(continued from above) ..

From the feedback Dr Syed Haider has provided - he has prescribed ivermectin + fluvoxamine to hundreds of patients - it is becoming clear that if you give ivermectin + fluvoxamine there is near zero progression to the hyperinflammatory stage post-day8.

This is very intriguing, because the single biggest source of tension with the traditional treatment of covid19 - ivermectin + famotidine + vitamins - and then steroids-at-day7-8 is the timing of the steroids.

When a patient comes to a doctor while other drugs cocktail can be started at any time, the steroids needs to be carefully timed - not too early and not too late.

Complicating things further, with Delta variant and new variants for vaccinated patients, the timeline can sometimes be accelerated - ie day1-7 can be silent/asymptomatic.

What Dr Syed Haider is saying is that if given ivermectin + fluvoxamine early there is no oximeter dip ie need for steroids at day8.

This could simplify treatment - a one-time protocol with no timing complexity.

The only problem is that with Fluvoxamine (being an anti-depressant) a portion of patients do have issue with it's use. Which adds to the risk of patient non-compliance.

I have not used Fluvoxamine or pushed it precisely because of this risk.

But with the recent reconfirmation by Dr Syed Haider about the potential for avoiding steroids altogether if ivermectin + fluvoxamine is given to all - it sounds attractive. Those patients who don't comply because of side-effects can be switched to traditional steroids-at-day7-8 protocol.

In any case the negative sense around anti-depressants is what is holding Fluvoxamine back - otherwise it would be used by many more of the early treatment doctors. What is hindering it's spread is that early treatment doctors already know how to treat reliably - ie prevent 100pct from progressing to need for oxygen etc.

When they already have a protocol that works using drugs that have good acceptance by patients, many have been leery of testing Fluvoxamine. Primarily because they don't have a good feel for what to watch for etc (that they have already developed for ivermectin + steroids).

But we may see more interest, and early treatment doctors starting to use Fluvoxamine in more patients.

For this reason, I would request Dr Been u/mastcell to interview Dr Syed Haider once again to establish the parameters around prescription, what to watch for, what to do if patient want to stop fluvoxamine suddenly - what alternate to switch to - until these questions are resolved we will continue to have reluctance to adding Fluvoxamine.

Ivermectin vs. Fluvoxamine

So how does Fluvoxamine compare to Ivermectin?

Ivermectin seems to be very effective as pre-exposure and post-exposure prophylaxis.

That is, if Ivermectin is given before day1 of symptoms (viral peak occurs at day1 also) - then there is a good chance the person will not experience symptomatic disease, or asymptomatic progression to hypoxia (which can happen in covid19 if not treated i.e. you can have relatively mild day1-7 but then slow decline in oximeter reading after that if are not given steroids-at-day8.

So Ivermectin is effective for reducing logistical collapse of households if it is given to all eligible close contacts (pregnant, breastfeeding, and below 15kg weight - should avoid - and may instead do nasal flushing, gargling to reduce viral inoculum).

I have also observed that in household after household, if ivermectin is given as soon as index case emerges, almost no one else gets the disease.

In contrast, with Delta and new variants, whole households experience logistical collapse as everyone gets covid19 from the index case. Typical 4-5 days between cases (gestation period).

In addition, Ivermectin is very effective for reversing anosmia - 0.4mg/kg bodyweight per day for 3 days - seems to reverse anosmia (taste/smell loss) within 1-2 days. Usually bynnext day there is palpable improvement and it keeps improving after that. If recovery is partial, repeat after 1 week. Can also add Aspirin 75mg per day (Gustavo Aguirre Chang protocol).

However, once day1 has arrived (patient is showing symptoms) - the viral peak has already arrived, and the bulk of the viral debris that would be created has been created, then even if a patient is given ivermectin post-day1 - that still does not prevent some dip in oximeter readings from happening in the patient starting at day7-8.

For this reason, as I have mentioned before, steroids-at-day7-8 should be adopted in order to prevent organ damage and long hauler symptoms.

This strategy matches the view of Dr Shankara Chetty (who did not have access to Ivermectin and uses H1/H2 blocker antihistamines and steroids-at-day8). His view on day8 matches that outlined by the FLCCC MATH+ protocol from 1 year ago. The FLCCC has had a clear explanation of viral timeline - which informed it's guidance for steroids use - not use much earlier than day8, and don't start much later than day8.

So with Ivermectin, if you start it after patient has shown symptoms, then even if you are continuing to give Ivermectin and Famotidine and vitamins, still the patient will show some oximeter dip around day7-8 (earlier with Delta variant and in the vaccinated - where day1-7 may be silent/asymptomatic).

Thus Ivermectin + Famotidine needs to be accompanied by steroids-at-day7-8 (or on signs of daily oximeter declines, or elevated heart rate in 90s or 100+ even at rest and without fever). All these are indications for starting steroids.

What Fluvoxamine seems to offer is greater effectiveness than Ivermectin for the day1 onwards period.

While Ivermectin does not always prevent progress to hypoxia at day8, Fluvoxamine (from trial results, but also from feedback from early treatment doctors like Dr Syed Haider) seems to prevent progression to hypoxia at day8 as well.

This means that Fluvoxamine occupies a unique value proposition - as a possible replacement for steroids (if Fluvoxamine is given early).

I have not used Fluvoxamine, so have not had a chance to study if early use of Fluvoxamine completely prevents any oximeter declines, and thus would on it's own be an effective preventative against organ damage, and long hauler syndrome (as steroids-at-day8 seem to be).

Fluvoxamine may have potential for pre-exposure prophylaxis, but it's dosage for that is not established. Plus there may be opposition to chronic use of Fluvoxamine just as prophylaxis - esp if a safer alternative in Ivermectin is available.

I am also not aware if Fluvoxamine has potential for post-exposure prophylaxis - but it certainly will prevent progression to hypoxia. Just as administering Fluvoxamine at day1 onwards seems to do, similar results should follow if Fluvoxamine is given a day or two before day1 of symptoms.

While, Fluvoxamine retains some risk - some patients cannot tolerate it and may stop using it - therefore alternative safety net should be in place (steroids) if patient stops complying.

One strategy could be to start all patients on Fluvoxamine, and be ready for steroids-at-day8 - then at day7-8 confirm if patient is complying so far with Fluvoxamine protocol - and if is not then to administer the usual steroids-at-day8.