Thread on testing & treatment research for COVID-19
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Three super interesting articles from Italy (where deaths have gone from 900 a day to 300 a day in the last 3 1/2 weeks). First two are about new treatment strategies. (pull them up in Chrome and Google Translate will do its thing.) Some Italian medical centers are treating patients at home as soon as they can after symptoms first appear. Home treatments include HCQ and heparin to prevent blood clotting (this would never happen in the US partly because of the HCQ scare campaign and also the fact that no one wants to do home treatment).
Anyway the doctors involved report that ICU admissions have "collapsed" in areas that are doing this. Numbers look really good -- but this is not a controlled study (one is in the works) so the US will ignore it.
Third article is a backward look at 65,000 Italians with lupus and rheumatoid arthritis who take HCQ regularly. Of the 65,000, only 20 confirmed covid cases, no deaths, no ICU admissions. This kind of data is possible in Italy because prescriptions are all in a national database. Once again, it's not a double blind controlled study so this will be ignored in the US.
https://www.iltempo.it/cronache/202...rump-zelenko-clorochina-anti-malaria-1318090/
https://www.ilfattoquotidiano.it/20...-sperimentazione-crollo-dei-ricoveri/5783544/
https://www.iltempo.it/salute/2020/...-terapia-idrossiclorochina-sars-cov2-1321227/
Anyway the doctors involved report that ICU admissions have "collapsed" in areas that are doing this. Numbers look really good -- but this is not a controlled study (one is in the works) so the US will ignore it.
Third article is a backward look at 65,000 Italians with lupus and rheumatoid arthritis who take HCQ regularly. Of the 65,000, only 20 confirmed covid cases, no deaths, no ICU admissions. This kind of data is possible in Italy because prescriptions are all in a national database. Once again, it's not a double blind controlled study so this will be ignored in the US.
https://www.iltempo.it/cronache/202...rump-zelenko-clorochina-anti-malaria-1318090/
https://www.ilfattoquotidiano.it/20...-sperimentazione-crollo-dei-ricoveri/5783544/
https://www.iltempo.it/salute/2020/...-terapia-idrossiclorochina-sars-cov2-1321227/
It obvious that HQC works when taken early. But I’m sure we will be the anti HQC’s come here and refute this.
@tboyer -- your sarcasm (assuming that's what you were doing in what I bolded) is misdirected. The US will not ignore the studies. As you know from your son (the doctor), there is no established treatment for Covid-19 in the US. Physicians are scrambling, sharing observations and treatments, and doing their best to come up with best practices. And every single day they refine these treatments, or start over when they realize that what looked promising isn't working.
Physicians have some liberty in using drugs that have been approved (for specific treatments), in ways for which they were not approved. That's a large part of why HCQ became part of the treatment protocol that many doctors in the US were using when the pandemic started to break out in the US.
The FDA will not approve a treatment (which is much, much different than ignoring findings from abroad), until there are proper studies performed. For this, we should all be thankful, as many promising drugs and treatment protocols have proven to be less effective than initial observations indicated, and in fact a number of drugs proved to be dangerous.
The FDA protocol is the gold standard in drug testing and approval. And while it's very rigid, the FDA has, in response to the pandemic, loosened their standards in terms of allowing things to be released for Covid-19 treatment and testing. (For example, the plethora of antibody tests, which the FDA allowed to be released based solely on self-testing by the manufacturer, many of which have been shown to be faulty by independent testing (not FDA) while the FDA is struggling to put the already released antibody tests through their rigorous testing protocols.)
Honest question because I haven’t followed Italy’s approach that carefully. Do you believe it is the early HCQ treatment and heparin that is responsible for the decrease in deaths in the last three weeks there? Or are they just ahead of the US in reaching their peak?
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I don't know obviously, I just wish the experts in the US would talk to the Italians and the Spanish about why their death/recovery ratios have improved so dramatically during the month of April. McAndrew thinks that conversation will happen -- I just doubt it. I think Washington is too arrogant.
https://www.worldometers.info/coronavirus/country/spain
It may not be about medicines per se but when to give them. The US is running clinical trials of HCQ largely with very sick people in hospitals. The Italians are giving it (along with a bunch of other drugs) to people in their homes as soon as they have a confirmed infection.
They also monitor people closely with pulse ox. Rather than doing what they had been doing (and what the US does now) which is tell people to stay at home untreated (even with pneumonia) until they get short of breath.
