5th Study: CFR Way Lower than Previously Reported

_{Barry Arrington

May 4, 2020

Intelligent Design

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Intelligent Design}

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Yet another study, this one out of Germany, confirms what was reported in Palo Alto, Los Angeles, Boston and New York. This one arrives at an infection rate of 15% (10X the previously thought number) and a CFR of .37%.

One wonders how orthomyxo will spin this (either “don’t believe it” or “it is what I have always been saying” is my guess).

Comments

Ipca Laboratories, the market leader for anti-malarial drug hydroxychloroquine in India, was one of only three top-20 drugmakers to post sales growth in April, when overall medicine sales slumped 11.2% year-on-year to ?10,211 crore, data from market research firm AIOCD-AWACS showed. The Mumbai-based drug-maker’s strong sales growth was likely on account of high demand for hydroxychloroquine, touted as a potential treatment for covid-19, even as all other segments witnessed a decline due to falling demand during the nationwide lockdown. High demand for hydroxychloroquine also reflected in an 11% jump in sales of anti-malarial drugs. However, sales at another hydroxychloroquine maker, Zydus Cadila, declined 11.6%. Almost all other segments, barring anti-diabetic and cardiac care drugs, showed a decline of up to 35%. Sales of anti-diabetic and cardiac care drugs were up 6% each on account of panic buying in the first half of the month. https://www.livemint.com/companies/news/hcq-maker-ipca-labs-biggest-gainer-in-april-despite-sales-slump-in-drug-industry-11588948371024.htmlrhampton7_{May 8, 2020
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As the virus began burning through southeast Michigan in March and April, the 14-hospital McLaren system added hydroxychloroquine to its treatment for COVID-19 patients, and a few doctors said there might be “some benefit in some patients,” said Dr. Dennis Cunningham, medical director of infection control at McLaren Health Care. But by this week? “I have to say that doctors are moving away from using it. It’s just not effective,” he said Wednesday. At Detroit Medical Center, Dr. Teena Chopra said doctors believe the drug may be helping keep some COVID inpatients off ventilators. “We haven't seen any harm,” said Chopra, who oversees DMC’s infection prevention efforts. “And we've been able to take patients, use this [drug] and delayed the need for ventilation in some category of our patients.” Beaumont Health doctors, like those at Ascension healthcare system, have been less impressed. “I don't think [it] is hurting anything, but we don't feel that it's been helpful,” said Heidi Pillen, director of pharmacy for medication use policy at Beaumont. Michigan Medicine also has stopped using hydroxychloroquine to treat COVID, unless the patient is enrolled in a clinical trial. That’s because of side effects ranging from vomiting to heart and liver problems, said Dr. Vineet Chopra, Michigan Medicine’s Chief of Hospital Medicine. https://amp.freep.com/amp/3093146001rhampton7_{May 8, 2020
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Hydroxychloroquine Market to Reach USD 2.3 Billion by 2027; Driven by the Increasing Number of Covid-19 Cases, says Fortune Business Insights™ Key Companies Covered in the Hydroxychloroquine Market Research Report are Sanofi, Zydus Cadia, Ipca Laboratories Ltd, Sandoz International GmbH, Mylan N.V., Teva Pharmaceutical Industries Ltd, Bayer AG and other key market players. https://www.globenewswire.com/news-release/2020/05/04/2026540/0/en/Hydroxychloroquine-Market-to-Reach-USD-2-339-1-Million-by-2027-Driven-by-the-Increasing-Number-of-Covid-19-Cases-says-Fortune-Business-Insights.htmlrhampton7_{May 7, 2020
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India accounts for 70 percent of global production of hydroxychloroquine, which is also used to treat lupus and rheumatoid arthritis. To meet the growing demand, Ipca Laboratories, one of four key makers of hydroxychloroquine, is increasing output by a third to 130 million tablets a month in May -- despite having only 40 percent of its 18,000 workers on deck. Zydus Cadila, another major producer, said it would boost production tenfold to about 150 million tablets a month in May. India exports about $20 billion of pharmaceuticals a year and increased production of hydroxychloroquine has come at the cost of making other drugs commonly used to combat diseases ranging from tuberculosis to cancer. https://news.yahoo.com/india-boosts-output-anti-malarial-drug-hyped-trump-023032411.htmlrhampton7_{May 7, 2020
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From the week ending April 17 to the week ending April 24, demand for hydroxychloroquine plunged 62% among hospitals placing orders for the decades-old malaria drug. The number of tablets sought fell to 198,500 from 462,850 during that stretch, according to Vizient, a group purchasing organization that negotiates contracts for medicines on behalf of about 3,000 hospitals and health care facilities in the U.S. At the same time, supplies appear to be stabilizing, most likely due to donations from several large manufacturers — including Bayer, Teva Pharmaceutical and Novartis — that agreed to provide millions of tablets to the U.S. Strategic National Stockpile after the Food and Drug Administration issued an emergency use authorization for hospitals. Lupus and rheumatoid arthritis patients have become collateral damage. For weeks, many were unable to obtain their usual prescriptions, causing concerns about their health. Some also