Coronavirus

[Papafox]

Your argument for a study is weakened by the studies that show compelling safety concerns with HCQ. You make no case that Zinc improves safety. IMO few review boards would approve a Zinc study with HCQ. Perhaps with a more safe alternative to HCQ and it would likely go against the next best alternative.

The problem with any study with HCQ at this point remains safety as I see it. If Zinc is the key then find a safer substitute for HCQ at least.

Safety is relative.You need to weigh the safety of the treatment vs. the ability to save lives with it. The FDA this spring approved emergency use of HCQ and azithromycin for COVID 19. They retracted that emergency authorization when a number of clinical studies that didn't include zinc suggest no significant benefits from HCQ in the treatment of COVID 19. Right now, hundreds of thousands, maybe even millions of lupus and arthritis patients are taking HCQ. In terms of relative safety, the threat of COVID 19 is far greater to one's life than lupus or arthritis. Do you see where I'm going? If HCQ is safe enough taken over a long period of time for these less threatening ailments, it ought to be safe enough to be taken in low dose for 5 days by a COVID 19 patient.

 

[bkp_duke]

@Papafox - responses in bold.

There is no inconsistency. His odds of survival if NOTHING is done for someone of his age are 90%.
90% eh? If it was you, would you take the roll of the dice on 90% survival? I sure wouldn't. Instead, I'd do everything in my power to stop the disease before it progressed into the serious battle within the lungs. Right now, I haven't seen a treatment more adept at preventing that progression than using HCQ, an antibiotic, and zinc. Show me one scientific study done on patients who were given HCQ and zinc early in the disease that indicates the treatment is without value. Studies that exclude zinc are of zero value in this discussion. Zinc is an essential ingredient in the successful treatment of Covid 19 with HCQ and it's the missing ingredient again and again in studies.

YOU AGAIN miss the point. HCQ, with AZTH or not, with Zinc, or not, does NOT affect baseline survivability. I don't HAVE to prove that Zinc helps or hurts, the burden of PROOF is on those people like YOU. Basic scientific method requires you to disprove the null hypothesis.

And lets be real here, because HCQ is SO BAD in terms of the side effect profile, no one is going to try it in a cocktail for COVID-19 when we have things we know improve morbidity and mortality. There is no conspiracy here, it's simply a BAD DRUG. It was a BAD DRUG before COVID-19, it was a BAD DRUG before Trump came into office, and it continues to be a BAD DRUG. Adding in other components that may or may not help doesn't change that.

Those odds DO NOT improve with HCQ.
I notice you left out the word "zinc" in this reply. Zinc is an essential ingredient in the cocktail. You have no basis to say this about the cocktail with HCQ and zinc because you cannot produce a study that backs your position. Studies that lack zinc or are given to patients already in the advanced stages of the disease are of no value for our discussion.

The study you want is on-going:
Study: Hydroxychloroquine doesn't prevent Covid-19 infection if exposed

“This is not the end of the story with hydroxychloroquine,” said Ashish Jha, the director of the Harvard Global Health Institute. But given the data, he said, if there is any benefit to giving the drug to prevent infection, “it’s going to be small.”

The same group of researchers is also planning to publish the results of trials testing the drug as a treatment and as a “pre-exposure prophylaxis” — that is, before any exposure to SARS-CoV-2, the virus that causes Covid-19.

The latest trial enrolled 821 patients who were either living in the same household as someone with Covid-19 or who were health care workers who had been exposed to someone with Covid-19 without adequate protective gear. While the initial infections had to be confirmed with a diagnostic test, the researchers also counted patients who had symptoms consistent with disease, in part because testing wasn’t available.

Approximately 12% of those given hydroxychloroquine developed Covid-19, compared to 14% who were given the vitamin folate as a placebo. There was no further benefit among patients who chose to take zinc or vitamin C. Nearly 40% of patients on hydroxychloroquine experienced side effects such as nausea, upset stomach, or diarrhea. However, the study did not see a significant increase in disturbances of heart rhythms, or an imbalance of deaths.

