COVID-19 | science, damage limitation, NO POLITICS

[faberryman]

That seems like a serious, large volume study. You can't argue with the facts and well documented observations.

You must not have been following the discussion in the other thread.

[Jeremy Roussak]

I thought Playpen was the place to be

For politics, you are right. I have deleted some posts and banned some people for 7 days.

Some of us hoped to confine the petty squabbles and uninformed argumentation to that thread, but I fear that ship has sailed.

It hasn't.

Jeremy

[PeterAit]

That seems like a serious, large volume study. You can't argue with the facts and well documented observations.

Wanna bet? I shall say no more.

[LesPalenik]

Wanna bet? I shall say no more.

What do you mean? It might help to say more.

[Chris Kern]

The latest Imperial College report, published last week, assesses the course of the pandemic in the United States on a state-by-state level.

Nationally, our estimates show that the percentage of individuals that have been infected is 4.1% [3.7%-4.5%], with wide variation between states. For all states, even for the worst affected states, we estimate that less than a quarter of the population has been infected; in New York, for example, we estimate that 16.6% [12.8%-21.6%] of individuals have been infected to date. Our attack rates for New York are in line with those from recent serological studies [1] broadly supporting our modelling choices.

The researchers estimated that no state had achieved a level of infection and recovery which would indicate it was approaching a condition of "herd immunity."

Our estimates suggest that the epidemic is not under control in much of the US: as of 17 May 2020, the reproduction number is above the critical threshold (1.0) in 24 [95% CI: 20-30] states. Higher reproduction numbers are geographically clustered in the South and Midwest, where epidemics are still developing, while we estimate lower reproduction numbers in states that have already suffered high COVID-19 mortality (such as the Northeast). These estimates suggest that caution must be taken in loosening current restrictions if effective additional measures are not put in place.

Unsurprisingly, the researchers "predict that increased mobility following relaxation of social distancing will lead to resurgence of transmission, keeping all else constant. We predict that deaths over the next two-month period could exceed current cumulative deaths by greater than two-fold, if the relationship between mobility and transmission remains unchanged."

[LesPalenik]

The decreased air pollution makes it now possible to see and photograph Mount Everest. From a 160km distance.

With air pollution levels down during the pandemic, Kathmandu photographer Abhushan Gautam captured a sight that has been shrouded in the city's smog for nearly 50 years — a clear view of Mount Everest. Gautam and his neighbours in Kathmandu Valley live on the doorstep of the famous mountain range. But until now, it was extremely rare to catch a glimpse of Mount Everest and its sister peaks.

"This photo is symbolic," Gautam told As It Happens host Carol Off. "If we do our actions right, then things can be mended, and we can actually see Everest from our own backyard." Gautam says the mountain is occasionally visible from the outer city limits when the weather is clear. But it hasn't been documented in Kathmandu Valley for decades.

https://www.cbc.ca/radio/asithappens/as-it-happens-friday-edition-1.5580594/mount-everest-emerges-as-pandemic-lifts-veil-of-smog-from-kathmandu-valley-1.5580607

[Alan Goldhammer]

Ask the users.  Lots of people have taken it and say it helps.

Anecdotal data is close to useless in terms of drug therapy.  To cite but one example, when laetrile was being touted for cancer therapy there were lots of anecdotal reports that it worked. US patients were traveling to Mexican clinics in search of a cure.  It didn't work. That the President of the United States says he has heard a lot of good things about HCQ is a meaningless statement of obvious falsity.

[Bart_van_der_Wolf]

Anecdotal data is close to useless in terms of drug therapy.  To cite but one example, when laetrile was being touted for cancer therapy there were lots of anecdotal reports that it worked. US patients were traveling to Mexican clinics in search of a cure.  It didn't work. That the President of the United States says he has heard a lot of good things about HCQ is a meaningless statement of obvious falsity.

And besides the political angle (which is off-limits here), this article (and the report it mentions) sheds some more recent peer-reviewed light on the anecdotal evidence that's referred to:

Hydroxychloroquine linked to increase in COVID-19 deaths, heart risks
https://arstechnica.com/science/2020/05/hydroxychloroquine-linked-to-increase-in-covid-19-deaths-heart-risks/

Two closely related anti-malarial drugs championed by President Donald Trump as promising treatments for COVID-19 appear to substantially increase the risks of death and heart complications in patients hospitalized from the disease.