were alarmed after hearing a drumbeat of warnings about side effects risks, according to Kenneth Farber, president of Lupus Research Alliance, an advocacy group that is sponsoring an observational study to assess the incidence of Covid-19 among lupus patients who are already taking hydroxychloroquine for their condition. Over the past several days, however, he indicated that the shortage has abated most everywhere and lupus patients say they are finding it easier to obtain hydroxychloroquine. He attributed the change to increased production and reservations among some physicians to increasingly prescribe the tablet for Covid-19. But he worries hoarding may return if studies indicate the drug is useful for the coronavirus. https://www.statnews.com/pharmalot/2020/04/28/covid19-coronavirus-hydroxycholoroquine-lupus-trump/rhampton7_{May 7, 2020
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I think what’s happened is there’s been a lot of promotion of this drug as a cure-all by politicians and by the media. And, parenthetically, at the same time there’s been a lot of unnecessary vilification of the drugs,” Gellad says. “The reality is, there’s a ton of uncertainty … My guess is the FDA wanted to pull back on the idea that the government was promoting the use of this drug, not pushing this therapy but being very responsible, using it in clinical trials.” The FDA wanted to remind primary care physicians that while they were allowed to prescribe these drugs off-label, they had real side effects—and that some people who don’t have Covid-19 infections really need them for other reasons. “ Yet the fights over hydroxychloroquine continue, on the internet and in real life. If the drug works, some partisans argue, it’s wrong to delay its widespread use by waiting for results; if it doesn’t, it’s wrong to even try it on people. “The social media perspective is: About half of people think it’s an unethical trial because it clearly works, and the other half thinks it's clearly dangerous and we shouldn’t do it,” Boulware says. “We’re just trying to get the answer. Having a solid study design and having the actual answer is really important for both the country and the world, and that’s our goal.” Meanwhile, though, it’s important to remember that nobody actually knows that answer. The Silicon Valley adherents insisting that the problem with the negative results thus far is that researchers tested the wrong kind of people, or used the wrong dose, or didn’t use zinc—they don’t have the data that can say whether any of that is true. The people saying that hydroxychloroquine is clearly unsafe, or that it can’t possibly work? They don’t have that data, either. Nobody does. The studies aren’t finished. “It’s going to be May 1, and we still don’t know if it works. It’s a giant failure,” Gellad says. “We should have had an answer. All you need is a randomized controlled placebo trial with 1,000 patients, and we’d know.” https://www.wired.com/story/the-info-war-over-chloroquine-has-slowed-covid-19-science/ Published in late Aprilrhampton7_{May 7, 2020
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Rhampton7 @46 Conspiracy theory - a prediction: If the underlying political and financial motivations to "debunk" HCQ and AZT treatment are strong enough, then the study protocol will conveniently make sure that the conditions cause failure of the therapy. Such as, waiting too long in the course of the disease before treatment, unnecessarily and harmfully using intubation, and/or maybe using a wrong dosage. We'll see.doubter_{May 7, 2020
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Maybe New York doctors should talk to doctors in Houston who are having success with a treatment that includes HCQ. https://bit.ly/2SKgJcY
“I was really looking for a study that showed that people who were treated with it were less likely to get intubated,” said Dr. Luke O’Donnell, attending physician at NYU Langone. “And I think more and more data is showing that there is minimal to no difference.”
Did the New York study show severity and when the drug was administered?jerry_{May 7, 2020
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The study, published in the leading cancer journal Annals of Oncology, suggests that androgen-deprivation therapies (ADT) may protect men from Covid-19 infection. The researchers found that out of 4,532 men infected with Covid-19, 9.5 per cent (430) had cancer and 2.6 per cent (118) had prostate cancer. Male cancer patients had a nearly twofold higher risk of Covid-19 infection out of the whole male population, and developed more severe disease. However, when they looked at all prostate cancer patients, they found that only four out of 5,273 men on ADT developed Covid-19 infection and none of them died. This compared to 37,161 men with prostate cancer who were not receiving ADT, of whom 114 developed Covid-19 and 18 died. Among 79,661 patients with other types of cancer, 312 developed Covid-19 and 57 died.rhampton7_{May 7, 2020
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So NYC is not using zinc in conjunction with HCQ. What is wrong with these alleged medical professionals?ET_{May 7, 2020
