Coronavirus treatment options and the impact on public policy

[DIY-HP-LED]

Did The Oxford Covid Vaccine Work In Monkeys? Not Really

The latest data on the vaccine being developed out of Oxford shows limited success.

www.forbes.com

That's why they got a lot of shots on goal approach running many different trials using several different approaches in parallel, like a moon shot or Manhattan project, time is more important than money here. In any case if there is a vaccine it's 18 months away at least, NPI's and treatments are the only game in town until then, testing, tracing, case isolation, masks, personal distancing, the whole package.

Hope the governor's can hold the fort until ya get some leadership instead of a POS in the WH.

 

[Fogdog]

Here, send the guy an email and tell them they are full of shit!

Corresponding author: Joseph Rahimian, MD NYU Grossman School of Medicine, Department of Medicine 31 Washington Square West, Floor number 4 New York, NY 10011 [email protected] (212) 465-8834

Oh, so it's just the folk medicine you approve of.

 

[DIY-HP-LED]

Oh, so it's just the folk medicine you approve of.

The criteria I'd like to use on this thread is if a treatment is used by medical professionals to impact the CFR and therefore the IFR in a significant way. This includes enough new evidence to recommend vitamin D supplementation and even free testing for vulnerable populations, there is enough for a public health education effort and no down side to speak of, but this again is something for the public health officials to address, it just my opinion.

There are lots of small scale correlation studies as researchers compete for funding and they often appear with click bait titles, mostly in the health and nutrition arena, we are all familiar with the claims. As you know randomized, blinded placebo trials are the gold standard in the field and are often causation studies and not mere correlation studies, these provide PROOF as opposed to evidence, but proof takes time to obtain, time is of the essence in these circumstances.

Doctors will make the calls informed by science and depending on circumstances, will use evidence until proof is obtained, their game is all about saving lives, science is about discovering the truth, they are not mutually exclusive, just different priorities.

 

[DIY-HP-LED]

Oh, so it's just the folk medicine you approve of.

One day a heart surgeon took his motorcycle to a mechanic and found out the engine valves needed replacing. While looking over the job the mechanic turns to the doctor and says "Hey doc,, how come I only get paid $30 and hour for fixing your valves and you make a fortune fixing mine"? The doctor smiled and said, "but can you do it while the engine is running"?

 

[DIY-HP-LED]

They are running the trials out of Dal, maybe I'll sign up and perhaps grow a nice set of horns, a victim of science... It's chinese, so what could go wrong?
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Canada approves first COVID-19 vaccine trials

The first Canadian clinical trials for a possible COVID-19 vaccine have been approved by Health Canada. Dr. Scott Halperin, the director of the Canadian Center for Vaccinology, explains the different phases of testing that a potential vaccine would have to go through.

 

[Fogdog]

The criteria I'd like to use on this thread is if a treatment is used by medical professionals to impact the CFR and therefore the IFR in a significant way. This includes enough new evidence to recommend vitamin D supplementation and even free testing for vulnerable populations, there is enough for a public health education effort and no down side to speak of, but this again is something for the public health officials to address, it just my opinion.

There are lots of small scale correlation studies as researchers compete for funding and they often appear with click bait titles, mostly in the health and nutrition arena, we are all familiar with the claims. As you know randomized, blinded placebo trials are the gold standard in the field and are often causation studies and not mere correlation studies, these provide PROOF as opposed to evidence, but proof takes time to obtain, time is of the essence in these circumstances.

Doctors will make the calls informed by science and depending on circumstances, will use evidence until proof is obtained, their game is all about saving lives, science is about discovering the truth, they are not mutually exclusive, just different priorities.

A glance through the pages of this therad shows you don't actually believe that. Whatever happened to Doctor Suess at Crapmed?

Honey has been proven effective at boosting immunity and therefore is a great folk medicine for Covid according, there are papers from real doctors that say this.

 

[captainmorgan]

Could the reproduction number of SARS-CoV-2 be double early estimates? | Harvard Magazine

A critical scientific question that bears on policies for fighting the pandemic

www.harvardmagazine.com

 

[DIY-HP-LED]

A glance through the pages of this therad shows you don't actually believe that. Whatever happened to Doctor Suess at Crapmed?

Honey has been proven effective at boosting immunity and therefore is a great folk medicine for Covid according, there are papers from real doctors that say this.

It's mostly news articles and papers on prospective treatments, though I'm not as uptight about my threads as others. I expect policy issues to be discussed as well, particularly on the impact of effective treatments as they become available.

