triplehorn

It's more relatable when read with a Geordie Brit accent.

Just read this lay article on covid19 Ab tests. It's vexing. Gold-standard review does 'not support the roll out of coronavirus antibody tests'

seen on his golf cart bumper

I hadn’t seen that yet. Like a modern day polio. Horrible.

If I read you right, yes it’s great for that. But when someone chooses to ignore the source by attacking the twitterer, it’s a different kind of red herring all together. lol

"Publication by press release" A new normal? Former Harvard Med School prof discusses why Moderna's vaccine result announcement is akin to a CFO releasing earnings without sustainable data. He also draws a second similar comparison to Gilead's remdesivir, and separately comments on associated public remarks by close friend Dr. Fauci.

Gilead to start testing inhaled remdesivir, eyeing earlier COVID-19 use yep. This is a direct attempt to work around that Achilles heel I mentioned just above.

I'm not going to be initiating any more HCQ research, news, or opinion after this post on this or any thread. I'm open to dispassionate discussion about it in the future, but that won't be until others are on board, which isn't now. Why it matters? Understanding HCQ applies beyond this pandemic. That is because of its potential importance fighting RNA viruses as a class. One common shared trait of RNA viruses essential for viral replication is the use of RNA-dependent RNA polymerase (RdRp). If you find agents that inhibit the function of this enzyme, you potentially have a tool with a broader spectrum to fight a variety of pathogenic RNA viruses. Remdesivir inhibits this enzyme, and this is also a mechanism of action enhanced by and demonstrated for HCQ in vitro. The Achilles heel of Remdesivir, for one, is that it has to be administered IV and is very expensive. The major limitations of technical IV use and high cost make it unsuitable for broad application to mild/mod severity, non-critical cases - a large percentage of whom would develop no complications without any intervention. But what if attacking RdRp for meaningful life saving and organ protecting is dependent on hitting the infection early and hard, where doing so means you have to expose a lot of people early to a treatment who would otherwise not develop complicated illness and hospitalization? In that case you need something that is safe, easy to administer, and inexpensive (cheaper per day than OTC TheraFlu) HCQ checks those 3 boxes. The most important question to be answered is if early application is a key clinical outcome differentiator for RdRp inhibiting meds. This key question relates to all the 'vir meds in the current mix and HCQ. How many other meds in the mix check those boxes, or even two of them? Because of the active threat of recurrent deadly pandemics for years to come from various RNA viruses beyond this novel coronavirus, there is a huge amount of medical money in the balance globally. Some are primarily motivated by profit. We rely on publicly funded research to answer these questions about checking those 3 boxes, because Big Pharma has no interest in offering a helping hand or paying for studies that could tip the scale towards a safe, cheap, easy to take generic like HCQ. It's why the NIH early intervention study getting shut down is such a setback. It's not stopping other studies being done here and internationally though. Stalled and late-start domestic studies notwithstanding, today the results of a randomized controlled trial (the elusive RCT) became public from a Chinese study which demonstrate superiority of both Chloroquine and Hydroxychloroquine over control when used for early intervention in Covid-19: Efficacy and safety of chloroquine or hydroxychloroquine in moderate type of COVID-19: a prospective open-label randomized controlled study When you get this degree of decreased recovery time, it follows that peak severity of illness should also be less. Less of everything bad.

It's the latest information on very relevant NIH research. It's a medical discussion thread. I've been posting on this thread from the beginning. Try the ignore function instead of thread shitting.

After expecting to rapidly enroll 2000 subjects, NIH early intervention study gets shuttered due to only enrolling 20 patients since the start of May. BULLETIN—NIH Clinical Trial Evaluating Hydroxychloroquine and Azithromycin for COVID-19 Closes Early - "No safety concerns were associated with the trial." - "Preliminary evidence had suggested that the drug, alone or in combination with the FDA-approved antibiotic azithromycin, might benefit people with COVID-19." - "Although recent research suggests that hydroxychloroquine may not be an effective treatment for patients hospitalized with COVID-19, the question of whether it offers benefit when given early in the course of the disease remains unanswered." what in the hell. unfortunate doesn't begin to describe it.

Beyond this novel coronavirus, maybe we should be looking at common ways to attack all RNA viruses. This article puts it into some perspective. About 2-3 novel zoonotic RNA viruses per year are identified, each possibly poised to go pandemic. From 2017: Are RNA Viruses Candidate Agents for the Next Global Pandemic? A Review So more than a vaccine, targeting ways to disrupt replication of RNA viruses as a class may pay big public health dividends.

Turns all year Part 2 🤘 I summited Mt. Adams (elev 12,281) yesterday for the first time and did a ski descent with two buddies. Almost a 7000 ft vertical climb up, and an uninterrupted 4000 ft ski down via the SW chutes. Our route took us about 11 hrs and 14 mi round trip. At the summit, the visibility allowed seeing Mt. Baker 178mi to the north, just south of the Canadian border, and Sisters mountains 150 mi to the south in central Oregon. I am completely wrecked today, but the ski descent is an epic 10/10. VVV heading up to Piker's peak (aka the false summit) VVV top of Piker's (still over 700 ft. elev. to gain to reach summit) VVV SW chutes descent VVV Looking back up from about 5000ft below summit and start of SW chutes between/below the two snowy peak bumps at top. VVV The brutal part was not picking a higher elevation to traverse back over to the South Climb route we ascended . When the snow ended, we bushwhacked down another 500ft with boots and skis on our backs to find the round-the-mountain trail and hiked 2 more mi on that (more like a steeplechase this time of year) before finding the path to base. Start of bushwhack with Mt. Hood on the horizon VV Probably the biggest plus about this climb and descent is that it's generally not technical, with minimal fatal fall risk. And I can't think of another peak in the PNW that lets you view so many other major peaks spanning hundreds of miles. I highly recommend this mountain 🤘

🎯 lol.

