Covid-19 News

Quote from RobertBryant

Co-use of arbs (sartans) for hypertension correlates badly with recovery,,) arbs are much worse than other BP meds)

but not so much co-use of metformin..

Reference or link please... I don't recall reading that and there seems to be evidence that the virus does not use the same receptor type at all. Also that there is little or no cross-reactivity. I posted that before. The idea seems basically incorrect. Or my reference was wrong. I am not an expert about ACE receptors but the write of the information I linked seemed to be.

Quote from seven_of_twenty

because of the gigantic quantity of records reviewed.

Multiple authors is a problem .. the message gets confused..

I would put more weight on Dr Raoult's (HCQ +AZM) results with Covid patients rather than with retrospective RA patinets

and where he actually measures the HCQ plasma concentration and other clinically relevant stuff..

Quote from RobertBryant

Multiple authors is a problem .. the message gets confused..

I would put more weight on Dr Raoult's results with Covid patients rather than with retrospective RA patinets

and where he actually measures the HCQ plasma concentration and other clinically relevant stuff..

The papers that Raoult emphasized are certainly tantalizing. But they lack rigor and proper controls. And the only controlled study I saw excluded patients for inappropriate reasons so whether or not it was properly controlled is arguable. Also, these are not primarily Raoult papers. He is actually listed last in a long list of authors. Nonetheless the papers are tantalizing. I hope well done studies of HCQ with and without AZI are reported very soon!

Quote from seven_of_twenty

Reference or link please... I

You need to read the data referenced

https://www.mediterranee-infec…ebsite_IHU_09_04_2020.pdf

Raoult's results suggest higher risk with Angiotensin !! blockers than metformin statins other BP meds (nifedipine metoprolol etc)

One question

is Raoult including AceInhibitors.. where are they? since they are popular for hypertension.

The good thing about Raoult is his single authorship is quicker

I don't expect much from the WHO big multiple authorship studies within six months

too many authors quibbling over details in the edit stage

https://techstartups.com/2020/…ine-with-91-success-rate/

I want to restate that the paper referred to in the above link is not a controlled study. Yes, 91% of patients improved. I don't think they cheated. But absent a control group which was matched and randomized and not given the drugs, there is no way to know this would not happened without treatment. Finally, any controlled experiment should be at least double blinded so the patients and the doctors directing the treatment do not know who is getting treatment and who is getting placebo. This can also be done as a multi-armed study in which different drugs are tested against each other but that is more complicated.

Our dirty rotten scoundrels Vladimir Zelenko and Didier Raoult are at it again! Our anti bat virus combo works. It's all over twitter. The low incidence of Corona virus cases in malarial regions is due to the use of anti malarial drugs. Now present evidence to disprove all.of this!

robert bryant

Quote

Given the common use of ACE inhibitors and ARBs worldwide, guidance on the use of these drugs in patients with Covid-19 is urgently needed. Here, we highlight that the data in humans are too limited to support or refute these hypotheses and concerns. Specifically, we discuss the uncertain effects of RAAS blockers on ACE2 levels and activity in humans, and we propose an alternative hypothesis that ACE2 may be beneficial rather than harmful in patients with lung injury. We also explicitly raise the concern that withdrawal of RAAS inhibitors may be harmful in certain high-risk patients with known or suspected Covid-19.

... and much more.

https://www.nejm.org/doi/full/…uery=featured_coronavirus

Quote from seven_of_twenty

Twitter said it thus it is so.

The medical profession hates to be told "I told you so"

If Twitter says so then many others will be telling..

If HCQ +AZM has low risk... then they may respond

https://www.sciencemag.org/new…ven-coronavirus-treatment

Quote from Dr Richard

Our dirty rotten scoundrels Vladimir Zelenko and Didier Raoult are at it again! Our anti bat virus combo works. It's all over twitter.

Oh Joy! Problem solved. No worries mate. Twitter said it thus it is so. Now we have time to go look for Big Foot and the Loch Nesss Monster. I think they were in Twitter also.

Quote from seven_of_twenty

Now we have time to go look for Big Foot and the Loch Nesss Monster.