I've broken the treatment options into several categories:
Supportive therapies that address blood clotting and inflammation issues, these apparently can dramatically cut mortality rates of those on ventilators, over doubling survival rates. This will also involve an expanding circle of specialists now that it's recognised to be a systemic illness and not confined to the lungs. It's these things that actually kill people and addressing it should help quite a bit.

Antiviral drugs like Remdisevar and others in the pipeline that can be quickly deployed, this might include zinc and HCQ, we will have to see, it's a hot potato.

Convalescent Plasma therapy, testing , efficacy trials, immunoassays and organisation are required for this promising one, tens of thousands of Americans could be treated daily with this, if it was properly organised and executed.

Antibody therapies, there are several candidates and some that have been used before with other things are expected to be rolled out this summer.

Vitamin D was covered because of its importance on Covid-19 and because there was new evidence dealing directly with it, normally nutrition is not something I'd post to this particular thread. It's only a thread though, used to log things that will likely be up for discussion soon for the most part.

I'll also cover vaccines here, but any movement on that front is a long way off, treatments will most likely have the biggest scientific impact in the short term for acute cases. There are no magic bullets in the offing save plasma therapy with immunoassay to determine potency, it will work if proven to be effective, we can scale it on the back of the existing blood infrastructure and they already are doing the preparation and a lot of transfusions currently. All of these things will be fodder for discussion here and their impact on reopening society for which there will be a constant pressure.

We all are gonna depend on treatment options to get us through this until a vaccine is developed and deployed and even then many will not be immune, vaccines are not that effective in the elderly for instance. These treatment options being developed right now will be of great benefit to those who are most at risk, particularly conversant plasma and artificial antibodies, even after a vaccine is deployed.

 

[DIY-HP-LED]

A glance through the pages of this therad shows you don't actually believe that. Whatever happened to Doctor Suess at Crapmed?

Honey has been proven effective at boosting immunity and therefore is a great folk medicine for Covid according, there are papers from real doctors that say this.

One more thing about effective treatment options that might make a big impact on mortality is getting sick people to show up at the hospital. Many have no hope and choose to die at home instead of on a ventilator. It will also do a lot to help the medical staff and give them a sense of empowerment, they will no longer have to watch helplessly as patients and colleagues die. They are beginning to harness to power of medical science in this fight and increased understanding has lead to improvements in care and soon the payoffs will come from research on anti viral treatments. They will whittle down the CFR to fraction of its current level and cut the IFR from. .5% or even 1.15% to an acceptable number, to be determined by Fauci's question, "How many deaths are you willing to accept?".

 

[DIY-HP-LED]

Could the reproduction number of SARS-CoV-2 be double early estimates? | Harvard Magazine

A critical scientific question that bears on policies for fighting the pandemic

www.harvardmagazine.com

It would appear the R0 number might have to be broken down a bit in America between urban and rural environments. The basics of transmission don't change however and rural people socialise too, there are bars and restaurants there too.

If the R0 is as high as they suggest the red states that drank the Koolaid should be taking a real shit kicking in a month or so.

 

[DIY-HP-LED]

Could the reproduction number of SARS-CoV-2 be double early estimates? | Harvard Magazine

A critical scientific question that bears on policies for fighting the pandemic

www.harvardmagazine.com

I picked this link up from the article you posted and just ran through it quickly, another promising treatment possibility. They even had control subjects!
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https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31042-4/fulltext

Triple combination of interferon beta-1b, lopinavir–ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial

"The triple combination also alleviated symptoms completely within 4 days—a significantly shorter time than the control. The triple combination also suppressed IL-6 levels. The clinical and virological efficacy resulted in shorter hospital stays and facilitated infection control. This treatment regimen was also shown to be safe, with minor and self-limiting gastrointestinal adverse events of diarrhoea and vomiting. Increased liver enzymes were uncommon, and resolved upon stopping the medications".

"Implications of all the available evidence
This study showed that early treatment with the triple combination of antiviral therapy with interferon beta-1b, lopinavir–ritonavir, and ribavirin is safe and highly effective in shortening the duration of virus shedding, decreasing cytokine responses, alleviating symptoms, and facilitating the discharge of patients with mild to moderate COVID-19. Furthermore, the triple antiviral therapy rapidly rendered viral load negative in all specimens, thereby reducing infectiousness of the patient".

