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Scott

Hydroxychloroquine

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The other thread got locked, but this isn't good news. ☹️    

Study finds no benefit, higher death rate in patients taking hydroxychloroquine for COVID-19

https://fox40.com/news/national-and-world-news/study-finds-no-benefit-higher-death-rate-in-patients-taking-hydroxychloroquine-for-covid-19/

The study was limited though and not definitive and only included a few hundred people.   Still it isn't looking as promising as before.   

Hopefully something will pan out.  Virus are generally so much harder to cure than bacteria.

 

 

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6 minutes ago, Scott said:

The other thread got locked, but this isn't good news. ☹️    

Study finds no benefit, higher death rate in patients taking hydroxychloroquine for COVID-19

https://fox40.com/news/national-and-world-news/study-finds-no-benefit-higher-death-rate-in-patients-taking-hydroxychloroquine-for-covid-19/

The study was limited though and not definitive and only included a few hundred people.   Still it isn't looking as promising as before.   

Hopefully something will pan out.  Virus are generally so much harder to cure than bacteria.

 

 

Aren’t many hospitals treating it as a last-line medication?

I mean, the mortality rate of COVID-19-positive folks who went to the hospital is much higher than the mortality rate of COVID-19-positive folks who didn’t go.  But we don’t extrapolate, from that, that hospitals have no benefit for (or are even detrimental to) COVID-19 patients.

One wonders if the study accounted for that.  

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1 minute ago, Just_A_Guy said:

Aren’t many hospitals treating it as a last-line medication?

I mean, the mortality rate of COVID-19-positive folks who went to the hospital is much higher than the mortality rate of COVID-19-positive folks who didn’t go.  But we don’t extrapolate, from that, that hospitals have no benefit for (or are even detrimental to) COVID-19 patients.

One wonders if the study accounted for that.  

Seems obvious, doesn't it? I mean, how could it NOT account for that? But human stupidity and irresponsibility know no bounds, so the possibility is not off the table.

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4 minutes ago, Just_A_Guy said:

I mean, the mortality rate of COVID-19-positive folks who went to the hospital is much higher than the mortality rate of COVID-19-positive folks who didn’t go.  But we don’t extrapolate, from that, that hospitals have no benefit for (or are even detrimental to) COVID-19 patients.

One wonders if the study accounted for that.  

Here is a link to the abstract from the study (though unfortunately the amount of detail leaves much to be desired):

https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v1.article-metrics

All of the patients in the study went to the hospital.  It didn't count anyone who wasn't hospitalized.    There were only a few hundred patients studied though.

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1 hour ago, Scott said:

Here is a link to the abstract from the study (though unfortunately the amount of detail leaves much to be desired):

https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v1.article-metrics

All of the patients in the study went to the hospital.  It didn't count anyone who wasn't hospitalized.    There were only a few hundred patients studied though.

Based solely on the abstract Scott linked to, this looks like not a bad idea for a study. Who knows if the study might have shown a clear, statistically significant positive correlation between hydroxychloroquine usage and good outcomes? As it is, the data show, if anything, a negative correlation between survivability and hydroxychloroquine usage. But the size of the study, the fact that it was just a retrospective of patients admitted to the hospital, and the inability to randomly assign patients or use controls appears to make this study useless as it is, in the sense that I don't think it gives us any usable data or any insight into the possible effectiveness of hydroxychloroquine outside of emergency, end-case, grasping-at-straws usage.

I'd be interested to hear @MarginOfError's take on this.

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1 hour ago, Just_A_Guy said:

Aren’t many hospitals treating it as a last-line medication?

I mean, the mortality rate of COVID-19-positive folks who went to the hospital is much higher than the mortality rate of COVID-19-positive folks who didn’t go.  But we don’t extrapolate, from that, that hospitals have no benefit for (or are even detrimental to) COVID-19 patients.

One wonders if the study accounted for that.  

A similar deficiency diminished the outlook for the Bautista Procedure. It was believed that the fact it was only used on terminally ill patients tilted the data to one side.

Then they decided, what if they did it on otherwise healthy people with only this one defect.  There was a boost in survivability.  But as years went on, there was a lower survival rate.  Now it isn't used much in the US.

Edited by Carborendum

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31 minutes ago, Vort said:

Based solely on the abstract Scott linked to, this looks like not a bad idea for a study. Who knows if the study might have shown a clear, statistically significant positive correlation between hydroxychloroquine usage and good outcomes? As it is, the data show, if anything, a negative correlation between survivability and hydroxychloroquine usage. But the size of the study, the fact that it was just a retrospective of patients admitted to the hospital, and the inability to randomly assign patients or use controls appears to make this study useless as it is, in the sense that I don't think it gives us any usable data or any insight into the possible effectiveness of hydroxychloroquine outside of emergency, end-case, grasping-at-straws usage.

I'd be interested to hear @MarginOfError's take on this.

Unfortunately, the abstract or news article doesn't tell us that much other than death rates.  

