Coronavirus/COVID-19, Thread 2

[exculpatory]

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/video/1

Change of pace!

Too adorable for words!

[SuperDeluxe]

Here's a nice summary of all things vaccine:

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[ConstableGeneva]

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[claycarver]

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White people appropriating Hamilton.

[Bill Bradley]

My main takeaway from the study is that regardless of whether the statistically insignificant difference in hospitalization between the two groups is a consequence of random fluctuation or a genuine difference between the two samples that just didn't have the sample size to result in a low enough p score, apparently such a small % of people presenting with *mild* cases of COVID-19 are hospitalized or die that treating them with a drug that has adverse side effects to prevent hospitalizations probably makes very little sense even if it is modestly efficacious (which we don't have the statistical power to show on hospitalization, and on all other metrics appears not to be the case), and as far as I'm aware there is even less evidence that HCQ is efficacious for treating *serious* cases where hospitalization and death are likely and therefore where treatment could have a dramatic impact on population health.

I mean, if we took the results of this study at face value, and I am not saying we can or should, early HCQ would be likely to cut hospitalizations in half. It would also be likely to shorten the length of symptoms, and hence shorten the length of hospitalization required. The study also found an albeit small (12%) decrease in symptom severity (or severe symptoms?) with HCQ. And we could conclude that a decrease in 911 calls might be proportionate to a decrease in hospitalizations.

To be clear, the 'adverse effects' we are talking about - well, I'm entirely sure without pulling up the data sets - but it says that the most common adverse effects reported by those who took HCQ, were nausea, and related gastrointestinal symptoms, and that there was no correlation with Covid symptom severity. So it sounds like we're talking pesky side effects, and nothing adverse as far as treatment progress itself is concerned.

There seems to be evidence that HCQ is dangerous, or potentially dangerous in more severe contexts where patients are already hospitalized, coupled with evidence that it is also not very, if at all efficacious in such contexts. Even as far as early/mild administration is concerned, I am not really here to argue in favor of HCQ. I'm just taken aback that this study - which IMO is very clearly favorable to HCQ if anecdotally - is being widely twisted as indicating that HCQ confers zero benefit to Covid outpatients with mild symptoms. It reeks of agenda.

I'm a researcher at a medical school (dept of psychiatry) and agree with your assessment. Researchers know that effect sizes and not statistical significance is what's most important in clinical studies of this kind. I've published randomized controlled trials with nonsignificant findings while the general conclusion was that the intervention was effective.

I've been very disappointed in how politicized this medical research has been. The media running with narratives like HCQ is dangerous and ineffective because it's linked to Trump. A large anti-HCQ study published in Lancet that was all over the news and had to be retracted because it appears it was fraudulent, and that barely got reported. It's shameful how medical research is being politicized in this way because it ultimately puts others in danger.

[exculpatory]

My main takeaway from the study is that regardless of whether the statistically insignificant difference in hospitalization between the two groups is a consequence of random fluctuation or a genuine difference between the two samples that just didn't have the sample size to result in a low enough p score, apparently such a small % of people presenting with *mild* cases of COVID-19 are hospitalized or die that treating them with a drug that has adverse side effects to prevent hospitalizations probably makes very little sense even if it is modestly efficacious (which we don't have the statistical power to show on hospitalization, and on all other metrics appears not to be the case), and as far as I'm aware there is even less evidence that HCQ is efficacious for treating *serious* cases where hospitalization and death are likely and therefore where treatment could have a dramatic impact on population health.

I mean, if we took the results of this study at face value, and I am not saying we can or should, early HCQ would be likely to cut hospitalizations in half. It would also be likely to shorten the length of symptoms, and hence shorten the length of hospitalization required. The study also found an albeit small (12%) decrease in symptom severity (or severe symptoms?) with HCQ. And we could conclude that a decrease in 911 calls might be proportionate to a decrease in hospitalizations.

To be clear, the 'adverse effects' we are talking about - well, I'm entirely sure without pulling up the data sets - but it says that the most common adverse effects reported by those who took HCQ, were nausea, and related gastrointestinal symptoms, and that there was no correlation with Covid symptom severity. So it sounds like we're talking pesky side effects, and nothing adverse as far as treatment progress itself is concerned.

