91 Replies to “Hydroxychloroquine wars, 6: Dr Zelenko’s interview with Rudy Giuliani

  1. 1
    kairosfocus says:

    Hydroxychloroquine wars, 6: Dr Zelenko’s interview with Rudy Giuliani

  2. 2
    kairosfocus says:

    My concern, his statement 8 days.

  3. 3
    jerry says:

    There are three legs to the chair for normalcy to return, probably more.

    1 Quick testing for virus, now down to 5 minutes with a new test. Who can go back to work.

    2 A cure besides toughing it out with in-hospital care. Hydroxychloroquine maybe one of these cures. It apparently acts to prevent translation of proteins. Not sure if that is correct but someone here should know. Other cures? How do they work?

    3 A test to determine if someone is now immune to the disease. So they can go about staffing the businesses and organizations that had to shut down.

    Probably additional steps but the above are key.

    I wish this would appear somewhere besides with Rudy Giuliani. Not that I don’t believe it is correct but a lot of people will use him as reason to not pay attention to it.

    The edit function is back!!!!!!

  4. 4
    kairosfocus says:

    Jerry, Zelenko is emphasising one suggested mode, forming a gateway for Zn to get into the cell and wreck the replication process for the virus. There are others . . . e.g. helping modify receptor shapes through pH effects thus breaking key-lock fit and stopping invasion of the cell . . . and that is good, if a drug cocktail has several redundant modes of action it becomes exponentially harder for mutations to block it. My bet is, we don’t really know. KF

  5. 5
    jerry says:

    Thanks KF.

    I watched a video yesterday on this from another site and it mentioned the efficacy of zinc in this process. All I could think of was that Zicam is widely used when coming down with a cold. I wonder if they are related.

    Our family often jokes about Zicam. It works 100% of the time since every time we take it the cold goes away eventually. We don’t know if it is psychological or actually has some therapeutic effect.

    Just after posting my comment, I was trying to provide my wife with a layman’s account of what is going by describing transcription and translation. I said what I am saying was probably about 60% correct as I am far from an expert. Maybe we will all know more about these two processes after this is over.

  6. 6
    Truthfreedom says:

    @Jerry
    We do not know about the immunity process right now. We do not know if it is protective and for how long. We do not know either if, as Kairosfocus suggests, there are 2, 3 (maybe more?) strains of the virus. It has gone through a crazy amount of replicative cicles.
    There could be 2 waves of infection (as it happened in 1918).
    We need LOTS of data and people capable of understanding it.

  7. 7
    jerry says:

    We do not know about the immunity process right now

    I would think there should be a quick test of the blood of everyone on the Diamond Princess. 83% did not get the virus. Why? Only 7 died, Why? What was the path for the 17% who did get it and survived.

    It is the perfect Petri dish.

    What about the Crown Princess? Another Petri dish and the recent Holland American ship returning from South America.

    I was on the Emerald Princess (last current voyage) while this was going on and we were wondering if any of the crew had transferred from the Crown Princess when they were in Hawaii in close time proximity. These cruise ship are the perfect research labs. Everyone on these ships are at most 3 persons away from everyone else on the ship. As in Sweet Caroline which is sung on every cruise ship sometime, “Hands touching Hands.”

  8. 8
    Truthfreedom says:

    @7 Jerry
    You can have antibodies, but due to the rate of mutations, they could be only partially protective. Or minimally.
    Sometimes, having the ‘wrong’ antibodies is very dangerous (they can become lethal).
    The immune system is marvelous but a ‘natural born killer’.
    We need more information. Right now even the specialists are guessing.

  9. 9
    ET says:

    Jerry- The passengers were quarantined. That stopped the spread.

  10. 10
    jerry says:

    The passengers were quarantined. That stopped the spread.

    Not really. Eventually yes if you get kept in your cabin. But for an extended period they were on a cruise ship that was infected going about normal activities. On any given day everyone is in contact with everyone else on the ship in the sense that a person will be in contact with passengers or crew who are in contact with everyone else on the ship. In other words pick any two random people on the ship and the two of you will have someone in common who you have been in contact with on that day.

    So over a few days there was no way to avoid contact. Though I assume the eventual quarantine reduced it some but probably not much.

    An aside: it is really painful to listen to Rudy Giuliani. He has someone with extensive knowledge and he is frustrating both his listeners and his interviewee. I have learned a lot listening but found myself shouting at the computer screen for him to shut up.

  11. 11
    Truthfreedom says:

    Because [the virus] is so new, we do not yet know how long any protection generated through infection will last. We urgently need more research looking at the immune responses of people who have recovered from infection to be sure,” says Openshaw.

    Other immunologists agree. “Immunity to SARS-CoV-2 is not yet well understood and we do not know how protective the antibody response will be in the long-term,” says Erica Bickerton at the Pirbright Institute in the UK.

    https://www.newscientist.com/article/mg24532754-600-can-you-catch-the-coronavirus-twice-we-dont-know-yet/#ixzz6II0KSV3V

  12. 12
    kairosfocus says:

    Jerry, a lawyer, and a former prosecutor. KF

  13. 13
    daveS says:

    KF,

    Jerry, a lawyer, and a former prosecutor. KF

    Also, a future convicted felon who is being investigated by the very office he used to head. 😛

  14. 14
    jerry says:

    a lawyer, and a former prosecutor

    I know who Giuliani is very well. I lived in Westchester county just north of the city during the time he was mayor. He saved New York City.

