Good news on many fronts
Russians claim to have an effective treatment for the coronavirus, which hospitals will start using this month – they certainly have people to test this on (#2 in confirmed cases 500k+) – https://www.cnbc.com/2020/06/01/russia-approves-drug-to-treat-covid-19-hospitals-to-use-in-june.html
“Preliminary trials are said to have shown that it could shorten recovery times for patients with Covid-19.
The final stage of Avifavir clinical trials involving 330 patients, are ongoing.
Russia’s Ministry of Health on Saturday temporarily approved the use of the drug as a coronavirus treatment”
“According to data received from an earlier clinical trial of the drug, 65% of the 40 patients tested negative for coronavirus after five days of treatment, which was two times higher than in the standard therapy group, RDIF and ChemRar said last month.”
Paper on HCQ released May 27th -perhaps another confirmation bias paper – https://academic.oup.com/aje/advance-article/doi/10.1093/aje/kwaa093/5847586
“Dr. Harvey A. Risch, Department of Chronic Disease Epidemiology, Yale
School of Public Health, P.O. Box 208034, New Haven, CT”
“Funding: None”
“Hydroxychloroquine+azithromycin has been used as standard-of-care in more than
300,000 older adults with multicomorbidities, with estimated proportion diagnosed with cardiac
arrhythmias attributable to the medications 47/100,000 users, of which estimated mortality is
<20%, 9/100,000 users, compared to the 10,000 Americans now dying each week. These
medications need to be widely available and promoted immediately for physicians to prescribe.”
“the key to returning society toward normal functioning and to preventing huge loss
of life, especially among older individuals, people with comorbidities, African Americans and
Hispanics and Latinos, is a safe, effective and proactive outpatient treatment that prevents hospitalization in the first place.”
“Numerous reviews of HCQ efficacy and adverse events
have been and continue to be published. To my knowledge, all of these reviews have omitted the
two critical aspects of reasoning about these drugs: use of HCQ combined with AZ or with
doxycycline, and use in the outpatient setting.”
“first study of HCQ+AZ (24) was controlled but not randomized or
blinded, and involved 42 patients in Marseilles, France. This study showed a 50-fold benefit of
HCQ+AZ vs standard-of-care, with P-value=.0007. In the study, six patients progressed,
stopped medication use and left the trial before the day-6 planned outcome measure of swab sampled nasopharyngeal viral clearance.”
“Examination of
the database for adverse events reported from the beginning of the database in 1968 through
2019 and into the beginning of 2020, shows for hydroxychloroquine 1064 adverse event reports
including 200 deaths for the total of cardiac causes that could be both specifically and broadly
classified as rhythm-related. Of these, 57 events including 10 deaths were attributed to Torsades
de Pointes and long QT-interval syndrome combined. This concerns the entirety of HCQ use
over more than 50 years of data, likely millions of uses and of longer-term use than the 5 days
recommended for Covid-19 treatment.
“All but one of the scientists on the Scientists to Stop Covid-19
panel are laboratory or clinical scientists; only one is an epidemiologist. Their recommendation
for remdesivir use as early as possible was made without either FDA approval or RCT evidence
of efficacy in the outpatient context. This recommendation therefore appears to be an
extrapolation from animal and laboratory data and from use in severely ill hospitalized patients.
However, a history of epidemiology shows numerous instances of failed extrapolation from
animals to humans. “Animal research on almost any topic of epidemiologic interest is so
heterogeneous and inadequately synthesized that it is possible to selectively assemble a body of
evidence from the animal and in-vitro studies that support almost any epidemiologic result.””