Even though the study used the gold standard methodology of conducting clinical research, outside researchers saw significant limitations. The study was conducted in an unusual way: over the internet, without patients being seen by study doctors.

Specifically, the WHO study which is ongoing has said the following, and it doesn't mince any words:
"There was no further benefit among patients who chose to take zinc or vitamin C."

I know you have an EMOTIONAL attachment to this drug, but I don't. I'm not biased against it, I simply KNOW the side-effect profile of the drug. This is NOT a drug with the side-effect profile of aspirin. I'm about the coldest, most harsh, hard-data person you will ever (not) meet. The only real thing that pushes my buttons is stupidity, and there is a @#$% ton of that in this thread by people that want to promote things they are emotionally attached do, but that the data do not support.
There you go again, belittling your opponent by calling his position emotion-based. Please, stick to facts and logic and attempt to exclude emotion and inappropriate digressions from your replies.

But you ARE emotionally attached to this. So much so that you refuse to consider BETTER, CHEAPER alternatives that have completed clinical trials and PROVEN to reduce morbidity and mortality. So now who is biased?

Simply put, the data to support HCQ as a treatment for ANY phase of COVID-19 is simply NOT THERE.
Let's consider this statement.
Nobody has done a controlled random test of HCQ with zinc yet. Retrospective studies are the best we have to go on right now, and they're suggesting that the cocktail that contains both HCQ and zinc is VERY effective at preventing the progression of the disease IF GIVEN EARLY.

Wrong - see above about WHO study in progress.

LETS BE CLEAR - in studies where there is a MARKED, POSITIVE EFFECT, we would have had preliminary data showing that by now (we saw this with dexamethasone and remdesivir). The researchers are always re-running the stats to see if anything statistically significant pops up. Because nothing pops up, it means if there is an effect, it is going to be INCREDIBLY SMALL.

The data that it does MORE HARM than good is there.
Wrong. If anywhere near 10% of patients who took Hydroxychloroquine for lupus or arthritis died after 5 days of the treatment, then you would have a point. The reality is the risk is extremely small for this low dose of HCQ given over five days. Granted, the inclusion of azithromycin increases the arrhythmia threat, but the combined drugs don't pose more than 1/10 of 1% of a risk over 5 days, and we know that number is likely way too high. In contrast, a 10% chance of dying from Covid 19 if it progresses to advanced levels is a very serious threat. Again, this is a question of balancing risks, and many, many doctors would opt for the minor risk with HCQ and azithromycin versus the severe threat of COVID 19 progressing to advanced stages in an older patient.

WRONG - I've posted the data from 10s of thousands of people using HCQ (see image below), and the Hazard Ratio is VERY CLEAR. The HR is so bad that the only things with an HR AS bad as being on HCQ for COVID-19 is having a pre-existing heart condition (arrhythmia or congestive heart failure) - THAT'S BAD AND WITH ANY NORMAL STUDY WOULD BE AN INSTANT SHOW STOPPER. Anything with HCQ in it puts people at risk. The people we treat with Lupus (we don't use HCQ for arthritis anymore, haven't for a VERY long time since there are much better biologics out now) do undergo routine cardiac screening while on the drug.



Those are simply the facts, like them or not be damned. Furthermore, you keep misinterpreting those retrospective studies you are so fond of. If you ACTUALLY read the conclusions of the authors, they say MORE studies (prospective, randomized control studies) should be undertaken to look at HCQ further. Those prospective, randomized control studies have been done, at least enough with 10s of thousands of people and the data for them so far, and they show that HCQ doesn't work.
This is the mistake you keep making again and again. You are grouping HCQ studies with studies of HCQ, azithromycin, and zinc (especially with zinc). Those studies that exclude zinc are worthless because zinc is an absolutely essential ingredient in the cocktail. The HCQ allows the zinc into the cells. Without zinc, the treatment loses its effectiveness.

I'm no making a mistake, YOU KEEP MISSING THE BIGGER POINT - because HCQ has a bad side-effect profile, EVERY study that has it in it as an ingredient is starting in the hole in terms of potential harm to patients due to the bad side effect profile.

