Coronavirus: Dexamethasone proves first life-saving drug?
bbc.com
bbc.com
The drug was hyper-effective. An unbelievably tiny quantity can remove any inflammation (eye, skin, hair skin rash, etc...). But the fall out and side-effects are no joke even for seemingly super minuscule doses. It was a horror story for me with horrible eye inflammation, small inflammations in different parts of the body and a skin rash I still struggle with until today. Mind you I took small localized doses and not an injection. I wasn't aware that it can travel through your skin, get into your blood and make a mess.
I think the research will need to specify potential side-effects and their probabilities. It's trade-off at the end of the day.
PS: Do not ever think of trying it without medical advice and doctor supervision.
[1]: https://en.wikipedia.org/wiki/Dexamethasone#Adverse_effects
Steroids plus eyes can lead to glaucoma. My doc won't let me use them anywhere near the face.
I don’t even really use the term “my doctor”, I just see a doctor when I need to. I’m 30 and live in a large city, and I’ve rarely seen the same doctor more than a couple times in a row. I go in for a physical roughly once a year, and the doctor will sit and talk with me for 10 minutes or so. But otherwise if I need something checked out in between I often get seen by a PA or whatever doctor in the practice is free. I’ve never really felt encouraged by the same doctor to see them repeatedly, or to email them personally if I have a medical question like I know some people do. So when I move to a different neighborhood or something, I just end up seeing a different doctor next time.
Am I just getting bad doctors? How do you find this type of buddy doctor that becomes a long term relationship and really cares about you personally, like I hear about other people seeming to have.
If you switch jobs regularly, you will likely end up on multiple insurance plans, each with their own set of participating medical professionals. Sometimes there is overlap, often there is not.
My mom has a fairly good relationship with her doctor, but she worked in the same hospital with him for 30 years.
Doc here:
Stay in one place, go to the same guy repeatedly over time, and ideally, be really candid with them, and send them your family members. When I see half (or more) of a household, it's an entirely different dynamic. You can't buy the sort of relationship that comes of seeing someone's kids grow up, and then treating that kid. That kid is like... 5% blood relative to the doc at that point. He will never be "just a patient." Or when you treat someone and their mother - that's a different level of candor right there, because that person trusts me with their mother - that right there suggests I can be more open with them, because they won't immediately blame/hate me for news they don't like.
Time is the key, though. A lot of patients, if they get "tough love", turn around and go to a different doc. Especially the ones that say they just want to hear it straight - they are trying to convince themselves, I think. So getting to "tough love" is something that's built up over time, in both directions. (Also, studies suggest that it's somewhere between "not effective" and "actively harmful" when it comes to positively changing patient's health-related behavior, so it's not a super high priority.)
Bonus points if you go to someone that only takes cash. For a once or twice a year visit, it's not that much money (compared to, say, one month of most prescription meds), but it means they don't have to hustle you through an 8-minute visit to keep their lights on. You can only get so much of a connection with someone that's forced to hustle you out of the door - it's jarring and kind of upsetting to everyone involved, on both sides of the interaction. (When I was in training I was told pretty candidly I'd make a fantastic attending one day, if I learned to actually hustle patients fast enough to be able to afford keeping an office open. ... You can imagine, I structured my career towards cash patients only. I don't like being inaccessible to folk, but I hate it less than I hate giving people half-assed help when they're in need.)
Another good element is going to a physician that you're community-bound to in some way other than a strict transaction. Your kid's little league coach will have an entirely different relationship to you than "random doctor." That's becoming less common these days, unfortunately - with the way reimbursement is swinging, I don't know of many docs that still have time for much in the way of community activities. They exist, but they're a lot rarer than they used to be.
In fact, I would recommend going to MORE doctors if you have concerns. That's why you get second and third opinions for important medical decisions.
I have high cholesterol. My father had a heart attack around 40. His father died of a heart attack. I told all my past doctors this and I have never gotten "tough love". Maybe because I have a young looking face and I'm rail thin. Maybe because I know my family history so they assume I know the risks. I put off statins in favor of trying diet and exercise unsuccessfully until I met a doctor that finally DID more forcefully suggest a statin. I should have started taking them way sooner.
A doctor is not where to find tough love or to find a friend. A doctor is where you go for expert opinions and recommendations. Inform yourself and be responsible for your own health.
