Pelican Parts Forums - Chloroquine?

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So here is the paper link:
https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2.full.pdf

Here are my two issue with this study (bold is mine):
1. "...all received the is the standard treatment (oxygen therapy, antiviral agents, antibacterial agents, and immunoglobulin, with or without corticosteroids), patients in the HCQ treatment group received additional oral HCQ
(hydroxychloroquine sulfate tablets, Shanghai Pharma) 400 mg/d (200 mg/bid) between days 1 and 5 (Figure 1), patients in the control group with the standard treatment only."

With that soup of meds, how on earth are you going to know if the med you are testing is doing anything!

2. I know that the paper points out that the few that got really sick are in the control group, but that is 4 patients out of 62, or 6%. They do say that the age of the patients is 44.7 +/-15 years (~29-60) and they also say: "...There was no significant difference in the age and sex distribution between the two groups of patients..." but they do not say what the ages were or give a variance. IF the significant difference is a mean age of each group, the control group could have easily had the eldest participants balanced by the youngest.

The FOMs for COVID are temperature and cough. For body temperature, the control group recovery time spanned 1.9 to 4.5 days. The test group was 1.8 to 2.6 days. So the test group didn't get better faster, just possibly shorter, but there are no numbers given on how many folks when. IMHO this should be binned data in a histogram. For all we know there could have been a single outlier skewing the control roup to 4.5 days. There is no data given to support the improvement in cough claims.

It seems that this is SUPER preliminary and is still up in the air, not even remotely an answer.

Quote:

Originally Posted by tadd (Post 10807730)

So the Infectious Disease physician(s) at Vandy is/are wrong? They are "the Harvard of the South" you know. ;) Seriously, when your hospitals are MAXED out , anything that gets patients out of a bed a few days quicker is a pretty serious win.

Quote:

Originally Posted by tdw28210 (Post 10808044)

So the Infectious Disease physician(s) at Vandy is/are wrong? They are "the Harvard of the South" you know. ;) ....

Mebbe in basketball ;)

Dook

If the recovery rate is 98%, as it appears to be, the process for confirming an effective "cure" is frustratingly long.

I'd call your attention to all the various "cures" for the common cold that were popular before statistical analysis showed them to be useless.

This seems appropriate for a few notorious Pelicanheads:

http://forums.pelicanparts.com/uploa...1585846622.png

The:
I got my PhD in p-chem at vandy ��.

Not saying he is wrong, but read the original source. It’s pretty sparse.

I’m sure the guy was thrilled to be quoted by a newspaper.

I’m happy to discuss your thoughts on the paper...

Quote:

Originally Posted by tdw28210 (Post 10806155)

Don't agree. "Doesn't work" runs counter to actual clinical research done in places like France and soon to be NYC and India. Is it the double-blind, randomized gold-standard? No, but were in a fox hole here. Have credible researchers provided evidence of efficacy? yep.

Been testing over a week in NY. Deaths still climbing exponentially. Not hearing positive news.......

No offense to our Interweb experts and rumor mill here, the doctors on the front lines are the first to notice what works for their patients... not the CDC.

Quote:

https://www.sun-sentinel.com/coronavirus/fl-bz-cano-health-promotes-chloroquine-to-treat-coronavirus-20200325-hr2pgk4mwfcovbpmc5gm275hye-story.html

Hernandez said Cano Health doctors have prescribed chloroquine to “a few dozen” patients in recent days, including at-risk elderly patients with preexisting conditions and patients experiencing early-onset COVID-19 symptoms such as difficulty breathing, muscle aches, dry cough and loss of appetite.

So the CEO of a facility is recommending a medication for hardly sick people that haven’t really been tested for COVID and they have tried 30ish paitents?

From the article:
“Only a couple of the patients have tested positive for COVID-19, he said. Most haven’t been tested at all because Cano Health clinics have no tests, he seaid. Patients who present flu symptoms are given a test for the normal flu. If they test positive, they are given over-the-counter Theraflu. If they test negative for the normal flu, Cano Health doctors assume the patients have COVID-19 and offer chloroquine, Hernandez said.”

Dr knows best my butt.

Quote:

Originally Posted by tadd (Post 10808177)

Dr knows best my butt.

Given your certainty and expertise in this matter, do something about it.

Call that doctor and/or the patients about your findings and let us know what they say.

Here's the contact

Quote:

855.226.6633
Cano Health, specializing in care for the elderly, serves about 60,000 patients at clinics in Broward, Palm Beach, Miami-Dade, Hillsborough, Orange and Osceola counties.