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Today, researchers at The Lundquist Institute began a randomized, double-blind, placebo-controlled clinical trial designed to find out whether hydroxychloroquine and azithromycin reduce hospitalization and/or death in individuals suffering from COVID-19, the disease caused by the novel coronavirus, SARS-CoV-2. This trial, sponsored by the National Institutes for Health, will include 2,000 adults with symptomatic SARS-CoV-2 infections. Under the direction of Dr. Eric Daar, The Lundquist Institute will be one of 25 to 30 sites nationwide, each looking to enroll about 100 patients over the next six weeks. During the trial, patients will receive seven days of treatment with drugs or placebo, with a follow-up appointment at 20 days. A randomized selection of participants will receive oral doses of hydroxychloroquine or placebo twice daily for seven days, as well as a daily dose of azithromycin or placebo for five days. This combination of medications has been used to treat a few COVID-19 patients and is advocated by some in the medical and political communities, but its efficacy, as well as its safety, is unproven at this point, which is why this trial is required. The initial endpoint of the study would be to evaluate the levels of hospitalization and/or death within 20 days following enrollment in the study. https://finance.yahoo.com/news/nih-sponsored-covid-19-clinical-140000628.htmlrhampton7_{May 7, 2020
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Hospitals in NYC Have Abandoned Hydroxychloroquine “We know now it probably doesn’t help much," said Dr. Thomas McGinn, Deputy Physician-In-Chief at Northwell Health. "We’re not recommending it as a baseline therapy anymore. It is only in a treatment protocol in a study that we’re recommending it." “As of last week, we stopped using hydroxychloroquine as a routine medication in our hospital based upon the cumulative experience in our hands and in others, and recommendations by the FDA that it should not be used outside of clinical trials,” said Dr. Charles Powell, chief of the Division of Pulmonary, Critical Care and Sleep Medicine at the Mount Sinai Health System and CEO of the Mount Sinai-National Jewish Health Respiratory Institute. “I was really looking for a study that showed that people who were treated with it were less likely to get intubated,” said Dr. Luke O’Donnell, attending physician at NYU Langone. “And I think more and more data is showing that there is minimal to no difference.” https://www.ny1.com/nyc/all-boroughs/news/2020/05/07/hospitals-in-nyc-abandon-hydroxychloroquine-treatment-touted-by-trump-rhampton7_{May 7, 2020
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No, I don’t agree. Why would anyone try to be so confusing?
Because it is not confusing and it communicates. A disinfectant is preventing infection or rendering something from creating an infection. That is essentially what a disinfectant does. There may be other methods of preventing something from creating an infection than by killing it.jerry_{May 7, 2020
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If someone made a spray that prevented germs from being infectious even if it didn’t kill them I bet they would say it is like a disinfectant. Such a spray would prevent infection or dis-infect. Don’t you agree?
No, I don't agree. Why would anyone try to be so confusing?Bob O'H_{May 7, 2020
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No, Jerry. It’s nothing like a disinfectant, and if you read the title of the article, you’d realise that it doesn’t kill the virus
Oh. I read it and knew exactly how it works. Couldn’t help being a little sarcastic though with a somewhat gratuitous comment. If someone made a spray that prevented germs from being infectious even if it didn’t kill them I bet they would say it is like a disinfectant. Such a spray would prevent infection or dis-infect. Don’t you agree? Let’s just say it’s a pro-life disinfectant. By the way I describe the effect of zinc is like birth control till the killers arrive from the immune system to finish the job.jerry_{May 7, 2020
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No, Jerry. It's nothing like a disinfectant, and if you read the title of the article, you'd realise that it doesn't kill the virus - it blocks infection (so it acts more like a contraceptive than a poison).Bob O'H_{May 7, 2020
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Jerry, let's hope! KFkairosfocus_{May 7, 2020
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RH7, many diseases take damaging effect by throwing the immune system out of kilter. In the case of Covid-19, cytokine storm is an all too familiar outcome that is a killer. BTW, things as familiar as asthma or hay fever or allergic shock or auto-immune diseases are similar. The go out of control happens as things reach a point where there is in effect an out of control reaction. So, damping down that over-reaction is in fact a feature not a bug, just as inhalers etc bring allergic reactions under control. Other plausible mechanisms for HCQ cocktails include providing open gateways for Zn to enter the cell, suppressing viral replication. Of course, that is suppressing cell systems also. That, again is a feature: drugs are poisons in small doses. The immune reaction, under control, is defending the body from potentially destructive invaders but if it goes out of control it can have damaging or deadly effects. KFkairosfocus_{May 7, 2020
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A new way to attack the virus. https://www.nature.com/articles/s41467-020-16256-y
The emergence of the novel human coronavirus SARS-CoV-2 in Wuhan, China has caused a worldwide epidemic of respiratory disease (COVID-19). Vaccines and targeted therapeutics for treatment of this disease are currently lacking. Here we report a human monoclonal antibody that neutralizes SARS-CoV-2 (and SARS-CoV) in cell culture. This cross-neutralizing antibody targets a communal epitope on these viruses and may offer potential for prevention and treatment of COVID-19.