That’s according to the largest study yet on the topic, which involved more than 96,000 hospitalized COVID-19 patients on six continents. The peer-reviewed study, appearing Friday in The Lancet, was led by Mandeep Mehra, a professor of medicine at Harvard.

[...]

The researchers primarily looked at risks of in-hospital deaths and serious heart arrhythmias.

Comparing the treatment groups to controls and adjusting each patient’s risk factors, such as congestive heart failure, the researchers found the following:

COVID-19 patients given hydroxychloroquine alone had a 34-percent increased risk of dying in the hospital and a 137-percent increased risk of developing a serious arrhythmia.
Those given hydroxychloroquine with a macrolide had a 45-percent increased risk of dying in the hospital and a 411-percent increased risk of developing a serious arrhythmia.
Those given chloroquine had a 37-percent increased risk of dying in the hospital and a 256-percent increased risk of developing a serious arrhythmia.
Those given chloroquine and a macrolide had a 37-percent increased risk of dying in the hospital and a 301-percent increased risk of developing a serious arrhythmia.

Mehra and colleagues conclude:
"In this large multinational real-world analysis, we did not observe any benefit of hydroxychloroquine or chloroquine (when used alone or in combination with a macrolide) on in-hospital outcomes, when initiated early after diagnosis of COVID-19. Each of the drug regimens of chloroquine or hydroxychloroquine alone or in combination with a macrolide was associated with an increased hazard for clinically significant occurrence of ventricular arrhythmias and increased risk of in-hospital death with COVID-19".

The study has some significant limitations, including that it is merely an observational study—not a randomized, controlled trial thought of as a gold standard for assessing treatments. As an observational study, it cannot prove cause and effect; it only reveals associations with the treatments. Randomized trials—several of which are currently underway—are still needed to definitely determine risks and benefits of the drug.

As mentioned in the article, this type of observational study has its limitations (i.e. correlation doesn't necessarily imply causation), but more studies are being conducted to clarify cause and effect. However, the correlation is alarming. Given that, its unlikely that many tests will be done before patients contracted the virus.

[Robert Roaldi]

Anecdotal data is close to useless in terms of drug therapy.  To cite but one example, when laetrile was being touted for cancer therapy there were lots of anecdotal reports that it worked. US patients were traveling to Mexican clinics in search of a cure.  It didn't work. That the President of the United States says he has heard a lot of good things about HCQ is a meaningless statement of obvious falsity.

Lack of efficacy aside, what would the thinking behind taking the drug as a preventative measure in the first place? Is it analogous to the giving of anti-biotics to livestock?

Under normal circumstances, is it prescribed as a preventative for malaria or something that is prescribed once you have caught malaria? I am trying to understand if there would be any point taking it if you're not already infected.

[Ray]

Lack of efficacy aside, what would the thinking behind taking the drug as a preventative measure in the first place? Is it analogous to the giving of anti-biotics to livestock?

Under normal circumstances, is it prescribed as a preventative for malaria or something that is prescribed once you have caught malaria? I am trying to understand if there would be any point taking it if you're not already infected.

There's a distinction to be made between prevention and cure. Most people who die from Covid-19 infection have other conditions, such as heart disease and obesity, so administering Hydroxychloroquine to such patient who already have serious medical conditions might not serve any purpose and might even have negative consequences.

However, Hydroxychloroquine in combination with Zinc and Vitamin C and D supplements might have a prophylactic effect in preventing the development of Covid-19 in otherwise healthy people.

From the following article, it appears that Hydroxychloroquine helps the Zinc get inside the cells which are infected with the virus. It's the Zinc which destroys the virus.

https://www.webmd.com/lung/news/20200409/chloroquine-zinc-tested-to-block-covid-infection

"Mahir Ozmen, a professor of surgery at the Istinye University, School of Medicine in Istanbul, Turkey, says he thinks the best way to use chloroquine is in combination with zinc and vitamins C and D. He is running a clinical trial, testing to see whether this combination protects health care workers and their immediate families – including his own.

