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COVID-19 and the need for skeptics in science

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Now more than ever:

Since World War II, America has suffered two respiratory pandemics comparable to COVID-19: the 1958 “Asian flu,” then the 1969 “Hong Kong flu.” In neither case did we shut down the economy—people were simply more careful. Not all that careful, of course—Jimi Hendrix was playing at Woodstock in the middle of the 1969 pandemic, and social distancing wasn’t really a thing in the “Summer of Love.”

And yet COVID-19 was very different thanks to a single “buggy mess” of a computer prediction from one Neil Ferguson, a British epidemiologist given to hysterical overestimates of deaths, from mad cow to bird flu to H1N1.

For COVID-19, Ferguson predicted 3 million deaths in America unless we basically shut down the economy. Panicked policymakers took his prediction as gospel, dressed as it was in the cloak of science.

Now, long after governments plunged half the world into a Great Depression, those panicked revisions are being quietly revised down by an order of magnitude, now suggesting a final tally comparable to 1958 and 1969.

COVID-19 would have been a deadly pandemic with or without Ferguson’s fantasies, but had we known the true scale and parameters of the threat we might have chosen better tailored means to both safeguard the elderly and at-risk, while sustaining the wider economy. After all, economists have long known that mass unemployment and widespread bankruptcies carry enormous health consequences that are very real to the victims suffering drained life savings, ruined businesses, broken families, widespread mental and physical health deterioration, even suicide. Decisions involve tradeoffs.

COVID-19 has illustrated the importance of free and robust inquiry…

Indeed, every major scientific advance challenged the “settled science” of its day, and was often denounced as pernicious and false, even dangerous. The modern blood transfusion, for example, was developed in the late 1600s, then banned for nearly a century by a hostile medical establishment, “canceling” tens of millions of lives at the altar of groupthink and hostility to skeptics.

Peter St. Onge, “The COVID-19 Panic Shows Us Why Science Needs Skeptics” at Mises Wire

The thing is, it used to just be sympathizers of some unpopular viewpoint like ID getting deplatformed. Now, COVID-19 has raised the stakes, with so many official sources demanding obedience to conflicting and wrong ideas. And our neighbors can’t afford to ignore just how destructive the establishment line, unfettered and unhinged, can be.

It’s a good time to talk to them about the problems with Establishment Science today. Too much arrogance and politicking; not enough humility or integrity.

Comments
ET
The point being is that 150,000 would be many thousands fewer if not for them.
Does that make them any less deserving of our thoughts and prayers? I honestly don’t understand what would make you respond in this way to a comment that is asking for people to give their thoughts and prayers to the people who have died of COVID.Mac McTavish
July 28, 2020
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A week ago he said he was skeptical but now nails the issue.
Does it strengthen or weaken the HCQ conspiracy case to see experts continuously tweet the wrong kinds of studies (hospitalized patients) to show why the proposed use (outpatient) doesn’t work?
We see that here as RHampton continually posting fake news with the wrong kinds of studies I guess he wants links to studies like this. Which RHampton linked to above (although he linked to the pre-print version). So unless an outpatient study is the wrong sort of study for a study of outpatients, you're going to have to try harder to dismiss the study.
Are those attacking HCQ an example of one of the most callous movements in the history of mankind?
let's be clear about this - the evidence says HCQ isn't an effective treatment. This has been shown in several RCTs, for different stages of the disease, as well as high-quality retrospective studies (e.g. the VA study, and this one, on outpatients). We'd all love it if an effective treatment was found, but unfortunately the evidence is saying HCQ isn't it. We're not monsters, and I don't think people pushing for HCQ are either.Bob O'H
July 28, 2020
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Alex Berenson reported one of the the most viral videos in the history of Facebook got taken down in a very short time. It was of a group of doctors touting the effectiveness of HCQ and zinc and Azithromycin. 14 million views in 6 hours. Facebook said it was communicating false information. Scott Adams has come out of nowhere to understand what has been going on with HCQ. A week ago he said he was skeptical but now nails the issue.
Does it strengthen or weaken the HCQ conspiracy case to see experts continuously tweet the wrong kinds of studies (hospitalized patients) to show why the proposed use (outpatient) doesn't work?