So an interviewer quoted the guy saying they had tested “a couple” of people for COVID, yet he states they have treated “a few dozen” which are ‘assumed’ to have COVID.

You truly think that is supportable data?

I design experiments for a living testing various aspects of toxic materials. Animal models included.
Not an MD, but can speak to IV&V.

Quote:

Dr. Stephen Smith on effectiveness of hydroxychloroquine: 'I think this is the beginning of the end of the pandemic'
Talia Kaplan

Dr. Stephen Smith, founder of The Smith Center for Infectious Diseases and Urban Health, said on “The Ingraham Angle” on Wednesday night that he is optimistic about the use of antimalarial medications and antibiotics to treat COVID-19 patients, calling it “a game-changer.”

“I think this is the beginning of the end of the pandemic. I’m very serious,” Smith, an infectious disease specialist, told host Laura Ingraham.

Currently there is no known cure for the coronavirus pandemic ravaging the globe.

Smith, who is treating 72 COVID-19 patients, said that he has been treating "everybody with hydroxychloroquine and azithromycin [an antibiotic]. We’ve been doing so for a while.”

He pointed out that not a single COVID-19 patient of his that has been on the hydroxychloroquine and azithromycin regimen for five days or more has had to be intubated.

“The chance of that occurring by chance, according to my sons Leon and Hunter who did some stats for me, are .000-something,” he said, adding that “it’s ridiculously low."

Smith explained that “intubation means actually putting a tube down into your trachea and then you’re placed on the ventilator for respiratory support.”

The Food and Drug Administration recently announced an emergency-use authorization for several drugs, including hydroxychloroquine and chloroquine, despite a lack of clear evidence of their effectiveness.

A study published earlier this month by French researchers suggested that COVID-19 patients could be treated with antimalarial medication and antibiotics in the battle against the novel coronavirus.

Smith noted on Wednesday that he thinks his data supports the French study.

“Now you actually have an intra-cohort comparison saying that this regimen works,” he told Ingraham.

Speaking on “Fox & Friends” on Thursday, Dr. Mehmet Oz brought up an “important randomized study still unpublished from Wuhan, China.”

He said that his team spoke to the medical leadership in China and vetted the study.

“We think it's real,” Dr. Oz said on Thursday.

He then went on to explain what the study, which looked at 62 patients, showed. He noted that half of the patients got the traditional therapy being offered in China and the other half got the traditional therapy plus hydroxychloroquine.

“In terms of symptoms, their temperatures, their fevers broke instead of three days, which is the norm over there on this treatment, they got two days,” Dr. Oz said.

He added that “in terms of coughing, the other big symptom you have, again it takes a little over three days oftentimes for that to go away and that was dropped at two days.”

Dr. Oz then pointed out the part that “really caught my attention.”

“They did CT scans of the chest in all the patients. All the patients had pneumonia when they started. Over the course of the five-day treatment with the hydroxychloroquine and 55 percent of the control population where they just got the normal therapy there was resolve and resolution of the pneumonia in 81 percent of the patients on the hydroxychloroquine, there was improvement in the lung's images,” he pointed out.

Dr. Oz noted that these results are “statistically significant.”

He went on to say that even though the study only monitored a small group of people, “they still got the measures that we like to see.”

Dr. Oz acknowledged that a bigger clinical trial is still needed, adding that the Chinese study “is an early effort to try to show a lot of people whether this is the right way or the wrong way to go.”

“I should point out in the 31 patients that were the control group, four patients had bad outcomes, they got significantly worse. None of the patients in the hydroxychloroquine group got significantly worse,” he said.

“So the Chinese are using this as part of their routine treatment. They have a national protocol for measuring COVID-19. I think we ought to consider something like that in this country, but at least physicians and patients should be able to discuss this a bit more comfortably until we have the bigger randomized data from studies done in this country.”

A new study in the United States, which will be conducted by the University of Washington in conjunction with New York University, looks to enroll 2,000 people who are "close contacts of persons with confirmed or pending COVID-19 diagnoses," according to a statement announcing the study.

New York State recently said it would start coronavirus drug trials in an attempt to control the pandemic's impact on the state, according to Gov. Andrew Cuomo, who announced the state had acquired 70,000 doses of hydroxychloroquine, 10,000 doses of the antibiotic Zithromax and 750,000 doses of chloroquine, another antimalarial drug.

Recently President Trump has spoken out about the potential promise of hydroxychloroquine to help treat COVID-19 patients.

A New York Times article published on Wednesday also referenced the Chinese study Dr. Oz had referred to on “Fox and Friends.”

