Coronavirus

[Rockfords Fosgate]

Sharp guy. Wait until he gets banned for wrongthink.

 

[Julian]

I just read the Belgian study. Here is the conclusion published in it:

Whether antimalarial drugs could be effective in changing the disease course in patients with severe COVID-19—in particular, in cases requiring ICU admission—remains unknown. Moreover, for patients receiving antimalarial drugs who then require ICU admission, it is not known whether the drug should be continued or considered clinically ineffective and stopped. Assessing viral load, either on a nasopharyngeal swab or in bronchoalveolar lavage fluid, might be of use in understanding whether targeting viral replication, rather than other injurious lung pathways, is a reasonable therapeutic strategy. Future studies should aim to clarify the precise role, if any, of chloroquine and hydroxychloroquine in critically ill patients with COVID-19. We declare no competing interests. Fabio S Taccone, Julie Gorham, *Jean-Louis Vincent jlvincent@intensive.org Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium 1 Yang X, Yu Y, Xu J, et al.

I fail to understand how anyone who reads the whole study could come away with anything other than "HCQ was ineffective ". Makes me seriously question the intent of anyone referencing it to support its use.

 

[GTBRMC]

I just read the Belgian study. Here is the conclusion published in it:

Whether antimalarial drugs could be effective in changing the disease course in patients with severe COVID-19—in particular, in cases requiring ICU admission—remains unknown. Moreover, for patients receiving antimalarial drugs who then require ICU admission, it is not known whether the drug should be continued or considered clinically ineffective and stopped. Assessing viral load, either on a nasopharyngeal swab or in bronchoalveolar lavage fluid, might be of use in understanding whether targeting viral replication, rather than other injurious lung pathways, is a reasonable therapeutic strategy. Future studies should aim to clarify the precise role, if any, of chloroquine and hydroxychloroquine in critically ill patients with COVID-19. We declare no competing interests. Fabio S Taccone, Julie Gorham, *Jean-Louis Vincent jlvincent@intensive.org Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium 1 Yang X, Yu Y, Xu J, et al.

I fail to understand how anyone who reads the whole study could come away with anything other than "HCQ was ineffective ". Makes me seriously question the intent of anyone referencing it to support its use.

I'd challenge you to watch any 10 of John Campbell's COVID-19 videos and see if you still question his intent. Up until this video, he was clearly of the mindset HCQ treatment for COVID was not only ineffective but also likely harmful. This change of opinion is what caught my attention.

Me, personally, I have no interest in any particular approach to solvimg the COVID-19 crisis - but I want to see it solved as quickly, cleanly, and economically as possible.

 

[Enduro900]

I just read the Belgian study. Here is the conclusion published in it:

Whether antimalarial drugs could be effective in changing the disease course in patients with severe COVID-19—in particular, in cases requiring ICU admission—remains unknown. Moreover, for patients receiving antimalarial drugs who then require ICU admission, it is not known whether the drug should be continued or considered clinically ineffective and stopped. Assessing viral load, either on a nasopharyngeal swab or in bronchoalveolar lavage fluid, might be of use in understanding whether targeting viral replication, rather than other injurious lung pathways, is a reasonable therapeutic strategy. Future studies should aim to clarify the precise role, if any, of chloroquine and hydroxychloroquine in critically ill patients with COVID-19. We declare no competing interests. Fabio S Taccone, Julie Gorham, *Jean-Louis Vincent jlvincent@intensive.org Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium 1 Yang X, Yu Y, Xu J, et al.

I fail to understand how anyone who reads the whole study could come away with anything other than "HCQ was ineffective ". Makes me seriously question the intent of anyone referencing it to support its use.

I Have been taking zinc, vitamin D and a multi-vitamin every day since this started.......Is there a double-blind 2 year long study to prove this helps ward off the virus?

