Trump said he was being sarcastic. If that were true, and he was being sarcastic, it was EXTREMELY inappropriate.
He did not appear to me as being sarcastic. Therefore, his behavior was inappropriate...especially for a POTUS, so I would have to agree with you. Even if being sarcastic as he claims, it was not the place, and setting for the leader of the free world to say what he did.
I see that he has decided to make fewer appearances at the daily briefings. That is a good idea IMO.
It is well worth watching this video. Very good analysis on HCQ and the mysterious sudden appearance of serious side effects. It also has a very good analysis on comparing COVID19 with the flu. Even with the revised numbers, it is not 5x the flu. It is more like 25-40x the flu in terms of IFR. The reason is that people have been comparing the new IFR numbers to flu CFR numbers.
Correction:
I looked into this and his numbers don't look right. I'm not seeing anyone else saying that IFR for flu is .02% like he said in the video for one flu season. More like CFR of 3 and IFR of .1.
Other world leaders eg Morrison, Ardern in my locale ..rehearse what they will say before public Covid updates..
and run it by advisers before that
A bit more of the King's Speech and less of the Apprentice would be helpful
That is a good idea IMO.
So is this likely to be a different strain from the one in New York?
("95% of positives are asymptomatic")
I did a preliminary Scholar search and found this.
https://www.regenhealthsolutio…solating-asymptomatic.pdf
Not 95% but lots. About the article cited by ZenoOfElea --I don't understand why the prisons don't release the data. I don't understand why the US Dept of Health does not force them to.
If I have time, I will pursue this more tomorrow. It's an interesting finding, to say the least, if it bears out.
Trump said he was being sarcastic.
I saw the clip and replayed it 3 times. He was not, as he alleged, addressing reporters. He was looking directly at the medical people seated at the side of the room especially Dr. Birx. And it can be clearly seen and heard that he was not being sarcastic. When he said he had been being sarcastic, he was blatantly lying. I am sure the clip is on Youtube if anyone wants to see it and decide for themselves.
QuoteIt is well worth watching this video. Very good analysis on HCQ and the mysterious sudden appearance of serious side effects. It also has a very good analysis on comparing COVID19 with the flu. Even with the revised numbers, it is not 5x the flu. It is more like 25-40x the flu in terms of IFR. The reason is that people have been comparing the new IFR numbers to flu CFR numbers
I browsed the video a bit. First this doctor is a PhD not an MD. Second, he is incredibly verbose. Not only that, but he presents text and then reads it to the audience. Absurd way to present stuff. So I didn't really get to the stuff. If he's trying to say HCQ and Azi are not very toxic, no argument and we've gone over this ad nauseam. From the little I saw (and believe me, I would not want to see more), he is trying to make the conservative establishment view seem like a conspiracy. I didn't get to the part about why, if such a part is there. But the video is so unpalatable and obnoxious, I don't see how anyone can watch it, and it runs 44 f'n minutes.
I (and others) would really appreciate transcripts and/or summaries of long videos. Unless, of course, they are either comedy or porn.
Display MoreThis is exactly what Chris Martenson does,, discusses it at the level of the written paper
watch again and then maybe THH can tell us where Chris Martenson is in error in his analysis from TM 12.31
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-the retro VA study reviewed medical charts..only .. there was no study design..
-it was not a randomised prospective controlled study
-
However..HCQ was more likely to be prescribed to patients with more severe disease
Thus the expected increased mortality was observed,,,
No compensation for the level of the severe disease.. no adjustment stated..
No statement of level of dosage or frequency of HCQ... how long after onset..unknown one day two day three day..one week?
was it a "Hail Mary for crashing patients"?
Chris discusses this paper at the level of the written review...
perhap THH has zero medical expertise,, and cannot understand medical terminology...
Pure garbage...
Limitations.. non randomisation of treatment... H
However ..selection bias.. or residual confounding cannot be ruled out
And neither can a potential conflict of interests... be ruled out
The imminent prospective VA Remdesevir will have rigour
in contrast to this retro VA HCQ 'study'
RB - what you have said he says is what we all know, with spin.
The fact that the HCQ patients were more severe is obvious, stated in the study. The issue is how good is the way they compensate for this using a propensity score.
I'm not saying this is as good as an RCT. I've called it weak (twice, I think).
The authors point out that a confounding covariate not tracked (a lot is tracked, including disease severity) would make these results less accurate.
So: comment on how good is their propensity score would be helpful. What you have put there is superficial and what anyone reading the title (observational study) would know.
