Coronavirus

[Rockfords Fosgate]

Julian the biggest issue I have with the henry ford study is that the HCQ arm also got lots of steroids. Which we now already know helps. So it is a big confounding factor in that study.

Yes that definitely muddies the water. It seems every study has some sort of fatal flaw associated with it, which is why I think we are forced to look at things based on the entirety of the body of work. I see several that did not include steroids in the link above, but they were not double-blind/placebo, etc.

Study 1
Prevalence and clinical correlates of COVID-19 outbreak among healthcare workers in a tertiary level hospital. (NO STEROIDS)
"Findings of present study found some protective role of full course prophylactic hydroxychloroquine as compared to a control group (p=0.021) and use of N95 masks over others (p<0.001). Our results did not show any added protection with the use of prophylactic Vitamin C, D, Zinc, or betadine gargles."

Study #2
Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis (NO STEROIDS)
"Although this is a retrospective analysis, results suggest that early diagnosis, early isolation and early treatment of COVID-19 patients, with at least 3 days of HCQ-AZ lead to a significantly better clinical outcome and a faster viral load reduction than other treatments."

 

[Julian]

Here is a HCQ study tracking site. link

1. Broken down by: Pre / Post / Early / Late / All
2. 40 of 60 were peer reviewed

After a quick look at all those references its the same sort of stuff....patients who were taking HCQ died at a lower rate. SOUNDS amazing....but if those docs were being good doctors, they weren't giving HCQ to high risk patients.....that blows the anecdotal story out of the water. It is EXACTLY the same point Dr Risch should be making....OF COURSE when you give HCQ to low risk patients they will die less.

 

[Rockfords Fosgate]

After a quick look at all those references its the same sort of stuff....patients who were taking HCQ died at a lower rate. SOUNDS amazing....but if those docs were being good doctors, they weren't giving HCQ to high risk patients.....that blows the anecdotal story out of the water. It is EXACTLY the same point Dr Risch should be making....OF COURSE when you give HCQ to low risk patients they will die less.

Wait, are you really going to dismiss all 60 of those studies out of hand like that?

 

[Julian]

Wait, are you really going to dismiss all 60 of those studies out of hand like that?

When you look at the studies the vast majority of them are very low count - not statisicially meaningful, or not randomized- and they admit its only corollary data - that requires randomized studies as follow on (stated in the papers themselves).

To quote the Madrid Study:

"Randomized, controlled trials of these medications in patients with COVID-19 are needed to avoid heavy administration of treatments with no strong evidence to support them."​

​

Not dismissing them, but they are of minor scientific value. They point to the need to do random studies...which have since been DONE and yielded no conclusive help from HCQ. Hopefully more random studies can prove otherwise....but if I were funding studies I'd put my money into something with more promise.

Julian the biggest issue I have with the henry ford study is that the HCQ arm also got lots of steroids. Which we now already know helps. So it is a big confounding factor in that study.

Didn't read that....but that makes sense. Have you read of ANY random double blind studies that have shown HCQ to be helpful? That was the only one I could find.

 

[Rockfords Fosgate]

When you look at the studies the vast majority of them are very low count - not statisicially meaningful, or not randomized- and they admit its only corollary data - that requires randomized studies as follow on (stated in the papers themselves).

To quote the Madrid Study:

"Randomized, controlled trials of these medications in patients with COVID-19 are needed to avoid heavy administration of treatments with no strong evidence to support them."​

​

Not dismissing them, but they are of minor scientific value. They point to the need to do random studies...which have since been DONE and yielded no conclusive help from HCQ. Hopefully more random studies can prove otherwise....but if I were funding studies I'd put my money into something with more promise.

Maybe that is a secondary point he is making. As a physician in the middle of a pandemic, do you wait for a perfect study to be concluded with all the credentialed support behind it, or do you use all available tools and peer group to complement your medical training and expertise? This is the same conversation that has been held in the cancer sphere, where somewhere around 50% (don't quote me) of the scripts being prescribed were not studied and indicated for the specific reason they are being prescribed.

Before we put too much weight behind a single study, let's remember that the Lancet HCQ study was retracted after it was found out that they did not have the data to support their conclusions. Unfortunately, dogma, politics, competing interests, financial gain and all sorts of other maladies have infected the research world.

