Coronavirus

[madodel]

As a physician, if I got sick with COVID-19 tomorrow, I would be screaming at the doc treating me to put me on Dexamethasone and Remdesivir.

My wife keeps saying when she gets it she will immediately go on Lovenox. Dex and Remdesivir are SoC now are they not?

 

[bkp_duke]

My wife keeps saying when she gets it she will immediately go on Lovenox. Dex and Remdesivir are SoC now are they not?

Correct, Dex and Remdesivir are Standard of Care currently.

Lovenox, probably not a bad idea for just about anyone bed ridden for weeks.

 

[dfwatt]

With pier review, longer = not good. It usually means the pier review process found substantial problems and are giving the authors a chance to address those problems (if possible).

Love that hopelessly paraphasic Google speech to text. Just to clarify . . . peer review is when your study gets a review by your peers. Pier review is when your peer-reviewed study is dropped off the pier because it sucked. See Santa Clara antibody study.

 

[bkp_duke]

Love that hopelessly paraphasic Google speech to text. Just to clarify peer review is when you get a review by your peers. Pier review is when your peer-reviewed study is dropped off the pier because it sucked. See Santa Clara antibody study.

Yeah, who wants to type posts that long?

 

[scottf200]

Will Herman Cain passing away convince others in his sphere to wear mask and social distance?

https://twitter.com/THEHermanCain/status/1274489632886075398

 

[dfwatt]

Will Herman Cain passing away convince others in his sphere to wear mask and social distance?

https://twitter.com/THEHermanCain/status/1274489632886075398

It just boggles the mind to see black people supporting a white supremacist. It'd be like attending a rally with Jews for Hitler. The fact that he gave his life in the service of covid-19 denial adds another painful layer of irony.

 

[AlanSubie4Life]

Will Herman Cain passing away convince others in his sphere to wear mask and social distance?

No.

In other news, Fauci and Birx recommend face shields or goggles today (in addition to a mask). The thought is that it provides extra protection to the wearer. No surprise. My insistence on this back in March or April is what @SageBrush put me on ignore for, lol.

 

[SteveG3]

I've said this at least a dozen times in this thread, but it bears repeating now:

When evaluating scientific evidence - you MUST look at the body of evidence as a whole, not cherry pick anything. Bias in science is not tolerated, and for good reason.

If we apply that to HCQ +/- AZTH +/- zinc we come to the following inevitable conclusions:
1) HCQ in any setting, with or without AZTH has NO POSITIVE effect on COVID-19. This is for all spectrum of disease (mild, moderate, and severe). Over 95% of studies show that now, with the 5% that show a benefit being the earlier pilot studies that have been pointed out to have significant methodology problems.
2) Zinc - the definitive jury is out on this, but by adding in HCQ and AZTH - both of which cause significant heart arrhythmias in a significant percentage of the population - the harm to benefit ration is not looking good. Zinc would have to have a massive effect to overcome that detrimental landscape caused by the two other drugs. If the effect were that great, it should be visible in and of itself.



So again, not cherry picking, but looking at the body of evidence as a whole, HCQ looks like a complete dud.

in your point 1) you wrote that there is a 20:1 ratio of studies showing HCQ and AZTH has no positive impact for all spectrum of disease, setting aside zinc for what you wrote in point 2). you left out the third variable I’ve seen regularly in the studies that did not show a positive impact for HCQ + antibiotic, the dosing of the pair. Typically I’ve seen HCQ given at 2X the dosing in Zelenko and HF’s papers.

Dosing 2X is not a subtle difference. When you include a requirement of the same dosing, do you stand by that 20:1 claim re studies finding no efficacy to efficacy? Are there any examples you have of published studies with HCQ & antibiotic at dosage at the same level (or even close to) as Zelenko & HF that did not show efficacy?

If there are not examples that clearly are a preponderance in numbers to the ~700 HCQ in the HF study that saw the 50% reduction, you’ve actually made an argument for my suggestion that HCQ is still a treatment meriting strong interest (am getting to your statements in your second point now...)

as to your point 2), I saw strong assertions, “the definitive jury is out,” in your comments that the risk of heart adverse events is at a harm to benefit ratio that makes HCQ, HCQ/AZTH is not looking good. What I did not see was any data.

