COVID-19 Pandemic: Transmissions, Deaths, Treatments, Vaccines, Interventions and More...
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Not sure if this has been posted but a new therapy looking to be tested for handling the cytokine storm that happens to some patients. Plasma gelsolin...well actually recombinant plasma gelsolin. Best to be used in conjunction with an antiviral like remdemsivir.
From the article:
Discovered nearly two decades ago in a Harvard lab by the late Dr. Thomas Stossel, a professor of medicine at Harvard Medical School and head of translational medicine at Brigham and Women’s Hospital in Boston, plasma gelsolin is an abundant, naturally occurring circulating protein found in the human body’s immune system.
According to Stossel, it is “a master regulator of the immune system.” In a wide range of diseases, it balances the inflammatory process without suppressing the immune system, thus preventing severe consequences and greatly improving survival.
For nine years the scientists at BioAegis have been studying this unique anti-inflammatory and its effect on treating a wide range of conditions, including influenza, pneumonia, arthritis, Alzheimers, lupus, inflammatory bowel disease, multiple sclerosis and more.
What they discovered was that plasma gelsolin is depleted in severe inflammatory conditions and that restoring a recombinant human form of plasma gelsolin in the body has enormous potential to prevent the lethal ravages of inflammation, such as those caused by Covid-19.
Since 2015, BioAegis has generated data in several models of pneumonia and most recently published a paper on severe influenza entitled “Delayed administration of recombinant plasma gelsolin improves survival in a murine model of severe influenza.”
“We looked at the gene transmission that occurs when you give gelsolin to the animals that have flu, and it shows how it down-regulates genes for the kinds of mediators that cause a cytokine storm, which is exactly what happens in Covid -19, and it up-regulates genes that lead to healing,” Levinson says. Additionally, it’s been shown to protect the lungs from damage.
Because BioAegis’ recombinant human plasma gelsolin has been manufactured to be identical to the natural human protein, it is not expected to result in serious side effects when supplementing the depleted protein. BioAegis confirmed that no safety signals were seen when it conducted its Phase 1b/2a clinical trial last year in hospitalized pneumonia patients, animal toxicology studies or prior human studies when dosed either intravenously or by inhalation.
“We looked at three different doses of the drug, thinking that with the highest one there might be side effects and we would have to back off. But it turns out that at that highest dose, there were no side effects. It actually raised the levels of gelsolin way above normal, and still there were no side effects,” said Levinson.
She added that the trial also revealed how long the gelsolin lasts in the bloodstream: “We could dose once a day and there was still plenty of drug around,” she said.
As far as comparing plasma gelsolin to remdesivir, Levinson says they each play a completely different role in treating Covid-19 and that perhaps the BioAegis therapy could be looked at as something that could be used in conjunction with the Gilead drug.
“Remdesivir is an antiviral, so it’s trying to remove the virus before things get out of control. What is missing from that is addressing the overexuberant inflammatory response that the body often uses to get rid of the virus. So I think if you treat people early enough before that overexuberant inflammation has started, then the remdesivir will be helpful. But once that inflammatory response has gotten out of control, I don’t think the remdesivir is going to work. You’re going to need something else,” she says.
Dr. Steven M. Opal, an infectious disease specialist at Alpert Medical School of Brown University in Providence Rhode Island, is a medical advisor for BioAegis. He agrees that remdesivir would be much for effective if used with an anti-inflammatory.
“Remdesivir, which is an antiviral drug, has shown efficacy by shortening the duration of illness in a Phase 3 human trial. There is still significant need for agents which modulate the host immune response, such as recombinant human plasma gelsolin, which could have additive effects and significantly improve survival rates,” he told CNBC.
https://www.cnbc.com/2020/05/11/bio...n-regulator-best-weapon-against-covid-19.html
From the article:
Discovered nearly two decades ago in a Harvard lab by the late Dr. Thomas Stossel, a professor of medicine at Harvard Medical School and head of translational medicine at Brigham and Women’s Hospital in Boston, plasma gelsolin is an abundant, naturally occurring circulating protein found in the human body’s immune system.