 

[DIY-HP-LED]

Could the reproduction number of SARS-CoV-2 be double early estimates? | Harvard Magazine

A critical scientific question that bears on policies for fighting the pandemic

www.harvardmagazine.com

I believe care must be taken with the triple drug regimen I just posted, what would it do to your immunity? Would the acquired immune system see enough of the virus to make endogenous antibodies? Would you be immune to future infection if this one ya got is stopped in its tracks? Something to be considered for some people and not for others I imagine. Maybe in some folks ya might wanna throttle the fucker enough to get immunity and that's it.

 

[DIY-HP-LED]

We now have three possible contenders in the antiviral drug category of treatments, the triple drug regimen has the most solid evidence of efficacy though there is no evidence that it impacts CFR (Case Fatality Rates). All antiviral treatments appear to work best in the early course of the illness and there will be supply issues with remdesivir and the triple drug treatments. If HCQ and zinc are used in some people there should be no issues with supply! I think that might be an option used in developing countries and tropical ones where HCQ is in common usage as both a treatment and prophylaxis against malaria, more evidence is forthcoming on it's efficacy, but unless it's used with zinc supplementation I wouldn't expect any effect on outcomes, as studies have shown, including the one I recently posted.

We are still awaiting more information on remdesivir and it should be out soon, many of these trials are ongoing and will take awhile to come out because they are carefully conducted randomized control studies the seek causation when they can. Often though preliminary studies are good enough for doctors when approved or off label medications of proven safety are involved and circumstances warrant it. Blood thinners are approved for clotting so there are no issues there as with many of the anti inflammatories they are using for supportive treatment of acute cases.

 

[Fogdog]

One more thing about effective treatment options that might make a big impact on mortality is getting sick people to show up at the hospital. Many have no hope and choose to die at home instead of on a ventilator. It will also do a lot to help the medical staff and give them a sense of empowerment, they will no longer have to watch helplessly as patients and colleagues die. They are beginning to harness to power of medical science in this fight and increased understanding has lead to improvements in care and soon the payoffs will come from research on anti viral treatments. They will whittle down the CFR to fraction of its current level and cut the IFR from. .5% or even 1.15% to an acceptable number, to be determined by Fauci's question, "How many deaths are you willing to accept?".

Oh, so honey can make it so that people don't have to go to the hospital?

I want to thank you for liberating me from stodgy old doctors and their risk averse advice. Something I don't understand is how your beliefs in folk medicine that are reinforced by low quality studies are any different in kind from that of the anti-vaxxers?

 

[DIY-HP-LED]

Oh, so honey can make it so that people don't have to go to the hospital?

I want to thank you for liberating me from stodgy old doctors and their risk averse advice. Something I don't understand is how your beliefs in folk medicine that are reinforced by low quality studies are any different in kind from that of the anti-vaxxers?

Many die at home because they feel there is no point in going to the hospital, this might change that and lower the stress on the medical people by empowering them a bit. Honey won't cut it foggy, the triple drug treatment might though, another tool in the arsenal for doctors to use, it was a randomized trial with controls published in the Lancet and will prompt other trials. No doubt supply chain issues are gonna be a problem like everything else in this business, perhaps I'll look into it more, there should be some journalist doing the leg work on this now.

The treatment options are starting to add up foggy, its an exiting scientific adventure in the midst of a tragedy and that gives impetus to great effort. It also gives us hope of taming the beast a bit in the near future and lessening the death and suffering.

 

[Fogdog]

Many die at home because they feel there is no point in going to the hospital, this might change that and lower the stress on the medical people by empowering them a bit. Honey won't cut it foggy, the triple drug treatment might though, another tool in the arsenal for doctors to use, it was a randomized trial with controls published in the Lancet and will prompt other trials. No doubt supply chain issues are gonna be a problem like everything else in this business, perhaps I'll look into it more, there should be some journalist doing the leg work on this now.

The treatment options are starting to add up foggy, its an exiting scientific adventure in the midst of a tragedy and that gives impetus to great effort. It also gives us hope of taming the beast a bit in the near future and lessening the death and suffering.

Oh, so thank you so much for liberating me from stodgy old doctors advice. That stuff about HCQ and Vitamin D is fascinating!!!

I'm wondering how that kind of loose approach toward medical science differs from what anti-vaxxers do?

 

[DIY-HP-LED]

Oh, so thank you so much for liberating me from stodgy old doctors advice. That stuff about HCQ and Vitamin D is fascinating!!!

