“Just anecdotal”…
…but powerful nevertheless:
However, from everything I’ve heard and read, the medication combination is probably most effective if given before things really go south. If a person is already on a ventilator, for example, the amount of lung damage that has already taken place may often make it very difficult for any drug to do its work.
At a certain point, “anecdotal” evidence – in a situation in which we have few other tools to fight a disease that kills too many people – becomes very compelling. To not treat, and to wait for large-scale controlled studies, considering that the drug has already been approved for 60 years and is generally considered extremely safe, is hard to justify. Not only that, but although controlled experiments are necessary to really understand whether it’s helping at all and to what degree, is it ethical to have untreated controls in a situation like this?
It’s a very real dilemma.
When the left speaks so forcibly against Trump’s mentioning that the drug has shown promise, I think they have two motives. The first is obvious: anything Trump says might be good is by definition bad. The second is a little more subtle: the left positions itself as the science-based group and has put out a relentless message that Trump and his supporters are anti-science. That message has been received by liberal Democrats; I have heard it many times from friends and family, and increasingly in the past week or two. Controlled studies are definitely science-based, so that’s another way in which the left wants to position itself as champions of science as opposed to charlatan Trump.
Now of course, Trump never said not to do controlled trials. It doesn’t have to be either/or. But the left needs to pretend that’s the situation. To do so, though, they have to work against the emotional appeal of stories such as Dr. Siegel’s, as well as the tale told by Michigan state Rep. Karen Whitsett.
However, if this drug combination does end up being proven effective against COVID-19, I wouldn’t be surprised if the MSM and the Democrats pretend they never criticized it, and that in fact Trump was too slow to recommend it and therefore has blood on his hands.
Who you going to believe all those anecdotes (not dead) or my models? Must be an extremely powerful placebo effect, if tried early, but it seems that many in the politico/medical community prefer the ventilator approach and are opposed to more anectodical survivors.
The problem with all the anecdotal data put forward about these drugs is very simple: very few people, percentage-wise, die from the disease. If you run a study that puts 80 people on this drug and no one dies, what do you know exactly? You need to put 1000 people on the drug and 1000 people on a placebo to have any idea whether it helps.
Is it ethical to run a study where the control group gets nothing? Given that most patients get nothing, to me it’s obvious that running such a study would be ethical.
Your last paragraph is so so true.
Luke:
The trouble is that you would have to purposely withhold it from some people. That’s different from the way it is now, when it’s being used more and more. For example (don’t have time right now to find the link) I read today that in NY, all patients in the hospital (I assume even if they’re not inpatients) are getting it. So, who do you compare them to? It can’t be those outside the hospital, because that’s not random; they have different characteristics.
Goofiness has been more and more a staple of American political discourse over the last 30 years.
Bill Clinton was accused of being a drug runner and I believe Hillary supposedly had Vince Foster killed to cover up a lesbian affair or something. George W. Bush was going to postpone the 2004 elections and Obama, of course, wasn’t even born in the United States. As crazy as all that was though, Trump-haters have entered a new era of schizophrenic delusion.
I mean, how many liberals right now are blaming Trump for the coronavirus when the epicenter of the outbreak is the crown jewel of American liberalism, New York City.
Mike
Tucker was excellent last night. Asked valid questions
https://www.youtube.com/watch?v=VdK77bhAwO0
Luke,
The problem is that there already exist “anecdotes” like this one with 699 covid-19 patients with 100% recoveries. Two patients were intubated, and then recovered. These were all NY state patients.
What do we know about NY state covid fatality rates? Just taking the raw numbers now, we see that about 4.5% of those that have tested positive have died. Now that’s an undercount estimate because we also know that some of those in the “tested positive” group will die in the near future. I’ve seen numbers over 5% estimated for NY, but let’s call it 5% even.
So of 699 patients, 35 of them should have died, but no one did. Because of the treatment they received with hydroxychloroquine, Z-pak, and zinc supplement.
Luke, you make this sound like it is the flu, with 0.1% mortality rate. It isn’t. It’s very much higher than that.
Not so anecdotal. Excellent video
https://www.youtube.com/watch?v=Z7SDemHGl8U&feature=emb_title
Is the President Forgetting Politics 101?
Regardless of when Trump acts to reopen the country, the ruling class will do whatever is in their power to prevent him from exiting the path to political perdition which he has entered.
https://amgreatness.com/2020/04/07/is-the-president-forgetting-politics-101/
NY Doctor Describes What It’s Really Like In Hospitals
https://www.youtube.com/watch?v=CNd7ml9VUAc
What about lockdowns? They are more expensive and have harsher side effects than hydroxychloroquine by several orders of magnitude, but where are the randomized controlled studies proving that they are a safe and effective in controlling the spread of the Wuhan coronavirus? As far as I know, all we have is anecdotal/observational evidence from places like China. What we would need to do is take two similar regions, say North and South Dakota, and randomly put one of them under lockdown for a year. If the results are positive with a p-value of 0.05 or better, and the side effects are acceptable, only then should we consider using lockdowns outside of a controlled study.
MBunge: Sorry, but Obama wasn’t born in the United States. He was born on a Pacific island which is illegally occupied by the United States.
