Thread on testing & treatment research for COVID-19
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Just saw a very good update on COVID 19 pathophysiology from Medcram ( update 61 ) which I highly advise. Dr. Seuhelt provided a detailed explanation of how the viral targeting of ACE 2 in vascular endothelium causes uncontrolled clotting and was successfully treated in a 72 year old with heparin.
This is the same mechanism that is killing younger people affected by COVID with strokes.
This is the same mechanism that is killing younger people affected by COVID with strokes.
Let me guess what is going to happen to Pepcid supplies in pharmacies.
Maybe- I guess we won't know for awhile. I'm just going by what I'm reading about these antibody studies, that say a lot more people have already had it. Plus it seems to be a very low risk for people under 55.
That's a known deficiency with the US data. Some states, including PA, don't require hospitals to report discharges.
Oxford Univ vaccine proven effective on Rhesus Monkeys heavily exposed to Covid 19, 6 of 6 have no illness after 28 days.
The study may have been more fair and balanced than many here indicate but that is because the media all over has screamed headlines that this study is strong evidence that HCQ is not only worthless but actually does more harm than good.
For the life of me, can't figure out why they would do such a thing......
The lawyers here in NEPA are already running ads for neglected nursing home patients.
The study may have been more fair and balanced than many here indicate but that is because the media all over has screamed headlines that this study is strong evidence that HCQ is not only worthless but actually does more harm than good.
For the life of me, can't figure out why they would do such a thing......
The media has also heavily criticized it. The irony of those critics is that they also are the ones pushing hope of HQC based on anecdotal reports or non-blinded studies without controls. Now they want to lament how this analysis is baloney for the very same reasons.
Even in Didier Raoult’s initial study of HCQ, they discontinued treatment with HCQ for all three patients that were admitted to ICU. Apparently that wasn’t a risk they felt comfortable with at the time. And another patient who received HCQ treatment and was negative for the virus on Day 2 died on Day 3.
Yup. Conveniently Left off the headline and front of the story. No idea why they only showed half the clinical trial solution. . Has to be injected and not pills. Hope it works. Would live to have many options. Why can’t any of them report fairly. And I mean all of them
They said that HQC was part of trial because at the time doctors/patients were insisting to use it, but that HCQ might not be part of the trial going forward. They don’t necessarily intend it to be a conjunctive therapy with HCQ. Seems prudent to leave out of headline if trial sponsors are not even certain if they will continue to use it.
Doctor's insisted on using it? Those doctors must not watch The View or they would know HCQ does not work.
Just ignore the doctors going forward.
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A collective “ Whew ! “ just issued from the Rhesus Monkey community.
The problem is the Medscape headline and summary which very misleading and will be misinterpreted by poorly educated and informed media employees.
For example, the headline and first sentence on Medscape were "Hydroxychloroquine Ineffective for COVID-19, VA Study Suggests...
Hydroxychloroquine (HCQ) with or without azithromycin (AZ) is not associated with a lower risk of requiring mechanical ventilation, according to a retrospective study of Veterans Affairs (VA) patients hospitalized with COVID-19.... The new data are not the first to suggest no benefit with HCQ among patients with COVID-19."
The actual study is worded in much the same way and doesn't say it has very little if no relevance to treatment given at the beginning of an infection or for moderate infections.
As in the Medscape post, most of the commenters here were negative. One person mentioned that in retrospective studies you could bias the study by choosing what factors you evaluate. This resonated with me because I remember that my researcher, deceased wife (a Chinese doctor from Wuhan), told me that in the ear molecular biology research she was doing that the lab director could manipulate the research by changing the solution in which ear cells were placed.
Additionally, not enough attention has been placed on the medrxiv.orgdirective regarding preprints, such as this, that preprints "should not be reported in news media as established information."
Covid-19 can linger for hours in the air in crowded spaces and rooms such as toilets that lack ventilation, according to a new study by scientists who now recommended wearing masks in public.
While the transmission of the coronavirus from direct human contact and through respiratory droplets, such as coughing or sneezing, is clear, the potential for airborne transmission is much less understood.
