COVID-19 Pandemic: Transmissions, Deaths, Treatments, Vaccines, Interventions and More...

[RU848789]

Anecdotal but be worth a look.

https://medicaldialogues.in/medicin...may-be-new-effective-covid-19-treatment-65868

We have got astounding results. Out of 60 COVID-19 patients, all recovered as the combination of the two drugs were applied, said Professor Dr Md Tarek Alam, the head of medicine department at private Bangladesh Medical College Hospital (BMCH).

Alam, a reputed clinician in Bangladesh, said a frequently used antiprotozoal medicine called Ivermectin in a single dose with Doxycycline, an antibiotic, yielded virtually the near-miraculous result in curing the patients with COVID-19. A

It doesn't really make sense that an anti-parasitic drug, like ivermectin, would work on a virus, which is why so many have been skeptical about the anti-malaria (also caused by a parasite) drug HCQ working on a virus, but it can't hurt to look, I guess. Would be cool for me, personally, to see ivermectin work, since I worked on this drug in the late 80s at Merck (it's almost completely an animal-heath drug - it's the active ingredient in Heartguard and it has been donated to African countries for decades to cure river blindness) - it's a beast to make, but is usually active at very low doses.

There was a preprint awhile ago on this that hasn't apparently been published yet (so large grains of salt required), showing mortality reduction, but it was a prospective observational trial not a controlled clinical trial, as the study noted - studies like this are often done to generate interest in doing more definitive controlled studies.

https://poseidon01.ssrn.com/deliver...2074111111029069011028099028000103024&EXT=pdf

 

[RU848789]

Peer-reviewed retrospective study out of China

https://link.springer.com/content/pdf/10.1007/s11427-020-1732-2.pdf

The levels of inflammatory cytokine IL-6 were significantly reduced from 22.2 (8.3–118.9) pg mL–1 at the beginning of the treatment to 5.2 (3.0–23.4) pg mL–1 (P<0.05) at the end of the treatment in the HCQ group but there is no change in the NHCQ group. These data demonstrate that addition of HCQ on top of the basic treatments is highly effective in reducing the fatality of critically ill patients of COVID-19 through attenuation of inflammatory cytokine storm. Therefore, HCQ should be prescribed as a part of treatment for critically ill COVID-19 patients, with possible outcome of saving lives.

The retrospective study above was part of the meta-analysis paper (preprint, not peer-reviewed yet) that just came out looking at 11 trials, through 5/13, on HCQ, which has found no statistical differences in favor of HCQ treatment in viral clearance, symptom improvement or mortality. This kind of variability in largely non-controlled studies is what one would expect to see for a drug with little to no efficacy in a highly dynamic pandemic with less control than usual on what's going on in the clinical setting, i.e., some indications of modest effectiveness and many more with no indications of effectiveness. The meta-analysis paper is below, as is an excerpt from Derek Lowe's latest blog on HCQ.

https://www.medrxiv.org/content/10.1101/2020.05.14.20101774v2.full.pdf

Here's a review of everything in the literature on COVID-19 and hydroxychloroquine treatment up to May 13. It summarizes eleven studies (3 controlled trials and 8 observational/retrospective efforts), totaling 2354 patients receiving HCQ (alone or in combination) and 1952 controls. Overall, there was no difference in viral clearance. No difference in symptomatic improvement. No difference in overall mortality. The only clear difference between the two groups was in adverse effects, which were (on again) higher in the HCQ treated population.

https://blogs.sciencemag.org/pipeline/archives/2020/05/19/taking-hydroxychloroquine-may-19-update

Lowe also discussed a few trials that have hit the internet since 5/13, including an open-label randomized study of 150 people from China (no change in viral clearance) an observational study of 181 patients in France (no benefit from HCQ and increased side effects) and a retrospective study from NYU of HCQ + AZ + Zn in 411 patients that showed some efficacy. My guess is 1 of 3 showing a modest benefit wouldn't budge the conclusions of the meta-analysis of the 11 studies above. He has links to all three in his blog.

 

[RUhasarrived]

The front page of tomorrow's NY Post presents the non-scientific side of all of this.

 

[wisr01]

The retrospective study above was part of the meta-analysis paper (preprint, not peer-reviewed yet) that just came out looking at 11 trials, through 5/13, on HCQ, which has found no statistical differences in favor of HCQ treatment in viral clearance, symptom improvement or mortality. This kind of variability in largely non-controlled studies is what one would expect to see for a drug with little to no efficacy in a highly dynamic pandemic with less control than usual on what's going on in the clinical setting, i.e., some indications of modest effectiveness and many more with no indications of effectiveness. The meta-analysis paper is below, as is an excerpt from Derek Lowe's latest blog on HCQ.

https://www.medrxiv.org/content/10.1101/2020.05.14.20101774v2.full.pdf

Here's a review of everything in the literature on COVID-19 and hydroxychloroquine treatment up to May 13. It summarizes eleven studies (3 controlled trials and 8 observational/retrospective efforts), totaling 2354 patients receiving HCQ (alone or in combination) and 1952 controls. Overall, there was no difference in viral clearance. No difference in symptomatic improvement. No difference in overall mortality. The only clear difference between the two groups was in adverse effects, which were (on again) higher in the HCQ treated population.

https://blogs.sciencemag.org/pipeline/archives/2020/05/19/taking-hydroxychloroquine-may-19-update

Lowe also discussed a few trials that have hit the internet since 5/13, including an open-label randomized study of 150 people from China (no change in viral clearance) an observational study of 181 patients in France (no benefit from HCQ and increased side effects) and a retrospective study from NYU of HCQ + AZ + Zn in 411 patients that showed some efficacy. My guess is 1 of 3 showing a modest benefit wouldn't budge the conclusions of the meta-analysis of the 11 studies above. He has links to all three in his blog.

