Stayin' Alive - Covid-19 #10

[Frey family reunion]

Just now, The Great Unwashed said:

I don't think anyone is actually hoping the drug will fail because of Trump. We just have zero faith in the messenger.

If he was the only messenger than I would agree.  But he’s not.  Do a little research and you’ll find that a number of doctors who have been treating this thing up close and personal seem to believe that there may be a benefit to this drug.  They may be right or not.  But the impression I’m getting is that people seem to be going out of there way to declare that the drug isn’t effective.  Which is just as irresponsible at this point in declaring the effectiveness of the drug.

[Guest]

Just now, Frey family reunion said:

If he was the only messenger than I would agree.  But he’s not.  Do a little research and you’ll find that a number of doctors who have been treating this thing up close and personal seem to believe that there may be a benefit to this drug.  They may be right or not.  But the impression I’m getting is that people seem to be going out of there way to declare that the drug isn’t effective.  Which is just as irresponsible at this point in declaring the effectiveness of the drug.

The only thing out there is anecdotal evidence. Which there's just as much anecdotal evidence in the opposite direction, such as the article @Ran linked about Sweden discontinuing treatment with the drug because of reported negative side effects that were worse than the symptoms. Also, the anecdotal evidence I've seen only says that hydroxychloroquine only mitigates symptoms in patients with mild to moderate symptoms, and doesn't appear to have an effect on serious or critical cases.

And no one is claiming that the drug isn't effective. They're saying that a drug that the drug should go through trials instead of being widely prescribed. And even if it does turn out to mitigate some aspects of COVID-19, it's still not a damn silver bullet.

[The Anti-Targ]

3 hours ago, Frey family reunion said:

I have to admit I'm flummoxed over this recent trend I've been seeing in this attempt to demonize hydroxychloroquine as a possible treatment option.  Is it just because Trump is promoting it?  I'm no fan of the guy either, but it seems that a lot of people are going overboard in an attempt to discount it.  It's gaining traction among a lot of doctors who are at least anecdotally reporting on its benefits.  Governor Cuomo has even agreed that there are increasing anecdotal reports about the treatment benefits that some of the New York doctors are seeing, and has talked with Trump about obtaining additional supplies.

 

I don't know enough about hydroxychloroquine to comment really. But as an anti-malarial there is no obvious reason why this chemical should be effective in any way. Until someone advances a biochemical rational for how this drug might be working is there any reason to believe anecdotal positive effects aren't just placebo?

Why did anyone even think to try it?

Wikipedia also tells me it is used as a treatment for rheumatoid arthritis, lupus, and porphyria cutanea tarda, as auto-immune and genetic diseases this form of pharmacological action might show more promise.

But I'm not a big fan at throwing drugs at a disease and seeing what sticks.

And I don't know that I like the idea of diverting a drug supply away from malaria where it is known to work, which is still an extremely serious disease that has not gone away just because we have COVID-19, into use for a disease that so far no proper scientific study has been carried out to demonstrate significant effectiveness. If you can guarantee supply for malaria treatment and then increase supply for COVID-19 experimental treatment, then go for it. But supplies should not be diverted away from other essential use merely because malaria mostly kills people in poorer countries and COVID-19 is killing people in rich countries.

 

[The Anti-Targ]

3 hours ago, HelenaExMachina said:

Ah, we laugh about things like this but just this evening i saw fresh claims that this is all because “China lost its trade war with the US” so “released this pandemic on the world” and that we should note that they “told their friends Russia and North Korea” so they could get prepared.

Sometimes i just despair

Also don't assume that all the tinfoil hat people are in the USA. My colleague's EX (I say EX!) husband has his tinfoil hat firmly placed on his head. Though he doesn't believe it's bio warfare he just thinks it's not a real thing and we're all in lock down for reasons.

1 hour ago, Fez said:

Double post, but speaking of possible treatments, this is the first I'm hearing of this one:

https://www.nytimes.com/2020/04/03/health/coronavirus-bcg-vaccine.html?smtyp=cur&smid=tw-nytimesscience

It seems to partly be because of this analysis: https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1

The study only looked at middle- and high-income countries too, because of concern that reporting in low income countries is too unreliable; and low income countries are actually even more likely to have broad BCG vaccination policies.