The World Health Organisation has said the risk is limited to very specific circumstances, pointing to an analysis of more than 75,000 cases in China in which airborne transmission was recorded.
However, a study carried out by scientists from the University of Wuhan and published on Monday in the scientific research journal Nature, suggests the virus can potentially remain in the air for some time in areas with poor ventilation.
The study took samples from 30 sites across Wuhan, China, where the novel virus was first reported, including inside hospitals as well as public areas of the city during the height of its outbreak in February and March.
It found levels of airborne virus particles in the majority of public areas was too low to be detectable, except in two areas prone to crowding - including the entrance of a department store.
In open, public areas outside the hospitals such as residential buildings and supermarkets, the study said the concentrations of Covid-19 “aerosols” were generally low.
Meanwhile, in the hospitals, the number of virus particles detected in isolation wards and ventilated patient rooms were very low, but elevated in the patients’ toilet areas, which were not ventilated.
“Airborne SARS-CoV-2 may come from either the patient's breath or from the virus-laden aerosol from patient’s faeces or urine during use,” the study reported.
People produce two types of droplets when they breathe, cough or talk. Larger ones drop to the ground before they evaporate, causing contamination mostly via the objects on which they settle. Smaller ones - those that make up aerosols - can hang in the air for hours.
High concentrations also appeared in ventilated rooms without ventilation where medical staff removed their protective equipment, which may suggest that particles contaminating their gear became airborne again when masks, gloves and gowns were removed.
If the virus is being transmitting in aerosols, it is possible that particles can build up over time in enclosed spaces or be transmitted over greater distances.
The scientists behind the study said it did not seek to establish whether the airborne particles could cause infections.
However, Ke Lan, who led the research, said the work demonstrates that “during breathing or talking, SARS-CoV-2 aerosol transmission might occur and impact people both near and far from the source.”
As a precaution, the general public should avoid crowds, he wrote, and should also wear masks “to reduce the risk of airborne virus exposure”.
He said their findings highlighted the importance of the ventilation and sterilisation of surfaces, which could be a potential spread source of the virus.
While the transmission of the coronavirus from direct human contact and through respiratory droplets, such as coughing or sneezing, is clear, the potential for airborne transmission is much less understood.
The World Health Organisation has said the risk is limited to very specific circumstances, pointing to an analysis of more than 75,000 cases in China in which airborne transmission was recorded.
However, a study carried out by scientists from the University of Wuhan and published on Monday in the scientific research journal Nature, suggests the virus can potentially remain in the air for some time in areas with poor ventilation.
The study took samples from 30 sites across Wuhan, China, where the novel virus was first reported, including inside hospitals as well as public areas of the city during the height of its outbreak in February and March.
It found levels of airborne virus particles in the majority of public areas was too low to be detectable, except in two areas prone to crowding - including the entrance of a department store.
In open, public areas outside the hospitals such as residential buildings and supermarkets, the study said the concentrations of Covid-19 “aerosols” were generally low.
Meanwhile, in the hospitals, the number of virus particles detected in isolation wards and ventilated patient rooms were very low, but elevated in the patients’ toilet areas, which were not ventilated.
“Airborne SARS-CoV-2 may come from either the patient's breath or from the virus-laden aerosol from patient’s faeces or urine during use,” the study reported.
People produce two types of droplets when they breathe, cough or talk. Larger ones drop to the ground before they evaporate, causing contamination mostly via the objects on which they settle. Smaller ones - those that make up aerosols - can hang in the air for hours.
High concentrations also appeared in ventilated rooms without ventilation where medical staff removed their protective equipment, which may suggest that particles contaminating their gear became airborne again when masks, gloves and gowns were removed.
If the virus is being transmitting in aerosols, it is possible that particles can build up over time in enclosed spaces or be transmitted over greater distances.
The scientists behind the study said it did not seek to establish whether the airborne particles could cause infections.
However, Ke Lan, who led the research, said the work demonstrates that “during breathing or talking, SARS-CoV-2 aerosol transmission might occur and impact people both near and far from the source.”