There seems to be evidence that HCQ is dangerous, or potentially dangerous in more severe contexts where patients are already hospitalized, coupled with evidence that it is also not very, if at all efficacious in such contexts. Even as far as early/mild administration is concerned, I am not really here to argue in favor of HCQ. I'm just taken aback that this study - which IMO is very clearly favorable to HCQ if anecdotally - is being widely twisted as indicating that HCQ confers zero benefit to Covid outpatients with mild symptoms. It reeks of agenda.

I'm a researcher at a medical school (dept of psychiatry) and agree with your assessment. Researchers know that effect sizes and not statistical significance is what's most important in clinical studies of this kind. I've published randomized controlled trials with nonsignificant findings while the general conclusion was that the intervention was effective.

I've been very disappointed in how politicized this medical research has been. The media running with narratives like HCQ is dangerous and ineffective because it's linked to Trump. A large anti-HCQ study published in Lancet that was all over the news and had to be retracted because it appears it was fraudulent, and that barely got reported. It's shameful how medical research is being politicized in this way because it ultimately puts others in danger.

And I have published plenty over the years - albeit in endocrine.
To wit:
1. I would potentially agree with you if the non significant p values ‘just missed’ at 0.055 to 0.06 - rather than being off the charts statistically insignificant.
2. The editorial I posted earlier accompanying that study in the Annals of Internal Medicine was excellent & provided excellent context & a summary of the HCQ trials/fiasco/cluster **** to date.
https://www.acpjournals.org/doi/10.7326/M20-5041
3. The other recent paper published on 7/16/2020 in Clinical Infectious Diseases (which I also included in my earlier post - https://www.acpjournals.org/doi/10.7326/M20-5041) with similar efficacy endpoints showed ZILCH significance - WITHOUT any ‘positive appearing trends’.
4. The original + French study was pure trash & in the more recent + Henry Ford Hospital study, many more patients in the HCQ group also received dexamethasone (which has been found to be highly efficacious - which certainly casts doubt on the reported + findings).
5 I will wait to see the published, peer reviewed results of the remaining numerous ongoing HCQ trials, but, IMO, this drug is a loser.
6. Oh yeah, and a significant number of patients prolong their QTc intervals putting them at risk for lethal torsade de pointes/V Tach - severely damaging the risk benefit analysis.
https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC7211688&blobtype=pdf
7. Although I am VERY much to the right on many non-COVID matters & I am acutely aware of the flagrant anti-DJT bias of the MSM, the politicization of HCQ was primarily performed by the WH & Fox.

Edit

And then there was this paper PUBLISHED TODAY in the NEJM - 0 efficacy of HCQ in hospitalized Covid-19 patients,

https://www.nejm.org/doi/full/10.1056/NEJMoa2019014?query=RP

[threrf23]

Sweden appears to potentially be (almost) over Covid (at least a first wave). 18 deaths in the past week and steadily declining numbers. They have seen about 5700 confirmed deaths, and there are reportedly at least another 3k deaths that are probably attributable to Covid. If current trends hold, final numbers should end up in the 9-10k range.

I am not pointing this out to advocate for Sweden's strategy. Finland and Norway, between them, have seen less than 700 confirmed deaths and have been mostly over Covid for some time.

But I increasingly get the sense that herd immunity thresholds may be much lower than presumed.

[sam_I_am]

[gfycat][/gfycat]

Sweden appears to potentially be (almost) over Covid (at least a first wave). 18 deaths in the past week and steadily declining numbers. They have seen about 5700 confirmed deaths, and there are reportedly at least another 3k deaths that are probably attributable to Covid. If current trends hold, final numbers should end up in the 9-10k range.

I am not pointing this out to advocate for Sweden's strategy. Finland and Norway, between them, have seen less than 700 confirmed deaths and have been mostly over Covid for some time.

But I increasingly get the sense that herd immunity thresholds may be much lower than presumed.

Sweden is surrounded by countries that have isolated and locked down. Europe was hit early and hard but Sweden was isolated from that much the way that Maine is from NY. 10000 deaths for a population of 10 million would equate to 330k deaths here in US which is about where US is trending. I have read that only 5% of their population is antibody positive compared to 25% in NY so that could mean they are still at risk of another surge in cases. Their economy is only marginally less impacted than Norway and Denmark so I’m not sure how history will Judge their decision......it’s too early to say for sure. At least the government listened to expert advice in choosing that strategy even If it was controversial and followed through with it rationally.

