Coronavirus

[Papafox]

Your premise is that the French are acting out of a rational mind. I disagree with that premise. I posted an article where the French study's SEVERE limitations were outlined by other researchers and doctors:
Coronavirus

This is the THIRD TIME I have told you to look at the above post for a STRONG refutation of the French data. Are you intentionally ignoring that?

And as I've said previously, my colleagues at Cornel in NYC do NOT regard Dr. Zelenko as . . . well respected and there is a big question of if he is being truthful. Notice how he just posted he has treated 669 patients with this combination? No publishing of his data (and 669 is a CRAP ton of patients to prescribe this to in just 2 short weeks, if you were doing proper follow up). Is he dolling it out like candy? Did he have a positive SARS-CoV-2 test on each one first? If he did, he's certainly getting testing results back MUCH faster than the approximate week turn-around time for the rest of NYC that my colleagues are reporting. This dataset . . . isn't even a dataset. It's a guy posting on a blog that he did something and not providing any proof for peer review. Sounds like click bait to me, pure and simple. He should share the data with everyone, like ANY peer review process requires, or retract his statements (and likely lose his medical license).

I just did a pubmed search on the guy - he's never published any peer reviewed journal articles that I could find.

You keep ascribing hope in place of facts. Plain and simple.

Your document refuting the French study refers to the first study, the 20 person study, that has widely been criticized. The same group of doctors then conducted an 80 person study that shows significant promise for the drug but didn't include the type of control group that we'd prefer to see and so it too receives some criticism. But is criticism of the study the same thing as saying the study's findings are useless? No.

Nonetheless, the use of HCQ has become such an emotional topic due to the politics involved that we'll need a carefully conducted double-blind study. Such a study is apparently underway in the U.S. according to this story:

Clinical Trials Set To Determine If Anti-Malaria Drug Effective Against COVID-19

In the meantime, France, the United States, and Italy are doing what I believe is the right thing, which is to allow the use of the drug for Covid-19 because the evidence at this time suggests that the benefits outweigh the risks. Looking forward to seeing the results of a study that we can all accept.

By the way, please discontinue the insults such as "You keep ascribing hope in place of facts. Plain and simple." Please be less rude on this thread. There are serious subjects to be discussed here.

 

[SageBrush]

Daily test+ counts are influenced by testing policies, and I cannot find Covid-19 related hospitalization data so I've decided to migrate to covid-19 related deaths per capita. Not ideal due to lag from case definition and spotty reporting but it does have some redeeming features:

• Presumed not affected by testing policies
• Gives a better idea of disease burden in each country
• Still lets us compare countries effectiveness and find those still in exponential growth phase

I suggest that viewers concentrate on the trend over time for countries of interest and that they do not compare countries to each other on the same date because the epidemic started at different dates. Note the log scale.
The data is from Download today’s data on the geographic distribution of COVID-19 cases worldwide

Data through 4/1

 

[Norbert]

Talking about France: So far their max deaths in a day was 509. Today worldometers is reporting 1355.

 

[eevee-fan]

Talking about France: So far their max deaths in a day was 509. Today worldometers is reporting 1355.

NOTE:

France today reported 884 additional deaths that have occurred in nursing homes over the past days and weeks [source]. The French Government did not include these deaths in their official count, as their count only takes into consideration deaths of hospitalized patients. Following international standards of correct inclusion, our statistics will include these deaths, and will add them to the April 2, 2020 count following the attribution criteria of date of report.

If and when the French government determines and communicates the correct distribution of these additional deaths over time, we will adjust the historical data accordingly. A similar issue took place on February 12, when China reported an additional 13,332 new cases in a single day due to a change in how cases were diagnosed and reported in Hubei.

 

[SageBrush]

I get a Tesla Motors Club error on that last link.

Thanks. Fixed now ?

 

[cusetownusa]

Hospitals make more money per patient with elective procedures than they do on critical care. That's the reason for the large drop in revenue.

Exactly . In addition we barely have any cases around here(NYS but not NYC). The hospitals are way under capacity right now.

 

[eevee-fan]

Exactly . In addition we barely have any cases around here(NYS but not NYC). The hospitals are way under capacity right now.

Opportunity for "medical tourism". Have people drive/fly in, stay isolated in local hotel for a couple of weeks, get elective surgery, stay another couple of weeks, return home...