Covid patients, because of how it damages lungs, aren't short of breath even when they are dying of hypoxemia. This helps explain why so many people have died at home without even making it to the hospital.
https://www.nytimes.com/2020/04/20/opinion/sunday/coronavirus-testing-pneumonia.html
Anyway there are definitely US doctors pushing more aggressive early treatment now, and some states (NJ) are encouraging this
But there is no national focus on this that I can determine. The CDC just seems so behind the curve -- their big announcement of the week was an expanded list of covid symptoms, including things like coughing and fever. The CDC just determined that covid causes -- stop the presses -- a loss of sense of smell. Doesn't give me huge confidence in the people who are charged with controlling this disease.
https://www.worldometers.info/coronavirus/country/spain
It may not be about medicines per se but when to give them. The US is running clinical trials of HCQ largely with very sick people in hospitals. The Italians are giving it (along with a bunch of other drugs) to people in their homes as soon as they have a confirmed infection.
They also monitor people closely with pulse ox. Rather than doing what they had been doing (and what the US does now) which is tell people to stay at home untreated (even with pneumonia) until they get short of breath.
Covid patients, because of how it damages lungs, aren't short of breath even when they are dying of hypoxemia. This helps explain why so many people have died at home without even making it to the hospital.
https://www.nytimes.com/2020/04/20/opinion/sunday/coronavirus-testing-pneumonia.html
Anyway there are definitely US doctors pushing more aggressive early treatment now, and some states (NJ) are encouraging this
But there is no national focus on this that I can determine. The CDC just seems so behind the curve -- their big announcement of the week was an expanded list of covid symptoms, including things like coughing and fever. The CDC just determined that covid causes -- stop the presses -- a loss of sense of smell. Doesn't give me huge confidence in the people who are charged with controlling this disease.
I think the CDC needs to be reorganized or eliminated after their recent performance.
And you can throw the FDA in the same category.
part of the medical bureaucracy, which has a lot of people who are not directly treating patients. the CDC, NIH and FDA all need to support the real doctors treating patients or just get out of the way. they should be talking to the front line doctors and getting input especially if any are getting some type of results.
I could go with reorganization perhaps but I'm more concerned about properly funding and staffing them.
Here's a really good piece about how drug testing for covid could be piloted on a faster timetable -- using a model developed by Anthony Fauci during the AIDS epidemic. Disregard the publication here -- the author is a respected writer on health care who writes for a lot of publications.
https://www.washingtontimes.com/news/2020/apr/28/testing-covid-19-treatments-should-take-a-page-fro/
https://www.washingtontimes.com/news/2020/apr/28/testing-covid-19-treatments-should-take-a-page-fro/
Again, I’ve not followed Italy closely but my impression is that they are at least 1 - 2 weeks further in than we are and so will see their numbers drop off before ours.
Based on deaths, it seems debatable that Italy’s situation even now is better than the US. Over the past 7 days they’ve averaged ~380 deaths/day while the US averaged around 1961/day. However, on a per capita basis Italy is at 6.25 deaths per million while the US is at 5.95 deaths per million. The week prior Italy was 8.4 deaths per million and the US was at 6.6 deaths per million. The past two weeks have certainly been the worst numbers for the US, but Italy’s worst week was over three weeks ago where they saw 13.4 deaths per million. So even though they are decreasing, I’d be cautious to conclude they are outperforming the US. It is quite possible that the apparent improvement that Italy is seeing now is just exaggerated because they were so overwhelmed initially. Obviously this is just one indicator but not seeing that it points to Italy having a better response.
I think you have it backwards. Because we have apparently flattened the curve, our death/recovery rates won't improve as rapidly as Italy or Spain's. They are in the red below so while their peaks are higher, their return to normality is quicker. It isn't because they are doing anything better, it's because they got themselves in a worse scenario than we did.
The graph in this link illustrates The 3 day rolling average in deaths per million.
https://ourworldindata.org/grapher/...04-28&country=FRA+DEU+NLD+ITA+ESP+SWE+GBR+USA
Death rates (actual deaths, not just confirmed to Coronavirus) are now showing up from CDC data for the last few weeks. They are way up compared to April 2017, 2018, or 2019 in all of states hit hardest with CV19. They show many more deaths than reported for CV19 alone. This means the number of CV19 deaths is likely underreported by a large number.
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Each has billion dollar budgets with thousands of employees but the problem is that they are making bad decisions. If you double both, how would that prevent them from making more bad decisions?
Well, you can give them all of the money they want, but if the organization isn’t focusing on what it is supposed to be doing, it won’t matter. It also won’t matter much if the organization has become a bloated bureaucratic Leviathan, unable to respond in time to the emergencies it was originally tasked to manage.