As a precaution, the general public should avoid crowds, he wrote, and should also wear masks “to reduce the risk of airborne virus exposure”.
He said their findings highlighted the importance of the ventilation and sterilisation of surfaces, which could be a potential spread source of the virus.
https://www.nytimes.com/2020/04/27/...action=click&module=Spotlight&pgtype=Homepage
In Race for a Coronavirus Vaccine, an Oxford Group Leaps Ahead
As scientists at the Jenner Institute prepare for mass clinical trials, new tests show their vaccine to be effective in monkeys.
Prof. Adrian Hill, the Jenner Institute’s director, in Oxford on Friday. His team is working to produce a coronavirus vaccine.Credit...Mary Turner for The New York Times
By David D. Kirkpatrick
In the worldwide race for a vaccine to stop the coronavirus, the laboratory sprinting fastest is at Oxford University.
Most other teams have had to start with small clinical trials of a few hundred participants to demonstrate safety. But scientists at the university’s Jenner Institute had a head start on a vaccine, having proved in previous trials that similar inoculations — including one last year against an earlier coronavirus — were harmless to humans.
That has enabled them to leap ahead and schedule tests of their new coronavirus vaccine involving more than 6,000 people by the end of next month, hoping to show not only that it is safe, but also that it works.
The Oxford scientists now say that with an emergency approval from regulators, the first few million doses of their vaccine could be available by September — at least several months ahead of any of the other announced efforts — if it proves to be effective.
Alternate Link: https://bdnews24.com/coronavirus-pa...ronavirus-vaccine-an-oxford-group-leaps-ahead
In Race for a Coronavirus Vaccine, an Oxford Group Leaps Ahead
As scientists at the Jenner Institute prepare for mass clinical trials, new tests show their vaccine to be effective in monkeys.
Prof. Adrian Hill, the Jenner Institute’s director, in Oxford on Friday. His team is working to produce a coronavirus vaccine.Credit...Mary Turner for The New York Times
By David D. Kirkpatrick
In the worldwide race for a vaccine to stop the coronavirus, the laboratory sprinting fastest is at Oxford University.
Most other teams have had to start with small clinical trials of a few hundred participants to demonstrate safety. But scientists at the university’s Jenner Institute had a head start on a vaccine, having proved in previous trials that similar inoculations — including one last year against an earlier coronavirus — were harmless to humans.
That has enabled them to leap ahead and schedule tests of their new coronavirus vaccine involving more than 6,000 people by the end of next month, hoping to show not only that it is safe, but also that it works.
The Oxford scientists now say that with an emergency approval from regulators, the first few million doses of their vaccine could be available by September — at least several months ahead of any of the other announced efforts — if it proves to be effective.
Alternate Link: https://bdnews24.com/coronavirus-pa...ronavirus-vaccine-an-oxford-group-leaps-ahead
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Having ahead start is everything when it comes to pandemic vaccines.https://www.nytimes.com/2020/04/27/...action=click&module=Spotlight&pgtype=Homepage
In Race for a Coronavirus Vaccine, an Oxford Group Leaps Ahead
As scientists at the Jenner Institute prepare for mass clinical trials, new tests show their vaccine to be effective in monkeys.
Prof. Adrian Hill, the Jenner Institute’s director, in Oxford on Friday. His team is working to produce a coronavirus vaccine.Credit...Mary Turner for The New York Times
By David D. Kirkpatrick
In the worldwide race for a vaccine to stop the coronavirus, the laboratory sprinting fastest is at Oxford University.
Most other teams have had to start with small clinical trials of a few hundred participants to demonstrate safety. But scientists at the university’s Jenner Institute had a head start on a vaccine, having proved in previous trials that similar inoculations — including one last year against an earlier coronavirus — were harmless to humans.
That has enabled them to leap ahead and schedule tests of their new coronavirus vaccine involving more than 6,000 people by the end of next month, hoping to show not only that it is safe, but also that it works.
The Oxford scientists now say that with an emergency approval from regulators, the first few million doses of their vaccine could be available by September — at least several months ahead of any of the other announced efforts — if it proves to be effective
What is misleading about the headline or first sentence base on their study? They didn’t find that HCQ made a difference in # needing ventilation. And there are other studies that haven’t reported much benefit either. Both of those are accurate.
