An Open Letter To Dr. Anthony Fauci, 给福奇的公开信

[贵圈]

George C. Fareed, MD Brawley, California Michael M. Jacobs, MD, MPH Pensacola, Florida Donald C. Pompan, MD Salinas, California
Open letter to Dr. Anthony Fauci regarding the use of hydroxychloroquine for treating COVID-19
August 12, 2020
Anthony Fauci, MD
National Institute of Allergy and Infectious Diseases

Washington, D.C.
Dear Dr. Fauci:
You were placed into the most high-profile role regarding America’s response to the coronavirus pandemic. Americans have relied on your medical expertise concerning the wearing of masks, resuming employment, returning to school, and of course medical treatment.
You are largely unchallenged in terms of your medical opinions. You are the de facto “COVID-19 Czar." This is unusual in the medical profession in which doctors’ opinions are challenged by other physicians in the form of exchanges between doctors at hospitals, medical conferences, as well as debate in medical journals. You render your opinions unchallenged, without formal public opposition from physicians who passionately disagree with you. It is incontestable that the public is best served when opinions and policy are based on the prevailing evidence and science, and able to withstand the scrutiny of medical professionals.
As experience accrued in treating COVID-19 infections, physicians worldwide discovered that high-risk patients can be treated successfully as an outpatient, within the first five to seven days of the onset of symptoms, with a “cocktail” consisting of hydroxychloroquine, zinc, and azithromycin (or doxycycline). Multiple scholarly contributions to the literature detail the efficacy of the hydroxychloroquine-based combination treatment.
Dr. Harvey Risch, the renowned Yale epidemiologist, published an article in May 2020 in the American Journal of Epidemiology titled “Early Outpatient Treatment of Symptomatic, High-Risk COVID-19 Patients that Should be Ramped-Up Immediately as Key to Pandemic Crisis." He further published an article in Newsweek in July 2020 for the general public expressing the same conclusions and opinions. Dr. Risch is an expert at evaluating research data and study designs, publishing over 300 articles. Dr Risch’s assessment is that there is unequivocal evidence for the early and safe use of the “HCQ cocktail.” If there are Q-T interval concerns, doxycycline can be substituted for azithromycin as it has activity against RNA viruses without any cardiac effects.
Yet, you continue to reject the use of hydroxychloroquine, except in a hospital setting in the form of clinical trials, repeatedly emphasizing the lack of evidence supporting its use. Hydroxychloroquine, despite 65 years of use for malaria, and over 40 years for lupus and rheumatoid arthritis, with a well-established safety profile, has been deemed by you and the FDA as unsafe for use in the treatment of symptomatic COVID-19 infections. Your opinions have influenced the thinking of physicians and their patients, medical boards, state and federal agencies, pharmacists, hospitals, and just about everyone involved in medical decision making.
Indeed, your opinions impacted the health of Americans, and many aspects of our day-to-day lives including employment and school. Those of us who prescribe hydroxychloroquine, zinc, and azithromycin/doxycycline believe fervently that early outpatient use would save tens of thousands of lives and enable our country to dramatically alter the response to COVID-19. We advocate for an approach that will reduce fear and allow Americans to get their lives back.
We hope that our questions compel you to reconsider your current approach to COVID-19 infection.
QUESTIONS REGARDING EARLY OUTPATIENT TREATMENT:

1. There are generally two stages of COVID-19 symptomatic infection; initial flu like symptoms with progression to cytokine storm and respiratory failure, correct?
2. When people are admitted to a hospital, they generally are in worse condition, correct?
3. There are no specific medications currently recommended for early outpatient treatment of symptomatic COVID-19 infection, correct?
4. Remdesivir and Dexamethasone are used for hospitalized patients, correct?
5. There is currently no recommended pharmacologic early outpatient treatment for individuals in the flu stage of the illness, correct?
6. It is true that COVID-19 is much more lethal than the flu for high-risk individuals such as older patients and those with significant comorbidities, correct?
7. Individuals with signs of early COVID-19 infection typically have a runny nose, fever, cough, shortness of breath, loss of smell, etc., and physicians send them home to rest, eat chicken soup etc., but offer no specific, targeted medications, correct?
8. These high-risk individuals are at high risk of death, on the order of 15 percent or higher, correct?
9. So just so we are clear — the current standard of care now is to send clinically stable symptomatic patients home, “with a wait and see” approach?
10. Are you aware that physicians are successfully using Hydroxychloroquine combined with Zinc and Azithromycin as a “cocktail” for early outpatient treatment of symptomatic, high-risk, individuals?
11. Have you heard of the “Zelenko Protocol,” for treating high-risk patients with COVID-19 as an outpatient?
12. Have you read Dr. Risch’s article in the American Journal of Epidemiology of the early outpatient treatment of COVID-19?
13. Are you aware that physicians using the medication combination or “cocktail” recommend use within the first five to seven days of the onset of symptoms, before the illness impacts the lungs, or cytokine storm evolves?
14. Again, to be clear, your recommendation is no pharmacologic treatment as an outpatient for the flu-like symptoms in patients that are stable, regardless of their risk factors, correct?
15. Would you advocate for early pharmacologic outpatient treatment of symptomatic COVID-19 patients if you were confident that it was beneficial?
16. Are you aware that there are hundreds of physicians in the United States and thousands across the globe who have had dramatic success treating high-risk individuals as outpatients with this “cocktail?”
17. Are you aware that there are at least 10 studies demonstrating the efficacy of early outpatient treatment with the Hydroxychloroquine cocktail for high-risk patients — so this is beyond anecdotal, correct?
18. If one of your loved ones had diabetes or asthma, or any potentially complicating comorbidity, and tested positive for COVID-19, would you recommend “wait and see how they do” and go to the hospital if symptoms progress?
19. Even with multiple studies documenting remarkable outpatient efficacy and safety of the Hydroxychloroquine “cocktail,” you believe the risks of the medication combination outweigh the benefits?
20. Is it true that with regard to Hydroxychloroquine and treatment of COVID-19 infection, you have said repeatedly that “The Overwhelming Evidence of Properly Conducted Randomized Clinical Trials Indicate No Therapeutic Efficacy of Hydroxychloroquine (HCQ)?”
21. But NONE of the randomized controlled trials to which you refer were done in the first five to seven days after the onset of symptoms, correct?
22. All of the randomized controlled trials to which you refer were done on hospitalized patients, correct?
23. Hospitalized patients are typically sicker that outpatients, correct?
24. None of the randomized controlled trials to which you refer used the full cocktail consisting of Hydroxychloroquine, Zinc, and Azithromycin, correct?
25. While the University of Minnesota study is referred to as disproving the cocktail, the meds were not given within the first five to seven days of illness, the test group was not high risk (death rates were 3 percent), and no zinc was given, correct?
26. Again, for clarity, the trials upon which you base your opinion regarding the efficacy of Hydroxychloroquine, assessed neither the full cocktail (to include Zinc and Azithromycin or doxycycline) nor administered treatment within the first five to seven days of symptoms, nor focused on the high-risk group, correct?
27. Therefore, you have no basis to conclude that the Hydroxychloroquine cocktail when used early in the outpatient setting, within the first five to seven days of symptoms, in high risk patients, is not effective, correct?
28. It is thus false and misleading to say that the effective and safe use of hydroxychloroquine, Zinc, and Azithromycin has been “debunked,” correct? How could it be “debunked” if there is not a single study that contradicts its use?
29. Should it not be an absolute priority for the NIH and CDC to look at ways to treat Americans with symptomatic COVID-19 infections early to prevent disease progression?
30. The SARS-CoV-2/COVID-19 virus is an RNA virus. It is well-established that Zinc interferes with RNA viral replication, correct?
31. Moreover, is it not true that hydroxychloroquine facilitates the entry of zinc into the cell, is a “ionophore,” correct?
32. Isn’t also it true that Azithromycin has established anti-viral properties?
33. Are you aware of the paper from Baylor by Dr. McCullough et. al. describing established mechanisms by which the components of the “HCQ cocktail” exert anti-viral effects?
34. So, the use of hydroxychloroquine, azithromycin (or doxycycline), and zinc — the “HCQ cocktail” — is based on science, correct?