RETROSPECTIVE studies are ONLY designed to give you candidates and ideas to sus out further. NEVER are they used for medical decision making, BECAUSE they are ALWAYS full of confounding variables. THAT is the LEAP you keep making, treatment from RETROSPECTIVE, OBSERVATIONAL (i.e. non-interventional) studies is VERY incorrect.
We both agree that we need to get beyond a retrospective study and to a serious random trial with placebo or alternate treatment. Nonetheless, it's the best we have to go on at present. The authors of the study are not saying the retrospective study is without merit. They're saying the data strongly show that HCQ when used with zinc early in the disease progression is compelling enough that it should inspire a controlled study. Until that controlled study come out, if it ever does, the retrospective study is the best we have.

See above, the WHO re-started your prized study 2 months ago. We have yet to see any positive data from it (not a good sign).

Dexamethasone can easily be given as an outpatient (I agree with you on remdesivir), so that kills your outpatient argument for HCQ being the only thing that can be done. Dexamethasone is also FAR more prevalent a drug than HCQ, and cheaper too. It's also just one of many corticosteroids that could be prescribed (prednisone, prednisilone, etc. would all be viable alternatives to dexamethasone that work through the same
Here are two problems with your argument. First, an anti-inflamatory such as dexamethasone is primarily focused on promoting survival by minimizing the problems within the lungs as the disease progresses to more advanced stages. By contrast, the HCQ and zinc cocktail is best at preventing the evolution of the disease from reaching that battle in the lungs. Once a patient is experiencing shortage of breath, it's time to get him on remdesivir and dexamethasone, we both agree on that. Unfortunately, there's a shortage of remdesivir and some states such as Pennsylvania are holding lotteries to see who gets the remdesivir. A better outcome would be to reduce the number of patients who need hospitalization in the first place, and the HCQ and zinc cocktail appears to be the best solution so far. Again, I say appears to be because I'm basing my statement off a retrospective study rather than a controlled study. Why don't we both agree that what's necessary is a controlled study of HCQ, azythromycin, and zinc administered early and judged against a placebo or an alternative treatment? I'm saying the study by Scholz, Derwand, and Zelenko is so compelling it's time to get this study underway.

What you want is a vaccine. You are not going to find a magical drug to prevent infection by a virus that has spent eons evolving to infect cells. Hate to burst your bubble, but that's just the fact of it.

 

[bkp_duke]

Safety is relative.You need to weigh the safety of the treatment vs. the ability to save lives with it. The FDA this spring approved emergency use of HCQ and azithromycin for COVID 19. They retracted that emergency authorization when a number of clinical studies that didn't include zinc suggest no significant benefits from HCQ in the treatment of COVID 19. Right now, hundreds of thousands, maybe even millions of lupus and arthritis patients are taking HCQ. In terms of relative safety, the threat of COVID 19 is far greater to one's life than lupus or arthritis. Do you see where I'm going? If HCQ is safe enough taken over a long period of time for these less threatening ailments, it ought to be safe enough to be taken in low dose for 5 days by a COVID 19 patient.

What you want are the NNT and NNH (number needed to treat and number needed to harm).

NNT - you want this LOW. - I.e. you save one person for every 5 that you treat.
NNH - you want this HIGH - I.e. you harm one person for every 5 that you treat.


The FDA did not retract HCQ authorization just because they didn't see any benefit. They retracted it because they saw HARM when it was used (alone, or in any kind of mixture).


You keep repeating the same false talking points as well. Very few rheumatologists use HCQ anymore for arthritis. There are far better drugs with better outcomes, like remicade.

Lupus - we also have better drugs for that, but some people still use HCQ and it is authorized for it. But the patients on it are closely monitored with EKGs.

 

[bkp_duke]

@Papafox - if you REALLY want to promote zinc, find something better to use it with than HCQ. Something with a less toxic side effect profile. I would get fully behind that, because the NNH would be so much lower than with HCQ.