Channeling MY?

perhaps SOT might read Raoult's data.. and give an educated MD second opinion?

https://www.mediterranee-infec…ebsite_IHU_09_04_2020.pdf

robert bryant - you are so right, we have waited around for too long without using this treatment. I would be very surprised if the WHO did not give some recommendation for its use now given the !likely mass Corona virus deaths without it, The Chinese have been using it since Feb 20. Look at the fu******* graphs on Worldometer! Look at the infection rates, deaths in Tibet and Nepal which have massive Chinese interaction if you won't accept the sub Saharan/ or Papua New Guinea data. And Nessie is alive and well according to the Scots Tourist Boardl

Quote from Dr Richard

Look at the fu*******

Don't get sucked into emotional response..

A clinical look at benefits versus risks is probaly being done right now in many hospitals based on poor data..

Raoult's data isn't the best but where is the WHO stuff.???

.

Faced with a ten or so dying a day in a big hospital with more incoming I as a clinical director would probably put

the incoming on HCQ +AZQ a la Raoult..ASAP until better data arrives...

the CHO data has finished and was not so good either after how many patients.. 3000...10000

.. so does that mean wait for the WHO data?

when the cows come home?

No need for waiting for more data, the risks of using anti bat virus combo is so low - remember the WHO added chloroquine to table salt for mass distribution. Why not now? (read my previous post from Wikipedia if you don't believe me.) Drastic measures are required NOW!

Quote from Dr Richard

remember the WHO added chloroquine to table salt for mass distribution

the chloroquine doses used in the CHO Covid 'trials' were much higher than that..

HCQ is about 40% less toxic than CQ...

Although the Singapore MOH guidelines say not enough evidence..now... I am sure that

one team of doctors +pharmacists is conducting trials now on Covid patients as the cases mount

looking at pharmacokinetics plus ECG plus viral levels in plasma to get the maximum effective dose with the least adverse effect..

data published??? four weeks that's my bet.. Raoult may have given them a hurry up..

Too late to wait: MDA now! (Mass Drug Administration)

Quote from RobertBryant

so does that mean wait for the WHO data?

the WHO global 'Solidarity trials ' are double-blinded.??? I think it unlikely

Doctors in ICUs couldn't give a damn about Pygmalion

see correction below about the European 'Discovery' trials

which are not double blinded

https://www.sciencemag.org/new…ven-coronavirus-treatment

Quote from Shane D.

Another, new study out by the now famous French Dr. Raoult. BOLD is from article:

https://techstartups.com/2020/…ine-with-91-success-rate/

"From March 3rd to April 9th, 2020, 59,655 specimens from 38,617 patients were tested for COVID-19 by PCR. Of the 3,165 positive patients placed in the care of our institute, 1061 previously unpublished patients met our inclusion criteria. Their mean age was 43.6 years old and 492 were male (46.4%). No cardiac toxicity was observed. A good clinical outcome and virological cure was obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage at completion of treatment was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < 10-2) but viral culture was negative at day 10 and all but one were PCR-cleared at day 15. A poor outcome was observed for 46 patients (4.3%); 10 were transferred to intensive care units, 5 patients died (0.47%) (74-95 years old) and 31 required 10 days of hospitalization or more. Among this group, 25 patients are now cured and 16 are still hospitalized (98% of patients cured so far). Poor clinical outcome was significantly associated to older age (OR 1.11), initial higher severity (OR 10.05) and low hydroxychloroquine serum concentration. In addition, both poor clinical and virologicaloutcomes were associated to the use of selective beta-blocking agents and angiotensin II receptor blockers (P<0.05). Mortality was significantly lower in patients who had received > 3 days of HCQ-AZ than in patients treated with other regimens both at IHU and in all Marseille public hospitals (p< 10-2). Interpretation

"The HCQ-AZ combination, when started immediately after diagnosis, is a safe and efficient treatment for COVID-19, with a mortality rate of 0.5%, in elderly patients. It avoids worsening and clears virus persistence and contagiosity in most cases."

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He is looking retrospectively at 3165 COVID positive patients and selecting 1/3 that meet his "inclusion criteria". Difficult to evaluate the outcome statistics without knowing precisely what these are.