Neo,
That’s interesting about the NY hospital treatments. You suggest that outpatients might be getting the HCQ treatment too. Some medical polling data I saw last week suggested that of the 23% of U.S. doctors who were using HCQ, they were only using it for their most seriously ill patients; probably all inpatient. But that’s now relatively old information.
I’ve seen news on a few controlled studies in the U.S., including a New York one that Gov. Cuomo is watching. No one is asking or talking about time schedules concerning them.
Let me point out that randomized prospective double-blind clinical trials became the FDA standard maybe 45 years ago or so. The cry for “evidence-based medicine” arose from the leftwing academic medical bastions, particularly in Boston, as if medicine had formerly ignored evidence.
The New England Journal of Medicine is owned by the Mass. Medical Society and Lo! their editors are all leftwingers, if one reads the editorials–universal coverage, no opt-out is their song. Because they will be in control of generating the evidence, determining the clinical good from the bad, based on stuff like QALY. With the incomes that go along with power.
When one does not have solid data and one is faced with a sick patient, anecdotal evidence must suffice—it’s all you’ve got, for Pete’s sake!
Bureaucratic thinking wants clinical trials without a thought about any individual human.
That is what Luke wants. But if Luke gets ill with the virus tomorrow, what’s he gonna say? “Don’t give me the hydroxychloroquine”??
I doubt it.
The problem with all the anecdotal data put forward about these drugs is very simple: very few people, percentage-wise, die from the disease.
But there is a lot of data, albeit not from double-blind experiments. But so what? You’ve got thousands who have been treated with it, thousands who haven’t. It’s possible to analyze that data, control for other factors, and assess whether those who got treated with it had significantly better outcomes. It’s not that complicated. It doesn’t really matter if there’s a bit of a placebo effect mixed in (which I doubt anyway).
As far as harm, It’s been a few decades, but I had to take anti-malarials for business travel and I remember being told to expect some weird dreams and nightmares as a side effect, so my guess is I was given this stuff. It sounds like it is very commonly described in those situations.
I do remember taking courses of anti-malaria medication starting a week or two before traveling and I don’t recall specifics, but it did impact my sleep. I think I had more lucid dreams, or a nightmare, or two. I hear it can affect heart rhythm negatively, so folks with heart issues should probably avoid it, but I’d risk a few nightmares on the chance it could help, if I were a patient.
So, are we to believe that these a^^hole lefties would refuse this “anecdotal” drug if their loved ones or they themselves came down with the virus?
Would they refuse their doctor’s recommendation, if given, to take the drug, claiming that, “oh, the drug has not been properly vetted, so I will not take the drug.”
Uh, I don’t think so.
Frankly, if these lefty assholes came down with the virus, it would serve them right if they were refused the drug, regardless if it was their only hope to avoid death.
They can go F themselves.
The climactic event in Arrowsmith is precisely this, whether to treat everyone in an outbreak of the plague, or to make a proper test of it. It is somewhat curious that the method being tested in the novel was a phage therapy, a topic of research in the Soviet Union at the time of writing. Makes me wonder about Sinclair Lewis’ source of medical advice.
About that “science” thing.
Peasants in the middle ages believed in the God who created the universe, and set everything in order. Among things set in order are planetary motion, as well as position of the stars. Laws of nature and physics were set down. Cause-and-effect, for example. To believe we can do an experiment and work from the results requires belief in the ordering of our world. How did that happen? My belief is this was done by God the Father. Western culture springs out of Christianity. So do they really believe in science?
Neo, there is a third and – in my view – more realistic reason why some are not on the same page with Trump when he touts the drug. And it’s simply that not enough tests have been done.
There have been cases that show there may be an effect, and there are others to show there’s no effect,” Fauci said on CBS’s “Face the Nation. “So, I think in terms of science, I don’t think we could definitively say it works.”
I don’t read that as a criticism of Trump. I read that as being skeptical of a drug that hasn’t been tested. Over 22,000 people in the US have recovered from CV-19 and in only a very small number of cases did they take hydroxychloroquine. So clearly all 22,000 have not taken the drug and then recovered. Some of them may have taken anything from Tylenol to Shenzhen [in Japan] and recovered. But not necessarily because of those drugs. So it’s very anecdotal at this point.
But the FDA and the CDC and many hospitals are not in the business of mass releasing a drug without testing. So when Trump touts the drug a lot of people want it – but that alone doesn’t mean it works. It does mean more tests should be done. And, look, if someone wants the drug and it’s an option then take it.
Rufus T. Firefly:
It it was just a few decades ago, I doubt you were given this drug. Malaria became resistant to it quite some time ago, and they changed to other drugs:
Montage:
“Not enough tests have been done” for what?
Of course “not enough tests have been done” to prove its efficacy. That is not the point at all, and I believe that’s crystal clear. Nor does anyone disagree. It’s not something with which anyone disagrees – and that includes Trump and the doctors using it. Of course more tests are needed, and no one is trying to stop them from being done, and everyone is advocating that they be done.
The real question is this: have enough tests been done to use it? In other words, is the evidence sufficient balanced against the risks of the meds, the risks of not using it, and the risks of the disease itself? A great many physicians say the answer is “yes.”
The medication is approved for long-term use for people with lupus and certain other auto-immune diseases. Doctors who have many years of experience with it consider it very safe.
“Neo, there is a third and – in my view – more realistic reason why some are not on the same page with Trump when he touts the drug.” — Montage
See. It’s all about what Trump says. Even when an issue is a matter of life or death, politics must determine everything.