I’ve seen a very compelling case from Yale epidemiologist MD/PHD Harvey Risch that this is by no means the case. Note the extremely large set of applicable data, 320,000 patients in a Oxford University study, at the end that showed a 1/10,000 fatality risk re such heart issues with these meds. that is roughly 1% of the fatality rate of corona patients, and when you consider only patients at high risk would get this treatment, this implies a harm to benefit ratio of something like 1 to 500 for the treatment

“Third, concerns have been raised by the FDA and others about risks of cardiac arrhythmia, especially when hydroxychloroquine is given in combination with azithromycin. The FDA based its comments on data in its FDA Adverse Event Reporting System. This reporting system captured up to a thousand cases of arrhythmias attributed to hydroxychloroquine use. In fact, the number is likely higher than that, since the reporting system, which requires physicians or patients to initiate contact with the FDA, appreciably undercounts drug side effects.


But what the FDA did not announce is that these adverse events were generated from tens of millions of patient uses of hydroxychloroquine for long periods of time, often for the chronic treatment of lupus or rheumatoid arthritis. Even if the true rates of arrhythmia are ten-fold higher than those reported, the harms would be minuscule compared to the mortality occurring right now in inadequately treated high-risk COVID-19 patients. This fact is proven by an Oxford University study of more than 320,000 older patients taking both hydroxychloroquine and azithromycin, who had arrhythmia excess death rates of less than 9/100,000 users, as I discuss in my May 27 paper cited above. A new paper in the American Journal of Medicine by established cardiologists around the world fully agrees with this.“


https://www.newsweek.com/key-defeat...inion-1519535?amp=1&__twitter_impression=true

 

[SteveG3]

See above reply. If Zinc were a magic bullet, it would have to overcome the known detrimental effects of HCQ and AZTH. I still have that offer of a (very nice) steak dinner to you if that turns out to be true.

See above reply.

 

[bkp_duke]

in your point 1) you wrote that there is a 20:1 ratio of studies showing HCQ and AZTH has no positive impact for all spectrum of disease, setting aside zinc for what you wrote in point 2). you left out the third variable I’ve seen regularly in the studies that did not show a positive impact for HCQ + antibiotic, the dosing of the pair. Typically I’ve seen HCQ given at 2X the dosing in Zelenko and HF’s papers.

Dosing is 2X is not a subtle difference. When you include a requirement of the same dosing, do you stand by that 20:1 claim re studies finding no efficacy to efficacy? Are there any examples you have of published studies with HCQ & antibiotic at dosage at the same level (or even close to) as Zelenko & HF that did not show efficacy?

If there are not examples that clearly are a preponderance in numbers to the ~700 HCQ in the HF study that saw the 50% reduction, you’ve actually made an argument for my suggestion that HCQ is still a treatment meriting strong interest (am getting to your statements in your second point now...)

as to your point 2), I saw strong assertions, “the definitive jury is out,” in your comments that the risk of heart adverse events is at a harm to benefit ratio that makes HCQ, HCQ/AZTH is not looking good. What I did not see was any data.

I’ve seen a very compelling case from Yale epidemiologist MD/PHD Harvey Risch that this is by no means the case. Note the extremely large set of applicable data, 320,000 patients in a Oxford University study, at the end that showed a 1/10,000 fatality risk re such heart issues with these meds. that is roughly 1% the fatality rate of corona patients, and when you consider only patients at high high risk would get this treatment, this implies a harm to benefit ratio of something like 1 to 500

“Third, concerns have been raised by the FDA and others about risks of cardiac arrhythmia, especially when hydroxychloroquine is given in combination with azithromycin. The FDA based its comments on data in its FDA Adverse Event Reporting System. This reporting system captured up to a thousand cases of arrhythmias attributed to hydroxychloroquine use. In fact, the number is likely higher than that, since the reporting system, which requires physicians or patients to initiate contact with the FDA, appreciably undercounts drug side effects.


But what the FDA did not announce is that these adverse events were generated from tens of millions of patient uses of hydroxychloroquine for long periods of time, often for the chronic treatment of lupus or rheumatoid arthritis. Even if the true rates of arrhythmia are ten-fold higher than those reported, the harms would be minuscule compared to the mortality occurring right now in inadequately treated high-risk COVID-19 patients. This fact is proven by an Oxford University study of more than 320,000 older patients taking both hydroxychloroquine and azithromycin, who had arrhythmia excess death rates of less than 9/100,000 users, as I discuss in my May 27 paper cited above. A new paper in the American Journal of Medicine by established cardiologists around the world fully agrees with this.“


https://www.newsweek.com/key-defeat...inion-1519535?amp=1&__twitter_impression=true

You KEEP falling into the same trap. You keep cherry-picking things that you believe support your wishes, and ignoring the preponderance of evidence as a whole. You also fail to point out that when I made those "the jury is out" comments, it was before the large RCT trials of HCQ that have since shown it to be . . . . worthless for COVID-19, and dangerous overall.