It is funny how Lowe missed these gems.


In the study by Tang et al., the main biases are that in the group with hydroxychloroquine (HCQ) the patients were older, had more comorbidities, and had received almost twice as much HCQ as those recommended. The majority of patients in the groups (including the controls) had also received antivirals (which is annoying to measure the antiviral effect of HCQ versus the control group). The mean duration before treatment was 17 days (far too long for antiviral therapy). Despite these biases, the study shows a positive effect of 4 points *** between the HCQ group and the control group. However, the authors prefer to conclude that there is no efficacy of HCQ .


In the study by Mahévas et al., the patients were all in a severe condition (severe acute respiratory syndrome with need for oxygen). Curiously in the control group, 29% of the patients also took azithromycin, while only 18% of the cases took it in the HCQ group. When looking at patients transferred to intensive care (ICU), the HCQ effect is nevertheless visible since 1.5 times less ICU transfer in the HCQ group is observed compared to the control group. But above all, in an extraordinary way, we can see in the details of the study that in the small group of patients taking both HCQ and azithromycin, there were zero deaths and no transfer to ICU. On the other hand, the small control group also taking azithromycin (but no HCQ) had to deplore 6 ICU admissions and 5 deaths.However, the authors also prefer to conclude that hydroxychloroquine is ineffective while the study clearly shows the efficacy of the hydroxychloroquine + azithromycin treatment versus the control taking only azithromycin.

Also copied directly from the same French study:

Our study has several limitations. Firstly, although we used robust methods and statistical techniques to draw causal inferences from observational data, treatment was not randomly assigned and potential unmeasured confounders could bias our results. Secondly, four potentially important prognostic variables could not be balanced in the propensity score model because none or only one patient in the treatment group presented with these variables. Accordingly, caution is required in interpreting these results, especially for overall mortality for which only a few events were observed. Nevertheless, this limitation did favour the hydroxychloroquine group and the absence of any difference between treated and untreated patients further strengthens our conclusions. Thirdly, we did not take a centre effect into account in the propensity score model because the number of patients treated with hydroxychloroquine in centres was unbalanced (some centres treated all their patients, whereas others did not). Nevertheless, that the decision to treat or not treat patients with hydroxychloroquine was based on local medical consensus rather than on their characteristics should reduce this bias. Fourthly, our sample was limited to the number of eligible patients available at the time of analysis; we cannot rule out the possibility that our findings are owing to a lack of power. Fifthly, because we included only patients admitted to hospital, we cannot reach a conclusion about the possible efficacy of hydroxychloroquine in preventing covid-19 or in preventing severe forms of the disease. Finally, our study was not designed to assess the efficacy of the association of hydroxychloroquine and azithromycin, and no conclusion about its efficacy can be reached. Further research is ongoing.

 

[T2Kplus10]

600+ Doctors raise alarm about health effects of continued coronavirus shutdown: 'Mass casualty incident'

https://www.foxnews.com/politics/do...lth-effects-of-continued-coronavirus-shutdown

More than 600 doctors signed onto a letter sent to President Trump Tuesday pushing him to end the "national shutdown" aimed at slowing the spread of the coronavirus, calling the widespread state orders keeping businesses closed and kids home from school a "mass casualty incident" with "exponentially growing health consequences."

The letter outlines a variety of consequences that the doctors have observed resulting from the coronavirus shutdowns, including patients missing routine checkups that could detect things like heart problems or cancer, increases in substance and alcohol abuse, and increases in financial instability that could lead to "[p]overty and financial uncertainty," which "is closely linked to poor health."

"We are alarmed at what appears to be the lack of consideration for the future health of our patients," the doctors say in their letter. "The downstream health effects ... are being massively under-estimated and under-reported. This is an order of magnitude error."

The letter continues: "The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.

"Because the harm is diffuse, there are those who hold that it does not exist. We, the undersigned, know otherwise."

The letter comes as the battle over when and how to lift coronavirus restrictions continues to rage on cable television, in the courts, in protests and among government officials. Those for lifting the restrictions have warned about the economic consequences of keeping the shutdowns in effect. Those advocating a more cautious approach say that having more people out and about will necessarily end with more people becoming infected, causing what National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci warned in a Senate hearing last week would be preventable "suffering and death."

But these doctors point to others that are suffering, not from the economy or the virus, but simply from not being able to leave home. The doctors' letter lists a handful of patients by their initials and details their experiences.

 

[wisr01]

Nope. Not even a tiny bit better. junk science is all over the place now, and it's like wild west Covid Dodge City. Let's throw it against the wall and see if it sticks. And I've been doing this a long time and I am always seemingly the one running into thatthat 1% who is supposed to not have an adverse reaction or so forth.
Let's create a narrative. And then let's go prove that narrative. Pretty much anybody can do that. That's why we have peer review and a lot of stuff gets retracted in the aftermath.