“… there are others [studies] to show there’s no effect,” Fauci said.
Yes, one study with 15 patients showed no effect, versus thousands of patients who’ve had miraculous recoveries. That’s a 50/50 situation if I ever saw one.
“…only a very small number of cases did they take hydroxychloroquine [in the U.S.].” — Montage
In the U.S. thousands have taken it and recovered. This is a small minority of the total number of U.S. cases, but that is because the U.S. is behind the curve rather than ahead of it. Medical poll results released last week indicate that 33% of physicians outside the U.S. are using this covid-19 treatment.
I’ve read that nearly all of the S. Korean patients also got this treatment, and their country’s process is seen as exemplary.
“But the FDA and the CDC and many hospitals are not in the business of mass releasing a drug without testing.” — Montage
Too late. Plaquenil was tested and released decades ago. Maybe Montage was referring to efficacy and not safety. But regarding safety, there is not a significant heart danger. Possibly chloroquine, a similar but less safe drug is different.
My wife had taken Plaquenil for roughly 15 years. She got an M.D.’s eye exam every year as a precaution against vision side effects. Every few years she would take a Z-pak antibiotic for a sinus infection, while taking Plaquenil. She never had any difficulties of any sort. When the honest doctors say that hydroxychloroquine is an exceptionally safe drug, believe them.
bof….”What about lockdowns? They are more expensive and have harsher side effects than hydroxychloroquine by several orders of magnitude, but where are the randomized controlled studies proving that they are a safe and effective in controlling the spread of the Wuhan coronavirus?”
That is a very good point.
This is a purely speculative comment.
I haven’t yet read a good description of how hydroxychloroquine might work to help people recover from COVID-19, or even help them from getting sick.
We have, however, been told that many infected people go into a tailspin that starts with a cytokine storm. Explaining the steps to a cytokine storm would take longer than a blog comment, but it’s easy enough to look up. In shorthand terms, the infected person’s immune system goes into overdrive. Feedback effects kick in. Among other things, the lungs start filling with fluid, and pneumonia develops. Then it gets worse.
Currently, hydroxychloroquine is used to treat lupus and other auto-immune disorders. Given that, is it any wonder that the drug might be effective in treating a coronavirus infection that produces a severe and dramatic auto-immune reaction?
Anyway, I’m being a little lazy here. I haven’t done the research. Have I just told a story that everybody knows? Or is it a story that’s so obvious that nobody even thinks it’s worth talking about? All I hear, from those who oppose the use of hydroxychloroquine, are sneering remarks about idiots who want to force an unproven malaria drug on desperate patients. Giving them false hope, etc.
In the debate, I’ve not read a good explanation of the hypothetical mechanism.
Any references would be appreciated.
I have generally found that when run of the meal Lefties starting throwing around the word “ science” and you challenge them on specifics, generally the best they can do is offer links. Few seem able to articulate arguments in their own words. They generally refer back to the idea that only a person with a degree in the specific topic being discussed can offer any thoughts. A nation of specialist is a lot easier to control than a nation of generalist.
The speculation I have read about hydroxychloroquine goes as follows:
(1) the novel coronavirus contains a protein that binds to the porphyrin in hemoglobin, releasing the iron. This prevents the hemoglobin from carrying oxygen, leading to hypoxia. Plus, lots of free iron in the blood creates all kinds of oxidative damage, causing immune system reaction.
(2) Chloroquine protects the porphyrin by competing to bind with the viral protein.
See “COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism” by Wenzhong Liu and Hualan Li.
Here is one PDF I found:
See https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&cad=rja&uact=8&ved=2ahUKEwilodSUqtroAhUVsZ4KHakEDVMQFjAGegQIBxAB&url=https%3A%2F%2Fs3-eu-west-1.amazonaws.com%2Fpstorage-chemrxiv-899408398289%2F22129965%2Fcovid19202000328EN1.pdf&usg=AOvVaw3A49uE8pnMlRgZRsWw6IL-
Oh you’re good Cornflour! Let me give the longer response, with your point in the middle.
From the WSJ, by former Gov. Jeff Colyer M.D.
So generally, this all began with test tube experiments, including CDC work with the old SARS. What about those newer Chinese in vitro experiments with SARS-CoV-2 virus?
In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).(with 15 authors!)
Maybe if we looked at the original CDC in vitro study we would find some better rationale for why they were looking at chloroquine and SARS. Oh, wait!
Chloroquine is a potent inhibitor of SARS coronavirus infection and spread
Nothing I see about zinc, but there is a long paper after the abstract.
This too is anecdotal.
Locals in Wuhan, where the Chinese coronavirus pandemic originated, have heard screams coming from funeral home furnaces, and some treated in hospitals say they saw workers put living coronavirus patients in body bags, Radio Free Asia (RFA) reported on Monday.