Nope....but i can say I’ve been out in public practically this whole time and have not caught this........and frankly this is probably the longest period of time I’ve ever gone without even catching a cold or feeling ill........So since i havent caught it yet the argument could be taking these does help......I am a 1-person case study

Don’t tell this congresswoman HCQ doesn’t work:

Michigan Rep. Karen Whitsett credits hydroxychloroquine, President Trump for her recovery from COVID-19

State Rep. Karen Whitsett (D-Detroit) found out she had tested positive for coronavirus (COVID-19) the day her friend and House colleague died from it.

www.clickondetroit.com

And i wouldn’t exactly call these doctors crackpots:

Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients, Henry Ford Health System Study Shows

www.henryford.com

So MY personal opinion is the jury is still out.........and frankly NO treatment works 100% of the time for 100% of the people....yet IF there is a chance something will help it is odd some doctors are swearing by it, and some doctors refuse to even consider it.......

 

[tabbibus]

I Have been taking zinc, vitamin D and a multi-vitamin every day since this started.......Is there a double-blind 2 year long study to prove this helps ward off the virus?

Nope....but i can say I’ve been out in public practically this whole time and have not caught this........and frankly this is probably the longest period of time I’ve ever gone without even catching a cold or feeling ill........So since i havent caught it yet the argument could be taking these does help......I am a 1-person case study

Don’t tell this congresswoman HCQ doesn’t work:

Michigan Rep. Karen Whitsett credits hydroxychloroquine, President Trump for her recovery from COVID-19

State Rep. Karen Whitsett (D-Detroit) found out she had tested positive for coronavirus (COVID-19) the day her friend and House colleague died from it.

www.clickondetroit.com

And i wouldn’t exactly call these doctors crackpots:

Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients, Henry Ford Health System Study Shows

www.henryford.com

So MY personal opinion is the jury is still out.........and frankly NO treatment works 100% of the time for 100% of the people....yet IF there is a chance something will help it is odd some doctors are swearing by it, and some doctors refuse to even consider it.......

A few observations.
- The risk / benefit equation is squarely in the side of taking the Zn, VitD, MV vs not. Quite the opposite for HCQ. It is all about that equation.
- Did that Congresswoman get better due to HCQ or simply because most people do get better? At this point I've seen enough patients who rode out the disease at home and where very very sick. Some just didn't want to go the hospital. And they got better without HCQ. So, yeah, you can get better with and without HCQ. Which is why anecdotal evidence is not useful.
- We should really stop using the Henry Ford trial as evidence for HCQ. I've mentioned it before, the majority of patients on the HCQ arm of this trial also received steroids. Steroids have recently been shown to be beneficial (without HCQ). This makes the data on HCQ from this study impossible to use.

I'm always open to new data and expert opinions. I, and all my colleagues, are very open to using ANYTHING that will help us fight off this virus. But is has to be based on good data or on sound clinical judgement. It goes back to my first observation. If the risk/benefit equation shows greater possibility of harm than benefit... hell to the no.

 

[Julian]

A few observations.
- The risk / benefit equation is squarely in the side of taking the Zn, VitD, MV vs not. Quite the opposite for HCQ. It is all about that equation.
- Did that Congresswoman get better due to HCQ or simply because most people do get better? At this point I've seen enough patients who rode out the disease at home and where very very sick. Some just didn't want to go the hospital. And they got better without HCQ. So, yeah, you can get better with and without HCQ. Which is why anecdotal evidence is not useful.
- We should really stop using the Henry Ford trial as evidence for HCQ. I've mentioned it before, the majority of patients on the HCQ arm of this trial also received steroids. Steroids have recently been shown to be beneficial (without HCQ). This makes the data on HCQ from this study impossible to use.

I'm always open to new data and expert opinions. I, and all my colleagues, are very open to using ANYTHING that will help us fight off this virus. But is has to be based on good data or on sound clinical judgement. It goes back to my first observation. If the risk/benefit equation shows greater possibility of harm than benefit... hell to the no.

Well said. Also, the Henry Ford study itself says:

Dr. Zervos also pointed out, as does the paper, that the study results should be interpreted with some caution, should not be applied to patients treated outside of hospital settings and require further confirmation in prospective, randomized controlled trials that rigorously evaluate the safety and efficacy of hydroxychloroquine therapy for COVID-19.​

​

Henry Ford is performing such a study and is looking to enroll 3000 people in it. In the meantime, I'd be listening to my Doctor and taking what they recommend, not what I read about on FB, forums or whatever! Far too many of these so called experts with nothing to gain are making a FORTUNE off their Youtube videos. The more you watch, the more they make! And YES, they simply publish videos with things you want to hear (confirmational bias)....and it works....they spread like wild fire.