Compare that to Florida and Texas that locked down like Norway before there was a surge and after suffering the economic consequences of a shutdown and successfully mitigating the pandemic, ignored all rational indicators to reopen and now are getting crushed. In US, the case fatality rate is 1% but when you look at just completed cases it is a whopping 7%. Right now in Fl for example 12,000 cases per day is leading to 120 deaths per day but when all is said and done it could end up as 840 deaths for each of these days. It is tragic that after suffering the economic consequences of an economic shutdown and spending billions in tax money on the Cares Act to get through the shutdown....that the states just negligently let what will soon be a NYC like wave of deaths unfold anyway.

[Captain_Caveman]

Sweden appears to potentially be (almost) over Covid (at least a first wave). 18 deaths in the past week and steadily declining numbers. They have seen about 5700 confirmed deaths, and there are reportedly at least another 3k deaths that are probably attributable to Covid. If current trends hold, final numbers should end up in the 9-10k range.

I am not pointing this out to advocate for Sweden's strategy. Finland and Norway, between them, have seen less than 700 confirmed deaths and have been mostly over Covid for some time.

But I increasingly get the sense that herd immunity thresholds may be much lower than presumed.

Sweden was a failed experiment. Even just with the reported numbers, they have the 6th most deaths per capita in the world (7th if you count tiny Andorra). This despite being in a region that was otherwise not hit that hard. If we take the 5,700 reported deaths at face value, Sweden has 10x as many deaths per capita as neighboring Finland and Norway, and 5x as many as Denmark and Germany. This would translate to more than 180k deaths in a country the size of the US. With 3k additional deaths, it would be 280k dead on a US scale.

Sweden started taking it a lot more seriously after the failure of their strategy became more apparent, so hard to say what role herd immunity even plays in the recent reduction in numbers. Possible that immunity may also only be temporary to begin with.

In contrast, Japan and South Korea both have like 1.5% as many deaths per capita as Sweden is reporting, and their economies fared far better as well. If I am looking for a model of how to handle this pandemic, I start there and not with a country whose failed experiment needlessly killed thousands of people, while in all likelihood permanently debilitating many thousands more.

[claycarver]

As hard as it is to get accurate Covid death counts across states, it's impossible to get accurate counts across countries. For instance, in the city of Tokyo, they reported about 100 covid deaths for April, but their excess death count for the month was about 1,000.

Not that excess death count is perfect, but it's a better method of assessing the covid situation across nations than just taking the official covid death count at face value: https://www.economist.com/graphic-detail/2020/07/15/tracking-covid-19-excess-deaths-across-countries

[threrf23]

Sweden is surrounded by countries that have isolated and locked down. Europe was hit early and hard but Sweden was isolated from that much the way that Maine is from NY. 10000 deaths for a population of 10 million would equate to 330k deaths here in US which is about where US is trending.

I mean, based on population density and other factors, Sweden should have ended up with fewer deaths per capita than the US. Sweden is a failed experiment, or otherwise a deadly experiment, and I wasn't questioning that. It's fairly obvious.

I have read that only 5% of their population is antibody positive compared to 25% in NY

The 5% figure was from a couple of months ago I believe. NYC was reportedly around 20% around the end of April. However, this is assuming that we know the right antibodies to look for, and that the antibody tests used were accurate, and that research methodology was on point.

In NYC btw, this more recent report from the NY Times suggests based on antibody testing that nearly 70% of residents in some areas of NYC may have antibodies. And if we were to presume a 0.4% mortality rate, approximately presumed by many, the death toll would suggest that 68% of residents had been infected.

Anyways, this analysis/model suggests that the herd immunity threshold could be as low as 43% depending on the dynamics of spread. These researchers predict that the herd immunity might situationally be as low as 10-20%.

And according to that Science Mag link above, "the classical herd immunity level hC is defined as hC = 1 – 1/R0, where R0 is the basic reproduction number, defined as the average number of new infections caused by a typical infected individual during the early stage of an outbreak in a fully susceptible population (7)." R0 is presumably a bit lower in Sweden than elsewhere (especially NYC), so their herd immunity threshold would conceivably be lower. (of course R0 is also lessened by social distancing and mask wearing, tracing and isolating, etc I guess)

Compare that to Florida and Texas that locked down like Norway before there was a surge and after suffering the economic consequences of a shutdown and successfully mitigating the pandemic, ignored all rational indicators to reopen and now are getting crushed.

