Covid-19: bad news on the science front
Unfortunately the last few days have been pretty brutal for scientists trying to develop covid-19 treatments. Note that all of these studies are not yet peer reviewed nor fully clinic trials (good science can't work that fast). However their lack of statistically significant results (with moderate sample sizes) suggest that the potential effect size of the drug is likely minor which is terrible news.
hydroxychloroquine -
https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v2
"no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19"
https://www.medrxiv.org/content/10.1101/2020.04.10.20060699v1.full.pdf
"No evidence of clinical efficacy of hydroxychloroquine in patients hospitalised for COVID-19 infection and requiring oxygen"
remdesivir -
https://twitter.com/GileadSciences/status/1253404143714066432/photo/1
A study summary accidentally posted by WHO suggests that remdesivir had no beneficial affect. The company claims the results were inconclusive. Either way it is bad news, as a highly effective drug would have a large effect and likely be detected in a trial of this size.
These studies are all preliminary, and future studies could suggest that either of these treatments are more effective than these studies suggest. Additionally the drugs may be more successful when used in different situations. However the news over the last few days suggests that no highly effective cure-all is going to be ready any time soon.
Lastly, there is no way to say this without sounding political, but government scientists are reporting pressure to investigate drugs for political -- rather than scientific --- reasons. Please trust your trained professionals during these times. It is a bad idea to inject yourself with disinfectants.
April 24th, 2020 at 12:33 AM ^
The CCP is not to be trusted in any manner or form whatsoever.
April 24th, 2020 at 12:29 PM ^
Lol. China wanting to protect THEIR intellectual property. That is rich
April 23rd, 2020 at 11:44 PM ^
I will also add that although the toxicity of Remdesivir always concerned me, I believe the downside is being overblown a bit in all the reports I read today.
In my personal opinion, a similar but superior drug by the name of Galidesivir is the best option currently available to help fight Cover-19. It has a much lower toxicity than Remdesivir, has benign characteristics, and is inert to human ran/dna incorporation. The mouse/rat testing shows it stops viral replication immediately after use, and some animals were given the drug late in late stages of illness (at peak viremia) and all survived. This characteristic shows that the drug is able penetrate tissues in large quantities, which when paired with the low toxicity is very important.
Obviously a lot to be learned still, but in my opinion is the best hope we have of fighting this disease with solid results and low risks until a vaccine can be created and distributed (hopefully within about 9 months, best case).
April 24th, 2020 at 12:19 AM ^
Do you have any peer reviewed articles to support this? I'm interested in finding out more.
Fear of the unknown has elements of reason attached to it. Here, the fact is that we actually know very little about China. Given what we do know about ourselves and our governmental responses I am not sure why we are so worried about China.
Otherwise, our world has many very gifted and well-reasoned people. Someone is going to find a solution and there will be a group/nation that is paying enough attention to find a better way out of this wilderness. There is a time and a place for most everything-even for our rugged individualism. As things stand, I believe our obsession with the right of the individual (over the collective good) will relegate us to a position of being one of the last nations to come out the other side of this event.
April 23rd, 2020 at 11:31 PM ^
I'm gonna wait out the clinicaltrials.gov macro studies on Remdisivir before moving to any conclusions.
It is pretty interesting that preliminary data was published. Unfortunately, WHO credibility is going to be somewhat problematic given their previous statements on Covid.
April 23rd, 2020 at 11:53 PM ^
While I don't trust The Who on this at all. I do worry about the toxicity of their drug. Look into Galidesivir for something similar - much smaller company so it's not as heard of and will definitely take more time to get full testing results and to market.
April 24th, 2020 at 12:14 AM ^
IIRC it's BioCryst that is running the Galidesivir trials; this was fairly widely reported in some investment related releases earlier in the month. I haven't checked but I'm sure their stock is probably getting pounded today/tomorrow as the market will link the approach with Gilead possible outcomes.
April 23rd, 2020 at 11:31 PM ^
Maybe if we can find a way to inject UV light. ?