The CDC has undergone “ mission creep “ in recent years. A perusal of their budget reveals them spending money on things not at all related to diseases and pandemics. If there was a problem with them not being adequately funded to respond to a pandemic, why were they spending money on things like playground safety, forestry and mining ?
yes it is perplexing why we don't see more communication from the doctors in Europe or the US who are trying all types of existing drugs to slow the virus. the medical bureaucrats like to refer to randomized controlled trials. they forget that in science you start by observation which gives you an hypothesis, which is then tested by RCT. the doctors treating patients actually are making observations, but are largely ignored.
BTW - never in our history have the medical bureaucrats and government had so much control of our freedoms. the "new normal" means less freedom.
Good news this morning regarding remdesivir
https://www.marketwatch.com/story/g...imary-endpoint-in-government-study-2020-04-29
Gilead Sciences Inc. GILD, -1.53% on Wednesday morning announced data from two clinical trials testing its experimental drug remdesivir in severely ill COVID-19 patients. The drugmaker's stock was halted in premarket trading on Wednesday in advance of company disclosures about remdesivir's performance in the studies. Gilead said an open-label Phase 3 trial testing the therapy in severely ill patients found that those taking a 5-day or 10-day course of treatment led to similar results. At least 52% of participants taking either dosing regimen were discharged from the hospital after 14 days of treatment, and at least 53% of those patients were reported as reaching "clinical recovery." "Multiple concurrent studies are helping inform whether remdesivir is a safe and effective treatment for COVID-19," Gilead chief medical officer Merdad Parsey said in a statement. "The study demonstrates the potential for some patients to be treated with a 5-day regimen, which could significantly expand the number of patients who could be treated with our current supply of remdesivir." Minutes before this topline data was released, Gilead also said that a government-run clinical trial evaluating remdesivir in severely ill COVID-19 patients met the study's primary endpoint. That study is being conducted by the National Institute of Allergy and Infectious Diseases, which is expected to provide additional information about that trial, Gilead said. Gilead's stock has gained 21.0% year-to-date, while the S&P 500 SPX, -0.52% is down 11.3%.
https://www.marketwatch.com/story/g...imary-endpoint-in-government-study-2020-04-29
Yes and yes. Hopefully people will see the need for greater funding of public health and research. But we need reform and accountability too. I understand the FDA's critical role as the gatekeeper for drugs and therapies. And I'm glad the FDA is trying to make decisions faster even if it means some imperfect tests are out on the market -- that will get sorted out.
I don't know about you but at the moment I am having trouble understanding what the CDC contributes. You'd think CDC would be at the heart of a national response to a deadly pandemic but I just don't see the value added. I'm sure some of it is behind the scenes but ...
I don't know about you but at the moment I am having trouble understanding what the CDC contributes. You'd think CDC would be at the heart of a national response to a deadly pandemic but I just don't see the value added. I'm sure some of it is behind the scenes but ...
The Gilead announcement is hopeful, but why is nobody noticing that that for the data release there's no control group. So it's impossible to know if it works because you only have data on a treated population.
The second study referred to today where all they say they met their endpoints -- that is a controlled study so hopefully that will be good news. Even if there's something that reduces the death rate from severe cases by just 20 percent, that would save thousands of lives.
The second study referred to today where all they say they met their endpoints -- that is a controlled study so hopefully that will be good news. Even if there's something that reduces the death rate from severe cases by just 20 percent, that would save thousands of lives.
The CDC Director only reappeared before the American public last week. Aside from a local Georgia NPR interview a few weeks ago, he disappeared from view for about a month. Internal emails leaked in March portrayed an organization led by people who appeared to be living in an alternate reality bubble as the pandemic was going global.
Simply throwing money at an organization like this is not likely to fix deficits in purpose and leadership.
well they did massively screw up the initial testing protocol and then doubled down by making bad decisions after screwing up the first time. Which is the sign of an organization that has both poor management and a lot of bureaucracy. Probably cost the USA about 2 full weeks where they could have been ramping up the testing numbers and had stopped some of that initial outbreak.
This is exactly what has happened...there are >100 active trials for COVID-19 treatments based on such hypothesis.