That came to my attention through work late last week. As a non-specific immune stimulant it's promising, but it's not the same as finding something that targets the virus directly.

[Frey family reunion]

8 minutes ago, The Anti-Targ said:

Wikipedia also tells me it is used as a treatment for rheumatoid arthritis, lupus, and porphyria cutanea tarda, as auto-immune and genetic diseases this form of pharmacological action might show more promise

Scientists have also been looking at drugs which have been used for HIV as well for treatment of this virus, so there may be something to the auto-immune aspect of these drugs.

[Frey family reunion]

27 minutes ago, Triskele said:

I have not seen anyone going out of their way to declare that the drug isn't effective exactly.  I've seen a lot of people from Fauci on down stressing that we just don't have enough research to know yet.

And even if there are anecdotes of doctors saying it's "effective" that only means so much.  Say there's one doc out there that's seen two subjects with COVID and decided to give HC a shot and those patients got better.  That doctor, if they're being responsible and careful how they describe it, cannot say it's "effective" from that experience.  they may be able to say "I've seen it seem to be effective in two patients."  You simply must have much greater numbers in more carefully controlled trials before you would know that it was HC that made the difference and whether it was far more effective than placebo, and only then could you confidently say it's a great treatment.  

For the record I agree that if anyone is wanting this drug to fail just cause Trump that is not great.  But if anyone is hoping that Trump himself takes it and has terrible side effects himself that would be a great sign that one is human.

I’ll take him being voted out in November.  

And yes I’m not happy about him using his platform to hype the drug.  I am very concerned about my wife being unable to fill her next prescription. 
 

Having said that I can’t bring myself to root for the drug to fail.  Even if the drug isn’t a “silver bullet” (which I doubt we’ll find until or if we get a vaccine), we need something  to more effectively treat the symptoms.  Without more effective treatments this virus dangerously handcuffs our society.

 

[S John]

36 minutes ago, The Anti-Targ said:

Also don't assume that all the tinfoil hat people are in the USA. My colleague's EX (I say EX!) husband has his tinfoil hat firmly placed on his head. Though he doesn't believe it's bio warfare he just thinks it's not a real thing and we're all in lock down for reasons

I’ll bet $20 these tinfoil hat folks are still washing their hands more than they used to.

[The Anti-Targ]

1 hour ago, Frey family reunion said:

Scientists have also been looking at drugs which have been used for HIV as well for treatment of this virus, so there may be something to the auto-immune aspect of these drugs.

Not the same thing. HIV =/= auto-immune disease. Actually it's the opposite. Auto-immune disease is hyperactive immune system that attacks your own cells like they are bacteria or viruses. HIV causes your immune system to become too weak to deal with diseases a normal immune system handles in it's sleep.

HIV treatments are direct attacks on the virus. Auto-immune treatments suppress your immune system. if the auto-immune treatment functionality of the anti-malarial is what appears to be benefiting it would be because a lot of the damage being done during the disease is because of the immune system's reaction to the disease rather than direct virus damage. It is common for the most severed symptoms of viral diseases to be due to one or more part of the immune system overreacting (like an allergic response is an overreaction to whatever you are allergic to). If the immune suppression effect of the malaria drug targets the part of the immune system that is causing the most severe symptoms in COVID-19 then that may be promising.

BCG the Tb vaccine has the opposite effect to immune supressors in that it stimulates the immune system. However as the immune system has many moving parts stimulating one part of the immune system while suppressing another part may combine for a synergistic effect. But that's all hypothetical with some anecdotal support for now.

End of the day neither of these treatments is COVID-19 specific and so they are likely to only knock the hard edges off the pandemic not be a panacea.

HIV drugs could possibly stop it in its tracks, like they do with HIV. But HIV is a retrovirus not closely related to Coronavirus at all, with very different mechanisms of activity in the cell (HIV inserts its RNA into your genome to reproduce, Coronavirus hijacks your cells RNA transcribing machinery to reproduce). So it will be interesting to see if there is any efficacy. Perhaps the fact both are RNA viruses is enough commonality for the drugs to work.

