OtherGround Forums OG doc. AMA on COVID-19

10 days ago
10/23/05
Posts: 4253
Barry_BondsMVP - 
mataleo1 -
bungee up - 

Have you watched this doc ?


Which one?

It’s a broken link, but I’m assuming it’s that video Trump is trying to push. Some group of Doctors called America’s Frontline Doctors, held a press conference stating we don’t need to wear masks and hydroxychloroquine is the cure to the virus. 
 

Breitbart was first to post it. 
 

https://www.vice.com/en_us/article/v7gpvj/trump-shared-a-covid-19-video-full-of-lies-and-misinformation-twitter-just-deleted-it?


Some OGers prefer trusting that weird video of that Houston physician, while completing overlooking that real science is being published.

PROSPECTIVE RANDOMIZED TRIALS are coming out. Not anecdotal data. Not uncontrolled, unblinded retrospective stuff.

5 days ago the NEJM published a trial showing no benefit from HCQ and HCQ+AZY over nothing. These were not late and very sick patients (No or little O2).

I'll only say that among people I really respect in the field, we've almost all stopped using it a while ago.

10 days ago
10/23/05
Posts: 4254
akbar87 - 

there is an mlb player juan soto if you want to look it up but i was wondering what you think about his test results 

it seems like he has been testing positive then negative then back to positive then back to negative 

 

what do you think would cause that ? 


I haven't read much about it except for major news outlets.

I don't know how he was tested and how the lab processed his samples. I also don't understand the philosophy of retesting someone who is positive 24h later. My lab has 98% accuracy with occasional false negatives but almost no false positives.

There are a few batch testing glitches reported (in Connecticut and Florida not long ago), showing wrong results.

10 days ago
10/23/05
Posts: 4256

For those interested in the trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

10 days ago
2/4/09
Posts: 13158
mataleo1 -

For those interested in the trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

Seems like even the authors acknowledge their limitations in the trial

10 days ago
10/23/05
Posts: 4262
NoNeed4aScreenName - 
mataleo1 -

For those interested in the trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

Seems like even the authors acknowledge their limitations in the trial


To be fair, ALL studies have limitations.

Not only that, all journals of note require that a paragraph be inserted tackling flaws and limitations.

Open any trial published in the last 5 years and you'll see a similar paragraph.

10 days ago
1/1/01
Posts: 12117


Only 76 new cases recorded here in Ontario, Canada (Population 14.5 million).

Very happy to be living in a place that's been taking it seriously enough to keep things under control.

Edited: 10 days ago
1/1/01
Posts: 27580

if you think those are limitations, you should see nutritional studies, or even better, manual therapy studies which almost never have control groups. 

10 days ago
10/23/05
Posts: 4265
prof - 

Only 76 new cases recorded here in Ontario, Canada (Population 14.5 million).

Very happy to be living in a place that's been taking it seriously enough to keep things under control.


I'm in Italy at the moment, close to where it was hit the hardest, and it's incredible to see how seriously people are taking this.

Everything is open, people are out on the beach, in restaurants, but everyone is properly distancing and putting masks inside. Masks are close to useless here at the present because there are no cases, but they know it's coming back and they've adapted to the new reality. No policing necessary. And it keeps businesses open.

10 days ago
10/23/05
Posts: 4266
yusul - 

if you think those are limitations, you should see nutritions studies, or even better, manual therapy studies which almost never have control groups. 


Haha. I'm just happy trials are coming out. These were badly needed.

10 days ago
1/13/10
Posts: 48053
mataleo1 -
Barry_BondsMVP - 
mataleo1 -
bungee up - 

Have you watched this doc ?


Which one?

It’s a broken link, but I’m assuming it’s that video Trump is trying to push. Some group of Doctors called America’s Frontline Doctors, held a press conference stating we don’t need to wear masks and hydroxychloroquine is the cure to the virus. 
 

Breitbart was first to post it. 
 

https://www.vice.com/en_us/article/v7gpvj/trump-shared-a-covid-19-video-full-of-lies-and-misinformation-twitter-just-deleted-it?


Some OGers prefer trusting that weird video of that Houston physician, while completing overlooking that real science is being published.

PROSPECTIVE RANDOMIZED TRIALS are coming out. Not anecdotal data. Not uncontrolled, unblinded retrospective stuff.

5 days ago the NEJM published a trial showing no benefit from HCQ and HCQ+AZY over nothing. These were not late and very sick patients (No or little O2).

I'll only say that among people I really respect in the field, we've almost all stopped using it a while ago.

