Doctor Ivette Lozano from Dallas, Texas on treating patients with HCQ Cocktails

_{kairosfocus

May 18, 2020

Defending our Civilization, Medicine, News Highlights, rhetoric, Sci-Tech watch}

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https://youtu.be/coyfWpwxedQ

Food for thought.

U/D: When it reaches the pharmacy . . .

U/D May 19, another Lozano interview:

And, oh yes, breaking 1: Mr Trump is praising — yes, I am NOT using, “touting” — a promising vaccination. Announcement by the firm, here.

Breaking, no 2, courtesy Daily Mail as usual:

Of course, the now standard, it’s risky is in the subheads.

U/D: Video:

Compare our Texas Doctor’s remarks. And then, there is the latest from Dr Raoult:

Whose report do you believe, why? END

Comments

North Dakota Gov. Doug Burgum became emotional Friday as he pleaded with residents not to divide themselves over mask wearing amid the coronavirus pandemic or shame those who choose to wear masks, but to instead be empathetic. "I would really love to see in North Dakota that we could just skip this thing that other parts of the nation are going through, where they're creating a divide -- either it's ideological or political or something -- around mask versus no mask," Burgum, a Republican, said during a news conference Friday in Bismarck. "This is a, I would say, senseless dividing line." He urged people to "try to dial up your empathy and your understanding." https://www.kbzk.com/news/coronavirus/north-dakota-governor-makes-emotional-plea-to-avoid-divide-over-face-masksrhampton7_{May 24, 2020
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What do you mean by “late stage”?
The virus proceed in stages. At first there are little or no indications that anything is wrong. In fact most never get past this stage and their immune system eliminate the virus. This is usually the first 5 days. Then there is a stage where there are mild symptom such as coughing and these can progress to something more severe with in this stage such as shortness of breath. Again the immune system may beat the virus but the more susceptible should be treated at this stage with HCQ, zinc and azithromycin. This has nearly 100% effect of defeating the virus. This is usually less than 12 days. Then if not treated the patient will start to develop pneumonia like symptoms or other symptom of lung damage. This usually starts about 12 days after infection if not treated or the immune system does not defeat the virus. This is when hospitalization is prescribed. This is what seems to be when the Lancet study is saying the patients were being diagnosed. At this point the virus is well established and something like HCQ is less likely to have an effect. This seems to be what is being presented in the Lancet study,.
And how is this relevant to cases outside the US?
Two thirds of the studies were from North America which mainly means the US. There is also no indication that the testing was any different outside the US so all could be late stage studies and irrelevant. Your questions indicate you do not understand what this disease is about. I suggest you visit the MedCram site. It will be very informative.jerry_{May 24, 2020
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Ohio Gov. Mike DeWine says wearing masks while in public during the coronavirus pandemic should not be a political issue but is about people acting to protect others. “ This is not about politics, this is not about whether you’re liberal or conservative, left or right, Republican, Democrat," he said. “... You wear the mask not to protect yourself so much as to protect others. And this is one time when we truly are all in this together. What we do directly impacts others." “As we go out, a lot of stores you’ll see 90% of the ... customers are wearing masks," the Republican governor said. “But we want to continue to up that throughout the state because it is really what we need as we open up the economy." https://abc6onyourside.com/news/local/ohio-governor-wearing-masks-shouldnt-be-political-issuerhampton7_{May 24, 2020
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KF
EG, there has been ample discussion for weeks. The point Zelenko made so forcefully is obvious, stomp on it early and you avert the cascade down the U, especially if you fit a vulnerability profile.
Again, you are evading the obvious question, that I have asked twice already. . If the HCQ treatment must be used at very early stages, how do you identify the people with new infections? Do you test everyone? Every couple weeks until the virus is gone? We can barely keep up with testing people who show any symptoms. My career has been in the testing field. I can assure you that you can’t just flip a switch and dramatically increase testing capacity. If it were that easy we would be testing far more than a low single digit percentage of the population. Since we can’t rely on testing to effectively identify people with early infections, we would have to rely on providing it as a prophylactic to everyone, probably on an ongoing basis until the virus is gone. How do you propose that we do this with a drug that is already in short supply.Ed George_{May 24, 2020