    It is just that he is terrible as an interviewer.

  15. 15
    kairosfocus says:

    DS, I suggest there is in Anglophone jurisprudence a standard of innocence until proved guilty in a proper court. KF

  16. 16
    daveS says:

    KF,

    He’s still a free man, and to be honest, I think it’s unlikely he will be convicted of anything. I am free to engage in wishful thinking, however.

  17. 17
    kairosfocus says:

    DS, in my jurisdiction, for cause, wishful thinking like that is in carry a fat cheque book to court territory. KF

  18. 18
    kairosfocus says:

    Jerry, more explanation. I think his background shaped how he interviewed. KF

  19. 19
    daveS says:

    KF,

    That’s unfortunate (IMHO).

    I’ve skimmed a few articles about the chloroquine issues (which I hadn’t been following closely) and am hoping that new studies yield positive results.

  20. 20
  21. 21
    ET says:

    daves- You want wishful thinking? Rudy says that he has evidentiary support that Joe Biden is corrupt. Evidence that will get Joe impeached if he becomes President.

  22. 22
    daveS says:

    ET,

    That’s not wishful thinking, there are literally video recordings of Rudy saying that. 😛

  23. 23
    daveS says:

    Anyway, sorry for the derail, I’ll stop talking politics now. 🙂

  24. 24
    ET says:

    The wishful thinking is that what he said is true.

  25. 25
    Truthfreedom says:

    In vitro study for Hydroxychloroquine/ Chloroquine:
    Hydroxychloroquine was found to be more potent than chloroquine in vitro.
    https://www.google.com/url?sa=t&source=web&rct=j&url=https://academic.oup.com/cid/advance-article-pdf/doi/10.1093/cid/ciaa237/32882334/ciaa237.pdf&ved=2ahUKEwig-cjRsMfoAhWCsKQKHYVND2UQFjAIegQICRAB&usg=AOvVaw3orscITIF6UDW9do0OUs7c
    Let’s wait for the clinical trials.
    DO NOT BOTHER WITH “MEDIA OUTLETS” AND ANONYMOUS POSTERS THAT DO NOT HAVE A CLUE ABOUT SCIENCE.

  26. 26
    Claude Pariseau says:

    I’ve just come upon this report on our National television station here in Canada , on colchisine , another anti-viral drug that’s safe and low cost , studies are now being done on it’s potency , and are about to be published , you should check this out too . Sorry that what i’m presenting is in french , but for those who understand the language , this should prove interesting … i don’t know if you”ll be able to watch this in your country , but it’s worth a try . La colchicine et la COVID-19 : entrevue avec Jean-Claude Tardif
    https://www.youtube.com/watch?v=OCyzU07U2sg&feature=youtu.be&fbclid=IwAR1gLfxvkb5o8-DqZSKC85RJ4B-2dsv-zDGIZUohS55Zg7RbP8vyEwN9Oxo

  27. 27
    kairosfocus says:

    F/N: FDA approval, next stage https://www.fda.gov/media/136534/download Read for yourself KF

  28. 28
    kairosfocus says:

    DS, one’s innocent reputation is A BASIC HUMAN RIGHT. That’s why in normally functional jurisdictions, it is protected in law. My right to wag my tongue as I please ends where your innocent reputation begins. KF

  29. 29
    kairosfocus says:

    A paper on Zinc and the immune system:

    https://www.ncbi.nlm.nih.gov/pubmed/31305906

    >>Adv Nutr. 2019 Jul 1;10(4):696-710. doi: 10.1093/advances/nmz013.
    The Role of Zinc in Antiviral Immunity.
    Read SA1,2, Obeid S3, Ahlenstiel C3, Ahlenstiel G1,2.
    Author information
    Abstract

    Zinc is an essential trace element that is crucial for growth, development, and the maintenance of immune function. Its influence reaches all organs and cell types, representing an integral component of approximately 10% of the human proteome, and encompassing hundreds of key enzymes and transcription factors. Zinc deficiency is strikingly common, affecting up to a quarter of the population in developing countries, but also affecting distinct populations in the developed world as a result of lifestyle, age, and disease-mediated factors. Consequently, zinc status is a critical factor that can influence antiviral immunity, particularly as zinc-deficient populations are often most at risk of acquiring viral infections such as HIV or hepatitis C virus. This review summarizes current basic science and clinical evidence examining zinc as a direct antiviral, as well as a stimulant of antiviral immunity. An abundance of evidence has accumulated over the past 50 y to demonstrate the antiviral activity of zinc against a variety of viruses, and via numerous mechanisms. The therapeutic use of zinc for viral infections such as herpes simplex virus and the common cold has stemmed from these findings; however, there remains much to be learned regarding the antiviral mechanisms and clinical benefit of zinc supplementation as a preventative and therapeutic treatment for viral infections.