The article, which cited doctors in China, titled “Malaria Drug Helps Virus Patients Improve, in Small Study,” highlighted the fact that hydroxychloroquine “helped to speed the recovery of a small number of patients who were mildly ill from the coronavirus.”

“Cough, fever and pneumonia went away faster, and the disease seemed less likely to turn severe in people who received hydroxychloroquine than in a comparison group not given the drug,” the article said. “The authors of the report said that the medication was promising, but that more research was needed to clarify how it might work in treating coronavirus disease and to determine the best way to use it.”

Speaking on “Fox & Friends” on Thursday Dr. Oz also noted another observation the Chinese made in their study, saying they noticed that people who were already taking hydroxychloroquine, like the people who suffer from the autoimmune disease lupus and are prescribed the drug for that condition, didn’t contract COVID-19.

“So we ought to think about looking at it for doctors and nurses and loved ones of people who get ill,” Dr. Oz said on Thursday.

https://www.foxnews.com/media/dr-stephen-smith-on-effectiveness-of-hydroxychloroquine-with-coronavirus-symptoms-beginning-of-the-end-of-the-pandemic

Sammy:
I hope it does turn out to work.

But I posted the wuhan paper Dr Oz is talking to and it is sparse on the data...assuming it is trying to prove effectiveness. For example, they took temperature 3 times a day for the 5 days they have the med. Dollars to doughnuts that got written down. Why wasn’t it presented? Only reason it wasn’t is because it shows no pattern or support to their conclusions.

If IIRC, you build turbines. You measure everything, right? It’s recorded, so you know it was done right. The customer prob has engineers that want to see that info to verify what they are getting.
How often to your customers ‘buy on faith’?

Quote:

Originally Posted by sammyg2 (Post 10808247)

https://www.foxnews.com/media/dr-stephen-smith-on-effectiveness-of-hydroxychloroquine-with-coronavirus-symptoms-beginning-of-the-end-of-the-pandemic

Thanks for the link. I didn't know Dr Oz commented on the study, this statement caught **my** attention.

Quote:

Dr. Oz then pointed out the part that “really caught my attention.”

“They did CT scans of the chest in all the patients. All the patients had pneumonia when they started. Over the course of the five-day treatment with the hydroxychloroquine and 55 percent of the control population where they just got the normal therapy there was resolve and resolution of the pneumonia in 81 percent of the patients on the hydroxychloroquine, there was improvement in the lung's images,” he pointed out.

Also interesting to note our resident Interweb experts made no mention of this minor detail.

Dr Oz????

We are discussing what Dr Oz thinks? We are screwed.

I may get my wish yet.

Are we treating pneumonia or COVID?

Pneumonia can be viral or bacterial. It can be caused by covid or a co-morbidity because of covid.

In the Wuhan paper HCQ was given, in addition to(!), anti bacterials.

So who knows what cleared up what. Hence I stated it was a soup of meds.

All you have to do is RTFP yourself. It isn’t hard. Why regurgitate pre-chewed food when you can go right to the source? Make an informed decision and think for yourself. If you think there is enough there to prove the case, GREAT! I think that the paper is crap, and I wouldn’t allow it to be published. Even as a rapid communication.

Quote:

Originally Posted by tadd (Post 10808287)

I don't build turbines, but I worked on them before I moved into management a couple of decades back.
I'm basically retired now doing a little consulting.
My customers hire me based on their faith in my reputation, proven expertise and experience and hands-on knowledge. Or not ;)

I don't know if that stuff works against covid 19 or not and have not taken a side in that argument in this thread. I haven't even read the entire thread, only some of it.

I simply added some more information that I felt was pertinent to the discussion. A doctor with an opinion based on personal observation, and a reference to the study discussed above.

So now I'll throw in my 2 cents:
It looks to me that lots of people with hands-on experience say it helps.
It's also my understanding that it has been used for a long time as a malaria drug with limited and known side effects.
So I don't see the rationale behind the big pushback. "Just because" doesn't feed the bulldog.
I'm not aware of significant risks and I'm hearing about potential benefit according to many.

Worst case is it's just a placebo and we waste time and money?
Best case is it prevents the premature death of thousands of patients?
If it were up to me I'd be pushing for a nation-wide trial, a hands-on test.
But it's not up to me.

I know one thing for sure: if I were sick with covid 19, I'd be saying GIVE ME SOME OF THAT CHLOROQUINE STUFF RIGHT FRIGGIN NOW!!!!!

Wouldn't you?

Quote:

Originally Posted by 93nav (Post 10808365)

Dr Oz????

We are discussing what Dr Oz thinks? We are screwed.

I may get my wish yet.

This is the other comment which stood out on a second reading of that article.