QUESTIONS REGARDING SAFETY:

1. The FDA writes the following: “In light of on-going serious cardiac adverse events and their serious side effects, the known and potential benefits of CQ and HCQ no longer outweigh the known and potential risks for authorized use.” So not only is the FDA saying that hydroxychloroquine doesn’t work, they are also saying that it is a very dangerous drug. Yet, is it not true the drug has been used as an anti-malarial drug for over 65 years?
2. Isn’t it true that the drug has been used for lupus and rheumatoid arthritis for many years at similar doses?
3. Do you know of even a single study prior to COVID-19 that has provided definitive evidence against the use of the drug based on safety concerns?
4. Are you aware that chloroquine or hydroxychloroquine has many approved uses for hydroxychloroquine including steroid-dependent asthma (1988 study), advanced pulmonary sarcoidosis (1988 study), sensitizing breast cancer cells for chemotherapy (2012 study), the attenuation of renal ischemia (2018 study), lupus nephritis (2006 study), epithelial ovarian cancer (2020 study), just to name a few? Where are the cardiotoxicity concerns ever mentioned?
5. Risch estimates the risk of cardiac death from hydroxychloroquine to be 9/100,000 using the data provided by the FDA. That does not seem to be a high risk, considering the risk of death in an older patient with co-morbidities can be 15 percent or more. Do you consider 9/100,000 to be a high risk when weighed against the risk of death in older patient with co-morbidities?
6. To put this in perspective, the drug is used for 65 years, without warnings (aside for the need for periodic retinal checks), but the FDA somehow feels the need to send out an alert on June 15, that the drug is dangerous. Does that make any logical sense to you Dr. Fauci based on “science”?
7. Moreover, consider that the protocols for usage in early treatment are for five to seven days at relatively low doses of hydroxychloroquine similar to what is being given in other diseases (RA, SLE) over many years — does it make any sense to you logically that a five to seven day dose of hydroxychloroquine when not given in high doses could be considered dangerous?
8. You are also aware that articles published in the New England Journal of Medicine and Lancet, one out of Harvard University, regarding the dangers of hydroxychloroquine had to be retracted based on the fact that the data was fabricated. Are you aware of that?
9. If there was such good data on the risks of hydroxychloroquine, one would not have to use fake data, correct?
10. After all, 65 years is a long-time to determine whether or not a drug is safe, do you agree?
11. In the clinical trials that you have referenced (e.g., the Minnesota and the Brazil studies), there was not a single death attributed directly to hydroxychloroquine, correct?
12. According to Dr. Risch, there is no evidence based on the data to conclude that hydroxychloroquine is a dangerous drug. Are you aware of any published report that rebuts Dr. Risch’s findings?
13. Are you aware that the FDA ruling along with your statements have led to Governors in a number of states to restrict the use of hydroxychloroquine?
14. Are you aware that pharmacies are not filling prescriptions for this medication based on your and the FDA’s restrictions?
15. Are you aware that doctors are being punished by state medical boards for prescribing the medication based on your comments as well as the FDA’s?
16. Are you aware that people who want the medication sometimes need to call physicians in other states pleading for it?
17. And yet you opined in March that while people were dying at the rate of 10,000 patients a week, hydroxychloroquine could only be used in an inpatient setting as part of a clinical trial- correct?
18. So, people who want to be treated in that critical five- to seven-day period and avoid being hospitalized are basically out of luck in your view, correct?
19. So, again, for clarity, without a shred of evidence that the hydroxychloroquine/HCQ cocktail is dangerous in the doses currently recommend for early outpatient treatment, you and the FDA have made it very difficult, if not impossible in some cases, to get this treatment, correct?

QUESTIONS REGARDING METHODOLOGY:

1. In regards to the use of hydroxychloroquine, you have repeatedly made the same statement: “The Overwhelming Evidence from Properly Conducted Randomized Clinical Trials Indicate no Therapeutic Efficacy of Hydroxychloroquine.” Is that correct?
2. In Dr. Risch’s article regarding the early use of hydroxychloroquine, he disputes your opinion. He scientifically evaluated the data from the studies to support his opinions. Have you published any articles to support your opinions?
3. You repeatedly state that randomized clinical trials are needed to make conclusions regarding treatments, correct?
4. The FDA has approved many medications (especially in the area of cancer treatment) without randomized clinical trials, correct?
5. Are you aware that Dr. Thomas Frieden, the previous head of the CDC wrote an article in the New England Journal of Medicine in 2017 called “Evidence for Health Decision Making — Beyond Randomized Clinical Trials (RCT)?” Have you read that article?
6. In it Dr. Frieden states that “many data sources can provide valid evidence for clinical and public health action, including analysis of aggregate clinical or epidemiological data.” Do you disagree with that?
7. Frieden discusses “practiced-based evidence” as being essential in many discoveries, such SIDS (Sudden Infant Death Syndrome). Do you disagree with that?
8. Frieden writes the following: “Current evidence-grading systems are biased toward randomized clinical trials, which may lead to inadequate consideration of non-RCT data.” Dr. Fauci, have you considered all the non-RCT data in coming to your opinions?
9. Risch, who is a leading world authority in the analysis of aggregate clinical data, has done a rigorous analysis that he published regarding the early treatment of COVID-19 with hydroxychloroquine, zinc, and azithromycin. He cites five or six studies, and in an updated article there are five or six more, a total of 10 to 12 clinical studies with formally collected data specifically regarding the early treatment of COVID. Have you analyzed the aggregate data regarding early treatment of high-risk patients with hydroxychloroquine, zinc, and azithromycin?
10. Is there any document that you can produce for the American people of your analysis of the aggregate data that would rebut Dr. Risch’s analysis?
11. Yet, despite what Dr. Risch believes is overwhelming evidence in support of the early use of hydroxychloroquine, you dismiss the treatment insisting on randomized controlled trials even in the midst of a pandemic?
12. Would you want a loved one with high-risk comorbidities placed in the control group of a randomized clinical trial when a number of studies demonstrate safety and dramatic efficacy of the early use of the hydroxychloroquine “cocktail?”
13. Are you aware that the FDA approved a number of cancer chemotherapy drugs without randomized control trials based solely on epidemiological evidence? The trials came later as confirmation. Are you aware of that?
14. You are well aware that there were no randomized clinical trials in the case of penicillin that saved thousands of lives in World War II? Was not this in the best interest of our soldiers?
15. You would agree that many lives were saved with the use of cancer drugs and penicillin that were used before any randomized clinical trials, correct?
16. You have referred to evidence for hydroxychloroquine as “anecdotal,” which is defined as “evidence collected in a casual or informal manner and relying heavily or entirely on personal testimony,” correct?
17. But there are many studies supporting the use of hydroxychloroquine in which evidence was collected formally and not on personal testimony, has there not been?
18. So, it would be false to conclude that the evidence supporting the early use of hydroxychloroquine is anecdotal, correct?

COMPARISON BETWEEN U.S. AND OTHER COUNTRIES REGARDING CASE FATALITY RATE:
(IT WOULD BE VERY HELPFUL TO HAVE THE GRAPHS COMPARING OUR CASE FATALITY RATES TO OTHER COUNTRIES.)