    Copyright © American Society for Nutrition 2019.>>

    KF

  30. 30
    Claude Pariseau says:

    This just came out too on hydroxychloroquine . This study has not yet been published in a scientific journal (therefore reviewed and corrected by experts), but made public in advance on an ad hoc site (MedRXiv). If the protocol offers the guarantees of a satisfactory level of evidence, it is of course not free from some weaknesses:
    – the study was most likely carried out in an emergency (testify to this in rough English and a fairly low level of detail);
    – the patients were able to receive other treatments, in particular antivirals, which somewhat clouded the results of the study;
    – the short follow-up time (5 days) of the patients does not exclude a rebound of the disease in the following days.
    https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2?fbclid=IwAR2jj9i5TBYC-MKU5Hrdsi-U9H8eUxf-M-BNJSBstM6f-aDMwAnlh3ddoFU

    And this article that comments on the medrxiv study , it’s in french , but there’s always Google translate … https://www.heidi.news/sante/chloroquine-un-essai-mene-a-wuhan-vient-appuyer-son-interet-contre-le-coronavirus?fbclid=IwAR2iBlVVfNjN6AnQ3A3TJ3pv8ulUbxEl5rAHuItlJxKcM_5QJcr7X2uvLjU

  31. 31
    Ed George says:

    KF@27, the following restrictions on its use are interesting.

    The chloroquine phosphate may only be used to treat adult and adolescent patients who weigh 50 kg or more and are hospitalized with COVID-19, for whom a clinical trial is not available, or participation is not feasible.

    So, it can only be prescribed in a hospital, and only if they aren’t eligible for a clinical trial. The very same restrictions that some of us have been raked over the coals for advocating.

  32. 32
    Ed George says:

    KF@29, my understanding is that colchicine (often used for gout) causes the body to absorb more zinc, and is effective in reducing inflammation. That is why it is being researched as a possible treatment for COVID-19.

    I doubt there will be a magic cure unless a vaccine can be developed. Any effective treatment will probably involve a combination of drugs.

  33. 33
    vividbleau says:

    EG
    Third request, when did Trump use the word “promise”

    Vivid

  34. 34
    ET says:

    FYI- Zinc kills bacteria by starving them of manganese, an essential element for them. Yes, I know that bacteria ain’t viruses.

  35. 35
    ET says:

    Acartia Eddie:

    So, it can only be prescribed in a hospital, and only if they aren’t eligible for a clinical trial. The very same restrictions that some of us have been raked over the coals for advocating.

    Moar lies. This is the very thing we have been telling YOU.

  36. 36
    kairosfocus says:

    CP, useful result, adding to the pattern. Of course, the test is not for the cocktail, but it helps us further see the clear antiviral impact again demonstrated. The pattern of repeatable, cumulative evidence is growing. As it does so, the chances of all of this being by chance drop exponentially. KF

  37. 37
    daveS says:

    Y-you mean the virus was created deliberately?

    Edit: I misunderstood; I don’t think that’s what you’re suggesting.

  38. 38
    kairosfocus says:

    EG, no, you and others have not advocated for emergency use, but have dismissed evidence of efficacy as at best anecdotal and further claimed that until there was extensive testing to your satisfaction, it would be improper or even dangerous to suggest that it is promising. Now, you are re-writing. The problem in so interpreting the FDA approvals is that there is an earlier stage of approval dating to March 19 — on the strength of which it seems the despised Mr Trump spoke of HCQ as a promising treatment — for compassionate and emergency use. Further to all of this, the next step of expansion of approval is coming just after the second Didier Raoult study [of 80]. What I have explicitly argued is that there is mounting evidence of efficacy, as can be seen, with the implication that on known chemical effectiveness against viri and known ability to translate that into drug dose with a well known toxicity management framework, it becomes reasonable in the first instance to provide off label prescription and further reasonable — not “touting” — to point to this as a point of hope. KF

  39. 39
    Ed George says:

    KF

    EG, no, you and others have not advocated for emergency use,…

    KF, if you are going to lie, what is the point of trying to have a discussion. This is what I said:

    Nobody is suggesting that this combination shouldn’t be used. If a patient in hospital tests positive I have no problem with having it administered on a routine basis. But until a comprehensive clinical trial has demonstrated its efficacy and, more importantly, its contraindications, it would be irresponsible to prescribe it to people with mild symptoms, even if they test positive.

  40. 40
    ET says:

    And we told you that it was only being used in hospitals where the patients were closely monitored. That is what we have been telling you and you went off on some tardic tangent. And then you said what we have been telling and now you are acting as if you said it first. KF’s entire string of posts on the subject was about that- the treatments were to be used in hospitals under supervision.

    You are clearly just an ass and apparently proud of it

  41. 41
    ET says:

    But until a comprehensive clinical trial has demonstrated its efficacy and, more importantly, its contraindications, it would be irresponsible to prescribe it to people with mild symptoms, even if they test positive.

    No one here, nor from the White House, has ever said to prescribe it for mild symptoms. That was something YOU invented. Well, perhaps other tards invented it, too.

