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InspectorSector
Re: Viral Facts

did Dr. Roberts say zinc was also contraindicated with chloroquine?

That might be my confusion. It has been a few days since I watched the video.

Apr 2, 2020 1:52:13 AM       
Jrinne
Re: Viral Facts

A small study about hydroxychloroquine.

New York Times version: HERE

Original article: HERE

This was a small study. My only comment remains: Why don’t we have a study with 200+ people in New York/New Orleans in about 2 weeks?. Maybe we will.

Actually, I am aware of a study that has enrolled 1,000 healthcare professionals to see if hydroxychloroquine (Plaquinil) can work prophylactically. So, it would be wrong to suggest that the scientific community is sleeping through this.

From the above study:

"...a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 32) compared with the control group (54.8%, 17 of 32). Notably, all 4 patients progressed to severe illness that occurred in the control group. However, there were 2 patients with mild adverse reactions in the HCQ treatment group. Significance: Among patients with COVID-19, the use of HCQ could significantly shorten TTCR and promote the absorption of pneumonia."

From time to time you will encounter Luddites, who are beyond redemption.
--de Prado, Marcos López on the topic of machine learning for financial applications

Apr 2, 2020 4:17:51 AM       
Edit 8 times, last edit by Jrinne at Apr 2, 2020 8:21:50 AM
Sterling
Re: Viral Facts

"promote the absorption of pneumonia."


Reading studies from doctors can be a frustrating experience. They may have passed medical school but they might fail a writing class. I wonder if other doctors really get the lingo or are just as flummoxed as I am but don't want to admit it.

Apr 2, 2020 9:00:56 AM       
nisser
Re: Viral Facts

A small study about hydroxychloroquine.

New York Times version: HERE

Original article: HERE

This was a small study. My only comment remains: Why don’t we have a study with 200+ people in New York/New Orleans in about 2 weeks?. Maybe we will.

Actually, I am aware of a study that has enrolled 1,000 healthcare professionals to see if hydroxychloroquine (Plaquinil) can work prophylactically. So, it would be wrong to suggest that the scientific community is sleeping through this.

From the above study:

"...a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 32) compared with the control group (54.8%, 17 of 32). Notably, all 4 patients progressed to severe illness that occurred in the control group. However, there were 2 patients with mild adverse reactions in the HCQ treatment group. Significance: Among patients with COVID-19, the use of HCQ could significantly shorten TTCR and promote the absorption of pneumonia."


Among patients with COVID-19, the use of HCQ could significantly shorten TTCR and promote the absorption of pneumonia.

So no effect on mortality as I suspect. It's a smalls study and may not be powered enough to see a difference in mortality, you bet they looked at it and likely found it flat, or else they would have commented on it.

It's a meaningless metric in practice. People aren't dying from Pneumonias: they're dying from ARDS, cytokine storm, and cardiac arrest.

Apr 2, 2020 11:11:24 AM       
Jrinne
Re: Viral Facts

It's a smalls study and may not be powered enough to see a difference in mortality,…..

Nisser,

Good to see some good use of statistics!

Not only is it a small study, as you say, there is the bias of small studies with any positive result possibly getting published while negative results may not get published.

I just talked to an anesthesia friend who discussed some of the recommendations about EKGs and the risk of prolongation of the QT interval. He started discussing this before I mentioned anything about QT intervals.

Good call on the risks! Some are recommending 12 EKGs before starting hydroxychloroquine, he says.

BTW, my anesthesia friend was quarantining at home (waiting for a negative test). Before he went home he stopped at the hospital pharmacy to fill a hydroxycholoroquine and Z-Pak prescription.

He does not believe in hydroxychloroquine but still he filled the prescription (just interesting).

Best,

Jim

From time to time you will encounter Luddites, who are beyond redemption.
--de Prado, Marcos López on the topic of machine learning for financial applications

Apr 2, 2020 11:33:28 AM       
wwasilev
Re: Viral Facts

It's a meaningless metric in practice. People aren't dying from Pneumonias: they're dying from ARDS, cytokine storm, and cardiac arrest.

Speaking of cytokine storm, any opinions on CTSO? I'm holding a bit in my coronavirus portfolio.