RFA noted that it could not independently verify that the Chinese Communist Party was burning coronavirus patients alive, nor has the Communist Party confirmed or denied the rumors. Yet the rumors persist that, to make room for new patients in Wuhan’s overcrowded hospitals, medical staff chose older patients less likely to survive the infection and shipped them to incinerators while they were still alive and conscious.
oooooops…
Coronavirus Deaths Will Be ‘Much, Much, Much Lower’ Than Predicted Models, Says Head of CDC
In the ever-changing contradictory nature of information during the pandemic age, the head of the CDC, Robert Redfield, told listeners of Arizona’s 1030 KVOI radio he believes there’s good news ahead. Redfield said the death toll from the Chinese COVID-19 will be “much, much, much lower” than the models have predicted. “If we just social distance, we will see this virus and this outbreak basically decline, decline, decline. And I think that’s what you’re seeing,” he said.
The models the White House is using projected the deaths of between 100,000 and 240,000 Americans. Redfield says models aren’t the end of the story. “Models are only as good as their assumptions, obviously there are a lot of unknowns about the virus,” he said. “A model should never be used to assume that we have a number.”
https://pjmedia.com/trending/coronavirus-deaths-will-be-much-much-much-lower-than-predicted-models-says-head-of-cdc
Out west a father was temporarily arrested for playing T ball with his daughter and wife… then let go..
i dont think that the politicians realize their stay at home orders dont carry any legal weight (and that the arguments were thoroughly worked through the years over typhoid mary)… they are at best voluntary.. they do not have the power to make law by decree, they certainly dont have the power to make law or nullify the constittional right to assembly..
so you can bet in a short while there is going to be a whole bunch of lawsuits and a whole bunch of lucky people who have had their rights abridged… now wether it will be shifted to the officers as the ones to be in trouble, or the state to pay the damages, will have to be seen… but its going to be a big money thing!!
then there is this
‘This Is Not Nazi Germany or Soviet Russia Where You Are Asked For Your Papers!’ Says Maine Sheriff
Maine’s Franklin County Sheriff Scott Nichols has a strong message for the Governor of Maine, Janet Mills, who issued “stay-at-home” orders with threats of police punishment if not followed. Sheriff Nichols issued a statement on the Franklin County Facebook page saying in no uncertain terms he will not follow the unconstitutional order.
“We will not be setting up a Police State. PERIOD,” he wrote. “The Sheriff’s Office will not purposefully go out and stop vehicles because they are on the road or stop and ask why people are out and about. To do so puts our officers at risk. This is not Nazi Germany or Soviet Russia where you are asked for your papers!”
The sheriff’s announcement comes as a welcome sign to Americans who have been arrested for inane things like praying outside, surfing, or trying to drive to work. Someone has to stand up to the unconstitutional directives that are being handed down daily by government officials and it will fall on the sheriffs to uphold what they know to be their legal and lawful duties, none of which involve trampling the rights of citizens.
“Please use common sense during this executive order. We are more interested in the safety and well-being of the public as well as our officers at this time. With that being said, we are sworn to uphold the Constitution and laws of the State – for any unlawful act/situation, arrestees will be taken into custody and transported for fingerprinting and bail.”
Nichols made it clear that he only intends to arrest for matters of law-breaking, and nothing else. Executive orders aren’t laws. He finished his announcement with words of encouragement for his constituents: “Most of you are doing a fantastic job – we appreciate that! Please look out for one another, especially the elderly and shut-ins. Please be a good neighbor/citizen always showing compassion. Please be kind especially on social media, negativity online only adds to the stress people are currently experiencing.”
Cornflour:
a modest expansion, if you please, on your “the lungs fill with fluid, and then pneumonia develops.”
The tiny little air sacs where gas exchange (O2 in, CO2 out) takes place are alveoli. The very thin alveolar walls contain capillaries. So when the “lungs”, actually the multibillion alveoli, fill with fluid, gas diffusion is blocked. That is a form of so-called alveolar-capillary block. Another form of said block is pulmonary fibrosis of sometimes unknown cause, in which fibroblasts, which make scar tissue, proliferate within the alveolar walls, thickening them and so making the diffusion distance of CO2 and O2 to the capillaries within those walls longer; the O2 can’t get in. the CO2 can’t get out.
In short, you’re literally drowning with fluid-filled alveoli. You asphyxiate. That I think explains the very rapid decline of some Wuhan virus patients–rapidly progressive shortness of breath after a few mild days of dry cough and mild fever.
I watched Dr. Oz yesterday while my bride was seeing an orthopedic specialist for a broken bone she got from a fall. (She’s in pain, but will recover in good time. Taking care of her is keeping me busy at this time of social distancing. 🙂 ) Dr. Oz, who is a real doctor, but a Cardiologist, interviewed a doc who is a Rheumatologist with many years of experience with treating patients (rheumatoid arthritis and lupus) with HC. He said that his only concern with HC was for a side effect to the eyes, which he guarded against by having his patients tested every six months. He added that few of his patients ever showed those eye side effects. As to the cardiac side effects he said that he only worried about it if the patient had really advanced cardiac disease and that he had seen none of those side effects even with people with mild cardiac problems.. So, he concluded that the medication is widely used on a variety of patients with minimal side effects. In other words, it’s a safe drug. Does it work against Covid-19? There is a large body of anecdotal evidence that many people have been cured when it was prescribed. It is safe, why not try it off label?
I know some doctors who believe that any off label drug use is risky and sets them up for litigation. However, if the patient signs a release, why not try it? It’s a five day course. If the patient doesn’t respond to HC + Z-pak + ZN then supplemental O2 could be tried, and if that doesn’t work, the last ditch – a ventilator.