EDIT - Hell, we should be using more convalescent serum. The effect of that on moderate to severe COVID-19 patients is greater than all of the drugs we have looked at to date. Giving someone pre-made antibodies to fight of the infection . . . just makes sense.

 

[TespaceX]

Some stories from this weekend so far:

One of my friend’s wife is a nurse in TX, and her office has been getting calls asking to be prescribed HCQ because one of the TX state reps (Gohmert), who is an anti-masker, said he has coronavirus and that he will start an HCQ treatment plan.
Also, the office constantly get calls from people asking for a mask waiver. And children up to 10 yo aren’t required to have a mask.

In my county (SF Bay Area), one city decided to tear up a baseball/softball field at a local park because they’ve been having problems with adult leagues having games (teams all decked out in uniform with umps, bases, cheering section, and everything).


And, stupidity seems to be everywhere:
Thousands march in Berlin against coronavirus curbs

 

[bkp_duke]

Some stories from this weekend so far:

One of my friend’s wife is a nurse in TX, and her office has been getting calls asking to be prescribed HCQ because one of the TX state reps (Gohmert), who is an anti-masker, said he has coronavirus and that he will start an HCQ treatment plan.
Also, the office constantly get calls from people asking for a mask waiver. And children up to 10 yo aren’t required to have a mask.

In my county (SF Bay Area), one city decided to tear up a baseball/softball field at a local park because they’ve been having problems with adult leagues having games (teams all decked out in uniform with umps, bases, cheering section, and everything).


And, stupidity seems to be everywhere:
Thousands march in Berlin against coronavirus curbs

Lived for 10 years in TX. Sadly, none of this surprises me in the least.



Screw it, I give up. Anyone that wants HCQ, make them sign a waiver, and give it to them. Perhaps it will thin a little bit of the stupid out of the herd (although it is so prevalent, I have my doubts).

 

[AlanSubie4Life]

@dfwatt you may have another candidate.

https://twitter.com/billhagertytn/status/1289722726433738752?s=21

I’m really happy to see that we’re getting back to normal and putting this pandemic behind us. It is a quintessentially American success story.

As expected 15/18 of the past-Covid-19-infected samples showed a strong immune reaction to Covid-19. But also 35% of the samples from people that never had Covid-19 in the past seemed to recognize Covid-19, at least partially.

Edit: Should have added that they suspect that the reaction from the non-Covid-19-exposed patient-samples come from previous exposure to other Corona viruses like influenza or the common cold.

The big question is whether this cross immunity results in a less infectious carrier.

It’s not clear that this will have any impact on the dynamics of SARS-2 spread, but it is certainly something they need to look into as the authors say. Definitely want to know whether it will affect the herd immunity threshold (lots of institutionalized population data points suggest it probably doesn’t but we will see). If it simply results in mild disease, that has already been accounted for in the IFR of 0.5-0.7%.

 

[Papafox]

@Papafox - responses in bold.

There is no inconsistency. His odds of survival if NOTHING is done for someone of his age are 90%.
90% eh? If it was you, would you take the roll of the dice on 90% survival? I sure wouldn't. Instead, I'd do everything in my power to stop the disease before it progressed into the serious battle within the lungs. Right now, I haven't seen a treatment more adept at preventing that progression than using HCQ, an antibiotic, and zinc. Show me one scientific study done on patients who were given HCQ and zinc early in the disease that indicates the treatment is without value. Studies that exclude zinc are of zero value in this discussion. Zinc is an essential ingredient in the successful treatment of Covid 19 with HCQ and it's the missing ingredient again and again in studies.

YOU AGAIN miss the point. HCQ, with AZTH or not, with Zinc, or not, does NOT affect baseline survivability. I don't HAVE to prove that Zinc helps or hurts, the burden of PROOF is on those people like YOU. Basic scientific method requires you to disprove the null hypothesis.

And lets be real here, because HCQ is SO BAD in terms of the side effect profile, no one is going to try it in a cocktail for COVID-19 when we have things we know improve morbidity and mortality. There is no conspiracy here, it's simply a BAD DRUG. It was a BAD DRUG before COVID-19, it was a BAD DRUG before Trump came into office, and it continues to be a BAD DRUG. Adding in other components that may or may not help doesn't change that.