We see that here as RHampton continually posting fake news with the wrong kinds of studies One has to ask the question, are they that dumb or do they have an agenda that entails hundreds of thousands dying for what they believe is a greater cause. Are those attacking HCQ an example of one of the most callous movements in the history of mankind? Are those pointing to the number of dead from the virus the same people who cheer on attacks on what is probably the most effective known treatment against the virus? And at the same time do not offer an alternative.jerry
July 28, 2020
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Mac, How many elderly were killed due to callous Governors sending sick people to nursing homes? The point being is that 150,000 would be many thousands fewer if not for them.ET
July 28, 2020
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Still more burial of inconvenient issues. Okay, again -- underscoring just how much there is refusal to recognise and address inconvenient factors: https://www.newsweek.com/key-defeating-covid-19-already-exists-we-need-start-using-it-opinion-1519535 >>The Key to Defeating COVID-19 Already Exists. We Need to Start Using It | Opinion Harvey A. Risch, MD, PhD , Professor of Epidemiology, Yale School of Public Health On 7/23/20 at 7:00 AM EDT As professor of epidemiology at Yale School of Public Health, I have authored over 300 peer-reviewed publications and currently hold senior positions on the editorial boards of several leading journals. I am usually accustomed to advocating for positions within the mainstream of medicine, so have been flummoxed to find that, in the midst of a crisis, I am fighting for a treatment that the data fully support but which, for reasons having nothing to do with a correct understanding of the science, has been pushed to the sidelines. As a result, tens of thousands of patients with COVID-19 are dying unnecessarily. Fortunately, the situation can be reversed easily and quickly. I am referring, of course, to the medication hydroxychloroquine. When this inexpensive oral medication is given very early in the course of illness, before the virus has had time to multiply beyond control, it has shown to be highly effective, especially when given in combination with the antibiotics azithromycin or doxycycline and the nutritional supplement zinc. On May 27, I published an article in the American Journal of Epidemiology (AJE) entitled, “Early Outpatient Treatment of Symptomatic, High-Risk COVID-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis.” That article, published in the world’s leading epidemiology journal, analyzed five studies, demonstrating clear-cut and significant benefits to treated patients, plus other very large studies that showed the medication safety. Physicians who have been using these medications in the face of widespread skepticism have been truly heroic. They have done what the science shows is best for their patients, often at great personal risk. I myself know of two doctors who have saved the lives of hundreds of patients with these medications, but are now fighting state medical boards to save their licenses and reputations. The cases against them are completely without scientific merit. Since publication of my May 27 article, seven more studies have demonstrated similar benefit. In a lengthy follow-up letter, also published by AJE, I discuss these seven studies and renew my call for the immediate early use of hydroxychloroquine in high-risk patients. These seven studies include: an additional 400 high-risk patients treated by Dr. Vladimir Zelenko, with zero deaths; four studies totaling almost 500 high-risk patients treated in nursing homes and clinics across the U.S., with no deaths; a controlled trial of more than 700 high-risk patients in Brazil, with significantly reduced risk of hospitalization and two deaths among 334 patients treated with hydroxychloroquine; and another study of 398 matched patients in France, also with significantly reduced hospitalization risk. Since my letter was published, even more doctors have reported to me their completely successful use . . . . Beyond these studies of individual patients, we have seen what happens in large populations when these drugs are used. These have been “natural experiments.” In the northern Brazil state of Pará, COVID-19 deaths were increasing exponentially. On April 6, the public hospital network purchased 75,000 doses of azithromycin and 90,000 doses of hydroxychloroquine. Over the next few weeks, authorities began distributing these medications to infected individuals. Even though new cases continued to occur, on May 22 the death rate started to plummet and is now about one-eighth what it was at the peak. A reverse natural experiment happened in Switzerland. On May 27, the Swiss national government banned outpatient use of hydroxychloroquine for COVID-19. Around June 10, COVID-19 deaths increased four-fold and remained elevated. On June 11, the Swiss government revoked the ban, and on June 23 the death rate reverted to what it had been beforehand. People who die from COVID-19 live about three to five weeks from the start of symptoms, which makes the evidence of a causal relation in these experiments strong. Both episodes suggest that a combination of hydroxychloroquine and its companion medications reduces mortality and should be immediately adopted as the new standard of care in high-risk patients .