Hydroxychloroquine, he says, helps the zinc get inside the infected cells to destroy the virus, and vitamins C and D support immune function."

https://clinicaltrials.gov/ct2/show/NCT04326725

"This study provides the first in vivo evidence that zinc sulfate in combination with hydroxychloroquine may play a role in therapeutic management for COVID-19."

[Alan Goldhammer]

There's a distinction to be made between prevention and cure. Most people who die from Covid-19 infection have other conditions, such as heart disease and obesity, so administering Hydroxychloroquine to such patient who already have serious medical conditions might not serve any purpose and might even have negative consequences.

However, Hydroxychloroquine in combination with Zinc and Vitamin C and D supplements might have a prophylactic effect in preventing the development of Covid-19 in otherwise healthy people.

From the following article, it appears that Hydroxychloroquine helps the Zinc get inside the cells which are infected with the virus. It's the Zinc which destroys the virus.

https://www.webmd.com/lung/news/20200409/chloroquine-zinc-tested-to-block-covid-infection

"Mahir Ozmen, a professor of surgery at the Istinye University, School of Medicine in Istanbul, Turkey, says he thinks the best way to use chloroquine is in combination with zinc and vitamins C and D. He is running a clinical trial, testing to see whether this combination protects health care workers and their immediate families – including his own.

Hydroxychloroquine, he says, helps the zinc get inside the infected cells to destroy the virus, and vitamins C and D support immune function."

https://clinicaltrials.gov/ct2/show/NCT04326725

"This study provides the first in vivo evidence that zinc sulfate in combination with hydroxychloroquine may play a role in therapeutic management for COVID-19."

Quite frankly this is a lot of BS from people who suffer from confirmation bias and are grasping at straws.  Nobody has every come up with a plausible mechanism for how HCQ works for COVID-19 other than affecting the lysosomal pH.  It does not inhibit any of the key enzymes responsible for COVID-19 production.  The ionophoric activity of HCQ mechanism for getting zinc into cells is pure poppycock as well.  It has no ability to do this at all.  There are more loony clinical trials going on than I can count.  I suspect that the anti-psychotic, chlorpromazine is just as effective as HCQ as it has in vitro activity against the virus at a lower concentration than HCQ.  So many clinical trial resources have been wasted chasing down the HCQ rabbit hole that other compounds that actually might work are being neglected.  I address all of this in a paper on my COVID-19 Website where you also have free access to my daily emails that will separate out the truth from the hype.

[Craig Lamson]

Quite frankly this is a lot of BS from people who suffer from confirmation bias and are grasping at straws.  Nobody has every come up with a plausible mechanism for how HCQ works for COVID-19 other than affecting the lysosomal pH.  It does not inhibit any of the key enzymes responsible for COVID-19 production.  The ionophoric activity of HCQ mechanism for getting zinc into cells is pure poppycock as well.  It has no ability to do this at all.  There are more loony clinical trials going on than I can count.  I suspect that the anti-psychotic, chlorpromazine is just as effective as HCQ as it has in vitro activity against the virus at a lower concentration than HCQ.  So many clinical trial resources have been wasted chasing down the HCQ rabbit hole that other compounds that actually might work are being neglected.  I address all of this in a paper on my COVID-19 Website where you also have free access to my daily emails that will separate out the truth from the hype.

Currently there is no drug available to treat or prevent Covid-19.  So they tried HCQ and if its a failure, so be it. People were and are dying of Covid and without a validated treatment, "grasping for straws" seems perfectly reasonable.  You have a problem with that?   How many other drugs are also a "rabbit hole"?  Is trying them also "grasping at straws? 

[Alan Goldhammer]

Currently there is no drug available to treat or prevent Covid-19.  So they tried HCQ and if its a failure, so be it. People were and are dying of Covid and without a validated treatment, "grasping for straws" seems perfectly reasonable.  You have a problem with that?   How many other drugs are also a "rabbit hole"?  Is trying them also "grasping at straws?

I have a problem with the random prescribing of drugs in the absence of evidence and in particular a drug such as HCQ that can cause fatal arrhythmia.  I seriously doubt that all the doctors who have been prescribing this drug to their patients in the community even did an EKG prior to prescribing to see if their patient might be in potential danger.  The drug hangs around in the body for 24 days when most drugs are cleared from the body in a day or maybe two at the most.  What is the weight of evidence to use in "straw grasping."  I can give you a list of 100 drugs that have been identified in one study or another as potential treatments for COVID-19.  I'm taking one right now for allergies.  Do I think it is protecting me from the virus?  Absolutely not.