If hydroxychloroquine causes such dangerous side effects why do lupus and rheumatoid arthritis patients take for years with little to no monitoring except for eye exam after a few years? Why is it given as malaria prophylaxis with no monitoring? HCQ when given at normal doses is a safe medicine. The degree of alarm being spread is mostly by doctors who have never prescribed the medicine. Talk to a rheumatologist or a tropical med expert, and there is no alarm.

Sounds more like MSM, politicians and junk doctors...

 

[RUevolution36]

600+ Doctors raise alarm about health effects of continued coronavirus shutdown: 'Mass casualty incident'

https://www.foxnews.com/politics/do...lth-effects-of-continued-coronavirus-shutdown

More than 600 doctors signed onto a letter sent to President Trump Tuesday pushing him to end the "national shutdown" aimed at slowing the spread of the coronavirus, calling the widespread state orders keeping businesses closed and kids home from school a "mass casualty incident" with "exponentially growing health consequences."

The letter outlines a variety of consequences that the doctors have observed resulting from the coronavirus shutdowns, including patients missing routine checkups that could detect things like heart problems or cancer, increases in substance and alcohol abuse, and increases in financial instability that could lead to "[p]overty and financial uncertainty," which "is closely linked to poor health."

"We are alarmed at what appears to be the lack of consideration for the future health of our patients," the doctors say in their letter. "The downstream health effects ... are being massively under-estimated and under-reported. This is an order of magnitude error."

The letter continues: "The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.

"Because the harm is diffuse, there are those who hold that it does not exist. We, the undersigned, know otherwise."

The letter comes as the battle over when and how to lift coronavirus restrictions continues to rage on cable television, in the courts, in protests and among government officials. Those for lifting the restrictions have warned about the economic consequences of keeping the shutdowns in effect. Those advocating a more cautious approach say that having more people out and about will necessarily end with more people becoming infected, causing what National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci warned in a Senate hearing last week would be preventable "suffering and death."

But these doctors point to others that are suffering, not from the economy or the virus, but simply from not being able to leave home. The doctors' letter lists a handful of patients by their initials and details their experiences.

A letter pre-written by the white house and endorsed by doctors that the administration has been desperately scouring the country for to co-sign this statement? Please. The reality is, we won't be remotely safe from a resurgence of virus cases no matter what we do. The slow, cautious reopening is the sensible thing to do. However, we need to be ready for potential shutdowns at any point in time until we have a vaccine or two.

 

[T2Kplus10]

A letter pre-written by the white house and endorsed by doctors that the administration has been desperately scouring the country for to co-sign this statement? Please. The reality is, we won't be remotely safe from a resurgence of virus cases no matter what we do. The slow, cautious reopening is the sensible thing to do. However, we need to be ready for potential shutdowns at any point in time until we have a vaccine or two.

Sorry, jumping to a lot of conclusions there. You need to keep an open mind. Thank you.
:)

 

[formerlyknownasrutgers100]

Sorry, jumping to a lot of conclusions there. You need to keep an open mind. Thank you.
:)

like you did by continuously posting that this the flu??

 

[RUfubar]

If hydroxychloroquine causes such dangerous side effects why do lupus and rheumatoid arthritis patients take for years with little to no monitoring except for eye exam after a few years? Why is it given as malaria prophylaxis with no monitoring? HCQ when given at normal doses is a safe medicine. The degree of alarm being spread is mostly by doctors who have never prescribed the medicine. Talk to a rheumatologist or a tropical med expert, and there is no alarm.

Sounds more like MSM, politicians and junk doctors...

Many covid 19 patients present with concurrent myocardial injury so they're not your typical rheumatological patient or tropical medicine patient. Many of these patients are acutely ill and decompensate quickly and are predisposed to lethal arrhythmias.
B. Loading dose is 800 mg on the first day which is not your normal dose
C. What does HCQ historical safety profile have to do with the way we're using it in this particular disease along with zithromax which can also pre-dispose to cardiac arrhythmias?
D. So when you are the prescriber you can weigh it out. I prescribe it, but I don't like it ,
I'm not convinced it works Even though I've had positive anecdotal evidence. Anecdotal evidence is not a good way to practice medicine. But if the patients are convinced that it works, And we have informed consent, And I have what looks like a stable patient who I know pretty well - then I'll give it to him. Any safe drug can become a dangerous drug depending on the clinical situation.

 

[RU848789]

A letter pre-written by the white house and endorsed by doctors that the administration has been desperately scouring the country for to co-sign this statement? Please. The reality is, we won't be remotely safe from a resurgence of virus cases no matter what we do. The slow, cautious reopening is the sensible thing to do. However, we need to be ready for potential shutdowns at any point in time until we have a vaccine or two.

Naked political posturing at its worst and the kind of crap that belongs on the CE board not here. If those doctors were so concerned with saving lives, they'd be applauding the lockdowns for saving lives not lost due to COVID, plus the huge numbers of lives saved by much lower car accident and murder death rates. Truth is this is a political stunt, since other than a 4-6 week period in NY/NJ and a few other states, most people have been able to get the medical care they need, especially critical care.