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Missouri overcounted the number of people it claimed have been tested for COVID-19 by at least 17,000, state health officials said Saturday, raising the percentage infection rate and muddying the state’s assessment of the viral spread even as regional officials ease restrictions. Until Saturday, health officials were lumping together two different types of tests: viral tests that show who is currently sick with COVID-19, and antibody tests that look for signs of past exposure. Meanwhile 148,303 people have been tested for active COVID-19 infections, DHSS said. Of those, 11,751 people, or 7.9%, tested positive. The department previously reported that as of May 21, 172,946 viral tests for active COVID-19 infections had been done, and 11,340 people — or 6.5% — had tested positive. https://www.stltoday.com/news/local/state-and-regional/missouri-among-states-overcounting-coronavirus-testing-blurring-picture-of-virus-spread/article_1f520733-7d60-56ff-89ea-34965ec48f28.htmlrhampton7_{May 24, 2020
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A second Missouri hairstylist who showed up for work at a salon earlier this month while exhibiting coronavirus symptoms may have exposed as many as 56 clients, health officials said. On Saturday, officials said that another symptomatic hairstylist at the Great Clips salon in Springfield may have exposed up to 84 customers and seven coworkers while working for eight days between May 12 and May 20. The Springfield-Greene County Health Department said that both hairstylists and their clients were wearing face coverings. “It is the hope of the department that because face coverings were worn throughout this exposure timeline, no additional cases will result,” the department said. Officials said they are tracking down everyone who was potentially exposed and advising them to watch for symptoms. https://www.thedailybeast.com/second-infected-missouri-hairstylist-in-springfield-may-have-exposed-56-clients-to-coronavirusrhampton7_{May 24, 2020
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A high school pool party “everybody thought was harmless” has fueled a second peak of coronavirus cases in Arkansas, Gov. Asa Hutchinson said Saturday. “A high school swim party that I’m sure everybody thought was harmless,” Hutchinson said at a press briefing, a video shows. “They’re young, they’re swimming, they’re just having activity, and positive cases resulted from that.” Hutchinson did not say how many people attended the party or subsequently tested positive for the COVID-19 virus. He called the incident “just an encouragement for us to be disciplined in our activities.” https://www.star-telegram.com/news/coronavirus/article242967096.htmlrhampton7_{May 24, 2020
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EG, there has been ample discussion for weeks. The point Zelenko made so forcefully is obvious, stomp on it early and you avert the cascade down the U, especially if you fit a vulnerability profile. Hence, a stitch in time. But then YT etc took down his message, predictably. Raoult is comfortably isolated behind language barriers. And the like. What we are seeing with that note discussed in 197 - 8, is that there are things that may help pull back up from further down the U. It seems once you need intubation or go on a ventilator, things are not favourable at all. KFkairosfocus_{May 24, 2020
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Bo'H, late stage is far down the U descending leg. The US is a good slice of the pandemic and dominates global discussion. Note, please the issues pointed out in 199, KFkairosfocus_{May 24, 2020
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kf @ 215 - I asked you to explain clearly. I guess that was a waste. You ignored 2 of my questions, and gave an almost incomprehensible answer to the third. §t may help to pull up people further down the descending leg of the U" What the **** is the U? I have absolutely no idea what you're on about.Bob O'H_{May 24, 2020
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Jerry @ 213 -
These are hospitalized patients which usually means they are In the late stage of the infection.
What do you mean by "late stage"?
In the US it was nearly impossible to get a valid test done till early March. Even then it would take a lot of time. The CDC screwed up big time on testing. So my guess is that these tests were not done early in the progression of the disease.
And how is this relevant to cases outside the US? The Lancet paper uses data from 6 continents, and finds a consistent pattern across them all.Bob O'H_{May 24, 2020
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KF, you have not addressed how we decide who to give this cocktail to. If it is only effective at the very early stages of infection, before any significant symptoms appear, how do we identify these people? Especially given the problems we have had in testing capacity.Ed George_{May 24, 2020
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BO'H, kindly see Jerry. I already noted point by point at 199 above. Ivermectin is a new twist as Jerry linked and I clipped and commented on at 197-8 . It may help to pull up people further down the descending leg of the U, i.e. the pattern points to incremental and marginal effects making the difference with survival. KFkairosfocus_{May 24, 2020
