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White and nerdy
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After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity), when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531), chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each independently associated with an increased risk of in-hospital mortality.

https://marlin-prod.literatumonline.com/pb-assets/Lancet/pdfs/S0140673620311806.pdf
 

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Basically if given at the right time in the right patients, it may help. It’s not a magic bullet though.
 

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White and nerdy
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Discussion Starter · #4 ·
Basically if given at the right time in the right patients, it may help. It’s not a magic bullet though.
From what part of the study did you get that theory?
 
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After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity), when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531), chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each independently associated with an increased risk of in-hospital mortality.

https://marlin-prod.literatumonline.com/pb-assets/Lancet/pdfs/S0140673620311806.pdf
Not a double blind study.


"Added value of this study

In the absence of reported randomised trials, there is an urgent need to evaluate real-world evidence related to outcomes with the use of hydroxychloroquine or chloroquine (used with or without macrolides) in COVID-19. Using an international, observational registry across six continents, we assessed 96 032 patients with COVID-19, of whom 14 888 were treated with hydroxychloroquine, chloroquine, or their combination with a macrolide. After controlling for age, sex, race or ethnicity, underlying comorbidities, and disease severity at baseline, the use of all four regimens was associated with an increased hazard for de-novo ventricular arrythmia and death in hospital. This study provides real-world evidence on the use of these therapeutic regimens by including a large number of patients from across the world. Thus, to our knowledge, these findings provide the most comprehensive evidence of the use of hydroxychloroquine and chloroquine (with or without a macrolide) for treatment of COVID-19.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext "
 

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When proclaimed a "Game changer" many assumed that was a good thing.
 

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After looking at this in more detail, I consider this the key statement: We included patients hospitalised between Dec 20, 2019, and April 14, 2020, with a positive laboratory finding for SARS-CoV-2.

Hospitalized patients, by definition, are a subgroup of ChinaFlu patients that are the sickest. This fits with the paper's overall reported mortality of 9% in the control group and 11% in the HCQ group. A mortality rate of roughly 10% is orders of magnitude higher than the mortality rate of KungFlu for the entire population.

So we have one research paper from NEJM that concludes that once on a ventilator, HCQ is ineffective, and now another paper from The Lancet that concludes that once crossing the threshold of being sick enough to require hospitalization, HCQ is ineffective. Both are very small subgroups of HCQ patients and of the population as a whole.
 

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So we have one research paper from NEJM that concludes that once on a ventilator, HCQ is ineffective, and now another paper from The Lancet that concludes that once crossing the threshold of being sick enough to require hospitalization, HCQ is ineffective. Both are very small subgroups of HCQ patients and of the population as a whole.
That is the case for all medications that are anti-viral. I have had the flu twice in my life where I felt like I was going to die. One of those times, I asked the doc about Tamiflu, and he said that it does nothing when the viral load has built to the point it has to make one as sick as I was. Anti-viral compounds can only work when given at initial onset of symptoms.
 

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I read the full article at the Lancet. Did a little looking around and I found this:

https://www.thelancet.com/diversity

Notice the “no all male panel policy” in their diversity statement. If they were truly interested dispensing “unbiased science” they wouldn’t care about the makeup of their panels. Tells you everything about their research. Total BS!

Here’s the last paragraph of the Lancets manifesto:

“Increasing the social impact of science
We recognise that a great research paper is not enough and that it requires development, mobilisation, and exposure. So we promise to set agendas, create context, inform leaders, start debates, and advocate for the idea that research can and will make a difference.”

Set “agendas” and “create context”?! Allow me to give you some “context”: We will blow our “agenda” up your collective arses.
 

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They hand picked the data from some patients that were already circling the drain and were given meds that left out the most important part of the "cocktail" - the zinc. It doesn't even qualify as a study. It's a hack job.
When they decided on day 1 to push negative stories on it, they weren't going to come up with studies that proved Trump right. Doesn't matter this drug has been used for 6 decades, FDA approved, and CDC approved. It will kill you instantly.

upload_2020-5-26_20-17-35.png
 

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Discussion Starter · #15 ·
Why is the science on this so hard?