According to Stossel, it is “a master regulator of the immune system.” In a wide range of diseases, it balances the inflammatory process without suppressing the immune system, thus preventing severe consequences and greatly improving survival.
For nine years the scientists at BioAegis have been studying this unique anti-inflammatory and its effect on treating a wide range of conditions, including influenza, pneumonia, arthritis, Alzheimers, lupus, inflammatory bowel disease, multiple sclerosis and more.
What they discovered was that plasma gelsolin is depleted in severe inflammatory conditions and that restoring a recombinant human form of plasma gelsolin in the body has enormous potential to prevent the lethal ravages of inflammation, such as those caused by Covid-19.
Since 2015, BioAegis has generated data in several models of pneumonia and most recently published a paper on severe influenza entitled “Delayed administration of recombinant plasma gelsolin improves survival in a murine model of severe influenza.”
“We looked at the gene transmission that occurs when you give gelsolin to the animals that have flu, and it shows how it down-regulates genes for the kinds of mediators that cause a cytokine storm, which is exactly what happens in Covid -19, and it up-regulates genes that lead to healing,” Levinson says. Additionally, it’s been shown to protect the lungs from damage.
Because BioAegis’ recombinant human plasma gelsolin has been manufactured to be identical to the natural human protein, it is not expected to result in serious side effects when supplementing the depleted protein. BioAegis confirmed that no safety signals were seen when it conducted its Phase 1b/2a clinical trial last year in hospitalized pneumonia patients, animal toxicology studies or prior human studies when dosed either intravenously or by inhalation.
“We looked at three different doses of the drug, thinking that with the highest one there might be side effects and we would have to back off. But it turns out that at that highest dose, there were no side effects. It actually raised the levels of gelsolin way above normal, and still there were no side effects,” said Levinson.
She added that the trial also revealed how long the gelsolin lasts in the bloodstream: “We could dose once a day and there was still plenty of drug around,” she said.
As far as comparing plasma gelsolin to remdesivir, Levinson says they each play a completely different role in treating Covid-19 and that perhaps the BioAegis therapy could be looked at as something that could be used in conjunction with the Gilead drug.
“Remdesivir is an antiviral, so it’s trying to remove the virus before things get out of control. What is missing from that is addressing the overexuberant inflammatory response that the body often uses to get rid of the virus. So I think if you treat people early enough before that overexuberant inflammation has started, then the remdesivir will be helpful. But once that inflammatory response has gotten out of control, I don’t think the remdesivir is going to work. You’re going to need something else,” she says.
Dr. Steven M. Opal, an infectious disease specialist at Alpert Medical School of Brown University in Providence Rhode Island, is a medical advisor for BioAegis. He agrees that remdesivir would be much for effective if used with an anti-inflammatory.
“Remdesivir, which is an antiviral drug, has shown efficacy by shortening the duration of illness in a Phase 3 human trial. There is still significant need for agents which modulate the host immune response, such as recombinant human plasma gelsolin, which could have additive effects and significantly improve survival rates,” he told CNBC.
https://www.cnbc.com/2020/05/11/bio...n-regulator-best-weapon-against-covid-19.html
My son works at Shop Rite and came home with a fever one day. He had a fever for about 4 days and then a cough for a few days and was fine. I'm 60 and in generally good health (exercise regularly, not over weight, non smoker). It's true that they say younger people recover easier.
The "best" data so far for HCQ was the retrospective study the other day from Wuhan showing lower mortality in moderately to severely sick patients treated with HCQ vs. standard of care, as it proposed that HCQ was being effective in a more "traditional" sense by utilizing its known anti-inflammatory effects to prevent the cytokine storm. However, people have just noted that that Wuhan study has some "irregularities" and might have been HCQ vs. an herbal treatment instead of vs. standard of care. Also, other studies in moderately to severely ill patients with HCQ have not been this positive.