Those odds DO NOT improve with HCQ.
I notice you left out the word "zinc" in this reply. Zinc is an essential ingredient in the cocktail. You have no basis to say this about the cocktail with HCQ and zinc because you cannot produce a study that backs your position. Studies that lack zinc or are given to patients already in the advanced stages of the disease are of no value for our discussion.

The study you want is on-going:
Study: Hydroxychloroquine doesn't prevent Covid-19 infection if exposed


Specifically, the WHO study which is ongoing has said the following, and it doesn't mince any words:
"There was no further benefit among patients who chose to take zinc or vitamin C."

I know you have an EMOTIONAL attachment to this drug, but I don't. I'm not biased against it, I simply KNOW the side-effect profile of the drug. This is NOT a drug with the side-effect profile of aspirin. I'm about the coldest, most harsh, hard-data person you will ever (not) meet. The only real thing that pushes my buttons is stupidity, and there is a @#$% ton of that in this thread by people that want to promote things they are emotionally attached do, but that the data do not support.
There you go again, belittling your opponent by calling his position emotion-based. Please, stick to facts and logic and attempt to exclude emotion and inappropriate digressions from your replies.

But you ARE emotionally attached to this. So much so that you refuse to consider BETTER, CHEAPER alternatives that have completed clinical trials and PROVEN to reduce morbidity and mortality. So now who is biased?

Simply put, the data to support HCQ as a treatment for ANY phase of COVID-19 is simply NOT THERE.
Let's consider this statement.
Nobody has done a controlled random test of HCQ with zinc yet. Retrospective studies are the best we have to go on right now, and they're suggesting that the cocktail that contains both HCQ and zinc is VERY effective at preventing the progression of the disease IF GIVEN EARLY.

Wrong - see above about WHO study in progress.

LETS BE CLEAR - in studies where there is a MARKED, POSITIVE EFFECT, we would have had preliminary data showing that by now (we saw this with dexamethasone and remdesivir). The researchers are always re-running the stats to see if anything statistically significant pops up. Because nothing pops up, it means if there is an effect, it is going to be INCREDIBLY SMALL.

The data that it does MORE HARM than good is there.
Wrong. If anywhere near 10% of patients who took Hydroxychloroquine for lupus or arthritis died after 5 days of the treatment, then you would have a point. The reality is the risk is extremely small for this low dose of HCQ given over five days. Granted, the inclusion of azithromycin increases the arrhythmia threat, but the combined drugs don't pose more than 1/10 of 1% of a risk over 5 days, and we know that number is likely way too high. In contrast, a 10% chance of dying from Covid 19 if it progresses to advanced levels is a very serious threat. Again, this is a question of balancing risks, and many, many doctors would opt for the minor risk with HCQ and azithromycin versus the severe threat of COVID 19 progressing to advanced stages in an older patient.

WRONG - I've posted the data from 10s of thousands of people using HCQ (see image below), and the Hazard Ratio is VERY CLEAR. The HR is so bad that the only things with an HR AS bad as being on HCQ for COVID-19 is having a pre-existing heart condition (arrhythmia or congestive heart failure) - THAT'S BAD AND WITH ANY NORMAL STUDY WOULD BE AN INSTANT SHOW STOPPER. Anything with HCQ in it puts people at risk. The people we treat with Lupus (we don't use HCQ for arthritis anymore, haven't for a VERY long time since there are much better biologics out now) do undergo routine cardiac screening while on the drug.



Those are simply the facts, like them or not be damned. Furthermore, you keep misinterpreting those retrospective studies you are so fond of. If you ACTUALLY read the conclusions of the authors, they say MORE studies (prospective, randomized control studies) should be undertaken to look at HCQ further. Those prospective, randomized control studies have been done, at least enough with 10s of thousands of people and the data for them so far, and they show that HCQ doesn't work.
This is the mistake you keep making again and again. You are grouping HCQ studies with studies of HCQ, azithromycin, and zinc (especially with zinc). Those studies that exclude zinc are worthless because zinc is an absolutely essential ingredient in the cocktail. The HCQ allows the zinc into the cells. Without zinc, the treatment loses its effectiveness.