As an internist and primary care physician, he had one patient who presented with back pain and was loaded on opiates, wanting refills plus more dope. He talked with her for almost an hour (a unique privilege most don't have in today's healthcare system, and likely none will going forward) and ended up sending her home with an SSRI and a note to check back in a little while. A few weeks later she was calling the clinic's owner raving about how she felt so much better, her back didn't hurt anymore, etc. I'm not writing that to say SSRIs > opiates, just to say in her situation he correctly identified her pain was due to depression. You don't get there unless you have rapport with your doc and the time to talk with them.
The point is that you have to find a doc you like and one that can spend time with you. Unfortunately I don't know of a good way of doing that. I'd hook you up but my dad passed some years ago. I'd love to hear people's ideas on finding someone like him — I need a doc, too.
If it's in the blood stream for enough generations, the body will find some alternate use for it. It's like a compression algorithm on your DNA.
...and so when we try to use meds to counter certain proteins or block receptors, we discover that it has a dozen totally unrelated impacts. "Oh, that blood pressure medication? Well let's just have it also randomly give you prostate cancer!" (real example).
Organic evolved animals are the worst type of spaghetti code - if there was ever something you'd want to redesign from the ground up, it's us.
Then add to that that there isn't even any "standard" type of human. We're all different - and even different groups of us have different smatterings of genes. Sometimes it correlates with our ancestors background - sometimes it doesn't. Who knows! Evolution! We're all each just individual experiments running around to see which genes can procreate the most.
...and it's not even as though each of us is a single experiment on a specific gene, that would be too easy. We're each an experiment on a unique collection of thousands of genes that evolution hopes will average out the results across the entire population. Try to wrap your statistics PhD around that!
Then also factor in that modern human evolutionary pressures are totally different than they were even a couple of generations ago, and it becomes clearly evident that evolution is in a complete state of dysfunctional disarray.
Again, people love teaching for analogy here but humans are just nothing like code, to be honest.
A classical example is https://en.wikipedia.org/wiki/Recurrent_laryngeal_nerve. Nobody in his right mind would design a nerve running from your brain to your larynx that way.
In code, a single typo breaks the whole thing. So spaghetti code by definition is bad and breaks easily.
Sure, we have a fuck ton of complexity. But it’s only messy to us because we don’t understand all the conditions that led to it.
Humans certainly have flaws, but in general we are as well suited to surviving on Earth as you possibly can be, especially on the whole.
I’d say: we’re so so much better designed than any code that exists anywhere today, that it’s a farce. We are literally the opposite of spaghetti code. We’re Antifragile!
A single typo sometimes breaks the whole thing. Sometimes, it does not. The same is true for genetic mutations in humans - most typos are harmless, a few give us nasty cancers.
"Spaghetti code" doesn't mean "broken". It means "hard to maintain". Our modern medical system is pretty decent proof that maintaining a human is quite a bit of work.
Furthermore, there are plenty of examples of single gene mutations/interventions that are deadly/crippling.
There are myriad of examples of our body having feature which you could equate to biological spaghetti.
Only in high-level languages, when you have to deal with grammar.
DNA is better compared to binary code fed to a CPU. There is no equivalent of "a single typo breaks the whole thing" there; whatever you feed the CPU, it will execute something. Whether you'll like the results or not is another question - but the same is true with biology. The DNA is there, physically, and it will interact with proteins in one way or another.
> A classical example is https://en.wikipedia.org/wiki/Recurrent_laryngeal_nerve. Nobody in his right mind would design a nerve running from your brain to your larynx that way.
The matter is, the possibilities of DNA are infinite, you can create Godzilla if you knew how. The problem is, nobody knows how, so evolution is all we have - random mutations and survival will lead to /something/. Even genetical engineering now is in essence copy pasting of certain parts that we know work in a specific way, bound by what currently exists. But if you could really grasp biology, that works down to the single molecule and atomic levels, and actually dictate it however you like, I think it would be the final technology we would ever need.
No such advantage with our bodies, as they are only "worked on" by probabilistic processes.
Well, and doctors. Who often have to deal with unintended or undesired side effects of medications and surgical procedures.
The more complex a species, the less adaptivity it has to fundamental shifts in environmental pressures. The interconnections between protein functions are directly responsible for that trade-off, and become a liability.