Yes, there real risks of things like depression and suicide rates going up, as this has been difficult for almost all Americans, but opening up the economy prematurely, without appropriate testing/tracing/isolating in place and nowhere near strong enough mask-wearing/social distancing guidance/leadership from the Feds, will result in having a lot more people die from the virus and that fear and uncertainty won't bring the economy back. Only eliminating fear/uncertainty through controlling the virus will improve both public health and the economy. I might have to post a link to the McKinsey study (and my post on it) every day...

https://www.mckinsey.com/business-f...-uncertainty-the-big-unlock-for-our-economies

https://rutgers.forums.rivals.com/t...ocial-distancing.191275/page-115#post-4562473

 

[T2Kplus10]

Naked political posturing at its worst and the kind of crap that belongs on the CE board not here. If those doctors were so concerned with saving lives, they'd be applauding the lockdowns for saving lives not lost due to COVID, plus the huge numbers of lives saved by much lower car accident and murder death rates. Truth is this is a political stunt, since other than a 4-6 week period in NY/NJ and a few other states, most people have been able to get the medical care they need, especially critical care.

Yes, there real risks of things like depression and suicide rates going up, as this has been difficult for almost all Americans, but opening up the economy prematurely, without appropriate testing/tracing/isolating in place and nowhere near strong enough mask-wearing/social distancing guidance/leadership from the Feds, will result in having a lot more people die from the virus and that fear and uncertainty won't bring the economy back. Only eliminating fear/uncertainty through controlling the virus will improve both public health and the economy. I might have to post a link to the McKinsey study (and my post on it) every day...

https://www.mckinsey.com/business-f...-uncertainty-the-big-unlock-for-our-economies

https://rutgers.forums.rivals.com/t...ocial-distancing.191275/page-115#post-4562473

These 600+ doctors seem pretty sincere and logical. It's good they voiced their opinion based on medical expertise. Something to think about.

 

[RU848789]

It is funny how Lowe missed these gems.


In the study by Tang et al., the main biases are that in the group with hydroxychloroquine (HCQ) the patients were older, had more comorbidities, and had received almost twice as much HCQ as those recommended. The majority of patients in the groups (including the controls) had also received antivirals (which is annoying to measure the antiviral effect of HCQ versus the control group). The mean duration before treatment was 17 days (far too long for antiviral therapy). Despite these biases, the study shows a positive effect of 4 points *** between the HCQ group and the control group. However, the authors prefer to conclude that there is no efficacy of HCQ .


In the study by Mahévas et al., the patients were all in a severe condition (severe acute respiratory syndrome with need for oxygen). Curiously in the control group, 29% of the patients also took azithromycin, while only 18% of the cases took it in the HCQ group. When looking at patients transferred to intensive care (ICU), the HCQ effect is nevertheless visible since 1.5 times less ICU transfer in the HCQ group is observed compared to the control group. But above all, in an extraordinary way, we can see in the details of the study that in the small group of patients taking both HCQ and azithromycin, there were zero deaths and no transfer to ICU. On the other hand, the small control group also taking azithromycin (but no HCQ) had to deplore 6 ICU admissions and 5 deaths.However, the authors also prefer to conclude that hydroxychloroquine is ineffective while the study clearly shows the efficacy of the hydroxychloroquine + azithromycin treatment versus the control taking only azithromycin.

Also copied directly from the same French study:

Our study has several limitations. Firstly, although we used robust methods and statistical techniques to draw causal inferences from observational data, treatment was not randomly assigned and potential unmeasured confounders could bias our results. Secondly, four potentially important prognostic variables could not be balanced in the propensity score model because none or only one patient in the treatment group presented with these variables. Accordingly, caution is required in interpreting these results, especially for overall mortality for which only a few events were observed. Nevertheless, this limitation did favour the hydroxychloroquine group and the absence of any difference between treated and untreated patients further strengthens our conclusions. Thirdly, we did not take a centre effect into account in the propensity score model because the number of patients treated with hydroxychloroquine in centres was unbalanced (some centres treated all their patients, whereas others did not). Nevertheless, that the decision to treat or not treat patients with hydroxychloroquine was based on local medical consensus rather than on their characteristics should reduce this bias. Fourthly, our sample was limited to the number of eligible patients available at the time of analysis; we cannot rule out the possibility that our findings are owing to a lack of power. Fifthly, because we included only patients admitted to hospital, we cannot reach a conclusion about the possible efficacy of hydroxychloroquine in preventing covid-19 or in preventing severe forms of the disease. Finally, our study was not designed to assess the efficacy of the association of hydroxychloroquine and azithromycin, and no conclusion about its efficacy can be reached. Further research is ongoing.

You're really reaching. You seem to think you know more about both of these studies than the authors, whose conclusions are below. I suggest you take it up with them or Lowe, since you haven't done anything to convince me that they reached inappropriate conclusions.

Conclusions
In patients admitted to hospital with covid-19 pneumonia who require oxygen, hydroxychloroquine treatment seemed to have no effect on reducing admissions to intensive care or deaths at day 21 after hospital admission. Additionally, hydroxychloroquine treatment did not have any effect on survival without acute respiratory distress syndrome at day 21 after hospital admission. These results do not support the use of hydroxychloroquine in these patients.