1. Are you aware that countries like Senegal and Nigeria that use hydroxychloroquine have much lower case-fatality rates than the United States?
2. Have you pondered the relationship between the use of hydroxychloroquine by a given country and their case mortality rate and why there is a strong correlation between the use of HCQ and the reduction of the case mortality rate.?
3. Have you considered consulting with a country such as India that has had great success treating COVID-19 prophylactically?
4. Why shouldn’t our first responders and front-line workers who are at high risk at least have an option of HCQ/zinc prophylaxis?
5. We should all agree that countries with far inferior healthcare delivery systems should not have lower case fatality rates. Reducing our case fatality rate from near 5 percent, to 2.5 percent, in line with many countries who use HCQ early would have cut our total number of deaths in half, correct?
6. Why not consult with countries who have lower case-fatality rates, even without expensive medicines such as remdesivir and far less advanced intensive care capabilities?

GIVING AMERICANS THE OPTION TO USE HCQ FOR COVID-19:

1. Harvey Risch, the pre-eminent epidemiologist from Yale, wrote a Newsweek Article titled: “The key to defeating COVID-19 already exists. We need to start using it.” Did you read the article?
2. Are you aware that the cost of the hydroxychloroquine “cocktail” including the Z-pack and zinc is about $50?
3. You are aware the cost of remdesivir is about $3,200?
4. So that’s about 60 doses of HCQ “cocktail,” correct?
5. In fact, President Trump had the foresight to amass 60 million doses of hydroxychloroquine, and yet you continue to stand in the way of doctors who want to use that medication for their infected patients, correct?
6. Those are a lot of doses of medication that potentially could be used to treat our poor, especially our minority populations and people of color that have a difficult time accessing healthcare. They die more frequently of COVID-19, do they not?
7. But because of your obstinance blocking the use of HCQ, this stockpile has remained largely unused, correct?
8. Would you acknowledge that your strategy of telling Americans to restrict their behavior, wear masks, and distance, and put their lives on hold indefinitely until there is a vaccine is not working?
9. So, 160,000 deaths later, an economy in shambles, kids out of school, suicides and drug overdoses at a record high, people neglected and dying from other medical conditions, and America reacting to every outbreak with another lockdown — is it not time to re-think your strategy that is fully dependent on an effective vaccine?
10. Why not consider a strategy that protects the most vulnerable and allows Americans back to living their lives and not wait for a vaccine panacea that may never come?
11. Why not consider the approach that thousands of doctors around the world are using, supported by a number of studies in the literature, with early outpatient treatment of high-risk patients for typically one week with HCQ + zinc + azithromycin?
12. You don’t see a problem with the fact that the government, due to your position, in some cases interferes with the choice of using HCQ. Should not that be a choice between the doctor and the patient?
13. While some doctors may not want to use the drug, should not doctors who believe that it is indicated be able to offer it to their patients?
14. Are you aware that doctors who are publicly advocating for such a strategy with the early use of the HCQ cocktail are being silenced with removal of content on the internet and even censorship in the medical community?
15. You are aware of the 20 or so physicians who came to the Supreme Court steps advocating for the early use of the hydroxychloroquine cocktail. In fact, you said these were “a bunch of people spouting out something that isn’t true.” Dr. Fauci, these are not just “people,” these are doctors who actually treat patients, unlike you, correct?
16. Do you know that the video they made went viral with 17 million views in just a few hours, and was then removed from the internet?
17. Are you aware that their website, American Frontline Doctors, was taken down the next day?
18. Did you see the way that Nigerian immigrant physician, Dr. Stella Immanuel, was mocked in the media for her religious views and called a “witch doctor?”
19. Are you aware that Dr. Simone Gold, the leader of the group, was fired from her job as an Emergency Room physician the following day?
20. Are you aware that physicians advocating for this treatment that has by now probably saved millions of lives around the globe are harassed by local health departments, state agencies and medical boards, and even at their own hospitals? Are you aware of that?
21. Don’t you think doctors should have the right to speak out on behalf of their patients without the threat of retribution?
22. Are you aware that videos and other educational information are removed off the internet and labeled, in the words of Mark Zuckerberg, as “misinformation?”
23. Is it not misinformation to characterize hydroxychloroquine, in the doses used for early outpatient treatment of COVID-19 infections, as a dangerous drug?
24. Is it not misleading for you to repeatedly state to the American public that randomized clinical trials are the sole source of information to confirm the efficacy of a treatment?
25. Was it not misinformation when on CNN you cited the Lancet study based on false data from Surgisphere as evidence of the lack of efficacy of hydroxychloroquine?
26. Is it not misinformation as is repeated in the MSM as a result of your comments that a randomized clinical trial is required by the FDA for a drug approval?
27. Don’t you realize how much damage this falsehood perpetuates?
28. How is it not misinformation for you and the FDA to keep telling the American public that hydroxychloroquine is dangerous when you know that there is nothing more than anecdotal evidence of that?
29. Fauci, if you or a loved one were infected with COVID-19, and had flu-like symptoms, and you knew as you do now, that there is a safe and effective cocktail that you could take to prevent worsening and the possibility of hospitalization, can you honestly tell us that you would refuse the medication?
30. Why not give our healthcare workers and first responders, who even with the necessary PPE are contracting the virus at a three to four times greater rate than the general public, the right to choose along with their doctor if they want to use the medicine prophylactically?
31. Why is the government inserting itself in a way that is unprecedented in regard to a historically safe medication and not allowing patients the right to choose along with their doctor?
32. Why not give the American people the right to decide along with their physician whether or not they want outpatient treatment in the first five to seven days of the disease with a cocktail that is safe and costs around $50?

FINAL QUESTIONS:

1. Fauci, please explain how a randomized clinical trial, to which you repeatedly make reference, for testing the HCQ cocktail (hydroxychloroquine, azithromycin, and zinc) administered within five to seven days of the onset of symptoms is even possible now given the declining case numbers in so many states?
2. For example, if the NIH were now to direct a study to begin September 15, where would such a study be done?
3. Please explain how a randomized study on the early treatment (within the first five to seven days of symptoms) of high-risk, symptomatic COVID-19 infections could be done during the influenza season and be valid?
4. Please explain how multiple observational studies arrive at the same outcomes using the same formulation of hydroxychloroquine + azithromycin + zinc given in the same time frame for the same study population (high risk patients) is not evidence that the cocktail works?
5. In fact, how is it not significant evidence, during a pandemic, for hundreds of non-academic private practice physicians to achieve the same outcomes with the early use of the HCQ cocktail?
6. What is your recommendation for the medical management of a 75-year-old diabetic with fever, cough, and loss of smell, but not yet hypoxic, who Emergency Room providers do not feel warrants admission? We know that hundreds of US physicians (and thousands more around the world) would manage this case with the HCQ cocktail with predictable success.
7. If you were in charge in 1940, would you have advised the mass production of penicillin based primarily on lab evidence and one case series on five patients in England, or would you have stated that a randomized clinical trial was needed?
8. Why would any physician put their medical license, professional reputation, and job on the line to recommend the HCQ cocktail — that does not make them any money — unless they knew the treatment could significantly help their patient?
9. Why would a physician take the medication themselves and prescribe it to family members (for treatment or prophylaxis) unless they felt strongly that the medication was beneficial?
10. How is it informed and ethical medical practice to allow a COVID-19 patient to deteriorate in the early stages of the infection when there is inexpensive, safe, and dramatically effective treatment with the HCQ cocktail, which the science indicates interferes with coronavirus replication?
11. How is your approach to “wait and see” in the early stages of COVID-19 infection, especially in high-risk patients, following the science?

While previous questions are related to hydroxychloroquine-based treatment, we have two questions addressing masks.

1. As you recall, you stated on March 8, just a few weeks before the devastation in the Northeast, that masks weren’t needed. You later said that you made this statement to prevent a hoarding of masks that would disrupt availability to healthcare workers. Why did you not make a recommendation for people to wear any face covering to protect themselves, as we are doing now?
2. Rather, you issued no such warning and people were riding in subways and visiting their relatives in nursing homes without any face covering. Currently, your position is that face coverings are essential. Please explain whether or not you made a mistake in early March, and how would you go about it differently now.