 

[fireflymedic]

I did find Mr Cambells question of why the other studies OD the pts with a drug none to have heart arrhythmias side effects at high doses. The recamended dose was 6.5 mg/kg and the studies showing HCQ dangerous was doubling that. I would like to know why such high doses were given. It's a known drug with established dosing recommendations. Mskes you wonder if they wanted HCQ to fail.

 

[GTBRMC]

But is has to be based on good data or on sound clinical judgement.

Absolutely. Scientific method works.

It goes back to my first observation. If the risk/benefit equation shows greater possibility of harm than benefit... hell to the no.

Of course. This was one Campbell's main points. In this study, they used doses near the normal used for others diseases, proven low enough risk to be part of the UK's national formulary. Most previous trials were using dosage regimes in the 10x range - which, obviously, great increases chances for adverse effects.

Neither he, nor I, advocate for immediately dropping everything and jumping on HCQ as the silver bullet. But, this new study points out possible merit and a research follow-up path worth pursuing where previous research did not.

Widely available, off patent, produced easily, very inexpensive, massive field usage experience (particularly in many 3rd/developing world counties that lack ability to effectively deliver other therapies) - all make it worthwhile to pursue HCQ to the end.

 

[GTBRMC]

In the meantime, I'd be listening to my Doctor and taking what they recommend, not what I read about on FB, forums or whatever!

100% agreed. Absolutely.

Pointing out interesting new research in what was thought to be a dead end is far from advocating people independently begin a new therapy (also, HCQ is only available by prescription in most countries, AFAIK.)

Far too many of these so called experts with nothing to gain are making a FORTUNE off their Youtube videos. The more you watch, the more they make! And YES, they simply publish videos with things you want to hear (confirmational bias)....and it works....they spread like wild fire.

Valid points. I still suggest you dig into Campbell's catalog and see if you think he is the type of charlatan you seem to suggest he is. Also, confirmation bias cuts both ways.

Edit: Full disclosure, I took a course of HCQ (for its anti-malarial properties) on advice and prescription of both my personal doctor as well as a travel clinic doctor ahead of a trip to the Philippines in 2011 with zero side effects. For perspective, nearly 6 million people took HCQ by prescription in the US in 2017 (presumably safely). Source: Hydroxychloroquine Sulfate - Drug Usage Statistics, ClinCalc DrugStats Database

 

[GTBRMC]

I just read the Belgian study. Here is the conclusion published in it:

Whether antimalarial drugs could be effective in changing the disease course in patients with severe COVID-19—in particular, in cases requiring ICU admission—remains unknown. Moreover, for patients receiving antimalarial drugs who then require ICU admission, it is not known whether the drug should be continued or considered clinically ineffective and stopped. Assessing viral load, either on a nasopharyngeal swab or in bronchoalveolar lavage fluid, might be of use in understanding whether targeting viral replication, rather than other injurious lung pathways, is a reasonable therapeutic strategy. Future studies should aim to clarify the precise role, if any, of chloroquine and hydroxychloroquine in critically ill patients with COVID-19. We declare no competing interests. Fabio S Taccone, Julie Gorham, *Jean-Louis Vincent jlvincent@intensive.org Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium 1 Yang X, Yu Y, Xu J, et al.

I fail to understand how anyone who reads the whole study could come away with anything other than "HCQ was ineffective ". Makes me seriously question the intent of anyone referencing it to support its use.

You appear to reference this study from April 2020. https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30172-7.pdf&ved=2ahUKEwj03a7Fu77rAhVSZc0KHYlCAWwQFjABegQIBBAB&usg=AOvVaw0xR8BlIEFQ_5HJDsOX-6IT

Campbell discussed a newly published (August 24, 2020) Belgian study: Low-dose Hydroxychloroquine Therapy and Mortality in Hospitalized Patients with COVID-19: A Nationwide Observational Study of 8075 Participants

Its title, highlights, and abstract:


International Journal of Antimicrobial Agents
Available online 24 August 2020, 106144
In Press, Journal Pre-proofWhat are Journal Pre-proof articles?