The time scales for evolution far beyond our current level of genetic complexity, probably extend beyond the life span of the Earth.
Now the benefit of this speghetti-code situation is that no intelligent designer is required - obviously a fundamental ingredient of abiogenesis, but does it benefit an species that's capable of genetic editing?
Nope. At this point, it's really just a bottleneck to even repairing the most straight-forward genetic diseases.
As a species, we're approaching the time where we've obviated evolution. ...I won't say we've seen that yet because reproduction rates are still very uneven across population segments, but it's only a matter of a few more generations (cataclysms not withstanding).
Not sure how you’re defining complex but humans pretty soundly refute that adaptability thing.
It’s not a “bottleneck” it’s just... life. Can you point to an animal anywhere near as successful as humans that doesn’t have.. genetic variability? No. It’s a requirement and precondition for our success, not some flaw we overcame despite.
What's my private key? It's a mystery, but not a very interesting one.
Why does the universe exist? It's mysterious, maybe the most mysterious thing of all, and 8lit's interesting, but I'd say it's not the most interesting question of them all.
i mean to convey: something that is difficult or impossible to explain. something that is deeply interesting and provokes wonderment.
what is more difficult to explain and understand than the fundamental nature of existence?
perhaps it is not apparently immediately _useful_.
but in a cosmic sense, of what use is it to understand thought objects in the world when there is a complete lack of understanding of the consciousness in which these thought objects arise?
i’m curious what are some candidates for “most interesting question of them all” in your view. this is something which sparks a genuine curiosity in me and would love to hear your perspective.
how is it possible to know what is _actually_ of value as opposed to what is _apparently_ of value?
in your profile you mention:
> I do software nowadays, but I'm constantly looking for opportunities to do something actually useful for humanity.
how does one arrive at a belief about what is useful?
It's in our heads, but since we all run the same hardware architecture, it generalizes quite well.
even with this, this doesn’t address the concern of actuality versus appearance.
consensus reality has been wrong in the past, and can be shown wrong again.
so how can you be so sure?
Every protein has multiple functions, so we can't make changes easily without side effects. Bottlenecking human intervention specifically.
This is hubris. Everything that humanity may accomplish in the future, from editing its own genome to creating general artificial intelligence, is a product of that same evolutionary process. We do all that out of our innate need for self preservation and reproduction—evolutionary imperatives for all organisms.
But it’s more accurate to think of evolution as a universal computational process occurring within the substrate of (bio)chemistry. That computation will yield further computation (intelligence and its products).
If we stick to traditional, useful definition of biological evolution, then we can confidently say that it stopped being the driving force for plant and animal life no later than when we've first learned to communicate and remember ideas; we've made it irrelevant when we've learned to write. It still works on microscale, but that's mostly because things breed and die faster at that scale, there's more of it, and we can't efficiently poke at it with any sort of precision.
If we're so insanely flexible and efficient, why do we have the same body plan as every other tetrapod? We walk upright, but our weight is cantilevered out from a spine that is manifestly not designed for that.
But you also can’t point to anything better.
I mean, not yet. The days of "let's tweak it so the blood vessels go behind the retina" or "let's add a bit more cartilage to the knees" aren't here yet, but they're probably coming eventually.
Evolution doesn't really optimize for the "keep this body running at age 100" scenarios that we find ourselves in lately, and there's a lot of legacy code.
I like the idea of evolution, because "it is what it is". It happens whether you believe it or not. It has no goal, it just happens. And, it's not that evolution "changes" species, it's that whoever survives becomes the definition of what a species is at all, therefore "evolution" is just the observable outcome, the process is natural selection. So, it's pointless to "blame" evolution, to say "it is not good enough". I, you, we don't even know what's "Good enough" and for whom. Even whatever we consider "humanity" is the outcome of our natural selection. Your very wish to live forever, is the outcome of our natural selection.
The wish to genetically engineer our species' future members, will only be judged good or bad by its outcome, not by our planning. What you see now is what works, and the proof it works is we are still here. For example, if we end up destroying the world and our species with nuclear weapons, the path of evolution giving us intellect will have proven to be a bad one for this branch of DNA called "human species".