But hey, what does the guy here with an M.D. and a Ph.D. in molecular biology, that has real life experience with genetic manipulation of viruses (adenovirus in this case) know, right?

If you want a "cheap", simple, and effective single drug treatment, use dexamethasone (a 70 year old steroid drug). If you want to further improve your chances, add in Remdesivir. That is the CURRENT, STANDARD OF CARE.

You are wrong about the FDA adverse event reporting on HCQ. ALL of them used to support the removal of HCQ as a recommended treatment were ACUTE events after Jan 1, 2020 (i.e. during the pandemic). You have the American College of Physicians, the American Heart Association, and MANY other physician groups ALL recommending against HCQ.

I don't know you, and I could care less if you take HCQ (have fun with that btw).

 

[SteveG3]

Let me Google that for you:
Gilead reports reduced mortality risk with remdesivir for Covid-19
"The data include findings from a comparative analysis of the Phase III SIMPLE-Severe clinical trial and a real-world retrospective cohort of patients with a severe form of the disease.

According to the analysis, the drug demonstrated an improvement in clinical recovery and a 62% reduction in the risk of mortality compared to standard of care."


As a physician, if I got sick with COVID-19 tomorrow, I would be screaming at the doc treating me to put me on Dexamethasone and Remdesivir.

thanks. so, in fact, about two weeks ago some encouraging data on fatalities did come out in Remdesivir subsequent to the original data a couple of months back. excellent! we can use anything that will help. this data does not do better than the 50% fatality reduction in the HF study or the 80+% Zelenko claims, but this very good news in my view as it looks like it gives a big boost to the likelihood there will be very substantial numbers of use cases where Remdesivir reduces fatalities!

 

[SteveG3]

I suspect that the only contribution of hydrochloriquine is as a zinc ionophore. However there are far less toxic zinc ionophores particularly, for example, quercetin and EGCG. They also both have health benefits as opposed to health risks associated with hydroxychloroquine. Therefore in my estimation there is no good reason to take hydroxychloroquine.

HCQ doesn’t appear “very toxic” (see the Newsweek op-ed from an MD/PHD who I quoted on this topic above), but, if quercetin or EGCG are as effective and less toxic, let’s use them to the extent they are available and ramp up supplies of them if the data holds up.

 

[SteveG3]

As I posted already Elsewhere on the Forum, hydroxychloroquine is simply a bad choice for a zinc ionophore, in terms of its risk / benefit ratio. It's toxic, risks cardiac arrhythmias, and the job can be done by less toxic compounds such as quercetin and a green tea polyphenol known as EGCG. Additionally those polyphenols have potential health benefits whereas HCQ does not.

please see prior reply

 

[bkp_duke]

PLEASE stop quoting the Henry Ford study, every physician group I have seen has denounced that study as EXTREMELY flawed:
A flawed Covid study gets Trump's attention — and FDA may pay the price

At the core:
"The study that sparked the latest controversy was anything but randomized. Not only was it not randomized, outside experts noted, but patients who received hydroxychloroquine were also more likely to get steroids, which appear to help very sick patients with Covid-19. That is likely to have influenced the central finding of the Henry Ford study: that death rates were 50% lower among patients in hospitals treated with hydroxychloroquine."


We know, for FACT, that corticosteroids improve COVID-19. HCQ did not add anything additional to this.


I'm actually appalled that the Institutional Review Board for the hospital allowed this study at all. What they gave patients was basically a "cocktail of anything we can think might help". It was a colossal confounding of variables. The right-leaning media, of course, focused in on HCQ. What anyone unbiased should have done was to test serially each cocktail component, and then start grouping them in batches for testing that way. Not toss in the entire kitchen sink.

But hey, I did train at a better institution than this, so I guess I'm being too harsh on them, right?

 

[SteveG3]

Fortunately others have backed up the claims. (And my claims were at best vague and non-specific, since I really have no idea which treatment exactly appears to be bringing down mortality a bit.) I specifically said I’m tired of it and have no interest in relitigating studies and data that have already been covered in this thread. If we get a double-blind placebo-controlled randomized trial showing HCQ cocktail, as promoted, reduces mortality significantly, my interest will be piqued.