Conclusion and policy implications
The results of our trial did not show additional benefits of virus elimination from adding hydroxychloroquine to the current standard of care in patients with mainly persistent mild to moderate covid-19. Adverse events, particularly gastrointestinal events, were more frequently reported in patients receiving hydroxychloroquine, who were given a loading dose of 1200 mg daily for three days followed by a maintenance dose of 800 mg daily for the remaining days for a total treatment duration of two weeks in patients with mild to moderate disease and three weeks in those with severe disease. Overall, these data do not support the addition of hydroxychloroquine to the current standard of care in patients with persistent mild to moderate covid-19 for eliminating the virus. Our trial may provide initial evidence for the benefit-risk profile of hydroxychloroquine and serve as a resource to support further research.

https://rutgers.forums.rivals.com/t...ocial-distancing.191275/page-118#post-4564602

 

[wisr01]

Many covid 19 patients present with concurrent myocardial injury so they're not your typical rheumatological patient or tropical medicine patient. Many of these patients are acutely ill and decompensate quickly and are predisposed to lethal arrhythmias.
B. Loading dose is 800 mg on the first day which is not your normal dose
C. What does HCQ historical safety profile have to do with the way we're using it in this particular disease along with zithromax which can also pre-dispose to cardiac arrhythmias?
D. So when you are the prescriber you can weigh it out. I prescribe it, but I don't like it ,
I'm not convinced it works Even though I've had positive anecdotal evidence. Anecdotal evidence is not a good way to practice medicine. But if the patients are convinced that it works, And we have informed consent, And I have what looks like a stable patient who I know pretty well - then I'll give it to him. Any safe drug can become a dangerous drug depending on the clinical situation.

A. Patients present myocardial injury within the first few days of showing symptoms? I have not seen that anywhere. Effective treatment for the virus on Day 1-4 of symptoms will likely be very different than day 12, 16, etc. I am hopeful the place for HCQ is early in the course.

B. As for 800 mg per CDC guidelines on Malaria:
For P. falciparum infections acquired in areas without chloroquine-resistant strains, which include Central America west of the Panama Canal, Haiti, the Dominican Republic, and most of the Middle East, patients can be be treated with oral chloroquine. A chloroquine dose of 600 mg base (=1,000 mg salt) should be given initially, followed by 300 mg base (=500 mg salt) at 6, 24, and 48 hours after the initial dose for a total chloroquine dose of 1,500 mg base (=2,500 mg salt). Alternatively, hydroxychloroquine may be used at a dose of 620 mg base (=800 mg salt) by mouth given initially, followed by 310 mg base (=400 mg salt) by 4 U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION APRIL 2019 mouth at 6, 24, and 48 hours after the initial dose for a total hydroxychloroquine dose of 1,550 mg base (=2,000 mg salt).

C. The RCT that just completed evaluating early treatment with HCQ is being peer reviewed. That did not include AZ.

 

[RU848789]

View embedded media

Fauci clearly underestimated the importance of wearing masks back 3/8, likely because back then the full extent of transmissions by asymptomatic, infected and contagious people was not fully known. He wasn't the only one, as the CDC, WHO and others were in line with that thinking, plus Fauci was surely also concerned about the coming onslaught of cases in the US and very afraid we would not have enough PPE for health care workers and he was right, since the Administration completely dropped the ball on medical supplies too (in addition to testing). Right around this time I went from being kind of neutral on masks to being a believer for this particular virus and have said so since then. If only I had been POTUS, lol.

https://rutgers.forums.rivals.com/t...social-distancing.191275/page-14#post-4450962

 

[RUfubar]

A. Patients present myocardial injury within the first few days of showing symptoms? I have not seen that anywhere. Effective treatment for the virus on Day 1-4 of symptoms will likely be very different than day 12, 16, etc. I am hopeful the place for HCQ is early in the course.

B. As for 800 mg per CDC guidelines on Malaria:
For P. falciparum infections acquired in areas without chloroquine-resistant strains, which include Central America west of the Panama Canal, Haiti, the Dominican Republic, and most of the Middle East, patients can be be treated with oral chloroquine. A chloroquine dose of 600 mg base (=1,000 mg salt) should be given initially, followed by 300 mg base (=500 mg salt) at 6, 24, and 48 hours after the initial dose for a total chloroquine dose of 1,500 mg base (=2,500 mg salt). Alternatively, hydroxychloroquine may be used at a dose of 620 mg base (=800 mg salt) by mouth given initially, followed by 310 mg base (=400 mg salt) by 4 U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION APRIL 2019 mouth at 6, 24, and 48 hours after the initial dose for a total hydroxychloroquine dose of 1,550 mg base (=2,000 mg salt).

C. The RCT that just completed evaluating early treatment with HCQ is being peer reviewed. That did not include AZ.

Maybe you should have hung out a few days with me in the ER. damn right they present with myocardial injury. because we don't see them when they're pre-symptomatic or minimally symptomatic because they're not coming in. So if you're lucky enough to get somebody real early which is really not usually how things play out. Most of the times they're sick and they're inflammatory markers and they're d dimer and they're ferritin and they're cardiac enzymes and probnp is off the wall and they're O2 sats are 94 or lower and they're tachycardic. And they're not even in the cytokine storm yet.And guess what.. they don't even feel short of breath. But they can de
Compensate pretty damn quick. And this is The reality of the situation not some hypothetical minimally symptomatic person who just happens to come in super early. The minimally symptomatic ones have been the minority of my patients. But hey what do I know?