“it is not my point to say that remdesivir has little evidence to
support its potential outpatient utility, only efficacy considerations that have not been addressed
and that could lead to lack of efficacy under general use, but that HCQ+AZ has been directly
studied in actual early high-risk outpatient use with all of its temporal considerations and found
empirically to have sufficient epidemiologic evidence for its effective and safe employment that
way, and that requiring delay of such general use until availability of additional RCT evidence is
untenable because of the ongoing and projected continuing mortality. No studies of Covid-19
outpatient HCQ+AZ use have shown higher mortality with such use than without, cardiac arrhythmias included, thus there is no empirical downside to this combined medication use”
“Substantial fractions of physicians treating Covid-19 patients in
Europe and elsewhere report use of HCQ+AZ: 72% in Spain, 49% in Italy, 41% in Brazil, 39%
in Mexico, 28% in France, 23% in the US, 17% in Germany, 16% in Canada, 13% in the UK
(45), much of the non-US use in outpatients. HCQ+AZ has been standard-of-care treatment at
the four New York University hospitals, where a recent study showed that adding zinc sulfate to
this regimen significantly cut both intubation and mortality risks by almost half”
“I conclude that HCQ+AZ and HCQ+doxycycline,
preferably with zinc (47) can be this outpatient treatment, at least until we find or add something
better, whether that could be remdesivir or something else. It is our obligation not to stand by,
just “carefully watching,” as the old and infirm and inner city of us are killed by this disease and
our economy is destroyed by it and we have nothing to offer except high-mortality hospital treatment. We have a solution, imperfect, to attempt to deal with the disease. We have to let
physicians employing good clinical judgement use it and informed patients choose it. There is a
small chance that it may not work. But the urgency demands that we at least start to take that
risk and evaluate what happens, and if our situation does not improve we can stop it, but we will
know that we did everything that we could instead of sitting by and letting hundreds of thousands
die because we did not have the courage to act according to our rational calculations.”
It must be Yale day – another Yale article pointing out another cost effective option ACE inhibitors – https://www.medrxiv.org/content/10.1101/2020.05.17.20104943v1
“there was a nearly 40% lower risk of hospitalization with the use of ACE inhibitors in the Medicare population. This finding merits a clinical trial to evaluate the potential role of ACE inhibitors in reducing the risk of hospitalization among older individuals, who are at an elevated risk of adverse outcomes with the infection.”
Food for thought – so important to read and take in thoughts you don’t necessarily agree with – https://www.aier.org/article/nobel-laureate-michael-levitt-on-the-lockdowns-i-think-it-is-a-huge-mistake/
Michael Levitt is Professor of computer science and structural biology at Stanford Medical School and winner of the 2013 Nobel Prize in chemistry.
“The R-0, which is very popular, is in some ways a faulty number. Let me explain why. The rate of growth doesn’t depend on R-0. It depends on R-0 and the time you are infectious. So if you are twice as long infectious and have half the R-0 you’ll get exactly the same growth rate. This is sort of intuitive, but it’s not explained, and therefore it seems to me that I would say at the present time R-0 became important because of a lot of movies — it was very popular — talked about R-0. Epidemiologists talk about R-0 but, looking at all the mathematics, you have to specify the time infectious at the same time to have any meaning. The other problem is that R-0 decreases — we don’t know why R-0 decreases. It could be social distancing, it could be prior immunity, it could be hidden cases.”
“The reason I felt that social distancing was unimportant is that I had two examples in China to start with and then we had the additional examples. The first one was South Korea (yeah), and Iran, and Italy. The beginning of all the epidemics showing a slowing down, and it was very hard for me to believe that those three countries could practice social-distancing as well as China. China was amazing, especially outside Hubei, in that they had no additional outbreaks. People left Hubei, they were very carefully tracked, had to wear face masks all the time, had to take their temperatures all the time, and there were no further outbreaks.
So this did not happen in either in South Korea or in Italy or in Iran. Now, two months later something else suggests that social distancing might not be important, and that is that the total number of deaths we’re seeing in New York City, in parts of England, in parts of France, in northern Italy — all seem to stop at about the same direction of the population so are they all practicing equally good social distancing? I don’t think so”
“My feeling is that in London, and in New York City, all the people who got infected, all got infected before anybody noticed. There’s no way that the infection grew so quickly in New York City without the infection spreading very quickly. So one of the key things is to stop people, who know that they’re sick, from infecting the others. Here again, China has three very, very important advantages that are not high-tech that don’t involve security tracking of telephones.”
Here is a little bit of confirmation bias with the “SMART” lockdowns I was promoting from the beginning.
“I think we need smart lockdowns. If we were to do this again, we would probably insist on face masks, hand sanitizers, and some kind of payment that did not involve touching right from the very beginning.”