CONCLUSION:
Since the start of the pandemic, physicians have used hydroxychloroquine to treat symptomatic COVID-19 infections, as well as for prophylaxis. Initial results were mixed as indications and doses were explored to maximize outcomes and minimize risks. What emerged was that hydroxychloroquine appeared to work best when coupled with azithromycin. In fact, it was the president of the United States who recommended to you publicly at the beginning of the pandemic, in early March, that you should consider early treatment with hydroxychloroquine and a “Z-Pack.” Additional studies showed that patients did not seem to benefit when COVID-19 infections were treated with hydroxychloroquine late in the course of the illness, typically in a hospital setting, but treatment was consistently effective, even in high-risk patients, when hydroxychloroquine was given in a “cocktail” with azithromycin and, critically, zinc in the first five to seven days after the onset of symptoms. The outcomes are, in fact, dramatic.
As clearly presented in the McCullough article from Baylor, and described by Dr. Vladimir Zelenko, the efficacy of the HCQ cocktail is based on the pharmacology of the hydroxychloroquine ionophore acting as the “gun” and zinc as the “bullet,” while azithromycin potentiates the anti-viral effect. Undeniably, the hydroxychloroquine combination treatment is supported by science. Yet, you continue to ignore the “science” behind the disease. Viral replication occurs rapidly in the first five to seven days of symptoms and can be treated at that point with the HCQ cocktail. Rather, your actions have denied patients treatment in that early stage. Without such treatment, some patients, especially those at high risk with co-morbidities, deteriorate and require hospitalization for evolving cytokine storm resulting in pneumonia, respiratory failure, and intubation with 50% mortality. Dismissal of the science results in bad medicine, and the outcome is over 160,000 dead Americans. Countries that have followed the science and treated the disease in the early stages have far better results, a fact that has been concealed from the American Public.
Despite mounting evidence and impassioned pleas from hundreds of frontline physicians, your position was and continues to be that randomized controlled trials (RCTs) have not shown there to be benefit. However, not a single randomized control trial has tested what is being recommended: use of the full cocktail (especially zinc), in high-risk patients, initiated within the first 5 to 7 days of the onset of symptoms. Using hydroxychloroquine and azithromycin late in the disease process, with or without zinc, does not produce the same, unequivocally positive results.
Dr. Thomas Frieden, in a 2017 New England Journal of Medicine article regarding randomized clinical trials, emphasized there are situations in which it is entirely appropriate to use other forms of evidence to scientifically validate a treatment. Such is the case during a pandemic that moves like a brushfire jumping to different parts of the country. Insisting on randomized clinical trials in the midst of a pandemic is simply foolish. Dr. Harvey Risch, a world-renowned Yale epidemiologist, analyzed all the data regarding the use of the hydroxychloroquine/HCQ cocktail and concluded that the evidence of its efficacy when used early in COVID-19 infection is unequivocal.
Curiously, despite a 65+ years safety record, the FDA suddenly deemed hydroxychloroquine a dangerous drug, especially with regard to cardiotoxicity. Dr. Risch analyzed data provided by the FDA and concluded that the risk of a significant cardiac event from hydroxychloroquine is extremely low, especially when compared to the mortality rate of COVID-19 patients with high-risk co-morbidities. How do you reconcile that for forty years rheumatoid arthritis and lupus patients have been treated over long periods, often for years, with hydroxychloroquine and now there are suddenly concerns about a 5 to 7-day course of hydroxychloroquine at similar or slightly increased doses? The FDA statement regarding hydroxychloroquine and cardiac risk is patently false and alarmingly misleading to physicians, pharmacists, patients, and other health professionals. The benefits of the early use of hydroxychloroquine to prevent hospitalization in high-risk patients with COVID-19 infection far outweigh the risks. Physicians are not able to obtain the medication for their patients, and in some cases are restricted by their state from prescribing hydroxychloroquine. The government’s obstruction of the early treatment of symptomatic high-risk COVID-19 patients with hydroxychloroquine, a medication used extensively and safely for so long, is unprecedented.
It is essential that you tell the truth to the American public regarding the safety and efficacy of the hydroxychloroquine/HCQ cocktail. The government must protect and facilitate the sacred and revered physician-patient relationship by permitting physicians to treat their patients. Governmental obfuscation and obstruction are as lethal as cytokine storm.
Americans must not continue to die unnecessarily. Adults must resume employment and our youth return to school. Locking down America while awaiting an imperfect vaccine has done far more damage to Americans than the coronavirus. We are confident that thousands of lives would be saved with early treatment of high-risk individuals with a cocktail of hydroxychloroquine, zinc, and azithromycin. Americans must not live in fear. As Dr. Harvey Risch’s Newsweek article declares, “The key to defeating COVID-19 already exists. We need to start using it.”
Very Respectfully,
George C. Fareed, MD
Brawley, California
Michael M. Jacobs, MD, MPH
Pensacola, Florida
Donald C. Pompan, MD
Salinas, California

 

[贵圈]

乔治·法雷德（George C. Fareed），马里兰州布劳利（马里兰州）迈克尔·雅各布斯（马里兰州），医学博士，佛罗里达州彭萨科拉（Donald C. Pompan），马里兰州萨利纳斯市
给安东尼·富奇博士的公开信，内容涉及使用羟氯喹治疗COVID-19
2020年8月12日

Anthony Fauci，医学博士

国立过敏与传染病研究所

华盛顿特区。

亲爱的福西博士：

在美国对冠状病毒大流行的反应中，您扮演了最重要的角色。美国人在戴口罩，恢复工作，重返学校以及当然接受医疗方面依靠您的医学专业知识。

就您的医疗意见而言，您基本上不受挑战。您实际上是“ COVID-19 Czar”，这在医学界是不寻常的，在医学界，医生的观点在医院，医学会议上的医生之间的交流以及医学杂志上的辩论受到其他医生的质疑。您可以毫无挑战地提出自己的观点，而不会受到热情的医生的正式反对，而当您的观点和政策基于主流证据和科学依据并能够经受医务人员的审查时，可以为公众提供最好的服务。

根据治疗COVID-19感染的经验，全世界的医生发现，高风险患者可以在症状发作的前五到七天内成功地作为门诊病人，接受由羟氯喹，锌，和阿奇霉素（或强力霉素）。对文献的多项学术贡献详细说明了基于羟氯喹的联合治疗的疗效。

耶鲁大学著名的流行病学家Harvey Risch博士于2020年5月在《美国流行病学杂志》上发表了一篇文章，题为“应立即加强对有症状，高风险的COVID-19患者的早期门诊治疗，这是大流行性危机的关键。” “他进一步于2020年7月在《新闻周刊》上发表了一篇文章，表达了相同的结论和意见。Risch博士是评估研究数据和研究设计的专家，发表了300多篇文章。Risch博士的评估是有明确的证据尽早安全使用“ HCQ鸡尾酒”。如果存在Q-T间隔问题，可以用强力霉素代替阿奇霉素，因为它对RNA病毒具有活性，而没有任何心脏影响。

但是，您继续拒绝使用羟氯喹，除非在医院以临床试验的形式进行，一再强调缺乏支持其使用的证据。尽管羟氯喹用于疟疾已有65年历史，而对于狼疮和类风湿性关节炎已有40多年历史，并且具有公认的安全性，但您和FDA认为使用羟氯喹治疗有症状COVID-19感染是不安全的。您的意见影响了医生及其患者，医疗委员会，州和联邦机构，药剂师，医院以及几乎所有参与医疗决策的人的思维。

实际上，您的意见影响了美国人的健康以及我们日常生活的许多方面，包括就业和学校。我们中那些开处方羟氯喹，锌和阿奇霉素/强力霉素的人坚决相信，早期门诊使用可以挽救成千上万人的生命，并使我们的国家大大改变对COVID-19的反应。我们主张采取一种减少恐惧并允许美国人恢复生活的方法。

