What you need to know about the virus in China "2019 Novel Coronavirus (2019-nCoV)"

[Thomas savage]

I'm not sure why efficacy is related to personalities and I admit to paying zero attention to that aspect. "Raoult" in my world is a way of predicting partial pressures of a mixture.

Perhaps I'm missing something, but if the choice is between trying something for which evidence is not yet solid (solid evidence will take years) but has very little downside versus doing nothing, with an obvious downside, the former would seem to be a better path. But usual disclaimers, my doctorate is not in epidemiology or pharmacology.

There's definitely a ' doctor pepper ' meme in here somewhere.

 

[PierreV]

I'm not sure why efficacy is related to personalities and I admit to paying zero attention to that aspect. "Raoult" in my world is a way of predicting partial pressures of a mixture.

Perhaps I'm missing something, but if the choice is between trying something for which evidence is not yet solid (solid evidence will take years) but has very little downside versus doing nothing, with an obvious downside, the former would seem to be a better path. But usual disclaimers, my doctorate is not in epidemiology or pharmacology.

Solid evidence will take a couple of weeks at most in this case.

Virtually all patients in ICU are on 1 out of 4 possible strategies, some of them on two. (in practice, I'd say 3 now as it seems one of the options is clearly failing).

The downside is dose-dependent. It's real (hence the many exclusions and checks in Raoult's protocol, hence his risk analysis scoring).

Rest assured that this option is definitely being tried on a large scale.

Also, if some combo magically worked wonderfully, the word would get out in something like a couple of days.

 

[SIY]

Solid evidence will take a couple of weeks at most in this case.

Is that actually the case? It strikes me that a true double blind statistically significant trial with a large enough scale to be valid (this would include people at all stages of infection so that efficacy at different stages could be evaluated) would take considerably longer.

But my disclaimer again.

 

[vert]

It might be time to ' agree to disagree ' regarding Raoult.

Well said. It just came out that the two studies, in Angers and Montpellier, on several treatments including the Raoult protocol, where initially HCQ was going to be tested without the azythromicin association and only at the later stages of the infection, will be modified to include the exact Raoult protocol and not a grossly altered version of it, at the request of Macron himself apparently. That should settle the psychodrama, sooner or later.

 

[PierreV]

Is that actually the case? It strikes me that a true double blind statistically significant trial with a large enough scale to be valid (this would include people at all stages of infection so that efficacy at different stages could be evaluated) would take considerably longer.

But my disclaimer again.

I don't disagree with you in principle, but...

- "all stages of the disease" is impossible to test right now, because we aren't testing enough people (except maybe Germany) and we don't have reliable tests (edit: for all stages of the disease).

- prophylaxis at lower doses is relatively easy to assess partially (for fully, see above) given the population that is on it currently.

- the vast majority of patients who do absolutely nothing do not die. A lot are asymptomatic.

What we want/need now are those severely affected patients to not die or to not spend 3 weeks in ICU.

 

[Deleted member 65]

End of social distancing, at least for this evening ... ;-)

 

[PierreV]

Darunavir is out (no activity in vitro)
https://www.medrxiv.org/content/10.1101/2020.04.03.20052548v1.full.pdf+html

Tests are improving (single tests are not good enough, PCR based ones are relatively time-consuming and expensive)
https://www.medrxiv.org/content/10.1101/2020.04.07.20053660v1

 

[raistlin65]

A large number of doctors are saying it is effective. In a recent poll covering 30 countries, 37% of doctors ranked HCQ as the best treatment....

If you look at the previous question in the survey, you'll see that the 37% result is extremely misleading.
https://public-cdn.sermo.com/covid1...ve-i-sermo-covid-19-global-analysis-final.pdf

Question 12, the previous question, Please indicate which medications, if any, you have personally prescribed or
have seen used in your setting to fight COVID-19? N=6227

Question 13: 37% of physicians who have treated COVID-19 patients believe Hydroxychloroquine is the most effective therapy
of a list of 15 options. N=2171

This means that 2/3 of the doctors who answered question 12 were unwilling to answer question 13 and specify which therapy is most effective.

There's your take away from that survey. A large majority of doctors find their personal experience with COVID-19 medical treatment to be inconclusive. Like people have repeatedly said here, such personal experience is unreliable.

 

[Soniclife]

If you look at the previous question in the survey, you'll see that the 37% result is extremely misleading.
https://public-cdn.sermo.com/covid1...ve-i-sermo-covid-19-global-analysis-final.pdf

Question 12, the previous question, Please indicate which medications, if any, you have personally prescribed or
have seen used in your setting to fight COVID-19? N=6227

Question 13: 37% of physicians who have treated COVID-19 patients believe Hydroxychloroquine is the most effective therapy
of a list of 15 options. N=2171

This means that 2/3 of the doctors who answered question 12 were unwilling to answer question 13 and specify which therapy is most effective.