Otherwise I'd say this is fairly robust against unconsidered covariates because they include a lot (see my previous post where there is a long specification of all the covariates included.
For me the tech questions are:
Quantisation errors matter because of the skewed distribution so that within bins there could be consistently different distributions
I fully admit to not being medically trained. But I can read, have doctors in the family, and in observational studies the issue is the quality of the covariates captured and the correctness of the statistics (maths). One reason I liked this study is that the input data appears uniform and fairly high quality.
Finally can I suggest that the wise way to rate these studies is as straws in the wind. Raoult's initial data had some merit (nor much, less than this). The 31+31 RCT had much merit, reduced however by the fact that the outcomes reported were different from those initially proposed, and the trial stopped early. You can I am sure see the possibilities for cherry picking if outcomes are chosen post hoc (the classic medical study "measure 100 things and claim significance because p value of one of them is < 0.05" problem).
Any comments? For example how would you rate this study versus the 31+31 RCT and Raoult's original results?
Surely, if you agree RCTs are gold standard, then a good observational study that captures and matches or does Bayesian estimation based on covariates will be heaps better than any non-randomised study such as Raoult's or data from an undocumented propensity population such as Zelenko?
I've still read nothing to persuade me that youtube video has value, and I think any serious reviewer would want written text properly written to consider: but if you, having listened to it, can answer the above questions it would be helpful.
THH
Not quite surprisingly even the Nature study didn't mention this simple map: Zika distribution closely matched GMO mosquitoes (source). What we should think about the rest of study, after then? The tendency to deny instead of investigate belongs into signs of pathological skepticism. In particular because another study show, there's nothing wacky about conspiracy theorists: Their doubts are is rooted in evolution – not ignorance. They're just not biased by financial interests of researchers and companies involved in research.
LOL.
I venture to suggest that whereas I would probably be low on the conspiracy theory belief scale, you are high on the same.
You argue that your judgements are realistic because there are a lot of conspiracies. As they say, it is not paranoia if they are out to get you.
I do have a point about accepting random data on the internet. I've no idea what is the evidence for or against Zika comes from GMO mosquitoes. I did think I should check your map above.
https://wwwnc.cdc.gov/travel/page/zika-information
Travel advice about Zika.
Does not look much like your map? Maybe it is cherry-picked?
THH
The VA paper should never have made it into the mass media where it is doing a lot of damage, I wouldn't be surprised if planned clinical trials of hydroxychloroquine or their funding is abandoned as a result. The message that it is ineffective has probably spread internationally so clinicians who were intending to treat COVD19 patients with it have now given up on the idea. Based on zero evidence. Except for the few clinicians like Zelenko and Raoult who from believing the evidence of their own studies and the firmly established incontrovertible biochemical in vitro evidence will persist in saving lives. Hopefully the paper will be rejected by peer review (a general rule about statistical methods is the worse the data the more statistical analysis is required- in this study massaging the data in this way can achieve any result you want). But by then it will be too late and pharma will have triumphed yet again in eradicating a cheap remedy which could have been deployed to defeat this pandemic leaving their path open to cash in on the next round of expensive pharmaceuticals like remdesivir they can patent over the next few years.
Zephir_AWT Could be the genetic modification makes the mozzie a better Zika virus carrier - it was designed against dengue fever not Zika
virus. Did they even test for this possibility?
Surely, if you agree RCTs are gold standard
Why mention RCT? THH
RCT is irrelevant
The VA Covid study has absolutely zilch to do with a RCT.
"
Our study has certain huge and uncertain limitations including those inherent to all retrospective analyses
such as non-randomization of treatment.. My correction in red
1.The data has been selected from ALL VA.(. up to 170 sites) across the USA with no basis for selection stated.
As of today there are 6000 cases with 400 deaths.... this study has a total of 368/70 cases /deaths.
How random was the selection?
The use of so many different sites is incredible in any RCT.
What does standard treatment mean? All patients received the same treatment???
How can one control for all the treatment variables in 170 sites..
for example ICU nurse:patient ratios... dr:patient ratios .. ventilator availabilty.. patient turnover..
Are these assumed to be equal for the two groups?
Any of these variables can have a huge effect on patient survival..
2. There is no control stated of the dose, frequency starting day or no of days for the HCQ drug.
Did they measure the HCQ plasma levels? How can one be sure the HCQ even reached effective levels for 1 minute let alone 3 days?
in any patient. Therapeutic level is the basis of any pharmacotherapy
3. There is no clear statement of the way in which disease severity has been adjusted for.
Just statistical word salad..
The authors need to state plainly all the assumptions they have made
how they have compensated for an increased severity
when they have little idea about the disease progresses..