我们希望我们的问题能促使您重新考虑当前的COVID-19感染方法。

 

[贵圈]

找不到整页翻译工具。这封信比较长。谷歌翻译需要切成很多段。晚上再说。

 

[贵圈]

2020年8月12日

Anthony Fauci，医学博士

国立过敏与传染病研究所


华盛顿特区

亲爱的福西博士：

在美国对冠状病毒大流行的应对中，您扮演了最重要的角色。美国人在戴口罩，恢复工作，重返学校以及当然接受医疗方面依靠您的医学专业知识。

就您的医疗意见而言，您基本上不受挑战。您实际上是“ COVID-19 Czar”。这在医学界是不寻常的，在医学界，医生的观点在医院，医学会议上的医生之间的交流以及在医学期刊上的辩论都受到其他医生的质疑。您可以毫无挑战地提出自己的观点，而不会受到热情的医生的正式反对，这是无可争辩的，当观点和政策基于流行的证据和科学，并且能够经受医务人员的审查时，可以为公众提供最好的服务。

根据治疗COVID-19感染的经验，世界各地的医生发现，高风险患者可以在症状发作的前五到七天内成功地作为门诊病人接受由羟氯喹，锌，和阿奇霉素（或强力霉素）。对文献的多项学术贡献详细说明了基于羟氯喹的联合治疗的疗效。

耶鲁大学著名的流行病学家Harvey Risch博士 于2020年5月在《美国流行病学 杂志》上发表了一篇文章， 题为“有症状，高风险的COVID-19患者的早期门诊治疗，应立即将其作为大流行性危机的关键。 “他进一步发表的 文章 在 新闻周刊 于2020年7月向公众表达了相同的结论和意见。Risch博士是评估研究数据和研究设计的专家，发表了300多篇文章。Risch博士的评估是，有明确的证据表明可以早期安全地使用“ HCQ鸡尾酒”。如果存在QT间隔问题，可以用强力霉素代替阿奇霉素，因为它对RNA病毒具有活性，而没有任何心脏影响。

但是，您继续拒绝使用羟氯喹，除非在医院以临床试验的形式进行，一再强调缺乏支持其使用的证据。尽管羟氯喹用于疟疾已有65年历史，而对于狼疮和类风湿性关节炎已有40多年历史，并且具有公认的安全性，但您和FDA认为使用羟氯喹治疗有症状COVID-19感染是不安全的。您的意见影响了医生及其患者，医疗委员会，州和联邦机构，药剂师，医院以及几乎所有参与医疗决策的人的思维。

实际上，您的意见影响了美国人的健康以及我们日常生活的许多方面，包括就业和学校。我们中那些开处方羟氯喹，锌和阿奇霉素/强力霉素的人坚信，早期门诊使用可以挽救成千上万人的生命，并使我们的国家大大改变对COVID-19的反应。我们主张采取一种减少恐惧并允许美国人恢复生活的方法。

我们希望我们的问题能促使您重新考虑当前的COVID-19感染方法。

有关早期门诊治疗的问题：

1. 一般而言，COVID-19症状性感染分为两个阶段：最初的流感样症状会发展为细胞因子风暴和呼吸衰竭，对吗？
2. 人们入院后通常情况较差，对吗？
3. 目前尚无推荐的针对症状性COVID-19感染的早期门诊治疗的特定药物，对吗？
4. Remdesivir和地塞米松用于住院患者，对吗？
5. 目前尚无针对处于流感感冒阶段的患者的推荐药理早期门诊治疗，对吗？
6. 的确，对于像高龄患者和患有严重合并症的高危人群，COVID-19的致死性要比流感高得多，对吗？
7. 有早期COVID-19感染迹象的人通常会出现流鼻涕，发烧，咳嗽，呼吸急促，嗅觉不佳等情况，医生将其送回家休息，吃鸡汤等，但没有针对性，针对性药物，对吗？
8. 这些高风险个体有很高的死亡风险，大约15％或更高，对吗？
9. 因此，我们很清楚-当前的护理标准是采用“拭目以待”的方法将临床稳定的有症状患者送回家。
10. 您是否知道医师已经成功地将羟氯喹与锌和阿奇霉素一起作为“鸡尾酒”用于有症状，高风险的早期个人门诊治疗？
11. 您是否听说过用于治疗高危COVID-19的门诊患者的“ Zelenko协议”？
12. 您是否读过《美国流行病学杂志》中Risch博士关于COVID-19早期门诊治疗的文章？
13. 您是否知道，使用药物组合或“鸡尾酒”的医生建议在症状发作的前五到七天内，在疾病影响肺部或细胞因子风暴发展之前使用它？
14. 同样，要明确一点，您的建议是，对于稳定的患者，无论其危险因素如何，都不要作为门诊患者使用类似流感症状的药物治疗，对吗？
15. 如果您确信有症状的COVID-19患者是有益的，您是否主张提倡早期药物门诊治疗？
16. 您是否知道美国有成百上千的医生以及全球成千上万的医生通过这种“鸡尾酒”将高风险患者作为门诊病人获得了巨大的成功？
17. 您是否知道至少有10项研究证明了使用羟氯喹鸡尾酒对高危患者进行早期门诊治疗的功效-但这是传闻，是正确的吗？
18. 如果您所爱的人之一患有糖尿病，哮喘或任何潜在的复杂性合并症，并且COVID-19测试呈阳性，您是否会建议“等一下看他们的病情”，如果症状恶化，去医院就诊？
19. 即使有多项研究证明羟氯喹“鸡尾酒”具有出色的门诊疗效和安全性，您仍然相信药物组合的风险大于收益？
20. 关于羟氯喹和COVID-19感染的治疗，您是否真的重复说过：“正确进行的随机临床试验的绝大多数 证据表明羟氯喹（HCQ）没有治疗功效？”
21. 但是您所引用的随机对照试验中，没有一项是在症状发作后的头五到七天内进行的，对吗？
22. 您引用的所有随机对照试验都是针对住院患者进行的，对吗？
23. 住院病人通常比门诊病人病得更重，对吗？
24. 您所引用的随机对照试验中没有一个使用由羟氯喹，锌和阿奇霉素组成的完整混合物，对吗？
25. 虽然明尼苏达大学的研究被认为是不合格鸡尾酒，但在疾病的前五至七天内没有服用药物，测试组的风险也不高（死亡率为3％），并且没有给予锌，正确？
26. 再次，为清楚起见，您基于羟氯喹功效的观点所进行的试验既未评估完整的鸡尾酒（包括锌和阿奇霉素或强力霉素），也未在症状的前五至七天内进行治疗，也未关注高危人群，对吗？
27. 因此，您没有理由得出结论，在门诊患者的初期，症状出现后的五到七天内使用羟氯喹鸡尾酒对高危患者无效，正确吗？
28. 因此说羟基氯喹，锌和阿奇霉素的有效和安全使用已被“揭穿”是对的，这具有误导性，对吗？如果没有一项研究与它的使用相矛盾，如何将其“揭穿”？
29. 对于NIH和CDC来说，尽早寻找治疗有症状COVID-19症状的美国人以预防疾病进展的方法不是绝对优先事项吗？
30. SARS-CoV-2 / COVID-19病毒是一种RNA病毒。众所周知，锌会干扰RNA病毒复制，对吗？
31. 此外，羟基氯喹是否有助于锌进入细胞，“离子载体”是否正确？
32. 阿奇霉素具有抗病毒特性，这不是真的吗？
33. 您是否知道McCullough等人从Baylor发表的论文？等 描述“ HCQ鸡尾酒”成分发挥抗病毒作用的既定机制？
34. 因此，使用羟氯喹，阿奇霉素（或强力霉素）和锌（“ HCQ混合物”）是基于科学的，对吗？