 

[wisr01]

Maybe you should have hung out a few days with me in the ER. damn right they present with myocardial injury. because we don't see them when they're pre-symptomatic or minimally symptomatic because they're not coming in. So if you're lucky enough to get somebody real early which is really not usually how things play out. Most of the times they're sick and they're inflammatory markers and they're d dimer and they're ferritin and they're cardiac enzymes and probnp is off the wall and they're O2 sats are 94 or lower and they're tachycardic. And they're not even in the cytokine storm yet.And guess what.. they don't even feel short of breath. But they can de
Compensate pretty damn quick. And this is The reality of the situation not some hypothetical minimally symptomatic person who just happens to come in super early. The minimally symptomatic ones have been the minority of my patients. But hey what do I know?

I did not ask if they present when you see them. I asked if they present at days 1-4 after symptom onset. I understand your plight, but to judge the safety and efficacy of HCQ on severely ill patients and say that means it is not safe or effective for early onset patients is wrong. What if we treated patients EARLY with HCQ and it reduces the number of people who need to go to the hospital? Sounds like a win. We would also have less concerns about the HCQ safety profile because the patients would not have much myocardial damage, if any at all. Sounds like win-win.

Why do we keep using retrospective data on either severe patients or patients who have been sick for 3 or more weeks to dismiss HCQ? Just because it does not provide great benefit at that stage does not mean it won't be of great benefit early. To not understand that is where we get bad science.

To not understand the risk profile for HCQ on a person with severe lung and heart damage is not the same as on a patient who just started symptoms yesterday is how we get bad science.

 

[tom1944]

These 600+ doctors seem pretty sincere and logical. It's good they voiced their opinion based on medical expertise. Something to think about.

2000 doctors called Physicians for national healthcare are calling you out

 

[formerlyknownasrutgers100]

I did not ask if they present when you see them. I asked if they present at days 1-4 after symptom onset. I understand your plight, but to judge the safety and efficacy of HCQ on severely ill patients and say that means it is not safe or effective for early onset patients is wrong. What if we treated patients EARLY with HCQ and it reduces the number of people who need to go to the hospital? Sounds like a win. We would also have less concerns about the HCQ safety profile because the patients would not have much myocardial damage, if any at all. Sounds like win-win.

Why do we keep using retrospective data on either severe patients or patients who have been sick for 3 or more weeks to dismiss HCQ? Just because it does not provide great benefit at that stage does not mean it won't be of great benefit early. To not understand that is where we get bad science.

To not understand the risk profile for HCQ on a person with severe lung and heart damage is not the same as on a patient who just started symptoms yesterday is how we get bad science.

why are you so obsessed with HCQ?? For weeks you post about its positives all the time. What's your angle?

 

[RU848789]

I did not ask if they present when you see them. I asked if they present at days 1-4 after symptom onset. I understand your plight, but to judge the safety and efficacy of HCQ on severely ill patients and say that means it is not safe or effective for early onset patients is wrong. What if we treated patients EARLY with HCQ and it reduces the number of people who need to go to the hospital? Sounds like a win. We would also have less concerns about the HCQ safety profile because the patients would not have much myocardial damage, if any at all. Sounds like win-win.

Why do we keep using retrospective data on either severe patients or patients who have been sick for 3 or more weeks to dismiss HCQ? Just because it does not provide great benefit at that stage does not mean it won't be of great benefit early. To not understand that is where we get bad science.

To not understand the risk profile for HCQ on a person with severe lung and heart damage is not the same as on a patient who just started symptoms yesterday is how we get bad science.

The reason we keep doing studies on moderately to severely ill hospitalized patients is because the early data that started the Rigano-Musk-Fox-Trump right wing hype machine came from Raoult's study in hospitalized patients, claiming it was a "cure" completely eliminating the virus from moderately to severely ill patients. That is why we've now wasted millions of dollars and precious thousands of medical/clinical hours disproving this sham of discredited "research," instead of simply running a couple of controlled clinical trials and waiting for the results, like we've done with remdesivir and others.

I would love to see it work on early patients, but you do realize how difficult it's going to be to prove something statistically on that front, don't you? With a patient population which gets better without treatment in the vast majority of cases (or who might not get infected post-exposure in the Boulware trial), it's going to be difficult to discern definitive efficacy, unless it's a slam dunk. The Boulware trial is enrolling 1500 post-exposure patients and the NIH trial just announced is enrolling 2000 mild to moderate patients and both might not be enough (especially Boulware's trial).

https://www.nih.gov/news-events/new...ydroxychloroquine-azithromycin-treat-covid-19

 

[rutgersguy1]

Foot pedals instead of buttons for mall elevators in Thailand.

https://mobile.reuters.com/article/amp/idUSKBN22W294

 

[WhiteBus]

Foot pedals instead of buttons for mall elevators in Thailand.

https://mobile.reuters.com/article/amp/idUSKBN22W294

Ha. And the CDC announced yesterday you are not getting the virus from surface contact. It person to person contact. None of the media mentions that today.

 

[rutgersguy1]

Ha. And the CDC announced yesterday you are not getting the virus from surface contact. It person to person contact. None of the media mentions that today.

