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Early treatment COVID19?

"patients (median age, 62), with COVID-19 pneumonia and with symptom onset averaging about 1 week prior to enrollment, received either convalescent plasma or placebo." Allan S. Brett, MD and Helmut Albrecht, MD reviewing Simonovich VA et al. N Engl J Med 2020 Nov 24

Another negative study for convalescent serum for COVID19 raises the question, what are they trying to prove? If the use of convalescent serum in preventing pneumonia and death in the double blind study only starts with the onset of hospitalized pneumonia, then it seems unlikely that any agent in question would prevent pneumonia, and if 83% of hospitalized COVID19  pneumonia patients die, then it would seem unlikely that the use of a preventative modality at this late stage would have much benefit. The changes in the lungs with COVID19 pneumonia go far beyond infection. The damage is hard to reverse. Steroids appear to mitigate some of the damage, but  when the CAT scan shows massive pneumonia, it may be too late.

Even these double blind studies need to be viewed with skepticism. In an out of control epidemic, the first-hand experience of front line physicians may be a better guideline for treatment, ivermectin for instance and early treatment. Early treatment requires distribution of testing and treatment products to primary care physicians. By the time a patient experiences shortness of breath and hospitalization, the opportunity for early treatment is passed. President Trump's experience with early treatment is a case in point.

acknowledgment: I am not a frontline physician, but comment from the perspective of retirement and age related experience.

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