[HexMachina]

3 hours ago, Fragile Bird said:

Weird, I don't understand that last bit. The US stopped generally using the vaccine in the 60s or 70s, I think, like most western countries. In Canada it is used against TB in very restricted cases, not generally. Native communities have higher rates of TB as do "foreign born Canadians", but I could not see what nations they come from. I assume when they go home they have a greater chance to pick up TB.

Canada has a much lower death rate than the US, 9 per million so far, as opposed to 33 per million in the US, so this doesn't seem to make sense. But I did read Australia and somebody else, the Netherlands (?) have started phase 3 testing.

The UK (well, England certainly, I’m not certain on the rest of the country) still gave the BCG to schoolchildren as late as the mid-2000’s. It was stopped i think the year I would have received it - i know my friend in the school year above got it. i remember fairly well because whenever a year group got it the boys would go around punching people in the arm where they had just had the injection because that was just hilarious. Children are the worst.

2 hours ago, The Anti-Targ said:

Also don't assume that all the tinfoil hat people are in the USA. My colleague's EX (I say EX!) husband has his tinfoil hat firmly placed on his head. Though he doesn't believe it's bio warfare he just thinks it's not a real thing and we're all in lock down for reasons.

That came to my attention through work late last week. As a non-specific immune stimulant it's promising, but it's not the same as finding something that targets the virus directly.

Yep, this was in the U.K. so not assuming tin-foilers are just Americans at all. 

[Pebble thats Stubby]

5 minutes ago, HelenaExMachina said:

The UK (well, England certainly, I’m not certain on the rest of the country) still gave the BCG to schoolchildren as late as the mid-2000’s. It was stopped i think the year I would have received it - i know my friend in the school year above got it. i remember fairly well because whenever a year group got it the boys would go around punching people in the arm where they had just had the injection because that was just hilarious. Children are the worst.

Yep, this was in the U.K. so not assuming tin-foilers are just Americans at all. 

I remember getting my bcg at 14.  We where all tested first to see if we reacted we had our arm stabbed with multiple short cone tool.  Those that had a reaction a week later where told they where allready immune to TB so did not need to have the BCG.

I had it, I don't think my brother did.   And yes afterwards you need to dodge arm punches.

[The Anti-Targ]

15 minutes ago, Pebble thats Stubby said:

I remember getting my bcg at 14.  We where all tested first to see if we reacted we had our arm stabbed with multiple short cone tool.  Those that had a reaction a week later where told they where allready immune to TB so did not need to have the BCG.

I had it, I don't think my brother did.   And yes afterwards you need to dodge arm punches.

Or you are infected with Tb and it is latent, if you are not showing symptoms. Kinda surprised that people would be told they are immune to Tb if they'd never been vaccinated with BCG previously, because the only other way to become immune is to get the disease and then recover. And I think a family would know if that had happened.

You can also have false positive reactions. If you have birds as pets or otherwise exposed to a lot of birds you might pick up the M. avium bacteria, which is not harmful to people, but it does prime your immune system to react to the tuberculin test. And of course if you are around a lot of cattle and it's endemic to cattle locally you can also pick up the M. bovis bacteria which can cause Tb in humans.

Not sure how the test works in people. In cattle and deer we test for Tb and if they are positive then we come back a couple of months later and test to see if the animal reacts more strongly to the avium antigen or the bovis antigen.

In NZ they stopped jabbing 14 year olds en masse when I was 13. So when I went to vet school they tested  and vaccinated me then. 30 years later I still squeeze the occasional little string of pus out of my TB scar.

26 minutes ago, HelenaExMachina said:

The UK (well, England certainly, I’m not certain on the rest of the country) still gave the BCG to schoolchildren as late as the mid-2000’s. It was stopped i think the year I would have received it - i know my friend in the school year above got it. i remember fairly well because whenever a year group got it the boys would go around punching people in the arm where they had just had the injection because that was just hilarious. Children are the worst.