有关安全性的问题：

1. FDA写道：“鉴于持续的严重心脏不良事件及其严重的副作用，CQ和HCQ的已知和潜在益处不再超过授权使用的已知和潜在风险。” 因此，FDA不仅说羟氯喹不起作用，还说它是一种非常危险的药物。但是，难道该药已经被用作抗疟药超过65年了吗？
2. 这种药物以相似的剂量用于狼疮和类风湿关节炎已经多年了吗？
3. 您是否知道甚至在COVID-19之前的一项研究就安全性考虑提供了明确的证据反对使用该药物？
4. 您是否知道氯喹或羟氯喹已被批准用于羟氯喹的许多用途，包括类固醇依赖性哮喘（1988年研究），晚期肺结节病（1988年研究），使乳腺癌细胞对化疗敏感的药物（2012年研究），肾缺血的缓解（2018年研究） ），狼疮肾炎（2006年研究），上皮性卵巢癌（2020年研究），仅举几例？哪里提到过心脏毒性问题？
5. Risch使用FDA提供的数据，估计因羟氯喹导致心脏死亡的风险为9 / 100,000。考虑到老年合并症患者的死亡风险可能为15％或更高，因此这似乎并不是高风险。当权衡老年合并症患者的死亡风险时，您是否认为9 / 100,000是高风险？
6. 从这个角度来看，该药物已经使用了65年，没有任何警告（需要定期进行视网膜检查），但是FDA某种程度上认为有必要在6月15日发出警告，指出该药物很危险。福西博士基于“科学”对您来说是否合乎逻辑？
7. 此外，考虑到在早期治疗中使用的方案是在相对低剂量的羟氯喹下持续五到七天，这与多年以来其他疾病（RA，SLE）中给予的类似—从逻辑上讲，您认为这有意义吗？如果不按高剂量服用五至七天的羟氯喹，是否被认为是危险的？
8. 您还知道，在哈佛大学的《新英格兰医学杂志》和《柳叶刀》杂志上发表的有关羟氯喹危险性的文章必须根据数据被捏造的事实撤消。你知道吗？
9. 如果有关于羟氯喹风险的良好数据，人们将不必使用伪造数据，对吗？
10. 毕竟，确定药物是否安全需要65年，您同意吗？
11. 在您引用的临床试验中（例如，明尼苏达州和巴西的研究），没有一个直接归因于羟氯喹的死亡，对吗？
12. 根据Risch博士的说法，没有基于数据的证据得出羟氯喹是危险药物的结论。您是否知道有任何发表的报告可以反驳Risch博士的发现？
13. 您是否知道FDA的裁决以及您的声明已导致许多州的州长限制使用羟氯喹？
14. 您是否知道药店没有根据您和FDA的限制填写这种药物的处方？
15. 您是否知道根据您的意见以及FDA的处方开药会受到州医疗委员会的惩罚？
16. 您是否知道需要这种药物的人有时需要打电话给其他州的医生恳求？
17. 然而，您在三月表示，虽然人们以每周10,000名患者的速度死亡，但是羟氯喹只能在住院患者中作为临床试验的一部分使用？
18. 因此，在您看来，希望在五到七天的关键时期内接受治疗并避免住院的人基本上是不走运的，对吗？
19. 因此，为了清楚起见，再次重申，在目前建议用于早期门诊治疗的剂量下，没有丝毫证据表明羟氯喹/ HCQ鸡尾酒是危险的，您和FDA使得很难做到这一点，即使在某些情况下也不可能治疗，对吗？

有关方法的问题：

1. 关于羟基氯喹的使用，您已经反复做出相同的陈述：“ 来自正确进行的随机临床试验的绝大多数证据表明羟基氯喹没有治疗功效。” 那是对的吗？
2. 在Risch博士关于早期使用羟氯喹的文章中，他对您的观点提出了异议。他科学地评估了研究数据，以支持他的观点。您是否发表过任何文章来支持您的观点？
3. 您反复声明需要进行随机临床试验以得出有关治疗的结论，对吗？
4. FDA已经批准了许多药物（尤其是在癌症治疗领域），没有进行随机临床试验，对吗？
5. 您是否知道CDC的前任负责人Thomas Frieden博士于2017年在《新英格兰医学杂志》上发表了一篇名为“健康决策依据-超越随机临床试验（RCT）”的文章？你读过那篇文章吗？
6. Frieden博士在报告中指出：“许多数据源可以为临床和公共卫生行动提供有效证据，包括对临床或流行病学综合数据的分析。” 你不同意吗？
7. Frieden讨论了“基于实践的证据”在许多发现中都至关重要，例如SIDS（婴儿猝死综合症）。你不同意吗？
8. 弗里登写道：“目前的证据分级系统偏向于随机临床试验，这可能导致对非RCT数据的考虑不足。” Fauci博士，您是否考虑了所有非RCT数据？
9. Risch是综合临床数据分析领域的全球领先权威，他发表了关于使用羟氯喹，锌和阿奇霉素对COVID-19进行早期治疗的严格分析。他引用了五或六项研究，在更新的文章中又引用了五六项，总共进行了十至十二项临床研究，其中包括正式收集的有关COVID早期治疗的数据。您是否分析了有关羟氯喹，锌和阿奇霉素的高危患者早期治疗的综合数据？
10. 您是否可以为美国人民提供有关汇总数据分析的任何文件，这些文件可以反驳Risch博士的分析？
11. 然而，尽管Risch博士认为有大量证据支持早期使用羟氯喹，但您仍拒绝坚持随机对照试验的治疗，即使在大流行期间也是如此？
12. 当多项研究证明了早期使用羟氯喹“鸡尾酒”的安全性和显着疗效时，您是否希望将一个患有高风险合并症的亲人置于随机临床试验的对照组中？
13. 您是否知道FDA批准了许多癌症化学药物，但没有仅基于流行病学证据的随机对照试验？审判后来被证实。你知道吗？
14. 您很清楚，在青霉素的情况下，尚无随机临床试验挽救了第二次世界大战中数千人的生命？这不符合我们士兵的最大利益吗？
15. 您会同意，在任何随机临床试验之前使用抗癌药和青霉素可以挽救许多生命，对吗？
16. 您将羟氯喹的证据称为“轶事”，即“偶然或非正式收集的证据，严重或完全依赖于个人证词”，对吗？
17. 但是，有许多研究支持使用羟氯喹，这些证据是正式收集的，而不是根据个人证词收集的，是否没有？
18. 因此，断定支持早期使用羟氯喹的证据是轶事，对吗？

美国和其他国家/地区在案例死亡率方面的比较：

（将图的故障率与其他国家的情况进行比较非常有用。）

1. 您是否知道使用羟基氯喹的塞内加尔和尼日利亚等国家的病死率比美国低得多？
2. 您是否曾考虑过某个国家使用羟氯喹与他们的案例死亡率之间的关系，以及为什么使用HCQ与降低案例死亡率之间存在很强的相关性？
3. 您是否考虑过与印度等在预防性治疗COVID-19方面取得巨大成功的国家进行磋商？
4. 为什么我们的高风险第一响应者和一线工人至少不应该选择HCQ /锌预防？
5. 我们都应该同意，医疗服务体系较差的国家的病死率不应该降低。与许多早期使用HCQ的国家/地区相比，将我们的病死率从5％降低到2.5％可以将我们的死亡总数减少一半，是吗？
6. 为什么不与病死率较低的国家进行咨询，即使没有昂贵的药物，如瑞姆昔韦和先进的重症监护功能也较弱呢？