Laura Ingraham had a doctor on her show tonight, didn’t catch his name, but he made a shocking claim. I hope he’s wrong or got bad info. He claims that the hospitals in New York are being paid $13,000 for every Covid-19 intake and $39,000 for every Covid-19 patient put on a ventilator. He implied that there was a profit motive involved in the way patients were being classified and treated. Ghastly, if true.
I have seen Dr. Siegal many, many times on Fox. He has always seemed the kind of doctor I would want treating me. Maybe his father experienced an Easter Time miracle, but it’s just one more very convincing anecdote.
TomR:
Thanks for posting a link to the paper “COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism.”
In addition to you own comments, I had these reactions:
1. For better or worse, this paper has not undergone peer review. As far as I can tell, it hasn’t yet been submitted to a journal. Given the importance of the subject, I assume that journal editors would assign the paper to some kind of rapid review process. For now, it’s only available at the ChemArxiv preprint server.
2. I don’t have the background to judge this paper, so in his case peer review would be important to me.
3. Most of this paper consists of computational molecular modeling and bioinformatics. No experimental work. No biochemistry. No clinical work. Again, I’m not qualified to assess their modeling, so I can’t evaluate their conclusions. But I have to admit that I have a bias against research that’s so heavily dependent on computational modeling.
4. The cytokine storm phenomenon has been widely reported, but isn’t mentioned by the authors.
5. I wouldn’t expect hydroxychloroquine to be an effective antiviral in the most narrow sense of the word. Instead, I wonder whether it can limit the cascade of inflammatory symptoms caused by the virus. This idea isn’t mentioned by the authors. Maybe the idea is so naive, that it’s not worth mentioning.
5. The authors don’t address the mechanism of hydroxychloroquine treatment of lupus or other auto-immune diseases.
6. I have NO academic training in this area, but I can’t help but be a little skeptical about this paper. Not fair, I know.
7. I just spent about 30 minutes looking for other papers on hypothetical mechanisms. Will try to get back to it tomorrow. Too sleepy now.
Observational conclusions are scientific, too. Take cigarette smoking. Anti-smoking taxes and advertising laws were based on the statistical linking of cigarette smoking and lung cancer. Take fluoride in water. That originated from an observation by a dentist. From https://en.wikipedia.org/wiki/Water_fluoridation (footnotes omitted),
Further tests were done by putting fluoride in the water of some communities and not in the water of others, and seeing if there were differences in tooth decay.
I say that if NY treats all patients with hydoxychloroquine and the rate of recoveries increases, that would be sufficiently scientific. If there is no change in the rate of recoveries, or if the rate diminishes, that would be sufficiently scientific.
Just because a double-blind test is scientific does not mean that other methods are unscientific.
Two thoughts on this:
First, Ira is correct that significant scientific progress can be made simply by observing phenomenal events. Most people, even hard leftists, would agree that Astromony is a science. Yet, to the best of my knowledge no one has yet created a star, or Galaxy, or universe in a lab. VBG
Second, many of those objecting to letting MD’s use various medications that anecdotally, but not yet proven in double blind tests, to treat the virus are fine with unlicensed medical ‘personnel’ selling marijuana and CDB oil.
And there are known nasty side effects that some people have with cannabinol usage.
The New York doctor, an Orthodox Jew, with significant experience in treating affected patients in that community reports dramatic success with use of the drug together with a Z pack and zinc nitrate. Another doctor explained in a video that zinc is very effective in disrupting the genetic material in the cell which replicates the virus but is incapable of penetrating the cell wall without the assistance of hydroxychloroquine, which opens a gateway into the cell.
Morning update: Bad news, Good news.
First the Bad. The drop in new active cases 4 days ago pushed the fit towards flattening by the weekend. However the last 2 days has shown the new active cases back on the same linear slope as before, so now the flattening has been pushed out 6-7 days. More testing pushing those numbers up?? I’ve been subtracting out the NY cases from the US cases. The NY cases increase the total US cases by nearly 33%. However, the US cases trend does not change by subtracting out NY. i.e. The entire US active cases rate of increase is not affected by NY, just the total.
Good news: 5 days ago I noted the unprecedented 40% increase in serious cases. For the past 4 days the increase in serious cases has been around 2.5% and yesterday was just 1% of the previous day. At the moment, the number of serious cases is flattening. The number of serious cases is still averaging around 2.5% of the active cases. I can match the total deaths if about 19% of those serious cases die. That huge spike in serious cases 5 days ago is unexplained.
Editorial comment: Ira just said, “Observational conclusions are scientific, too.”
AMEN Brother! Observation is how ALL real science starts; especially new discoveries. Someone notices something that catches their attention. Someone tries something just on a hunch. The best science is intuitive and done at the “gut” level. It’s only after that does the formal “scientific method” kick in to check and verify. A failing of the education system is making people believe the “scientific method” is how science progresses. NO. The “scientific method” is the way science makes sure it is not fooling itself, but the actual science is much more a creative endeavor. While I was working I found the people who most understood what we do were not the social scientists (very hung up on the “method” without understanding its limitations), and certainly not the humanists (scientists are racists, sexist), but the artists. The sculptors were particularly in tune with us as they also had some very practical “blue collar” skills.
Great comments above, thanks!