  42. 42
    kairosfocus says:

    EG, do you really want to go down the long list of times that you and others have cast severe doubts on the utility of HCQ? Or, how often you have withheld substantial, operational agreement on when I have pointed out the FDA approval of March 19, including in OP? Which, would have shifted the balance of discussion. In short, the TONE of the exchanges up until this past weekend speaks far more than your weasel words do, and frankly weasel words they are as otherwise there should have been mutual agreement not sharpish exchanges. So, forgive me if in that context I overlooked points where you asserted what was actually highlighted by us, on the way to scanting the quality of evidence providing warrant for the promise and now credible effectiveness of the drug. Do you notice the tenor of your following words, “until a comprehensive clinical trial has demonstrated its efficacy [–> cf the trials in China etc] and, more importantly, its contraindications [–> cf. the long since known toxicity effects of the drug], it would be irresponsible to prescribe it to people with mild symptoms, even if they test positive”? Why are such words there when at the start point by March 19th FDA had approved compassionate and emergency use? Also, there were on the table studies in France, Australia and China, the latter with actual set protocols for use [–> see, for Canton aka Guangdong] so that studies in the US etc, strictly, were by way of corroborating replication, not pioneering studies? (Or, are we dealing with unwarranted dismissiveness to the pioneering Chinese work all the efforts since then build on?) And BTW, it is not helpful to be needlessly casting seriously loaded accusations such as “lie” in our teeth. Where, an operative word is, ADVOCATED. KF

    PS: Note this, from my response at 11 in the relevant HCQ wars, 4 thread:

    [KF] who has been advocating broadcast use? (Apart from somebody deciding to swallow aquarium cleaner not for human consumption.) Nearest I see is that prophylaxis would go to critical health workers and maybe to those with danger-sign preconditions.

    PPS: You, at 20 in thread, summarising with apparent approval:

    Ontario has prohibited doctors prescribing chloroquine for COVID-19.

    Where, HCQ Wars, 4 was about the second, 80-patient Raoult test and his linked in vitro studies that we learned later tipped the balance in France and led to US FDA second stage approval.

  43. 43
    kairosfocus says:

    F/N: Notice, Seversky at 27:

    If chloroquine and azithromycin are effective against COVID-19 then great, let’s get them into full production as soon as possible. But it will take more than the word of a reality-show President who thinks the USAF has Romulan cloaking-devices to convince me. That will need to be confirmed by results from the large-scale trials that are being prepared now.

    His highlighted if speaks volumes against the backdrop of what the OP reported from France, which corroborated what had been coming from China etc. So do his onward remarks on a tangential matter, his scorn for the current US President.

  44. 44
    kairosfocus says:

    F/N2: observe, my comment at 34:

    I note, that by end of February to early March, there was already a considerable body of evidence of effectiveness on the table, as I have partly documented from a series of OPs here. Note, this specifically includes tests documented in the professional literature from 15 Years ago, post SARS, that Chloroquine was effective chemically against a broad range of RNA and DNA viruses. As it is a well studied and widely used drug, the translation between chemical and in vivo effectiveness should have been recognised. The REAL scandal and debate we should have been having — given the longstanding, pressing need for effective antivirals — is why there was not a concerted effort to test and approve it over a decade ago. I suggest, that it is a longstanding generic and that approvals processes are now extremely cumbersome and costly just might have something to do with that.

    Set that against the backdrop of my earlier note in 31 how Bahrain, by Feb 26 began routine use based on existing evidence, with the result:

    Total Cases: 499
    of which 1 in severe condition
    Deaths: 4
    Deaths/ Total Cases: (1%)
    Recovered: 272
    Recovered/ Total Cases: (55%)

    As noted there, Bahrain is relevant as the curve of cumulative cases there is clearly flattening, joining S Korea and possibly China in the group of countries that have beaten the epidemic.

  45. 45
    Jim Thibodeau says:

    Ed George has been properly skeptical of this new scientific claim, which is the appropriate position. I’ve seen some other people be way too credulous, because they want to believe something is true.

    I hope it’s a miracle drug, But we are awaiting confirmation on its efficacy.

  46. 46
    daveS says:

    KF,

    Have you read Derek Lowe’s take on chloroquine? If so, what do you make of it? (Apologies if you’ve already discussed this in previous threads).

  47. 47
    kairosfocus says:

    DS, I have been tracking Raoult and other actual studies and set up protocols with a side helping of the FDA’s approvals to date. On searching, I see his https://blogs.sciencemag.org/pipeline/archives/2020/03/20/chloroquine-past-and-present which on glancing is an article I saw and glanced through. Indeed, his feel free to read someone else’s work in respect of overconfident mechanism suggestions is echoed in my earlier comments. Yes, it is always possible that what we imagine are causal effects are accidents that make mincemeat of our suggested efficacy and mechanisms. That possibility falls exponentially as evidence and cases accumulate. For France, tipping point has been reached and the US has taken a second step up the approvals ladder this weekend. As US testing started already, we will see further in coming days. KF

  48. 48
    daveS says:

    Lowe does offer some detailed critiques of the methods used in Raoult’s work, which is worth keeping in mind. The section entitled “This Latest Study” of this blog post contains some.

  49. 49
    ET says:

    The fact that “Ed George” was erecting strawmen is evidence he was not being properly skeptical about the new treatments.

  50. 50
    ET says:

    Derek Lowe was a good pitcher and won a world series with the Red Sox, but I am not sure what he can offer in the way of science and medicine. 😉 😎

  51. 51
    daveS says:

    He’s a man of many talents.

  52. 52
    Jim Thibodeau says:

    @DaveS Derek Lowe is a scientist, and properly skeptical.

    For lay people: proper scientific skepticism is not disbelieving something, it’s reserving judgement until there’s adequate evidence. We’re still waiting for this drug, hopefully we’ll know in a few weeks.

  53. 53
    jerry says:

    Zinc is the killer, hydroxychloroquine is the facilitator.