I'm no making a mistake, YOU KEEP MISSING THE BIGGER POINT - because HCQ has a bad side-effect profile, EVERY study that has it in it as an ingredient is starting in the hole in terms of potential harm to patients due to the bad side effect profile.

RETROSPECTIVE studies are ONLY designed to give you candidates and ideas to sus out further. NEVER are they used for medical decision making, BECAUSE they are ALWAYS full of confounding variables. THAT is the LEAP you keep making, treatment from RETROSPECTIVE, OBSERVATIONAL (i.e. non-interventional) studies is VERY incorrect.
We both agree that we need to get beyond a retrospective study and to a serious random trial with placebo or alternate treatment. Nonetheless, it's the best we have to go on at present. The authors of the study are not saying the retrospective study is without merit. They're saying the data strongly show that HCQ when used with zinc early in the disease progression is compelling enough that it should inspire a controlled study. Until that controlled study come out, if it ever does, the retrospective study is the best we have.

See above, the WHO re-started your prized study 2 months ago. We have yet to see any positive data from it (not a good sign).

Dexamethasone can easily be given as an outpatient (I agree with you on remdesivir), so that kills your outpatient argument for HCQ being the only thing that can be done. Dexamethasone is also FAR more prevalent a drug than HCQ, and cheaper too. It's also just one of many corticosteroids that could be prescribed (prednisone, prednisilone, etc. would all be viable alternatives to dexamethasone that work through the same
Here are two problems with your argument. First, an anti-inflamatory such as dexamethasone is primarily focused on promoting survival by minimizing the problems within the lungs as the disease progresses to more advanced stages. By contrast, the HCQ and zinc cocktail is best at preventing the evolution of the disease from reaching that battle in the lungs. Once a patient is experiencing shortage of breath, it's time to get him on remdesivir and dexamethasone, we both agree on that. Unfortunately, there's a shortage of remdesivir and some states such as Pennsylvania are holding lotteries to see who gets the remdesivir. A better outcome would be to reduce the number of patients who need hospitalization in the first place, and the HCQ and zinc cocktail appears to be the best solution so far. Again, I say appears to be because I'm basing my statement off a retrospective study rather than a controlled study. Why don't we both agree that what's necessary is a controlled study of HCQ, azythromycin, and zinc administered early and judged against a placebo or an alternative treatment? I'm saying the study by Scholz, Derwand, and Zelenko is so compelling it's time to get this study underway.

What you want is a vaccine. You are not going to find a magical drug to prevent infection by a virus that has spent eons evolving to infect cells. Hate to burst your bubble, but that's just the fact of it.

I'm sorry, but many of your arguments lack logic. Others lack an appreciation for relative benefits of a drug vs. its hazards. If your view of HCQ plus zinc is that the benefits are tiny, I could understand your position, but the retrospective study showed MASSIVE improvements in survivability. What we need is a clinical trial of HCQ, AZTH, and zinc to gauge the value of the treatment. Don't kill this option until we see how viable it is in a study you'd accept.

* Quoting a WHO statement about Vitamin C and zinc says nothing about the value of HCQ when combined with zinc.

* You cannot say that the use of HCQ and zinc in a cocktail will produce little in the way of results because the best data we have to go on are retrospective studies that show MASSIVE advantages when the ingredients are combined, prescribed in the right doses, and given to early in the COVID 19 disease.

* The FDA would not have approved HCQ for COVID 19 treatment if the hazard was inappropriate for the perceived benefits. When those perceived benefits disappeared in trials that lacked zinc, the FDA retracted the emergency authority. If the use of HCQ plus zinc is anywhere near effectiveness suggested by the retrospective trial I quoted, the FDA would reinstate emergency authority in short order.

