Capitol Hill Blue Forums Political Issues Politics In General Concerning prediction for the COVID-19 pandemic

These two epidemiologists think COVID-19 will last two years and have multiple waves:

https://www.cnn.com/2020/04/30/heal...uptDrN8UwLENLNHf&bt_ts=1588327770495

Opinions?

Can't rightly see why it wouldn't. Probably have hospitals dedicated to it. Maybe all those rural hospitals that closed down will become CV Sanatoriums....

I actually think that is exactly what will happen, but ONLY IF we wind up with real executive leadership in Washington and a legislative branch that cooperates. If so, then I agree that we will see something like that become a reality.
It has to, if we expect to survive this in a manner that resembles something other than Lord of the Flies.

If we don't put that kind of leadership in charge, enjoy those flies.
You are not going to enjoy the "lords".

I watched somebody say something to the effect that; "Covid-19 will continue until either over 85% of the populations gets Covid-19 or there is a vaccine." I think that is, pretty much, a simple fact. There are some states, like Georgia, that seems to be working, very hard, at the 86% thing whilst killing off their own citizens. Where I live the county has now actually registered a whole 18 Covid-19 victims, 14 of which have survived and moved on. My thought remains, the longer I can stay free of Covid-19 the better off I am. I fully expect to get it although they are saying a vaccine will appear by January which may, or may not, be true.

I think the trick to survival is probably to last as long as you can as there are literally thousands of science types working on the problem, worldwide. Hopefully the vaccine will appear. They have also made headway in treatment and are examining how to do better. So, in theory, if you haven't had it, pay attention, wear a mask, stay away from others, stay home, etc. (basically, avoid getting it as much as you can) things will continue to get better, better treatments and closer to a vaccine.

For myself, I am grateful to be living in Washington state. We have been doing better than most and almost everybody is paying attention. My main concern is the survival of our hospital which is gong broke due to rules that don't allow it to do regular business and the Covid-19 business is, basically, not there. Our governor, however, has changed the rules on that so our hospital just might survive!

Hopefully our governor will solve the testing thing (not enough for everybody - either one) which will make it a lot easier to track outbreaks, slow new cases, etc. Anyway, perhaps I am being too positive but these thoughts, I think, are probably correct.

We may all survive if our leaders can control the gun toting, racist, virus spreading loons and keep them under control. On the upside those idiots are starting to show that even they are open to infection after gathereingin large groups even though they seem to think that Trump will save them all. My own hope is that Trump descends, into their groups and lay his hands on them and PRAISE BE!

I'm not that optimistic for a new treatment. The only promising lead so far is remdesivir, which made a non-significant little dent in death rate (from 11.5% to 8%) and made those who recover, recover a little faster from 15 to 11 days. I'll take that, but it's not enough. Meanwhile it's been discovered that the virus does a lot more to the body than a pneumonia. It can attack the heart muscle to the point of rupture, cause acute kidney failure, blood clots everywhere... it's is a nasty, nasty virus and the covidiots keep running protests against the lockdown... And I'm not so sure that we'll have an effective and safe vaccine in January. That timeline is if everything goes right, all phase II an III trials go well, there is enough stimulation of the immune system, and it is lasting, and the vaccine doesn't cause more problems than the disease (like happened with the also rushed H1N1 vaccine that cause thousands of Guillain-Barre syndrome). If any of these items doesn't go as planned, it won't be in January. I think we're in for a lot of trouble, with steep economic deterioration.

Look at this:

https://www.newyorker.com/science/medical-dispatch/what-we-dont-know-about-covid-19

Remdesivir is a scam. It's going to cost a LOT of money and it's not going to work any better than hydroxychloroquine. The reason it's test results look so weak is that it's an antiviral. Just like Tamiflu (and hydroxychloroquine), you have to give it to people at their first symptoms for it to do any good. It would work even better if you gave it to everybody pre-exposure, but then you would have to give it to them long-term for continued protection.

But if you are going to do that, you might as well just give them hydroxychloroquine + zinc. Thousands of RA and lupus patients in Italy were taking hydroxychloroquine every day for their disease, and almost none of them caught Covid-19. If somebody set up a true random double blind trial for hydroxychloroquine + zinc with a few thousand unexposed negative antibody subjects I think they would see the same result as the retrospective findings in Italy. Georgia would be a terrific place to do that right now, as the state opens up and a lot of the test subjects would be exposed.

One thing you need to know about resdemivir is that most of the President's advisory committee have financial ties to Gilead or actually work their. Nobody can make money on a 10 cent hydroxychloroquine pill, but Gilead can make a TON of money on resdemivir.

By the way, Dr. Seheult at Loma Linda says every Covid-19 patient he sees gets hydroxychloroquine and ivermectin. These may not be FDA approved but doctors can prescribe them off-label if they want. He also says he can't get resdemivir unless he puts together a trial and gets it approved. That would also require a grant and some free resdemivir from Gilead. His current treatment probably cost about $5 per day.

Cool, if it works. Nothing proves that it works, yet. There are already published (small) trials, some with HCQ being given to milder/initial trials, and I'm still to see a convincing one that it works.

There *are* ongoing trials of HCQ as a prophylactic. Columbia University is doing one, although the N is a bit small (500 subjects, the design is to use it in half of a population of health care workers often exposed to SARS-CoV-2, and another half will serve as controls, then after a few months they will compare the rate of infections).

And by the way, yes, there are several documented cases of lupus and RA patients on long-term HCQ therapy who DID catch COVID-19.