Yep, this was in the U.K. so not assuming tin-foilers are just Americans at all. 

Apologies, I forgot you are a Brit.

[HexMachina]

18 minutes ago, Pebble thats Stubby said:

I remember getting my bcg at 14.  We where all tested first to see if we reacted we had our arm stabbed with multiple short cone tool.  Those that had a reaction a week later where told they where allready immune to TB so did not need to have the BCG.

I had it, I don't think my brother did.   And yes afterwards you need to dodge arm punches.

14, really? It was primary school for us, i think it would have been year 6 (so 10/11). 

Had forgot about the pre-test but yes, i remember the six-pricks was done. Didn’t know that is what people were told if they reacted though.

[Pebble thats Stubby]

I cantvsay for certain that's what we where told if we reacted, it was a very long time ago.  But it's certainly the info spread arround the playground. 

I vividly remember the punch cone test i erm fainted when I saw it and was taken to sit with some 6th formers for a bit.  I was a third year  er 9th now I think my birthday is early in the school year, so was the year below starting GCSE   so 1992.  My brother was 13 when he had his, but his bd is late in the school year and a couple of years older than me.

 

I'm surprised at the age difference you had it Helena, maybe they brought it younger.

 

I know my mum had the bcg and i vaguely remember dad saying he didn't need it when it was his turn, so I reasoned he'd passed natural immunity on to my brother.  

[RhaenysBee]

77 new patients over here I think. On the upside, we had like 11 yesterday so it’s really just two days’ new cases unequally split between Sunday and Monday, which I  strongly believe to be down to the lack of work that had been done on Sunday. I assume most patients from Sunday were actually tested yesterday. We will see. But More and more people are dying and the number of recovered is quite low. Then again, say it takes 2 weeks to recover, so those who are now recovered were infected two to three weeks ago and back then we had about the same number total cases as we now have recovered. So it makes statistic sense... it’s just a terrible waiting game. 

Read some UK updates too, poor Boris Johnson. Hope he gets through this safely. And from what I gather, Prince Charles is all right? Is that correct? If any UK posters have more accurate info, please share. 

[Pebble thats Stubby]

17 minutes ago, RhaenysBee said:

77 new patients over here I think. On the upside, we had like 11 yesterday so it’s really just two days’ new cases unequally split between Sunday and Monday, which I  strongly believe to be down to the lack of work that had been done on Sunday. I assume most patients from Sunday were actually tested yesterday. We will see. But More and more people are dying and the number of recovered is quite low. Then again, say it takes 2 weeks to recover, so those who are now recovered were infected two to three weeks ago and back then we had about the same number total cases as we now have recovered. So it makes statistic sense... it’s just a terrible waiting game. 

Read some UK updates too, poor Boris Johnson. Hope he gets through this safely. And from what I gather, Prince Charles is all right? Is that correct? If any UK posters have more accurate info, please share. 

Charlie is fine, and out of isolation a few days ago,  last I heard Camilla was still symptom free but still isolated just in case. 

[dog-days]

23 minutes ago, RhaenysBee said:

77 new patients over here I think. On the upside, we had like 11 yesterday so it’s really just two days’ new cases unequally split between Sunday and Monday, which I  strongly believe to be down to the lack of work that had been done on Sunday. I assume most patients from Sunday were actually tested yesterday. We will see. But More and more people are dying and the number of recovered is quite low. Then again, say it takes 2 weeks to recover, so those who are now recovered were infected two to three weeks ago and back then we had about the same number total cases as we now have recovered. So it makes statistic sense... it’s just a terrible waiting game. 

Read some UK updates too, poor Boris Johnson. Hope he gets through this safely. And from what I gather, Prince Charles is all right? Is that correct? If any UK posters have more accurate info, please share. 

Prince Charles is fine - there was a recording of him reading Wordsworth as part of the 250th anniversary celebrations on the radio this morning. I think he also remotely presided over the opening of the Nightingale hospital. Not quite sure how you cut a ribbon via Skype, but I don't want to question the powers of the Lord's deputy-anointed. 

Boris is on oxygen but not on a ventilator yet, according to Michael Gove this morning. 