https://blogs.sciencemag.org/pipeline/archives/2020/05/04/hydroxychloroquine-update-may-4
Also, the position that HCQ is an "anti-viral" in humans is questionable. Yes it shows anti-viral activity in-vitro, but to date it hasn't shown any significant anti-viral activity in humans and that's what's really important - there are tons of compounds that work in petri dishes that don't work in the real world. Drug R&D and clinical research is mostly filled with failures - it's simply really hard to prove safety and efficacy in humans. The paper that came out last week has the following conclusion on this topic:
The in-vitro cell culture based data of viral inhibition does not suffice for the use of hydroxychloroquine in the patients with COVID-19. Current literature shows inadequate, low level evidence in human studies. Scarcity of safety and efficacy data warrants medical communities, health care agencies and governments across the world against the widespread use of hydroxychloroquine in COVID-19 prophylaxis and treatment, until robust evidence becomes available.
https://www.medrxiv.org/content/10.1101/2020.04.16.20068205v2.full.pdf
Weekend deaths down to 50.If they stay in double digits the entire week,it's time to return to real living.
Elon Musk is suing Ca. and threatening to take Tesla to Texas if they don't open up. Things are getting interesting!
@wisr01 - Following your posts it really sounds like you believe HCQ to be a game changer if not a true cure but that big pharma is hiding it from the population for financial reasons. Is that a correct statement of your thoughts?
This treatment that has been talked about for many months, studied by many universities, hospitals and almost every developed country in the world. It is being studied by the best medical minds on earth. The race to find a cure/treatment/vaccine is probably the largest project ever in the history of the planet and spans corporations, religions, cultures, politlical dogmas, etc. How do you think such an easy treatment could be covered up by so many?
Deaths are on the decline in NJ but the Monday totals have been a lot less due to weekend reporting.
The # most likely be greater the next couple days.
Easy - it's not a gamechanger or cure and nothing is being covered up, although the original Raoult trial where he called HCQ/Az a "cure" was discredited. This (confusion) is exactly what happens in clinical science when we're trying to rely on mostly suboptimal uncontrolled (and often unrandomized) clinical trials and retrospective observational analyses for what is possibly marginally effective in some situations to ineffective in others.
And we won't have truly definitive data until we have data from the "gold standard" of clinical trials soon, i.e., placebo (or standard of care) controlled, randomized, double-blind trials from a variety of clinical applications (e.g., for mildly symptomatic, moderately sick and severely ill patients). But given that this drug or combos of it have been given to so many patients already, if it were a cure, we'd know about it by now. And if it's more than marginally effective in any of these trials, I'll be the first to say hallelujah and say I was wrong.
Congratulations to Georgia for moving forward successfully!
The same moron who implied HCQ was a cure based on a flawed clinical trial.
https://www.theguardian.com/world/2020/apr/06/hydroxychloroquine-trump-coronavirus-drug
https://www.medpagetoday.com/infectiousdisease/covid19/86413
3 drug cocktail shows promise. why not give this kind of therapy to people when they show symptoms why do people have to wait until the are going on a ventilator to get help.
3 drug cocktail shows promise. why not give this kind of therapy to people when they show symptoms why do people have to wait until the are going on a ventilator to get help.
If you haven’t yet, you’ve gotta check out Dr. Chris Martensen on YouTube. His channel is called “Peak Prosperity” and he simply provides the best, most unbiased info and analysis of the virus. He has been pumping out videos since December or January and has been right every step of the way. His videos are long so I watch on 1.5 or 1.75x, and he puts one out every day so just find ones that interest you and you won’t be able to turn away. Fascinating stuff.
States with real leaders are showing us the way forward. Chicken Littles like Cuomo and Murphy need to pay attention.
CDC says death toll in NYC may be as much as 5K higher than official tally.
https://www.cnbc.com/2020/05/11/cdc...yc-deaths-possibly-linked-to-coronavirus.html
https://www.cnbc.com/2020/05/11/cdc...yc-deaths-possibly-linked-to-coronavirus.html
I like you but your troll act is so old. Take it to the CE board for trolling and then be your serious self here.
Same with Cali. Super cringy stuff that really has nothing to do with this thread.
Stopped reading here.