They need to address the criticism that for some severe patients the HCQ treatment was
just a Hail Mary .their illness was so severe that no treatment would save them from Heaven.
maybe they waved some HCQ incense at them to hasten the saints along the way to the pearly gates.
Therefore there is no way of fairly comparing the HCQ versus non HCQ effectiveness without much more data
Although thanks to the press it has achieved a shortlived notoreity.
this medrxiv paper is not going to be published for a long long time..in any respectable journal... definitely not the NEJM
Any competent reviewer will be asking for a lot more data from the writers
clear statements of all assumptions and ALL limitations..
The authors will be a lot less definite in their conclusions at the end of a peer review process...if they get to the end..
Display MoreWhy mention RCT? THH
because you mentioned RCT as gold standard, as also did the paper authors, and I agree.
RCT is irrelevant - no - we have both quoted it so I presume there is some relevance
The VA Covid study has absolutely zilch to do with a RCT. - not much but it is a study which compares HCQ with no HCQ controlling for many cavariates and therefore attempts to approximate what an RCT would do
"
Our study has
certainhuge and uncertain limitations including those inherent to all retrospective analysessuch as non-randomization of treatment.. My correction in red
1.The data has been selected from ALL VA.(. up to 170 sites) across the USA with no basis for selection stated.
As of today there are 6000 cases with 400 deaths.... this study has a total of 368/70 cases /deaths.
How random was the selection?
We developed a cohort comprising patients with laboratory confirmed SARS-CoV-2 infection in
an inpatient setting. SARS-CoV-2 status was classified by laboratory results that were extracted
from VA laboratory data. A text search for SARS-CoV-2 laboratory tests was used to query VA
lab results. The study index date was defined as the date of a hospitalization with a positive
SARS-CoV-2 laboratory test. Index dates range from March 9, 2020 to April 11, 2020, and
patients were followed from index until hospital discharge or death. The period prior to index is
designated as the baseline period and on or after index is designated the follow-up period.
Patients were included in the study if their information included 1) a body mass index, 2) vital
signs during an encounter (temperature, heart rate and blood pressure), and 3) discharge
disposition status available for the hospitalization.
Note that the inclusion criteria are stated, and involve no cherry picking. Given the ways deaths have changed in US you would expect a much smaller number of cases/deaths
within this period. All appears correct but anyone wanting to query them (e.g. thinking they were lying) could ring them up to ask?
As I understand, they have electronic data and have processed it including all data that meet their requirements for
The use of so many different sites is incredible in any RCT.
The strength of this study is that they have a lot of data from a single database as they state (but your guy seems not to have noticed) here:
This national retrospective cohort study evaluated information on hospitalized patients with
confirmed SARS-CoV-2 infection using data from the Department of Veterans Affairs (VA).
Data were extracted from the Veterans Affairs Informatics and Computing Infrastructure
(VINCI), which includes inpatient, outpatient data (coded with International Classification of
diseases (ICD) revision 9-CM, revision 10-CM), laboratory, and pharmacy claims. The
completeness, utility, accuracy, validity, and access methods are described on the VA website,
http://www.virec.research.va.gov.
The findings of this nationwide study of one of the most complete national datasets in the United
States can accelerate our understanding of the outcomes of these drugs in Covid-19 while we
await the results of the ongoing prospective trials.
What does standard treatment mean? All patients received the same treatment???
How can one control for all the treatment variables in 170 sites..
for example ICU nurse:patient ratios... dr:patient ratios .. ventilator availabilty.. patient turnover..
Are these assumed to be equal for the two groups?
Any of these variables can have a huge effect on patient survival..
There were 27 deaths (27.8%) in the HC group, 25 deaths (22.1%) in the HC+AZ group, and 18
deaths (11.4%) in the no HC group (Table 3). Mechanical ventilation occurred in 13.3% of the
HC group, 6.9% of the HC+AZ group, and 14.1% of the no HC group (Table 4).
Access to ventilators might have some effect.
13.3 % HCQ
14.1 % (no HCQ)
6.9 %(HCQ+AZT)
Looks same HCQ /no HCQ. But HCQ+AZT are less likley on ventilators.
While there is no guarantee untracked covariates generate large errors there is equally no particular reason to expect systematic variations correlated to HCQ
and uncorrelated to disease severity (which is a covariate)
2. There is no control stated of the dose, frequency starting day or no of days for the HCQ drug.
No - or is that needed for this purpose
Did they measure the HCQ plasma levels? How can one be sure the HCQ even reached effective levels for 1 minute let alone 3 days?
in any patient. Therapeutic level is the basis of any pharmacotherapy
Since no-one knows what effective levels are that applies to any trial. We could perhaps hope that the doctors involved are doing their best for their patients?