I can only say I have a very bad gut feeling about conscious genetic altering of humans, and I trust there are many arguments to find if I analyze it. Perhaps it's only some aspect of my DNA's self preservation not wanting to lose over some made-up DNA.
Extra Credit: A prehensile tail would be extremely useful in many situations and I believe may decrease the risk of injury for elderly people. With an adequately strong prehensile tail, older people would be able to use it as a sort of a tripod leg to keep themselves upright with less risk of falling.
But, I think the double use of orifices (air, food, urine, semen) is a good idea. Minimizing orifices seems to be an advantage... fewer avenues for outside stuff getting in. (And I don't think human sexual organs are necessarily dirtier due their location; urine is more or less sterile, and feces shouldn't really come into play under ordinary circumstances... )
Well god wrote all the code in like 7 days for this dump, so what did you expect? Quality?
Though I sometimes equate end times with "I'll get around to fixing that bug one day" as every supposed date of end times never comes. god really is a programmer.
I was tweaking my back every 4-6 months (like Nearly bed ridden for a week each time for 2 years, then Last summer I started doing an hour yoga class once a week and haven’t had any problems since!
You might have been manic. That's a well known side effect of dexamethasone.
Don’t mess around with steroids.
So x happens that triggers inflammation. Then you get stuck in a loop.
It really is quite amazing how it makes you feel superhuman ... but oh dear, the crash the other side is horrible.
I remember reading the side effects the first time I took it and was shocked - but it's essentially the "nuclear" option when it comes to inflammation and honestly, still one of the best things we have.
Systemic (that is, oral/intravenous for full-body effect) corticosteroid use doesn't usually have this specific side effect.
The side-effects of corticosteroids are generally No Fun Whatosever (I speak both as a former pharmacist and as someone who has needed them on occasion) but they're the go-to treatment for some very unpleasant inflammatory conditions. But you should remember that they're immune system depressants and should never be used without medical supervision.
(Side effects range from glaucoma leading to blindness -- for misuse of topical creams on the face -- through to sudden death -- for abrupt withdrawl from prolonged systemic doses.)
The next day I got out of bed and pretty much fell over. I could barely stand up. Wife took me to the hospital again, it turns out I had a reaction to dexamethasone.
Definitely not something to play around with.
*I don't recall if it was a pill or an injection. Probably injected, since I had trouble swallowing.
The side-effects when the dose was just a little too high were......scary. In the sense of severe, bewildering psychosis.
Could work in short term but this seems more like a stop gap than any cure/medicine which works against the virus. This is something which would taper your immune system down so you wont have adverse effects. The potential side-effects are huge.
The chinese lead scientist in SARS/Covid19 is known for saving lives with these drugs (super high dose and cocktail drugs) but also warned their serious effect after the treatment. There was a huge debate of stop using them all together in favour of traditional chinese medicine (which is equally biased). Of course they save lives but you are at risk of huge comprises of the human body.
reference: http://www.j-smu.com/oa/pdfdow.aspx?Sid=2009112284 or https://wenku.baidu.com/view/7eef29aa0029bd64783e2c40
While modern medicine was not able to tell me what happened with me, I created this little mental model: Prednisone was keeping my immune system in check. Without enough of it, the immune system went haywire, and I was experiencing something akin to severe acute rheumatic arthritis. Once I upped my dose, this went away. I was then very disciplined with my tapering, and eventually, after 3 more months, I got off of Prednisone. Five days from now I'll be 2 years Prednisone free.
Here's a different perspective on dexamethasone:
https://www.statnews.com/2020/06/16/major-study-finds-common...
The problem is that there is little more than a press announcement at this point. There are no data. There is no paper. There are no details to consider.
We've seen this movie before, and it's gone badly (remdesivir, hydroxychloroquine). Safe and effective drugs require copious details, and you'll find none of them here.
It’s entirely plausible that giving remdesivir to COVID-19 patients when they first show symptoms would make a big difference, but it’s impractical.
https://www.recoverytrial.net/files/recovery_dexamethasone_s...
You're being unreasonably negative.
It's a very positive study in one of the world's biggest trials. It would be unethical not to release the results as soon as possible.
I'm sure more details will be released imminently.
It would be unethical to delay this announcement, especially when most hospitals are already supplied with the treatment.
At any rate, hype over initial briefly reported findings is rarely useful.
