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Similar authors in the HCQ study.

Here's another article:


 
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Mman

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It shouldn't take years to get meaningful information. With the caseload present in NY alone, the fact that we couldn't get nonblinded randomized trials to at least mostly put any issues to rest with whatever the treatment de jure happens to be (hcq, remdesivir) should actually be quite embarrassing to the country. It highlights how messed the beurocracy is in academia. Given the emergent quality the media and most politicians have assigned to this crisis, irbs should have become vastly more efficient and enrollment equivalent to the consent you need to give for a para or central line.

It's a very big missed opportunity.

has such a thing ever been accomplished in weeks with a new virus? I mean we went from it barely being a thing to total lockdown over the country in a few weeks. It's tough to randomize patients to therapies when you aren't even sure you can get the drugs to give to enough patients.
 

Leon'sMom

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This article makes some fine points about research infrastructure. I would also add that that money is a main factor in creating this divide.

1) Big Pharma profiting from an expensive new drug is a big motivator for protracted research. Whereas, more expeditious clinical research done on the front lines to learn what existing and cheaper modalities may help the patient do not bring windfalls. Look at the amount of time and money being put into the development of a vaccine, the mother-lode of all profiteering.

2) Today's medical education and practice is evidence-based in nature. Academia, medical organizations, and societies have fallen more on the side of "Let's wait and see." There is little willingness for systems of medicine (academia, hospitals) to break with this mentality. Throughout this crisis, I've observed the tendency of our facility (who is admittedly struggling to gather, discern, and apply all of the various pieces of data and research) to defer to 'the expert' recommendations as gospel. There is a large homogenization in today's medicine, for better or worse. This leads to less clinical sites being willing to step out of line and do something different, like a small, but possibly meaningful, study. I think we see more of a propensity to try 'unproven' modalities from outpatient practitioners because they are more distanced from hospital bureaucratic mentality (more autonomy), payment for modalities is the choice of patient, a patient with minor symptoms or early illness is potentially most helped by these modalities. We have a dichotomy of large, organized inpatient medicine (let's wait and see) and independent outpatient practitioners (benefit>risk).

3) In addition to the lack of RCT data, I also wonder if money and supply chain has played a role in the unwillingness of hospitals to trial other/existing modalities. For example, at my hospital, when I asked the ID pharmacist about why our treatment regime did not include an older, cheaper modality which had shown some evidence of usefulness with Covid, the answer I personally received was non-conclusive evidence of efficacy and the concern over supply chain issues (whether our facility would be able to adequately stock the volume of drug necessary for the recommendation.) I couldn't help but think about the waffling recommendations for public mask wearing, which went from 'no need' to 'highly recommended' based on PPE availability. I also wonder if inventory costs (relative cheap drug but in high volume) and lack of reimbursement were the nails in the coffin for this even being available for use at my hospital. In other words, did money play a role in treatment options? Of course it did. It always does. Why would this be any different?
 

marr65

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So, we did a good job at slowing down the spread. We need to keep at it.

People who say that they already contracted COVID 19 in December are just full of it. Antibody testing shows we aren’t even at 5% infection rate outside of NYC.

Sweden isn’t at herd immunity level either. Their antibody testing showed 7% infected which is nowhere close to the 20% needed for probable herd immunity. Even if Sweden didn’t close their entire economy, people still took precautions and limit their social interactions.
 
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Mman

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So, we did a good job at slowing down the spread. We need to keep at it.

People who say that they already contracted COVID 19 in December are just full of it. Antibody testing shows we aren’t even at 5% infection rate outside of NYC.

Sweden isn’t at herd immunity level either. Their antibody testing showed 7% infected which is nowhere close to the 20% needed for probable herd immunity. Even if Sweden didn’t close their entire economy, people still took precautions and limit their social interactions.

20% is not herd immunity, depending on the disease it's more like 70-80%.
 
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pgg

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Herd immunity threshold varies greatly. Measles, as a truly airborne and ridiculously contagious disease, has a threshold of something like 95%, but influenza is under 50%. Depends on R0 ... which we can influence with social measures. 20% for COVID-19 is probably wildly optimistic but we'd probably start seeing herd-related benefits before even 1/2 the population has been exposed.
 
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FFP

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Herd immunity threshold varies greatly. Measles, as a truly airborne and ridiculously contagious disease, has a threshold of something like 95%, but influenza is under 50%. Depends on R0 ... which we can influence with social measures. 20% for COVID-19 is probably wildly optimistic but we'd probably start seeing herd-related benefits before even 1/2 the population has been exposed.
As long as there are asymptomatic supercarriers who can infect even 60 people with the coronavirus, the concept of herd immunity in Covid-19 sounds ridiculous.
 
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This is a failure of the highest order. In the midst of a Freaking pandemic, you are so thrilled to prove the President wrong you push out this garbage. One would have thought the Lancet would have learned and tightened up peer review standards after the vaccines/autism fiasco - guess not!
 