 

[BeauSko]

Study taken from the Virology Journal, official publication of the National Institute of Health, back in 2005. The study suggests that Chloroquine is an effective treatment, both prophylactic and therapeutic, against SARS-Cov. I understand it is not SARS-Cov-2 (COVID-19 is caused by SARS-Cov-2) but they are both from the coronavirus family and have many similarities.

Chloroquine is a potent inhibitor of SARS coronavirus infection and spread

Severe acute respiratory syndrome (SARS) is caused by a newly discovered coronavirus (SARS-CoV). No effective prophylactic or post-exposure therapy is currently available.We report, however, that chloroquine has strong antiviral effects on SARS-CoV infection ...

www.ncbi.nlm.nih.gov

 

[tabbibus]

When you look at the studies the vast majority of them are very low count - not statisicially meaningful, or not randomized- and they admit its only corollary data - that requires randomized studies as follow on (stated in the papers themselves).

To quote the Madrid Study:

"Randomized, controlled trials of these medications in patients with COVID-19 are needed to avoid heavy administration of treatments with no strong evidence to support them."​

​

Not dismissing them, but they are of minor scientific value. They point to the need to do random studies...which have since been DONE and yielded no conclusive help from HCQ. Hopefully more random studies can prove otherwise....but if I were funding studies I'd put my money into something with more promise.


Didn't read that....but that makes sense. Have you read of ANY random double blind studies that have shown HCQ to be helpful? That was the only one I could find.

I have not. And our own anecdotal experience in our less sick hospitalized patients support this notion. I have no idea what happens in the outpatient world.

 

[BeauSko]

Lockdowns, isolation, distancing, mask wearing and the like have a much more incredibly devastating impact on the health, sanity, economy, and livelihood of the world than many want to believe, or refuse to acknowledge.

‘The Biggest Monster’ Is Spreading. And It’s Not the Coronavirus. (Published 2020)

Tuberculosis kills 1.5 million people each year. Lockdowns and supply-chain disruptions threaten progress against the disease as well as H.I.V. and malaria.

www.nytimes.com

U.N. Warns Number Of People Starving To Death Could Double Amid Pandemic

Some 700 million of the world's most vulnerable people will require food assistance, according to the U.N. humanitarian office, which is asking wealthy nations to commit $90 billion in aid.

www.npr.org

Just a different perspective.

 

[tabbibus]

yeah man. lock downs are the worst. The impact they've had is tremendous. I "get" to leave my house every day to see patients, but the rest of my family is worn down. And we are among the fortunate ones, we are not struggling financially or mentally (at least not as bad as others in the mental area).

I wish this thing to be over. I'm so done with it.

 

[BeauSko]

yeah man. lock downs are the worst. The impact they've had is tremendous. I "get" to leave my house every day to see patients, but the rest of my family is worn down. And we are among the fortunate ones, we are not struggling financially or mentally (at least not as bad as others in the mental area).

I wish this thing to be over. I'm so done with it.

I hear ya. It take ls quite a bit to break my spirits. Sometimes I can’t help but just feel beaten down. For those who aren’t as mentally, spiritually, and physically strong are fighting an uphill battle. So frustrating.

 

[Rockfords Fosgate]

Study Update
Why are kids being spared in the COVID 19 pandemic?

This study suggests it is because children lack an abundance of the ACE2 enzyme.

**************
This new study detailed in the Journal of the American Medical Association (JAMA) on May 20, discovered that the angiotensin-converting enzyme 2 (ACE2), which grows in abundance as the individual grows, might be the reason that less than two percent of all individuals infected with SARS-CoV-2 - the virus that causes the COVID-19 disease - are children.

Researchers had suspected that COVID-19 susceptibility could be linked to the amount of gene expression of ACE2 seen in the nasal cavity, given that the enzyme acts as a receptor to allow the SARS-CoV-2 virus to pass into the body.

To investigate this potential link, researchers looked for a relationship between the two - the level of gene expression of ACE2 in the nose and COVID-19 infection - by taking nasal swabs from 305 people involved in an asthma study. Researchers hypothesized that the lower the levels of enzyme gene expression, the less likely it is a person will be infected by COVID-19.
***************

 

[seanmclean]

Study taken from the Virology Journal, official publication of the National Institute of Health, back in 2005. The study suggests that Chloroquine is an effective treatment, both prophylactic and therapeutic, against SARS-Cov. I understand it is not SARS-Cov-2 (COVID-19 is caused by SARS-Cov-2) but they are both from the coronavirus family and have many similarities.