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EG, predictably, the turnabout game continues. While Jerry has addressed some good points just above, I add . . . and note the medicine category traces much of what will again come up. The truth is, cases are not a good direct metric of infections, there is a variable lag to onset of symptoms, averaging 5 days but 14 days is a conventional good enough upper limit. From onset of symptoms again it is variable but the talk is of the U, with deaths being those who cannot make the recovery bend. About 10 days seems a conventional average IIRC a physician in New Orleans who put notes up online early in the crisis. Vulnerable groups obviously tend to deteriorate faster and would find it harder to recover. Note the remarks above on suddenness of collapse. There is talk of a pyramid (I tend to think, iceberg), with techniques used to estimate the hidden profile of an epidemic, e.g. with the annual Flu season. Once enough key data is in hand, links to demographic profiles can be and are made. Epidemiological models can be calibrated. Usually, post epidemic. In that context, the HCQ cocktail is about stopping the downslide early. If that happens, you tend not to get hospital admissions, as opposed to outpatient basis or the like. That is where we can do tea blend calculations on say Raoult's numbers and see the difference in accumulative deaths. The new twist suggests that adding Ivermectin could reach further down the descending leg, once things have not reached to intubation or ventilators and obviously cytokine storms etc. I sure hope that pans out. Remdesivir, obviously, has some effect. Many other drugs are being tried. The caricature that HCQ cocktails poison people needs to be moderated. Start with, why would doctors resort to potentially controversial remedies listed as compassionate or emergency use. And more. But then, we are getting a good look at how people tend to think and form opinions. With fatal disaffection now looming over the horizon. KFkairosfocus_{May 24, 2020
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What “stitch in time effect” when all patients in the study were treated within 48 hours of diagnosis
These are hospitalized patients which usually means they are In the late stage of the infection. Not clear when the evaluation/diagnosis took place but if was after the patient exhibited severe symptoms then it was not appropriate to evaluate HCQ. In the US it was nearly impossible to get a valid test done till early March. Even then it would take a lot of time. The CDC screwed up big time on testing. So my guess is that these tests were not done early in the progression of the disease. They may have also been confirmatory tests done by the hospital after the patient was admitted. I have a friend who contacted the disease in early March but didn't get tested right away and was hospitalized with pneumonia before being diagnosed in the hospital. He was eventually given HCQ and survived. Have no idea if this was a typical episode but there was little testing outside of hospitals at first. The term “stitch in time” refers to avoiding serious trouble if a preventive is done early. It’s an old English expression. The other analogy being used is that of using a fire extinguisher to put out a fire when a small fire is found in a room. But a fire extinguisher is useless when the house is ablaze.jerry_{May 24, 2020
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kf @ 208 -
You have again failed to look at the context: the stitch in time effect, and even more directly, how ivermectin has shown early indications in vitro and in clinic.
What context? What "stitch in time effect" when all patients in the study were treated within 48 hours of diagnosis? And what does ivermectin have to do with this? Please explain clearly.Bob O'H_{May 24, 2020
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KF, not turnabout, just astute observation. There are many criticisms of Raoult‘s methods so I am not going to go into all of them. But one that jumps out to me is that there is no way of knowing how long after initial infection the treatments started. Given that we now know that the vast majority of cases are minor and often asymptomatic, we don’t know how many of his subjects already had declining viral loads. Maybe HCQ is very effective if administered early but this is only going to be effective if you test everyone, or administer it to everyone. Given that testing capacity is such that most countries are still limiting testing to those who are symptomatic and to health care workers, how do you propose to test everyone? At present, the US has only performed 43,750 tests per million. This would appear to be approximately 4% but the true per capita testing is much lower than that because many people (positives, essential workers, Anyone near Trump) receive multiple tests. Administering it to everyone is just not feasible, and extremely dangerous given it’s possible side effects.Ed George_{May 24, 2020
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EG, turnabout projection, while dodging the force of the point by point discussion correcting errors of sample framing, fact [as in, controls and of what type], inference and more, as well as the earlier article. Not unexpected, but underscoring what has been going wrong. KFkairosfocus_{May 24, 2020
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KF
EG, evasion again. KF
Yes, you have been repeatedly evasive, but I didn’t want to be the one to bring it up.Ed George_{May 24, 2020
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BO'H: You have again failed to look at the context: the stitch in time effect, and even more directly, how ivermectin has shown early indications in vitro and in clinic. But then, all of this is helping us to understand how, too often, we address controversial, polarised matters. And, it isn't pretty. The political operators of course are well aware of such issues and happily manipulate them. We are heading to fatal disaffection. KFkairosfocus_{May 24, 2020
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JVL- Proteins are not static, they vibrate. Look it up. Said vibrations can change the structural form of the protein.ET_{May 24, 2020