April 24th, 2020 at 12:42 AM ^
Nano lights...patent pending.
April 24th, 2020 at 12:48 AM ^
That’s called an x ray
Ohh, man, c'mon... Doesn't the actual name of the light spectrum involved tell you something? Ultraviolet and X-ray are two different light spectrum, and they do very different things to the body.
Yikes figured that was an obvious joke.
I’m not suggesting people blast themselves with x rays.
I guess I’ll explain it cause it’s not as clever as I thought. The joke is that UV and x rays are both photons, actually next to each other on the spectrum, the distinction is really just due to popular nicknames and convention, they are in fact the same thing. Technically all “x rays” are “ultra violet” because they have energies above violet light. Is a photon with a 10 nm wavelength UV or X-ray? There’s not really a hard cut off. Also the term x ray from a medical perspective means the black and white pictures you get from the doctor, but in physics an X-ray can be considered any photon produced by an electron changing orbitals (so includes UV light).
Besides he said “inject UV light”, well how would you do that? Up the energy of course, until the wavelength is sufficiently small to penetrate the skin, and that’s commonly called an x ray.
So yeah I realize now why the joke may not have landed. I guess in a world where people aren’t so vigilant about shooting down the presidents strange suggestions it may have been more obvious sarcasm.
April 23rd, 2020 at 11:35 PM ^
I think it's also important to keep in mind that the evidence and recommendations are changing literally day to day. Many hospital systems will continue to do what is effective for their patients until large scale trials can be conducted or a definitive answer is reached.
For example, there have been studies out of China and WHO recommendations that say high dose steroids do not help, but two major health systems in SE michigan have had success with solumedrol early in the disease process. At least one of these two health systems is still using plaquenil and azithromycin because it has worked for them.
April 23rd, 2020 at 11:36 PM ^
Reports on the VA study are misleading. According to the VA Secretary "It's not a clinical study," Wilike explained. "It was done on a small number of veterans. Sadly, those who were in the last stages of life, and the drug was given to them." "We know the drug has been working on middle age and younger veterans...working in stopping the progression of the disease," Wilkie explained.
April 23rd, 2020 at 11:46 PM ^
I linked the whole study if you'd like to read it. A clinical study (as I mentioned in the post) would be better but unfortunately it also isn't a small number of Veterans. This is also where effect size comes in.
I've seen no published evidence for the second part of your response but would love to see it if you have it!
April 24th, 2020 at 12:03 AM ^
I’d be more reassured if Wilkie had some actual medical training or if he hadn’t been appointed by the man promoting the drug,
"...the man promoting the drug"
Who also owns a stake in the drug maker...
April 24th, 2020 at 10:23 AM ^
https://www.snopes.com/fact-check/trump-profit-hydroxychloroquine/
"Trump’s financial stake in these companies is virtually negligible — contained indirectly via mutual funds — and administered through three family trusts he does not control. As a generic drug, hydroxychloroquine is unlikely to provide any one company with significant profits compared to other proprietary drugs."
April 23rd, 2020 at 11:41 PM ^
Nobody knows.
April 24th, 2020 at 12:56 AM ^
The trouble I've seen...
Nobody knows the sorrow...
April 23rd, 2020 at 11:43 PM ^
So I shouldn't ingest coy pond cleaner?
April 24th, 2020 at 12:16 AM ^
Koi Pond > Coy Pond
I don’t know, a coy pond sounds intriguing
April 24th, 2020 at 11:58 AM ^
You like a little mystery in your ponds? Kinky...
April 23rd, 2020 at 11:46 PM ^
I was saddened by the Gilead report today.... remdesivir seemed to be the best hope for a treatment. I do think we need a treatment before we will really be able to start climbing back to normal. I was also down because I had bet about 20% of my retirement on Gilead. I got out with no real damage but I still hope the report is wrong.
It was bad news for us all.
April 23rd, 2020 at 11:54 PM ^
Frankly it depressed me.