Edit: I was checking how common was it to give corticosteroids before the trial (pretty common as I suspected) but it's almost amusing that the WHO was recommending not to use it[0]. I wonder if this will be yet another miss for them.
0. https://www.contagionlive.com/news/is-there-any-reason-to-us...
Why is everyone picking on the WHO constantly? It's like it's a reflex at this point, as far as I can tell designed to shift "blame" off of... other parties who got lots of stuff wrong.
In this case you're spinning really hard. The WHO guidance you're quoting, quoted in the article you link, was really mild: "“Given lack of effectiveness and possible harm, routine corticosteroids should be avoided unless they are indicated for another reason,” WHO authors wrote." Is that really unreasonable? In January they didn't have evidence of effectiveness, and drugs have side effects. Sounds like correct reasoning to me. Do you actually disagree?
And in any case that quote is from a document in January, the current version (from March, also linked from the article) is here, and makes a bunch of complicated points about steroid use, citing contemporary research which was inconsistent about effect: https://www.who.int/docs/default-source/coronaviruse/clinica...
Because they've made multiple avoidable bad calls.
>In this case you're spinning really hard.
'WHO was recommending not to use it' is a quick summary of statements like "routine corticosteroids should be avoided unless they are indicated for another reason,”. How is this not a recommendation against it and 'spinning really hard'?
At any rate, I didn't dig into that part much (WHO recommendations are much much less important than medical trials), I just found it interesting enough to mention.
Could you say more about this ?
1. They stated, more assertively than they probably should, that they believed the virus was contained in Wuhan and not spreading in the community (that's the "no human-to-human transmission" quote that gets taken out of context).
2. Their statements that people should not try to acquire PPE masks were poorly phrased and seemed to imply that masks don't work (obviously they do).
3. There was that one incident, not related to the outbreak really, where a WHO official hung up the phone rather than take questions about Taiwan (for geopolitical reasons, Taiwan is not a member of the WHO). This led to a thousand "WHO is in China's pocket" takes.
I mean, just in general the WHO has not comported themselves well here. There's been plenty of routine incompetence to complain about, and frankly they haven't really don't much to help.
But the political vitriol you hear about them is 100% blame shifting. Most of the people yelling loudest about the WHO failing to give good advice about this dangerous disease tend to argue in other contexts that the disease isn't so dangerous, we shouldn't be forced to wear masks, the economic damage is too great, liberty is at stake, etc...
> Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus (2019-nCoV) identified in #Wuhan, #China🇨🇳.
They're not the CIA. They don't have an adversarial spy arm. They rely enormously on member nations' self-reporting, and they rely on those reports being honest. That clear evidence came later on doesn't mean the WHO had clear evidence at the time.
(And, as the saying goes, absence of evidence isn't evidence of absence. Nothing in that tweet says "it can't spread"; it says "we can't solidly confirm it has been yet".)
Consider this imaginary scenario. Imagine a dead body is found in the street in front of your house. The dead person has multiple stab wounds, and there is a knife 20 feet away from the body.
Imagine you inform the police, but they come 2 hours later, and announce that they'll investigate the death. Then 2 days later they come and announce that they had no evidence that this was a murder. They also announced that staying in and locking your doors had shown to not stop serial killers and was counter productive.
Do you want such an investigative agency?
I would prefer if the police said something like this within 1 hours of arriving at the crime scene "the stab wound and a bloody knife indicate that this might be a murder. In order to stay safe, the residents should stay in, take precautions and lock their doors"
In case you didn't get what I referred to, there is no reason to doubt via a SARS like virus with respiratory sickness may be transmitted via air. Their default reaction should have been to assume the worst. Further, saying that travel restrictions do not stop a disease is a stupid statement to make. Specially when we see South Korea, Taiwan, Vietnam, Hong Kong, NZ etc exterminate the virus.
WHO is to blame as much as individual governments.
> Van Kerkhove added, however, that human-to-human transmission would not be surprising given the WHO’s experience with SARS, MERS and other respiratory pathogens.
> Van Kerkhove’s message was not lost on reporters. The Telegraph in Britain headlined its article on the news conference: “WHO refuses to rule out human-to-human spread in China’s mystery coronavirus outbreak.”
Within a week (Jan 20) they'd confirmed the human-to-human transmission, too.