>> What is being drowned out. And, again: >>Why has hydroxychloroquine been disregarded? First, as all know, the medication has become highly politicized. For many, it is viewed as a marker of political identity, on both sides of the political spectrum. Nobody needs me to remind them that this is not how medicine should proceed. We must judge this medication strictly on the science. When doctors graduate from medical school, they formally promise to make the health and life of the patient their first consideration, without biases of race, religion, nationality, social standing—or political affiliation. Lives must come first. Second, the drug has not been used properly in many studies. Hydroxychloroquine has shown major success when used early in high-risk people but, as one would expect for an antiviral, much less success when used late in the disease course. Even so, it has demonstrated significant benefit in large hospital studies in Michigan and New York City when started within the first 24 to 48 hours after admission. In fact, as inexpensive, oral and widely available medications, and a nutritional supplement, the combination of hydroxychloroquine, azithromycin or doxycycline, and zinc are well-suited for early treatment in the outpatient setting. The combination should be prescribed in high-risk patients immediately upon clinical suspicion of COVID-19 disease, without waiting for results of testing. Delays in waiting before starting the medications can reduce their efficacy. Third, concerns have been raised by the FDA and others about risks of cardiac arrhythmia, especially when hydroxychloroquine is given in combination with azithromycin. The FDA based its comments on data in its FDA Adverse Event Reporting System. This reporting system captured up to a thousand cases of arrhythmias attributed to hydroxychloroquine use. In fact, the number is likely higher than that, since the reporting system, which requires physicians or patients to initiate contact with the FDA, appreciably undercounts drug side effects. But what the FDA did not announce is that these adverse events were generated from tens of millions of patient uses of hydroxychloroquine for long periods of time, often for the chronic treatment of lupus or rheumatoid arthritis. Even if the true rates of arrhythmia are ten-fold higher than those reported, the harms would be minuscule compared to the mortality occurring right now in inadequately treated high-risk COVID-19 patients. This fact is proven by an Oxford University study of more than 320,000 older patients taking both hydroxychloroquine and azithromycin, who had arrhythmia excess death rates of less than 9/100,000 users, as I discuss in my May 27 paper cited above. A new paper in the American Journal of Medicine by established cardiologists around the world fully agrees with this. In the future, I believe this misbegotten episode regarding hydroxychloroquine will be studied by sociologists of medicine as a classic example of how extra-scientific factors overrode clear-cut medical evidence. But for now, reality demands a clear, scientific eye on the evidence and where it points . . . >> I think there are a few questions to be asked and answered. The May 27, 2020 paper: >> Am J Epidemiol . 2020 May 27;kwaa093. doi: 10.1093/aje/kwaa093. Online ahead of print. Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis Harvey A Risch 1 Affiliations PMID: 32458969 DOI: 10.1093/aje/kwaa093 Abstract More than 1.6 million Americans have been infected with SARS-CoV-2 and GT 10 times that number carry antibodies to it. High-risk patients presenting with progressing symptomatic disease have only hospitalization treatment with its high mortality. An outpatient treatment that prevents hospitalization is desperately needed. Two candidate medications have been widely discussed: remdesivir, and hydroxychloroquine+azithromycin. Remdesivir has shown mild effectiveness in hospitalized inpatients, but no trials have been registered in outpatients. Hydroxychloroquine+azithromycin has been widely misrepresented in both clinical reports and public media, and outpatient trials results are not expected until September. Early outpatient illness is very different than later hospitalized florid disease and the treatments differ. Evidence about use of hydroxychloroquine alone, or of hydroxychloroquine+azithromycin in inpatients, is irrelevant concerning efficacy of the pair in early high-risk outpatient disease. Five studies, including two controlled clinical trials, have demonstrated significant major outpatient treatment efficacy. Hydroxychloroquine+azithromycin has been used as standard-of-care in more than 300,000 older adults with multicomorbidities, with estimated proportion diagnosed with cardiac arrhythmias attributable to the medications 47/100,000 users, of which estimated mortality is LT 20%, 9/100,000 users, compared to the 10,000 Americans now dying each week. These medications need to be widely available and promoted immediately for physicians to prescribe. >> It is time to face responsibility for needless politicisation and polarisation of discussion over a manifestly effective treatment and needless deaths by at least tens of thousands. There will be a day of reckoning over such culpable irresponsibility. KFkairosfocus
July 28, 2020
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Another sad milestone. 150,000 COVID-19 deaths. Might I suggest that everyone keep the family and friends of the victims in your thoughts and prayers during these trying times.Mac McTavish
July 27, 2020
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Why is there still no word on the patients' pH level when HCQ was being considered as a treatment? rhampton:
The Pakistani RCT showed a 67% recovery rate without any medication, 75% with HCQ. So it’s statistically more likely that Bolsonaro fought off the virus then did the HCQ.