Low-dose Hydroxychloroquine Therapy and Mortality in Hospitalized Patients with COVID-19: A Nationwide Observational Study of 8075 Participants


Highlights

•
Hydroxychloroquine (HCQ) 2400 mg during 5 days was used in Belgium for COVID-19
•
Impact of HCQ on mortality among 8075 patients with COVID-19 was assessed
•
Lower mortality in HCQ-treated patients as compared to supportive care
•
Lower mortality is irrespective of symptoms duration

Abstract
Background
Hydroxychloroquine (HCQ) has been largely used and investigated as therapy of COVID-19 across various settings, at total dose usually ranging from 2400 mg to 9600 mg. In Belgium, off-label use of low-dose HCQ (2400 mg in total over five days) was recommended for hospitalized patients with COVID-19.
Methods
We conducted a retrospective analysis of in-hospital mortality in the Belgian national COVID-19 hospital surveillance data. Patients treated either with HCQ alone and supportive care (HCQ group) were compared to patients treated with supportive care only (no-HCQ group) using a competing risks proportional hazards regression with discharge alive as competing risk, adjusted for demographic and clinical features with robust standard errors.
Results
Of 8075 patients with complete discharge data on 24th of May and diagnosed before the 1st of May, 4542 received HCQ in monotherapy and 3533 were in the no-HCQ group. Death was reported in 804/4542 (17.7%) and 957/3533 (27.1%), respectively. In the multivariable analysis, the mortality was lower in the HCQ group compared to the no-HCQ group (adjusted hazard ratio [HR] 0.684, 95% confidence interval [CI] 0.617–0.758). Compared to the no-HCQ group, mortality in the HCQ group was reduced both in patients diagnosed ≤ 5 days (n=3975) and > 5 days (n=3487) after symptom onset (adjusted HR 0.701, 95% CI 0.617–0.796 and adjusted HR 0.647, 95% CI 0.525–0.797, respectively).
Conclusions
Compared to supportive care only, low-dose HCQ monotherapy was independently associated with lower mortality in hospitalized patients with COVID-19 diagnosed and treated early or later after symptom onset.

 

[malibu Dan]

Rode out Covid myself this week at home. Not fun and I am extremely greatful for my health and fortunate that I did not have to go to the hospital for care..( coming from a cardiac RN married to an ICU RN)...

 

[GTBRMC]

Rode out Covid myself this week at home. Not fun and I am extremely greatful for my health and fortunate that I did not have to go the hospital for care..( coming from a cardiac RN married to an ICU RN)...

Happy to hear that you've likely fought it off. Any advise for the rest of us?

 

[malibu Dan]

Unfortunately as it effects people differently it’s difficult to relay a one size fits all advise. I would just say if you start to feel symptoms you usually equate to past flu experience, isolate, check for fever, Tylenol on schedule, aspirin due to high prevelance of DVT/PE , rest but at the same time do not become sedentary..schedule same day Covid test, reach out to your PCP..

 

[Enduro900]

A few observations.
- The risk / benefit equation is squarely in the side of taking the Zn, VitD, MV vs not. Quite the opposite for HCQ. It is all about that equation.
- Did that Congresswoman get better due to HCQ or simply because most people do get better? At this point I've seen enough patients who rode out the disease at home and where very very sick. Some just didn't want to go the hospital. And they got better without HCQ. So, yeah, you can get better with and without HCQ. Which is why anecdotal evidence is not useful.
- We should really stop using the Henry Ford trial as evidence for HCQ. I've mentioned it before, the majority of patients on the HCQ arm of this trial also received steroids. Steroids have recently been shown to be beneficial (without HCQ). This makes the data on HCQ from this study impossible to use.

I'm always open to new data and expert opinions. I, and all my colleagues, are very open to using ANYTHING that will help us fight off this virus. But is has to be based on good data or on sound clinical judgement. It goes back to my first observation. If the risk/benefit equation shows greater possibility of harm than benefit... hell to the no.