I don't know if they ignored indicators, or whether they just didn't care, and are hoping to do the bare minimum necessary to avoid overflooded hospitals. In most places I'm not sure it is practical or necessarily even productive to shut most things down until the pandemic is over, to me the problem is these states never really devised a plan to move forward in a more reasonable manner that would limit the pandemic's impact. I'm in AZ and we would have been in decent shape if reopening happened as our governor said it would, but we basically flipped into full Sweden mode for a month or two around the middle of March.

[sam_I_am]

Sweden is surrounded by countries that have isolated and locked down. Europe was hit early and hard but Sweden was isolated from that much the way that Maine is from NY. 10000 deaths for a population of 10 million would equate to 330k deaths here in US which is about where US is trending.

I mean, based on population density and other factors, Sweden should have ended up with fewer deaths per capita than the US. Sweden is a failed experiment, or otherwise a deadly experiment, and I wasn't questioning that. It's fairly obvious.

I have read that only 5% of their population is antibody positive compared to 25% in NY

The 5% figure was from a couple of months ago I believe. NYC was reportedly around 20% around the end of April. However, this is assuming that we know the right antibodies to look for, and that the antibody tests used were accurate, and that research methodology was on point.

In NYC btw, this more recent report from the NY Times suggests based on antibody testing that nearly 70% of residents in some areas of NYC may have antibodies. And if we were to presume a 0.4% mortality rate, approximately presumed by many, the death toll would suggest that 68% of residents had been infected.

Anyways, this analysis/model suggests that the herd immunity threshold could be as low as 43% depending on the dynamics of spread. These researchers predict that the herd immunity might situationally be as low as 10-20%.

And according to that Science Mag link above, "the classical herd immunity level hC is defined as hC = 1 – 1/R0, where R0 is the basic reproduction number, defined as the average number of new infections caused by a typical infected individual during the early stage of an outbreak in a fully susceptible population (7)." R0 is presumably a bit lower in Sweden than elsewhere (especially NYC), so their herd immunity threshold would conceivably be lower. (of course R0 is also lessened by social distancing and mask wearing, tracing and isolating, etc I guess)

Compare that to Florida and Texas that locked down like Norway before there was a surge and after suffering the economic consequences of a shutdown and successfully mitigating the pandemic, ignored all rational indicators to reopen and now are getting crushed.

I don't know if they ignored indicators, or whether they just didn't care, and are hoping to do the bare minimum necessary to avoid overflooded hospitals. In most places I'm not sure it is practical or necessarily even productive to shut most things down until the pandemic is over, to me the problem is these states never really devised a plan to move forward in a more reasonable manner that would limit the pandemic's impact. I'm in AZ and we would have been in decent shape if reopening happened as our governor said it would, but we basically flipped into full Sweden mode for a month or two around the middle of March.

Excellent post. Others, like Caveman on Sweden too.

The Daily podcast from NYT today reviews what went wrong in NYC and it is horrifying. I had no idea how unfair the public vs. private hospital system is there. Boston doesn’t really have such distinctions. The idea that some public hospitals had ICU nurses taking care of 10-20 ventilated patients while private hospitals had more capacity and the Jarrett center was empty and paying nurses $2000 a day and doctors up to $600/hr to search the internet because they couldn’t transfer patients there is shocking. Enough ventilated patients were pulling out there tubes to use bathroom and being found dead on the floor because nobody was watching them that they started calling them bathroom codes. Truly horrific. It does explain why NYC is such an outlier.

[exculpatory]

For the ladies amongst us:

Preliminary good news.
Must be validated.

https://dgalerts.docguide.com/study-finds-menstrual-status-hormones-may-help-explain-sex-bias-sars-cov-2-infection-outcomes

[ConstableGeneva]

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[Slax]

Sweden is surrounded by countries that have isolated and locked down. Europe was hit early and hard but Sweden was isolated from that much the way that Maine is from NY. 10000 deaths for a population of 10 million would equate to 330k deaths here in US which is about where US is trending.

I mean, based on population density and other factors, Sweden should have ended up with fewer deaths per capita than the US. Sweden is a failed experiment, or otherwise a deadly experiment, and I wasn't questioning that. It's fairly obvious.