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Lawpy

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This is a failure of the highest order. In the midst of a Freaking pandemic, you are so thrilled to prove the President wrong you push out this garbage. One would have thought the Lancet would have learned and tightened up peer review standards after the vaccines/autism fiasco - guess not!

Thats because the Editor in Chief is the same since 1995.
 
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kmurp

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This is a failure of the highest order. In the midst of a Freaking pandemic, you are so thrilled to prove the President wrong you push out this garbage. One would have thought the Lancet would have learned and tightened up peer review standards after the vaccines/autism fiasco - guess not!
Why would the editors of a British Medical Journal care about the president of another country?
 

AdmiralChz

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Why would the editors of a British Medical Journal care about the president of another country?

It’s about optics and keeping your journal to a higher standard. These are 2 heinous missteps during this editor’s tenure. This is a complete and total failure of the peer-review system.

Also, hatred of Trump isn’t limited to this country.
 
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wamcp

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This is a failure of the highest order. In the midst of a Freaking pandemic, you are so thrilled to prove the President wrong you push out this garbage. One would have thought the Lancet would have learned and tightened up peer review standards after the vaccines/autism fiasco - guess not!


You know what's crazy is the Lancet, one of the most 'prestigious' medical journals with supposedly thorough and stringent peer review processes, lets a fake article through to publication (let me be clear here, current known data shows hydroxychloroquine doesn't work but that doesn't give a free pass to fake studies), while Amazon can simply ban a book that criticizes COVID shutdowns that is filled with real evidence/facts and not made up numbers.

Amazon reverses ban on book critical of coronavirus shutdown
 
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Lawpy

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Likely already known but i found a cool chart


respsupport68.jpg
 
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narcotics999

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I read this study a bit further. The dosage of HCQ is unconventional:
2400mg first 24hours,
800mg per day for 9 days

Way way higher than the dosages of other covid protocols. The Chinese version was 400mg bid the first day, 400mg Qd for day 2-5?

4g HCQ is potentially lethal. 2g ingestion warrants hospitalization.

Question is why the investigators used such a high dose? Someone suspected that the PI "might have mistaken HCQ with hydroxyquinolines"
 
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nimbus

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I read this study a bit further. The dosage of HCQ is unconventional:
2400mg first 24hours,
800mg per day for 9 days

Way way higher than the dosages of other covid protocols. The Chinese version was 400mg bid the first day, 400mg Qd for day 2-5?

4g HCQ is potentially lethal. 2g ingestion warrants hospitalization.

Question is why the investigators used such a high dose? Someone suspected that the PI "might have mistaken HCQ with hydroxyquinolines"

Yeah I would love to hear their rationale for unconventional dosing. The study was rightly ripped to shreds by hcq proponents. This is the same group who published positive results for decadron. At least that dosing (6mg/day) was reasonable.
 

Lawpy

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Thoughts? @FFP @vector2 @nimbus @chocomorsel @pgg etc?

Dexamethasone blog:


Prone positioning:

 
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chocomorsel

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Thoughts? @FFP @vector2 @nimbus @chocomorsel @pgg etc?

Dexamethasone blog:


Prone positioning:

I honestly saw no difference. They still died and many of their inflammatory markers did not change much. But my experience is limited.
It certainly makes sense, but I wasn't around long enough to see a difference.
 
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Lawpy

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Sandman192799229

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What do you guys think about this Covid test by T2 bio systems ? Does it offer any advantages over what your hospital is using right now? Someone was telling me about this test like it’s one of the best. It has sensitivity of 95% and specificity of 100% according to the manufacturer’s data.


 

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Dude why do you keep posting these videos? Are you somehow involved with making them? You’ve posted enough of them that anyone who watches them could have just subscribed to the YouTube channel by now- no need to keep spamming them here
 

Lawpy

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Dude why do you keep posting these videos? Are you somehow involved with making them? You’ve posted enough of them that anyone who watches them could have just subscribed to the YouTube channel by now- no need to keep spamming them here

I actually don't post them that often. However, the videos i sometimes post have essential groundbreaking stuff that's described well. There is a lot of covid misinformation garbage on the internet and news. The medcram videos i post are pretty much the goto resources since a lot of stuff posted is worth noting
 
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chocomorsel

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Isn’t this a Covid thread? That would mean the above videos would therefore be relevant?
Unlike the other Covid thread that went way left, even if it was in a rather heated and interesting way?
Keep them coming.
 
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vector2

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I actually don't post them that often. However, the videos i sometimes post have essential groundbreaking stuff that's described well. There is a lot of covid misinformation garbage on the internet and news. The medcram videos i post are pretty much the goto resources since a lot of stuff posted is worth noting

I don't mind you posting them but I wish (mostly because I'm too impatient to sit through a half hour video) that you'd give us the top 3 highlights or something if you're actually watching them all.
 

Lawpy

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I don't mind you posting them but I wish (mostly because I'm too impatient to sit through a half hour video) that you'd give us the top 3 highlights or something if you're actually watching them all.

Yeah i'll post the links to the actual articles directly and add a brief summary going forward. But the biggest takeaway from this is the additional stuff on covid related thrombosis
 

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