:)
Seriously, Murphy has been a disaster, especially regarding his policy of returning corona positive patients back to their LTC/nursing homes. He deserves a lot of scorn for that.
Confirmed cases under 1000 for NJ and NY currently. If that holds, first time since March. I know it’s a weekend data thing, but look back the last few Monday’s and it’s a good trend.
Dunno why they removed the 7 day moving average.
Dunno why they removed the 7 day moving average.
I was told my multiple people in this thread to watch what happens after they open up because they're "doomed" and so are the other states that are opening.
Other people throw political jabs into this thread including OP, which is fine but you're only complaining about the comments that you don't agree with.
What are you talking about? Nobody even mentioned anything political.
Was there really multiple people that said they are doomed?
Also, do we know that Georgia is out of the woods yet? Haven’t been paying attention to their numbers. I know that they still have social distancing measures in place so was hoping they would avoid flare-ups by semi-opening and keeping social distancing. Would be good news for us when we get to their level of infected population.
Georgia opened up partially just over a couple of weeks ago. There's no reason to pat them on the back yet and call them a success story.
Yes they still have some social distancing measures in. I would expect that everywhere for a few months. Like restaurants/movie theaters half capacity etc.
A second larger observational/retrospective study on COVID patients in NYC was published today in the Journal of the American Medical Association. Like the NEJM study, it was peer-reviewed and in one of the best journals out there, so while it's not a controlled clinical trial it was at least randomized and given its size it should be paid attention to.
The findings were pretty straightforward, showing no benefit from HCQ treatment with regard to the primary endpoint of mortality and showing an increased risk of cardiac arrest for the HCQ/AZ treatment arm; see the excerpt below. The analysis was done on a random sample of 1438 patients, of which 70% were treated with either HCQ (18.8%) or HCQ/Azithromycin (51.1%), while 14.7% were treated with AZ alone and 15.4% received neither drug and treatment was begun within 1 day of admission into the hospital.
https://jamanetwork.com/journals/jama/fullarticle/2766117#full-text-tab
In this study, during rapidly expanding hospitalization for COVID-19, 70% of patients received hydroxychloroquine alone or with azithromycin. Patients who received hydroxychloroquine with or without azithromycin were more likely (relative to patients receiving neither drug) to be male, have preexisting medical conditions, and have impaired respiratory or liver function at presentation. There were no significant differences in in-hospital mortality between patients who received hydroxychloroquine with or without azithromycin and patients who received neither drug.
The lack of observed benefit of hydroxychloroquine associated with in-hospital mortality, following adjustment for preexisting disease and severity of illness on admission, is consistent with recently reported data from other observational studies.17,23,24
To our knowledge, this study is the largest report of adverse effects of hydroxychloroquine among patients with COVID-19. Cardiac arrest was more frequent in patients who received hydroxychloroquine with azithromycin, compared with patients who received neither drug, even after adjustment.
In my opinion, these two studies clearly show there's no benefit to HCQ or HCQ/AZ treatment upon hospital admission (at least moderately ill patients), whereas the original, discredited research from Raoult showed these to be the patients that were "cured" by HCQ/AZ, leading to the POTUS getting involved in recommending the drug. Yes, it will be nice to see the controlled clinical studies for these patients, but it's hard to believe these large retrospective studies wouldn't have shown some benefit, if HCQ was effective.
In anticipation of questions, yes, we still need those trials and yes it will be good to see what the controlled trial by Boulware at MN shows, looking at mildly symptomatic (or even pre-symptomatic) patients, although the evidence, so far, on the "anti-viral" activity of HCQ in humans is weak (as opposed to demonstrated in-vitro activity, but this is not uncommon).
https://www.medrxiv.org/content/10.1101/2020.04.16.20068205v2.full.pdf
HCQ isn’t useful after about day 10-12 of being infected, so any study that doesn’t show “when” HCQ was administered is also useless. No?