* Overall, I think the biggest mistake you're making is underestimating the effectiveness of the HCQ cocktail with zinc. The risks of HCQ are minor compared to the risks of COVID 19 if the cocktail really can deliver the kind of results suggested by the retrospective study. Let's get a good scientifically control study done and remove the doubt. Until then, neither of us can claim it's value as a COVID 19 treatment.

* No treatments (with possible exception of antibody treatments) exist that can match the results shown in the retrospective study of HCQ plus zinc that I linked to. This is the reason I continue to pursue this topic. Don't throw words like "emotional" into the discussion because they're unrelated to my motivation for seeking to see this possible treatment properly vetted.

* A safe and effective vaccine would, of course, be a better solution. Maybe we'll have one come January. Until then, we have lots of people dying of COVID 19 and need the best possible treatments.

 

[Unpilot]

I nominate this thread for the award of the most impressive examples of talking past one another.

 

[Papafox]

I nominate this thread for the award of the most impressive examples of talking past one another.

One of the frustrations of this "discussion" is that it's being carried out without knowledge of the real numbers. If the two sides cannot come even close to one another in the numbers we're both assuming, there's no real chance of reaching a consensus. For example, if the treatment of HCQ with zinc yielded only a 2% reduction in deaths, then the risks of arrhythmia would overweigh the benefits of the drug cocktail. On the other hand, if the reduction in deaths is more like 80%, as suggested by the study I quoted, then the benefits greatly exceed the risk.

My point is that we need a scientifically controlled study that yields reliable numbers. You would think that's something both sides could agree upon, but I haven't heard any agreement from the other side yet.

 

[AlanSubie4Life]

My point is that we need a scientifically controlled study that yields reliable numbers. You would think that's something both sides could agree upon, but I haven't heard any agreement from the other side yet.

I’m on the other side of it (mildly - I have to be on one side or the other, so I am on the side currently supported by the data). And this is what I keep saying. (Also this is what Dr. Fauci says - he says there’s currently no evidence to support HCQ, but he will be the first to support HCQ if any properly conducted RCT shows clear efficacy.) I also plan to switch immediately to the other side and support HCQ in appropriate circumstances and combination, in the event the evidence strongly supports said use.

I think there are multiple people on the other side, and you’re not acknowledging that they’re in agreement with you on this point.

Everybody wants HCQ to be effective at reducing COVID severity and reducing mortality, I think.

 

[SVMike]

In my county (SF Bay Area), one city decided to tear up a baseball/softball field at a local park because they’ve been having problems with adult leagues having games (teams all decked out in uniform with umps, bases, cheering section, and everything).

To me this just shows the stupidity of our city politicians since they'll have to repair/replant at a relatively great cost once this is over. It would have much easier and cheaper to just turn on the sprinklers and/or bring in a few of those concrete barriers they put up on highways when doing maintenance (miles of these things exist) and place them around the infield.

 

[alloverx]

HCQ article

 

[renim]

. In terms of relative safety, the threat of COVID 19 is far greater to one's life than lupus ....

that is so wrong, death from Lupus makes Covid19 look like Disneyland.

thanks to HCQ and/or corticosteroids, Lupus is no longer deserving its name, wolf's bite.

 

[lascavarian]

Do you see where I'm going? If HCQ is safe enough taken over a long period of time for these less threatening ailments, it ought to be safe enough to be taken in low dose for 5 days by a COVID 19 patient.

The problem here is the "it ought to be safe enough". You have a suggestion but are short of anything conclusive. There is a safety issue and it is speculative to suggest that a shorter duration mitigates safety concerns particularly in the case of more threatening ailments. It is a lot to ask any study review board to accept IMO.

 

[renim]

HCQ is safe enough if people don't follow the idea that more is better
which unfortunately, is unlikely

 

[renim]

FWIW, Australia has a large HCQ trial named COVID SHIELD
COVID SHIELD FAQs

Oxford vaccine candidate is also called Covid Shield, phase 2 and 3 trials start in India next month (August)
DCGI asks SII to revise protocol for phase 2, 3 trials of Oxford COVID-19 vaccine - Express Pharma

its possible that the vaccine may be ready before consensus is reached regarding HCQ....