    Here is a video from 3 weeks ago that is relevant to the cure for the virus and apparently what the South Koreans have done. It is from a medical site that prepares medical students for exams called MedCram. It shows that hydroxychloroquine is an ionophore (essentially a transporter to get into a cell) for zinc to enter the cell where zinc prevents the virus from replicating. So zinc is the essential ingredient.

    https://www.youtube.com/watch?v=U7F1cnWup9M&list=PLQ_IRFkDInv-NvRRUN0aqe51sMs188k8z&index=18

    This video is from 3 weeks ago so why have so many people died unnecessarily in that time when a known solution was out there? I would blame the blinders of those who are traditional thinkers on this.

    As far as following traditional approval patterns for medicine approval, the current situation is different. As someone said in a website yesterday there are no double blind studies for parachutes.

    The site MedCram has dozens of interesting videos on medicine and so far 47 on the virus. Here is the home Youtube site for it

    https://www.youtube.com/channel/UCG-iSMVtWbbwDDXgXXypARQ

    Here is how it kills. ARDS or Accute Respiratory Distress Syndrome. This is what Dr. Zelenko was describing in his video with Giuliani.

    https://www.youtube.com/watch?v=okg7uq_HrhQ

  54. 54
    daveS says:

    If I had the virus and my life was in danger, I would ask for chloroquine (or whatever drug combination appeared most effective at the time).

    Do these drugs actually provide a net benefit? That’s a separate question.

  55. 55
    kairosfocus says:

    JT,

    skepticism, contrary to many current ideas, is NOT an intellectual virtue, especially in the form, selective hyperskepticism. What is a virtue, instead, is prudence.

    Let me cite McManaman, with general approval but not necessarily complete endorsement:

    [I]t is prudence that determines the mean of reason in all human actions and situations.

    Prudence, however, is not merely an intellectual virtue; it is also a moral virtue. A moral virtue is a habit that makes its possessor good. One may be brilliant and learned without being morally good, but it is not possible to be prudent and not morally good. The prudent man is one who does the good, as opposed to one who merely knows the good . . . .

    [T]heories are normally revised in the physical sciences; for the objects of mathematics are more abstracted from matter than are the objects of the science of biology. Similarly, we enjoy a relatively high level of certainty when dealing with very general moral issues such as murder, euthanasia, lying, etc, but as we approach the level of the particular, that is, a more concrete level, we very often become less certain about what we ought to do, because the concrete level contains so many variables that render decision making much more complex; for there is much more to consider [–> and we are oh so prone to error and/or ill-will].

    This does not mean that there is no truth on the concrete level of moral decision making, or that on this level the moral good is merely relative (i.e., relative to how you feel or what you want). Nothing could be further from the truth. Rather, it means that a special virtue is required by which one might see and readily make one’s way through these murky waters to the right end. Prudence [then] is the application of universal principles to particular situations, and so an understanding of universal moral principles is absolutely necessary. But since prudence deals in particulars, in the here and now of real situations, a number of other intellectual qualities are also necessary if one is to choose rightly, qualities that one does not necessarily acquire in a classroom setting. St. Thomas refers to these as integral parts of prudence, without which there is no prudence, just as there is no house without a roof, walls, and a foundation . . .

    By switching the intellectual focus to the primacy of doubt over claims of warrant, a grave and damaging error has been made by our civilisation’s intellectual leaders over several centuries. That error has now become embedded in education and popular culture, leading to damaged ability to soundly, prudently warrant and decide aright.

    By contrast, in epistemology and the context of inductive logic applied to empirical observations, a better understanding informed by first duties of reason including prudence, leads to the concept of graded warrant. Mix in, the complex challenges of decision-making and praxis with a life-threatening crisis and we further face the concept of moral responsibility to conclude and act appropriately in good time, without undue delay or postponement tantamount to incremental refusal to do the right.

    Here, we see the issue of warrant to moral certainty such that one is irresponsible to act as if X were false on accessible evidence and reason pointing to its truth. Especially, in a context of cumulative, growing evidence that takes time to emerge in the face of a crisis where infection and linked death rates can double every two to three days due to quasi-exponential growth.

    Ideally, on the strength of in vitro evidence and HCQ’s base of evidence and experience as a clinical drug, multiplied by the pressing need for broad spectrum antivirals, studies on clinical efficacy, cocktails etc should have been done starting at least c 2005. By that time we saw the threat of SARS and had in hand published data on the promise of CQ and its relative HCQ. So, our first admission of failure is that we did not act in good time. A linked issue is that given generic status and the cost of trials, it would likely have been a financial loss to go through the complexity and cost of a trials and approvals process. (Notice, back in the 50’s, CQ’s action on arthritis etc was noted clinically and use of the drug for this seemed to grow from that. HCQ was brought in to reduce toxicity.)

    That brings in a second failure point, excessive bureaucratisation that apparently makes it difficult to explore and obtain certification of potential extended uses of existing drugs with known patterns and problems. Off label prescription comes across as an ad hoc patch in that context. The themes of where bureaucracy goes are well known.

    Now, we come to the specific case. By late Feb, enough was on the table for Bahrain to act. There was evidence of good promise. This was actually being more or less favourably tracked in the media. But, so soon as Mr Trump — in a context of actual FDA initial approval for compassionate, emergency use on March 19 — dared to suggest this as a point of hope, coverage instantly turned sharply hostile, dismissive and alarmist. The case of the people poisoning themselves with fish tank cleaner (I gather, the couple each swallowed a teaspoonful . . .) and its coverage is emblematic. This led to a wave of bans by state Governors, right on the eve of Raoult’s release of his second clinical study of 80 patients backed up by in vitro studies at plausible concentrations.