The misleading bit is to try to insist that what the WHO "meant" was something more akin to "it's not contagious, you can't catch it". NO ONE thinks a respiratory virus isn't contagious. The WHO quite clearly did not mean that. And yet we still have this argument months later because people like you steadfastly refuse to assume good faith (and bad writing) on the part of the WHO.
That, sorry, is politics. The WHO isn't your tribe, so they have to be skewered as enemies instead of interpreted as (however confuddled) people just trying to do their job under extreme time pressure and with limited information.
The WHO is clearly a very conservative and cautious organization. They won't do anything without really good studies and evidence. In this pandemic, though, this staunch stance gives a perception counter to lot of common sense and comes off as inaction.
Full timeline here: https://www.washingtonpost.com/politics/2020/04/17/trumps-fa...
Later that same day:
> Van Kerkhove added, however, that human-to-human transmission would not be surprising given the WHO’s experience with SARS, MERS and other respiratory pathogens.
> Van Kerkhove’s message was not lost on reporters. The Telegraph in Britain headlined its article on the news conference: “WHO refuses to rule out human-to-human spread in China’s mystery coronavirus outbreak.”
It only took a few more days for the evidence to emerge to the WHO's satisfaction, too. Widespread attempts to justify American officials' inaction in February/March based off the Jan 14 tweet are disingenuous.
> Jan. 19 WHO tweet: “An animal source seems the most likely primary source of this novel #coronavirus (2019-nCoV) outbreak, with some limited human-to-human transmission occurring between close contacts.”
> Jan. 20 WHO tweet: “It is now very clear from the latest information that there is at least some human-to-human transmission of #nCoV2019. Infections among health care workers strengthen the evidence for this.” At the time, there were only 222 confirmed cases in the world, including four deaths.
I was personally of the opinion that it was H2H at the time, but taking a few more days and having a complete confirmation was absolutely the right thing to do, given how we wasted that time anyways. There would have been no real upside and many downsides to such a decision for everyone.
That's going to need a cite.
But again, you're trying to ding them on a technicality about wording (you've just moved the goalposts from the usual "they said it wasn't contagious!" line) instead of applying what to most folks seems like the obvious interpretation.
There were some people in local Chinese government that had preliminary indications that it might have transmitted H2H, but that data propagated in under a week after the tweet and it's not the WHO job to run an intelligence agency.
There was legitimate concern early on that misuse of masks by the general public, along with behaviour changes caused by a false sense of security, might have a net negative effect. There's now data that this is not the case, so the recommendation has changed, but the concern wasn't crazy on the absence of data.
That part is politics. Talk about what they actually did wrong, don't drag them in here where they aren't relevant.
Because they are a political organization first and a medical organization second, and not a particularly effective political group either, combining the worst of bureaucracy with questionable alliance and motives.
In short, they're ineffective and untrustworthy.
Please expand with some sources if you can, because I keep hearing this as a particular political talking point, but have never seen any real backing to these claims.
So what you're saying here is that you blame the WHO for not recommending something before there was evidence for it, because now there is a study indicating effectiveness and they should have known that before the study was performed?
>they should have known that before the study was performed
I don't even think that's necessarily true given how common the use of corticosteroids both with COVID and in comparable situations.
It was just something that amused me and now I regret including it in my comment as it seems to distract from the main bit of information I was conveying.
"“Corticosteroid treatment should not be used for the treatment of COVID-19 -induced lung injury or shock outside of a clinical trial,” the commentary concludes."
So they're saying: don't use it until there is sufficient evidence that it works. That's not a "miss for them". It's a prudent and conservative recommendation, which is exactly the kind of recommendation they should be making.
This brings the list of currently effective pharmacological treatments to two:
- remedisivir (reduces hospital stay, might improve survival)
- dexamethasone (improves survival if requiring oxygen)
Edit: what's with the downvotes? Go look at my post history, I'm not some Russian astroturfing bot. And I got a lot of informative replies, which is why I asked in the first place.
it has known nontrivial side effects, but the study showing measurable harm was retracted.
https://www.theguardian.com/world/2020/jun/03/covid-19-surgi...
Others studies by one of the authors (Sapan Desai) whose company Surgisphere is supposed to be behind the alleged fraud are being scrutinised and even his credentials are under question now - https://www.theguardian.com/world/2020/jun/10/surgisphere-sa...