The JAMA study showed that these patients were being treated with HCQ from the day of admission, generally. These studies are clearly showing that HCQ is ineffective upon having symptoms significant enough for hospitalization, which has been an open question, ever since Raoult's initial paper on this, which was based on patients with COVID in hospitals miraculously being "cured" (after cooking the books on which patients were included in the study, which is why the society publishes the journal in which his paper was published eventually discredited the work).
All of this started because of excitement about HCQ possibly being a cure for moderately ill patients like the NYC ones in the JAMA paper, so demonstrating that that is not the case (or that it could've been the case) was critical for medical science. Why else do you think a random sample of thousands of NYC patients showed 70% were being treated with HCQ? I think it's worth showing that the vast majority, if not all of those patients, were being treated with a drug that was very likely ineffective (and potentially dangerous).
This should have never happened, but I understand why it did, since doctors and patients were desperate for anything that might work in a pandemic. In hindsight, it would've been far better to put all of these folks on remdesivir, which it turns out at least has some efficacy.
Nobody is "doomed" - this is not the end of humanity, but if we don't intervene in transmissions, we're likely to see at least 500K deaths in this country and possibly 1MM or more, eventually (12+ months), which would be a pretty lousy outcome. Opening back up before an outbreak is controlled and testing/tracing are in place simply means more will get infected and die, although that also depends on the level of mask-wearing and social distancing (and especially not holding large events), which can greatly reduce transmission if done well.
With modest social distancing and some mask-wearing, I'd guess we'd see a "slow burn" overall with hospitalizations/deaths staying fairly steady, but with some hotspots likely in densely populated areas and/or where distancing/masks are being ignored (especially if large gatherings go on). Georgia's certainly not immune to major outbreaks, like the one that occurred in Albany, GA. I'd also pay close attention to GA's cities.
Also, I think you have an error or typo in your logic above. We're way "ahead" of GA in terms of the number of people infected, given the far worse outbreak in the NY/NJ area. They're opening up before our area in spite of that (meaning they're at greater risk since there are many more left to infect).
Another study where the really sick patients got treatments and being compared to milder cases. So the two best journals out there published garbage comparing apples and oranges. Top notch work for sure.
Patients receiving either drug were more likely (relative to neither drug) to be male (Table 1). Black or Hispanic patients were as likely to receive hydroxychloroquine and/or azithromycin. Median patient age was similar in the 4 groups (hydroxychloroquine + azithromycin, 61.4 years; hydroxychloroquine alone, 65.5 years; azithromycin alone, 62.5 years; and neither drug, 64.0 years [P = .35]). Six of 25 (24.0%) children received either hydroxychloroquine or azithromycin. Patients receiving hydroxychloroquine + azithromycin and hydroxychloroquine alone were more likely to be obese and have diabetes than those in the groups receiving azithromycin alone and neither drug. Patients receiving hydroxychloroquine alone had the highest levels of chronic lung disease (25.1%) and cardiovascular conditions (36.5%).
As indicated by respiratory (chest imaging, respiratory rate, O2 saturation) and hepatic (AST, alanine aminotransferase) measurements during the first 24 hours, patients in the treatment groups, particularly hydroxychloroquine + azithromycin, presented as having more clinically severe disease than the neither drug group. Ninety-five percent of the hydroxychloroquine + azithromycin group had abnormal chest imaging findings (top 3: air space opacity [63.0%], lung infiltrate [23.8%], and bronchopneumonia/pneumonia [20.7%]). No differences were observed in the timing of COVID-19 diagnosis; only 13.9% (193/1384) of patients were diagnosed before admission (median, 2 days before).
The patients had very significantly different O2 saturations.
The columns below represent in order HCQ+AZ, HCQ, AZ, Nothing. The HCQ+AZ group had over three times the number of patients with )2 Sat <90%.
Why is this important?
https://www.sciencedirect.com/science/article/pii/S0025619620303670#fig2
We found that dyspnea, an easily assessed symptom, is associated with death in patients with COVID-19–associated pneumonia independently of age and sex. However, a related and also easily acquired clinical measure, SpO2 of 90% or less despite oxygen supplementation, provides a more robust risk factor for fatal outcomes; indeed, this measure is the most powerful predictor of the multiple measures we obtained, including the more standard demographic and inflammatory measures reported in earlier studies.