为AMERICANS提供对COVID-19使用HCQ的选项：

1. 耶鲁大学杰出的流行病学家Harvey Risch在 《新闻周刊》上发表了一篇文章，标题为：击败COVID-19的关键已经存在。我们需要开始使用它。” 您读过这篇文章吗？
2. 您是否知道包括Z-pack和锌的羟氯喹“鸡尾酒”的成本约为50美元？
3. 您知道remdesivir的费用约为3200美元吗？
4. 那是大约60剂HCQ“鸡尾酒”，对吗？
5. 实际上，特朗普总统的远见卓识是积累了6000万剂羟氯喹，但是您仍然继续阻碍那些想为受感染的患者使用这种药物的医生，对吗？
6. 这些都是很多剂量的药物，可用于治疗我们的穷人，尤其是我们的少数民族和有色人种，这些人很难获得医疗保健。他们死于COVID-19的频率更高，不是吗？
7. 但是由于您的阻挠使您无法使用HCQ，因此该库存基本上没有使用，对吗？
8. 您是否承认您告诉美国人限制自己的行为，戴口罩和保持距离，无限期搁置生命直到疫苗无法使用的策略？
9. 因此，160,000人死后，经济陷入混乱，失学的孩子，自杀和药物滥用以创纪录的高位，人们被忽视和死于其他医疗状况，美国对每次疫情都做出了反应，又一次封锁-是不是该死的时候了-认为完全依赖有效疫苗的策略？
10. 为什么不考虑一种保护最弱势群体并让美国人恢复生活，而不是等待永远不会出现的疫苗灵丹妙药的战略呢？
11. 为什么不考虑在众多文献研究的支持下，全球成千上万的医生正在使用这种方法，对高风险患者进行早期门诊治疗，通常使用HCQ +锌+阿奇霉素治疗一周？
12. 您不会看到这样的事实，即由于您的职位，政府在某些情况下会干扰使用HCQ的选择。那不是医生和病人之间的选择吗？
13. 尽管有些医生可能不想使用这种药物，但相信这种药物的医生是否可以向患者提供这种药物？
14. 您是否知道，早日使用HCQ鸡尾酒公开倡导这种策略的医生正在被互联网上的内容删除甚至医学界的审查制度所压制？
15. 您知道，大约有20位左右的医生来到最高法院，提倡提早使用羟氯喹鸡尾酒。实际上，您说的是 “一群人吐出不正确的东西。” 福西博士，这些不只是“人”，这些医生实际上是在治疗与您不同的患者，对吗？
16. 您是否知道他们制作的视频在短短几个小时内就获得了1700万的观看次数，然后又从互联网上删除了？
17. 您是否知道他们的网站“美国前线医生”在第二天就被删除了？
18. 您是否看到尼日利亚移民医生斯特拉·伊曼纽尔（Stella Immanuel）博士因其宗教观点被媒体嘲笑并称其为“巫医”的方式？
19. 您是否知道小组负责人西蒙妮·戈德（Simone Gold）博士第二天被辞去了急诊室医师的工作？
20. 您是否知道，提倡这种治疗方法的医生到现在可能已经挽救了全球数百万人的生命，却遭到当地卫生部门，州机构和医疗委员会甚至在自己医院的骚扰？你知道吗？
21. 您是否认为医生应该有权代表患者大声疾呼而不受报复的威胁？
22. 您是否知道视频和其他教育信息已从Internet上删除，并用Mark Zuckerberg的话标记为“错误信息”？
23. 以早期门诊治疗COVID-19感染的剂量将羟氯喹表征为危险药物，这不是误导吗？
24. 您一再向美国公众陈述随机临床试验是确认治疗功效的唯一信息来源，这是否对您产生误导？
25. 当您在CNN上引用基于Surgisphere虚假数据的Lancet研究作为缺乏羟氯喹功效的证据时，这不是误导吗？
26. 是不是因为您的评论而导致MSM反复出现错误信息，即FDA需要进行随机临床试验才能批准药物？
27. 您是否不知道这种虚假现象会持续多久？
28. 当您知道没有什么轶事证据时，对您和FDA不断告诉美国公众羟基氯喹是危险的，这是怎么回事？
29. Fauci，如果您或您所爱的人感染了COVID-19，并且出现了类似流感的症状，并且您像现在一样知道，可以使用一种安全有效的鸡尾酒来预防病情恶化和住院的可能性，您可以诚实地告诉我们您会拒绝服药吗？
30. 为什么不给我们的医护人员和急救人员（他们即使拥有必要的PPE感染病毒的速度也比普通市民高三到四倍）的权利，如果他们想预防性地使用该药物，他们可以与他们的医生一起选择？
31. 政府为什么要以一种历史上前所未有的安全药物进行干预，而不允许患者与医生一起选择？
32. 为什么不赋予美国人与他们的医师一起决定是否在疾病的前五至七天内使用安全且价格约为50美元的鸡尾酒的门诊治疗的权利？

最终问题：

1. Fauci，请说明在症状发作五到七天内，甚至可以进行随机临床试验（您反复参考）以测试症状发作后五到七天内服用的HCQ鸡尾酒（羟氯喹，阿奇霉素和锌）的情况在这么多州？
2. 例如，如果NIH现在要指导一项研究于9月15日开始，那么该研究将在哪里进行？
3. 请说明如何在流感季节期间对高风险的有症状COVID-19感染进行早期治疗（症状的前五至七天内）的随机研究，该研究是否有效？
4. 请解释在同一时间范围内针对同一研究人群（高危患者）使用相同配方的羟氯喹+阿奇霉素+锌进行的多种观察性研究如何达到相同的结果，不是证据表明该鸡尾酒有效吗？
5. 实际上，在大流行期间，数百位非学术私人执业医师在早期使用HCQ鸡尾酒时达到相同的结果，这又不是重要证据吗？
6. 对于75岁的糖尿病患者，发烧，咳嗽和嗅觉丧失但尚未缺氧，但急诊室提供者认为没有入院证书，您的医疗管理建议是什么？我们知道，数百名美国医生（全球成千上万名医生）将通过HCQ鸡尾酒来治疗该病例，并取得可预期的成功。
7. 如果您是1940年的负责人，您是否会建议主要根据实验室证据和一系列针对英国5名患者的案例研究来建议青霉素的批量生产，或者您是否表示需要进行随机临床试验？
8. 为什么没有医生知道自己的治疗方法对患者有很大帮助，为什么医生会把他们的医疗执照，专业声誉和工作推荐给HCQ鸡尾酒，这并不能赚钱呢？
9. 除非医生强烈认为药物是有益的，否则为什么医生会自己服用药物并开给家庭成员（用于治疗或预防）？
10. 当有便宜，安全且有效的HCQ鸡尾酒治疗方法（科学表明会干扰冠状病毒复制）时，如何在知情的和道德的医疗实践中使COVID-19患者在感染的早期恶化？
11. 遵循科学原理，您如何在COVID-19感染的早期阶段，尤其是在高危患者中“观望”？

虽然先前的问题与基于羟氯喹的治疗有关，但我们有两个问题涉及口罩。

1. 您记得，您是在3月8日说的，就在东北遭受破坏的几周前，不需要面具。您后来说，您这样做是为了防止to积口罩，否则会破坏医护人员的可用性。您为什么不像我们现在建议的那样建议人们戴上任何面罩以保护自己？
2. 相反，您没有发出这样的警告，人们正乘坐地铁在疗养院里探访他们的亲戚而没有任何遮脸。目前，您的立场是，遮盖面部至关重要。请说明您在3月初是否犯了一个错误，以及现在如何改变它。

结论：

自大流行开始以来，医生已使用羟氯喹治疗有症状的COVID-19感染以及预防。最初的结果混合在一起作为适应症，并探索剂量以最大程度地提高结果并最小化风险。结果表明，与阿奇霉素联用时，羟氯喹似乎效果最好。实际上，是美国总统在三月初大流行初期向您公开建议您应该考虑早期使用羟氯喹和“ Z-Pack”进行治疗。进一步的研究表明，在病程后期（通常在医院中）用羟氯喹治疗COVID-19感染似乎并没有使患者受益，但是即使在高危患者中，治疗也一直有效，在症状发作后的头五到七天内，将羟基氯喹与阿奇霉素和（关键的）锌一起“鸡尾酒”服用。结果实际上是惊人的。

