Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Early clinical trial shows anti-depressant prevents hospitalization from Covid

jamanetwork.com

Post reply on HN
Print view View original

91–100 of 116 posts

Re: Early clinical trial shows anti-depressant prevents hospitalization from Covid

#91

Post by Herodotus38 »

garmaine wrote: post #85
Herodotus38 wrote: post #56

Earlier quoted context omitted.

“ Keep in mind that Hydroxychloroquine is one of the existing drugs discovered to have some effect on early infections, but it clearly failed to have much impact on late-stage infections” Do you mind sharing your evidence that HCQ helps with early infections? Because I know many studies that showed no benefit, for example: https://www.nejm.org/doi/full/10.1056/nejmoa2016638 That is one of many studies.

The proposed mechanism for HCQ (zinc affinity) implies that it would be most effective if taken before the onset of symptoms, perhaps even before viral load is high enough to test positive. Obviously this makes it challenging to do a study. Nearly all studies that I’m aware of are initiated on patients that are already showing symptoms, because the patients are enrolled at the hospital, and few have the necessary zin…

Sure and when you have results of a RCT of zinc plus HCQ in prophylactic patients and publish it I will read it with great interest and if the data looks good I will be giving it to all my patients.

If, however, you want to tell me that I should be using it now, because of a proposed mechanism and theoretical benefit, by using that logic why shouldn't I be giving my patients all other vitamins/supplements/medications that have been variously proposed and have their own believers?

Aside from HCQ+zinc, what other cheap, low risk interventions do you propose be given and studied?

(edit: additional thoughts) If you don't have any others, than I suggest you reevaluate why you think HCQ+zinc is unique (it's not). If you do, then you'll have a list of them and probably a list of reasons for each and a ranking of which are the most promising and which are the least. When you do this, it forces you to critically think about how best to rank these and how that ranking might change with evidence. Then it forces you to study the evidence.

In an above post I mentioned that I did give HCQ to patients in the hospital back in March when it was the only thing that had ANY evidence (and the evidence was poor, but it was all they had). It made no difference, and it may have caused some deaths due to QTc prolongation (personally I believe it is very safe and I've taken it for malarial prophylaxis before).

edit: (I removed a snarky line, apologies)

Re: Early clinical trial shows anti-depressant prevents hospitalization from Covid

#92

Post by travmatt »

mlyle wrote: post #38
colossal wrote: post #19

Earlier quoted context omitted.

It has shown to be correlated with better outcomes. It is also correlated with being healthier, being active, and eating better. As far as I understand there is no strong evidence for a causal relationship. To be clear, if you live in the northern hemisphere, you should be taking vitamin D. It's cheap and at worst harmless. But that's not the same as saying it will improve the outcome of covid patients.

IV calcifediol (Vitamin D) in early-stage COVID has improved outcomes in small randomized controlled trials. Oral vitamin D has been shown to be ineffective at this point, but this isn't surprising: it takes a long time of sustained oral supplementation to raise levels. Then there's a whole lot of evidence showing correlation, but as you point out, low vitamin D is an indicator of frailty. This is much weaker evidenc…

I haven’t heard vitamin d administration is associated with better outcomes, but I’ve heard that vitamin d levels are inversely correlated with outcomes - i.e., people should take a blood test and determine if they are vitamin d deficient, and supplement as needed.

Re: Early clinical trial shows anti-depressant prevents hospitalization from Covid

#93

Post by travmatt »

amelius wrote: post #51
cinntaile wrote: post #33

Earlier quoted context omitted.

The NHS recommends it for example. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-... https://www.nhs.uk/conditions/coronavirus-covid-19/people-at...

The UK's health services are struggling at the moment. So can the conclusion be that vitamin D does not work as expected? Or is the conclusion that still not enough people are taking vitamin D, and its usefulness should be better communicated?

> The UK's health services are struggling at the moment.

Are you saying the NHS is struggling with their doctors publishing dangerous recommendations? I’m not sure what you’re implying.

Re: Early clinical trial shows anti-depressant prevents hospitalization from Covid

#94

Post by travmatt »

DoreenMichele wrote: post #52
amelius wrote: post #10

Several months ago there was a post about vitamin D supposedly being effective in preventing hospitalization. What happened to that idea?

Vitamin D is still being discussed quite a lot on HN. My understanding is that it boils down to "It helps those who are deficient but doesn't do much, if anything, if you aren't deficient." Now, a lot of people are deficient -- probably more now than usual due to the lock down because people aren't getting out much, so people are getting less sun exposure. So I tend to get downvoted when I say things like "If you are…

One possible candidate drug I’ve read quite a bit about but have not seen anything on HN about is high-dose melatonin, and even typical melatonin use is associated with a lower chance of testing positive. There’s a bunch of papers discussing how it _could_ be useful, there are several studies underway but none have been completed yet.

Re: Early clinical trial shows anti-depressant prevents hospitalization from Covid

#95

Post by garmaine »

Herodotus38 wrote: post #91
garmaine wrote: post #85

Earlier quoted context omitted.

