Interestingly the two big stories I kept seeing over and over was the failure of HCQ and then front page Remdesivris good news….coincident? perhaps?

Anyway lets use the power of our mind (critical thinking) to understand the reality from the reported – lets all be our own journalist we all have the capability to do this – some of us just need to unlock it – quarantine is a perfect time – Here is the source paper – https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v1.full.pdf

Lets first understand what they did – “ We performed a retrospective analysis of data from patients hospitalized with confirmed SARSCoV-2 infection in all United States Veterans Health Administration medical centers until April 11, 2020. Patients were categorized based on their exposure to hydroxychloroquine alone (HC)

or with azithromycin (HC+AZ) as treatments in addition to standard supportive management for Covid-19.”

Okay so no controlled experiment – the author had no control to how or when the dosage was given – did they gather notes and talked to doctors that prescribed it to understand the context of why they were giving the drug – based on paper that was not discussed. However they did do a good job of balancing the covariates. They present a table and it seemed very well balanced.

They did conclude what most press articles are noting “In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19.”

Lots to read in the paper but I kept coming back to HCQ dosage and timing. Also I feel left out based on several papers I posted before about HCQ – zinc vitamin C combination missing. Clearly HCQ is not a solution for all. Many papers note effectiveness is before inflammation and the issue for heart concerns.

A big concern was all these patients median age older than 65 and perhaps the decision to try HCQ was because things were getting so bad that they decided to throw a hail mary to HCQ whereas those that did not take HCQ never reached that point. The only way to know that is to be there and/or talk or review notes with the doctor on hand. There was no discussion on that in this paper. It would seem this was just a statistical matching paper from a large dataset. Could they have done the same approach to Remdesivirs? Would this approach typically produce the same result due to the concerns I have?

Also noted that I would think it shouldnt present a big influence but just as with campaign contributions its not super clean but the authors did get funding before from Gilead Sciences “SSS has received research grants from Boehringer Ingelheim, Gilead Sciences, Portola Pharmaceuticals, and United Therapeutics, all unrelated to

this work. The other authors declare no competing interests.” – but maybe everyone does this so I am not addressing it as a main point but its always important to understand.

So then I see on the front of my news feed – https://www.usnews.com/news/health-news/articles/2020-04-21/more-good-news-on-remdesivirs-power-to-treat-covid-19?src=usn_tw

No link to any paper just regurgitation of optimism. This is awesome if it will work but at $1000 a dose and 10 day treatment this better return 1000X return on efficacy than HCQ, Vitamin C, AZ, Zinc – combo.

Lots of issues being brought up with Santa Clara and LA county testing methods – well outside CA – in KY with a population density of only 89pop/mi^2 – they are showing similar results – this one around 3.8% – https://fox4kc.com/tracking-coronavirus/johnson-county-reveals-3-8-test-positive-in-random-coronavirus-testing/amp/

Also the prison results from Ohio are showing this thing spreads but doesn’t kill at least not immediately – https://www.npr.org/sections/coronavirus-live-updates/2020/04/20/838943211/73-of-inmates-at-an-ohio-prison-test-positive-for-coronavirus

Anti-Vac beware of the following discussion: Briefly discussed the BCG (bacille Calmette-Guerin, is a vaccine for tuberculosis (TB) disease) vaccination before – this person (Jun Santo ) went in depth on it – https://www.jsatonotes.com/2020/03/if-i-were-north-americaneuropeanaustral.html?m=1 . Lots of chatter with why East Europe doing so much better and many trace back to BCG vaccinations. My initial concern was perhaps testing was behind in Eastern European countries but that’s not the case Estonia, Latvia, Lithuana above 2% – Slovakia almost 1%.

Risk/Reward – get the BCG vaccination I am thinking (I already have it). He also concludes the same thing – little to no downside but a significant upside – “If I were North American/European/Australian, I would take BCG vaccination now.”

This is great news for countries such as India – lets hope this is real.

Well the weekend lull perhaps is real big jump in new US deaths today 2751 – big jump in confirmation to for the US 39460. Some can be accounted for adding US military and Veteran Hospitals into the dataset (~10500 for confirmation,~380 death)

Looks like LA is slowing down their testing now over 3%. NY positive/tested continues drop now under 39%. NJ still staying at 50^. MN looks to be alarming. MA big jump in confirmation 3122

Lots of press on KY – but really they are right in the pack – yes they have had a surge but so did MN, NC, PA, CT,CO. Remember CO was supposed to be past peak per the Washington model. MI looks to heading down. Even TX has hope to be on a downward move.

India Confirmed case now over 20K – but still limited deaths being reported.

Spain has a little uptick daily death. Sweden still rising and Germany hasn’t turned yet. Another positive note for the US – we have turned much quicker than the European countries.