Thanks doc, keep doing great work.

yea that Dr Immanuel is whacked out, here’s a direct quote from her.

 

certain medical issues like endometriosis, cysts, infertility and impotence are the result of sex with “spirit husbands” and “spirit wives,” which Immanuel described as having sex in dreams with witches and demons.

“We call them all kinds of names —endometriosis, we call them molar pregnancies, we call them fibroids, we call them cysts, but most of them are evil deposits from the spirit husband,” she said.

Dr Stella Immanuel 

 

10 days ago
10/23/05
Posts: 4267
Barry_BondsMVP - 
mataleo1 -
Barry_BondsMVP - 
mataleo1 -
bungee up - 

Have you watched this doc ?


Which one?

It’s a broken link, but I’m assuming it’s that video Trump is trying to push. Some group of Doctors called America’s Frontline Doctors, held a press conference stating we don’t need to wear masks and hydroxychloroquine is the cure to the virus. 
 

Breitbart was first to post it. 
 

https://www.vice.com/en_us/article/v7gpvj/trump-shared-a-covid-19-video-full-of-lies-and-misinformation-twitter-just-deleted-it?


Some OGers prefer trusting that weird video of that Houston physician, while completing overlooking that real science is being published.

PROSPECTIVE RANDOMIZED TRIALS are coming out. Not anecdotal data. Not uncontrolled, unblinded retrospective stuff.

5 days ago the NEJM published a trial showing no benefit from HCQ and HCQ+AZY over nothing. These were not late and very sick patients (No or little O2).

I'll only say that among people I really respect in the field, we've almost all stopped using it a while ago.

Thanks doc, keep doing great work.

yea that Dr Immanuel is whacked out, here’s a direct quote from her.

 

certain medical issues like endometriosis, cysts, infertility and impotence are the result of sex with “spirit husbands” and “spirit wives,” which Immanuel described as having sex in dreams with witches and demons.

“We call them all kinds of names —endometriosis, we call them molar pregnancies, we call them fibroids, we call them cysts, but most of them are evil deposits from the spirit husband,” she said.

Dr Stella Immanuel 

 


I'll give her the benefit of the doubt, because I don't know her.

However, I have no clue why people are listening to her over people who have published, who have more experience, who treat patients dying of this thing, who participate in registered clinical trials, etc... Sign of the times.

10 days ago
2/4/09
Posts: 13159
mataleo1 -
NoNeed4aScreenName - 
mataleo1 -

For those interested in the trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

Seems like even the authors acknowledge their limitations in the trial


To be fair, ALL studies have limitations.

Not only that, all journals of note require that a paragraph be inserted tackling flaws and limitations.

Open any trial published in the last 5 years and you'll see a similar paragraph.

It weird that they waited for so long post symptom to include patients. 

 

I think the argument for HCQ is more so a prophylaxis than cure. 

 

I think that gets conflated in media reports. But I understand the difficulties in creating studies that would focus on extremely early symptoms. Also would be a delay since the requirements of testing results to confirm Covid

10 days ago
10/23/05
Posts: 4268
NoNeed4aScreenName - 
mataleo1 -
NoNeed4aScreenName - 
mataleo1 -

For those interested in the trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

Seems like even the authors acknowledge their limitations in the trial


To be fair, ALL studies have limitations.

Not only that, all journals of note require that a paragraph be inserted tackling flaws and limitations.

Open any trial published in the last 5 years and you'll see a similar paragraph.

It weird that they waited for so long post symptom to include patients. 

 

I think the argument for HCQ is more so a prophylaxis than cure. 

 

I think that gets conflated in media reports. But I understand the difficulties in creating studies that would focus on extremely early symptoms. Also would be a delay since the requirements of testing results to confirm Covid


No argument there. If it's going to work, it probably works best early (whereas steroids would work best late). But you have 99.5% of people surviving this thing, so how do you select who to treat? I certainly wouldn't want to give this to a 20 year old who develops a bad reaction to HCQ (who would have done fine without it). And it means you'd need about 30k in a study to show an effect.

PS: did you read about the HCQ trial when used in prophylaxis? From the NEJM. Didn't show a benefit.

Here's the study: https://www.nejm.org/doi/full/10.1056/NEJMoa2016638

10 days ago
11/27/02
Posts: 18778
"I'll give her the benefit of the doubt, because I don't know her.

However, I have no clue why people are listening to her over people who have published, who have more experience, who treat patients dying of this thing, who participate in registered clinical trials, etc... Sign of the times."