 

[madodel]

One of the frustrations of this "discussion" is that it's being carried out without knowledge of the real numbers. If the two sides cannot come even close to one another in the numbers we're both assuming, there's no real chance of reaching a consensus. For example, if the treatment of HCQ with zinc yielded only a 2% reduction in deaths, then the risks of arrhythmia would overweigh the benefits of the drug cocktail. On the other hand, if the reduction in deaths is more like 80%, as suggested by the study I quoted, then the benefits greatly exceed the risk.

My point is that we need a scientifically controlled study that yields reliable numbers. You would think that's something both sides could agree upon, but I haven't heard any agreement from the other side yet.

If this is so critical then fund or find funding to do the one study you say is the answer to all this. Otherwise you are just here arguing for the sake of arguing.

 

[dfwatt]

One of the frustrations of this "discussion" is that it's being carried out without knowledge of the real numbers. If the two sides cannot come even close to one another in the numbers we're both assuming, there's no real chance of reaching a consensus. For example, if the treatment of HCQ with zinc yielded only a 2% reduction in deaths, then the risks of arrhythmia would overweigh the benefits of the drug cocktail. On the other hand, if the reduction in deaths is more like 80%, as suggested by the study I quoted, then the benefits greatly exceed the risk.

My point is that we need a scientifically controlled study that yields reliable numbers. You would think that's something both sides could agree upon, but I haven't heard any agreement from the other side yet.

I think you guys have hashed this one out about as much as it can be hashed.

Here's the problem with retrospective studies - as you know they can never separate correlation from causation. Some of the retrospective studies have showed what looks like an impressive benefits but you can't really draw any conclusions from those. All you can do is say maybe there's enough signal there that a properly randomized and controlled study would be able to find it. It's pretty clear at this point that hydroxychloroquine by itself does not have any such signal. Possibly combined with zinc there might be some signal but again hydroxychloroquine is a crappy way to get zinc into cells. If that's really the therapeutic effect of the combination we have far less toxic zinc ionophores, although I doubt they will be studied because they're cheap nutritional supplements. It's also doubtful that once patients become severely ill that therapy targeting an increase of intracellular zinc is going to be helpful. At that point clotting and / or severe inflammation and sepsis are killing people. If there is a role for zinc it looks like it's early before any version of cytokine release syndrome, severe pneumonia, devastation of endothelial cell lines with release of Von Willebrand factor Etc

One of the challenges, has Anthony Fauci himself has pointed out, is this is an enormously heterogeneous and variable disease. A significant fraction of folks have cross-reactivity of T Cell populations based on exposure to prior coronavirus now confirmed as related to S protein epitopes, and are either asymptomatic or minimally symptomatic. Another significant fraction perhaps head into a much more severe illness, with severe pneumonia and sepsis but as we've learned that's not the only lethal trajectory as another group develop severe pathological clotting and this may contribute to both lung failure, strokes and heart attacks. Finally kidney failure is another lethal trajectory.

We don't have the ability at this point when people become severely ill to know which one of those trajectories they're going to get into, as I'm not aware of any clear biomarkers that have predictive value. We are seeing the emergence of more differentiated therapy approaches such as use of anticoagulants early but at this point we still don't have clear biomarker prediction pathways.

Future therapies will no doubt be much more differentially and specifically targeted to those biomarker heuristics. I know a lot of your posting is aimed at trying to get a positive message out, but there is progress, we do have Remdesivir which may moderate severity, and for patients that had into nasty pneumonia / sepsis pathways, dexamethasone looks to be disease-modifying, and there is for sure increasing appreciation and clinical intervention around pathological clotting. I know the progress in getting close to or at least approaching the asymptote of effective and definitive treatment protocols is painfully slow. But what else is new. There is just so much humbling complexity to appreciate and map out.

 

[madodel]

This is disturbing that so many people of color are still afraid to go to a hospital when experiencing a serious condition.
https://www.docwirenews.com/docwire-pick/cardiology-picks/nearly-half-of-hispanics-blacks-scared-to-go-to-hospital-during-covid-19-2/