Coronavirus COVID-19 - Global Health Pandemic #66

[Trino]

San Antonio TX calling in military medical personnel to help with COVID.

 

[10ofRods]

Henry Ford Health System Study: Hydroxychloroquine Lowers COVID-19 Death Rate


Henry Ford Health System Study: Hydroxychloroquine Lowers COVID-19 Death Rate

Gosh I wish they'd publish this and we could see the actual peer review. I go through dozens and dozens of studies per day - and don't even bother to look at ones without randomized trials.

There's no citation, there's a claim of peer review. I guess I'll have to go look by author. But it's really rare for a hospital to deny what it thinks is a good drug to half its patients - so the research protocol needs to be published.

Of note (and of great interest) is their claim that early use of HCQ helps and that they used a different dosage than any other study.

So where's their help to the medical community? Can they not say where they published or what the dosage was? Higher or lower? I think that's pretty important (and was it the same or titrated in the chosen group - and how did they choose the groups??)

There's study after study without proper controls, here's one recent one:

COVID-19 Outpatients – Early Risk-Stratified Treatment with Zinc Plus Low Dose Hydroxychloroquine and Azithromycin: A Retrospective Case Series Study

It makes HCQ sound promising - but HCQ wasn't the only drug administered (it rarely is). But in this case of somewhat successful use of HCQ (no where near the claims of the newspaper article in the link), it was low dose and combined with something else. Isn't that something else possibly inportant?

The something else is Zinc - which, by itself, is shown to have an effect on mortality.

Did the Ford people use ZInc or not? (I believe they did, I cannot believe they didn't - it doesn't make medical sense to me). But if they really did a control on HCQ without Zinc, I would like to know in whose hands the pre-print currently may reside.

 

[gitana1]

You got this! You know what symptoms are, you know your own body, you can get a test if you really want one.

And yes, there are antivirals that will really help should you test positive. Just don't wait until your blood oxygen is down to 80%!

BTW, if you wore your mask and even half of the others did - given the volume of air in Home Depot, you were in fact fairly safe (not zero though - but pretty close).

Everyone was wearing a mask! Except one guy near the entrance when I first got there. And he left. And they had fans on the ceiling blowing down on us pretty hard so anything coming out of our mouths would hit the floor. So hopefully I’m okay. I will be worried for a bit.

 

[SouthAussie]

More about that here.
The Lancet retracts large study on hydroxychloroquine

"A first-year statistics major could tell you about major flaws in the design of the analysis," one expert said.

Study finds hydroxychloroquine treatment associated with lower mortality rate for COVID-19 patients

And remember this? There was much criticism of the President for promoting hydroxychloroquine. Turns out he was right. IMO

Ignoring Expert Opinion, Trump Again Promotes Use of Hydroxychloroquine

Strangely enough, this directly conflicts with the FDA.


July 1, 2020 Update: A summary of the FDA review of safety issues with the use of hydroxychloroquine and chloroquine to treat hospitalized patients with COVID-19 is now available. This includes reports of serious heart rhythm problems and other safety issues, including blood and lymph system disorders, kidney injuries, and liver problems and failure.

June 15, 2020 Update: Based on ongoing analysis and emerging scientific data, FDA has revoked the emergency use authorization (EUA) to use hydroxychloroquine and chloroquine to treat COVID-19 in certain hospitalized patients when a clinical trial is unavailable or participation is not feasible. We made this determination based on recent results from a large, randomized clinical trial in hospitalized patients that found these medicines showed no benefit for decreasing the likelihood of death or speeding recovery. This outcome was consistent with other new data, including those showing the suggested dosing for these medicines are unlikely to kill or inhibit the virus that causes COVID-19.

FDA cautions use of hydroxychloroquine/chloroquine for COVID-19

 

[Deleted member 39678]

Gosh I wish they'd publish this and we could see the actual peer review. I go through dozens and dozens of studies per day - and don't even bother to look at ones without randomized trials.

There's no citation, there's a claim of peer review. I guess I'll have to go look by author. But it's really rare for a hospital to deny what it thinks is a good drug to half its patients - so the research protocol needs to be published.