 

[EinSV]

Serum from recovered patients continues to have promising results.

U. of Maryland doctor reports 5 patients treated, 3 discharged, 2 stable. Usual caveats.

Monoclonal antibodies would prob be better but FDA approval will take too long.

Twitter

 

[ohmman]

Defend your position with data and stronger explanations than mine, if they exist.

By the way, please discontinue the insults such as "You keep ascribing hope in place of facts. Plain and simple."

From an outsider's point of view, the first quote seems to be an insult in line with the one you quote in the second blurb.

A problem with this pandemic, as I see it, is that the urgency level is high, which creates the obvious problem for the normal testing/validation cycles. That is, time. So while I understand excitement around HCQ as a treatment, and I think that careful administration is probably reasonable given the anecdotal nature of the current body of evidence, I also know that this is a fraught road. Human beings are known for believing just about anything based on anecdote. Look at how the MSG thing ballooned into what it still is today. That's decades of knowing that something isn't bad, but people still thinking it is. Obviously I could fill this text box with all of the things people believe, but are disproven in the end with careful testing. There is value in real testing, and that value is that it provides the only way we have to prove our intuitions wrong when they indeed are wrong.

I see a number of posters here who say things that are contrary to the current evidence or expertise out there (not the one I quoted, by the way). While they may be right in the end, and in general they're optimistic so I hope they are, there is significantly more value in being wrong because you followed the evidence and expertise than there is in being right because you were naturally contrarian or because you followed a "hunch".

Evidence and good, solid testing are the only way to actually know anything. I'm incredibly hopeful that anecdotes in this case are proven correct. But I also respect the fact that as humans, being wrong is nearly as common as being right when it comes to using heuristics to make determinations.

So, back to the initial quotes and reason I responded: I do respect what @bkp_duke is trying to say (I think), which is that we cannot suddenly put all of our chips in because of anecdote. And I also respect what I think @Papafox trying to say (I think), which is that there is promise in the HCQ as treatment.

Sorry if I misinterpreted either of you (and I'm sure you'll let me know). I just thought you were sort of talking past each other.

 

[bkp_duke]

So, back to the initial quotes and reason I responded: I do respect what @bkp_duke is trying to say (I think), which is that we cannot suddenly put all of our chips in because of anecdote. And I also respect what I think @Papafox trying to say (I think), which is that there is promise in the HCQ as treatment.

Essentially correct, but more than that HCQ is not something akin to an aspirin. In a significant portion of the population it will cause cardiac arrhythmias due to long QT syndrome, and subsequent death. This is why the media (over)hype of this medication is fraught with additional complications, that are being glossed over.

 

[TheTalkingMule]

Serum from recovered patients continues to have promising results.

U. of Maryland doctor reports 5 patients treated, 3 discharged, 2 stable. Usual caveats.

Monoclonal antibodies would prob be better but FDA approval will take too long.

Twitter

I'm gonna look back and regret not creating a plasma black market for treating the .001%

Dear lord, you could charge literally anything you like and wouldn't be hard to get up and running.

$200k a pint please.

 

[SageBrush]

In addition we barely have any cases around here(NYS but not NYC). The hospitals are way under capacity right now.

Be careful what you wish for

 

[cusetownusa]

Be careful what you wish for

not wishing for anything. Just stating the current situation and well aware things can ramp up quickly From here. But I do feel bad for all of the employees that were laid off at the hospitals and many other places of employment.

 

[SageBrush]

I'm gonna look back and regret not creating a plasma black market for treating the .001%

You still have time.
First things first though, go get infected

 

[HG Wells]

So, I need to be VERY clear on this one:
The researchers did NOT check for cat to human or ferret to human transmission.

Theoretically, yes it could happen, but no one has looked it and we just don't know.

Please, don't go out and start exterminating cats.

Would it be OK for me to buy a cat for my wife?
I'll let you know in two weeks if it works.

 

[Papafox]

Essentially correct, but more than that HCQ is not something akin to an aspirin. In a significant portion of the population it will cause cardiac arrhythmias due to long QT syndrome, and subsequent death. This is why the media (over)hype of this medication is fraught with additional complications, that are being glossed over.