Why did you not post this study:
https://www.medrxiv.org/content/10.1101/2020.05.05.20088757v1.full.pdf
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So there's been a fair amount of talk here about the "EVMS" protocols posted by the physicians in Virginia. Their protocols focus on treating inflammation (with steroids and vitamin C) and hypercoagulation/blood clotting (with heparin or similar). Martenson was talking about another treatment protocol called MATH+ which is very similar. I'm providing links to it below. It also focuses on using steroids (methyl-pred in particular) and very high doses of IV vitamin C, along with heparin.
Wondering if any of the MDs here (@RUfubar for one) can talk about whether these types of treatments are being used in their hospitals and if so, whether they are seeing better results. The claim from some of the doctors using the MATH+ protocol is that if treatment is started as early as possible (when someone shows up in the ER, not when they get sent to the ICU) it significantly reduces the need for intubation and lowers the death rate.
https://covid19criticalcare.com/ (main page including a short video)
https://www.hsgac.senate.gov/imo/media/doc/Testimony-Kory-2020-05-06-REVISED.pdf (description from one of the doctors involved)
As I've said before, I'm not an MD but all of this sounds very logical to me so I'm wondering if it's being used with success around the country.
Also, here's an interesting blog account of what it was like in the NYC ERs/ICUs during the surge phase of the epidemic:
https://emupdates.com/surge/
Wondering if any of the MDs here (@RUfubar for one) can talk about whether these types of treatments are being used in their hospitals and if so, whether they are seeing better results. The claim from some of the doctors using the MATH+ protocol is that if treatment is started as early as possible (when someone shows up in the ER, not when they get sent to the ICU) it significantly reduces the need for intubation and lowers the death rate.
https://covid19criticalcare.com/ (main page including a short video)
https://www.hsgac.senate.gov/imo/media/doc/Testimony-Kory-2020-05-06-REVISED.pdf (description from one of the doctors involved)
As I've said before, I'm not an MD but all of this sounds very logical to me so I'm wondering if it's being used with success around the country.
Also, here's an interesting blog account of what it was like in the NYC ERs/ICUs during the surge phase of the epidemic:
https://emupdates.com/surge/
With less than one-third of today's population,the Spanish flu killed 8 times the number that has COVID,making that one 25 times worse than the present one.How was that one handled?
Much less efficiently. If they had computers, cell phones and video conferencing..even television.. they could have crushed it. Even if you took the media aspect out, imagine what 100 years of medical knowledge (giving them access to our 2020 medicines, data banks, empirical evidence, etc) would have done greatly to help.
This virus is only the beginning of what is predicted... we have no clues... the so called experts don’t have a plan... the scientists saying 18 months for a vaccine are guessing... if the vaccine isn’t at least 70% effective then we still have a big problem... 60% won’t cut it... you’re the expert here....at what level does a vaccine need to be at ? or do you expect a combo of several vaccines?Nobody is "doomed" - this is not the end of humanity, but if we don't intervene in transmissions, we're likely to see at least 500K deaths in this country and possibly 1MM or more, eventually (12+ months), which would be a pretty lousy outcome. Opening back up before an outbreak is controlled and testing/tracing are in place simply means more will get infected and die, although that also depends on the level of mask-wearing and social distancing (and especially not holding large events), which can greatly reduce transmission if done well.
With modest social distancing and some mask-wearing, I'd guess we'd see a "slow burn" overall with hospitalizations/deaths staying fairly steady, but with some hotspots likely in densely populated areas and/or where distancing/masks are being ignored (especially if large gatherings go on). Georgia's certainly not immune to major outbreaks, like the one that occurred in Albany, GA. I'd also pay close attention to GA's cities.
Also, I think you have an error or typo in your logic above. We're way "ahead" of GA in terms of the number of people infected, given the far worse outbreak in the NY/NJ area. They're opening up before our area in spite of that (meaning they're at greater risk since there are many more left to infect).