“I see the standout winners as Germany and Sweden. They didn’t practice too much lock down, they got enough people sick to get some herd immunity. The standout losers are countries like Austria, Australia, Israel that actually had very very strict lockdowns but didn’t have many cases. So they have damaged their economies, caused massive social damage, damaged the educational year of their children, but not obtained any herd immunity. “
“There is no doubt in my mind that when we come to look back on this, the damage done by lockdowns will exceed any saving of lives by a huge factor. One very easy way to see this is, and again I am getting into a sensitive territory here, but economists have a very simple way of looking at death. They don’t count people. They come to the conclusion that if you’re 20 and you die that’s a greater loss than if you’re 85 and you die. It’s a hard issue, but in some ways are we valuing the potential future life of the 20 year old? Are we valuing the loss of more senior persons by what’s called daily disability-adjusted life years. Basically if somebody is in their 80s, has Alzheimer’s disease, and then dies from pneumonia (perhaps due to corona) that is less of a loss than if a 15 year old is riding his motorcycle bike and gets run over. This is an important way of looking at death”
“Another factor which has not been considered are all the cancer patients who aren’t being treated, or all the heart cardiology patients who aren’t being treated. I’ve got estimates of tens of thousands of people who are basically going to be dying because of lack of that treatment — and generally again the age group who die of cancer are younger than the age group who die of coronavirus.”
“in Europe there were about 140,000 excess deaths in the last nine weeks. The number of those excess deaths who are younger than 65 is about 10%. So basically 13,000 of 130,000 deaths are actually under 65 years old and if we had simply been able to protect elderly people then the death rate would have been much much less. But the key thing is to have as much infection for as little possible death and also do whatever you can to keep the hospitals full but not overflowing. It’s a difficult calculation and the trouble is that in Sweden there’s no political concerns.
The trouble is is that in Israel and I know as well in the United States, everything is political and therefore nobody could say something like this. They would say, “Ah, but you are not valuing death — the thing that should have been done is for the media to stress to people that everyday somebody dies. These people are essentially in the same age band, and they die from Corona and other comorbidities, other diseases.”
“The World Health Organization, and epidemiologists in general, can only go wrong if they give [politicians] a number smaller. If I said it’s going to be 1 billion deaths from coronavirus and it’s, “oh, you guys have done what I’ve said and there’s only gonna be a hundred thousands,” that is considered good policy. They overestimated bird flu by a factor of a hundred, or ten thousand in The Guardian. The Guardian wrote about this. Ebola was overestimated by a factor of 100 I think. They see their role as scaring people into doing something. I can understand that and there’s something to be said for it. If you could practice lock down with zero economic costs, and zero social costs — let’s do it. But the trouble is that those costs are huge, we’re gonna have fatalities from hospitals being closed down, additional children in trauma, businesses damaged — maybe less so in the UK because of the compensation policy — but certainly massive economic damage in the USA and in Israel, and in other countries. So you need to balance both of these things.”
“We have become very influenced by [rhetoric] that. I think this is another foul-up on the part of the baby boomers.
I am a real baby-boomer, I was born in 1947, and I think we’ve really screwed up. We cause pollution, we allowed the world’s population to increase three-fold, we’ve caused the problems of global warming, we’ve left your generation with a real mess in order to save a really small number of very old people. If I was a young person now, I would say, “now you guys are gonna pay for this.”
We have my family whatsapp and very early on I said this is a virus being designed to get rid of the baby boomers. You know I don’t know, I think my wife thinks this is going to be a take it to the streets thing,and we’re gonna have the young people on the street saying you guys have really screwed up it’s time to go. And I always joke with her, saying well at least I’ve made lots of friends among the young people, I’ll be okay.
But quite frankly you know I’ve had a great life, and I must say this to all the young faces in front of me. I have a grandson who’s 17. I’d much rather have young people live for a very long time. That said I do have a mother who’s a hundred and five years old living in London with my brother, she’s in lockdown and I talk to her by whatsapp every single day on FaceTime, and she’s fine. She still uses her phone and so on so you know these differences but…
You guys should get out there and do something don’t accept this anymore we screwed up too much”
No country over 1K. UK showed a big increase in deaths 556.
MA lead the way for the US at 189 deaths
Albany NY is showing up a darker red in the county map for deaths. Essex and Middlesex is the epicenter for MA deaths.
Brazil is the leader in confirmed cases when you break out the US – Russia and then NY. UK leads the death category followed by Italy, Brazil, and NY.
Brazil is actually looking like it has peak in 7 Day MA deaths. Mexico has been flat to. India and Russia continue to grow. Note UK spike.