Of note (and of great interest) is their claim that early use of HCQ helps and that they used a different dosage than any other study.

So where's their help to the medical community? Can they not say where they published or what the dosage was? Higher or lower? I think that's pretty important (and was it the same or titrated in the chosen group - and how did they choose the groups??)

There's study after study without proper controls, here's one recent one:

COVID-19 Outpatients – Early Risk-Stratified Treatment with Zinc Plus Low Dose Hydroxychloroquine and Azithromycin: A Retrospective Case Series Study

It makes HCQ sound promising - but HCQ wasn't the only drug administered (it rarely is). But in this case of somewhat successful use of HCQ (no where near the claims of the newspaper article in the link), it was low dose and combined with something else. Isn't that something else possibly inportant?

The something else is Zinc - which, by itself, is shown to have an effect on mortality.

Did the Ford people use ZInc or not? (I believe they did, I cannot believe they didn't - it doesn't make medical sense to me). But if they really did a control on HCQ without Zinc, I would like to know in whose hands the pre-print currently may reside.

Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with COVID-19

The purpose of this study was to evaluate the role of hydroxychloroquine therapy alone and in combination with azithromycin in hospitalized patients positive for COVID-19.

https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext

 

[10ofRods]

San Antonio TX calling in military medical personnel to help with COVID.

The situation in San Antonio is dire. I hope we haven't gotten to where we only feel bad when people die in large numbers. The percentages in San Antonio are heartbreaking.

382 intensive care patients is a lot. That's 10X what we have in my whole county (which is only slightly less populated than San Antonio).

 

[10ofRods]

Strangely enough, this directly conflicts with the FDA.


July 1, 2020 Update: A summary of the FDA review of safety issues with the use of hydroxychloroquine and chloroquine to treat hospitalized patients with COVID-19 is now available. This includes reports of serious heart rhythm problems and other safety issues, including blood and lymph system disorders, kidney injuries, and liver problems and failure.

June 15, 2020 Update: Based on ongoing analysis and emerging scientific data, FDA has revoked the emergency use authorization (EUA) to use hydroxychloroquine and chloroquine to treat COVID-19 in certain hospitalized patients when a clinical trial is unavailable or participation is not feasible. We made this determination based on recent results from a large, randomized clinical trial in hospitalized patients that found these medicines showed no benefit for decreasing the likelihood of death or speeding recovery. This outcome was consistent with other new data, including those showing the suggested dosing for these medicines are unlikely to kill or inhibit the virus that causes COVID-19.

FDA cautions use of hydroxychloroquine/chloroquine for COVID-19

Yeah - which is why I really want to see exactly who publishes some other point of view.

Lancet tried to be conservative - but the study was flawed in the same way that most ad hoc, crisis-borne studies are flawed.

Biting my tongue here.

 

[TravelingBug]

Stephanie Innes
@stephanieinnes
The Harvard Global Health Institute 2day has 4 states in the highest risk #COVID19 "red zone" - #Arizona, Florida, South Carolina & Louisiana, based on 7-day average of new cases/100K. Institute says in red zone, stay-at-home orders are "necessary"

https://twitter.com/stephanieinnes/status/1280301289180549121

 

[gitana1]

Gosh I wish they'd publish this and we could see the actual peer review. I go through dozens and dozens of studies per day - and don't even bother to look at ones without randomized trials.

There's no citation, there's a claim of peer review. I guess I'll have to go look by author. But it's really rare for a hospital to deny what it thinks is a good drug to half its patients - so the research protocol needs to be published.

Of note (and of great interest) is their claim that early use of HCQ helps and that they used a different dosage than any other study.

So where's their help to the medical community? Can they not say where they published or what the dosage was? Higher or lower? I think that's pretty important (and was it the same or titrated in the chosen group - and how did they choose the groups??)

There's study after study without proper controls, here's one recent one:

COVID-19 Outpatients – Early Risk-Stratified Treatment with Zinc Plus Low Dose Hydroxychloroquine and Azithromycin: A Retrospective Case Series Study

It makes HCQ sound promising - but HCQ wasn't the only drug administered (it rarely is). But in this case of somewhat successful use of HCQ (no where near the claims of the newspaper article in the link), it was low dose and combined with something else. Isn't that something else possibly inportant?