I have read that only 5% of their population is antibody positive compared to 25% in NY

The 5% figure was from a couple of months ago I believe. NYC was reportedly around 20% around the end of April. However, this is assuming that we know the right antibodies to look for, and that the antibody tests used were accurate, and that research methodology was on point.

In NYC btw, this more recent report from the NY Times suggests based on antibody testing that nearly 70% of residents in some areas of NYC may have antibodies. And if we were to presume a 0.4% mortality rate, approximately presumed by many, the death toll would suggest that 68% of residents had been infected.

Anyways, this analysis/model suggests that the herd immunity threshold could be as low as 43% depending on the dynamics of spread. These researchers predict that the herd immunity might situationally be as low as 10-20%.

And according to that Science Mag link above, "the classical herd immunity level hC is defined as hC = 1 – 1/R0, where R0 is the basic reproduction number, defined as the average number of new infections caused by a typical infected individual during the early stage of an outbreak in a fully susceptible population (7)." R0 is presumably a bit lower in Sweden than elsewhere (especially NYC), so their herd immunity threshold would conceivably be lower. (of course R0 is also lessened by social distancing and mask wearing, tracing and isolating, etc I guess)

Compare that to Florida and Texas that locked down like Norway before there was a surge and after suffering the economic consequences of a shutdown and successfully mitigating the pandemic, ignored all rational indicators to reopen and now are getting crushed.

I don't know if they ignored indicators, or whether they just didn't care, and are hoping to do the bare minimum necessary to avoid overflooded hospitals. In most places I'm not sure it is practical or necessarily even productive to shut most things down until the pandemic is over, to me the problem is these states never really devised a plan to move forward in a more reasonable manner that would limit the pandemic's impact. I'm in AZ and we would have been in decent shape if reopening happened as our governor said it would, but we basically flipped into full Sweden mode for a month or two around the middle of March.

Excellent post. Others, like Caveman on Sweden too.

The Daily podcast from NYT today reviews what went wrong in NYC and it is horrifying. I had no idea how unfair the public vs. private hospital system is there. Boston doesn’t really have such distinctions. The idea that some public hospitals had ICU nurses taking care of 10-20 ventilated patients while private hospitals had more capacity and the Jarrett center was empty and paying nurses $2000 a day and doctors up to $600/hr to search the internet because they couldn’t transfer patients there is shocking. Enough ventilated patients were pulling out there tubes to use bathroom and being found dead on the floor because nobody was watching them that they started calling them bathroom codes. Truly horrific. It does explain why NYC is such an outlier.

That's not the lesson you should take away from the problems with the New York hospital system. The Daily is kind of abbreviating this distinction between well-funded vs underfunded hospitals as "public" vs "private", but really it was between well-funded academic hospitals in higher income neighborhoods concentrated in Manhattan, vs underfunded community hospitals that served low income neighborhoods with mostly Medicaid and uninsured patient populations. They allude to this distinction at various points in the episode, as well as in the corresponding article. While it's true that a lot of the public hospitals in New York serve lower income neighborhoods, they are mixed in with lots of private not-for-profit community hospitals that were facing the exact same problems of overcrowding and poor staffing and lack of equipment that didn't hit some of the better-funded academic hospitals as hard. Even public hospitals serving higher income neighborhoods (eg Bellevue) had much better patient outcomes and less crowding than the private hospitals serving low income neighborhoods. Whereas my wife works for a private hospital in a low-income neighborhood in Brooklyn, and it was afflicted with exactly the same problems as public hospitals in similar neighborhoods. (I won't belabor the specifics again, but anyone can look at my post history in the COVID threads during March and April to see what sort of conditions my wife was working under during this time.)

Anyway, one big problem that popped up during New York's COVID crisis is that private hospitals were operating independently of each other because there was not one big "New York hospital system" that makes it easy to do top-down redistribution of patients from hospitals that are overburdened to hospitals that have more capacity. Cuomo attempted to create a unified system for distributing patients between all the public and private hospitals at the end of March, but by that point it was far too late to be effective. It's hard to just integrate into a big system like that ad hoc in the middle of a crisis, and a few weeks later the peak was already passed and numbers were coming down. Which is to say, New York was super poorly prepared for a crisis where some communities reach hospital capacity and others don't.