Blood type plays a big role. As does the patients' pH level. You know, with scientifically meaningful comparisons on the line, those should have been recorded. It could very well be the some people have a diet that has an effect on their pH level. That would be good to know. The vitamin D levels also seem to have a huge impact on who lives or dies. Scientifically meaningful comparisons should include all of thatET
July 27, 2020
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Recently, some research publications have suggested that COVID-19 can affect an infected person's hearing. They said that even asymptomatic patients could have problems in hearing. In the American Journal Otolaryngology by M.W.M. Mustafa of the Qena Faculty of Medicine at South Valley University in Egypt provided a more detailed link between the viral infection and hearing problems. In a hearing test Mustafa conducted on 20 asymptomatic patients aged 20 to 50 years old, all participants performed worse than normal on some parts of the tests. They performed badly on tests of transient evoked otoacoustic emissions (TEOAE) amplitudes and the high-frequency pure-tone thresholds. Another letter in Acta Otolaryngologica Italica described a case series of six patients aged 22 to 40 years old who had the typical symptoms of COVID-19: fever, cough, and shortness of breath. The participants also reported symptoms of hearing problems on one side, and four of them said they could hear ringing in their ears. But just because someone tested positive of COVID-19 and reported hearing problems, it does not mean that the former caused the latter. The letter published in the International Journal of Immunopathology and Pharmacology entitled "Don't forget ototoxicity during the SARS-CoV-2 (COVID-19) pandemic!" warns health experts that several medications used in treating the patients can have ototoxicity. https://www.sciencetimes.com/articles/26620/20200727/covid-19-loss-hearing-asymptomatic-patients.htmrhampton7
July 27, 2020
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Dr. Steven Nissen, chief academic officer for the Cleveland Clinic Heart, Vascular and Thoracic Institute, calls the pursuit of hydroxychloroquine as a treatment strategy “sheer madness” and tells Yahoo Life that “there has never been any good solid scientific evidence that it does work.” In addition, Dr. Dean Winslow, an infectious disease physician at Stanford Health Care, tells Yahoo Life that he was “very concerned” about the drug combination used in the study, which can cause heart rhythm changes. “Both macrolide antibiotics [like azithromycin] and antimalarial drugs [like hydroxychloroquine] have the potential of prolonging the QT interval [the time between the heart muscle contracting and relaxing] in EKGs and can cause fatal arrhythmias and increased mortality,” he explains. Adds Winslow: “This is further evidence that this is not a winning strategy. I think we’ve studied it enough.” Nissen agrees, saying: “It’s time to stop pursuing this. It’s time to move on and study something that has a chance to help people.” https://www.yahoo.com/lifestyle/new-study-shows-limitations-risks-hydroxychloroquine-for-treating-covid-19-204819038.htmlrhampton7
July 27, 2020
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More than three-quarters of recently recovered COVID-19 patients had heart muscle problems show up during magnetic resonance imaging (MRI) tests, German doctors reported on Monday in JAMA Cardiology. In some patients, the heart may be “in serious trouble as a part of COVID-19 disease,” Dr. Valentina Puntmann of University Hospital Frankfurt told Reuters. Among 100 patients ages 45 to 53, “a considerable majority” — 78 — had inflammation in the heart muscle and lining. Sixty-seven had recovered at home while 33 had required hospitalization. Half of the former patients were more than two months out since their diagnosis at the time of the MRI. https://www.stltoday.com/lifestyles/health-med-fit/health/new-heart-problems-seen-in-recovered-covid-19-patients/article_30ed9771-6c6d-59bf-a59e-a6b0093b4b82.htmlrhampton7
July 27, 2020
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ET, The Pakistani RCT showed a 67% recovery rate without any medication, 75% with HCQ. So it’s statistically more likely that Bolsonaro fought off the virus then did the HCQ. That’s the importance of RCTs — scientifically meaningful comparisons. It’s also why Israeli hospitals don’t consider HCQ to be a particularly effective treatment.rhampton7
July 27, 2020
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Obviously something else saved the Brazilian President. :roll:ET
July 27, 2020
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Just for fun: https://videos.whatfinger.com/2020/07/26/brazilian-president-bolsonaro-tests-negative-for-covid-19-thanks-hydroxy-which-can-save-hundreds-of-thousands-right-now/ Brazilian President Bolsonaro Tests Negative for COVID-19. Thanks Hydroxy which can save hundreds of thousands right nowkairosfocus
July 27, 2020
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RH7, more drowning out. In answer, Risch of Yale on Covid19: https://www.newsweek.com/key-defeating-covid-19-already-exists-we-need-start-using-it-opinion-1519535 >>The Key to Defeating COVID-19 Already Exists. We Need to Start Using It | Opinion Harvey A. Risch, MD, PhD , Professor of Epidemiology, Yale School of Public Health On 7/23/20 at 7:00 AM EDT As professor of epidemiology at Yale School of Public Health, I have authored over 300 peer-reviewed publications and currently hold senior positions on the editorial boards of several leading journals. I am usually accustomed to advocating for positions within the mainstream of medicine, so have been flummoxed to find that, in the midst of a crisis, I am fighting for a treatment that the data fully support but which, for reasons having nothing to do with a correct understanding of the science, has been pushed to the sidelines. As a result, tens of thousands of patients with COVID-19 are dying