First and foremost be very clear with your patients/clients that your goal is to slow down replication/reproduction of SARS-COV2 virus and not to cure or prevent COVID 19. Also, delineate the risk for QT prolongation with Hydroxychloroquine and Zithromax, since both drugs causes QT prolongation. Additionally, in the face of cardiac comorbidities, obesity, diabetes and hypertension, as well as, autoimmune disease, there will be an increase susceptibility for QT prolongation. The aforemnetioned chronic diseases also portend to electrolyte abnormalities that exacerbate QT prolongation such as hypocalcemia, hypomagnessemia and Vitamin D deficiency.
Prevention of QT prolongation
In medicine you are mainly restricted by the patient’s innate presenting comorbidities, innate immunity, genetic polymorphisms, epigenetic polymorphisms and pharmacogenetic polymorphisms. As a physician who includes Genomic Medicine in my practice, I am acutely aware of these determinants in the outcome of the patients COVID 19 disease course, and disease sequelae. Consequently, in my COVID 19 protocol I request that the patient consume Zinc, Vitamin D and Magnesium, 30 minutes to an hour before taking Hydroxychloroquine. I request that Zithromax be taken 2 hours after Hydroxychloroquine to minimize any drug-drug interaction relative to synergy or multiplicative QT prolongation side effects. I also address metabolic syndrome issues secondary to obesity, such as persistent chronic absorptivity issues, hypocalcemia, hypovitaminosis D and B12, as well as, the chronic inflammatory state due to obesity, which also affects myocardium and nerve/neural global conductivities.
The role of Telemedicine/Telehealth in the eradication of COVID 19
Telemedicine/Telehealth has the potential to eliminate health inequity and health disparities. In the COVID 19 era, I have seen where all the limitations and restrictions in the delivery, compensation/parity, and access to Telehealth/Telemedicine, basically evaporate or “gone with the wind”. I started practicing Telemedicine in 2016, and I thought it was the “Wild, Wild, Wild, Wild” West relative to the startup arm of the marketplace. I have even dappled in Telehealth consulting and was sometimes told I was too negative. Those companies of course eventually collapsed. We must understand in medicine that health care servants (MD, DO, PA, NP and DNP) are the Orcas in the food chain of the Trifecta that is medicine. The Trifecta is revenue cycle management, financial management and last but not least, medicine, the art and the science, which drives the whole space ship of reimbursement, the USS Enterprise.
Relative to Public Health, the validity and necessity for Telehealth/Telemedicine is indispensable in scope and reach, regarding the potential to eliminate health inequity, health disparity and underserved areas/population.