I'm wondering how that kind of loose approach toward medical science differs from what anti-vaxxers do?

It's just a science and public policy thread foggy, ya don't even have to visit it, if it upsets ya, others seem to enjoy the content.
You talk and defend NPI's and lockdowns, I'm focused on a way out or of mitigating the death and suffering, both human and economic, treatment options are the only logical way to achieve this, there is an emerging expert consensus on this. You are seeing experts mention treatment options now along with NPIs, testing, contact tracing and case isolation and you will hear more of it in the near future.

 

[Fogdog]

It's just a science and public policy thread foggy, ya don't even have to visit it, if it upsets ya, others seem to enjoy the content.
You talk and defend NPI's and lockdowns, I'm focused on a way out or of mitigating the death and suffering, both human and economic, treatment options are the only logical way to achieve this, there is an emerging expert consensus on this. You are seeing experts mention treatment options now along with NPIs, testing, contact tracing and case isolation and you will hear more of it in the near future.

I'm completely fascinated with your way of handling folk medicine. I just don't understand how your use of weak research is different from anti-vaxxers. Please explain.

 

[DIY-HP-LED]

I'm completely fascinated with your way of handling folk medicine. I just don't understand how your use of weak research is different from anti-vaxxers. Please explain.

Anti vaxers depend on one self confessed scientific fraud and a single fraudulent study.

Have a look around the web there are plenty of people touting things and I'm sure all the heath and nutrition sites will have the latest studies on Covid-19 and Vitamin D, are they wrong to do so? Are regular media wrong in reporting these findings in a responsible way? Can most normal people call their own balls and strikes about their own health based on reliable information? The two most recent things I posted on this thread about vitamin D were from reliable original sources and are evidence, but not considered proof, that requires a higher standard and takes time. However the implications of the evidence are profound in the current situation and has the potential to save many thousands of lives by addressing deficiencies in the population, particularly among minorities. In such circumstances to err on the side of caution by testing and supplementing vulnerable populations might be a good thing, public education would not hurt either. It's an area that needs urgent study IMHO and perhaps urgent action as well, its up to the public health Gods.

Locally the shelves have been almost cleaned out of vitamin D from a few weeks back, so somebody is getting the message and not from me except for family and friends..

 

[DIY-HP-LED]

Maybe Oprah will get interested, test and supplement a whole state in conjunction with a university and see what the results are statistically, make a show on it someday! There are correlations with chronic vitamin D deficiency and almost all the comorbidities that plague not just the african american community, but east indian dark skinned caucasians living in northern latitudes as well, whether in America or Europe. Many of the deaths in Sweden are Somali immigrants and the Muslim women are covered from head to toe, check the mortality rates from covid-19

Inhabitants of Swedish-Somali origin are at great risk for covid-19

www.bmj.com

In Editor’s choice of 19 March (2020), before the two latest studies with covid-19 and Vitamin D

Inhabitants of Swedish-Somali origin are at great risk for covid-19
"
A risk factor that we want to highlight, however, is the low vitamin D levels found in the Swedish-Somali population. Vitamin D status is strongly related to low sun exposure and dark skin. In two different studies, the great majority of Swedish women of Somali origin had very low levels of S-25(OH)-D (< 25 nmol/l).[3,4] In Finland, Somali women required more than twice the amount of vitamin D in order to maintain recommended vitamin D status. [5] In addition, vitamin D deficiency was twice as common, regardless of gender, in immigrants from Africa compared with those from the Middle East.[6]

There is evidence that vitamin D is involved in our defence against respiratory tract infections. According to a meta-analysis, vitamin D supplementation (daily-weekly dosage) prevents acute respiratory tract infections, especially in those with 25(OH)-D below 25 nmol/l (NNT = 4).[7] In a randomised trial on individuals with frequent respiratory tract infections, treatment with cholecalciferol 4000 IE/day reduced the need for antibiotic treatment.[8] The mechanism is debated; however, modulation of the renin-angiotensin system has been implicated in animal studies of acute respiratory distress syndrome,[9] and angiotensin-converting enzyme 2 is a well-established receptor for the SARS-CoV virus.[10]

In order to cope with the covid-19 epidemic, preventive measures could be administration of vitamin D to high-risk populations, e.g. dark-skinned adults with low sun-exposure and/or individuals with risk factors for respiratory tract infections. Although it may not always be helpful, it is unlikely to be harmful".