We know that behavior modification is the best way to protect yourself.  Social distancing, wear a mask, and wash hands frequently.  You don't have to be gripped by paralysis.  I'm 72 and maybe in the 'risk' category.  I go to the store twice a week and regularly get outside.  We have had friends over for conversation in our yard, making sure to keep our distance.  Is all this inconvenient, of course.

[Bart_van_der_Wolf]

I have a problem with the random prescribing of drugs in the absence of evidence and in particular a drug such as HCQ that can cause fatal arrhythmia.  I seriously doubt that all the doctors who have been prescribing this drug to their patients in the community even did an EKG prior to prescribing to see if their patient might be in potential danger.  The drug hangs around in the body for 24 days when most drugs are cleared from the body in a day or maybe two at the most.  What is the weight of evidence to use in "straw grasping."  I can give you a list of 100 drugs that have been identified in one study or another as potential treatments for COVID-19.  I'm taking one right now for allergies.  Do I think it is protecting me from the virus?  Absolutely not.

We know that behavior modification is the best way to protect yourself.  Social distancing, wear a mask, and wash hands frequently.  You don't have to be gripped by paralysis.  I'm 72 and maybe in the 'risk' category.  I go to the store twice a week and regularly get outside.  We have had friends over for conversation in our yard, making sure to keep our distance.  Is all this inconvenient, of course.

Indeed, and many countries are already cautiously opening up their economic activities, after they got back enough control over the spreading of the virus.
So, it's not a question of either/or, but rather a question of both locking down where needed and opening up where possible.

Common sense really, based on informed choices. But that's a known MO in this thread.

[John Camp]

I've been looking at numbers, and it seems to me that the virus spread is beginning to do what you'd expect -- the most virus cases in the states with the most population, irrespective of politics. The top ten states with the most virus (according to the Worldometer) include seven with the highest populations. (California, Texas, Florida, New York, Pennsylvania, Illinois and Michigan.) The biggest anomaly comes, as you'd expect, in the Northeast, which probably derives from the flood of people coming back to the US from Europe when the travel ban was announced but before it went into effect -- and since the transfer largely took place in the northeast (NY, NJ, Boston) those areas got hit the hardest. New Jersey is one of the hardest hit states, and is 11th in population, so didn't make my top-ten cutoff. Massachusetts, which is also part of that Northeastern "megaplex" is also in the top ten by infections, though it is 14th in population (and has Logan International, one of the biggest entrepots in the US.) But, it appears to me that the caseload is beginning to spread out, with viral reports aligning with population. Another interesting thing I guess you'd expect, is that university towns have a lot of virus, because people involved with universities tend to travel a lot, and also tend to be penned up together in apartments and dormitories. 

[Craig Lamson]

I have a problem with the random prescribing of drugs in the absence of evidence and in particular a drug such as HCQ that can cause fatal arrhythmia.  I seriously doubt that all the doctors who have been prescribing this drug to their patients in the community even did an EKG prior to prescribing to see if their patient might be in potential danger.  The drug hangs around in the body for 24 days when most drugs are cleared from the body in a day or maybe two at the most.  What is the weight of evidence to use in "straw grasping."  I can give you a list of 100 drugs that have been identified in one study or another as potential treatments for COVID-19.  I'm taking one right now for allergies.  Do I think it is protecting me from the virus?  Absolutely not.

We know that behavior modification is the best way to protect yourself.  Social distancing, wear a mask, and wash hands frequently.  You don't have to be gripped by paralysis.  I'm 72 and maybe in the 'risk' category.  I go to the store twice a week and regularly get outside.  We have had friends over for conversation in our yard, making sure to keep our distance.  Is all this inconvenient, of course.

If you are dying, I guess its a gamble some are willing to take.  Only you or your loved ones can decide that.  If someting better comes along and its not passed a trial I would say the same thing. 