These include HCQ, HCQ/Azithromycin, remsdesivir, lopinavir/ritonavir, favipiravir, tocilizumab, losarten, convalescent plasma, clazakizumab, peginterferon lambda 1a, gimsilumab, canakinumab, leronlimab, sarilumab, selinexor, dapagliflozin, sirolimus, enoxaparin, vazagepant, fluvoxamine, MSCs, ascorbic acid/folic acid, colchicine, progesterone, methylpredisolone, estradiol patch, hyperbaric oxygen, NO gas. This does not include vaccines or early stage investigational drugs that aren’t yet at the trial phases. There are also trials for nasal cannula and devices for oxygen.
Many of the trials are based on hypothesis or input from the frontline medical community.
Great... now compare and contrast it with the infinitely cheaper HCQ. Then go from there.
OK, here is the actual study.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext
I see mention of typical standard of care and also placebo... I see no mention of HCQ. Perhaps (the article is long and I flashed thru it) I missed it, but I did see other treatments mentioned they said were not working in the cases present.
https://www.thelancet.com/action/sh...l=true&tableId=tbl2&pii=S0140-6736(20)31022-9
If placebo here is sugar water (no idea since that is prop of Gilead), then the results seem almost pointless. If there was something used in the placebo that could be medically useful, that's a diff story. My very basic knowledge of placebos is they are benign and provide no medical benefit/value.
BTW, if I have covid-19 (and I did), remind me NOT to be part of the placebo group lol.
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Following up on what I posted yesterday, here is a long twitter thread of Italian doctors (most of them with video statements) talking about what they have learned about covid. (if you click into the thread you'll see the whole thing.)
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They have a twofold message for the USA:
1) The reason so many people died in Italy is because we didn't treat them when they got sick -- we waited until they got to the hospital and then it was too late to save them.
2) Now we treat them aggressively when they are first infected, and they recover at home and there is no need to admit them to the hospital.
But is the USA listening? Most definitely not. Dr. Fauci, on the basis of Gilead Pharma's announcement, today declared remdesivir the "standard of treatment." This means the CDC's official treatment protocol remains: "no treatment until your lungs shut down, at which point you can come to the hospital and be given remdesivir." So we will be continuing to intervene only in the final stage of the disease and saving people with a powerful (and very expensive) medicine.
But hey, hospitals make a lot of money, Gilead investors make a s-ton of money. Everybody's happy except for all the people who are still going to die.
.
They have a twofold message for the USA:
1) The reason so many people died in Italy is because we didn't treat them when they got sick -- we waited until they got to the hospital and then it was too late to save them.
2) Now we treat them aggressively when they are first infected, and they recover at home and there is no need to admit them to the hospital.
But is the USA listening? Most definitely not. Dr. Fauci, on the basis of Gilead Pharma's announcement, today declared remdesivir the "standard of treatment." This means the CDC's official treatment protocol remains: "no treatment until your lungs shut down, at which point you can come to the hospital and be given remdesivir." So we will be continuing to intervene only in the final stage of the disease and saving people with a powerful (and very expensive) medicine.
But hey, hospitals make a lot of money, Gilead investors make a s-ton of money. Everybody's happy except for all the people who are still going to die.
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Treating this disease aggressively asap will yield positive results.
And I'm going to trust my son in law on this one (yeah, he's more than a little qualified).
When i had it, we spoke often and the standard of care (along with other things) for those at the threshold (not death, but of falling backwards in the fight) was to add HCQ. It's cheap, it has a 90% efficacy rate against covid... and it's been proven safe over decades. And yes, giving it to those about to die is not particularly effective (and doesn't help it's success rate which is still damned good). I never had to go there, but it was good knowing I had options.
How Fauci landed on this as the treatment of course (albeit for those about to succumb) is what interested/concerned parties would be best examining... not DT's endorsement of HCQ.
Of course it's been years since i slept in a Holiday Inn so my medical training is a bit out date....
Or you could just appoint some competent leadership to those posts.
I don't recall him saying that. And I seriously doubt he did as remdesivir is an experimental drug in early trials. Not his style to endorse such an unknown.
Have a link?
"What it has proven is that a drug can block this virus," Fauci said.
Fauci, who is normally measured in tone, expressed genuine excitement over the results, calling them "reminiscent of 34 years ago in 1986 when we were struggling for drugs for HIV."
Hope he is right, but reading through the rest of the "news", most were not as optimistic. And there is this:
The analysis did not compare remdesivir to a placebo, so it's impossible to determine whether any benefits were due to the drug or whether patients would have improved on their own.
https://www.nbcnews.com/health/heal...remdesivir-shows-promise-large-trial-n1195171
Big leap from 'genuine excitement' to 'the standard of treatment'.
