Cont: The One Covid-19 Science and Medicine Thread Part 2

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Skeptic Ginger said:
But they didn't "assign" them. They looked back at patients already given the meds.

Unless you read something I didn't.
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They didn't give HQ to patients with certain heart issues.

Look at the mortality chart. After 7 days 5% of the HQ patients died while 17% of the standard treatment patients died. Difference is even stronger at 4 days.

Also, the mean age of the HQ patients was 63 v 68. But supposedly the overall risk score was matched. Hmm.

That's just weird. Something doesn't make sense.
 
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marting said:
A new observational study in conflict with most previous ones on Hydroxychloroquine showing significant (50%) mortality reduction.

Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with COVID-19

https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext
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Does it seem a little curious that the mortality rate with hydroxychloroquine alone was lower than with hydroxychloroquine plus an antibiotic? Then I read the CNN report:

The combination of hydroxychloroquine plus azithromycin was reserved for selected patients with severe COVID-19
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Oh, the treatments weren't selected at random.

Further down in the CNN report, there's this gem:

Finally, concomitant steroid use in patients receiving hydroxychloroquine was more than double the non-treated group.
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Oh, there was more difference in the treatment than just hydroxychloroquine.

https://www.cnn.com/2020/07/02/health/hydroxychloroquine-coronavirus-detroit-study/index.html
 
TellyKNeasuss said:
Oh, there was more difference in the treatment than just hydroxychloroquine.
https://www.cnn.com/2020/07/02/health/hydroxychloroquine-coronavirus-detroit-study/index.html
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Quite a few it seems, but they matched up the risk scores! Sure? I find the death curves v days in the hospital just stranger than hell. The immediate reductions in mortality were so astoundingly good they would have created a lot of noise way back when they were first doing this.

Still, might be something there but it strikes me as fishy so not holding my breath.

I'll wait til there's actually multiple controlled studies.
 
marting said:
They didn't give HQ to patients with certain heart issues.

Look at the mortality chart. After 7 days 5% of the HQ patients died while 17% of the standard treatment patients died. Difference is even stronger at 4 days.

Also, the mean age of the HQ patients was 63 v 68. But supposedly the overall risk score was matched. Hmm.

That's just weird. Something doesn't make sense.
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It makes sense that they excluded patients given the meds that had heart disease. Remember, it wasn't a clear factor at first.

Patient might die: give hC.

Patients given HC are dying of heart disease. Stop giving HC.


IMO, this is old data rehashed or something.
 
marting said:
A new observational study in conflict with most previous ones on Hydroxychloroquine showing significant (50%) mortality reduction.

Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with COVID-19

https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext
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This journal also included a letter criticizing the article:

https://www.ijidonline.com/article/S1201-9712(20)30530-0/fulltext#

Among the interesting observations in the letter was that the fatality rate for the non-treated significantly exceeded the rate at which they were put into the ICU.
 
James Fallows is a contributor to The Atlantic and a private pilot.

Here’s a recent article where he compares analyzing what went wrong with the coronavirus response with what happens when an aircraft accident is investigated.

It’s long, but I think it’s a worthwhile read.

https://www.theatlantic.com/politic...house-coronavirus-response-went-wrong/613591/

Note: I’m going to cross-post this to a Trump thread as well.
 
Skeptic Ginger said:
But they didn't "assign" them. They looked back at patients already given the meds.

Unless you read something I didn't.
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I think he means that patients who had been given HCQ were not selected randomly. It isn't double blind unless neither patient nor doctor know if it is placebo or remedy.

If the doctor knows that he is administering HCQ there can be bias.
 
TellyKNeasuss said:
Does it seem a little curious that the mortality rate with hydroxychloroquine alone was lower than with hydroxychloroquine plus an antibiotic? Then I read the CNN report:



Oh, the treatments weren't selected at random.

Further down in the CNN report, there's this gem:



Oh, there was more difference in the treatment than just hydroxychloroquine. https://www.cnn.com/2020/07/02/health/hydroxychloroquine-coronavirus-detroit-study/index.html
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Yes, this doesn't look good.
 
Ulf Nereng said:
I think he means that patients who had been given HCQ were not selected randomly. It isn't double blind unless neither patient nor doctor know if it is placebo or remedy.

If the doctor knows that he is administering HCQ there can be bias.
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That is not the point I was making. Blinded has nothing to do with it.

Randomly assigning patients to treatment groups is the issue. They were not randomly assigned.

The researchers attempt to make up for it by ruling out variables in other ways. That's not enough.
 
Skeptic Ginger said:
Randomly assigning patients to treatment groups is the issue. They were not randomly assigned.
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Right. And no one, including me, said they were randomly assigned. However, they were selected into 4 groups that were given one, or the other, or both, or neither of two medications. Far from being randomly assigned, grouping was limited based on certain pre-existing conditions.

And as far as I see no part of the study was blinded.
 
Aaaand... the USA reclaims the one-day record for new cases, 57,209 on July 3rd, from those upstart Brazilians who tallied 54,771 on June 19th.

To achieve this in a mere two weeks, the U.S. had to reverse its (admittedly meager) earlier declines, and recruit whole additional regions and demographic groups into the effort (since New York and the Northeast didn't want to play any more). An amazing accomplishment.
 