"These data convincingly rule out any meaningful mortality benefit of hydroxychloroquine in patients hospitalised with COVID-19."
Note this is not the same group or dataset as the discredited study.
See the discussion here[1] (from the person who wrote the open letter to Lancet on the now-retracted HCQ study).
[1] https://twitter.com/jwato_watson/status/1272734274823663616
But I wasn’t claiming they were doing so. I said “if” intentionally, since I know nothing about it.
I'm not expecting any different results than from this one, but we'll know soon enough.
The RECOVERY study is also studying azithromycin, a drug commonly administered with HCQ when used against this disease. It would be ironic if that one proves to be effective (study is still ongoing).
That study shows nothing. I assume there'll be others along in time.
[1] http://covexit.com/recovery-covid-19-research-blasted-for-to...
At a certain point, it's possibly worth considering that there may be no there there.
https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v...
Apparently most or all of the studies do not include zinc. Hooray.
Again, there may actually be a study which says what you've claimed. I'm not anti-HCQ, I'm anti-propaganda-posing-as-science.
EDIT: And to be clear the Indian studies suggested you wanted to be taking it for weeks before first exposure to SARS-2.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/00...
Just because something is a useful medicine that's been given for a while doesn't mean it can't also have serious side effects, some of which could conceivably exacerbate Sars-CoV-2.
Or not, there's no evidence that it does. But a lot of medicines are "dangerous", including Plaquenil, particularly if applied for the wrong circumstance or given to people with contraindications.
The reverse, there's confirmation it's ineffective. It may not be dangerous (I don't know) but it's no longer allowed as treatment in the US as the evidence has shown it's not useful.
Can we stop talking about this and move on yet? It was only ever really of interest because Trump was flailing about for anything to make it look like he had a plan earlier in the year.
Couldn't agree more. It's insane that medical science gets turned into a partisan pissing match.
This seems to have been going on since Wakefield and the anti-vaxers; and one of the big reasons for rejecting chloroquine was exactly that it was being promoted by a whole infrastructure of dodgy quack websites. Which is undoubtedly where Trump got the idea from.
This is not true. It is still allowed as a treatment, and there are still studies going on using it in the US. The FDA emergency approval has been removed, which is more of a technical status. You can no longer acquire it from the government stockpile, and it is no longer recommended.
Regardless, the point stands, evidence of efficacy is lacking, evidence of lack of efficacy appears to be coming in, this whole thing has turned into a political canard and is likely distracting from real progress.
All the early studies that indicated some effectiveness were basically garbage. The french study that caused most hype was flawed in multiple ways. The fact that a study showing its ineffectiveness was retracted is not evidence of the opposite.
AFAIK, at this point we can't tell if it has a very tiny positive effect or a small damaging one. None are good news, so why push it further?
But I would guess that the survival rate for patients who don't require oxygen must be pretty damn high to start with.
> Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).
https://www.sciencedaily.com/releases/2020/05/200513081810.h...
https://en.wikipedia.org/wiki/Disseminated_intravascular_coa...
https://emcrit.org/ibcc/covid19/#disseminated_intravascular_...
- low dose of blood thinner (also significant improvement and widely available)
- IL-6 inhibitor tocilizumab (some improvement in severe cases but expensive and hard to scale up)
Both dexamethasone and tocilizumab weaken the immune system. Helps against the overshooting but risks other infections.
I have a particular interest in this because of Crohn's Disease - might the disease be making me high risk, and might my treatment (Entyvio, which operates differently from Remicade and its kin) help offset that anyway?
This looks like a technical phrase, and the parenthesis suggests that its meaning or implications should maybe be obvious, but they aren't to me! Do you mind elaborating?
As you can imagine, it is quite variable in what it means, because it varies across countries and occasionally even hospitals (I'm sure the RECOVERY people have taken this into account, though).
It is different from a placebo study because in that case your control is something you know is inert and "does nothing".
> Assuming that when it goes through peer review it stands — and these are well-established researchers — it’s a huge breakthrough, a major breakthrough,” said Dr. Sam Parnia, a pulmonologist and associate professor of medicine at the Grossman School of Medicine at New York University.
[0] - https://www.nytimes.com/2020/06/16/world/coronavirus-live-up...