The reality is such that it isn’t the slam dunk cure all that we hoped it might be. That doesn’t mean it won’t show benefit even if marginal in the clinical trial studies in infected patients or in prophylactic treatment.
And the disclaimer about preprints isn’t something to get your hackles up about. Most articles are not changed in substantial ways upon peer-review.
4/28/2020, WSJ page A7.
Kids Less Vulnerable to Virus
Only 1.7% of the nearly 150,000 infection were found in people under 18 years of age., according to a nationwide analysis of US data published this month by the CDC.
The review also turned up a more tantalizing, although less certain finding:That children may be less susceptible than adults in catching the virus at all, meaning they are less likely to spread it, too.
Some experts caution, though, that while the evidence is persuasive it is incomplete, and there is some risks to children's health and the wider community form Covid-19, the disease caused by the virus , if schools open their doors too soon or without safeguards to limit infections.
However, the review's broader findings, if borne out by further research , should ease concerns the reopening schools risks sickening children or spreading illness undetected through young people who show no outward signs of infection, disease experts say.
Kids Less Vulnerable to Virus
Only 1.7% of the nearly 150,000 infection were found in people under 18 years of age., according to a nationwide analysis of US data published this month by the CDC.
The review also turned up a more tantalizing, although less certain finding:That children may be less susceptible than adults in catching the virus at all, meaning they are less likely to spread it, too.
Some experts caution, though, that while the evidence is persuasive it is incomplete, and there is some risks to children's health and the wider community form Covid-19, the disease caused by the virus , if schools open their doors too soon or without safeguards to limit infections.
However, the review's broader findings, if borne out by further research , should ease concerns the reopening schools risks sickening children or spreading illness undetected through young people who show no outward signs of infection, disease experts say.
The headline is very misleading because the drug was administered to a small slice of very ill patients. The "study" didn't disprove that it didn't work in many other situations.
I agree that the first sentence is excusable, but it still could have been written better. Here is a much better description from a commenter:
"If you read the actual study, the authors state that hydroxychloroquine was more likely to be prescribed to patients with more severe disease. They even say “as expected, increased mortality was observed in patients treated with hydroxychloroquine...” Medscape conveniently left limitation out their report."
The last sentence I quoted was awful. It stated: "The new data are not the first to suggest no benefit with HCQ among patients with COVID-19." It said NO BENEFIT for Covid 19 when all it showed was no benefit for a small slice of patients. It is technically correct but is designed to mislead by failing to give a fair picture of the larger context.
If it works in 10 or 20% of patients that is a big plus. As I said let the chips fall where they may. This "study", since it was so poorly designed, does more harm than good when the response of the media and politicians to it is factored in.
This analysis looked at death and ventilation as the outcomes to compare HCQ versus no treatment, so obviously it should go without mentioning that they are looking at severe cases. There is no need to caveat that or to speculate that it works in other ways or other population groups. Scientific articles aren’t speculative and they aren’t going to be suggest that it works when they don’t have data to back that up. As noted, they will wait for other studies to make those determinations. This study is a piece of the information not the whole picture.
The big problem is what you refer to as “potential effectiveness”. That means it may or may not work, not that it does work. Again, everyone hopes it does work, but to assume it works is just as misleading.
I don't know why the VA "study" got so much media attention (though I have a theory). They gave a drug to dying people and they died. Maybe next time they could insert pills into dead bodies and ascertain whether HCQ has resurrectional powers, though I suspect it will fail that trial as well.
All the antivirals (including the $450 Gilead one) are failing trials on late stage disease but I don't know why that's surprising. That's like proving water doesn't work very well on house fires when every room is blazing and the roof has collapsed.
It would be great to see data on early treatment but none of the studies I've seen so far have tried early treatment. And in the case of remdesivir it can only be given to hospitalized patients because it's an infusion, so early administration is unlikely even if it does work.
