COVID-19 drugs that work

[jyl]

Originally Posted by DanielDudley

I think that shortening a moderate illness is only mildly useful. Reducing a severe life threatening episode so a person survives with few repercussions would be very useful. That's the game changer.

I agree. Efficacy in mild cases is both hard to measure and of less importance. Hence my general disinterest in HCQ.

[pmax]

Originally Posted by DanielDudley

I think that shortening a moderate illness is only mildly useful. Reducing a severe life threatening episode so a person survives with few repercussions would be very useful. That's the game changer.

From what I have read, HCQ might help prevent developing the second more severe and lethal stage of the illness after the initial infection and mild disease.

[RWebb]

Treating a moderate illness can be very useful in a pandemic. Useful to the gen'l popn.

[Aurel]

It looks like Remedsivir is giving better results than HCQ for the severe cases.
Here is how I would approach the prevention and treatment of COVID-19 if I was a doctor, which I actually am, just not in medicine .

1) For prevention: Zn (25mg/day), vitamin C, vitamin D3 supplements
2) For mild cases: HCQ + ZPAK + more Zn (150 mg/day)
3) For severe cases: Remedsivir

[jyl]

Roche CEO saying discouraging things about time to vaccine and also saying that many SARS-COV-2 antibody tests out there now are not useful.

[RWebb]

a lot of the time to vaccine is how safe you want it to be

you pointed out the post-chicken era we now live in, but that is for candidates

an actual vaccine goes thru 3 phases of trials (I'm sure you know this, but not everyone does)

IIRC, there are ~~ 70 being worked on with just a few in Phase I - from memory, no warranty expressed or implied...

[jyl]

They can speed things up. For example, they can do challenge trials - inoculate 5000 volunteers with vaccine or placebo, then intentionally infect 100% of them with SARS-COV-2. Ethical issues of course, but they could probably find 5,000 to volunteer with knowing consent. And of course any study participant who gets sick is promised all the HCQ they want :-) A challenge trial would be vastly faster and more powered than a traditional trial. Inoculating people and then waiting months or years for them to maybe get exposed and maybe not, or watch the trial get confounded by social distancing at some of the trial sites, I don’t think we’ll have a vaccine even in 2021 using the traditional processes.

[RWebb]

I suspect that may be happens. Hopefully, none of the ethical challenges will come to fruition...

[jyl]

Originally Posted by RWebb

I suspect that may be happens. Hopefully, none of the ethical challenges will come to fruition...

I mean, in the good old days you could do these trials in Bangladesh or whatever the compensation for a life is a few thousand bucks. Or better yet, with soldiers and prisoners, no need for volunteers. Sigh, what’s the namby pamby world come to.

[jyl]

Here is a trial to watch. In MN, testing if HCQ works to *prevent* infection with covid rather than if it works to *treat* a covid infection.



Had second interim look, DSMB (data safety monitoring board) did not stop trial for safety (good), did not stop trial for futility (good), allowed trial to be downsized by 1/3 (could imply data trending in right direction enough that don’t need original powering, or could imply dropout rate lower than planned - ambiguous but could be good).

[Aurel]

Originally Posted by jyl

They can speed things up. For example, they can do challenge trials - inoculate 5000 volunteers with vaccine or placebo, then intentionally infect 100% of them with SARS-COV-2. Ethical issues of course, but they could probably find 5,000 to volunteer with knowing consent. And of course any study participant who gets sick is promised all the HCQ they want :-) A challenge trial would be vastly faster and more powered than a traditional trial. Inoculating people and then waiting months or years for them to maybe get exposed and maybe not, or watch the trial get confounded by social distancing at some of the trial sites, I don’t think we’ll have a vaccine even in 2021 using the traditional processes.

The virus mutates so much that a vaccine will never work, or it will be like the flu vaccine: a crapshoot that needs to be redone every year. Of course, that is every drug company’s dream, and there is a lot more money to be made than in a prophylactic drug.

And of course, just like computer viruses, new ones will emerge, either natural or man made. Bill Gates knows about that very well...

This is why we are headed into a medical tyranny of forced vaccinations, or a life of self distancing and wearing masks, unless an efficient drug is proven quickly. I had big hopes on HCQ, and it may not be the silver bullet it was touted to be, as more studies unravel. Up to the next then.

[jyl]

Originally Posted by Aurel

The virus mutates so much that a vaccine will never work, or it will be like the flu vaccine: a crapshoot that needs to be redone every year. Of course, that is every drug company’s dream, and there is a lot more money to be made than in a prophylactic drug.

And of course, just like computer viruses, new ones will emerge, either natural or man made. Bill Gates knows about that very well...

This is why we are headed into a medical tyranny of forced vaccinations, or a life of self distancing and wearing masks, unless an efficient drug is proven quickly. I had big hopes on HCQ, and it may not be the silver bullet it was touted to be, as more studies unravel. Up to the next then.