3. There is no clear statement of the way in which disease severity has been adjusted for.
Just statistical word salad..
The authors need to state plainly all the assumptions they have made
how they have compensated for an increased severity
when they have little idea about the disease progresses..
actually they say how they do this, maybe your guy did not understand it?
As baseline characteristics corresponding to clinical
severity varied across the three groups of patients and could have influenced the non-randomized
utilization of hydroxychloroquine and azithromycin, we computed propensity scores for HC use
and HC+AZ use based on all baseline characteristics.
To account for non-randomized assignment to
the treatment groups, we utilized propensity score adjustment. For the outcomes of death and
death after ventilation, we created propensity scores for hydroxychloroquine use alone and
hydroxychloroquine and azithromycin use during the hospital stay. For the ventilation outcome,
we created propensity scores for hydroxychloroquine use alone prior to ventilation and
hydroxychloroquine and azithromycin use prior to ventilation. Both sets of propensity scores
were estimated via multinomial logistic regression of treatment group. All baseline covariates
were included in the propensity score models. The propensity scores were entered into the
outcome models with restricted cubic splines.16 Statistical analyses were performed with the use
of SAS software, version 9.4 (SAS Institute) and R software, version 3.6.1
They need to address the criticism that for some severe patients the HCQ treatment was
just a Hail Mary .their illness was so severe that no treatment would save them from Heaven.
maybe they waved some HCQ incense at them to hasten the saints along the way to the pearly gates.
word salad.
Therefore there is no way of fairly comparing the HCQ versus non HCQ effectiveness without much more data
Although thanks to the press it has achieved a shortlived notoreity.
this medrxiv paper is not going to be published for a long long time..in any respectable journal... definitely not the NEJM
Any competent reviewer will be asking for a lot more data from the writers
clear statements of all assumptions and ALL limitations..
Agreed. None of these rush to publish preprints are up to the standard of high quality journals (except as immediate interest letters).
The authors will be a lot less definite in their conclusions at the end of a peer review process...if they get to the end..
They are not claiming very much.
The key issue here is whether HCQ treatment is given or not determined only by institutional policy and baseline assessment, or whether patients are put onto HCQ
later as result of condition deteriorating. the former will be corrected by this analysis, the latter not.
Detailed comments above.
I note you are spending time fuming about the deficiencies of this work, and not doing what I recommend.
Which leaves the matter undecided, but given the interest you might expect better evidence for by now if there was significant clinical effectiveness.
Display MoreWhy mention RCT? THH
RCT is irrelevant
The VA Covid study has absolutely zilch to do with a RCT.
"
Our study has
certainhuge and uncertain limitations including those inherent to all retrospective analysessuch as non-randomization of treatment.. My correction in red
1.The data has been selected from ALL VA.(. up to 170 sites) across the USA with no basis for selection stated.
As of today there are 6000 cases with 400 deaths.... this study has a total of 368/70 cases /deaths.
How random was the selection?
The use of so many different sites is incredible in any RCT.
What does standard treatment mean? All patients received the same treatment???
How can one control for all the treatment variables in 170 sites..
for example ICU nurse:patient ratios... dr:patient ratios .. ventilator availabilty.. patient turnover..
Are these assumed to be equal for the two groups?
Any of these variables can have a huge effect on patient survival..
These objections will make sure this paper is eventually rejected by referees, but the authors should contact the various press organisations to correct at least some of the damage their mis-information has caused. If nothing happens in this regard then we know for sure this is part of a pharma backed move to block HCQ use in COVID19 treatment. Profit before people.
note you are spending time fuming about the deficiencies of this work
For those who want to argue about relative merits.. its really simple there are no merits
Why does THH inject fuming ??? into the argument.
The deficiencies are great no randomisation no control no RCT
1. Treatment uncontrolled
2. HCQ dosage and timing uncontrolled
3. Severity uncontrolled
4. NIL Randomization
The NEJM won't publish it.. I can assure you.. no conclusion possible.
They wouldn't touch it with a barge pole
Display MoreFor those who want to argue about relative merits.. its really simple there are no merits
The deficiencies are great
1. Treatment uncontrolled
2. HCQ dosage uncontrolled
3. Severity uncontrolled
4. NIL Randomization
The NEJM won't publish it.. I can assure you.. no conclusion possible.