Chloroquine is a potent inhibitor of SARS coronavirus infection and spread

Severe acute respiratory syndrome (SARS) is caused by a newly discovered coronavirus (SARS-CoV). No effective prophylactic or post-exposure therapy is currently available.We report, however, that chloroquine has strong antiviral effects on SARS-CoV infection ...

www.ncbi.nlm.nih.gov

This is an in vitro study. Randomized controlled trials in humans have shown that HCQ is ineffective, and potentially more dangerous in some patients.

 

[Rockfords Fosgate]

This is an in vitro study. Randomized controlled trials in humans have shown that HCQ is ineffective, and potentially more dangerous in some patients.

HCQ for COVID-19: real-time analysis of all 239 studies

HCQ for COVID-19: real-time analysis of all 239 studies

c19study.com

Every medicine has a risk value matrix. Countless drugs have blackbox and misuse warnings, which indicate levels of danger. Making a statement like that without context is misleading. In reality, HCQ has been prescribed hundreds of millions of times over the past 60 years. It's a WHO essential medicine...

 

[seanmclean]

Yeah, duh. Risk/Benefit analysis is an obvious step in the prescribing process, exposing patients to risk without benefit is something you don't do. There are hundreds of medicines on the essential medicine list that carry enormous risk, ones worth exposing yourself to when there is a commensurate benefit.

Nothing I stated is misleading. The potential benefit based on case study outweighed the cardiovascular risks of HCQs, and this was clearly stated in the EUA. Now that we have data from RCTs, the risk benefit analysis is no longer favorable.

 

[ripler]

yeah man. lock downs are the worst. The impact they've had is tremendous. I "get" to leave my house every day to see patients, but the rest of my family is worn down. And we are among the fortunate ones, we are not struggling financially or mentally (at least not as bad as others in the mental area).

I wish this thing to be over. I'm so done with it.

When/if this virus is under control, every healthcare worker deserves a long ass paid vacation, you guys are hereos.

 

[tabbibus]

When/if this virus is under control, every healthcare worker deserves a long ass paid vacation, you guys are hereos.

except many HCW are getting pay cuts or being laid off.

 

[Rockfords Fosgate]

Yeah, duh. Risk/Benefit analysis is an obvious step in the prescribing process, exposing patients to risk without benefit is something you don't do. There are hundreds of medicines on the essential medicine list that carry enormous risk, ones worth exposing yourself to when there is a commensurate benefit.

Nothing I stated is misleading. The potential benefit based on case study outweighed the cardiovascular risks of HCQs, and this was clearly stated in the EUA. Now that we have data from RCTs, the risk benefit analysis is no longer favorable.

That is exactly why Dr Risch said they were studying the wrong people. The EUA focused on hospitalized patients. I think everyone is in agreement now that HCQ does not work after the virus has taken hold. It's value, according to many studies, is when used prophylactically or within 72 hours of EDIT> "exposure".

 

[Rockfords Fosgate]

except many HCW are getting pay cuts or being laid off.

I can definitely see Dr/Rn from ED, Pulmonology and Infectious Disease taking early retirements or some sort of sabbatical. Not sure how they can continue at this pace, on top of what was already a stressful job.

The pause on elective surgeries and healthcare is definitely causing cuts all over the place. I'm not sure anyone has a good answer on what to do there.

 

[BeauSko]

This is an in vitro study. Randomized controlled trials in humans have shown that HCQ is ineffective, and potentially more dangerous in some patients.

In vitro studies still provide value. And there are studies that show prophylaxis and EARLY HCQ administration are effective.

 

[Rockfords Fosgate]

In vitro studies still provide value. And there are studies that show prophylaxis and EARLY HCQ administration are effective.

Correctamundo. The purpose of HCQ here is to prevent the cytokine storm. Cytokine storms are what is damaging the heart and lung. If you take HCQ after the cytokine storm has happened, it will be of little to no benefit...and as noted above does carry some risk.