    I ask, what are the odds of fast acting success typically on order of 5+ days, for 78 of 80 patients, by simple chance?

    Let me cite from my earlier OP:

    Our two articles published this evening help to demonstrate:

    1. The effectiveness of our protocol, on 80 patients.

    2. The relevance of the association of hydroxychloroquine and azithromycin, thanks to research carried out in our P3 containment laboratory. https://t.co/Y91bsFOgB2

    – Didier Raoult (@raoult_didier) March 27, 2020 . . . .

    New article published online by my teams: in vitro demonstration of the hydroxychloroquine / azithromycin synergy to counter the replication of SARS-COV2

    In vitro testing of Hydroxychloroquine and Azithromycin on SARS-CoV-2 shows synergistic effecthttps: //t.co/KUaag6N5FF

    – Didier Raoult (@raoult_didier) March 27, 2020 . . . .

    Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: an observational study
    Running title: Hydroxychloroquine-Azithromycin and COVID-19

    Abstract
    We need an effective treatment to cure COVID-19 patients and to decrease the virus carriage duration. In 80 in-patients receiving a combination of hydroxychloroquine and azithromycin we noted a clinical improvement in all but one 86 year-old patient who died, and one 74 year- old patient still in intensive care unit. A rapid fall of nasopharyngeal viral load tested by qPCR was noted, with 83% negative at Day7, and 93% at Day8. Virus cultures from patient respiratory samples were negative in 97.5% patients at Day5. This allowed patients to rapidly de discharge from highly contagious wards with a mean length of stay of five days. We believe other teams should urgently evaluate this cost-effective therapeutic strategy, to both avoid the spread of the disease and treat patients as soon as possible before severe respiratory irreversible complications take hold . . . .

    In vitro testing of Hydroxychloroquine and Azithromycin on SARS-CoV-2 shows synergistic effect

    Abstract
    Human coronaviruses SARS-CoV-2 appeared at the end of 2019 and led to a pandemic with high morbidity and mortality. As there are currently no effective drugs targeting this virus, drug repurposing represents a short-term strategy to treat millions of infected patients at low costs. Hydroxychloroquine showed an antiviral effect in vitro. In vivo it also showed efficacy, especially when combined with azithromycin in a preliminary clinical trial. Here we demonstrate that the combination of hydroxychloroquine and azithromycin has a synergistic effect in vitro on SARS-CoV-2 at concentrations compatible with that obtained in human lung.

    Prudence, i/l/o the value of human life, would manifestly support initial, provisional use of the drug for treatment to prevent fatal complications for the at-risk, and for prophylaxis for health care workers on the frontlines, who obviously have higher exposure.

    In short, we do not have the luxury to act at leisure here. That opportunity, due to our structural institutional errors, was lost over a decade ago. Now, with SARS-CoV-2 virus — even the reference to SARS has been challenged here at UD — on the prowl with 2-3 or possibly up to 49 strains already, we have to act under pressure where days count in the face of exponential growth.

    KF

  56. 56
    Truthfreedom says:

    @47 Kairosfocus:

    Yes, it is always possible that what we imagine are causal effects are accidents

    Bacteria to dinosaurs gradualist non-sense fits here. Darwin (who was NOT very original, more like a plagiarist) saw what breeders had been doing for centuries and tried to apply it to ‘nature’. And gullible people were on his side.

  57. 57
    ET says:

    I take 45-60mg of zinc a day. 45 minimum and up to 60 if I am feeling sick. 30 comes in a ZMA stack- zinc aspartate, zinc mono-L-methionine and magnesium, with B-6 added. The rest comes from zinc lozenges to coat my throat.

  58. 58
    kairosfocus says:

    DS, kindly see just above. KF

  59. 59
    ET says:

    Thanks and a HT to Jerry.

    Thanks and HT to kairosfocus.

  60. 60
    jerry says:

    Anyone with the current information who argues against the use of Hydroxychloroquine and zinc or something shown equally equivalent is essentially sentencing large numbers of people to death.

    The overall problem is obviously bigger than this. Everyone has to get this disease either through exposure or a vaccine. But the path to that is precarious. That is why the testing for the disease or the anti bodies in the blood is essential. People have to go back to a normal way of life or we will see chaos like the world has never seen in centuries.

  61. 61
    kairosfocus says:

    Jerry, see my just above on the switcheroo where “skepticism” has been put up in substitution for prudence, leading to severe breakdown of soundness in decision-making and epistemology. KF

  62. 62
    kairosfocus says:

    ET, good for you. KF

  63. 63
    daveS says:

    KF,

    Prudence, i/l/o the value of human life, would manifestly support initial, provisional use of the drug for treatment to prevent fatal complications for the at-risk, and for prophylaxis for health care workers on the frontlines, who obviously have higher exposure.

    I don’t know enough about the risks to say who should be allowed the drug, but ideally, at least people who are seriously ill should be given the choice. There are other concerns, for example people who are taking these drugs for rheumatoid arthritis already are having difficulty finding them.

    And yes, prudence is a good word.

  64. 64
    kairosfocus says:

    Jerry, we crossed in posting. I agree we have been acting imprudently for perhaps 15 years since SARS 1. KF

  65. 65
    jerry says:

    who should be allowed the drug

    Zelenko addresses that in his video with Giuliani. He suggests shortness of breath. There are simple point of care tests for strain on the oxygen system.