I don't think Massachusetts is immune to these problems. If anything, Massachusetts hospitals could be more fragmented than the New York ones, due to lack of a single large public hospital system that treats a large fraction of the population, and therefore if Greater Boston had faced a New York-like peak could plausibly have seen even more disparity in treatment than New York did. Try to imagine whether or not it would be easy to systematically redistribute patients between hospitals in a few different "classes" of neighborhoods and in different hospital systems - for example, Cambridge Hospital, Carney, and Brigham and Women's. You would need either a bunch of private hospitals to independently decide to temporarily merge into a super-network that works for the good of the greater regional needs instead of their own organizational and local community needs, or the state government to step in and make them do it. And that's just motivations - you also need to create a mechanism for coordinating patient load between different hospitals, and the middle of a crisis is a hard time to do that. I very much assume that the Massachusetts state government saw what happened in New York and has already considered this possibility and therefore planned for it, but nonetheless it was never a unique problem for New York that could not have happened in Boston. This is a problem that can affect any region with neighborhood health capacity disparities.

[exculpatory]

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**** moron.
Disgraceful

[24SecondRule]

https://theweek.com/speedreads/927908/even-mild-coronavirus-cases-cause-lasting-cardiovascular-damage-study-shows

A recent study of 100 recovered coronavirus patients reveals 78 of them now have lasting cardiovascular damage even though a vast majority of them had mild cases of COVID-19 in the first place.

The study published Monday in JAMA Cardiology details the results of cardiac MRI exams of 100 recovered coronavirus patients. Twenty-eight of them required oxygen supplementation while fighting the virus, while just two were on ventilators. But 78 of them still had cardiovascular abnormalities after recovery, with 60 of them showing "ongoing myocardial inflammation," the study shows. These conditions appeared to be independent of case severity and pre-existing conditions, though JAMA researchers note these findings need a larger study.

[claycarver]

Remembering how we were initially told that wearing masks wasn't important...and that we found out later that they were lying to us because there was a mask shortage.
https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-masks.html

Now, the FDA is warning that hydroxychloroquine should only be used in hospital settings or cliinical trials (unless you're taking it for malaria, rheumatoid arthritis, etc.)
https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or
And what's being reported is that hydroxychloroquine has no benefit in treating the virus. At the same time, there's a shortage of hydroxychloroquine.
https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Hydroxychloroquine%20Sulfate%20Tablets&st=c

So then I read this:
https://www.newsweek.com/key-defeating-covid-19-already-exists-we-need-start-using-it-opinion-1519535
especially:

Third, concerns have been raised by the FDA and others about risks of cardiac arrhythmia, especially when hydroxychloroquine is given in combination with azithromycin. The FDA based its comments on data in its FDA Adverse Event Reporting System. This reporting system captured up to a thousand cases of arrhythmias attributed to hydroxychloroquine use. In fact, the number is likely higher than that, since the reporting system, which requires physicians or patients to initiate contact with the FDA, appreciably undercounts drug side effects.

But what the FDA did not announce is that these adverse events were generated from tens of millions of patient uses of hydroxychloroquine for long periods of time, often for the chronic treatment of lupus or rheumatoid arthritis. Even if the true rates of arrhythmia are ten-fold higher than those reported, the harms would be minuscule compared to the mortality occurring right now in inadequately treated high-risk COVID-19 patients. This fact is proven by an Oxford University study of more than 320,000 older patients taking both hydroxychloroquine and azithromycin, who had arrhythmia excess death rates of less than 9/100,000 users, as I discuss in my May 27 paper cited above. A new paper in the American Journal of Medicine by established cardiologists around the world fully agrees with this.

In the future, I believe this misbegotten episode regarding hydroxychloroquine will be studied by sociologists of medicine as a classic example of how extra-scientific factors overrode clear-cut medical evidence.

So yeah, I'm skeptical. And before anyone says it, No, I did not and will not vote for Trump. He's irrelevant (in all things) and it is annoying that anything he says becomes gospel or poison. Please, don't take this heavy handed oppressive tack. If you see no reason to doubt the narrative that hydroxychloroquine has no value in the treatment of Covid, just present information that undermines Risch's article. As it stands, it seems very possible to me that, under the conditions Risch describes, hydroxychloroquine might be useful in treading covid...and also reasonable that the FDA is playing up minor health concerns to keep idiots from self medicating and exasperating a drug shortage.