unnecessarily. Fortunately, the situation can be reversed easily and quickly. I am referring, of course, to the medication hydroxychloroquine. When this inexpensive oral medication is given very early in the course of illness, before the virus has had time to multiply beyond control, it has shown to be highly effective, especially when given in combination with the antibiotics azithromycin or doxycycline and the nutritional supplement zinc. On May 27, I published an article in the American Journal of Epidemiology (AJE) entitled, “Early Outpatient Treatment of Symptomatic, High-Risk COVID-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis.” That article, published in the world’s leading epidemiology journal, analyzed five studies, demonstrating clear-cut and significant benefits to treated patients, plus other very large studies that showed the medication safety. Physicians who have been using these medications in the face of widespread skepticism have been truly heroic. They have done what the science shows is best for their patients, often at great personal risk. I myself know of two doctors who have saved the lives of hundreds of patients with these medications, but are now fighting state medical boards to save their licenses and reputations. The cases against them are completely without scientific merit. Since publication of my May 27 article, seven more studies have demonstrated similar benefit. In a lengthy follow-up letter, also published by AJE, I discuss these seven studies and renew my call for the immediate early use of hydroxychloroquine in high-risk patients. These seven studies include: an additional 400 high-risk patients treated by Dr. Vladimir Zelenko, with zero deaths; four studies totaling almost 500 high-risk patients treated in nursing homes and clinics across the U.S., with no deaths; a controlled trial of more than 700 high-risk patients in Brazil, with significantly reduced risk of hospitalization and two deaths among 334 patients treated with hydroxychloroquine; and another study of 398 matched patients in France, also with significantly reduced hospitalization risk. Since my letter was published, even more doctors have reported to me their completely successful use . . . . Beyond these studies of individual patients, we have seen what happens in large populations when these drugs are used. These have been “natural experiments.” In the northern Brazil state of Pará, COVID-19 deaths were increasing exponentially. On April 6, the public hospital network purchased 75,000 doses of azithromycin and 90,000 doses of hydroxychloroquine. Over the next few weeks, authorities began distributing these medications to infected individuals. Even though new cases continued to occur, on May 22 the death rate started to plummet and is now about one-eighth what it was at the peak. A reverse natural experiment happened in Switzerland. On May 27, the Swiss national government banned outpatient use of hydroxychloroquine for COVID-19. Around June 10, COVID-19 deaths increased four-fold and remained elevated. On June 11, the Swiss government revoked the ban, and on June 23 the death rate reverted to what it had been beforehand. People who die from COVID-19 live about three to five weeks from the start of symptoms, which makes the evidence of a causal relation in these experiments strong. Both episodes suggest that a combination of hydroxychloroquine and its companion medications reduces mortality and should be immediately adopted as the new standard of care in high-risk patients .>> What is being drowned out. And, again: >>Why has hydroxychloroquine been disregarded? First, as all know, the medication has become highly politicized. For many, it is viewed as a marker of political identity, on both sides of the political spectrum. Nobody needs me to remind them that this is not how medicine should proceed. We must judge this medication strictly on the science. When doctors graduate from medical school, they formally promise to make the health and life of the patient their first consideration, without biases of race, religion, nationality, social standing—or political affiliation. Lives must come first. Second, the drug has not been used properly in many studies. Hydroxychloroquine has shown major success when used early in high-risk people but, as one would expect for an antiviral, much less success when used late in the disease course. Even so, it has demonstrated significant benefit in large hospital studies in Michigan and New York City when started within the first 24 to 48 hours after admission. In fact, as inexpensive, oral and widely available medications, and a nutritional supplement, the combination of hydroxychloroquine, azithromycin or doxycycline, and zinc are well-suited for early treatment in the outpatient setting. The combination should be prescribed in high-risk patients immediately upon clinical suspicion of COVID-19 disease, without waiting for results of testing. Delays in waiting before starting the medications can reduce their efficacy. Third, concerns have been raised by the FDA and others about risks of cardiac arrhythmia, especially when hydroxychloroquine is given in combination with azithromycin. The FDA based its comments on data in its FDA Adverse Event Reporting System. This reporting system captured up to a thousand cases of arrhythmias attributed to hydroxychloroquine use. In fact, the number is likely higher than that, since the reporting system, which requires physicians or patients to initiate contact with the FDA, appreciably undercounts drug side effects. But what the FDA did not announce is that these adverse events were generated from tens of millions of patient uses of hydroxychloroquine for long periods of time, often for the chronic treatment of lupus or rheumatoid arthritis. Even if the true rates of arrhythmia are ten-fold higher than those reported, the harms would be minuscule compared to the mortality occurring right now in inadequately treated high-risk COVID-19 patients. This fact is proven by an Oxford University study of more than 320,000 older patients taking both hydroxychloroquine and azithromycin, who had arrhythmia excess death rates of less than 9/100,000 users, as I discuss in my May 27 paper cited above. A new paper in the American Journal of Medicine by established cardiologists around the world fully agrees with this. In the future, I believe this misbegotten episode regarding hydroxychloroquine will be studied by sociologists of medicine as a classic example of how extra-scientific factors overrode clear-cut medical evidence. But for now, reality demands a clear, scientific eye on the evidence and where it points . . . >> I think there are a few questions to be asked and answered. The May 27, 2020 paper: >> Am J Epidemiol . 