I agree with @RU848789 and have said as much before with regards to that. There is probably a chance you can get it from surfaces and then to face especially with so many now wearing gloves and not changing/sanitizing them and then transferring germs and turning things they touch into high touch surfaces. But still the highest risk is through the air, surface touching is a risk but more likely a low risk especially if you wash your hands frequently.

I didn't wipe down groceries I bought myself back in March before everyone was wearing gloves just put them away and washed my hands. I wipe down the deliveries of groceries now because of the mass glove wearing. It is still probably a low risk thing but just to take it as low as possible and relieve any lingering anxiety I do it.

 

[RU4Real]

600+ Doctors raise alarm about health effects of continued coronavirus shutdown: 'Mass casualty incident'

https://www.foxnews.com/politics/do...lth-effects-of-continued-coronavirus-shutdown

More than 600 doctors signed onto a letter sent to President Trump Tuesday pushing him to end the "national shutdown" aimed at slowing the spread of the coronavirus, calling the widespread state orders keeping businesses closed and kids home from school a "mass casualty incident" with "exponentially growing health consequences."

The letter outlines a variety of consequences that the doctors have observed resulting from the coronavirus shutdowns, including patients missing routine checkups that could detect things like heart problems or cancer, increases in substance and alcohol abuse, and increases in financial instability that could lead to "[p]overty and financial uncertainty," which "is closely linked to poor health."

"We are alarmed at what appears to be the lack of consideration for the future health of our patients," the doctors say in their letter. "The downstream health effects ... are being massively under-estimated and under-reported. This is an order of magnitude error."

The letter continues: "The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.

"Because the harm is diffuse, there are those who hold that it does not exist. We, the undersigned, know otherwise."

The letter comes as the battle over when and how to lift coronavirus restrictions continues to rage on cable television, in the courts, in protests and among government officials. Those for lifting the restrictions have warned about the economic consequences of keeping the shutdowns in effect. Those advocating a more cautious approach say that having more people out and about will necessarily end with more people becoming infected, causing what National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci warned in a Senate hearing last week would be preventable "suffering and death."

But these doctors point to others that are suffering, not from the economy or the virus, but simply from not being able to leave home. The doctors' letter lists a handful of patients by their initials and details their experiences.

lol @ Fox and its minions pretending to suddenly care about stuff they never cared about.

Give it a rest. You're moving rapidly across the scale from ass clown to total asshole.

 

[RUevolution36]

Ha. And the CDC announced yesterday you are not getting the virus from surface contact. It person to person contact. None of the media mentions that today.

They have. But the CDC won't show how they came to that conclusion.

 

[brad1218]

To the poster above that said we need to be ready to shut things down again that ain’t happening. I am more I. The conservative side of this and believe in slow re-opening etc. However once we open we aren’t closing again.

 

[wisr01]

The reason we keep doing studies on moderately to severely ill hospitalized patients is because the early data that started the Rigano-Musk-Fox-Trump right wing hype machine came from Raoult's study in hospitalized patients, claiming it was a "cure" completely eliminating the virus from moderately to severely ill patients. That is why we've now wasted millions of dollars and precious thousands of medical/clinical hours disproving this sham of discredited "research," instead of simply running a couple of controlled clinical trials and waiting for the results, like we've done with remdesivir and others.

I would love to see it work on early patients, but you do realize how difficult it's going to be to prove something statistically on that front, don't you? With a patient population which gets better without treatment in the vast majority of cases (or who might not get infected post-exposure in the Boulware trial), it's going to be difficult to discern definitive efficacy, unless it's a slam dunk. The Boulware trial is enrolling 1500 post-exposure patients and the NIH trial just announced is enrolling 2000 mild to moderate patients and both might not be enough (especially Boulware's trial).

https://www.nih.gov/news-events/new...ydroxychloroquine-azithromycin-treat-covid-19

There was one retrospective study on moderately (and a few mildly) ill patients done where typically treatment started 17 days after symptoms which is 3-4 weeks in the course of the disease. To confound that data with early treatment data is why to most people there is conflicting evidence. Mild or moderate disease <> early disease. You can be mild or moderately ill on symptoms day 1, 5, 9 13, 17, 21, etc. You can be severely ill at any or all of those points. They are not the same thing. Early in the disease course is days 1-4 of symptoms. Late in the course is say days 12 and beyond. Any anti-viral that works would be most effective when given in the early phase before viral load peaks in the body and the earlier the better.

In the same vein, causing arrhythmia by administering a drug to patients with severe damage to their hearts should not be confounded with treating those with healthier hearts. Treating patients with a drug and monitoring side effects when you have given them one or more of 5 other drugs as well should not be confounded with a safety profile on patients receiving on the one drug (see China study you referenced).


Boulware's study:

This trial is targeting 5 groups of people NATIONWIDE to participate:

1. If you are symptomatic with a positive COVID-19 test within the first 4 days of symptoms and are not hospitalized; OR
2. If you live with someone who has been diagnosed with COVID-19, with your last exposure within the last 4 days, and do not have any symptoms; OR
3. If you live with someone who has been diagnosed with COVID-19, and your symptoms started within the last 4 days; OR
4. If you have had occupational exposure with known exposure to someone with lab-confirmed COVID-19 within the last 4 days and do not have symptoms; OR
5. If you have had occupational exposure with known exposure to someone with lab-confirmed COVID-19 within the last 4 days AND have compatible symptoms starting within the last 4 days;

That study ended accepting new patients on May 6th and finished following them yesterday. They had significant enough findings to close the study to new patients and publish.