The something else is Zinc - which, by itself, is shown to have an effect on mortality.

Did the Ford people use ZInc or not? (I believe they did, I cannot believe they didn't - it doesn't make medical sense to me). But if they really did a control on HCQ without Zinc, I would like to know in whose hands the pre-print currently may reside.

Here it is:

https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext

 

[Deleted member 39678]

Here it is:

https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext

No mention of zinc in the article.

 

[Reasonable & Just]

Strangely enough, this directly conflicts with the FDA.


July 1, 2020 Update: A summary of the FDA review of safety issues with the use of hydroxychloroquine and chloroquine to treat hospitalized patients with COVID-19 is now available. This includes reports of serious heart rhythm problems and other safety issues, including blood and lymph system disorders, kidney injuries, and liver problems and failure.

June 15, 2020 Update: Based on ongoing analysis and emerging scientific data, FDA has revoked the emergency use authorization (EUA) to use hydroxychloroquine and chloroquine to treat COVID-19 in certain hospitalized patients when a clinical trial is unavailable or participation is not feasible. We made this determination based on recent results from a large, randomized clinical trial in hospitalized patients that found these medicines showed no benefit for decreasing the likelihood of death or speeding recovery. This outcome was consistent with other new data, including those showing the suggested dosing for these medicines are unlikely to kill or inhibit the virus that causes COVID-19.

FDA cautions use of hydroxychloroquine/chloroquine for COVID-19

It would be great if it does work, and it certainly has some adherents in the medical community. The most recent work from Ford seems to show confounding effects of steroids, and as pointed out, is not randomized. But it's another piece of the puzzle, and worth examining. It is bizarre that it has been politicized - a politician shouldn't be pitching any drugs, and any "vindication" (not that science really works that way) would be for the doctor who told them about it in the first place - not the politician who is definitely not an expert and would have otherwise not known about it. Strange times indeed. But let's hope this additional research brings us closer to to understanding how to treat this disease. JMO.

 

[10ofRods]

Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with COVID-19


https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext

Thank you SO much.

I understand why they published, but there's no explanation of how people got into each group.

I wrote a lot more but deleted it. For those interested, here's a quote that's a pretty good summary:

//Hydroxychloroquine was dosed as 400 mg twice daily for 2 doses on day 1, followed by 200 mg twice daily on days 2-5. Azithromycin was dosed as 500 mg once daily on day 1 followed by 250 mg once daily for the next 4 days. The combination of hydroxychloroquine + azithromycin was reserved for selected patients with severe COVID-19 and with minimal cardiac risk factors. An electrocardiogram (ECK) based algorithm was utilized for hydroxychloroquine use. QTc>500 ms was considered an elevated cardiac risk and consequently hydroxychloroquine was reserved for patients with severe disease with telemetry monitoring and serial QTc checks. The clinical guidelines included adjunctive immunomodulatory therapy with corticosteroids and tocilizumab.//

Note the last line (important).

Note the exclusion of cardiac patients. (Just in case you are going to ask your doctor for HCQ should you need to).

HCQ by itself also worked better than nothing, in this retrospective study (although again, since many CoVid patients present with abnormalities on ECK on presentation, this group of patients may be less inclined to die in the first place.

It's a known separate variable (cardiovascular disease and/or arrhythmias of the heart). People who have that on admission, regardless of fever or lung pathology, are more likely to die.

 

[Warwick1991]

Has anyone heard which antivirals are used for prophylaxis for exposure?

 

[gitana1]

More about that here.
The Lancet retracts large study on hydroxychloroquine

"A first-year statistics major could tell you about major flaws in the design of the analysis," one expert said.

Study finds hydroxychloroquine treatment associated with lower mortality rate for COVID-19 patients

And remember this? There was much criticism of the President for promoting hydroxychloroquine. Turns out he was right. IMO

Ignoring Expert Opinion, Trump Again Promotes Use of Hydroxychloroquine

This is why we need to not make decisions based on politics. Trump grasped on to news of the French study in the hopes that it would work.