Something not much mentioned is how easy it is for a ventilator to damage a person’s lungs, especially with too much pressure or too much oxygen. It’s NOT a “set it and go do other things”, it’s a constant watching for patient response. One of the “too much oxygen” responses is the creation of fibrous bodies, which was mentioned above w/o quite a cause; and it’s not clear that it was too much O2 in these cases, tho it might be.
The release of iron in hemoglobin is something I hadn’t heard of before.
If the question is HCQ + “usual treatment”, or just “usual treatment” — most doctors will prefer HCQ+. It seems to be better. Similar with adding zinc and anti-bacterial azithromycin (even tho it’s a virus).
More tests would be better; more clarity about what is happening in people’s bodies (which, themselves, are far more individualistic than different cars). But the silly “science” folk failed to have a good testing regime, so far less info is known now — but until good testing is done, we don’t know and won’t know.
Still, a possible treatment that helps seems far far better than a “usual treatment” that, in hospitalization cases, so often does NOT help.
In the Ben Shapiro interview with a NY doctor, she noted Trump was right about his Jan 31 ban on travel with China, and then with Europe — but wishes he had been stronger, earlier. She IS using HCQ, plus other treatments. And claims all patients are now getting all the treatments they need.
Trump complaining folk need to be challenged — when Dems were complaining about Trump’s actions, were these folk supporting Trump? were they opposing the Dems doing the complaints? If not, they are more guilty than Trump of failing to raise awareness earlier. THEY should have acted, correctly, sooner.
Including complaining about the Dem’s non-science based attacks on Trump.
Scott Adams, like Trump and a pro-Trump supporter, was tweeting how he was more right than the Dem experts – the Fake Experts. Most important is to know what you don’t know, so you avoid making mistakes.
All who said Trump’s travel ban was wrong, were wrong. None of them are real experts. Those who said they didn’t know might be experts who knew they didn’t know, but such are a bit wimpy in the “expert” area if they are supposed to know.
The WHO leader is no expert; or, perhaps more accurate, is a great example of a Fake Expert.
From being in the business, I can tell you that the United States lags behind Europe and the rest of the world when it comes to many medical treatments, especially when it comes to cancer. I can tell you that I’ve personally worked with two such treatments that have been approved by the FDA in the past 10 years, and it took for each at least 10 years of “anecdotal” evidence (published data from Europe and the rest of the world) before they were even allowed to undergo initial (Phase I) testing here, and then another 4-5 years to get officially approved (and this was even after FDA “fast-tracking” for highly promising results had been put in play).
Many of the “new” treatments elite American hospitals are touting in 2020 have been administered in Europe and elsewhere since the early 2000’s. And even though these drugs and treatments are now available here, because of the FDA, we in the States are hamstrung on how we can use and administer them. Whereas in Europe and elsewhere, doses and treatment regimens can be adjusted to optimize efficacy for individual patients, in the US, we are constrained by the very narrow “one-size-fits-all” guidelines that were approved by the FDA. It then takes years or even decades to gain FDA-approved flexibility to best treat patients with these drugs as they do elsewhere. Otherwise, two patients who have the same type of cancer, albeit with very different presentations and prognoses, will undergo the exact same dosing regimens and treatment schedules, because any other method of treatment with the same drug is still “anecdotal” by their standards.
The draconian nature of the FDA basically ensures that a treatment whose risks outweigh the benefits will never get approved, but for every one of those that gets stopped, there are hundreds, if not thousands, of effective treatments widely used elsewhere which are waiting in the wings for lengthy and redundant controlled trials to be completed.
My prediction is that hydroxycholorquine, if it ever gets approved for the treatment of viral infections, will take may years, if not a decade, to be approved. And even then, it will only be approved in the treatment of this very specific strain of Covid-19. For any other viral illness, even a related but slightly different type of Coronavirus, the amassed data and evidence for the drug will once again be deemed “anecdotal”.
https://web.archive.org/web/20200405061401/https://medium.com/@agaiziunas/covid-19-had-us-all-fooled-but-now-we-might-have-finally-found-its-secret-91182386efcb
Humans are finally figuring out that they don’t know things about science and biology.
Hurry up with the lawsuits and constitution before its gone
CUOMO WARNS ‘NEW NORMAL’
Take cigarette smoking. Anti-smoking taxes and advertising laws were based on the statistical linking of cigarette smoking and lung cancer.
Where in the constitution does it allow you to use taxes as a means of social control of the people by the servants?
“Observational conclusions are scientific, too.”
and if not, we never would have discovered penicillin… you can throw in some laziness there too since the petri dishes were not washed as they were supposed to be… and some luck… it was tested on rabbits not guinea pigs, which penicillin is toxic..
Same in mathematics. The formal proof that ends up published is seldom how the discovery was made. Gauss was (in)famous for the spare elegance of his proofs. “He is like the fox, who effaces his tracks in the sand with his tail.”
Newton had phenomenal powers of observation.
Yammer:
You are five or six days late to the party. Your cite was noted by J.J. in a comment thread in Instapundit over the weekend. Do try harder.
Nearly every dietary recommendation you’ve ever received from an “expert” (government or otherwise) was based on anecdotal evidence, not a traditional double-blind study. Double-blind studies are the gold standard for slowly and carefully nailing down whether a theory is valid, but they’re sometimes impractical–such as in the middle of a deadly fast-moving epidemic, when you have a somewhat promising treatment with very, very few side effects.