And btw the Minnesota HCQ trial which is focused on early stage disease is having trouble getting volunteers because of the avalanche of bad publicity - they need 200 more people to enroll if you know someone infected or exposed.
I suspect we'll be sitting here 3 years from now discussing as all the lives that might have been saved by drugs we had on the shelf, but our chaotic and slow drug trial process didn't give us answers in time.
All the antivirals (including the $450 Gilead one) are failing trials on late stage disease but I don't know why that's surprising. That's like proving water doesn't work very well on house fires when every room is blazing and the roof has collapsed.
It would be great to see data on early treatment but none of the studies I've seen so far have tried early treatment. And in the case of remdesivir it can only be given to hospitalized patients because it's an infusion, so early administration is unlikely even if it does work.
And btw the Minnesota HCQ trial which is focused on early stage disease is having trouble getting volunteers because of the avalanche of bad publicity - they need 200 more people to enroll if you know someone infected or exposed.
I suspect we'll be sitting here 3 years from now discussing as all the lives that might have been saved by drugs we had on the shelf, but our chaotic and slow drug trial process didn't give us answers in time.
Gimmie a freaking break ! US pharm companies don’t want this vaccine because they want exclusive rights ! ? Great. There’ll be a vaccine available for the rest of the world six months or more before one is available in the US.
If there was ever a time to apply the Defense Authorization Act to pharm companies, this is it.
Hydroxychloroquine Has about 90 Percent Chance of Helping COVID-19 Patients
April 28, 2020
In a letter to Gov. Doug Ducey of Arizona, the Association of American Physicians and Surgeons (AAPS) presents a frequently updated table of studies that report results of treating COVID-19 with the anti-malaria drugs chloroquine (CQ) and hydroxychloroquine (HCQ, Plaquenil®).
To date, the total number of reported patients treated with HCQ, with or without zinc and the widely used antibiotic azithromycin, is 2,333, writes AAPS, in observational data from China, France, South Korea, Algeria, and the U.S. Of these, 2,137 or 91.6 percent improved clinically. There were 63 deaths, all but 11 in a single retrospective report from the Veterans Administration where the patients were severely ill.
The antiviral properties of these drugs have been studied since 2003. Particularly when combined with zinc, they hinder viral entry into cells and inhibit replication. They may also prevent overreaction by the immune system, which causes the cytokine storm responsible for much of the damage in severe cases, explains AAPS. HCQ is often very helpful in treating autoimmune diseases such as lupus and rheumatoid arthritis.
Additional benefits shown in some studies, AAPS states, is to decrease the number of days when a patient is contagious, reduce the need for ventilators, and shorten the time to clinical recovery.
Peer-reviewed studies published from January through April 20, 2020, provide clear and convincing evidence that HCQ may be beneficial in COVID-19, especially when used early, states AAPS. Unfortunately, although it is perfectly legal to prescribe drugs for new indications not on the label, the Food and Drug Administration (FDA) has recommended that CQ and HCQ should be used for COVID-19 only in hospitalized patients in the setting of a clinical study if available. Most states are making it difficult for physicians to prescribe or pharmacists to dispense these medications.
As the letter to Gov. Ducey notes, “Many nations, including Turkey and India, are protecting medical workers and contacts of infected persons prophylactically. According to worldometers.info, deaths per million persons from COVID-19 as of Apr 27 are 167 in the U.S., 33 in Turkey, and 0.6 in India.”
After Morocco and Algeria began using HCQ, a trend break and sharp reduction in their COVID-19 case fatality rate occurred.
Vaccines and results of randomized double-blind controlled trials of new drugs are at best months away. But patients are dying now, while affordable, long-used drugs would be available except for government restrictions, AAPS states.
The Association of American Physicians and Surgeons (AAPS) has represented physicians of all specialties in all states since 1943. The AAPS motto is omnia pro aegroto, meaning everything for the patient.
Don't 90% of COVID-19 patients improve regardless of treatment?
BTW - AAPS is an anti-vaxxer organization. I would not trust a damn thing that they say.
https://sciencebasedmedicine.org/th...geons-ideology-trumps-science-based-medicine/