Doc, if the African doc isn't lying and she has treated over 300 patients early with hydro (with the other stuff) many who have asthma, diabetes, hypertension, and other conditions already, do you think it's more likely that every patient would have recovered without the hydroxy treatment early regardless?

Of course we have no clue if any of what she is saying is true.
10 days ago
2/4/09
Posts: 13161
mataleo1 -
NoNeed4aScreenName - 
mataleo1 -
NoNeed4aScreenName - 
mataleo1 -

For those interested in the trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

Seems like even the authors acknowledge their limitations in the trial


To be fair, ALL studies have limitations.

Not only that, all journals of note require that a paragraph be inserted tackling flaws and limitations.

Open any trial published in the last 5 years and you'll see a similar paragraph.

It weird that they waited for so long post symptom to include patients. 

 

I think the argument for HCQ is more so a prophylaxis than cure. 

 

I think that gets conflated in media reports. But I understand the difficulties in creating studies that would focus on extremely early symptoms. Also would be a delay since the requirements of testing results to confirm Covid


No argument there. If it's going to work, it probably works best early (whereas steroids would work best late). But you have 99.5% of people surviving this thing, so how do you select who to treat? I certainly wouldn't want to give this to a 20 year old who develops a bad reaction to HCQ (who would have done fine without it). And it means you'd need about 30k in a study to show an effect.

PS: did you read about the HCQ trial when used in prophylaxis? From the NEJM. Didn't show a benefit.

Here's the study: https://www.nejm.org/doi/full/10.1056/NEJMoa2016638

I didn't see that reading it now. Seems like after 14 days there was a very minor benefit to HCQ group but the variance is too great to conclude anything.

I still havent finished yet. But doesnt the initial 600 mg treatment also a pretty high dosage?

Edited: 10 days ago
10/23/05
Posts: 4269
supersonic - "I'll give her the benefit of the doubt, because I don't know her.

However, I have no clue why people are listening to her over people who have published, who have more experience, who treat patients dying of this thing, who participate in registered clinical trials, etc... Sign of the times."

Doc, if the African doc isn't lying and she has treated over 300 patients early with hydro (with the other stuff) many who have asthma, diabetes, hypertension, and other conditions already, do you think it's more likely that every patient would have recovered without the hydroxy treatment early regardless?

Of course we have no clue if any of what she is saying is true.

As far as I can tell, she's a pediatrician. Meaning she treats patients below 18 years old only. I may be mistaken here. But for the argument let's say she is.

What is the mortality of COVID in the under 18 population? It's about 0.01% (it's actually less but let's play). So if I sent those 350 patients to someone who does nothing (aside from giving O2 let's say), you'd expect, on average, 0.03 to die (about 0). So that claim is nothing spectacular.

Even if she treated 350 patients who have a 1% mortality rate (example older patients), then you'd expect about 3.5 patients to die from those 350. Statistically, this represents within the confidence interval for a chance result.

Why not listen to the experience of physicians who have used HCQ on 15k patients? At least a gives a better sample size. Not saying we should (that doesn't represent a statistical study).

10 days ago
10/23/05
Posts: 4270
NoNeed4aScreenName - 
mataleo1 -
NoNeed4aScreenName - 
mataleo1 -
NoNeed4aScreenName - 
mataleo1 -

For those interested in the trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

Seems like even the authors acknowledge their limitations in the trial


To be fair, ALL studies have limitations.

Not only that, all journals of note require that a paragraph be inserted tackling flaws and limitations.

Open any trial published in the last 5 years and you'll see a similar paragraph.

It weird that they waited for so long post symptom to include patients. 

 

I think the argument for HCQ is more so a prophylaxis than cure. 

 

I think that gets conflated in media reports. But I understand the difficulties in creating studies that would focus on extremely early symptoms. Also would be a delay since the requirements of testing results to confirm Covid


No argument there. If it's going to work, it probably works best early (whereas steroids would work best late). But you have 99.5% of people surviving this thing, so how do you select who to treat? I certainly wouldn't want to give this to a 20 year old who develops a bad reaction to HCQ (who would have done fine without it). And it means you'd need about 30k in a study to show an effect.

PS: did you read about the HCQ trial when used in prophylaxis? From the NEJM. Didn't show a benefit.

Here's the study: https://www.nejm.org/doi/full/10.1056/NEJMoa2016638

I didn't see that reading it now. Seems like after 14 days there was a very minor benefit to HCQ group but the variance is too great to conclude anything.

