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Chloroquine, past and present

blogs.sciencemag.org

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Re: Chloroquine, past and present

#161

Post by Judson »

aazaa wrote: post #151
Judson wrote: post #117

Earlier quoted context omitted.

Are you referring to this study? https://drive.google.com/file/d/186Bel9RqfsmEx55FDum4xY_IlWS... Afaikt, 57% patients on HCQ alone were “virologically cleared” by day 6 and 100% on HCQ+Azithromycin were clear By day 6. Compared with ~12% of control group.

Yes, and I'm looking at the aggregate data in the last two graphs, and also the big table. HCQ + AZ was the only group with clearance for all after six days. It was also the smaller of the two groups, which makes it hard to give any weight to the finding. But there are many other features of this study that make the result hard to interpret.

Great that we’re looking at the same study! I’m not sure what you mean by:

“No patient was cleared of virus after six days using hydroxychloroquine alone.“

Because the percentages there are 57% Of patients on HCQ alone we’re cleared, vs 12% control.

Re: Chloroquine, past and present

#162

Post by SketchySeaBeast »

schrodinger wrote: post #157
SketchySeaBeast wrote: post #133

Earlier quoted context omitted.

How utterly and inconceivably selfish. How would that work out if everyone thought like that?

Is it really? I've heard there's some logic to this… If instead, we all stay home and quarantine, the second we start reducing the quarantine the virus flares back up again. If instead, we start acquiring immunity in low-risk populations, at a rate that the hospitals can sustain, we'll have a degree of herd immunity and a portion of the population that can no longer spread it. I'm certainly not an epidemiologist thou…

> If instead, we start acquiring immunity in low-risk populations, at a rate that the hospitals can sustain, we'll have a degree of herd immunity and a portion of the population that can no longer spread it.

A fair portion of low-risk people will require intervention. Given that a lot more people are low than high risk, you're still overwhelming the health system, and all those low-risk people are still going to interact with others while they are asymptomatic but transmissible.

Re: Chloroquine, past and present

#163

Post by 1996 »

hannob wrote: post #113
1996 wrote: post #84

Earlier quoted context omitted.

to the best of my knowledge, there has been no randomized study against placebo of several important things - like parachutes. Next time I am in a burning plane, I'll make sure to refuse a parachute, as the lack of studies means anecdotal evidence tells us basically nothing.

You may want to read this: http://cmajopen.ca/content/6/1/E31.full I don't know if Chloroquine works, but I'm pretty sure Chloroquine is no parachute (i.e. it's not a drug where the benefits are so obvious that it doesn't need a proper trial).

Nice article, thank you. Still it doesn't adresse the question: statistically, the benefits can sometimes be so obvious that no randomized trial is needed. RCT and large series are needed when trying to prove some minimal effects. The article is more like a sociological study to say invoking this parachute argument is no definite proof based on cases where the parachute argument was invoked and in retrospective was misguided.

That is very true. But unless we are to argue that the virus is not what causes the disease, using the viral load as a proxy for clinical status and contagiousness is acceptable. And unless the effect is small enough that sample selection can affect the conclusion, it doesn't matter much in practice.

I meean, for chloroquine, we have studies showing non inferiority and strong effects. We will not know if it works according to modern standards of statistics using direct survival statistics for another two weeks at best. What to do in the meantime?

In this article, the comparison to flossing in the intro is not good: lack of flossing does not entail mortality rate >.5%.

And all the other approaches selected for study do not feature infectious agents creating a risk of death, so the conclusions of the article are not very transposable to the problem here. For chemotherapy, surgery, etc. yes, they have a point. For microbiology, no.

Everybody seems to be doing armchair critique of the methodology used. I respect the desire to understand, but I believe the critique stands: we do not have RCT for parachutes. And at the moment, we do not have RCT for chloroquine either. We have a long experience of using it for other diseases. It's an old drug with well known side effects and toxicity.

If you are infected, you are free to wait until there is a trial to accept the drug. Yet, based on the information available, I still think it is a wrong decision, akin to asking for a RCT on parachutes aboard a burning plane.

Re: Chloroquine, past and present

#164

Post by wtallis »

ApolloFortyNine wrote: post #92
tibbydudeza wrote: post #88

A vaccine was developed in haste for an outbreak of swine flu in 1976 (CDC feared it was a repeat of 1918 flu) and about 45 million Americans received it but 450 people developed GBS (Guillaine-Barre Syndrome) as a result. Going on a hunch or unproven stuff is simply going to give the anti-vaxxer idiots further ammo

Taking your numbers as fact, that would be a .001% death rate. Coronavirus has a death rate ranging from .6-2% (overall), varying drastically to upwards of 20% with age. It's not a hard call to make.

> Taking your numbers as fact, that would be a .001% death rate.

Death rate for GBS is more like 7.5%, not 100%. Though for today's challenge, the relevant stat may be that ~15% of GBP patients end up needing a ventilator. But even that wouldn't be a problem if we had such a vaccine for this coronavirus.