My bet is Vertical Limit is the next movie to trend (after Contagion): https://en.m.wikipedia.org/wiki/Vertical_Limit
> Of those who are admitted, most also recover but some may need oxygen or mechanical ventilation.
> And these are the high-risk patients dexamethasone appears to help.
At best this might take a little bit of pressure off the healthcare system in the treatment of the most severe cases. As others pointed, steroids are powerful/dangerous stuff so they won't be using this except in the most advanced cases.
"About 19 out of 20 patients with coronavirus recover without being admitted to hospital.
Of those who are admitted, most also recover but some may need oxygen or mechanical ventilation."
Get said along side a published ~10% death rate. There have 300,000 cases in the UK and 40,000 deaths.
The number of cases in the UK is likely to be underestimated by a factor of 10 because it only takes into account cases confirmed by testing, and not everyone is tested, especially not mild/asymptomatic cases. This is consistent with several other studies in various places.
[1] https://www.worldometers.info/coronavirus/coronavirus-death-...
It seems weird to use a corticosteroid as an anti-emetic but I have seen with my own eyes that it is helpful.
Your logic is essentially saying the lockdown did nothing to reduce deaths/infection.
https://in.dental-tribune.com/news/new-estimate-by-the-cdc-b...
Of course not, any estimate of this number is going to be controversial because it implies that someone messed up. The "reception" from one side in an ongoing debate means precisely nothing to me.
> An antibody survey in late April found a prevalence of about 25% in New York City, which, assuming it's accurate (huge assumption, obviously)
Yes, fairly big assumption. I wonder if the seropositive numbers have changed since then?
> NYC has...
NYC has/had a lot of uncommon things that you don't mention:
- Filthy subway system with horrible ventilation that is used by almost everyone many times a week.
- Large proportion of residents living in apartment buildings with shared HVAC.
- Public health protocols which were extremely quick to hospitalize and then intubate patients (even those without positive PCR tests).
- A directive from the state government which forced nursing homes to accept COVID-positive patients.
That's not what the article says:
> It cut the risk of death by a third for patients on ventilators. For those on oxygen, it cut deaths by a fifth.
That's the optimistic way of phrasing it. Let's look at the reality. From the article:
> For patients on ventilators, it cut the risk of death from 40% to 28%. > For patients needing oxygen, it cut the risk of death from 25% to 20%
28% of patients on vents (1 in 4!) still died. 20% of patients on oxygen (1 in 5!) still died.
Another thing: this is not going to help anyone who isn't in the hospital. You could still drop dead of a heart attack or stroke while at home with a "mild" case of the virus. It could happen even if you're asymptomatic. And the people who the drug does help are still at risk for significant, possibly lifelong complications.
> The death rate looks basically like the annual flu with this drug
No, it doesn't.
> particularly when we consider that it will just be one bad season then fairly minor from then on
"One bad season" will be 1-2 million dead from the virus here in America, plus more people who die as the healthcare is overwhelmed and ceases to function.
Please stop pretending this isn't a serious disease.
Essentially, dex is usable for treating the sickest of the sick patients — those who are closest to becoming the unlucky 1% who die. If every patient who reaches that stage received it, we could potentially see the death rate drop, maybe to around .6%. Still higher than the flu by a lot. And, if every hospital is overrun with runaway infections, not everyone could even get their dex.
Now we switched to the opposite. Behold, medical statistics the 8th world's marvel!
Corticosteroids were recommended to reduce the body’s overreaction.
What I am wondering about is whatever happened to Ivermectin, that was so promising back in April. MERCK makes Stromectol since the 70s. Clears the entire infection in 48 hours!
https://www.medicalnewstoday.com/articles/could-an-antiparas...
We had direct communication with those experts in my hospital and local guidelines didn't recommend steroids.
It's in at least one trial. https://clinicaltrials.gov/ct2/show/NCT04374279 Estimated completion date is this month, so keep an eye out.
Now, the belief is that the cytokine storm is what we want to avoid, and by suppressing the immune system, we can avoid it. So the original conclusion was completely wrong, but that's what happens when you have a new virus. Everyone thought this was a respiratory disease, but now it's looking more like a blood disease.
Yes, cheap until it gets patented because that is what usually happens when a drug is repurposed.