2020 May 27;kwaa093. doi: 10.1093/aje/kwaa093. Online ahead of print. Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis Harvey A Risch 1 Affiliations PMID: 32458969 DOI: 10.1093/aje/kwaa093 Abstract More than 1.6 million Americans have been infected with SARS-CoV-2 and GT 10 times that number carry antibodies to it. High-risk patients presenting with progressing symptomatic disease have only hospitalization treatment with its high mortality. An outpatient treatment that prevents hospitalization is desperately needed. Two candidate medications have been widely discussed: remdesivir, and hydroxychloroquine+azithromycin. Remdesivir has shown mild effectiveness in hospitalized inpatients, but no trials have been registered in outpatients. Hydroxychloroquine+azithromycin has been widely misrepresented in both clinical reports and public media, and outpatient trials results are not expected until September. Early outpatient illness is very different than later hospitalized florid disease and the treatments differ. Evidence about use of hydroxychloroquine alone, or of hydroxychloroquine+azithromycin in inpatients, is irrelevant concerning efficacy of the pair in early high-risk outpatient disease. Five studies, including two controlled clinical trials, have demonstrated significant major outpatient treatment efficacy. Hydroxychloroquine+azithromycin has been used as standard-of-care in more than 300,000 older adults with multicomorbidities, with estimated proportion diagnosed with cardiac arrhythmias attributable to the medications 47/100,000 users, of which estimated mortality is LT 20%, 9/100,000 users, compared to the 10,000 Americans now dying each week. These medications need to be widely available and promoted immediately for physicians to prescribe. >> It is time to face responsibility for needless politicisation and polarisation of discussion over a manifestly effective treatment and needless deaths by at least tens of thousands. There will be a day of reckoning over such culpable irresponsibility. KFkairosfocus
July 27, 2020
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Inconvenient for you that Israel does not consider HCQ to be an effective treatment.rhampton7
July 26, 2020
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@rhampton I just ordered a pulse oximeter. You can get an FDA approved one for about 35 bucks. There are lots of people who don’t know they have this disease but it turns out their oxygen saturation is low because they have hidden lung damage. Hoping when it arrives Tuesday my O2 sat is normal—95-100%. Back in the day, hell, we used to smoke in the lab. I’d take a drag on a camel, and then spin-coat some polymethylmethacrylate/polystyrene blends onto SiOx wafers before annealing them on a heated stage under a microscope. Smokin’ the whole time. Probably got some lung damage from that, but my O2 sat should still be pretty good. (You haven’t lived until you’ve gone to SLAC and characterized thin films using synchrotron radiation. Well, at least if you’re a Solid State geek)Retired Physicist
July 26, 2020
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Still trying to bury the inconvenient facts?kairosfocus
July 26, 2020
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Ivermectin, a drug used to treat parasitic infections in people and animals, is being tested at Israel’s Sheba Medical Center to see if it reduces symptoms and duration of Covid-19 infection. Dr. Eli Schwartz, founder of Sheba’s Center for Geographic Medicine and Tropical Disease, is one of the first researchers to do a randomized, double-blind, placebo-controlled trial of ivermectin on Covid-19 patients. “There is no single good study about any efficacious drug for corona treatment yet,” Schwartz says. He notes that many countries decided to treat Covid-19 patients with hydroxychloroquine despite lack of proof of safety and efficacy. “Later on, the World Health Organization and other authorities said it might even be harmful, but that wasn’t based on scientific evidence either.” https://www.israel21c.org/israelis-testing-anti-parasite-drug-against-covid-19/rhampton7
July 26, 2020
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Scientists across the globe are working on vaccines to prevent Covid-19 infection. But in the meanwhile, and even after initial vaccines are approved, there is an urgent need for effective treatments for the respiratory disease caused by the SARS-CoV-2 coronavirus. Israeli hospitals were among the first anywhere to use dexamethasone, a steroid drug, to stop cytokines storms and reduce lung inflammation in severely ill Covid-19 patients. However, steroids can suppress the immune response too strongly. Additionally, an Israeli hospital is among the first to do a randomized, double-blind, placebo-controlled clinical trial of ivermectin, a drug to treat parasitic infections in people and animals, to see if it can shorten the duration of the disease if given to Covid-19 patients immediately after diagnosis. Israelis are also formulating novel therapeutics of their own. Follow the link to read a summary of 13 potential Israeli treatments using a variety of approaches – such as placenta-derived cells, peptides, blood plasma of recovered patients, and the cannabis compound CBD. https://www.israel21c.org/13-promising-covid-treatments-emerging-from-israel/rhampton7
