once a treatment protocol has been established, even when evidence begins to show that treatment is less effective than once believed.

There appears to be a consensus opinion among leading public health authorities that a coronavirus vaccine for COVID-19 would take at least 12-18 months to develop, test and be ready for market distribution. The projection assumes that an aggressive development schedule would produce a licensed vaccine proven safe and effective for use in humans no earlier than March-August 2021.

On Feb. 11, 2020, the director general of the World Health Organization (WHO), Dr. Tedros Ghebreyesus, said that the first vaccine for COVID-19 could be ready within 18 months.¹ A week earlier Thomas Breuer, MD of British pharmaceutical corporation GlaxoSmithKline plc had noted that even if development of a vaccine for COVID-19 were to be done at an accelerated pace, approval of the vaccine would "take at least 12 to 18 months."²

Some coronavirus patients may suffer neurological problems such as dizziness, headaches and impaired consciousness, according to a study released Friday.

The study, conducted by several researchers in Wuhan, China, examined the symptoms of 214 coronavirus patients, and found nearly half of those with severe cases had neurological issues.

About a third of all patients studied — both severe and non-severe cases — had some neurological symptoms.

Iceland has tested one-tenth of its population for coronavirus at random and found that half of people have the disease without realising.

They also discovered that 1,600 people have been infected with Covid-19 since the start of the outbreak. Of these cases, there were only seven deaths, indicating a fatality rate of just 0.004 per cent, which is significantly lower than other countries, including the UK.

The findings were made during Iceland's rigorous testing campaign, conducted with the help of Reykjavik-based biopharmaceutical company deCODE genetics, which has seen 10 per cent of the 364,413 population swabbed, something yet to be achieved by any other nation.

Briefly, the literature on Vitamin D's role in immune health has exploded in the past 10 years, particularly in relation to viral infections and autoimmune disorders. Approximately 80% of the literature is new in the past decade and much of it has been published overseas. There are studies showing that Vitamin D sufficiency is important to reduce mortality in ventilated patients. There is a large and growing literature on Vitamin D's role in preventing viral infections and reducing their severity.

The populations at highest risk of severe cases of COVID-19 (the elderly and those with underlying health conditions) and the timing of the outbreak (end of winter in the Northern Hemisphere when population Vitamin D levels are typically lowest) are consistent with deficient Vitamin D status being a risk factor for COVID-19. The relatively small percentage of infections in children may reflect children's higher milk consumption since milk is fortified with Vitamins A and D. Vitamin D is both a vitamin and a steroid hormone with hundreds of roles in our bodies.

A 2018 study based on NHANES data from 2001-2010 found that 28.9% of American adults were Vitamin D deficient (serum 25(OH)D<20ng/ml) and an additional 41.4% of American adults were Vitamin D insufficient (serum 25(OH)D between 20ng/ml and 30ng/ml). Americans who were black, less-educated, poor, obese, current smokers, physically inactive or infrequently consumed milk had higher prevalence of Vitamin D deficiency. Those with intestinal disorders (Crohn's or celiac) that reduce dietary uptake of Vitamin D and those with liver or kidney diseases that may reduce the body's conversion of Vitamin D to its active form may also be at increased risk of deficiency regardless of age. Vitamin D is a fat-soluble steroid hormone that regulates over 200 genes in the human body.

On March 23, Dr. Zev Zelenko wrote an open letter "to medical professionals all around the world" about his treatment for COVID-19 using hydroxychloroquine, azithromycin, and zinc sulfate. Days before, he had addressed a YouTube video to President Trump about his success, which went viral and got picked up by many political commentators. This Wednesday Trump said at a briefing "you should add zinc" to any COVID-19 treatment, which has zinc all over the news right now.

I count myself among the advocates for zinc, and my protocol in The Food and Supplement Guide for the Coronavirus, supplies 46-78 milligrams of zinc per day, depending on how it's implemented, with an extra 36 milligrams of zinc around each potential exposure to the virus, and then additional zinc added for anyone experiencing any symptoms of cold, flu, or COVID-19. Someone who uses a typical zinc supplement and the recommended zinc lozenges, and goes out to the store once a day, would wind up getting 114 milligrams of zinc.

