Antiviral, Anti-inflammatory and HCQ in Covid-19

By pjain      Published Aug. 4, 2020, 1:05 a.m. in blog Health   

Antiviral, Anti-inflammatory and HCQ

Other Anti-virals

Remdesivir

Studies show not as effective as Hydroxychloroquine with more side effects.

In Canada, now Remdesivir is approved. Canadians should have options to choose w/ doctor. Would you prescribe HCQ if a patient requested

HCQ

In the Middle East, HCQ is working extremely well treating pts early.

HCQ in Covid-19 - Summary and Lessons

I am puzzled by the HCQ mess - can this be resolved?

CQ, HCQ approved decades ago - effective in Malaria, Lupus treatment

CQ chloroquine and HCQ hydroxychloroquine are anti-malaria drugs that were approved decades ago to treat and prevent malaria but are also used for other ailments, such as lupus and rheumatoid arthritis.

Current regulatory status

The Food and Drug Administration has revoked its emergency-use authorization for chloroquine and hydroxychloroquine for the treatment of Covid-19 after concluding they are unlikely to help fight the disease.

Vaccine Push - hundreds of billions of Profits at stake

Pharmas desire to push a more expensive medication onto the market, and to push a new vaccine on the world’s population. Due to the Covid fear - it becomes mandatory, and the price can be very high! In fact like the iPhone, "rationing" and national grabbing will help raise toe prices skyhigh.

Why Pharmas hate HCQ - Spanner in their Gold Making Machine

Hydroxychloroquine is a generic drug that is no longer covered by patent, and can be made and sold by any generic producer, for a fraction of the price that Gilead, for example, might charge for its still-patented Remdesivir. If it turns out that this “new” virus is easily treatable, with hydroxychloroquine or anything else, then the industry’s dreams go up in smoke.

Eventually, the silencing of dissenting voices, the “fact-checking” on social media, the campaigns against “misinformation” - will be revealed in plain sight, for what it has always been: Nothing more than a well-funded marketing campaign and damage-control effort on behalf of the industry that wants you to believe that you need to use its expensive products in order to go on living.

Pharmas control Narrative - Media Bias and control over Doctors XFR

Lobbyists and Capture of Congress

Pharmas totally control politicians such as Congressman Adam Schiff, who last year wrote to the CEOs of Amazon, Facebook and Google, requesting that those companies censor information and products that did not conform to the officially sanctioned position on vaccines. All three complied.

Media

Supposedly 70% of all US news ads come from pharmas .. “reporting” on medical issues can be difficult to distinguish from outright marketing for or representing positions of drug companies.

Doctors

Novartis was fined $700m (?) for trying to influence

Social-media platforms and Censoring

“partnerships” such as that between the CDC Foundation and MailChimp (which like many other platforms, has an explicit policy of censoring content about vaccines that does not align with the positions of the CDC and the WHO)

Pharmas totally control politicians such as Congressman Adam Schiff, who last year wrote to the CEOs of Amazon, Facebook and Google, requesting that those companies censor information and products that did not conform to the officially sanctioned position on vaccines. All three complied.

Twitter and Facebook have likewise removed posts about the drug, most notably–and with no visible sense of irony–removing posts of the video in which the Frontline Doctors speak out about widespread media censorship of the topic.

Capture of CDC

HCQ Major POSITIVE Studies and Thesis

HCQ Meta Studies

  • https://c19study.com/

Major NEGATIVE Studies

WRONG: LATE HCQ No benefit ALONE for mild illness - Boulware, July 15 2020

  • https://www.acpjournals.org/doi/10.7326/M20-4207

1. TRIAL SETUP - EARLY TREATMENT on SYMPTOMS, 40-year Average

Random assignment to placebo or HCQ. In Hydroxychloroquine arm, 201 received 800 mg, followed by 600 mg several hours later, and then 600 mg daily for four additional days. They were monitored for two weeks to track symptoms: whether they resolved or worsened, or if the patients needed hospitalization or died.

EARLY All subjects enrolled within four days of experiencing symptoms and were required to have either tested positive for Covid-19 or been exposed within two weeks to someone who had tested positive. More than half enrolled within one day of experiencing at least one symptom. Scope 491-person study

Sponsors: David Boulware, an infectious-diseases specialist at the University of Minnesota - https://covidpep.umn.edu/

The trial was double-blinded, meaning that neither the study subjects nor the researchers knew who received a drug or placebo.