July 26, 2020
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A Cluster-Randomized Trial of Hydroxychloroquine as Prevention of Covid-19 Transmission and Disease We conducted an open-label, cluster-randomized trial including asymptomatic contacts exposed to a PCR-positive Covid-19 case in Catalonia, Spain. Clusters were randomized to receive no specific therapy (control arm) or HCQ 800mg once, followed by 400mg daily for 6 days (intervention arm). The primary outcome was PCR-confirmed symptomatic Covid-19 within 14 days. The secondary outcome was SARS-CoV-2 infection, either symptomatically compatible or a PCR-positive result regardless of symptoms. Adverse events (AEs) were assessed up to 28 days. Results The analysis included 2,314 healthy contacts of 672 Covid-19 index cases identified between Mar 17 and Apr 28, 2020. A total of 1,198 were randomly allocated to usual care and 1,116 to HCQ therapy. There was no significant difference in the primary outcome of PCR-confirmed, symptomatic Covid-19 disease (6.2% usual care vs. 5.7% HCQ; risk ratio 0.89 [95% confidence interval 0.54-1.46]), nor evidence of beneficial effects on prevention of SARS-CoV-2 transmission (17.8% usual care vs. 18.7% HCQ). The incidence of AEs was higher in the intervention arm than in the control arm (5.9% usual care vs 51.6% HCQ), but no treatment-related serious AEs were reported. Conclusions Postexposure therapy with HCQ did not prevent SARS-CoV-2 disease and infection in healthy individuals exposed to a PCR-positive case. Our findings do not support HCQ as postexposure prophylaxis for Covid-19. https://www.medrxiv.org/content/10.1101/2020.07.20.20157651v1rhampton7
July 26, 2020
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professors at the University of Rennes 1 and hospital practitioners at the Rennes University Hospital Matthieu Revest “On hydroxychloroquine, I think it's an absolute disaster. On the one hand, Professor Raoult should not have communicated in the mainstream press before having published all the evaluation elements in the scientific press, which he never did with a sufficient level of proof.” “ Thus today, there is no solid data that validates the interest of treatment with hydroxychloroquine, whether it is to reduce deaths or intubations, for patients on oxygen or suffering from mild to moderate forms, or to prevent the appearance of symptoms following contamination. There is therefore an international scientific consensus which affirms the ineffectiveness of hydroxychloroquine in the fight against Covid-19. It was certainly a good idea to evaluate this treatment initially, but it should be done according to the standards used for this type of evaluation.” Vincent Thibault. “I do not understand how a person can waste so much energy, moreover in such a serious situation, from an unproven claim. If hydroxychloroquine had been effective, this demonstration could have been gained really very quickly, with a trial limited to the peak of the epidemic.” “ There has been a drift of politics, the media, and also social networks grappling with conspiracy theses. It's worrying. The idea that hydroxychloroquine was the right treatment skyrocketed without a solid study to back it up, and those who challenged it faced backlash.” https://www.ouest-france.fr/europe/france/coronavirus-aucune-donnee-solide-n-a-valide-l-hydroxychloroquine-6917357rhampton7
July 26, 2020
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PPS: Risch:
Am J Epidemiol . 2020 May 27;kwaa093. doi: 10.1093/aje/kwaa093. Online ahead of print. Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis Harvey A Risch 1 Affiliations PMID: 32458969 DOI: 10.1093/aje/kwaa093 Abstract More than 1.6 million Americans have been infected with SARS-CoV-2 and GT 10 times that number carry antibodies to it. High-risk patients presenting with progressing symptomatic disease have only hospitalization treatment with its high mortality. An outpatient treatment that prevents hospitalization is desperately needed. Two candidate medications have been widely discussed: remdesivir, and hydroxychloroquine+azithromycin. Remdesivir has shown mild effectiveness in hospitalized inpatients, but no trials have been registered in outpatients. Hydroxychloroquine+azithromycin has been widely misrepresented in both clinical reports and public media, and outpatient trials results are not expected until September. Early outpatient illness is very different than later hospitalized florid disease and the treatments differ. Evidence about use of hydroxychloroquine alone, or of hydroxychloroquine+azithromycin in inpatients, is irrelevant concerning efficacy of the pair in early high-risk outpatient disease. Five studies, including two controlled clinical trials, have demonstrated significant major outpatient treatment efficacy. Hydroxychloroquine+azithromycin has been used as standard-of-care in more than 300,000 older adults with multicomorbidities, with estimated proportion diagnosed with cardiac arrhythmias attributable to the medications 47/100,000 users, of which estimated mortality is LT 20%, 9/100,000 users, compared to the 10,000 Americans now dying each week. These medications need to be widely available and promoted immediately for physicians to prescribe.
kairosfocus
July 26, 2020
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PS: I suspect I need to note those were the statistics as at April 23 or thereabouts. So, they are face value accurate. C jun 11, his demographics were given again and rate climbed to 0.9% overall. He further summarises:
Treatment with HCQ-AZ was associated with a decreased risk of transfer to the ICU or death (HR 0.19 0.12-0.29), decreased risk of hospitalization ?10 days (odds ratios 95% CI 0.37 0.26-0.51) and shorter duration of viral shedding (time to negative PCR: HR 1.27 1.16-1.39). QTc prolongation (>60 ms) was observed in 25 patients (0.67%) leading to the cessation of treatment in 3 cases. No cases of torsade de pointe or sudden death were observed.