[Ray]

Quite frankly this is a lot of BS from people who suffer from confirmation bias and are grasping at straws.  Nobody has every come up with a plausible mechanism for how HCQ works for COVID-19 other than affecting the lysosomal pH.  It does not inhibit any of the key enzymes responsible for COVID-19 production.  The ionophoric activity of HCQ mechanism for getting zinc into cells is pure poppycock as well.  It has no ability to do this at all.  There are more loony clinical trials going on than I can count.  I suspect that the anti-psychotic, chlorpromazine is just as effective as HCQ as it has in vitro activity against the virus at a lower concentration than HCQ.  So many clinical trial resources have been wasted chasing down the HCQ rabbit hole that other compounds that actually might work are being neglected.  I address all of this in a paper on my COVID-19 Website where you also have free access to my daily emails that will separate out the truth from the hype.

Alan,
As far as I can see, searching the internet, there are a number of trials underway to test the prophylactic effect of Chloroquine or Hydroxychloroquine in combination with Zinc supplements. However, the jury is still out because these trials have not been completed. It takes more time to determine with certainty if a drug or supplement has a prophylactic effect than it does to determine if it has a cure. For obvious ethical reasons one can't organize two groups of people with similarly good health, give one group Hydroxychloroquine, then inject both groups with the Covid-19 virus to see which group does better. Also, it does not follow that a treatment which is a prophylaxis is also a cure.

However, since it has been determined that Chloroquine and Hydroxychloroquine can have serious side-effects for people with certain types of pre-existing medical conditions, then obviously that should be taken into consideration.

The following video explains the process of how the Covid virus enters a human cell and replicates, beginning at 2.35 minutes into the video. From 5.45 minutes, the role of zinc and Chloroquine is explained. Would you care to point out the flaws and BS in this video, Alan, since you are so knowledgeable on such matters?
https://www.youtube.com/watch?v=BIymfznD7YA

[degrub]

Latest pandemic planning models from US CDC fwiw -
https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html

[Paulo Bizarro]

Update from Portugal, now on week #3 of reopening:

1. Weekly average of around 250 new cases per day. Of these, the majority arecoming from the greater Lisbon area, particularly from industrial centres - wherehouses and logistical distribution platforms for some companies. In spite of all the precautions, we recently had about 100 positive cases in a population of 400 workers. These things were expected, really.

2. The north of the country, the region that was most severely hit during the initial phase of the pandemics in early March (lots of industries and companies were not closed, as it is the heart of our economy) is now doing very well.

3. This last weekend the temperature has gone up, and beaches had lots of people, we shall see the repercussions ina couple of weeks in terms of cases. From the stats, the new cases are mostly young people, so the number of internships and ICUs has been decreasing which is good news.

Comparing with ohter countries that have more or less the same population (Austria, Sweden, Belgium), we are better than Sweden and Belgium, but worse compared to Austria. Per capita, Belgium looks really bad in number of dead. Sweden chose a different tactic, but in the end, they have about 3x the dead of similar countries, and their economy will suffer as badly. Austria seems to be doing well.

[Bart_van_der_Wolf]

Update from Portugal, now on week #3 of reopening:

1. Weekly average of around 250 new cases per day. Of these, the majority arecoming from the greater Lisbon area, particularly from industrial centres - wherehouses and logistical distribution platforms for some companies. In spite of all the precautions, we recently had about 100 positive cases in a population of 400 workers. These things were expected, really.

2. The north of the country, the region that was most severely hit during the initial phase of the pandemics in early March (lots of industries and companies were not closed, as it is the heart of our economy) is now doing very well.

3. This last weekend the temperature has gone up, and beaches had lots of people, we shall see the repercussions ina couple of weeks in terms of cases. From the stats, the new cases are mostly young people, so the number of internships and ICUs has been decreasing which is good news.

Comparing with ohter countries that have more or less the same population (Austria, Sweden, Belgium), we are better than Sweden and Belgium, but worse compared to Austria. Per capita, Belgium looks really bad in number of dead. Sweden chose a different tactic, but in the end, they have about 3x the dead of similar countries, and their economy will suffer as badly. Austria seems to be doing well.

Yes, it's a mixed bag. However, one word of caution with comparing between countries. National statistics use different input and sources. I was wondering about the high Belgian numbers as well, but it has been explained that they also include e.g. cases in nursing homes, whereas other countries only report those in hospitals.

The Dutch economy is also gradually opening up, in a step by step fashion, now that the cumulative curves are flattening and the number of ICU patients is steadily declining.