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[No Politics] What you need to know about CoVID-19 by SARS-CoV-2 [No Politics]

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MarcT

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Really? No, it is not "nuff said". This retrospective analysis is not definitive at all. As the authors themselves say:

"Randomised clinical trials will be required before any conclusion can be reached regarding benefit or harm of these agents in COVID-19 patients."

And also:

"Our study has several limitations. The association of decreased survival with hydroxychloroquine or chloroquine treatment regimens should be interpreted cautiously. Due to the observational study design, we cannot exclude the possibility of unmeasured confounding factors, although we have reassuringly noted consistency between the primary analysis and the propensity score matched analyses. Nevertheless, a cause-and-effect relationship between drug therapy and survival should not be inferred."

It seems like you immediately jumped on the headline and are inferring indiscriminately.

And I also note that I don't see any mention of the use of zinc, which is increasingly being seen as a necessary component of a HCQ regimen for covid-19. So, I'll continue to keep an open mind on this, and consider all available data.
 

PierreV

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Really? No, it is not "nuff said". This retrospective analysis is not definitive at all. As the authors themselves say:

"Randomised clinical trials will be required before any conclusion can be reached regarding benefit or harm of these agents in COVID-19 patients."

And also:

"Our study has several limitations. The association of decreased survival with hydroxychloroquine or chloroquine treatment regimens should be interpreted cautiously. Due to the observational study design, we cannot exclude the possibility of unmeasured confounding factors, although we have reassuringly noted consistency between the primary analysis and the propensity score matched analyses. Nevertheless, a cause-and-effect relationship between drug therapy and survival should not be inferred."

It seems like you immediately jumped on the headline and are inferring indiscriminately.

And I also note that I don't see any mention of the use of zinc, which is increasingly being seen as a necessary component of a HCQ regimen for covid-19. So, I'll continue to keep an open mind on this, and consider all available data.

FWIW, I read the whole thing... Yes, there's the usual, "limitations", "caveats", "deserves further blah, blah..." That's standard stuff if, at least for people who are used to read medical studies. (Which is my case).

Bottom line, in the current protocols, patients consistently die more. That is a hard fact that has to be weighted against "keeping an open mind".

Now, none of this comes as a surprise. That is the expected outcome and the reason why caution was advised to begin with. Still, it was worth a shot as the expected additional therapy burden could have been an acceptable cost if it had reduced other burdens. The evidence piles up that it is not the case.

As far as Zinc is concerned, no comment...
 

maty

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-> No evidence for increased transmissibility from recurrent mutations in SARS-CoV-2
https://www.biorxiv.org/content/10.1101/2020.05.21.108506v1

[... We do not identify a single recurrent mutation convincingly associated with increased viral transmission. Instead, recurrent SARS-CoV-2 mutations currently in circulation appear to be either neutral or weakly deleterious. These mutations seem primarily induced by the human immune system via host RNA editing, rather than being signatures of adaption to the novel human host. There is no evidence at this stage for the emergence of more transmissible lineages of SARS-CoV-2 due to recurrent mutations. ]
 

Tubaman

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What happens is that if the independent review board detects a significant difference in outcomes, they will "unblind" the trial and find out which group is experiencing the better outcomes. Then, those in the other group will be offered the successful intervention, as it would no longer be ethical to deny them that treatment.

The only thing about Vitamin D is that it may take a period of time to really build up subjects' levels, which period of time covid-19 subjects may not have to spare. Now, they can give big Vitamin D doses by injections, so perhaps they could get their levels up in a hurry, in the event that a trial were to show a huge benefit.

Good to know. I think there are two separate questions: 1. Does an adequate vitamin D level help to protect against COVID (both infection and mortality), and 2. Will treatment of an infected person who is found to have low vit D provide benefit? I think the Harvard study will explore the former, and I remember having seen info. on a study that is underway attempting to answer the latter question.
 

PierreV

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The methodology is VERY sloppy. No standardized treatments no reporting standards as they vary from country to country and even among hospitals.
The LAncet has been Biases against HCQ from day 1. Poilitical aganda by the Lancet?

FWIW, "The Lancet" doesn't write the papers it publishes.

There's only one place in the world where the chloroquine debate is more a political hot potato than a medical issue...

Choloroquine, especially at high doses in association with macrolides, has significant side effects and risks. That was known well before it became a hot topic and is the reason why the (now retracted for sloppiness and missing data) initial Raoult's study took such precautions (multiple ECG, panels, etc...) and excluded so many patients. That's a fact that even the most active promoters of the therapy don't deny. But yes, that, in itself, isn't a reason to ignore the possibility that it could be useful and save more people than it kills. Hence the need for controlled studies which are ongoing, at least in the countries that did not actively opt-out of those trials because they decided, based on their own data, that it did more harm than good.

However, the evidence piling up isn't positive. If Chloroquine was a game-changer, you would expect more positive studies to show up. One may argue endlessly on the studies' designs, methodologies, constraints, but that is what it is given the circumstances. The same remarks could have applied had the study shown a positive effect btw.

And remember, that's a medical issue, not a political one.

I actually had a neutral opinion at the start of all this (a few of my practicing friends had a positive opinion, a few had a negative opinion), except on the issue of self-medication without precautions.
 

Wes

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interesting news out of Emory Univ. today
 

kevinh

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FWIW, "The Lancet" doesn't write the papers it publishes.

There's only one place in the world where the chloroquine debate is more a political hot potato than a medical issue...