So: to be clear, you think Raoult's un-peer-reviewed self-publication rates higher than this (with merits) or not? If higher, pray say what you consider its merits?
I'd point out (as I did above) that when trying to discover whether or not a specific new drug has merit (rather than how it can best be used) varying dosage is not a problem, although it means results are less useful in guiding future therapies. And that baseline severity was controlled in this case via a propensity score derived from very detailed baseline quantitative clinical data.
Such blanket rejection would seem to leave you viewing ALL of the current HCQ evidence as of no merit.
That is a principled stance - just a bit boring because nothing to talk about except the foolishness of politicians till we get decent RCT evidence.
How can they be made to compensate for the potential damage they've caused with this spurious VA study? I suppose THHuxleynew will claim there is no harm done since there was no evidence for HCQ being effective anyway. So it's wait and see if more data is forthcoming in the next two or three weeks.
o: to be clear, you think Raoult's un-peer-reviewed self-publication rates higher than this (with merits) or no
A clear diversion THH.. there is no Raoult or fuming in my comments..
I said the VA Covid study was severely deficient and no conclusion can be made. such as the authors.
for 4 clear reasons
.. if you want to go start a separate thread about Raoult or fuming
you are welcome
For a second opinion on the matter I refer to a GP in Hampshire,UK.. Philip Davies..
""
I believe I can confidently state that:
1. The HCQ cohort started with the sickest patients and had even more of the sickest added during ventilation.
Some were too sick to risk the addition of AZ to existing HCQ.
2. The HCQ/AZ cohort also had some very sick patients (again with more additions during ventilation).
3. The Non-HCQ cohort had the best prognosis overall from the very start (although likely a polarized mixture of the most frail and the most promising)...
and then its stats got even better when it jettisoned its sickest ventilated patients into the other 2 cohorts.
It is almost impossible to reach a conclusion from all this.
BUT, the most likely finding is NOT that adding HCQ delivers a worse outcome than standard treatment.
In fact, if we look at the pre-ventilator stats, the addition of HCQ might actually have provided considerable benefit to a particularly sick group of patients.
Whether or not the addition of AZ to HCQ adds benefit is also unclear ... although my 'swingometer' is pointing slightly more to benefit than harm.
Once again. I suggest that a robust study into prophylaxis and early treatment (using sensible safer doses adjusted for pulmonary sequestration) will deliver the most interesting results for CQ/HCQ.
A clear diversion THH..
I said the VA Covid study was severely deficient and no conclusion can be made. such as the authors.
for 4 clear reasons
.. if you want to go start a separate thread about Raoult or fuming
you are welcome
For a second opinion on the matter I refer to a GP in Hampshire,UK.. Philip Davies..
""
I believe I can confidently state that:
1. The HCQ cohort started with the sickest patients and had even more of the sickest added during ventilation.
Some were too sick to risk the addition of AZ to existing HCQ.
2. The HCQ/AZ cohort also had some very sick patients (again with more additions during ventilation).
3. The Non-HCQ cohort had the best prognosis overall from the very start (although likely a polarized mixture of the most frail and the most promising)...
and then its stats got even better when it jettisoned its sickest ventilated patients into the other 2 cohorts.
It is almost impossible to reach a conclusion from all this.
BUT, the most likely finding is NOT that adding HCQ delivers a worse outcome than standard treatment.
In fact, if we look at the pre-ventilator stats, the addition of HCQ might actually have provided considerable benefit to a particularly sick group of patients.
Whether or not the addition of AZ to HCQ adds benefit is also unclear ... although my 'swingometer' is pointing slightly more to benefit than harm.
Once again. I suggest that a robust study into prophylaxis and early treatment (using sensible safer doses adjusted for pulmonary sequestration) will deliver the most interesting results for CQ/HCQ.
I don't think talking past each other helps.
Nor do I think that blanket highlighting deficiencies helps, except relative to other deficiencies. While I agree (as do this paper's authors) with 1., 2. and 3. what is deduced from this depends on the details -
in this case propensity scoring and how it does or does not work in this case. I have at least commented on this - and if you or Philip have germane comments it would be good to hear them.
Just dismissing this without considering details - when good propensity scoring would deal with points 1,2,3 - is unhelpful.
In addition the whole HCQ debate is about strength of (weak in all places) evidence. So rather than being a distraction taking a view as to the relative merits of different papers is essential.
As for a view as to how well HCQ works. My view has changed over time and will probably change again when good RCT evidence emerges. At the moment, the dearth of positive evidence of any quality, even anecdotal, is discouraging, given that such a large number of doctors in the US and France are trying it.
NHS cohort trial?