I did find more on the study, but it still leaves some questions.   Here it is if you (or anyone else) wants to read it:

https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v1.full.pdf

One thing interesting is that the study was only done on male patients.   Only 17 females in those hospitals were available (vs 368 males), so it wasn't enough to test on femal vs. males.  

The demographic section is also interesting since it shows other unrelated medical conditions noted.

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There are still other ideas being posted out there.

One that I wonder about is if it may be more harmful than helpful.  When I was very young they had us line up to take a vaccine called the polio vaccine.  It used to be a very harmful disease that affected people.

Some have hypothesized that giving people this vaccine may give a jump to people's immune system and help them fight off Covid as a secondary measure.  Other thoughts have been given towards MMR or other vaccines doing a similar thing.

HOWEVER...this disease (COVID) seems to affect the elderly the most.  In particularly, those of my generation and older.  We all had this polio vaccine (at least I think we mostly did).  What if it's that vaccine that has made us more vulnerable?  Those that never took the vaccine (the young people of today) do not seem to suffer as much.  I'm not sure the polio vaccine is actually going to boost people's immune system as much as some are hypothesizing, but I have heard this theory of giving everyone the polio vaccine again.

Another idea is that there are some other drugs that are already used to fight viruses that may be useful and that need testing. 

All in all, there are other things to test beyond just the hydroxychloroquine.

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8 hours ago, Scott said:

Unfortunately, the abstract or news article doesn't tell us that much other than death rates.  

I did find more on the study, but it still leaves some questions.   Here it is if you (or anyone else) wants to read it:

https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v1.full.pdf

One thing interesting is that the study was only done on male patients.   Only 17 females in those hospitals were available (vs 368 males), so it wasn't enough to test on femal vs. males.  

The demographic section is also interesting since it shows other unrelated medical conditions noted.

Having only used males is actually a benefit to this study.  If they only had 17 females available, it would have been difficult to extract any information of statistical value while adding another layer of noise.  The thing that isn't stated clearly in the abstract is that the results should not be extrapolated to the female population.

I'm not too concerned about the unrelated medical conditions.  When performing the analysis, they adjusted the hazard ratios for "propensity score." What this means is they run the analysis in two models. First, they use all of the demographics and descriptors they can in a preliminary model to predict the probability of each person dying from factors unrelated to SARS-COV-2. Then they use that predicted probability as a moderating term in the primary model. While this methodology is known not to eliminate all of the bias associated with those demographics, it has been found to be successful in significantly reducing those biases*.

So what's my take on this study?  I wouldn't put too much weight on this one single study.  Instead, you add it to the pile.  Retrospective, observational studies were my bread and butter when I worked in the health field. They are rarely (never) conclusive on their own. But when studied in conjunction with other similar (or slightly dissimilar) studies, you can actually learn a fair amount.  The big thing you look for in concordant and discordant results.  If you have six or eight studies that study a similar outcome and have similar premises (they don't have to be identical, just similar) and they all show pretty similar results, then it typically ends up that a proper, randomized trial will confirm those results.  In my experience (anecdotal), this will hold when the smaller studies are about 80% concordant.  Less than 70% concordant, and you get into the "mixed results" range, which makes it harder to guess what the outcome of a clinical trial will be.

Based on the number of studies I've heard of studying this drug and the mixture of results, I'd guess that the drug isn't likely to prove very effective.  With enough research, we may find some marginal effect in some portion of the population that will benefit from the right dose.  But it will take a pretty long time for us to be able to tease out effects with that kind of granularity. So it seems unlikely this is some kind of miracle drug. At best, it's a tool that can be used to some undetermined benefit when used carefully in the right circumstances that we don't yet understand.

 

* some would argue that you should adjust for those factors directly.  Well, it turns out these kinds of models can only support about one predictor variable per death, not per patient.  So with only about 50 deaths total in the cohort, you get five terms, or degrees of freedom.  With three study groups, you'll eat up two of them. So you've only got three to play with.  Using the propensity score gives you the best balance of demographic adjustment while still having a model with good statistical characteristics.

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15 minutes ago, JohnsonJones said:

Some have hypothesized that giving people this vaccine may give a jump to people's immune system and help them fight off Covid as a secondary measure.  Other thoughts have been given towards MMR or other vaccines doing a similar thing.

HOWEVER...this disease (COVID) seems to affect the elderly the most.  In particularly, those of my generation and older.  We all had this polio vaccine (at least I think we mostly did).  What if it's that vaccine that has made us more vulnerable?  Those that never took the vaccine (the young people of today) do not seem to suffer as much.  I'm not sure the polio vaccine is actually going to boost people's immune system as much as some are hypothesizing, but I have heard this theory of giving everyone the polio vaccine again.