I did not hold out much hope for this to cure a virus. The only hope is for an antivirus but that could be only 50/50. This COVID-19 has changed our nation and I'm afraid the economy will slip into a depression. We have not had one since the market crash in '29 and it took WWII to get us out.
April 23rd, 2020 at 11:50 PM ^
Information from a few epidemiological studies also came out today (not clear that the studies themselves have actually been released)
https://www.nytimes.com/2020/04/23/us/coronavirus-early-outbreaks-citie…
A study at Northeastern suggests that about 28,000 people across 5 cities (New York, San Fransisco, Seattle, Boston and Chicago likely had Coronavirus on March 1.
https://www.nytimes.com/2020/04/23/nyregion/coronavirus-antibodies-test…
Antibody testing suggests 21% of New York City residents likely have had Covid and 14% of New York State residents. This suggests a mortality rate in the 0.6% to 0.7% range.
April 23rd, 2020 at 11:51 PM ^
They didn't use zinc so it didn't work. Dr. Zelenko in NY has treated 700 patients with 100% success using Hydroxycholoroquine and zinc.
Like I said yesterday I'm much more worried about mass starvation and societal collapse than a virus with 0.1% mortality as shown by the USC study. The whole thing is absurd.
April 23rd, 2020 at 11:56 PM ^
What about the New York study that shows more like 0.6% to 0.7%?
April 24th, 2020 at 12:00 AM ^
Could be true. Either way I'll take 0 point something over 30%+ if this isn't opened soon.
April 24th, 2020 at 12:59 AM ^
Too bad the virus doesn’t give a shit about what you or I “will take”.
0.3% is fucking 1 million people. That would be the equivalent of 300 9/11 attacks in 1 year. And you would have millions more with long term health issues. That is an unthinkable atrocity for society to deal with.
i am not even against the gradual and safe reopening of the economy but i can’t stand how stupid people throw numbers around.
But... these lockdown measures aren't even designed to limit the number of infections. If 300 million people are going to get infected without these measures, 300 million are going to get infected with these measures. The purpose of "flattening the curve" was to slow down the infection rate, not to limit the total -- rip off the band-aid slowly, rather than quickly. I promise. I'm not making this up -- you can go back and look.
The politicians keep moving the goalposts in a desperate attempt to "do something" when there is literally nothing that can be done. The best we can hope for is to isolate the most at-risk individuals and understand that some of the rest of us will die -- just like we might die from heart disease, or stroke, or accidents, or any of a number of other things. About 3 million Americans die every year. Even if you made the rather ridiculous assumption that none of your COVID patients would otherwise have died this year, you're looking at a one-third increase in the death rate for one year.
The unthinkable atrocity for our society is the one we're embarking on right now, shutting down the economy, putting millions of people out of work, and mortgaging the future with debt on which we're likely to default in our lifetimes. The cure is worse than the disease.
Th unthinkable atrocity is opening things back up before testing and tracing measures are in place. Testing is not that hard, it just requires leadership and coordination. There other countries that are doing it. If you want to get angry, get angry about that. We have the world's most expensive healthcare system and we can't even get enough COVID tests to test all those who need it. That should make your blood boil.
There's no point.
You can test and trace when you have a handful of cases in any given region. You can't do it when the numbers are as high as they have been in the US.
The only viable option is to let the disease run its course. Mass testing for it is a waste of time and money. It's just more pandemic security theatre, like x-rays at airports.
I'm really, really glad you're not an epidemiologist. Holy fuck dude.
These measures will take months! I think a lot of states, especially these D governors, which will result in a horrible recession or even a depression. A lot of people will lose their jobs forever. The government will have to play Robin Hood and take from those who have stored money in a 401K and distribute it to those who will have no money, so everyone will eventually end up poor. I feel sorry for future generations who will not have a chance to live in a great US.
You: "THE DEMS ARE RUINING EVERYTHING AND CAUSING A DEPRESSION"
Reality: The entire fucking world has implemented some sort of social distancing measures to deal with the virus - at least, those who are actually acknowledging it exists. A global recession was inevitable. You cannot face a global pandemic of this magnitude without some negative economic impacts. People like you seem to think "economy or mass virus spread", like they're mutually exclusive. They're fucking not.
