BCSnob
Middletown, MD
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Scenario (the one that is occurring for every test of these experimental drugs):
You (or a loved one) are so sick with covid you get admitted to the hospital (the only place where these off label drugs are allowed to be prescribed). Each of the possible experimental drugs have multi-day dosing regimens (at least 5 days for hydroxychloroquine). You have to choose between one or none of these drugs. Do you choose to use your first 5 days of treatment taking hydroxychloroquine where the studies have shown at best inconsistent benefits (for unknown reasons) to ineffective? Do you choose to use your first 5 or more days taking one of the other drugs still being evaluated or do you choose to not take an experimental drug?
I’m curious which choice you would make, especially since you would unlikely be admitted into one of the few hospitals where hydroxychloroquine has shown benefit?
* This post was
edited 07/08/20 04:48am by BCSnob *
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dturm
Lake County, IN
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Turtle n Peeps wrote:wing_zealot wrote:BCSnob wrote:...You do understand that all the facts won’t be known until after the world population has achieved herd immunity. Then why are you so eager to dismiss any possible treatment as ineffective when all the facts won't be known for about another 9 months or more?
I wondered the same thing. Very odd.
Apples vs oranges.
In medicine one is often confronted with a patient where you don't know what is going on. Worse yet is you know what is going on but there isn't a known treatment for that disease or the treatment you are doing isn't working. Sometimes you don't know all the facts until the autopsy is performed.
The best case in these situations is the communications that go on between physicians trying to treat the same disease provide verifiable experiences with their treatment protocols. We're often confronted with anecdotal evidence that is wrong but at the time seemed appropriate. That's why after action studies are important. During something like this epidemic, what works becomes refined and what does not work is discarded.
It is dangerous to become focused in and married to one drug or protocol thinking that it is the end all. The bottom line is the people who know best what works and what doesn't work are the people dealing with this on a daily basis. Those of us outside of the acute care personnel should avoid making pronouncement about appropriate care.
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Moderator
Tennessee
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Wise rationale.
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BCSnob
Middletown, MD
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Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics
This publication in Lancet has a good summary comparison of this pandemic to past pandemics. Table 1 has a good overview.
Quote:A mortality study59 in 17 cities in the USA during the 1918 influenza pandemic found that the cities which implemented mitigation strategies early on had a delayed, flatter epidemic curve, with a 50% lower peak mortality, and a 20% lower overall mortality. Thus, mitigating policies are of paramount importance to ensure that the burden on the health-care system remains manageable.
Here is the link to the referenced article on the 1918 pandemic
Public health interventions and epidemic........nsity during the 1918 influenza pandemic
Early closures lead to lower deaths.
Quote:We noted that, in some cases, outcomes appear to have correlated with the quality and timing of the public health response. The contrast of mortality outcomes between Philadelphia and St. Louis is particularly striking (Fig. 1). The first cases of disease among civilians in Philadelphia were reported on September 17, 1918, but authorities downplayed their significance and allowed large public gatherings, notably a city-wide parade on September 28, 1918, to continue. School closures, bans on public gatherings, and other social distancing interventions were not implemented until October 3, when disease spread had already begun to overwhelm local medical and public health resources. In contrast, the first cases of disease among civilians in St. Louis were reported on October 5, and authorities moved rapidly to introduce a broad series of measures designed to promote social distancing, implementing these on October 7. The difference in response times between the two cities (?14 days, when measured from the first reported cases) represents approximately three to five doubling times for an influenza epidemic. The costs of this delay appear to have been significant; by the time Philadelphia responded, it faced an epidemic considerably larger than the epidemic St. Louis faced. Philadelphia ultimately experienced a peak weekly excess pneumonia and influenza (P&I) death rate of 257/100,000 and a cumulative excess P&I death rate (CEPID) during the period September 8–December 28, 1918 (the study period) of 719/100,000. St. Louis, on the other hand, experienced a peak P&I death rate, while NPIs were in place, of 31/100,000 and had a CEPID during the study period of 347/100,000.
* This post was
edited 07/08/20 10:07am by BCSnob *
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MEXICOWANDERER
las peñas, michoacan, mexico
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The Oxford AztraZeneca studies in Africa look promising. In agreement. A drug cocktail like for HIV looks more feasible.
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BCSnob
Middletown, MD
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I read an interesting observation about the Henry Ford retrospective study on the effectiveness of hydroxychloroquine. The author of the analysis pointed out that the median age of the control group (not given the drug) was older (median age 68) than all the groups given drugs (median ages of 63). Based upon the steep increase in mortality seen with covid, one would expect the younger groups given drugs would have a better outcome than the older group not given any drugs.
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MEXICOWANDERER
las peñas, michoacan, mexico
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I was Rx'd Plaquenil, by a USA rheumatologist for R/A. His first statement was "Do not expect any relief for several weeks to months" it is a complex disease. I was perpetually tired had stomach and bowel problems as well as typical redness and swelling in fingers and toes. The pain was crippling. When I departed the states I had to switch to chloroquine. Aralen.
Aralen versus my symptoms was significantly more potent. But with me, it came at a price. Increased photosensitivity and a drastically suppressed blood platelet count. So chloroquine was stopped and hydroxycloroquine resumed. I had full panels done in major cities every few months. Plaquenil was next to impossible to find. Now it is common.
I am wondering how these antimalarials were determined to be a treatment against a virus. The latency of efficacy should signal this drug family should not be considered fast acting except perhaps as its primary function as an antimalarial.
Experimentation in my view should continue for several months. Then a rational conclusion can be made about it's efficacy. I am more interested in its immune suppression than as an antiviral.
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monkey44
Cape Cod, MA and Central Fla
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I'm curious?
If you test for CV-19, and come positive, then isolate, then test again in a couple weeks positive, does that count as TWO positives - as in Positive cases today data pile??
The data continues to say: Positive tests, or positive cases, NOT positive persons. If it counts positive tests, not positive persons, that will certainly skew the data.
And, if a positive person is hospitalized, and tested twice a week for five weeks until negative twice, does that show as ten positive tests? That would explain our skyrocketing positive counts, when the same person tests, and tests, and tests, until negative.
The presentation of data is very puzzling ...
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pianotuna
Regina, SK, Canada
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monkey44,
This site says total cases:
https://www.worldometers.info/coronavirus/#countries
It also lists total tests, etc.
Regards, Don
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monkey44
Cape Cod, MA and Central Fla
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Thanks!! ![[emoticon]](http://www.coastresorts.com/sharedcontent/cfb/images/smile.gif "smile")
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