[ConstableGeneva]

Read on Twitter

[Slax]

Remembering how we were initially told that wearing masks wasn't important...and that we found out later that they were lying to us because there was a mask shortage.
https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-masks.html

Now, the FDA is warning that hydroxychloroquine should only be used in hospital settings or cliinical trials (unless you're taking it for malaria, rheumatoid arthritis, etc.)
https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or
And what's being reported is that hydroxychloroquine has no benefit in treating the virus. At the same time, there's a shortage of hydroxychloroquine.
https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Hydroxychloroquine%20Sulfate%20Tablets&st=c

So then I read this:
https://www.newsweek.com/key-defeating-covid-19-already-exists-we-need-start-using-it-opinion-1519535
especially:

Third, concerns have been raised by the FDA and others about risks of cardiac arrhythmia, especially when hydroxychloroquine is given in combination with azithromycin. The FDA based its comments on data in its FDA Adverse Event Reporting System. This reporting system captured up to a thousand cases of arrhythmias attributed to hydroxychloroquine use. In fact, the number is likely higher than that, since the reporting system, which requires physicians or patients to initiate contact with the FDA, appreciably undercounts drug side effects.

But what the FDA did not announce is that these adverse events were generated from tens of millions of patient uses of hydroxychloroquine for long periods of time, often for the chronic treatment of lupus or rheumatoid arthritis. Even if the true rates of arrhythmia are ten-fold higher than those reported, the harms would be minuscule compared to the mortality occurring right now in inadequately treated high-risk COVID-19 patients. This fact is proven by an Oxford University study of more than 320,000 older patients taking both hydroxychloroquine and azithromycin, who had arrhythmia excess death rates of less than 9/100,000 users, as I discuss in my May 27 paper cited above. A new paper in the American Journal of Medicine by established cardiologists around the world fully agrees with this.

In the future, I believe this misbegotten episode regarding hydroxychloroquine will be studied by sociologists of medicine as a classic example of how extra-scientific factors overrode clear-cut medical evidence.

So yeah, I'm skeptical. And before anyone says it, No, I did not and will not vote for Trump. He's irrelevant (in all things) and it is annoying that anything he says becomes gospel or poison. Please, don't take this heavy handed oppressive tack. If you see no reason to doubt the narrative that hydroxychloroquine has no value in the treatment of Covid, just present information that undermines Risch's article. As it stands, it seems very possible to me that, under the conditions Risch describes, hydroxychloroquine might be useful in treading covid...and also reasonable that the FDA is playing up minor health concerns to keep idiots from self medicating and exasperating a drug shortage.

I don't know, I mean a Yale epidemiology professor is someone worth at least listening to. But it's just super difficult to take him seriously when he confidently makes extraordinary assertions about the effectiveness of HCQ like that it could prevent a majority of COVID-19 deaths (his interview on Fox he said 100k lives), while in this article he is citing unreviewed claims from charlatans like Dr. Zelenko who is currently shilling for the "alien DNA" doctor on Twitter:

Read on Twitter

?cxt=HHwWhsC9qa_zn-EjAAAA.

More broadly, I think you can find some not-crazy people who disagree on this point and think HCQ might be effective based on available evidence, and that's all fine. But a huge part of my social circle consists of doctors and medical science researchers - current and former colleagues of my wife, including a few of whom are currently working at NIH and FDA. A lot of them were excited about HCQ a couple months ago, and now it feels like there's just a pretty broad consensus in their academic community that there isn't a lot of evidence for HCQ as an effective COVID treatment, and that there is much better evidence for other more promising treatments.

I also don't buy that this is because of animus against Trump. I think there are things where animus against Trump causes people to jump to bad conclusions (eg, Trump's rush to reopen businesses and schools without preparing to make it sae has resulted in a liberal backlash against the general idea of reopening businesses and schools, which is intractable as a long term policy). And while I could see this driving ideas about effective COVID treatments for activists and politicians and randoms on Twitter and RealGM, I have trouble believing that my friends - people whose job it is to treat people, and all of whom would be very excited to have learned that there is an effective treatment for the most challenging health crisis of our lifetimes - just hate Trump too much to be willing to acknowledge a corpus of evidence that conclusively establishes HCQ as an effective COVID treatment, which is what Risch seems to be claiming here. I just have trouble imagining that. If there was convincing evidence that HCQ was effective enough to cut deaths in half, my friends and wife would be super excited.