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PS: And yes, I am pointing to something new that is beginning to climb the ladder of cumulative evidence, from in vitro to now early off label cases with a promising result.
You may think that more people dying when they are given a drug than when they aren't (after correcting for other differences that might affect the outcome) is a promising result, but that's going to be a difficult sell.Bob O'H_{May 24, 2020
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BO'H: The abstract implies that these are hospitalised, obviously serious cases, and are delayed relative to the target zone for the cocktail. The point is to hit early and prevent cases from moving to the point of needing hospitalisation or facing the rapid collapse that is warned of. Once tubes go in or people are on ventilators, odds are grim. From FDA rulings to study designs to reports and media amplification, there is a consistent pattern of failing the stitch in time test. Or, if you will, we can put it in terms of Machiavelli's comparison of political disorders to hectic fever: at the first, easy to cure but hard to diagnose; when, at length, the disease is obvious to all, it is too late to cure. The good news, courtesy Jerry, is that there is some promise that Invermectin can extend the window of effective treatment. KF PS: And yes, I am pointing to something new that is beginning to climb the ladder of cumulative evidence, from in vitro to now early off label cases with a promising result.kairosfocus_{May 24, 2020
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kf - what do you mean by "stitch in time"? I'd expect that to allude to "a stitch in time saves nine", but in this study all of the patients were treated within 48 hours of diagnosis. TBH, I think that's pretty early. Do you instead mean that patients with milder symptoms are the ones that should be looked at?Bob O'H_{May 24, 2020
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BO'H: I suggest you will find it advisable to examine my point by point response to the abstract of the study reported in Lancet, in 199 just above. Further to this, I suggest that -- as pharmacology is the study of poisons in small doses -- range of dosages vs range of excessive toxicity may well depend on stage of disease and individual sensitivity. LD50 is after all, a reflection of variation. Yet further to this, the markup I made overnight is very compatible with results from elsewhere WHEN THEY ARE SET IN PROPER DISTINCT CONTEXT. One of the problems we have faced is comparison of sweet crab apples and unfortunately just as sweet -- at first -- manchineel death apples. KF PS: 199 shows why sometimes it is necessary to take some length to address a contentious matter. UD exists for that specific purpose of addressing issues of civilisational importance.kairosfocus_{May 24, 2020
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ET: Thanks for your reply @192, changing the shape of the receptor I get. In your statement @175 mentioned changing a vibration and it was that part that puzzled me. As we say in Ye Olde England: Keep Calm and Carry On.JVL_{May 24, 2020
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kf @ 195 - Thanks. I think all of our scroll wheels appreciate the shorter summary of your comment.Bob O'H_{May 24, 2020
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kf @ 178 -
BO’H: SE France is not particularly exceptional, save in the dominant narrative.
OK, thanks. So the fact that we have evidence from around the world that HCQ is harmful suggests it is also harmful in the south-east of France. If the only difference is the narrative, it suggests this different narrative is doing harm.Bob O'H_{May 24, 2020
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F/N: Let's clip and comment from the Lancet Report in 130: >>Background Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. >> -- what defines "conclusive[ness]"? (If that becomes a gateway for gold standard fallacies of hyperskeptical denial, it will improperly undermine cumulative and collectively adequate warrant) >>Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19.>> -- If this becomes overly suspicious and fear driven, it can feed improper dismissal >>Methods We did a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without a macrolide [-->Macrolides inhibit protein synthesis in bacteria by reversibly binding to the P site of the 50S unit of the ribosome . . . . macrolides include azithromycin ] for treatment of COVID-19.>> -- Part of the cocktail . . . >>The registry comprised data from 671 hospitals in six continents. We included patients hospitalised between Dec 20, 2019, and April 14, 2020, with a positive laboratory finding for SARS-CoV-2. >> -- Jerry's point is clearly confirmed, the study effectively filtered out the key population, the stitch in time group, likely leading to biasing the result from the outset. -- This has been a consistent pattern with studies and designs, and has been embedded in FDA statements -- why is this divergence of framing joined to failure to note the difference so common? -- Ivermectin may, on Broward County results, repeat MAY, be a step to lengthen the window of success for the cocktail >>Patients who received one of the treatments of interest within 48 h of diagnosis were included in one of four treatment groups (chloroquine alone, chloroquine with a macrolide, hydroxychloroquine alone, or hydroxychloroquine with a macrolide),>> -- Notice, in-hospital, so beyond the stitch in time threshold unless ivermectin or the like is added, per recent news >> and patients who received none of these treatments formed the control group. >> -- notice, control group as BAU, vs treatment group beyond the stitch in time threshold >>Patients for whom one of the treatments of interest was initiated more than 48 h after diagnosis or while they were on mechanical ventilation, as well as patients who received remdesivir, were excluded.