The proposed mechanism for HCQ (zinc affinity) implies that it would be most effective if taken before the onset of symptoms, perhaps even before viral load is high enough to test positive. Obviously this makes it challenging to do a study. Nearly all studies that I’m aware of are initiated on patients that are already showing symptoms, because the patients are enrolled at the hospital, and few have the necessary zin…

Sure and when you have results of a RCT of zinc plus HCQ in prophylactic patients and publish it I will read it with great interest and if the data looks good I will be giving it to all my patients. If, however, you want to tell me that I should be using it now, because of a proposed mechanism and theoretical benefit, by using that logic why shouldn't I be giving my patients all other vitamins/supplements/medications…

You are reading way, way too much into what I actually said. This is obviously a political issue for you and I have no desire to engage any further. Good day, sir.

Re: Early clinical trial shows anti-depressant prevents hospitalization from Covid

#96

Post by Herodotus38 »

garmaine wrote: post #95
Herodotus38 wrote: post #91

Earlier quoted context omitted.

Sure and when you have results of a RCT of zinc plus HCQ in prophylactic patients and publish it I will read it with great interest and if the data looks good I will be giving it to all my patients. If, however, you want to tell me that I should be using it now, because of a proposed mechanism and theoretical benefit, by using that logic why shouldn't I be giving my patients all other vitamins/supplements/medications…

You are reading way, way too much into what I actually said. This is obviously a political issue for you and I have no desire to engage any further. Good day, sir.

Apologies if I did. There are a large number of people who believe that the reason we don't use HCQ is due to a conspiracy. You may have just wanted to point out that the combination has never been used.

Re: Early clinical trial shows anti-depressant prevents hospitalization from Covid

#97

Post by mlyle »

travmatt wrote: post #92
mlyle wrote: post #38

Earlier quoted context omitted.

IV calcifediol (Vitamin D) in early-stage COVID has improved outcomes in small randomized controlled trials. Oral vitamin D has been shown to be ineffective at this point, but this isn't surprising: it takes a long time of sustained oral supplementation to raise levels. Then there's a whole lot of evidence showing correlation, but as you point out, low vitamin D is an indicator of frailty. This is much weaker evidenc…

I haven’t heard vitamin d administration is associated with better outcomes, but I’ve heard that vitamin d levels are inversely correlated with outcomes - i.e., people should take a blood test and determine if they are vitamin d deficient, and supplement as needed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/

> Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50 %) p value X2 Fischer test p Strengths: Randomized, very strong effect, strongly statistically significant.

Weaknesses: single trial, single center, relatively small sample, not blinded.

https://pmj.bmj.com/content/early/2020/11/12/postgradmedj-20...

> Greater proportion of vitamin D-deficient individuals with SARS-CoV-2 infection turned SARS-CoV-2 RNA negative with a significant decrease in fibrinogen on high-dose cholecalciferol supplementation.

Strengths: Randomized, blinded trial

Weaknesses: single trial, single center, relatively small sample, secondary outcome measure

Re: Early clinical trial shows anti-depressant prevents hospitalization from Covid

#98

Post by TazzyEW »

amelius wrote: post #16
JoshTko wrote: post #13

Earlier quoted context omitted.

Vitamin D has been shown to reduce severity in several different studies. Everyone should consider taking it. https://www.reddit.com/r/COVID19/search?q=vitamin+D&restrict... https://www.youtube.com/watch?v=vN30emwcNS4

Yes, but are governments recommending it? Are doctors recommending it? Is WHO recommending it? I didn't hear anything about it except from that one post on HN, which I think is quite strange. If this works, then shouldn't there be a nation-wide plan to introduce more vitamin D in the diets of people?

https://petition.parliament.uk/petitions/564133

Re: Early clinical trial shows anti-depressant prevents hospitalization from Covid

#99

Post by TazzyEW »

amelius wrote: post #16
JoshTko wrote: post #13

Earlier quoted context omitted.

Vitamin D has been shown to reduce severity in several different studies. Everyone should consider taking it. https://www.reddit.com/r/COVID19/search?q=vitamin+D&restrict... https://www.youtube.com/watch?v=vN30emwcNS4

Yes, but are governments recommending it? Are doctors recommending it? Is WHO recommending it? I didn't hear anything about it except from that one post on HN, which I think is quite strange. If this works, then shouldn't there be a nation-wide plan to introduce more vitamin D in the diets of people?

Hello,please see petition for Vit D public health campaign https://petition.parliament.uk/petitions/564133

Re: Early clinical trial shows anti-depressant prevents hospitalization from Covid

#100

Post by TazzyEW »

amelius wrote: post #51
cinntaile wrote: post #33

Earlier quoted context omitted.

The NHS recommends it for example. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-... https://www.nhs.uk/conditions/coronavirus-covid-19/people-at...

The UK's health services are struggling at the moment. So can the conclusion be that vitamin D does not work as expected? Or is the conclusion that still not enough people are taking vitamin D, and its usefulness should be better communicated?

Please see Vitamin D public health campaign petition https://petition.parliament.uk/petitions/564133
Post reply on HN