Todays reported deaths for NJ were 77, which is up from 65 last Monday. So it will be interesting to see the #'s tomorrow, last Tuesday they reported 341. The Tuesday prior they reported 398.
Poorly. With the "Spanish Flu," the first wave in March/April/May was mild. The second wave was the deadly one, in the Fall. And there was a milder third wave.
Another study where the really sick patients got treatments and being compared to milder cases. So the two best journals out there published garbage comparing apples and oranges. Top notch work for sure.
Patients receiving either drug were more likely (relative to neither drug) to be male (Table 1). Black or Hispanic patients were as likely to receive hydroxychloroquine and/or azithromycin. Median patient age was similar in the 4 groups (hydroxychloroquine + azithromycin, 61.4 years; hydroxychloroquine alone, 65.5 years; azithromycin alone, 62.5 years; and neither drug, 64.0 years [P = .35]). Six of 25 (24.0%) children received either hydroxychloroquine or azithromycin. Patients receiving hydroxychloroquine + azithromycin and hydroxychloroquine alone were more likely to be obese and have diabetes than those in the groups receiving azithromycin alone and neither drug. Patients receiving hydroxychloroquine alone had the highest levels of chronic lung disease (25.1%) and cardiovascular conditions (36.5%).
As indicated by respiratory (chest imaging, respiratory rate, O2 saturation) and hepatic (AST, alanine aminotransferase) measurements during the first 24 hours, patients in the treatment groups, particularly hydroxychloroquine + azithromycin, presented as having more clinically severe disease than the neither drug group. Ninety-five percent of the hydroxychloroquine + azithromycin group had abnormal chest imaging findings (top 3: air space opacity [63.0%], lung infiltrate [23.8%], and bronchopneumonia/pneumonia [20.7%]). No differences were observed in the timing of COVID-19 diagnosis; only 13.9% (193/1384) of patients were diagnosed before admission (median, 2 days before).
The patients had very significantly different O2 saturations.
The columns below represent in order HCQ+AZ, HCQ, AZ, Nothing. The HCQ+AZ group had over three times the number of patients with )2 Sat <90%.
Why is this important?
https://www.sciencedirect.com/science/article/pii/S0025619620303670#fig2
We found that dyspnea, an easily assessed symptom, is associated with death in patients with COVID-19–associated pneumonia independently of age and sex. However, a related and also easily acquired clinical measure, SpO2 of 90% or less despite oxygen supplementation, provides a more robust risk factor for fatal outcomes; indeed, this measure is the most powerful predictor of the multiple measures we obtained, including the more standard demographic and inflammatory measures reported in earlier studies.
Why did you not post this study:
https://www.medrxiv.org/content/10.1101/2020.05.05.20088757v1.full.pdf
Very hard to control every variable in a retrospective study, so they did the next best thing and adjusted the mortality rates factoring in those differences, as clearly stated below - this is not unusual in retrospective studies and does not mean they're "garbage." In fact, prior to these adjustments, the primary outcome (mortality) showed significant differences in the treatment groups, with HCQ and HCQ/AZ being higher. However, rather than concluding that, they then factored in adjustments, such that there was no longer a statistically significant difference in mortality rates in any of the groups, which was their final conclusion (HCQ and HCQ/AZ deaths were still greater, but not statistically greater).
Overall in-hospital mortality was 20.3% (95% CI, 18.2%-22.4%). In unadjusted analyses, significant differences in in-hospital death were observed across the hydroxychloroquine + azithromycin (n = 189, 25.7% [95% CI, 22.3%-28.9%]), hydroxychloroquine alone (n = 54, 19.9% [95% CI, 15.2%-24.7%]), azithromycin alone (n = 21, 10.0% [95% CI, 5.9%-14.0%]), and neither-drug (n = 28, 12.7% [95% CI, 8.3%-17.1%]) groups (P < .001). Similar patterns were observed for death per patient-day overall and post drug initiation (Table 2).