These results are compatible with the point made by the Yale prof.kairosfocus
July 26, 2020
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RH7, scroll just up and kindly note, starting with the Yale prof of epidemiology in 88 above. When you come to grips with that there will be reason to further discuss. Beyond that we have seen far too much of snipping, sniping and spamming based on misframing the issue. And BTW, the tabulation of results as things wound down is in the Raoult Roars OP, look for yourself. You have been corrected any number of times on misframed studies and the ethics-epistemology challenges of giving people deliberately mislabelled sugar pills or the like. Notice, too, the sobering lesson of the Tuskegee syphilis/bad blood study that needs yet to be fully absorbed. The gold standard fallacy has destructive consequences. KFkairosfocus
July 26, 2020
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How is the study, “ Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19” spamming without evidence?rhampton7
July 25, 2020
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KF, On April 23rd you presented this claim as the truth: “(Raoult) His growing results show a steady pattern of a contrast of some 0.5% or less fatality rate contrasting to about 5% otherwise, i.e. we see the sort of 90% reduction highlighted by Dr Zelenko.“ Do you still stand by those remarkable recovery rate numbers given that current RCTs suggest something much more modest? Was this hype or carelessness or sloppiness on the part of Raoult, Zelenko?rhampton7
July 25, 2020
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RH7, it is clear you are spamming, not interacting with adequate evidence. KFkairosfocus
July 25, 2020
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The new study was carried out by scientists in Germany who tested HCQ on a collection of different cell types. They found that it does not inhibit the virus in human lung cells – the primary site of infection for the SARS-CoV-2 virus. Their findings clearly show that that HQC can block the coronavirus from infecting kidney cells from the African green monkey. But it does not inhibit the virus in human lung cells – the primary site of infection for the SARS-CoV-2 virus. In order for the virus to enter a cell, it can do so by two mechanisms - one, when the SARS-CoV-2 spike protein attaches to the ACE2 receptor and inserts its genetic material into the cell. In the second mechanism, the virus is absorbed into some special compartments in cells called endosomes. Depending on the cell type, some, like kidney cells, need an enzyme called cathepsin L for the virus to successfully infect them. In lung cells, however, an enzyme called TMPRSS2 (on the cell surface) is necessary. Cathepsin L requires an acidic environment to function and allow the virus to infect the cell, while TMPRSS2 does not. In the green monkey kidney cells, both hydroxychloroquine and chloroquine decrease the acidity, which then disables the cathepsin L enzyme, blocking the virus from infecting the monkey cells. In human lung cells, which have very low levels of cathepsin L enzyme, the virus uses the enzyme TMPRSS2 to enter the cell. But because that enzyme is not controlled by acidity, neither HCQ and CQ can block the SARS-CoV-2 from infecting the lungs or stop the virus from replicating. https://nationalinterest.org/blog/reboot/study-suggests-hydroxychloroquine-doesnt-protect-lung-cells-coronavirus-165523rhampton7
July 25, 2020
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Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19 We conducted a multicenter, randomized, open-label, three-group, controlled trial involving hospitalized patients with suspected or confirmed Covid-19 who were receiving either no supplemental oxygen or a maximum of 4 liters per minute of supplemental oxygen. Patients were randomly assigned in a 1:1:1 ratio to receive standard care, standard care plus hydroxychloroquine at a dose of 400 mg twice daily, or standard care plus hydroxychloroquine at a dose of 400 mg twice daily plus azithromycin at a dose of 500 mg once daily for 7 days. The primary outcome was clinical status at 15 days as assessed with the use of a seven-level ordinal scale (with levels ranging from one to seven and higher scores indicating a worse condition) in the modified intention-to-treat population (patients with a confirmed diagnosis of Covid-19). Safety was also assessed. A total of 667 patients underwent randomization; 504 patients had confirmed Covid-19 and were included in the modified intention-to-treat analysis. As compared with standard care, the proportional odds of having a higher score on the seven-point ordinal scale at 15 days was not affected by either hydroxychloroquine alone (odds ratio, 1.21; 95% confidence interval [CI], 0.69 to 2.11; P=1.00) or hydroxychloroquine plus azithromycin (odds ratio, 0.99; 95% CI, 0.57 to 1.73; P=1.00). Prolongation of the corrected QT interval and elevation of liver-enzyme levels were more frequent in patients receiving hydroxychloroquine, alone or with azithromycin, than in those who were not receiving either agent. CONCLUSIONS Among patients hospitalized with mild-to-moderate Covid-19, the use of hydroxychloroquine, alone or with azithromycin, did not improve clinical status at 15 days as compared with standard care. (Funded by the Coalition Covid-19 Brazil and EMS Pharma; ClinicalTrials.gov number, NCT04322123. opens in new tab.) https://www.nejm.org/doi/full/10.1056/NEJMoa2019014rhampton7
July 25, 2020
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NB: On U/L trajectory, I suggest, fairly fast descent to a crisis; of course, early successful intervention may stop the descent and lead to early recovery from higher on the descending arm. If failed, flatline. The L modifies the simpler U I used before, to explicitly show this. Recovery on the ascending arm takes longer. Given evidence of significant, early lung damage, recovery may not restore former vitality. Other damage later in the course of this destructive disease may worsen that. That means, long term debilitation and vulnerability may be an onward result. KFkairosfocus
July 23, 2020
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