2. RESULTS

About 24% of people or 49/201 given HCQ pills continued to show symptoms such as a cough or fever two weeks after first receiving the treatment, compared with 30% of people or 59/194 given a placebo.

3. SIDE-EFFECTS

Researchers didn’t find any serious safety problems associated with the drug’s use, such as irregular heart rhythms or deaths. Milder side effects such as nausea or diarrhea were more common in patients who received hydroxychloroquine in this study. Individuals with known heart arrhythmia problems weren’t included in the study.

ISSUES LEFT : ELDERLY

Dr. Boulware said the drug may still work early on in elderly Covid-19 patients who aren’t hospitalized, or in combination with other medications such as the antibiotic azithromycin.

CRITICISMS & REBUTTALs

PKJ COMMENT> This seems like a significant difference - but study seems to suggest not statistically conclusive ie could happen randomly. The conclusion of the study is actually a ~40% reduction in hospitalizations/deaths in patients treated with HCQ vs placebo (2.5% vs 4.1%). This did not reach significance, but would have been strong encouragement to proceed with additional higher powered RCTs. The study didn’t find that adding zinc or vitamin C to either the hydroxychloroquine or placebo treatment led to a faster resolution of symptoms, researchers said.

  1. Actual treatment was NOT early but LATE - 4 day after exposure and shipping delay - at least 1-2 days.

  2. Medical adherence was only 75% - with 16% not taking medication at all. This severely limits the conclusions.

  3. https://c19study.com/watanabe.html

  4. This was not really a RCT The Minnesota study is honestly an embarrassment to the term “randomized controlled trial” and should actually be called an “anonymous online survey” instead. The participants were evaluated via a static online survey and not actually seen by physicians or medical personnel.

  5. Only 34% of participants had a positive PCR test. The remaining 66% either did not have a PCR test or actually tested negative. This means that a positive diagnosis was made based on only SYMPTOMS for the vast majority of participants. What happens if a large percent of the participants didn’t actually have COVID-19? It would diminish the observed therapeutic effect of hydroxychloroquine (HCQ probably isn’t going to help allergies or the common cold).

  6. If the researchers had kept their original end point (hospitalization/death), the study would've actually shown a strong trend toward benefit for HCQ. Instead, the researchers changed the end point mid-study from hospitalizations/death to symptoms at 14 days.

  7. most criticisms from - https://twitter.com/JamesTodaroMD/status/1289563466819186695

LATE: Did not help Hospitalized Patients - NIH halted HCQ June 2020

National Institutes of Health halted its clinical trial of hydroxychloroquine, concluding the drug was very unlikely to help hospitalized patients.

Dr. Fauci & the NIH started a trial in May doing just this. The bad news is they cancelled the trial after enrolling only 20 subjects in order to focus on a new trial evaluating remdesivir plus baricitinib (another “novel” patented drug).

EARLY no HCQ benefit - Spain, July 16, 2020

Resources

Lessons about RCTs --- xfr ---

RCT ethics

  • How are they getting informed consent on these very sick patients? Double blind studies means some will not be treated which is unethical. You can’t pick and choose who lives & who dies in critically ill patients. john Veall @docveall

    It’s only unethical if there is an alternate treatment that has been proven to work. Treating someone with an ineffective drug with side effects is also unethical. Not treating something with an unproven drug— perfectly ethical and best practice

Nof1 - are they "Online Internet Surveys"

The Minnesota HCQ/Covid19 study is honestly an embarrassment to the term “randomized controlled trial” and should actually be called an “anonymous online survey” instead. The participants were evaluated via a static online survey and not actually seen by physicians or medical personnel.

Testing Limitations - Only take people tested positive - Can affect number in study.

A lack of testing availability was one limitation to the study. Some patients who initially enrolled after having been exposed to the virus ended up not having Covid-19 and needed to be excluded. This can affect study results if number of participants drops too much.

Random and Double Blind RCTs essential

Patients need to be randomly assigned to receive the drug or the placebo - so as to prevent bias or underlying "pre-selection" eg fraility, other disease loads, etc from affecting the split data! The trial was double-blinded, meaning that neither the study subjects nor the researchers knew who received a drug or placebo.

STAGE OF PATIENT: Minimum asymptomatic vs LATE stage/damaged lungs

PATIENT ENROLLMENT SCOPE: Early, or Late

  • Often to avoid side-effects, unnecessary deaths, exclude patients with proven other diseases or mortality. For example in HCQ studies looking at cardiac side effects - exclude people with prior Arrhythmia.

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