    If you watch the latest MedCram video, it covers a lot of very interesting things related to infectious disease such as hyperthermia treatment. But most importantly how to manage the disease so the hospitals are not overwhelmed.

    https://www.youtube.com/watch?v=H1LHgyfPPQ8&t=894s

    If it starts into the video go back to beginning.

  66. 66
    kairosfocus says:

    DS, we have been imprudent for 15 years and are paying the price with SARS . . . 2. I gather that a group of seven pharma co’s has set about producing 250 million pills by mid month, with obvious onward implications. I would suggest that there is no proper comparison between arthritis pain [bad though that is] and loss of life in the face of an epidemic manifesting quasi-exponential growth globally. Lupus, is a different case and if that had been the main comparison, a call for balance would have been on target. Language about unproven remedies and touting was and is out of order. KF

  67. 67
    kairosfocus says:

    Jerry, shortness of breath may mark initial long term lung damage. Then, there is the world of asthmatics and those with various similar lung and/or immune system disorders. The at risk and those showing shortness? Maybe there is a doctor in the house. KF

    PS I wonder who can tell us why we should not take serious note of Raoult’s two recent results, noting his status as a researcher.

  68. 68
    daveS says:

    KF,

    Eh? Rheumatoid arthritis is not just about pain, it’s an autoimmune disease like lupus that can produce fatal complications.

    Other than this, I don’t know what we’re disagreeing about. I didn’t say anything about touting, etc. Tough choices are going to have to be made.

    Singapore and South Korea have learned the lessons from SARS, but predictably, not many other countries have. Imprudence is pretty much the way we roll in the US. Nevermind planning for the future, investing in critical infrastructure, etc., we tend to wing it and hope for the best.

  69. 69
    jerry says:

    Kf,

    Zelenko said most shortness of breath was ameliorated in hours. Again a test for the disease that is easily available is essential so there will be no need to prescribe for non-infected. A test for oxygen delivery issues that is easily available and an indication of who should be tested. This exists. A test for antibodies to show who can go back to work. This test is in the pipeline.

    These all have to be worked out but there is an apparent cure with near 100% success and it should be limited to those in the high risk group due to potential side effects. Zelenko advocates this because the drugs are not completely risk free so do not give it to those who are young unless there are overriding issues.

    Maybe we are playing doctor so it is best left to them to figure out.

  70. 70
    ET says:

    Zinc must be taken in moderation! You don’t want people downing a bottle of the supplement.

    (as an aside- taking zinc will also help you cure your acne because it kills the bacteria causing it by starving them)

  71. 71
    kairosfocus says:

    DS, yes, that’s why an anti-inflammatory is common to all three diseases. However, my suggestion is that overwhelmingly arthritis is a slow progressive disease while Covid-19 is fairly rapid. That suggests a triage decision — always, a difficult choice — on scarce medical resources in a context where supply is being rapidly ramped up. My note on dismissive, denigratory language is about the toxic atmosphere that was needlessly created once Mr Trump pointed to HCQ and other drugs as signs of hope. Hope, BTW is not imprudent, especially informed hope (as opposed to wishful thinking); it is actually a virtue. KF

  72. 72
    kairosfocus says:

    ET, back in uni days on my campus we all had the standing joke about how a certain professor would begin pharmacology lecture 1: pharmacology is the study of poisons in small doses. This invariably shocked the bright-eyed, bushy-tailed 1st year med students and that evening we would see it in the Hall of Residence dining room. If anyone is so imprudent as to imagine that if X of a drug or supplement is good then more and more is better, s/he is begging for serious trouble. Even drunkenness is an early toxic effect and many spices can do bad things in large doses. You can kill yourself with enough carrot juice. Too much sugar at one sitting can be fatal — as a Chem prof told me once about a very bad childhood experience in Barbados with leftover sugar from a shipment workers gave to school kids standing around. KF

  73. 73
    daveS says:

    KF,

    I’m using “hope for the best” idiomatically here. As John McCain did in criticizing military action in Kosovo 20 years ago:

    Republican Sen John McCain, of Arizona, a former prisoner of war in Vietnam, said he saw no credible administration strategy. “Basically they’re saying, we’re going to bomb and hope for the best … there’s no plan-B here,” he said.

  74. 74
    kairosfocus says:

    DS, imprudence is suicidal. KF

  75. 75
    daveS says:

    Indeed.

  76. 76
    kairosfocus says:

    DS,

    Wikipedia is interesting, somewhat saddening:

    Prudence (Latin: prudentia, contracted from providentia meaning “seeing ahead, sagacity”) is the ability to govern and discipline oneself by the use of reason.[1] It is classically considered to be a virtue, and in particular one of the four Cardinal virtues (which are, with the three theological virtues, part of the seven virtues). Prudentia is an allegorical female personification of the virtue, whose attributes are a mirror and snake, who is frequently depicted as a pair with Justitia, the Roman goddess of Justice.

    The word derives from the 14th-century Old French word prudence, which, in turn, derives from the Latin prudentia meaning “foresight, sagacity”. It is often associated with wisdom, insight, and knowledge. In this case, the virtue is the ability to judge between virtuous and vicious actions, not only in a general sense, but with regard to appropriate actions at a given time and place. Although prudence itself does not perform any actions, and is concerned solely with knowledge, all virtues had to be regulated by it. Distinguishing when acts are courageous, as opposed to reckless or cowardly, is an act of prudence, and for this reason it is classified as a cardinal (pivotal) virtue.