In the primary analysis, following adjustment for demographics, specific hospital, preexisting conditions, and illness severity, no significant differences in mortality were found between patients receiving hydroxychloroquine + azithromycin (adjusted HR, 1.35 [95% CI, 0.76-2.40]), hydroxychloroquine alone (adjusted HR, 1.08 [95% CI, 0.63-1.85]), or azithromycin alone (adjusted HR, 0.56 [95% CI, 0.26-1.21]), compared with neither drug (Table 3) (complete case analysis variable completeness was 86%).
From this model, estimated direct-adjusted mortality at 21 days was 22.5% (95% CI, 19.7%-25.1%) with hydroxychloroquine + azithromycin, 18.9% (95% CI, 14.3%-23.2%) with hydroxychloroquine alone, 10.9% (95% CI, 5.8%-15.6%) with azithromycin alone, and 17.8% (95% CI, 11.1%-23.9%) with neither drug (Figure 2). No significant mortality difference was found between hydroxychloroquine alone and azithromycin alone (adjusted HR, 1.92 [95% CI, 0.99-3.74]). Results were similar in the 3 alternative Cox models (eTable 6 in Supplement 2).
The other study was just posted today and is a preprint, as opposed to the JAMA study, which was also posted today, but is peer-reviewed and in a prestigious journal, so why would you expect me to have seen the first one?
You're right that we're probably in about the top of the 3rd inning on this one, with a long way to go. However, most of the experts I know of absolutely have a plan, which is essentially the South Korea plan, which is essentially the US Pandemic Playbook, i.e., massive testing/tracing/isolating, with mask-wearing and social distancing, while doing a phased reopening of most of the economy/society.
That can work to detect and stamp out flare-ups, while keeping new infections and deaths low, until there's a cure or vaccine. Nobody knows how long that will take, but it's the one area I'm optimistic on, given my career in pharma and seeing the incredible level of scientific publication and collaboration going on across the world.
Convalescent plasma results, anecdotally have been very good, but it would be nice to see something more formal shared - this has the potential to at least prevent a large % of deaths. And engineered antibodies (more potent/selective than CP) has the potential to be just about a cure (and a preventative for some) and we should see some of these available by the end of the summer (for at least those on the front lines). I also think we'll see a commercial vaccine by the end of the year, especially if we go the "human challenge" route and it's very likely a coronavirus vaccine would be far more effective than the ones for influenza and last longer (far less mutation in CV vs. flu). This is what I see, but none of it is a given.
Was just about to post this then noticed your post. Anyway here's the full story. Latest CDC publication from the NY DOH on deaths in NYC is ugly. From 3/11 through 5/2, the official death toll in NYC has been 18,800, which roughly matches the 13,831 confirmed COVID deaths plus the 5048 probably COVID deaths (mostly in hospitals with COVID symptoms, but not a formal test, usually since the symptoms are obvious and taking the test sample for someone seriously ill is a danger to health care workers).
However, during this period there were an additional 5293 excess deaths in NYC, above normal baseline levels for that period and some to many of these are likely COVID related. As many have been saying, it's far more likely deaths in NYC and elsewhere are being undercounted, not overcounted. As the report says, "Estimation of all-cause excess deaths is used as a nonspecific measure of the severity or impact of pandemics (4) and public health emergencies (5). Reporting of excess deaths might provide a more accurate measure of the impact of the pandemic."
During March 11–May 2, 2020, a total of 32,107 deaths were reported to DOHMH; of these deaths, 24,172 (95% confidence interval = 22,980–25,364) were found to be in excess of the seasonal expected baseline. Included in the 24,172 deaths were 13,831 (57%) laboratory-confirmed COVID-19–associated deaths and 5,048 (21%) probable COVID-19–associated deaths, leaving 5,293 (22%) excess deaths that were not identified as either laboratory-confirmed or probable COVID-19–associated deaths (Figure).
The 5,293 excess deaths not identified as confirmed or probable COVID-19–associated deaths might have been directly or indirectly attributable to the pandemic. The percentages of these excess deaths that occurred in persons infected with SARS-CoV-2 or resulted from indirect impacts of the pandemic are unknown and require further investigation.
https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e5.htm
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