Thanks for ALL that you do.....sincerely.

The congresswoman......sure she might have recovered without it.....and it could have been coincidence (or placebo affect) that she started feeling better right after taking it.....but she will tell you in her mind it helped (actually in her mind it saved her).

Regarding your opinion about the Henry ford study.....you look at it one way, I look at it as it merits further investigation...

It may end up that HCQ wasn’t effective and it was the other elements of the package treatment......but i also don’t Buy it is all of a sudden this dangerous drug that should be avoided at all costs when it is widely used worldwide And has been for 70 years.

You have earned the right to proceed with your patients the way you see fit. You also mentioned things were getting bad again In your ICU/another strain possibly so i personally like the fact that other doctors are still pursuing this treatment direction.

This whole series of events have been a cluster if you look back.....masks are bad, then masks are required.......lockdowns are the only way (flatten the curve for 15 days to give our healthcare some time to get ready/it was NEVER about keeping it from spreading it was about slowing the spread) yet now we are approaching month 6 and its all about keeping everyone from getting it (impossible in my mind). It can stay on surfaces for days, now they are saying that is not accurate. We have extreme fear about kids/school but other countries are back and not one case of a kid giving it to their teacher.....yet i personally know a teacher that quit her job as she is so fearful she will catch it back in school. And of course now the death rate is not even discussed/reported (down 70%- 80% from April). Shouldn’t this be a positive? We are less locked down then we were in April yet less people are dying per day ( a lot less). Is it serious? Of course it is. Should the death rate per day decrease be talked about more so the fear factor is dialed down a bit? There are people that are paralyzed with fear right now.....

 

[Robconn]

Thanks for ALL that you do.....sincerely.

The congresswoman......sure she might have recovered without it.....and it could have been coincidence (or placebo affect) that she started feeling better right after taking it.....but she will tell you in her mind it helped (actually in her mind it saved her).

Regarding your opinion about the Henry ford study.....you look at it one way, I look at it as it merits further investigation...

It may end up that HCQ wasn’t effective and it was the other elements of the package treatment......but i also don’t Buy it is all of a sudden this dangerous drug that should be avoided at all costs when it is widely used worldwide And has been for 70 years.

You have earned the right to proceed with your patients the way you see fit. You also mentioned things were getting bad again In your ICU/another strain possibly so i personally like the fact that other doctors are still pursuing this treatment direction.

This whole series of events have been a cluster if you look back.....masks are bad, then masks are required.......lockdowns are the only way (flatten the curve for 15 days to give our healthcare some time to get ready/it was NEVER about keeping it from spreading it was about slowing the spread) yet now we are approaching month 6 and its all about keeping everyone from getting it (impossible in my mind). It can stay on surfaces for days, now they are saying that is not accurate. We have extreme fear about kids/school but other countries are back and not one case of a kid giving it to their teacher.....yet i personally know a teacher that quit her job as she is so fearful she will catch it back in school. And of course now the death rate is not even discussed/reported (down 70%- 80% from April). Shouldn’t this be a positive? We are less locked down then we were in April yet less people are dying per day ( a lot less).

 

[Robconn]

I believe focusing on a low mortality rate As a positive undermines the danger we still face with Covid. It does not account for the many who survived Covid that suffer from long term health effects. young people who are oxygen dependent upon discharge from the hospital. Migraines that occur frequently for months afterward, insomnia, and forgetfulness are just a few. Even before there was Covid, Long term ventilator days accounted for long term health complications usually requiring a tracheotomy, peg tube, greenfield filter and some form of rehabilitation after hospitalization. With that said, I believe we can back and function sooner with greater compliance with masks and general respiratory etiquette reducing the spread. Thus reducing the health and economic impact in its wake. Please note, Its not for me to interject my beliefs upon anyone. It’s not my intention. The above is my perspective as a front line health care worker.