In this study, which is fairly large, it does appear to. Why not at least discuss and explore using everything in our toolbox that might work?

Antivirals.
Malaria drugs
Zinc
Arythromyocin (sp.?)

Etc.

The study explains that the drug needs to only be given in a hospital setting with the patients’ hearts closet monitored and that it helps when given early rather than later.

 

[gitana1]

Has anyone heard which antivirals are used for prophylaxis for exposure?

No. But I have heard that people taking pRep to prevent HIV are showing much lower numbers of COVID.

 

[Tippy Lynn]

This is why we need to not make decisions based on politics. Trump grasped on to news of the French study in the hopes that it would work.

In this study, which is fairly large, it does appear to. Why not at least discuss and explore using everything in our toolbox that might work?

Antivirals.
Malaria drugs
Zinc
Arythromyocin (sp.?)

Etc.

The study explains that the drug needs to only be given in a hospital setting with the patients’ hearts closet monitored and that it helps when given early rather than later.

I think the entire world is grasping at anything hoping it will work.

 

[Reasonable & Just]

I think the entire world is grasping at anything hoping it will work.

Amen to that. And there are doctors that swear by it. So let's cautiously keep the scientific toolbox open and look at all the info.


A bit more info, for what it's worth...: Study finds hydroxychloroquine helped coronavirus patients survive better - CNN

"Kalkanis said that their findings do not necessarily contradict those of earlier studies. "We also want to make the point that just because our results differ from some others that may have been published, it doesn't make those studies wrong or definitely a conflict. What it simply means is that by looking at the nuanced data of which patients actually benefited and when, we might be able to further unlock the code of how this disease works," he said.

Researchers not involved with the study were critical. They noted that the Henry Ford team did not randomly treat patients but selected them for various treatments based on certain criteria.
"As the Henry Ford Health System became more experienced in treating patients with COVID-19, survival may have improved, regardless of the use of specific therapies," Dr. Todd Lee of the Royal Victoria Hospital in Montreal, Canada, and colleagues wrote in a commentary in the same journal.

"Finally, concomitant steroid use in patients receiving hydroxychloroquine was more than double the non-treated group. This is relevant considering the recent RECOVERY trial that showed a mortality benefit with dexamethasone." The steroid dexamethasone can reduce inflammation in seriously ill patients.

Rosenberg also pointed out that the Detroit paper excluded 267 patients -- nearly 10% of the study population -- who had not yet been discharged from the hospital.
He said this might have skewed the results to make hydroxychloroquine look better than it really was. Those patients might have still been in the hospital because they were very sick, and if they died, excluding them from the study made hydroxychloroquine look like more of a lifesaver than it really was."


It will be interesting to see the authors' responses to these critiques as it all plays out in the journal letters.

 

[MimosaMornings]

Atlanta mayor tests positive for COVID-19
Atlanta Mayor tests positive

 

[KALI]

Sold my beloved little sailboat today.
Why? Money.
Our restaurant business, and many other businesses here in San Diego were closed down again today for another minimum of 3 weeks.
Yes, we can do take out and outside dining. However, those rules lesson our income again, by 30 to 40%.
Restaurants operate on about a 10% margin. Sooooo, we're again looking at a loss of up to 30% per month.
Fortunately, we have a large outside open air, uncovered patio.
I am very concerned about when our weather turns cold, usually November. How are we supposed to protect our customers, will they even come in when it's too cold or wet to sit on our patio?
I refuse to take any of our meager savings and plow it back into our business as we go through this.
I want to add to our savings so that, if we have to leave, we've got a cushion.
I have to make hard decisions for hard times.

 

[mickey2942]

I think the entire world is grasping at anything hoping it will work.

That is SO funny. This weekend my Blackfoot friend and I did a small smudging ceremony with sage and sweet grass. It is partially spiritual/mental health, and supposed to banish bad spirits that cause disease. Anyway, we had a prayer circle, smudging.

My husband usually snorts, and calls it "Voodoo". Asks if we killed a chicken...anyway, he decided to join us. Whatever works.

Cleanse Your Home with this Sage Smudging Ritual and Prayer