There's your take away from that survey. A large majority of doctors find their personal experience with COVID-19 medical treatment to be inconclusive. Like people have repeatedly said here, such personal experience is unreliable.

And doing nothing was only 5% behind on 32%, I'm kind of surprised placebo and expectation bias does not count for more than 5%.

 

[MediumRare]

[ The graph shows how intensive care admissions plummeted after the age of eighty. While 12.3% of people hospitalized between 60 and 69 years are admitted to the ICU, the figure drops to 10.2% among those admitted between 70 and 79 years and only 1.2% of those admitted over 80 years old enter the ICU. ]

Is there any alternative explanation other than rationing/palliative policy?

 

[MediumRare]

It might be time to ' agree to disagree ' regarding Raoult.

Start new thread: Amateurs debate unanswerable question using incomplete third-hand information (2020, colorized).

 

[stalepie2]

 

[williamwally]

For better or worse (asymptomatic carriers?):

 

[Deleted member 65]

”Never let a good crisis go to waste."
Niccolo Machiavelli / Winston Churchill

I sincerely hope mankind won’t let this one go to waste!

 

[MarcT]

A large number of doctors are saying it is effective. In a recent poll covering 30 countries, 37% of doctors ranked HCQ as the best treatment. Just from what I read in recent days, doctors from Denver, New Jersey, New York, and another heading a hospital named after Henry Ford, I can't remember in which state, as well as some major medical figures in France and Italy. It also appears that Dr. Fauci was promoting use of HCQ in 2013 for a SARS type virus without any large precautions, and has completely reversed his stance since - why? Simple question to those who demand large-scale formal studies while people are falling left and right - setting aside the potential epistemological errors of this approach (see http://jdmichel.blog.tdg.ch/archive/2020/04/06/covid-l-imposture-evidence-based-305631.html) : how is it even ethical in a crisis situation to put people at the risk of dying being part of a control group. Those who warn about potential HCQ side effects do not seem bothered in the least by this. Dying for an ideology, for the cause of evidence-based medicine, is a-ok. And please stop misrepresenting the Raoult study, he didn't even call it a study. He said he would publish it to confirm the Chinese results and go on with his duty as a doctor which is to treat people, about which his 800-staff hospital reports every day https://www.mediterranee-infection.com/covid-19/. Then I read people gushing over what's being done Germany, while bashing HCQ advocates and Pr. Raoult for peddling a "miracle" drug (which Raoult, again, never did), rather than following such a strategy, and strangely ignoring the fact that that kind of massive screening is precisely what has been advised by the same Pr. Raoult for the past two months, with such advice falling on deaf ears at least as far as the French authorities are concerned... again I have to ask why ?

Agreed, but you better put on your helmet here!

 

[mi-fu]

For better or worse (asymptomatic carriers?):
View attachment 57773

same will happen to new york soon...

 

[MarcT]

It might be time to ' agree to disagree ' regarding Raoult.

Agreed, with respect to arguments regarding his publishing career and comments from long ago. But the fact remains that he is/has treating upwards of 1000 covid-19 patients, so it seems to me that people should want to pay some attention to his results, with, of course, a healthy dose of skepticism.

 

[Deleted member 65]

As far as I’ve learned, the nature of this (and most pandemics) is that all of us will be hit by the corona virus since we have a spread in the society.

Most of us will have no or very mild symptoms (90%) others with underlying things such as diabetes, obesity, very old age will be hit harder.

Considering this (assuming experts in the field are right), what good is a lockdown? What will happen when the lockdown ceases?

My daughter (mother of child in my profile pic) is a nurse working in the midst of all of this. Learning as we go along she says, that’s what the reality is in Covid-19 health care. The only provable cure that works in ICU is oxygen.

 

[raistlin65]

Agreed, with respect to arguments regarding his publishing career and comments from long ago. But the fact remains that he is/has treating upwards of 1000 covid-19 patients, so it seems to me that people should want to pay some attention to his results, with, of course, a healthy dose of skepticism.

Everyone on this list is paying attention to HCQ and hoping for it to be found effective. What people here seem to be tired of is someone belaboring the same point over and over again, like a record skipping in place. Pick up the cartridge and move the needle to the next groove.

I'm an advocate of field usage of HCQ due to the severity of the crisis, and have been before Trump recommended it as a cure. But I wish we could table the HCQ discussion on this list until we have some more clinical research.

 

[MarcT]

FWIW, an article on convalescent plasma treatment for covid-19 patients, published on April 6. The actual work was done in China in March.

https://www.pnas.org/content/early/2020/04/02/2004168117