>> -- For what it is worth, they could have cross tabulated those arms too. >> The main outcomes of interest were in-hospital mortality>> -- confirming the stitch in time forfeit. >> and the occurrence of de-novo ventricular arrhythmias (non-sustained or sustained ventricular tachycardia or ventricular fibrillation).>> -- which may tie to the Covid 19 disease process -- was there filtering on that issue? >>Findings 96?032 patients (mean age 53·8 years, 46·3% women) with COVID-19 were hospitalised during the study period and met the inclusion criteria. Of these, 14?888 patients were in the treatment groups (1868 received chloroquine, 3783 received chloroquine with a macrolide, 3016 received hydroxychloroquine, and 6221 received hydroxychloroquine with a macrolide)>> -- the treatment groups are not far beyond the magnitude of the IHU groups. As a rule of thumb, fluctuations tend to go as sqrt n, so it is hard to reduce them without very large shifts in numbers - let me add, say fluctuations for n1 are c*sqrt(n1), so we see fraction c * sqrt n1:n, to halve this, we need some x k so that sqrt k: k is 1/2, x k is x 4. To reduce to 1/10 of original fraction we need sqrt k:4 is 1/10, i.e. x k becomes x 100, and so forth. Costs, typically, are disproportionate to increased scale. >> and 81?144 patients were in the control group.>> -- control on BAU, confirmed >> 10?698 (11·1%) patients died in hospital. >> -- confirms, these are seriously ill, hospitalised and beyond the stitch in time threshold >>After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity),>> -- but not, the stitch in time group that was not studied >> when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531), chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each independently associated with an increased risk of in-hospital mortality.>> -- All beyond the stitch in time threshold >> Compared with the control group (0·3%), hydroxychloroquine (6·1%; 2·369, 1·935–2·900), hydroxychloroquine with a macrolide (8·1%; 5·106, 4·106–5·983), chloroquine (4·3%; 3·561, 2·760–4·596), and chloroquine with a macrolide (6·5%; 4·011, 3·344–4·812) were independently associated with an increased risk of de-novo ventricular arrhythmia during hospitalisation.>> -- Again, beyond the stitch in time threshold. -- As at now, consideration should be made to see if Ivermectin should come into the cocktail and obviously, monitoring for heart toxicity or preconditions >>Interpretation We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. >> -- being, beyond the stitch in time threshold -- Raoult, Lozano, Zelenko + 60 etc are studying a different population and seek to avert hospital admission -- The dismissals of their work on this report are ill-founded, on the mangoes vs guavas principle. Crab apples are not manchineel death apples; the latter LOOK and apparently TASTE like the former (based on report of a yachting case here some years ago) but are potentially deadly >>Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.>> -- But the populations are not relevant. CONCLUSION: It seems that apples and death apples are not to be compared. Could the gap in populations/ point along the disease process identified explain the gap in reported outcomes, rendering the two sets of studies actually compatible in logic but not directly comparable in evaluating the real world effectiveness of HCQ cocktails? KFkairosfocus_{May 23, 2020
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PPS: Notice, discussion in the context of a patient, a Mr Reed:
Dr. Rajter said Reed fit the criteria he set for trying the new regimen. Reed was in bad shape, rapidly going downhill, but not yet ready to intubate. As Rajter explains it, once they’re intubated, the medication does not have as much impact. “I took those people who invariably were going to crash, meant they were going from room air to 50% oxygen in a matter of hours, I know where that’s headed,” Dr. Rajter said, pointing out that COVID-19 patients often deteriorate extremely fast. The FDA issued a warning today, saying while Ivermectin is approved for use in humans to fight parasites, more studies need to be done to prove its worth in fighting COVID19. Dr. Rajter agrees and so does Dr. Cepelowicz-Rajter, saying that’s exactly what they are doing. [--> through cases implicitly compared to business as usual] In fact, Dr. Rajter received approval late Monday afternoon from Broward Health to use his protocol in all of their hospitals. That means COVID-19 patients at Broward Health Medical Center, Broward Health North. Broward Health Imperial Point, and Broward Health Coral Springs might be receiving the Ivermectin cocktail, depending on their conditions.
Notice, Ivermectin had in vitro effect and was tried using off label, emergency and compassionate principles. If this holds up, we may be seeing how further increments to the cocktail just may stretch the window of effectiveness. The pessimism on once one goes on tubes [or a ventilator] should also be noted.kairosfocus_{May 23, 2020
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