    In modern English, the word has become increasingly synonymous with cautiousness. In this sense, prudence names a reluctance to take risks, which remains a virtue with respect to unnecessary risks, but, when unreasonably extended into over-cautiousness, can become the vice of cowardice.

    In the Nicomachean Ethics, Aristotle gives a lengthy account of the virtue phronesis (Ancient Greek: ????????), traditionally translated as “prudence”, although this has become increasingly problematic as the word has fallen out of common usage. More recently ???????? has been translated by such terms as “practical wisdom”, “practical judgment” or “rational choice”.

    Ari has a point: prudence is right reason applied to practice. That ties to what I have been noting about inescapable first duties of reason.

    Our civilisation is in deeper trouble than it may first appear.

    KF

  77. 77
    Ed George says:

    KF

    EG, do you really want to go down the long list of times that you and others have cast severe doubts on the utility of HCQ?

    No, just the number of times I have. I have been clear that I support its use for COVID-19 patients in hospitals, as I would for colchicine. I have even provided links to other promising treatments. If you can’t find comments where I have opposed this treatment it is time that you walked back your original comment.

  78. 78
    ET says:

    Yes, Ed, you said not to use it until they ran clinical trials and got the results back.

  79. 79
    jerry says:

    I have been clear that I support its use for COVID-19 patients in hospitals

    You should look at the video.

    Dr. Zelenko is keeping people out of the hospital by prescribing a cocktail of three drugs/pills to at risk patients. Keeping people out of the hospital is the goal so the hospitals do not get overwhelmed. There is essentially a cure for this virus and it should be administered early when diagnosed and there are initial symptoms of shortness of breath. Essentially he found out that only a hand full of patients should get to the hospital when in fact they are being inundated when they should not be if known treatments were applied early.

    Again I recommend the latest video by MedCram (medical site for medical students) where some history of infectious disease is discussed but the most important part of this video is how to manage people who have the virus so they never get to the hospital.

    https://www.youtube.com/watch?v=H1LHgyfPPQ8&t=932s

  80. 80
  81. 81
    kairosfocus says:

    EG,

    I see there:

    “Our new study provides very much needed direct evidence that a drug — called APN01 (human recombinant soluble angiotensin-converting enzyme 2 – hrsACE2) — soon to be tested in clinical trials by the European biotech company Apeiron Biologics, is useful as an antiviral therapy for COVID-19,” . . . . “The virus causing COVID-19 is a close sibling to the first SARS virus,” adds Penninger. “Our previous work has helped to rapidly identify ACE2 as the entry gate for SARS-CoV-2, which explains a lot about the disease. Now we know that a soluble form of ACE2 that catches the virus away, could be indeed a very rational therapy that specifically targets the gate the virus must take to infect us. There is hope for this horrible pandemic.”

    They are using a candidate drug targetting the spike protein. They seem to be setting up a mimic to lock up enough of the virus that its ability to cascade in tissue is frustrated. They are also using cultured human tissue analogues and showed that SARS-2 is capable of attacking other tissues, suggestive in the context of multiple organ failures being clinically observed. Though, respiratory deterioration to sufficient degree also can lead/contribute to organ failures.

    I don’t know if this is part of the 69 test drugs count but it is at least worth trying clinically.

    My concern is, we definitely need broadly acting antivirals. Ditto, for fresh antibiotics.

    KF

  82. 82
    Bob O'H says:

    Worth noting that the drug used in the Canadian study has already gone through Phase I and Phase II trials (albeit in a different context), so it will be easier to move it to a Phase III trial (the same is true for hydroxychloroquine, of course). This is important, because it affects the speed with which these treatments can be shown to work. New drugs will need a lot more testing to be confident they aren’t going to kill people.

  83. 83
    ET says:

    As Jerry’s links to videos have shown, chloroquine needs to be used in conjunction with zinc.

  84. 84
    jerry says:

    chloroquine needs to be used in conjunction with zinc.

    Latest from Dr. Zelenko on his success rate

    https://techstartups.com/2020/04/03/updates-from-dr-vladimir-zelenko-now-treated-700-coronavirus-patients-with-99-9-success-rate-using-hydroxychloroquine-zinc-sulfate-and-z-pak-1-outpatient-died-after-not-following-protocol-exclusi/

    I posted this to some good friends and they were full of reasons why this cannot be so because the best minds are not on board. As always it is human behavior that is most fascinating as is seen in discussions of ID. The best minds are not on board there either.

  85. 85
    kairosfocus says:

    Folks, later on what physicians are saying and doing globally. Some need to brace for a shock. KF

  86. 86
    kairosfocus says:

    Meanwhile, i have headlined the latest Zelenko video

  87. 87
    kairosfocus says:

    BTW, earlier, I put up tracking plots that are pointing to peaking.

  88. 88
    daveS says:

    KF,

    Your post #85 is alarming. We’re having a big day in the US, sadly.

  89. 89
    Jim Thibodeau says:

    KF what did “Folks, later on what physicians are saying and doing globally” mean?

  90. 90
    kairosfocus says:

    The morrow, DV. Enough for one day.

  91. 91

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