From link in post immediately above this: In his hospital, every patient diagnosed with COVID-19 receives hydroxychloroquine combined with azithromycin, an antibiotic. Raoult claims this has resulted in a very low death rate, which he says he will document soon in a publication.

So these are retrospective inclusion criteria based on patient progress????

Interesting, though, the figures on comorbidities. The dependence of bad clinical outcome on all comorbidities is relatively low. Maybe if we looked at the number of comorbidities there would be a much stronger dependence? Really this data is difficult to analyse. As has previously been the case for Dr. Raoult.

Quote from seven_of_twenty

This is very impressive and complex study. It will take time to evaluate. One issue is based on the article linked below which concludes:

https://www.pharmaceutical-jou…7.article?firstPass=false

Many if not most patients stricken with COVID-19 with appreciable lung involvement should get an antibiotic to prevent overgrowth with bacteria. This might as well be azithromycin and often would be regardless of cardiac risk. The exception would be maybe people with a history of ventricular arythmias and especially those with clearly prolonged QTc (QT interval corrected for heart rate). Other patients could be monitored with daily EKG's if ambulatory or continuous monitoring if hospitalized.

There is also an issue with how the results are stated. For example the incidence of one adverse effect is said to be doubled. That isn't the right issue. The absolute occurrence is. That's because doubling a very low incidence won't matter. Doubling an appreciab;le incidence will. I suppose the actual incidence of adverse effects is there. I have not yet studied the paper yet. It is very impressive because of the gigantic quantity of records reviewed.

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The increase in cardiac mortality for AZT vs control within 30 days goes up by 31 / approx 30,000 = 0.1% - in other words this goes from 0.1% to 0.2% of population.

There again 'slowing the emergence of truth' by this medical populism appears to be 'slowing the emergence of death'. Those two scoundrels also have dodgy political connections! Like Trump and his dodgy drug dealing having major shares in US pharma. Get a life you ridiculous journalists.

Remdesivir

SOT commented on this trial above. I am more positive than he is.

https://www.nejm.org/doi/full/10.1056/NEJMoa2007016?query=RP

This prelim trial is promising because it shows low death rates amongst patients who normally are likely to die.

mortality was 18% (6 of 34) among patients receiving invasive ventilation and 5% (1 of 19) among those not receiving invasive ventilation.

You can't easily draw comparisons, but 18% is pretty low for people needing ventilators. They quote 66% from Wuhan, and I remember figures of around 50% are pretty typical. If you go onto a ventilator with COVID your life chances are not great. So, RCTs needed, but this is a positive not a negative result.

One extra check. The mortality figures are for 28 days from start of treatment. The median death time was 15 days, so it looks as though these figures will catch nearly all (though not all) the deaths. Still, they are not quite as good as they look here.

In a recent randomized, controlled trial of lopinavir–ritonavir in patients hospitalized for Covid-19, the 28-day mortality was 22%.10 It is important to note that only 1 of 199 patients in that trial were receiving invasive ventilation at baseline. In case series and cohort studies, largely from China, mortality rates of 17 to 78% have been reported in severe cases, defined by the need for admission to an intensive care unit, invasive ventilation, or both.23-28 For example, among 201 patients hospitalized in Wuhan, China, mortality was 22% overall and 66% (44 of 67) among patients receiving invasive mechanical ventilation.7 By way of comparison, the 13% mortality observed in this remdesivir compassionate-use cohort is noteworthy, considering the severity of disease in this patient population; however, the patients enrolled in this compassionate-treatment program are not directly comparable to those studied in these other reports. For example, 64% of remdesivir-treated patients were receiving invasive ventilation at baseline, including 8% who were receiving ECMO, and mortality in this subgroup was 18% (as compared with 5.3% in patients receiving noninvasive oxygen support), and the majority (75%) of patients were male, were over 60 years of age, and had coexisting conditions.

Remember, a drug that halves death rates of those on ventilators will likely halve overall death rates - an enormous difference. And there is a good chance (no evidence here) that overall ICU use will be reduced, which is the critical parameter for health systems coping.