I have a real problem with Dr. X or Dr. Z who issue *opinions* and non-controlled observations of people doing wonderfully on this or that treatment. The scientific value of these observations is close to a zero. The hierarchy of evidence in evidence-based medicine has 9 categories (4, with subdvisions) above the observational data introduced by experts, and this 10th and dead-last category of "evidence" is only considered when there is expert *consensus* which is VERY far from being the case for HCQ. Even when it *is* considered, it is thought to be "hypothesis-generating" at best.

To make any inference about a treatment being efficacious or not (not to forget, safe) you need RCTs, randomized controlled trials, and the ability to calculate "number needed to treat" and "number needed to harm".

Dr. Seheult may be very enthusiastic about his cocktail, but remember, COVID-19's case-fatality rate is likely to sit somewhere around 0.8% or maybe even a bit lower when it's all said and done. So, in a condition in which 99.2% of the patients recover *regardless* of medications they are given, it becomes extremely difficult to gauge what these cocktails are doing, if anything. Who is to say that the patients who are improving and recovering and Dr. Seheult is so enthusiastic about, wouldn't have recovered just as well without his drugs?

Ivermectin is an inhibitor of SARS-CoV-2 but in-vitro. Medicine is shock full of substances with in-vitro action against infectious agents, that then did not pan out when used in-vivo. Yes, in-vitro action is great for hypothesis generation, but then you need to put the potential agent through RCTs in-vivo to see if it still works, and if the doses that confer a benefit are safe.

In one of the studies with the combination of HCQ and AZ, the number needed to harm was 7. The number needed to treat, 100. So if you need to give it to just 7 patients to harm one, but you need to give it to 100 to treat 1, that's not very helpful, is it?

When the American College of Cardiology and the American Heart Association both issue a stern warning against using HCQ-AZ for COVID-19 patients, which they both did, you might want to realize that these people know a thing or two about hearts, and are looking at the number needed to harm.

You may say, desperate times, desperate measures, and people are dying now so we have no time to wait for the conclusion of the studies, and there is merit in that. Still, we can't just keep throwing the kitchen sink at people, because the mortality rate of even the severe cases is not 100%.

Let's say you get a ventilated patient (someone serious enough to require invasive ventilation), and those only survive 50% of the time. You think, let's just throw HCQ+AZ at them, as they have nothing to lose. But if a study shows an ADDITIONAL 17% of cardiac mortality in the treated patients (like the study that had to be interrupted in Brazil) that means that you are killing at least 8.5% of ADDITIONAL patients who might have recovered without the treatment (say, 50% of those 17% would have recovered). So you're dropping your recovery rate from 50% to 41.5%, so, yes, those additional ones who died DID have something to lose: their lives.

Yes, I understand that inhibition of replication works best when given early (like you said, that's why Tamiflu needs to be given immediately when someone starts developing flu symptoms).

But you also have to understand that a virus that is so prone to infect the cardiac muscle, inspires some safety concerns when a potentially cardiotoxic medication is given to that patient.

I don't know how you, who seems like a well-informed poster, may have acquired the impression that the cardiac toxicity of HCQ wasn't talked about before, in the 70 years that have passed since its first use for malaria. You even suggested that if true, the FDA should have created a warning for the insert. Well, that warning has been there for decades. I showed it to you in another post.

Now, malaria, lupus, and RA patients don't necessarily have a heart vulnerability. That's why you need to hold your horses on HCQ. Large RCTs that will answer the questions of efficacy and safety haven't concluded yet, and the smaller ones that have, are very discouraging.

You can't assume that remdesivir is a scam just because there is a for-profit pharmaceutical company looking into it, otherwise you'd have to call all commercial medications known to men, a scam.

Remdesivir at least has one largish (1067 subjects) RCT showing some efficacy. HCQ does not have that yet. Maybe HCQ works, but I have no proof at this point in time. I certainly hope it does, but I'm not very optimistic about it.

And before you ask, no, I have no Gilead stocks and I'm not planning to buy any. By the way, Gilead said they will pause/suspend their patent rights during the COVID crisis if Remdesivir pays off.

I agree: Most of these "studies" with N = 26 or some ridiculously low number are not really studies at all. They are just anecdotes. They might suggest something useful to study, but that's it. Most doctors are not scientists.

That large random double blind study of hydroxychloroquine as prophylactic should be very interesting. We need one of those for remdesivir as well. What is a bit of a scam is that the VA study came out and soured everybody off hydroxychloroquine, even though the study was garbage. And the fact that most of the team advising the President on the best Covid-19 treatment is working for Gilead. Talk about conflict of interest!

But remdesivir itself is not the scam. It may work just fine. Very noble of Gilead to forego some profits.

I see the FDA did modify their warnings on hydroxychloroquine in 2017. It would have been nice if they said how common those cardiac events were. It would also be interesting to see the same sort of information about remdesivir, but I don't think that exists yet without a large number of patients taking it. All I see so far is studies that seemed to work a bit, studies that failed, and studies that had to be halted because too many people died.

But that was probably because doctors used it just for their sickest patients which is useless.

Agreed


No, there's been studies with less severe patients too, that equally failed to show benefits for HCQ. And the VA study continued to show disadvantage of the HCQ arm even after the results were adjusted for severity of illness.

It's not just the VA study that soured people on HCQ. Other than the crazy Professor Raoult's extremely flawed "studies" which don't even deserve this name, nobody else except one small Chinese study, found an advantage for HCQ. While one Chinese study did, two others, bigger and better, did not.

I'm really not very optimistic about HCQ. But we'll see what the Columbia prophylactics study shows. The problem with that one is that it will take months... probably results will come way past the first wave of the pandemic.