Re: Chloroquine, past and present

#165

Post by m0zg »

aazaa wrote: post #130
m0zg wrote: post #121

Earlier quoted context omitted.

> The President is doing something very dangerous And if he didn't do what he did, you'd be saying the same thing once hundreds of people start dying per day because there's not enough chloroquine available. How do you know it's "hype"? Because orange man bad? It has shown effectiveness against SARS previously. It's been available for 50+ years and doctors are familiar with its side effects and safety profile. The Ch…

I would say the same thing regardless of the man on the podium. You're the one bringing partisanship into this. It's hype because nothing has been demonstrated yet using practices that have been worked out through a hundred years of painful trial and error. It's hype because he's saying he thinks it will work when he has no data to support that conclusion. It's hype because as the president must surely be aware, Amer…

> I would say the same thing regardless of the man on the podium.

Must have been hard for you to stomach 2009 then when 60 million Americans got infected with H1N1, nothing whatsoever was done, and the CDC budget was cut the very next year.

Re: Chloroquine, past and present

#166

Post by takinola »

cameldrv wrote: post #62

We definitely want more studies, but IMO we're reaching a tipping point. We have anecdotal evidence from China and South Korea, and this quite flawed, but at least data-containing study from France. Chloroquine's safety profile isn't great, but the safety profile of COVID is way worse. If you look at Chemotherapy for example, one would never take any of those drugs unless you had cancer. COVID isn't quite as bad as c…

I don't know about the efficacy of Chloroquine in treating COVID-19 but I would imagine that we already know a lot about the safety of dosing people with the drug. Any one growing up in the tropics during the 70s or 80s took regular doses for malaria treatment. The main adverse reaction that often happened was a crazy amount of itching (it would last for 3 days and would not let up even when you were trying to fall asleep)

Re: Chloroquine, past and present

#167

Post by m0zg »

SketchySeaBeast wrote: post #133
m0zg wrote: post #118

Earlier quoted context omitted.

>> Why spend 2 weeks To acquire immunity while there are still hospital beds available in some places, in the unlikely event that you need one. That won't be the case a month from now.

How utterly and inconceivably selfish. How would that work out if everyone thought like that?

Studies show it wouldn't work if _everyone_ thought like that at the same time. But studies also show that you need to "pulse" the infection rate among low-risk populations in order to get past this in a controllable fashion by temporarily and partially lifting the restrictions on those people and letting them acquire immunity, while carefully isolating and supporting the high risk populations. The fundamental truth of the situation is: 60-70% will have to go through the wringer before this is over. "When", "which subset", and "how" will determine the fatality rate. One thing is absolutely clear: we _must_ completely isolate (and support) the elderly and those with severe pre-existing conditions. Large numbers of immune people could help with that. Complete shutdown of the economy (if such a thing were even possible) would condemn a lot of the vulnerable people to die, since they still need food and a lot of them also need medical care, which could become unavailable, like in Italy.

Re: Chloroquine, past and present

#168

Post by SketchySeaBeast »

m0zg wrote: post #167
SketchySeaBeast wrote: post #133

Earlier quoted context omitted.

How utterly and inconceivably selfish. How would that work out if everyone thought like that?

Studies show it wouldn't work if _everyone_ thought like that at the same time. But studies also show that you need to "pulse" the infection rate among low-risk populations in order to get past this in a controllable fashion by temporarily and partially lifting the restrictions on those people and letting them acquire immunity, while carefully isolating and supporting the high risk populations. The fundamental truth…

And if that wants to get organized I can see how that would work. "Get sick to beat the rush", however, is not that - it's an action where the only good outcome would be if only you do it, which I think is a definition of selfishness.

Re: Chloroquine, past and present

#169

Post by axguscbklp »

mcguire wrote: post #155
axguscbklp wrote: post #127

Earlier quoted context omitted.

I'm not suggesting immediately starting to dose millions of people with it. I'm suggesting massively ramping up production so that if it turns out to be useful, we can at that point immediately start dosing millions of people with it. I think it likely that the cost of massively increasing hydroxychloroquine production would be a drop in the bucket compared to the total resources being spent on tackling the crisis. S…

Note that if hydroxychloroquine is not effective, your production facilities will be tied up if you do find something else that is effective.

But won't they be tied up one way or another producing something else, unless by chance they happen to currently be producing something that turns out to be important in the fight against the pandemic?

Re: Chloroquine, past and present

#170

Post by nradov »

tibbydudeza wrote: post #88

A vaccine was developed in haste for an outbreak of swine flu in 1976 (CDC feared it was a repeat of 1918 flu) and about 45 million Americans received it but 450 people developed GBS (Guillaine-Barre Syndrome) as a result. Going on a hunch or unproven stuff is simply going to give the anti-vaxxer idiots further ammo

I suspect people who don't understand vaccines may have reflexively downvoted your comment but in fact this is a real risk. There is also concern over repeating the debacle with the respiratory syncytial virus (RSV). Vaccine development will continue but certain steps can't be rushed.
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