Walter

Apr 2, 2020 11:41:48 AM       
nisser
Re: Viral Facts

Here's another very grounded answer from an Italian doc. He makes an excellent point.
twitter.com/rob_cosentini/status/1245721133120454662

I don't have much thoughts on that technology. I don't see it being used for COVID related storms as they are unpredictable

Apr 2, 2020 12:05:32 PM       
Edit 1 times, last edit by nisser at Apr 2, 2020 12:13:51 PM
Chipper6
Re: Viral Facts

Here is a video that warns against hydroxychloroquine with zinc. https://www.youtube.com/watch?v=qmcQMCB2li8&feature=youtu.be

I wrote up the "cliff notes" of this video.
Some notes on what he said:

1. Qualification: Dr. Roberts was the CEO of a pharmaceutical company that did the research in these types of drugs. So, he has a unique perspective and was involved in the modern research on this drug.
2. Little known research: The anti-biotic interferes with the body’s metabolism of Hydroxychloroquine. It may be dangerous for the heart. Your doctor should review the data on the subject before prescribing it.
3. Gov’t employees #1 priority is to protect their own job. They protect their job by following protocol. When Prez Trump says that the FDA fasttracked… don’t believe him. That’s not how it works. Don’t count on the FDA to come through anytime soon on the Hydroxy… study.
4. The good news: We don’t need FDA approval. It’s completely legal and regular to use it off label.
5. He does not know if the studies will show that it’s effective. On the other hand, you wouldn’t want to be overly cautious and follow the normal protocols when people are dying.
6. See Medcram; coronovirus update #34. It uses data from China and S Korea. Which supplements the study from France.
7. Approval of a vaccine will not be fast tracked. It will take at least a year+. By that time this catastrophe will be gone.

And this was Dr Roberts' response:
Richard H. Roberts, M.D., Ph.D.:

Your synopsis of my video is very impressive. You hit most or all of the important points in a concise, thorough, and clear manner. You should be a professional writer.
Thanks,

Rich Roberts
Dr Roberts himself put out a follow up video where he said that his initial research on zinc is very promising, and although it has not been tested properly yet, in this situation it is not prudent to wait. He himself said that he is taking 15 mg - 30 mg of zinc every day because it wont hurt and may help. Some interesting highlights from this newer video titled zinc coronavirus correlations:
Lack of zinc causes loss of smell. It also affects ability to fight germs/ immunity. Many older people have zinc deficiency. So they are more at risk of getting COVID-19. This drug opens the cells to allow Zinc to penetrate which inhibits the reproduction of the virus. Zinc also raises the immunity which in turn eliminates much DM II, Hypertension and other conditions, many conditions seen in the elderly.
Disclaimer: This synopsis of the new video was not done by me and was not approved by Dr Roberts. It also omits some important disclaimers by Dr Roberts such as that these are correlations; not proof.

Apr 2, 2020 9:24:05 PM       
Edit 2 times, last edit by Chipper6 at Apr 2, 2020 9:33:11 PM
Schm1347
Re: Viral Facts

This might be an offshoot but it appears that unfortunately when people go on ventilation it appears their chances of survival aren’t that great. Could draw into question the usefulness of manufacturing large quantities of ventilators and how long one can keep someone on a ventilator and still maintain reasonable chances of survival. It’s more anecdotal and of small study numbers mentioned, but still alludes to the concern at hand.

https://www.npr.org/sections/health-shots/202...lly-ill-covid-19-patients

Also studies are showing that Chloroquine is probably ineffective which isn’t surprising. If it was truly a game changer we wouldn’t be still shutting down the economy.

Ubiquitous testing - both for antibodies and active infections is key. Of course a viable vaccine would change the game overnight but everybody is either ready to start of starting trials.

Jeff

Apr 4, 2020 1:19:18 AM       
Jrinne
Re: Viral Facts

Jeff,

Penicillin (an antibacterial) was so effective people could tell immediately that it worked.

Acyclovir (an antiviral) was a game changer but the response is not as impressive as Penicillin and the range of disease is so wide that I do not think we could have been sure that it works without a large controlled study.

Even worse is a medicine like Lipitor. It takes a huge number of people in a controlled study over many years to find its small effect on heart attacks.

I am not going to try to pick a winner as far as a medication. But if the medicine is as effective as, say acyclovir (which would be very good), it will take a pretty large, controlled study, to really show that it works.

Nisser correctly says that a lot of studies are probably "underpowered." For any medicine we can expect a lot of false positives, selective reporting of positive studies (not the negative ones) and underpowered studies that really tell us nothing.

This is understandable, we will take a little evidence, one way or the other, in this dire situation.

I might ask (you know, write it on a pad) for both hydroxychloroquine and Ganovo+Ritanovir (in Phase IV studies by Ascletis) ) if I were on a ventilator. Can you even write while in the prone position they are now using? It is a dire situation if it is happening to you or a family member. Or just dire period. We are all acting on somewhat educated guesses.

I guess I am just hoping that maybe there is a medicine effective enough that our early underpowered studies are getting us something useful.

I go on about drug company monopolies in another tread. But it is also true that they are the only ones with enough resources to do some of this from beginning to end and it may take some time.

Here is a large list of medications in trial, their target and where they are as far as study phase: Lots of Drugs

Best,

Jim

From time to time you will encounter Luddites, who are beyond redemption.
--de Prado, Marcos López on the topic of machine learning for financial applications

Apr 4, 2020 5:03:21 AM       
Edit 8 times, last edit by Jrinne at Apr 4, 2020 5:39:21 AM
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