 

[Enduro900]

I believe focusing on a low mortality rate As a positive undermines the danger we still face with Covid. It does not account for the many who survived Covid that suffer from long term health effects. young people who are oxygen dependent upon discharge from the hospital. Migraines that occur frequently for months afterward, insomnia, and forgetfulness are just a few. Even before there was Covid, Long term ventilator days accounted for long term health complications usually requiring a tracheotomy, peg tube, greenfield filter and some form of rehabilitation after hospitalization. With that said, I believe we can back and function sooner with greater compliance with masks and general respiratory etiquette reducing the spread. Thus reducing the health and economic impact in its wake. Please note, Its not for me to interject my beliefs upon anyone. It’s not my intention. The above is my perspective as a front line health care worker.

With all due respect, the current death rate does not justify the current fear factor.

We are a country of 360 million people, so a daily death rate of around 1,000 that is undeniably critical to those with underlying health conditions, but otherwise a week or so of extreme discomfort To most does not justify the levels of fear induction we are currently at....again there are many people at extreme fear levels/at the point of being paralyzed......There is a way to tap down the fear/paralyzing elements without discouraging the preventative steps, but unfortunately instead an extreme policy of fear continues.

The other element is its a little disingenuous to go from Concentrating on the death rate daily when it was high, to not even discussing it anymore when it has dropped 70%-80%. Regardless it is news that should be shared, but is even hard to find these days....

And apparently you work in the healthcare industry so you probably know the specifics.....A school-age person (age 5-18yrs) that has no underlying heath conditions is extremely unlikely to even have a serious bout, let alone die. Of course its almost impossible to find that information as well:

• Children were 0%-0.3% of all COVID-19 deaths, and 21 states reported zero child deaths

Hence there should be school.....

 

[Robconn]

I’m not scared and I work in this Crap! Frustrated YES! You shouldn’t be Neither. I gather your not and that is good. it’s hard to get my point across without appearing like an alarmist. My point was don’t under estimate the virus solely on mortality Rate. There are other life altering consequences to factor In despite numbers dropping. In my locality, I attribute the numbers dropping due to greater compliance. I think once Covid spiked for a second time affecting more people, it had a profound effect on the public. they could then see it was cause and effect and not some random occurrence as the first spike was hard to grasp. the bottom line is, As long as you use common sense, and respiratory etiquette it will minimize any possibility of exposure. I tell my brother in education to not listen to the fear as well, take nessary precautions. I am optimistic if the schools treat and handle Covid similar to hospitals they can control and contain Covid from spreading. If you should let your guard down you may have severe consequences Not a definite but it still remains a possible outcome. otherwise, Diligence pays off.

as far as the pediatric population goes, Mortality numbers are statistically low Nation wide and even state wide. However, Unfortunately the state of Georgia is not included in the 21 states with zero mortality. I know of 3 in The Atlanta metro area. 1, 7, and a 15 year old Teen did not survive Covid. God rest their souls and I pray for the remaining family members. Some Local schools have pulled the plug on the start of the year as students and teachers were testing positive after the first week. In my county, out of approx 36k students, 30 were positive and 600 were quarantined for possible exposure. I feel confident with schools addressing Covid, students and parents can Soon have some normalcy again.
I appreciate your response. Stay safe and let’s continue to explore And examine Various viewpoints.

 

[Enduro900]

I’m not scared and I work in this Crap!

And thank your willingness to do so!

 

[Dean P]

With all due respect, the current death rate does not justify the current fear factor.

IMHO, I disagree. Unfortunately fear is a great motivator. Fear of getting caught, fear someone will find out, fear of getting bit/stung/hurt are all real factors that keep people from doing harm or getting harmed. "Don't stand in harms way" they say. "Fear of the unknown". I am confident if we did not fear COVID and what it does our death rates would be higher.

I fear too many people don't fear enough. I do admit MSM spreads this fear but is it really bad when people's lives are at stake? I personally do not know of anyone that has it or has dies from it. I do not want to either. My fear of getting this awful disease scares the sh!t out of me. My wife has type 1 diabetes, I fear for her as she is unlikely to survive.

The opposite of fear is hope. Hope is real also. It is what motivates/drives us to keep going despite our fears. Without all this is total ignorance of what surrounds us. I fear, hope and pray we ALL do what is right so more people can survive this fucking disease.