The virus has not mutated much at all, granted it’s only been in humans for several months. One thing we (humankind) have done right is sequence the heck out of many samples of SAR-COV-2. No doubt it will eventually mutate more, but so far so good.

It may well end up like the flu. When influenza first hit North America, it was devastating. I’m referring of course to the impact of European diseases on Native Americans, similar to how Cortez’s few men conquered the Aztecs with their diseases. But eventually immunities developed and now the flu is a routine part of the background.

I think that’s what will happen with this virus. It will mutate to be milder, more people will develop immunity to most strains of it, we’ll learn how to treat it and how to vaccinate against it, not perfectly but well enough.

Until then . . . I’m expecting us to wear masks for many months if not a year. And I’m concerned that the economy is going to be underwater for longer.

It really isn’t enough if the governor of your state says “open up”. Or if a few rural protestors and a bunch of 20-something young adults promptly go back to bowling alleys, bars, movies, restaurants, hairdressers, shops. The money and spending power in the US is in the middle/aged or older, better educated, more white collar part of the population. If they don’t feel safe, this recession/depression continues. The people rushing back to the bar will still be unemployed.

For that reason if nothing else, the Federal govt should be pouring tens of billions into mass testing programs and ample covid treatment facilities, and being incredibly visible about it. It should take the most trusted medical authorities, starting with Fauci, and use them in a PR campaign to reassure people. Hire Oprah to tell Americans they are being safeguarded - ick but do what you have to do.

Instead the Fed govt is chaotically changing its message every week, publicly telling states to find their own tests, PPE, vents, feuding with governors, and refusing to financially help state and local govts, allowing its surrogates to say old people’s deaths are an acceptable price.

This is not how you coax and reassure Americans to go out and spend money. At least not the bulk of the American consumers who have the bulk of the spending power.

[jyl]

https://www.statnews.com/2020/04/23/data-on-gileads-remdesivir-released-by-accident-show-no-benefit-for-coronavirus-patients/

Not good data - leaked from Chinese trial that was halted early (for lack of enrollment, futility, or ?).

As mentioned earlier, the subgroup data will be key - if the drug showed a benefit when it was started early, is probably okay if it didn’t when it was started late. But normally we’d get the topline data and the subgroup data close together, now we don’t know when the subgroup data will come out. Messy.

[RWebb]

Originally Posted by Aurel

The virus mutates so much that a vaccine will never work, or it will be like the flu vaccine: a crapshoot that needs to be redone every year. Of course, that is every drug company’s dream, and there is a lot more money to be made than in a prophylactic drug.

...

A pre-print from China says they ID'd 31 strains so far.

But you of all people should not discount our ability to develop comprehensive vaccines


... eventually

[speeder]

I'm not an infectious disease expert by any means but one thing I heard from someone who has read up a lot more on pandemics and IDs is that when the deadly virus mutates, it almost always mutates into something LESS deadly, not more. A virus's purpose in life is to survive and if it kills everyone, it runs out of hosts, so the theory goes, (in the extreme).

So hopefully, Covid19 will mutate into a much less severe and deadly virus in the near future. We hope. I personally think that it's already done that but the deadly strain is obviously still out there.

[RWebb]

almost...

the virus doesn't mutate in any 'direction' - mutation is random

what happens is that of the many mutations, natural selection favors the ones that have less virulence (since they don't kill the host as quickly, they can disperse and thrive)

ultimate example is to become via selection something the host benefits form - a mutualist (which is how you got mitochondria)

[group911@aol.co]

Back story on HCQ.
https://www.vanityfair.com/news/2020/04/internal-documents-reveal-team-trumps-chloroquine-master-plan

[Arizona_928]

Originally Posted by RWebb

almost...

the virus doesn't mutate in any 'direction' - mutation is random

what happens is that of the many mutations, natural selection favors the ones that have less virulence (since they don't kill the host as quickly, they can disperse and thrive)

ultimate example is to become via selection something the host benefits form - a mutualist (which is how you got mitochondria)

+1


Mutates good, mutates bad.
Mutates good for a few decades and we won't bat an eye.

Covid has already mutated twice last I read. Bark is worse than the bite if you're not in the demographics....

[island911]

Originally Posted by speeder

I'm not an infectious disease expert by any means but one thing I heard from someone who has read up a lot more on pandemics and IDs is that when the deadly virus mutates, it almost always mutates into something LESS deadly, not more. A virus's purpose in life is to survive and if it kills everyone, it runs out of hosts, so the theory goes, (in the extreme).

So hopefully, Covid19 will mutate into a much less severe and deadly virus in the near future. We hope. I personally think that it's already done that but the deadly strain is obviously still out there.

That's an interesting thought. - that it has already given us another version.

Or it could be that viral loading is making the big differences in how people experience this.

[group911@aol.co]

Please don't try this one.
https://www.bbc.co.uk/news/world-us-canada-52407177