On the lower end, functional medicine mogul Dr. Mark Hyman recommends 20 milligrams per day of zinc. On the higher end, Zelenko's protocol includes 240 milligrams per day.

In the last 3-5 days, a mountain of anecdotal evidence has come out of NYC, Italy, Spain, etc. about COVID-19 and characteristics of patients who get seriously ill. It's not only piling up but now leading to a general field-level consensus backed up by a few previously little-known studies that we've had it all wrong the whole time. Well, a few had some things eerily correct (cough Trump cough), especially with Hydroxychloroquine with Azithromicin, but we'll get to that in a minute.

There is no 'pneumonia' nor ARDS. At least not the ARDS with established treatment protocols and procedures we're familiar with. Ventilators are not only the wrong solution, but high pressure intubation can actually wind up causing more damage than without, not to mention complications from tracheal scarring and ulcers given the duration of intubation often required... They may still have a use in the immediate future for patients too far to bring back with this newfound knowledge, but moving forward a new treatment protocol needs to be established so we stop treating patients for the wrong disease.

This transcript has been edited for clarity.

John Whyte, MD, MPH: Hello. I'm Dr John Whyte, chief medical officer at WebMD. Welcome to "Coronavirus in Context." Today we're going to talk about whether we're managing coronavirus correctly; do we need to think about a change in our treatment regiments? My guest is Dr Cameron Kyle-Sidell. He's a physician trained in emergency medicine and critical care, and he practices at Maimonides in Brooklyn, New York. Welcome, Dr Sidell.

Cameron Kyle-Sidell, MD: Thank you very much. Thank you for inviting me.

Whyte: You've been talking a lot about the number of patients, the percentage of patients dying on ventilators. When did you first notice this trend?

Kyle-Sidell: In preparation of opening what became a full COVID-positive intensive care unit, we scoured the data just to see what was out there — those who have experienced it before us, primarily the Chinese and the Italians; it was hard to find exactly, like the rate of what we call successful extubation — meaning, someone was put on a ventilator and taken off. And that data are still hard to find. I imagine there are a lot of people still on ventilators. But from the data we have available, it appears to be somewhere between 50% and 90%. Most published data puts it around 70%. So, that's a very, very high percentage in general, when one thinks of a medical disease.

Whyte: You've been talking on social media; you say you've seen things that you've never seen before. What are some of those things that you're seeing?

The Centers for Disease Control and Prevention (CDC) has changed text on their website to remove guidance for physicians on the possible usage of hydroxychloroquine and chloroquine, two drugs touted as a wonder cure for covid-19 by Donald Trump, on patients.


Per Reuters, the page titled Information for Clinicians on Therapeutic Options for Patients with COVID-19 has changed from earlier this week, when it stated that both drugs have "in-vitro activity against SARS-CoV, SARS-CoV-2, and other coronaviruses, with hydroxychloroquine having relatively higher potency against SARS-CoV-2." While the page said that "optimal dosing and duration of hydroxychloroquine for treatment of COVID-19 are unknown," it also listed possible doses "reported anecdotally" by physicians.

On Tuesday, the page was slashed by several paragraphs and only states that clinical trials are ongoing, as well as that the Food and Drug Administration has approved emergency use of the drug for patients not eligible to participate in those trials.

A Democratic Michigan state lawmaker has credited President Trump's publicizing of the anti-malarial drug hydroxychloroquine with saving her life after her health "plummeted" when she contracted coronavirus.

State Rep. Karen Whitsett of Detroit told "The Ingraham Angle" on Monday that if it wasn't for Trump pushing the drug through the Food and Drug Administration's approval process for off-label use and touting it repeatedly during his daily press briefings, she may not have made it through the terrible contagion.

"I really want to say that you have to give this an opportunity," she said. "For me, it saved my life. I only can go by what it is that I have gone through and what my story is, and I can't speak for anyone else. So that's not what I'm trying to do here. I'm only speaking for myself."