Choloroquine, especially at high doses in association with macrolides, has significant side effects and risks. That was known well before it became a hot topic and is the reason why the (now retracted for sloppiness and missing data) initial Raoult's study took such precautions (multiple ECG, panels, etc...) and excluded so many patients. That's a fact that even the most active promoters of the therapy don't deny. But yes, that, in itself, isn't a reason to ignore the possibility that it could be useful and save more people than it kills. Hence the need for controlled studies which are ongoing, at least in the countries that did not actively opt-out of those trials because they decided, based on their own data, that it did more harm than good.

However, the evidence piling up isn't positive. If Chloroquine was a game-changer, you would expect more positive studies to show up. One may argue endlessly on the studies' designs, methodologies, constraints, but that is what it is given the circumstances. The same remarks could have applied had the study shown a positive effect btw.

And remember, that's a medical issue, not a political one.

I actually had a neutral opinion at the start of all this (a few of my practicing friends had a positive opinion, a few had a negative opinion), except on the issue of self-medication without precautions.

True much of the world is using Hydroxy chloroquine, Not Chloroquine, there is also no mention of Zinc. The role of HCQ is to act as an ionophore for Zinc ie to get it into the cell where it prevents the virus RNA from replicating. Ignoring Zinc renders the conclusions nonsense. This role on Zinc in Coron virus replication was established in peer reviewed paper over 5 years ago.

I published links to those papers earlier in this thread.
 

MediumRare

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It's estimated 25% of all restaurants will close, but it's likely their owners will open new ones later.
How do you figure? I'm a partner in a restaurant. We'd only close if we entirely ran out of money and defaulted on our rent/loans/vendors. We'd lose hundreds of thousands on our investment, our employees, and our loyal customers. So... how is it "likely" the worst performing 25% restaurateurs, forced to close, would open new ones?
 

MarcT

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How do you figure? I'm a partner in a restaurant. We'd only close if we entirely ran out of money and defaulted on our rent/loans/vendors. We'd lose hundreds of thousands on our investment, our employees, and our loyal customers. So... how is it "likely" the worst performing 25% restaurateurs, forced to close, would open new ones?
You may be right, but I could see some people panicking and cutting their losses right away, then trying to start again later when restaurants might be able to return to full capacity.
 

Ron Texas

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How do you figure? I'm a partner in a restaurant. We'd only close if we entirely ran out of money and defaulted on our rent/loans/vendors. We'd lose hundreds of thousands on our investment, our employees, and our loyal customers. So... how is it "likely" the worst performing 25% restaurateurs, forced to close, would open new ones?

I get my information from private ecocnomists. Restaurants which close are not necessarily the worst performing 25%. They may be located in areas with extended shutdowns like NYC, or were buffet style which is likely to be perceived as a health risk in the future. Also, some restaurants aren't geared for take out. What's happening is not normal competition. It's a tilted playing field. Fast food is doing fairly well.

We used to eat out 3 times a week. Not once since early March. Still pick up Chinese take out from our favorite place around the corner.

I wish you the best of luck with your business.
 

Ron Texas

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Thanks, we're trying to stay afloat and keep our employees in good shape. Hanging in there. 4.5 stars on Yelp gave us a good base and the chef has unlimited energy and commitment.

Have you been able to do anything with take out or grocery concepts? This weekend Texas restaurants go to 50% capacity and bars open at 25%.
 

BDWoody

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You may be right, but I could see some people panicking and cutting their losses right away, then trying to start again later when restaurants might be able to return to full capacity.

It will be an interesting one to watch. One of the things typically left when a restaurant goes out of business, is a restaurant location, often fully equipped, looking for a new tenant. In that case, the bankrupt or out of business owners will find some strip mall with a closed Italian restaurant, tell the owner who needs a new tenant a good story about how you got caught up in the tsunami, and are now starting over...or some version of that tale.

My company services the restaurant industry and there are lots and lots of restaurants opening and closing all the time. Not uncommon for a restaurant owner to have opened and closed several restaurants over a career... It is an incredibly tough business.

I don't know what percentage of restaurants simply lease their locations, but I would guess it is a high percentage. To them, walking away isn't the same as it is for the guy who owns the building, and might be their best shot at long term survival.

There are some really sad situations among the hundreds of restaurants we do business with. Many will certainly not make it. Others with outdoor seating and patios will be expanding.

We will ride it however it goes...
 

BDWoody

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How do you figure? I'm a partner in a restaurant. We'd only close if we entirely ran out of money and defaulted on our rent/loans/vendors. We'd lose hundreds of thousands on our investment, our employees, and our loyal customers. So... how is it "likely" the worst performing 25% restaurateurs, forced to close, would open new ones?

Tough tough business. Best of luck to you and your family (employees).
 

Tubaman

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Thanks, we're trying to stay afloat and keep our employees in good shape. Hanging in there. 4.5 stars on Yelp gave us a good base and the chef has unlimited energy and commitment.
May I ask what the name of your restaurant is? I live in Chicago, so, if you have a take-out service that is in operation, maybe I could stop by. Although, I should mention that I have celiac disease, so would need to restrict myself to gluten-free items.
 

kevinh

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One thing that concerns me is that some people will be afraid to go back to restaurants.

A couple of local restaurants in our area went to online orderin and take out. We give the normal tips, feel bad for owners and employees.
 

Wes

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I get my information from private ecocnomists. Restaurants which close are not necessarily the worst performing 25%. They may be located in areas with extended shutdowns like NYC, or were buffet style which is likely to be perceived as a health risk in the future. Also, some restaurants aren't geared for take out. What's happening is not normal competition. It's a tilted playing field. Fast food is doing fairly well.

We used to eat out 3 times a week. Not once since early March. Still pick up Chinese take out from our favorite place around the corner.

I wish you the best of luck with your business.

what is the 'normal' closure rate?

restaurants are about the worst small biz in terms of making a go of it and IIRC most don't make it 3 years in normal times
 
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