Antibodies like this can be made in the lab instead of purified from people’s blood and could conceivably be used as a treatment for disease, but this has not yet been demonstrated.
Maybe it is like a disinfectant that kills the virus but you put it into the body either linterveneously or by a pill or liquid.jerry_{May 6, 2020
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Increasing number of cases is not alarming in itself. Increasing number of cases not treated is what is alarming. The sad thing is we have the ability to treat every case with a potential cure but for political reasons we don’t do it. So the fact that certain states are increasing in number of cases is not worrisome but that they will not be treated is the real travesty of this virus. Some states political leaders have made the insane conclusion that because the number of cases is diminishing that the lockdown should continue since it is obviously working.jerry_{May 6, 2020
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In addition to keeping an eye on the tragic, and climbing, numbers of total coronavirus cases and deaths across the U.S., it's important to watch how those trends are playing out over time at the state level. Our chart compares each state's seven-day average of new cases from Monday and the seven-day average from a week prior, April 27. Comparing the averages of two dates helps smooth out a lot of the noise in how states sometimes inconsistently conduct and report tests. By this metric, Minnesota, Nebraska and Puerto Rico have the most worrisome trends, while Arkansas and Wyoming have the most positive trends. Twelve states are moving in the right direction. But more than a third of the nation still has growing numbers of cases. And that includes states such as Texas and Virginia, where Republican and Democratic governors are beginning to unveil re-opening plans. https://www.axios.com/coronavirus-caseloads-states-b24899a3-286e-4ea9-bd71-0e88ed645e68.htmlrhampton7_{May 6, 2020
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Some day RHampton will start reporting optimistic reports and not just doom and gloom. What about all those reports of people recovering and the lack of any side effects? Why does the CDC recommend HCQ as a prophylactic if it affects the immune system negatively? Are we to ignore a solution that may save a million because a couple thousand may not be saved? Why hasn't the NR writer heard about Zelenko? And if he has why wasn't he mentioned?jerry_{May 6, 2020
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The potential for serious arrhythmias from hydroxychloroquine treatment of COVID-19 patients received further documentation from a pair of studies released on May 1, casting further doubt on whether the uncertain benefit from this or related drugs to infected patients is worth the clear risks the agents pose. A report from 90 confirmed COVID-19 patients treated with hydroxychloroquine at one Boston hospital during March–April 2020 identified a significantly prolonged, corrected QT (QTc) interval of at least 500 msec in 18 patients (20%), which included 10 patients whose QTc rose by at least 60 msec above baseline, and a total of 21 patients (23%) having a notable prolongation (JAMA Cardiol. 2020 May 4. doi: 10.1001/jamacardio.2020.1834). This series included one patient who developed torsades de pointes following treatment with hydroxychloroquine and azithromycin, "which to our knowledge has yet to be reported elsewhere in the literature," the report said. https://www.medscape.com/viewarticle/929973rhampton7_{May 6, 2020
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Chloroquine and hydroxychloroquine actually slow down parts of a patient’s immune system by “interfere with lysosomal activity and autophagy, interact with membrane stability and alter signalling pathways and transcriptional activity, which can result in inhibition of cytokine production and modulation of certain co-stimulatory molecules” — which is a jargon-heavy way of saying it makes your immune system’s cells not work as well together. People might wonder why anyone would want to take a drug that weakens their immune system. The coronavirus identified as SARS-CoV-2 can generate a “cytokine storm” — when the body’s immune system kicks into overdrive and starts attacking healthy cells in important organs. Dr. Randy Cron, an expert on cytokine storms at the University of Alabama at Birmingham, told the New York Times last month that in about 15 percent of coronavirus patients, the body’s defense