I’m not 100% convinced the Trump pills will prove out. I won’t be 100% convinced until we have double-blind study results from a number of sources. In the meantime, taking “anecdotal” to mean “everything that’s not a double-blind study,” I’ve seen enough that I’d take the treatment myself in a New York minute. I say that even though I know perfectly well we may be seeing confirmation bias in the stories of miracle cures. People go on social media to talk about things that worked, not about loved ones who died anyway. It’s very hard to tell who would have recovered even without the pills, and who would have died even with them. I don’t care. The pills are extraordinarily safe, and worth a try.
I REALLY hope Boris Johnson is getting everything we have that might work.
For anybody who’s still interested in the mechanism for hydroxchloroquinine in the treatment of COVID-19, the most convincing explanation I found was in a recent paper on the use of the drug for rheumatic diseases. I couldn’t understand much of the paper, but here’s a critical point:
“Hydroxychloroquine can also inhibit the activity of the nucleic acid sensor cyclic GMP-AMP (cGAMP) synthase (cGAS) by interfering with its binding to cytosolic DNA. By preventing TLR signalling and cGAS–stimulator of interferon genes (STING) signalling, hydroxychloroquine can reduce the production of pro-inflammatory cytokines, including type I interferons.”
Here’s a link to the full text of the paper:
https://www.nature.com/articles/s41584-020-0372-x
Here’s the citation and abstract from PubMed
Nat Rev Rheumatol. 2020 Mar;16(3):155-166. doi: 10.1038/s41584-020-0372-x. Epub 2020 Feb 7.
Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology.
Schrezenmeier E(1), Dörner T(2)(3).
Author information:
(1)Department of Nephrology and Intensive Medical Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.
(2)Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany. thomas.doerner@charite.de.
(3)Deutsches Rheumaforschungszentrum (DRFZ), Berlin, Germany. thomas.doerner@charite.de.
Despite widespread clinical use of antimalarial drugs such as hydroxychloroquine and chloroquine in the treatment of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and other inflammatory rheumatic diseases, insights into the mechanism of action of these drugs are still emerging. Hydroxychloroquine and chloroquine are weak bases and have a characteristic ‘deep’ volume of distribution and a half-life of around 50 days. These drugs interfere with lysosomal activity and autophagy, interact with membrane stability and alter signalling pathways and transcriptional activity, which can result in inhibition of cytokine production and modulation of certain co-stimulatory molecules. These modes of action, together with the drug’s chemical properties, might explain the clinical efficacy and well-known adverse effects (such as retinopathy) of these drugs. The unknown dose-response relationships of these drugs and the lack of definitions of the minimum dose needed for clinical efficacy and what doses are toxic pose challenges to clinical practice. Further challenges include patient non-adherence and possible context-dependent variations in blood drug levels. Available mechanistic data give insights into the immunomodulatory potency of hydroxychloroquine and provide the rationale to search for more potent and/or selective inhibitors.
DOI: 10.1038/s41584-020-0372-x
PMID: 32034323
In case the link has not been shared – check out the Med Cram series of videos.
https://www.youtube.com/watch?v=9vMXSkKLg2I&list=PLQ_IRFkDInv_zLVFTgXA8tW0Mf1iiuuM_
Episode 34 explains the HCQ-Zinc concept.
https://www.youtube.com/watch?v=U7F1cnWup9M&list=PLQ_IRFkDInv_zLVFTgXA8tW0Mf1iiuuM_&index=35
I’m going back to the start of the series to listen to the ideas.
While we’re talking about COVID-19 treatments, does anyone know how the trials of Gilead’s drug Remdesivir are going? That one actually needs the draconian FDA seal of approval. I heard they were “accelerating” that process. I hope it works, and I hope they actually accelerate it.
J.J. – I thought that part of the C-19 deals was that the feds (us) would pay for hospital care, testing, etc. to make sure that all people had medical care, so having health insurance was not an issue. In addition, paying for the C19 cases would not overwhelm the hospitals with “charity/ no pay” cases as well as having to bail out the health insurance companies later.
When I worked in hospital finance, Medicare switched from cost based reimbursement to a diagnosis based flat rate reimbursement. So, I assume that this flat rate system is still being used. But, are the rates reasonable for an intensive treatment while the elective activity is almost eliminated? I suspect that there will be some additional reimbursement to hospitals to make sure they survive. I have seen reports of layoffs for departments which have been impacted.
I do have to wonder if this reimbursement is impacting the number of cases being moved to the hospital ship or the pop-up federal hospitals.
Another issue will be the impact of delaying normal healthcare on the health outcomes of those people. A friend had one eye surgery before the “safer at home” program was implemented. The second eye surgery has been delayed, so that is very annoying for her.
“I’m drowning! Throw me that inner tube!”
“But it’s an inner tube,
The Coast Guard says it’s not an approved life preserver.”
Kate,
This is a recently updated document from Dr. Fauci’s NIAID group on the Phase 3 trials for Remdesivir.
Completion Date: April 1, 2023 !!
____
LIz on April 9, 2020 at 11:05 am said:
That episode 34 on YouTube is wonderful. Thanks Liz. That doctor is great, and he says he will look at the ACE2 cell receptor issue in a later episode. That is what got the CDC interested in chloroquine in the case of the original SARS.