Quote:

He said that his team spoke to the medical leadership in China and vetted the study.

“We think it's real,” Dr. Oz said on Thursday.

Sammy:
That is an it depends.

HCQ does have a known established human tolerance. It acidifies the vesicles that transport stuff inside the cell. In theory the virus is not acid resistant/stable. In addition thanks to the tiny volume of a vesicle relative to the number of hydrated protons it gets really acidic.

The French study has been refuted. The Wuhan study is linked, and very lacking in support data. It is mostly observations and the HCQ was given along with a cocktail of other meds, so god knows what was doing what.

I get if you are on deaths door, use what you got (hence the Hail Mary exemption by the FDA).. but for an average case? That remains to be seen or best yet proven.

So is this a change of heart, or act of desperation?
Again, I can't help but question motives.

Quote:

Michigan reverses course on *****-touted coronavirus drugs
By Brooke Singman

Michigan Gov. Gretchen Whitmer’s administration has requested an emergency supply of the drugs President ***** touted as having success treating patients with severe symptoms of the novel coronavirus, in a reversal from the state's directive to medical professionals last week to avoid the medication for this purpose.

Michigan, this week, requested hydroxychloroquine and chloroquine from the Strategic National Stockpile for physicians to use to help treat patients with COVID-19, after the Food and Drug Administration over the weekend granted an emergency use authorization for the anti-malarial drugs.

But last week, Whitmer’s administration threatened physicians prescribing the drugs, saying they were subject to “administrative action” should they continue to use the medication.

“The Department of Licensing and Regulatory Affairs has received multiple allegations of Michigan physicians inappropriately prescribing hydroxychloroquine or chloroquine to themselves, family, friends, and/or coworkers without a legitimate medical purpose,” Deb Gagliardi, the director of the Bureau of Professional Licensing, and Forrest Pasanski, the director of the Enforcement Division, wrote in a letter to “licensed prescribers and dispensers.”

“Prescribing hydroxychloroquine or chloroquine without further proof of efficacy for treating COVID-19 or with the intent to stockpile the drug may create a shortage” for those patients who need the drug for its approved use, adding that “reports of this conduct will be evaluated and may be further investigated for administrative action.

“Again, these drugs have not been proven scientifically or medically to treat COVID-19.”

“Michigan pharmacists may see an increased volume of prescriptions for hydroxychloroquine and chloroquine and should take special care to evaluate the prescriptions’ legitimacy,” they continued, warning again that “licensed health professionals are required to report inappropriate prescribing practices.”

Michigan wasn’t the only state last week to threaten physicians using the drugs—Nevada Gov. Steve Sisolak’s administration also restricted the prescription of the medication, after a man died and his wife was hospitalized for using a fish tank cleaning additive with a similar name as a substitute.

"While the two drugs have necessary medical purposes, there is no conclusive evidence at this time among COVID-19 experts or Nevada's own medical health advisory team that the drugs provide treatment for COVID-19 patients," Sisolak said in a statement last week.

But Michigan reversed course, requesting a supply of the medications for physicians to use in treating patients of COIVD-19, after the Department of Health and Human Services received and accepted donations of the medications to the national stockpile to be used for coronavirus treatment.

“President ***** is taking every possible step to protect Americans from the coronavirus and provide them with hope,” HHS Secretary Alex Azar said in a statement. “Scientists in America and around the world have identified multiple potential therapeutics for COVID-19, including chloroquine and hydroxychloroquine.”

He added: “The President’s bold leadership and the hard work of FDA and HHS’s Assistant Secretary for Preparedness and Response have succeeded in securing this large donation of medicine. We’ll continue working around the clock to get American patients access to therapeutics that may help them battle COVID-19, while building the evidence to evaluate which options are effective.”

The FDA’s emergency use authorization allows hydroxychloroquine sulfate and chloroquine phosphate products donated to the national stockpile “to be distributed and prescribed by doctors to hospitalized teen and adult patients with COVID-19, as appropriate, when a clinical trial is not available or feasible.”

Hydroxychloroquine sulfate and chloroquine phosphate are oral prescription drugs approved to treat malaria and other diseases. HHS says there currently are no approved treatments for COVID-19, but that both drugs have “shown activity in laboratory studies against coronaviruses, including SARS-CoV-2 (the virus that causes COVID-19).”

“Anecdotal reports suggest that these drugs may offer some benefit in the treatment of hospitalized COVID-19 patients,” HHS said in a statement. “Clinical trials are needed to provide scientific evidence that these treatments are effective.”

...................

As of Thursday morning, the U.S. reported more than 216,700 positive cases of COVID-19 and more than 5,130 deaths.