mechanism of cytokines fight off the invading virus, but then attack multiple organs including the lungs and liver, and may eventually lead to death. As the patient’s body fights its own lungs, fluid gets into the lungs, and the patient dies of acute respiratory distress syndrome. From this, you can get a sense of how and why hydroxychloroquine might be effective in some circumstances and not others. It’s also easy to see why we would only want people taking this drug under a doctor’s recommendation and possibly supervision — take the drug too early, and you suppress the body’s immune system just when it needs that system functioning well to fight off the invading virus. Take the drug too late, and the damage to the vital organs can’t be overcome. https://www.nationalreview.com/the-morning-jolt/why-hydroxychloroquine-works-for-some-coronavirus-patients-but-not-others/rhampton7_{May 6, 2020
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With effective treatment the death rate is .03% or a normal flu season. Compare nursing home in Texas with other nursing homes that became infected. This will indicate more accurate rate. So elderly do not have to be sacrificed or quarantined. See https://bit.ly/2A523i5 It is the callousness of the press and politicians that are causing people to die unnecessarily. Look at these death curves and know that in late March, the cure was known but mocked (see link just above and follow other links). What would the curve look like it there had been widespread implementation of the treatment. See https://bit.ly/2Wa9f59 for liberals criticizing liberals on anti Trump bias. Maybe they do not want to die in a good cause? I doubt anyone does but that does not prevent the incredibly cynical rhetoric.jerry_{May 6, 2020
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Bob O'H,
It looks like it’s been smoothed, so they’ve removed the noisiness.
Yes, I just meant that the curve has almost no concavity from mid-March onward. I don't know how it was smoothed, but I would guess that significant concavity would not be all but erased by this process.daveS_{May 6, 2020
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BO'H: the linearity shows up at global levels too, see OWID on deaths https://ourworldindata.org/grapher/total-daily-covid-deaths and I don't think that is particularly smoothed other than by the fat lines stuff. The OWID global total cases with regional banding is effectively linear at both levels https://ourworldindata.org/grapher/total-covid-cases-region On dynamics of curves, there is a plateau in daily cases and deaths, pointing to an underlying bell-like impulse that is a cumulative impact of onward driving factors. The question is, what is creating that plateau in daily cases and deaths. I would not expect a point of inflexion to be prolonged in a strange equipoise. Obviously, there is not a running down of further vulnerable population to induce the usual type of saturation but something is restraining exponential explosive growth and as numbers of the active infected rise it has to have a stronger and stronger constraining effect to keep growth down to linear. Candidates? E.g. could part of it be northern summer coming with more actinic radiation and formation of vitamin D? Is it a linear growth in testing capability so the proxy confirmed cases is masking the actual incidence pattern? Or, what? KFkairosfocus_{May 6, 2020
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A simple graph from Bloomberg. I’d have a hard time drawing it any straighter with a ruler.
It looks like it's been smoothed, so they've removed the noisiness.Bob O'H_{May 6, 2020
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DS, per OWID US, Canada, UK have plateaus, Germany and Spain show turnover humps. Maybe, we should be asking, what is saturating -- flattening! -- rate curves, pointing to another level of driving impulse that creates its own sigmoid. Then, what can drive it down. KFkairosfocus_{May 6, 2020
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DS, it's not just the US but the global, too. At least I see a welcome bit of wobble. A steady net driving force at a plateau just does not sit right. That is tempting me to think cases per day is the v result of accumulation of a bell like impulse leading to a plateau, but what could that be that surges and falls to effectively nil and then leaves a steady daily number of cases in its wake apart from noise. Like, saturation postponed. KFkairosfocus_{May 5, 2020
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