Oh and BTW regarding your comment on understanding the data better than the authors of those retrospective studies themselves...for the last 20 years I have been paid to help pharmaceutical scientists analyze, better understand and report their data. It is exactly what I do. Understanding data, seeing patterns, putting meaning to complex data sets and solving problems is a unique skill that most do not have. When I say most I am talking about very educated scientists. Being well educated on a topic does not mean you have the skill I just described. Although fictional, I liken it to comparing Dr Gregory House versus a typical doctor. He has a skill set that most humans do not.

 

[T2Kplus10]

Ha. And the CDC announced yesterday you are not getting the virus from surface contact. It person to person contact. None of the media mentions that today.

The media has its own agenda.

 

[T2Kplus10]

To the poster above that said we need to be ready to shut things down again that ain’t happening. I am more I. The conservative side of this and believe in slow re-opening etc. However once we open we aren’t closing again.

Should have never mass closed to begin with. It was a panic move, nothing more. Several states have been open for weeks with no issues.

 

[jreinsdorf]

Maybe you should have hung out a few days with me in the ER. damn right they present with myocardial injury. because we don't see them when they're pre-symptomatic or minimally symptomatic because they're not coming in. So if you're lucky enough to get somebody real early which is really not usually how things play out. Most of the times they're sick and they're inflammatory markers and they're d dimer and they're ferritin and they're cardiac enzymes and probnp is off the wall and they're O2 sats are 94 or lower and they're tachycardic. And they're not even in the cytokine storm yet.And guess what.. they don't even feel short of breath. But they can de
Compensate pretty damn quick. And this is The reality of the situation not some hypothetical minimally symptomatic person who just happens to come in super early. The minimally symptomatic ones have been the minority of my patients. But hey what do I know?

Naturally, the inflammatory markers, d dimer and ferritin are off the wall. But most of your patients have elevated cardiac enzymes?

 

[RU4Real]

Should have never mass closed to begin with. It was a panic move, nothing more. Several states have been open for weeks with no issues.

Do you understand the concept of population density as relates to viral spread?

You're such a f*ckin' moron. Stop playing stupid games. Just stop posting here.

 

[RU-05]

plus Fauci was surely also concerned about the coming onslaught of cases in the US and very afraid we would not have enough PPE for health care workers and he was right, since the Administration completely dropped the ball on medical supplies too (in addition to testing). Right around this time I went from being kind of neutral on masks to being a believer for this particular virus and have said so since then. If only I had been POTUS, lol.

https://rutgers.forums.rivals.com/t...social-distancing.191275/page-14#post-4450962

This was precisely how the video closed.

Which is why I questioned what Wis's point was.

For as straight a shooter as Fauci can be we've also seen him fudge his answer's a few times. He's played a prominent role in infectious disease for a long time, he does have some politician in him.

 

[RU-05]

Should have never mass closed to begin with. It was a panic move, nothing more. Several states have been open for weeks with no issues.

There is no state that is fully open.

There is no state that is fully closed.

 

[Ronnie_B]

lol @ Fox and its minions pretending to suddenly care about stuff they never cared about.

Give it a rest. You're moving rapidly across the scale from ass clown to total asshole.

Maybe another Covid-19 thread should be started in here that welcomes all opinions and viewpoints since this one clearly doesn't.

 

[RU-05]

Maybe another Covid-19 thread should be started in here that welcomes all opinions and viewpoints since this one clearly doesn't.

You have a point, but it should be noted that the poster to whom he is replying has admitted he troll's for fun.

 

[Ronnie_B]

You have a point, but it should be noted that the poster to whom he is replying has admitted he troll's for fun.

He did a while back but he's toned it down, the post he's getting attacked for is not a trolling post. I agree no one should be trolling in a thread on a issue that is this serious and deadly.

 

[RU-05]

He did a while back but he's toned it down, the post he's getting attacked for is not a trolling post. I agree no one should be trolling in a thread on a issue that is this serious and deadly.

He's still pretty blatant.

Which is unfortunate because I do think his general platform has merit, but he prefers to be a pest rather then a serious poster.

 

[T2Kplus10]

Maybe another Covid-19 thread should be started in here that welcomes all opinions and viewpoints since this one clearly doesn't.

+1
Don't understand why people are getting so crazy just because of differing options. Interesting to watch.

 

[bac2therac]

Maybe another Covid-19 thread should be started in here that welcomes all opinions and viewpoints since this one clearly doesn't.

this

 

[GoodOl'Rutgers]

She is covering her a$$. Read the article I posted please. I ran a ballistics test on my own gun, and it wasnt used in the crime. Trust me. https://www.nature.com/articles/nm.3985.pdf

I will suggest that inability to definitively nail down a source is, itself, a clue. That is, it could be that the true source is being hidden, masked, covered-up.

We do know that China has a lot of influence in world health organizations and in universities around the world as well as total control of their nation. We also know that whistleblowers there have been "disappeared".. apparently.

Everything that is said about this virus needs to be checked and double-checked and triple-checked.

I don't think we will truly find out anything until this is long forgotten and self-interested parties have moved onto other things.