Anecdotal only:

Here on the campus for the elderly where I live with my mom, virus was kept almost completely at bay for 2 months or so. Now, with ramped-up testing, there's a cluster of cases in the nursing home and assisted living parts of campus. Meanwhile "independent living" has just one case. The spread seems to be from people in close contact for an hour or more and it seems to have crept in from the staff (generally young folks).

Independent living - separate apartments - is not struck nearly so hard, leading me to believe that truly casual contact is not a big factor in the spread. Hours in close proximity seems to be required. On the other hand there has been little testing of people in Independent Living, so it may be down to that.

With relatively small numbers and points of restricted access, contact tracing is feasible here and I expect it will be pursued vigorously.

ETA: Air conditioning is continuous use. Not enough evidence to conclude that AC is the culprit but it is does seem to be much worse with shared air. Not quite sure how that works in the apartments.
 
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Minoosh said:
Anecdotal only:

Here on the campus for the elderly where I live with my mom, virus was kept almost completely at bay for 2 months or so. Now, with ramped-up testing, there's a cluster of cases in the nursing home and assisted living parts of campus. Meanwhile "independent living" has just one case. The spread seems to be from people in close contact for an hour or more and it seems to have crept in from the staff (generally young folks).
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It seems that locking down the nursing home/assisted living part from the start might have been the only way to avoid it, with the staff inside and all material/food etc fully cleaned/sanitised etc on delivery. Not sure many nursing homes are set up for that sort of lockdown, nor that the staff would be prepared to remain on site for however long it takes.

Minoosh said:
Independent living - separate apartments - is not struck nearly so hard, leading me to believe that truly casual contact is not a big factor in the spread. Hours in close proximity seems to be required. On the other hand there has been little testing of people in Independent Living, so it may be down to that.

With relatively small numbers and points of restricted access, contact tracing is feasible here and I expect it will be pursued vigorously.

ETA: Air conditioning is continuous use. Not enough evidence to conclude that AC is the culprit but it is does seem to be much worse with shared air. Not quite sure how that works in the apartments.
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It might depend on whether the A/C has any filtration in the system and whether it is fine enough and changed often enough.
 
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Lplus said:
It seems that locking down the nursing home/assisted living part from the start might have been the only way to avoid it, with the staff inside and all material/food etc fully cleaned/sanitised etc on delivery. Not sure many nursing homes are set up for that sort of lockdown, nor that the staff would be prepared to remain on site for however long it takes....
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I am a nurse in a senior citizen residence. Early on during Germany's epidemic, there was an option of last resort to quarantine some staff with infected residents in a separate wing. The most difficult practical problem would obviously be that there is no room, and hardly a free bed, to house the staff on site.

Luckily, we were spared the virus, and I have not heard of a house where this has been done.

But this is also proof that you CAN "avoid it" - it takes good governance and a compliant public, which we mostly had.
 
Oystein said:
I am a nurse in a senior citizen residence. Early on during Germany's epidemic, there was an option of last resort to quarantine some staff with infected residents in a separate wing. The most difficult practical problem would obviously be that there is no room, and hardly a free bed, to house the staff on site.

Luckily, we were spared the virus, and I have not heard of a house where this has been done.

But this is also proof that you CAN "avoid it" - it takes good governance and a compliant public, which we mostly had.
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I was talking about locking down the entire nursing home before the virus got in, not quarantening infected patients, and I have heard of it happening in the UK, reasonably local to me.

If you avoided it whilst still changing shifts and having staff come in from outside you were lucky, but yes it can happen.
 
Myriad said:
Aaaand... the USA reclaims the one-day record for new cases, 57,209 on July 3rd, from those upstart Brazilians who tallied 54,771 on June 19th.

To achieve this in a mere two weeks, the U.S. had to reverse its (admittedly meager) earlier declines, and recruit whole additional regions and demographic groups into the effort (since New York and the Northeast didn't want to play any more). An amazing accomplishment.
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Pathetic achievement.

With just a little effort USA can pass 100k infections a day, easy. Late August would be my guess for when that happens.

I think the only challenger USA might have is India, and since they don't worry about things like testing or death certificates, you wouldn't know.
 
Meanwhile, in Australia, as it grapples with a surge that elsewhere in the world would be seen as a blip, with only a couple of hundred cases outside quarantine, we're able to see some valuable insights into the spread of the disease.

Since they only have one major cluster to deal with, Aussie scientists are giving superb, real-time evidence as to what happens.

The event seems to start with a single* super-spreader employed at a quarantine facility: https://www.nzherald.co.nz/world/news/article.cfm?c_id=2&objectid=12345350

Then, the trouble really starts when it gets to a housing complex of vulnerable people - poor, public housing, likely insanitary conditions, lots of indoor shared spaces, lifts, stairs, etc & people with a variety of health issues. Boom! Suddenly, you have 23 cases in just 12 households.

We need to find out what causes super-spreading asap.

Melbourne also matches what we know from China, Italy & USA - high-density housing is a huge problem. Shared indoor spaces are big trouble.



*If he wasn't single at the start, he will be now, as it looks like intimate physical contact may have been occurring.
 
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