I can't say I find much sense in this theory. Old people tend to suffer more from common maladies simply because their bodies are run down from having been alive for so long. I forget what the exact number is, but something like 80% of our elderly in the U.S. die within a few weeks of having a surgical procedure in a hospital.  They just don't recover. Their deaths are typically classified as cardiovascular death.  But that doesn't appear to account for the fact that the recovery time for elderly patients tends to be longer, harder, and riskier than it is for younger patients.

When a respiratory disease come around, the elderly have always been the most effected because they tend to have more difficulty getting adequate exercise to have a strong enough respiratory system to withstand a disease. It sucks, but it is reality.

The thing that is remarkable about SARS-COV-2 is not its mortality rate, nor its severity, nor its impact on the elderly population.  The thing that is remarkable about this disease is its transmission rate.  This thing spreads easily, and when combined with it's long incubation period, spreads fast. We're actually rather lucky it isn't a more severe disease or we'd really be hurting. (for flu vs SARS-COV-2 comparison, consider that flu kills about 60,000 each year in the U.S., while in the past two months, SARS-COV-2 has killed almost 50,000). If this thing had the even half the mortality rate among the 30 - 50 crowd that it does among the elderly, we'd be looking at Spanish Flu levels of death.

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I have been conducting my own personal study - I do not know anybody that has died of COVID 19.  This conclusively proves that anyone that has taken the time to get to know me is safe and will not die in this pandemic.    😎

 

The Traveler

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1 hour ago, Traveler said:

I have been conducting my own personal study - I do not know anybody that has died of COVID 19.  This conclusively proves that anyone that has taken the time to get to know me is safe and will not die in this pandemic.    😎

 

The Traveler

Did you randomize who gets to know you and who doesn't?  

Maybe we should do a crossover design

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2 hours ago, Traveler said:

I have been conducting my own personal study - I do not know anybody that has died of COVID 19.  This conclusively proves that anyone that has taken the time to get to know me is safe and will not die in this pandemic.    😎

 

The Traveler

Well, Taveler.  No matter what we disagree on, I still find it a pleasure to have known you.

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2 hours ago, MarginOfError said:

Did you randomize who gets to know you and who doesn't?  

Maybe we should do a crossover design

My wife thinks everything I do is random - but she does not understand scientific logic.  As for crossovers - NOT WITH MY WIFE!!!

BTW - Is anyone else "Sick" of this social distancing - stay at home thing?

 

The Traveler

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On 4/23/2020 at 3:28 PM, Traveler said:

BTW - Is anyone else "Sick" of this social distancing - stay at home thing?

We're all sick of it, and we're a stay at home family.

  • We homeschool.
  • We shop on Amazon.
  • I have a home based business.

We usually don't go anywhere.  And we're getting jumpy.  If our family feels like we're in a prison, then, yeah, a lot of people are messed up right now.

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On 4/23/2020 at 4:28 PM, Traveler said:

BTW - Is anyone else "Sick" of this social distancing - stay at home thing?

We were until the beaches opened back up.  

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1 minute ago, anatess2 said:

We were until the beaches opened back up.  

Especially when those hitting the beaches first were the one's eating extra meals while social distancing at home.  😝

 

The Traveler

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30 minutes ago, Traveler said:

Especially when those hitting the beaches first were the one's eating extra meals while social distancing at home.  😝

 

The Traveler

Our supply of pompanos were depleted.  We would have had to break out the frozen steaks.  :)

 

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On 4/27/2020 at 10:49 AM, Traveler said:

Especially when those hitting the beaches first were the one's eating extra meals while social distancing at home.  😝

 

The Traveler

I miss these very rare jokes from Traveler.  Why don't you crack these jokes more often?  I LOVE YOUR sense of humor.  But you so rarely let it out.

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36 minutes ago, Carborendum said:

I miss these very rare jokes from Traveler.  Why don't you crack these jokes more often?  I LOVE YOUR sense of humor.  But you so rarely let it out.

What can I say????  My wife says that my humor is the best and I am the funnest when I am trying extra hard to be serious.  When I try to be funny - it usually does not come across as very funny.  😨

 

The Traveler

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On 4/23/2020 at 6:35 AM, MarginOfError said:

We're actually rather lucky it isn't a more severe disease or we'd really be hurting. (for flu vs SARS-COV-2 comparison, consider that flu kills about 60,000 each year in the U.S., while in the past two months, SARS-COV-2 has killed almost 50,000). If this thing had the even half the mortality rate among the 30 - 50 crowd that it does among the elderly, we'd be looking at Spanish Flu levels of death.

Well, seems like if you jump off a plane at 30,000 feet over land and you're infected with covid you're counted as a covid death.

I wonder how true this "clear truth" really is...

 

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On 4/23/2020 at 6:35 AM, MarginOfError said:

(for flu vs SARS-COV-2 comparison, consider that flu kills about 60,000 each year in the U.S., while in the past two months, SARS-COV-2 has killed almost 50,000).

P.S.

Who has the ACTUAL numbers (not estimated) for the non-covid-19 flu deaths of 2019-2020 flu season?  Search strings are failing me on the internet.

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