[RhaenysBee]

13 minutes ago, dog-days said:

Prince Charles is fine - there was a recording of him reading Wordsworth as part of the 250th anniversary celebrations on the radio this morning. I think he also remotely presided over the opening of the Nightingale hospital. Not quite sure how you cut a ribbon via Skype, but I don't want to question the powers of the Lord's deputy-anointed. 

Boris is on oxygen but not on a ventilator yet, according to Michael Gove this morning. 

Ah thanks for the update. I did hear he was out of quarantine, I’m glad he is well enough to have returned to royal service so quickly. 

I hope he’ll be fine... it must be terrible for his fiancée. 

17 minutes ago, Pebble thats Stubby said:

Charlie is fine, and out of isolation a few days ago,  last I heard Camilla was still symptom free but still isolated just in case. 

Glad she is all right too. 

[john]

1 hour ago, The Anti-Targ said:

Kinda surprised that people would be told they are immune to Tb if they'd never been vaccinated with BCG previously, because the only other way to become immune is to get the disease and then recover. And I think a family would know if that had happened.

You get (or got) vaccinated as a baby. The test is to see if the first vaccination still holds, is my understanding. I have no idea if I got the vaccination or just the test. 

[Rippounet]

Wow, it seems as a Frenchman I've heard more about Chloroquine than most of you guys... So let's spread some info...

Where did the idea come from? As I understand it, from working on SARS. The idea seems to have come from China, but in the West microbiologist and epidemiologist Pr Didier Raoult quickly experimented with it when the new virus hit by using the drug Plaquenil (made by Sanofi) on Covid-19 patients.

There are indeed quite a few caveats to the drug (again, as I understand it, from what my GP and the media say, don't take my word for anything, I'm not a doctor and have zero medical expertise).
- The first tests by Raoult were performed without a comparison group, hence the controversy. I've read that the Chinese have since then done some better tests with hopeful results, but on a rather small scale. There are two Chinese studies, one that was published in the Zhejiang University Journal (which Raoult may have gotten his idea from), and another one in The Lancet. Don't take my word for it, I'm sure you can find some info on these in English.
- What Raoult did was use Plaquenil in combination with an antibiotic called Azithromycine. Full disclaimer: my GP prescribed this antibiotic to me yesterday and I'll be heading to the pharmacy right after I finish typing this to get it and start my treatment.
- Raoult is a bit of a controversial figure in medical circles, he cultivates a "mad scientist" look on purpose and hates various French medical authorities for reasons I'd find hard to explain (French bureaucracy being what it is, this isn't too surprising honestly). (check his picture here: https://www.lefigaro.fr/vox/societe/chloroquine-l-appel-de-trois-grands-noms-de-la-sante-en-faveur-des-preconisations-du-pr-raoult-20200405 )
- Patients using Chloroquine do tend to recover... But then, so do patients not using it. It's still very unclear how efficient the drug is.
- It's a very dangerous drug. It is classified (at least in France) as a narrow therapeutic index (NTI) drug, which means the difference between a therapeutic and a toxic dose is small. That's why the small doses of Plaquenil tends to be preferred to the bigger ones of Nivaquine. Side effects are very serious, including impact on the heart, blood sugar levels, and eyesight. Which is why (according to both the internet and my GP) tests must be conducted on patients before giving them the drug including an ECG and a blood test.

Long story short, it's a decent lead, but it's not a miracle drug, and it should definitely not be used or distributed without a lot of medical supervision. It's certainly not a miracle drug, and it's doubtless that Trump is trying to sell the existence of a cure for political reasons while hoping to make some money at the same time.
 

[ljkeane]

2 hours ago, HelenaExMachina said:

14, really? It was primary school for us, i think it would have been year 6 (so 10/11).

I definitely had it when I was something like 13/14. I remember it quite well actually. It was the first time I realised how many people are terrified of needles. There was just a big queue of us waiting to get the injections and probably one in every 5 or 6 people was absolutely shitting themselves, I think a couple of people fainted.

I didn't know they'd stopped doing it until I looked after seeing TB vaccinations mentioned in this thread.