April 24th, 2020 at 12:18 AM ^
There are some serious problems with that Stanford study. I hope it is relatively accurate, but there are multiple reasons to be very skeptical of their data.
The NY study is a little more logical, but not fully peer reviewed.
Because it doesn't fit the gloom narrative? Of course there are problems. EVERY study has problems but you have to decide if it is quality enough to be considered good. and again "not fully peer reviewed". What every DOOMER says.
April 24th, 2020 at 12:54 AM ^
Please point me to some data or statistics showing the parts of society that have collapsed or what areas are experiencing mass starvation.
Let’s deal with the real problem that exists right now, covid19 and not the problems that you made up.
26 million Americans, and counting, are out of work. Millions of those haven't been able to get unemployment insurance yet, because the systems are overwhelmed and also because it takes time to update things when the law changes.
I don't expect mass starvation in the US, although there will certainly be an exacerbation of hunger in at-risk communities. In fact, anyone who is able should consider donating to your local food bank, or to a charity such as Feeding America -- and if you're fortunate enough still to be employed, look to see if your employer might match donations as well.
Mass starvation overseas, though, is a very real possibility, alluded to this week by the head of the UN Food Programme in an address to the UN Security Council.
The economic problems are every bit as real as the medical problems. They're just not headlining the news.
50,000 dead in one month in the US and that is with quarantine measures in place. Poorer countries are on the brink of far worse (see Ecuador).
You are right that quarantine risk is significant and grows more so with each passing day, but it does not approach the very immediate risk of the disease currently.
But how much time are you buying people, and at what cost?
If the hospitals aren't overrun, and the disease is going to spread to the same extent with or without "flattening the curve" -- which, again, is what the people who were advocating it said; they just wanted to slow things down -- then you're not preventing any deaths.
I'm not saying that the disease isn't serious. I'm saying we need to follow Hippocrates's oath writ large -- first, do no harm. We're doing an immense harm, based upon scary computer projections that, so far, don't appear to be particularly realistic.
I am convinced that people have decided that if we all wear masks and stay six feet away from everybody, suddenly people will stop dying from the virus. But if that were the case, it should already have happened. People started changing their behavior six weeks ago, and the incubation period of the disease is two weeks.
Less people are dying with these measures in place. Unfortunately, not everyone is abiding by them (or is able to abide by them), and beyond that, family transmission is how many are infected; that continues with current measures in place, which is why "smart" quarantine facilities are critical. Flattening the curve doesn't just slow things down, it reduces total deaths significantly. Get on board!
No, it really doesn't. Maybe.. maybe.. with Wuhan-style lockdowns, enforced by guns. And that's only if you trust the numbers coming out of China. In order to reduce the number of deaths in a scenario where the hospitals weren't being overwhelmed, the lockdowns have to continue until a vaccine is found. If it ever is. The idea of a "safe reopening" is just typical politician-speak -- as soon as the virus is given a chance to spread, it will. Again, this isn't just me -- this is exactly what the "flatten the curve" people have been saying from the beginning. They just moved the goalposts once it became clear that their original fear -- hospitals being overrun -- was never a real threat in most of the country.
Fewer people are dying because fewer people are doing anything. No traffic accidents, no surgical mistakes, no accidental overdoses, no etc. If reducing the death rate is America's #1 priority, we should keep the lockdown on forever. Eliminate alcohol, cars, caffeine, nicotine!
We don't do those things because reducing the death rate is not supposed to be America's #1 priority, but rather just one out of a balanced set.
In other words, the stay home orders are working. Let's keep on doing it until tests and tracing procedures are ready.
But those same orders would have the same effect without a pandemic too! You could have had a stay-at-home order and cancelled the NCAA Tournament last year, and it would have saved lives. People are myopically focused upon death, to the exclusion of every other priority, and it's not a reasonable stance to take in a free society.