Liz: Thanks for recommending episode 34 of MedCram. Very well done. I’ve downloaded both papers that served as a basis for the video’s explanation of the way HCQ and Zn act together.
TommyJay: Thanks for recommending those two papers. I’ve downloaded a copy of the second one. As it happens, I’ve already read the first one and noted it in a comment here a few weeks(?) ago.
As an aside, on Neo’s old blog, we used to be able to search blog comments. This worked with both the built-in blog search feature and with Google. With her new blog, comments can’t be searched. I think that’s a regrettable change, though hardly tragic — especially in the context of a discussion about a pandemic.
Thanks, TommyJay. That link shows the design of the Remdesivir study, but not the results, as far as I can see.
An interesting article on the tracking of the virus between China, Europe and the US. https://www.nytimes.com/2020/04/08/science/new-york-coronavirus-cases-europe-genomes.html
TommyJay & Cornflower: You’re welcome. The doctor explains everything in a very understandable way that helps non-medical people. I saw the link in some comment somewhere and I sent it to my doctor. She reviewed it and sent an email out to her patients about how taking zinc helps with colds, so recommended a dosage amount if we started feeling like a cold was coming.
In an other email, she recommended melatonin in low dose (i.e. 3mg). It is used to help with sleep, but there may be some anti-inflammatory benefits. Search for melatonin and coronavirus and you’ll see a few articles about the possible impacts. It can’t hurt and getting better sleep during stressful times can help.
Please note that these recommendations were given when testing for C19 was very limited to people with certain symptoms. I took these recommendations in a manner that it wouldn’t harm you, but may help you until we know more.
Here an interesting new therapeutic approach, nominally Wuhanvirus related but of much wider concern: JPost — “Israeli COVID-19 treatment shows 100% survival rate – preliminary data
https://m.jpost.com/HEALTH-SCIENCE/Israeli-COVID-19-treatment-shows-100-percent-survival-rate-preliminary-data-624058
An excerpt:
“Six critically ill coronavirus patients in Israel who are considered high-risk for mortality have been treated with Pluristem’s placenta-based cell-therapy product and survived, according to preliminary data provided by the Haifa-based company.
The patients were treated at three different Israeli medical centers for one week under the country’s compassionate use program and were suffering from acute respiratory failure and inflammatory complications associated with COVID-19. Four of the patients also demonstrated failure of other organ systems, including cardiovascular and kidney failure.”
Cornflour:
The “search” bar here only works for posts and not comments, it’s true. But one thing you can do – although only on a post-by-post basis – is use the “find in this page” function to look for a particular word or phrase.
Neo – an interesting post topic could be the quality of communications with the state, their agencies and their websites.
Early on, I found the links for my state as well as for states where I had family and close friends. The websites vary a lot in quality and some of them are upgrading them as they gain more experience. I can sign up for the daily updates from the state.
The governor also had an Exec Order which required hospitals & labs to report availability of beds, equipment, PPE supplies, lab tests done, supplies available and what were limiting factors to doing more tests. An earlier version of the report listed the type of machines each lab had and there is a wide variety all with different reagents. So, I suspect that many states are having the same issue of matching testing capability and supplies with the desire for testing. But, I was surprised that the report is on the website and available for all to see.
A second report is on the status of the PPE state stockpile. The last one I looked at included CPAP machines and the SoClean machines. I am assuming that the state will send the PPE to hospitals if they need them as well as supplying the county health departments with PPE supplies for testing purposes.
I live in OK and here is the website – https://coronavirus.health.ok.gov/
And MedCram COVID episode 52 discusses the hemoglobin theory: https://www.youtube.com/watch?v=qc6VV7ue4cE
Dr. Seheult says in his clinical experience he does not see the effects he would expect if the hemoglobin theory were correct.
I get tired of hearing that the possibility of eye problems is a serious risk in prescribing hydrochloroquine in treating COVID-19.
Although rheumatologists often recommend an eye exam with screening for retinal toxicity every year, the American Academy of Ophthalmology recommends that after the initial baseline eye exam, further examination can be deferred for 5 years. In other words, a patient with lupus or RA taking the typical dosage of from 200-400 mg of hydrochloroquine per day wouldn’t expect to have any retinal damage for at least 5 years.
Hardly a consideration in the short term treatment or prophylaxis for COVID-19.
“Editorial comment: Ira just said, “Observational conclusions are scientific, too.”
AMEN Brother! Observation is how ALL real science starts; especially new discoveries. Someone notices something that catches their attention.”
One of my favourite comments about scientific discoveries is (from memory):
The most important exclamation in science isn’t ‘Eureka!’, it’s ‘Hmm, that’s interesting…”.
Ira, Tuvea, physicsguy,
Good points on observation.
I guess we have to take all internal combustion vehicles off the roads; ambulances, semi-trucks, automobiles…
We cannot use Benzene based on August Kekule’s dream. No more gasoline until we starve 1,000 snakes in a pit and compare how many bite their tails when compared with a pit of 1,000 well fed snakes.
Texan99,
Studies are especially hard with humans and nutrition. It’s very hard to reduce and isolate variables. And, different people definitely react differently to the inputs. And people are notorious liars when it comes to reporting what they eat.
How do you find a random sample of people with the same gut biomes and metabolisms?