The “funny” rating was just me smiling about HCQ cocktail being described as a powerful tool, and just the general absurdity that we are still talking about this after six months, and we still do not have an RCT study of the supposedly magic regimen (I really wish we had that!).



If you want to review the whole discussion here, the search feature with appropriate terms should bring up everything you want to know. The timing is coincident with when all of this stuff was big in the media several months ago.

see my prior replies. I still think it is far more likely then not that at the right RX, with zinc, at the first stage of the disease, HCQ is a powerful tool vs corona. if quercetin or some other option is even more effective, or as effective with lower adverse events, etc, let’s switch to that other option when we get the data.

 

[SteveG3]

No you can't just speculate away a large age difference with a disease where negative outcomes are skewed to the elderly. That study was extremely flawed in my opinion, non treatment group was older, treatment group eliminated people with cardiac issues, more people in the treatment group received steroids than the non treatment group, and there was no randomization so treatment biases were likely applied in all cases. I'd call this study garbage. Show me RCTs.

*duke beat me to it.

we’re in agreement re wanting to see better studies. don’t know if we have specific data from the study on the flaws you brought up... ie, what percent of patients in each group used steroids, what percent of the non treatment group had cardiac issues. would like to see the specifics on that and would like to see more studies that aim to eliminate these variables and include zinc in the HCQ treatment arm.

as to the variable of age- 3.9 years or 4.9 years, looks to me like a meaningful age difference in the context of covid, but I wouldn’t characterize it as a “large age difference,” particularly in contrast to a 50% reduction in fatalities, which I would characterize as a large difference.

 

[NikolaACDC]

https://www.washingtonpost.com/worl...b1e622-d25f-11ea-826b-cc394d824e35_story.html

"England topped Europe’s grim league table for highest levels of excess deaths during the coronavirus pandemic, according to new analysis published Thursday by Britain’s Office for National Statistics.

The analysis of more than 20 European countries — which looked at the four nations of the United Kingdom as separate entities — found that England’s death rate was 7.55 percent higher this year, through the end of May, compared with its five year average. Spain was next with a 6.65 percent increase over its average. Scotland was 5.11 percent above its average and Belgium 3.89 percent.

Because different countries have used different methods to calculate coronavirus deaths, many scientists consider excess mortality a more reliable way to measure the impact of the virus and to compare across countries.

When asked by a reporter if he was “ashamed” about the findings, British Prime Minister Boris Johnson said, “We mourn every loss of life that we've had throughout the coronavirus epidemic.” But he added that “clearly this country has had a massive success now in reducing the numbers of those tragic deaths.”

 

[dfwatt]

HCQ doesn’t appear “very toxic” (see the Newsweek op-ed from an MD/PHD who I quoted on this topic above), but, if quercetin or EGCG are as effective and less toxic, let’s use them to the extent they are available and ramp up supplies of them if the data holds up.

I didn't say it was very toxic. But it clearly has some potential toxicities around prolongation of the QT interval and again in patients with pre-existing cardiac conditions particularly pre-existing arrhythmias that's a concern. My problem with hydroxychloroquine is that I think it has a poorer risk-benefit ratio compared to some other things, even if you grant that it has therapeutic function as a zinc ionophore which by the way hasn't been proven clinically.

And at this point there is far stronger data supporting vitamin D, as a variable moderating severity of infection, remdesivir, and for patients particularly those with bad pneumonia and sepsis, dexamethasone. The evidence there around all three of those is compelling. Vitamin D may need to be at a decent level prior to infection to offer protection and giving it to patients who are already in sepsis may be too late.

 

[dfwatt]

see my prior replies. I still think it is far more likely then not that at the right RX, with zinc, at the first stage of the disease, HCQ is a powerful tool vs corona. if quercetin or some other option is even more effective, or as effective with lower adverse events, etc, let’s switch to that other option when we get the data.

It's unlikely any one's going to ante up the serious bucks it would take to study polyphenols in covid-19.

 

[bkp_duke]

HCQ doesn’t appear “very toxic” (see the Newsweek op-ed from an MD/PHD who I quoted on this topic above), but, if quercetin or EGCG are as effective and less toxic, let’s use them to the extent they are available and ramp up supplies of them if the data holds up.

Wrong. Quoting myself (which is a quote of @dfwatt):
Coronavirus