You know, the question right now comes down to risks vs. rewards. HCQ has long been used for lupus and other diseases, so we have some knowledge of the likely risks of using the drug. We'd all like to see a quality double-blind study with sufficient numbers to prove the effectiveness of HCQ for Covid-19, and we'll get results within a few weeks from the University of Minnesota study, but the question is: what do we do in the interim? We've actually seen HCQ used with arithromycin in the French studies, with zinc in South Korea, and with all three of these ingredients in Dr. Zelenko's writeup. We really need studies underway to test these other combinations, too, to both find out if they're more effective and if there are safety issues when the drugs are used together. I very much hope the studies are conducted. If HCQ by itself proves effective, then the other combinations are likely to be considered too. OTOH, if HCQ by itself is considered minimally effective or even not effective then we're in a bad place because the critics of HCQ will say stop and the proponents will say go, but with the "missing ingredient". I don't think we'll see such a conclusion, but I don't want to put the country in a position of increased tensions. In the meantime, there will be lots of data coming in. We need to digest it and include those results in our decision-making processes until better data comes our way.

 

[FoverM]

Here's a graph of the Positives per million versus Days since PPM exceeded 50 for the top 20 states (data up to 04/01):

The legend on the right is the order based on the latest PPM. Data is from covidtracking.com's states-daily.csv.

 

[Oil4AsphaultOnly]

Essentially correct, but more than that HCQ is not something akin to an aspirin. In a significant portion of the population it will cause cardiac arrhythmias due to long QT syndrome, and subsequent death. This is why the media (over)hype of this medication is fraught with additional complications, that are being glossed over.

From what I've read so far (without digging into your referenced prior posts - I promise to read them soon), I get that you're concerned about the issues with widespread HCQ use, but you're not even willing to acknowledge that Papafox's point is about the risk-reward tradeoff.

Right now, it seems that the risk of dying from covid for the over 60 crowd (from Italy's data) is close to 10%. If I were in that risk group, and I got the symptoms, I would be forced into a position where I have to gamble between HCQ or covid. And the odds of dying from covid seem to be so much higher than that from HCQ, that taking it away as an option is guilt through negligence.

There is such a thing as being too careful. The decision to try one treatment or another should really be with the people who are likely to die.

 

[dfwatt]

You know, the question right now comes down to risks vs. rewards.

Actually, in relationship to every conceivable intervention a healthcare professional might recommend or might discourage, it always comes down to parsing risks and rewards. Or now as it's called "rewards and harms". Although I don't agree with everything dkp_Duke has said about chloroquine he is absolutely right to insist on a balancing of the risk versus reward tabulation. And that we still lack any version of gold standard evidence.for efficacy.

Indeed if there's a single most common failure in many of my physician colleagues it's that risks often and perhaps even increasingly get the once-over-lightly. This is true around surgery, anesthesia, prescription medicines, just about everything you could consider in the mainstream medical wheelhouse treatment options for every single disorder the Healthcare System might potentially treat.

Since it takes actual and in some cases considerable time to discuss this stuff with patients and because increasingly Physicians are running literally from one patient contact to the next, a careful review of risks vs rewards often times is one of the vitally important discussions that get short shrift in our high-tech Healthcare System.

 

[renim]

You know, the question right now comes down to risks vs. rewards. HCQ has long been used for lupus and other diseases, so we have some knowledge of the likely risks of using the drug....

Re SLE. May take 2 tablets daily for 2 months initially, then scale back to 1 tablet a day. A tablet is 200mg so thats 400mg daily, keep in mind 5 grams is a fatal dose, so thats about 12 days worth...

Now the half life plaqaneil in a human is roughly around a month. So the initial 2 month treatment results in blood concentration of multiple amount sufficient to kill if it was a rapid dose. It is also roughly what is required to raise the amount in the body to maintainence level...

So here is the catch. It probably works as a protective medication against covid 19. But once someone is sick enough to have medical care, its too late to use because you'll kill the patient trying to ramp it up, and if its not high enough it not effective. It would possibly be useful earlier at point of testing, but not too much later.

And it has contradictions, with heart medications etc. At risk americans are on multiple medications so, its probably not much help there either.

But for healthy front line people ( doctors nurses etc) its possibly a decent low risk option for defensive covering

(Im not a medical person, but i once knew a SLE person on this stuff)

Drug spotlight on hydroxychloroquine