A drug that helps with one thing may harm with a different disease. All of these studies are showing that hcq in any combo is ineffective, and causes greater harm, when used in covid cases.

What miraculous mechanism do you think zinc embodies that will changes this? Why is it so important to argue against actual science because Trump espoused it at one point?
 
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My understanding is that the drug in question only has a chance of being effective at the onset of the viral symptoms. When you're at the point of hospitalization, it is not indicated. When you're experiencing organ failure, a cytocine storm, it's not indicated - even for malaria patients. It's not recommended for complicated malaria cases. I'm not sure what this article says other than agreeing that this drug is not for people who are already extremely sick. Sort of like Tamiflu isn't for people hospitalized for life threatening flu complications. Am I missing something here?
 

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Why is the science on this so hard?

A drug that helps with one thing may harm with a different disease. All of these studies are showing that hcq in any combo is ineffective, and causes greater harm, when used in covid cases.

What miraculous mechanism do you think zinc embodies that will changes this? Why is it so important to argue against actual science because Trump espoused it at one point?
Trump Espoused it in reference to this paper:

https://www.mediterranee-infection....2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf

French Doctors showed in a small sample study of 20 infected patients showed that HCQ was highly effective in reducing viral load when used with Azithromycin. They showed that at 6 days, the patients using this combination were "virologically cured."

When comparing the effect of hydroxychloroquine treatment as a single drug and the effect of hydroxychloroquine and azithromyc in combination, the proportion of patients that had negative PCR results in nasopharyngeal samples was significantly different between the two groups at days 3-4-5 and 6 post-inclusion (Table 3). At day6 post-inclusion, 100% of patients treated with hydroxychloroquine and azithromycin combination were virologicaly cured comparing with 57.1% in patients treated with hydroxychloroquine only, and 12.5% in the control group (p<0.001). These results are summarized in Figures 1 and 2. Drug effect was significantly higher in patients with symptoms of URTI and LRTI, as compared to asymptomatic patients with p<0.05 (data not show).

They started with 26, 6 dropped out or were lost to the study as follows:

Six hydroxychloroquine-treated patients were lost in follow-up during the survey because of early cessation of treatment. Reasons are as follows: three patients were transferred to intensive care unit, including one transferred on day2 post-inclusion who was PCR-positive on day1, one transferred on day3 post-inclusion who was PCR-positive on days1-2 and one transferred on day4 post-inclusion who was PCRpositive on day1 and day3; one patient died on day3 post inclusion and was PCR-negative on day2; one patient decided to leave the hospital on day3 post-inclusion and was PCR-negative on days1-2; finally, one patient stopped the treatment on day3 post-inclusion because of nausea and was PCR-positive on days1-2-3. The results presented here are therefore those of 36 patients (20 hydroxychloroquine-treated patients and 16 control patients)

Notice that there is no mention of heart issues or death related to HCQ, which I would think would be an important detail in include.

If you combine this with all the other doctors that have spoken up about the successful use of this combination in "curing" people of this disease, and two people I know are among them, it wasn't such a stupid thing to say as everyone wants to imply.

Something else that no one has mentioned. Pretty early on there were reports of this virus, at least some strains of it, becoming neuroinvasive. When that happens,the virus travels from the nerves in the lungs to the brain, attacking the part of the brain responsible for regulating heart rate and respiration, basically turning it off like a switch. Some say that this is why we were seeing people drop dead while walking down the street in China.

https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.25728

The neuroinvasive potential of SARS‐CoV2 may play a role in the respiratory failure of COVID‐19 patients

The infection of SARS‐CoV has been reported in the brains from both patients and experimental animals, where the brainstem was heavily infected. Furthermore, some coronaviruses have been demonstrated able to spread via a synapse‐connected route to the medullary cardiorespiratory center from the mechanoreceptors and chemoreceptors in the lung and lower respiratory airways. Considering the high similarity between SARS‐CoV and SARS‐CoV2, it remains to make clear whether the potential invasion of SARS‐CoV2 is partially responsible for the acute respiratory failure of patients with COVID‐19. Awareness of this may have a guiding significance for the prevention and treatment of the SARS‐CoV‐2‐induced respiratory failure.

Given the choice, I would take my chances with the drug.
 
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