I still havent finished yet. But doesnt the initial 600 mg treatment also a pretty high dosage?


I'm more comfortable with 600mg daily (after the loading dose) than the 800mg or the 1200mg that was essayed elsewhere. At those doses, I'm less worried of QT prolongation (also it's been reported at those doses too, see the other RCT published in NEJM on July 23rd).

Edited: 10 days ago
2/4/09
Posts: 13162
mataleo1 -
NoNeed4aScreenName - 
mataleo1 -
NoNeed4aScreenName - 
mataleo1 -
NoNeed4aScreenName - 
mataleo1 - For those interested in the trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

Seems like even the authors acknowledge their limitations in the trial


To be fair, ALL studies have limitations.

Not only that, all journals of note require that a paragraph be inserted tackling flaws and limitations.

Open any trial published in the last 5 years and you'll see a similar paragraph.

It weird that they waited for so long post symptom to include patients. 

 

I think the argument for HCQ is more so a prophylaxis than cure. 

 

I think that gets conflated in media reports. But I understand the difficulties in creating studies that would focus on extremely early symptoms. Also would be a delay since the requirements of testing results to confirm Covid


No argument there. If it's going to work, it probably works best early (whereas steroids would work best late). But you have 99.5% of people surviving this thing, so how do you select who to treat? I certainly wouldn't want to give this to a 20 year old who develops a bad reaction to HCQ (who would have done fine without it). And it means you'd need about 30k in a study to show an effect.

PS: did you read about the HCQ trial when used in prophylaxis? From the NEJM. Didn't show a benefit.

Here's the study: https://www.nejm.org/doi/full/10.1056/NEJMoa2016638

I didn't see that reading it now. Seems like after 14 days there was a very minor benefit to HCQ group but the variance is too great to conclude anything.

I still havent finished yet. But doesnt the initial 600 mg treatment also a pretty high dosage?


I'm more comfortable with 600mg daily (after the loading dose) than the 800mg or the 1200mg that was essayed elsewhere. At those doses, I'm less worried of QT prolongation (also it's been reported at those doses too, see the other RCT published in NEJM on July 23rd).

I havent been paying as much attention lately to new studies. My role has since changed and I dont have the same time on my hands to continue to follow attentively. 

 

Ive been continuing to check on APN001 trials (recombinant ACE2) but still nothing from that front. 

 

But it's pretty interesting to finally see some decent trial results come through. 

10 days ago
11/27/02
Posts: 18780
Appreciate the time put into this thread Mataleo1
9 days ago
7/22/15
Posts: 5819

So the concrete contractor I use on my projects stopped showing up to work, he didn't even come by to pick up his check, now I know why, he passed away yesterday morning, Just found out from one of his workers, he got COVID while on a weekend getaway with his wife.

He died five days after getting it. I had to make arrangements to get his guys paid, 44 years old.

Man, this shit is crazy. I just got done talking to his son.

9 days ago
10/23/05
Posts: 4285
Unkind Zuffa - 

So the concrete contractor I use on my projects stopped showing up to work, he didn't even come by to pick up his check, now I know why, he passed away yesterday morning, Just found out from one of his workers, he got COVID while on a weekend getaway with his wife.

He died five days after getting it. I had to make arrangements to get his guys paid, 44 years old.

Man, this shit is crazy. I just got done talking to his son.


Damn.

Way too young.

RIP to M. Cain too. Hopefully, this tragedy will encourage more people to wear masks, especially those at risk. Let's do what we can to protect those vulnerable.

8 days ago
2/18/20
Posts: 651
Unkind Zuffa - 

So the concrete contractor I use on my projects stopped showing up to work, he didn't even come by to pick up his check, now I know why, he passed away yesterday morning, Just found out from one of his workers, he got COVID while on a weekend getaway with his wife.

He died five days after getting it. I had to make arrangements to get his guys paid, 44 years old.

Man, this shit is crazy. I just got done talking to his son.


Wow.  Terrible news.

 

Question:  Did he have any underlying issues?  Overweight?  (If you know of course)

7 days ago
1/12/07
Posts: 22158

 

Positive news.

6 days ago
10/18/12
Posts: 1573

That tweet got deleted for some reason

6 days ago
10/23/05
Posts: 4294
SpunQ - 

 

Positive news.


Yup. Kids don't die from this. And they barely get sick of it either (very few symptoms generally, and almost no cases in ICU).

That's why I totally support reopening schools (as we've done in Quebec). The only question is whether they are important vectors of transmission. Study coming out this week suggests they are.