正如贝勒（Baylor）的McCullough文章中明确提出的，并由弗拉基米尔·泽连科（Vladimir Zelenko）博士描述的那样，HCQ鸡尾酒的功效基于羟氯喹离子载体的药理学作用，而锌则是“子弹”，而阿奇霉素则增强抗病毒作用。不可否认，羟氯喹联合治疗得到科学的支持。但是，您仍然忽略了疾病背后的“科学”。病毒复制在症状的前五到七天内迅速发生，并且可以在此时用HCQ鸡尾酒进行治疗。相反，您的行动在那个早期阶段拒绝了患者的治疗。没有这种治疗，某些患者，尤其是合并症的高危患者，会恶化并需要住院治疗，以应对不断发展的细胞因子风暴，从而导致肺炎，呼吸衰竭，和插管，死亡率为50％。对科学的开除会导致药物不良，结果有超过160,000死去的美国人。遵循科学并在早期治疗该病的国家取得了更好的结果，这一事实已被美国公众所掩盖。

尽管有越来越多的证据和数百名一线医生的慷慨激昂的恳求，但您的立场过去是，而且仍然是，随机对照试验（RCT）并未显示出这种益处。但是，没有一项随机对照试验测试了推荐的药物：在高危患者中，在症状发作的前5至7天内开始使用全鸡尾酒（尤其是锌）。在疾病过程的后期使用羟氯喹和阿奇霉素，无论有无锌，都不会产生相同，明确的阳性结果。

托马斯·弗里登（Thomas Frieden）博士在2017年《新英格兰医学杂志》上有关随机临床试验的文章中强调，在某些情况下，使用其他形式的证据科学地验证治疗是完全合适的。大流行期间就是这种情况，就像大火一样蔓延到该国不同地区。在大流行中坚持随机临床试验是愚蠢的。耶鲁大学世界流行病学专家Harvey Risch博士分析了有关使用羟氯喹/ HCQ鸡尾酒的所有数据，并得出结论，早期在COVID-19感染中使用其有效性的证据是明确的。

奇怪的是，尽管已有65多年的安全记录，但FDA突然认为羟氯喹是一种危险药物，尤其是在心脏毒性方面。Risch博士分析了FDA提供的数据，得出的结论是，羟氯喹引起重大心脏事件的风险极低，尤其是与高危合并症的COVID-19患者的死亡率相比。您如何调和使用羟氯喹对类风湿性关节炎和狼疮患者进行长期治疗（通常是多年）已经四十年了，现在突然担心剂量相似或略有增加的羟氯喹疗程为5至7天？FDA关于羟氯喹和心脏风险的声明显然是虚假的，并且以令人震惊的方式误导医生，药剂师，患者和其他卫生专业人员。在高风险的COVID-19感染患者中，早期使用羟氯喹预防住院的好处远远超过了风险。医师无法为其患者获得药物，并且在某些情况下，医师会因其状态而无法开处方羟氯喹。政府对早期治疗有症状的高危COVID-19患者使用羟氯喹（一种被广泛且安全地使用了很长时间的药物）的干预是前所未有的。

您必须向美国公众说明羟基氯喹/ HCQ鸡尾酒的安全性和有效性。政府必须允许医生治疗患者，以保护和促进这种神圣而受人尊敬的医患关系。政府的迷惑和阻碍就像细胞因子风暴一样致命。

美国人不得继续不必要地死亡。成人必须重新就业，而我们的青年必须重返学校。在等待不完善疫苗的同时封锁美国比对冠状病毒对美国人造成的损害要大得多。我们相信，使用羟氯喹，锌和阿奇霉素的混合物对高危人群进行早期治疗将挽救成千上万人的生命。美国人一定不要生活在恐惧中。正如Harvey Risch博士在《新闻周刊》上的文章所宣称的那样：“战胜COVID-19的关键已经存在。我们需要开始使用它。”

非常敬意

乔治·费雷德（MD）

加利福尼亚布劳利

迈克尔·雅各布斯（MD）

佛罗里达彭萨科拉

Donald C. Pompan，医学博士

加利福尼亚萨利纳斯

 

[贵圈]

那位看到福奇的回信的话，请给网址。

 

[冰中取火]

据我所知，医生都是自己对自己负责，并不是按其他医生的指导来医治病人，当一个医生收治一个病人，完全是按自己专业判断来处理，不太明白这些医生写信啥意思？他们如果收治covid-19病人，他们完全可以按他们自己的专业判断用他们认为合适的药品，不会有其他医生阻止他们用合适的药。自己没尽到责任，想摔锅？

 

[woow]

艾玛，忒长，刷屏刷到手软，没力气看了

 

[woow]

据我所知，医生都是自己对自己负责，并不是按其他医生的指导来医治病人，当一个医生收治一个病人，完全是按自己专业判断来处理，不太明白这些医生写信啥意思？他们如果收治covid-19病人，他们完全可以按他们自己的专业判断用他们认为合适的药品，不会有其他医生阻止他们用合适的药。自己没尽到责任，想摔锅？

废姐。 幕后的事，外人木吉

 

[lindamy]

据我所知，医生都是自己对自己负责，并不是按其他医生的指导来医治病人，当一个医生收治一个病人，完全是按自己专业判断来处理，不太明白这些医生写信啥意思？他们如果收治covid-19病人，他们完全可以按他们自己的专业判断用他们认为合适的药品，不会有其他医生阻止他们用合适的药。自己没尽到责任，想摔锅？

据我所知，某些病治疗方案是需要有关部门批准的，比如昨天获FDA特批的血浆法，其他方法如瑞德西维，羟氯喹都一样。虽然，羟氯喹是很老的药，但是用于治疗新冠肺炎，一样需要批准，好像记得是有什么级别的特批的。

 

[向问天]

听说福奇80多了。
正常情况是老年痴呆。
没办法，体制问题。
美国人民有劫难。
都是命。

 

[冰中取火]

据我所知，某些病治疗方案是需要有关部门批准的，比如昨天获FDA特批的血浆法，其他方法如瑞德西维，羟氯喹都一样。虽然，羟氯喹是很老的药，但是用于治疗新冠肺炎，一样需要批准，好像记得是有什么级别的特批的。

那就该写信给FDA， 不该是福奇啊。当一个guideline 出来的时候，有不明白或不理解的时候，是写信问相关机构，不是问某个曾经在那工作的人员。

 

[ygao]

第一个医生是家庭医生。这些前线医生的经验不一定可以推广，这些药不是解毒的，就像中药，可能增强抵抗力，但药效有限。比较可靠的大规模轻氯喹临床实验结果显示对新冠轻症重症都没有效果(有顶级医学论文）。中国在最新的指南也不推荐轻氯喹和阿奇霉素组合。who也不支持。

 

[冰中取火]

第一个医生是家庭医生。这些前线医生的经验不一定可以推广，这些药不是解毒的，就像中药，可能增强抵抗力，但药效有限。比较可靠的大规模轻氯喹临床实验结果显示对新冠轻症重症都没有效果(有顶级医学论文）。中国在最新的指南也不推荐轻氯喹和阿奇霉素组合。who也不支持。

如果是家庭医生，一般不是治疗covid-19的主要医生，应该是肺科相关的专科医生才是主要的。

 

[贵圈]

顶

 

[ygao]

如果是家庭医生，一般不是治疗covid-19的主要医生，应该是肺科相关的专科医生才是主要的。

就是一般家庭医生。呼吸道传染病专家的更靠谱。最终要看科学论文的结论。总之，目前没有特效药，瑞德西韦的药效是经过大样本数据分析后被肯定的，虽然药效有限。