This question has come up here previously - is there a difference in incidence and/or clinical course of Covid in patients with Rheumatic Diseases who are on disease-modifying antirheumatic drugs (DMARDs)? Based on this report, there appears to be a pre-exposure preventative effect as well as illness severity mitigating effect for Covid: Clinical Rheumatology: Impact of anti-rheumatic drugs and steroids on clinical course and prognosis of COVID-19

Sensible give and take: Tomorrow, the heavily populated tri-county area surrounding PDX begins Phase I re-opening, but starting next Wednesday, a mask wearing mandate begins for all people entering public indoor places involving any and all types of business - a requirement only in a limited number of qualifying counties across the state.

Thanks for taking the time. Regarding questions around how the practice of medicine is regulated, I'm not aware of anything I've previously said that contradicts what you posted or that reveals a misunderstanding on my part. A few posts above I specifically drew attention to States playing a primary role in regulating medical practice which naturally creates differences between States in what is available. Obviously this spans a number of different medical procedures and for what purposes various treatments can be prescribed. I pay attention to what my State authorizes and have always observed that. Off label-use of the med under scrutiny is permitted in some States at this time. Regarding the links you posted, there's nothing new in there. The WHO and NEJM articles relate only to studies done in hospitalized patients and post-exposure prophylaxis. The fda.gov letter is interesting in that the general language around the FDA/EUA for use in "hospitalized" patients is dropped. Not sure if that is a result of the letter-writer being casual or not. Of note from your second link: "The WHO noted in its announcement today’s decision to end hydroxycloroquine’s use in the Solidarity trial, which looks at stopping COVID-19, “does not apply to the use or evaluation of hydroxychloroquine in pre- or post-exposure prophylaxis in patients exposed to COVID-19.” First, what your link coveys is that this medication still remains under active investigation as a viable intervention albeit with a more narrowed focus. So yes, it's relevant for consideration and discussion. It leaves pre-exposure prophylaxis and early post-exposure mitigation of illness severity to be elaborated. Internationally, there are positive signs in both contexts, but nothing definitive at this time. Until results of additional ongoing studies are produced, positive or negative, I'll leave it that.

I disagree with your first sentence but don’t know how you’re slicing it. Even so, it’s obviously changing by the day in the US as more trial results come out, including with notable leaking of positive news in this Michigan based early use study. Regarding your last sentence, do you have an updated link ? There’s a lot of mixed messaging. NIH serves a big research function, not so much a regulatory function. The feds are not blocking it. However the governing bodies of individual States have a heavy say in what is available for use locally. My Oregon Governor put a hold on community off-label use of (H)CQ for Covid in late March, which was after off-label use was recognized within the State. At the time, it was understandable and I have observed it. I haven’t revisited it lately but do know a person who is hands on with State level public health research and policy. That person indicated that they are well aware of positive international studies generally and the 2 pre-exposure prophylaxis studies out of India in particular as they seek ways to best protect the front line Oregonians and other high risk groups. If this Michigan study, or others, support pre-exposure prophylaxis or early application for mitigation, I’d expect there to be some state level shifting here. There’s very real reason to be hopeful about this pre/early phase use.

If all you got is to show up and flame, take it elsewhere.

Following up on the above, this is the Detroit Metro Times reporting on a local ongoing FDA-approved study being conducted by Henry Ford Health System. They are looking at the effects of early application or a prophylactic effect of HCQ on Covid infection in medically stable people. The CEO of HFHS, Dr. Steven Kalkanis, says "We have analyzed our data and have seen a significantly improved outcome in a group of COVID-19 patients who received hydroxychloroquine." That's a heads up. Re this statement in the reporting: I take that to mean the feds are sitting on a stockpile of (H)CQ at the SNS that will no longer be available to supply hospitals for hospitalized patients w Covid. However, the federal SNS stockpile of (H)CQ will be available to distribute to States should they request it for use in some outpatient form of early prevention/intervention. If we're finally headed there, and this reporting is a real sign, it has the potential to be a morbid exercise to see if there's enough and, if not, where it gets funneled. Today, some States are more pre-disposed and have been more prepared to adopt this than others. * just a note on prescribing for off-label uses of medication: it is common and it is legal. the google tells me 1 in 5 prescriptions written in the US is for an off-label use. 20% of scripts written every day in the US are for off-label purposes. As a separate matter, it doesn't excuse gross incompetence, but nothing should.

It's like seeing some ants running around in the yard, then you decide to lift up a flagstone

Midstream sneak peek: WHIP COVID-19 study is an FDA-approved study looking at hydroxychloroquine as a potential preventative medication for healthy, pre-screened individuals "The FDA's decision bars the use of hydroxychloroquine sulfate and a similar drug called chloroquine phosphate from the Strategic National Stockpile for hospitalized COVID-19 patients. But the use of the drug as a prophylaxis, or preventive measure, is not impacted by the FDA decision." ^^^ Folks can wait for the peer reviewed publication to come out to get the complete presentation, but this intervention is available today for anyone interested.

This French flowchart (Dr Raoult) is pre-dexamethasone findings, but observable benefits of dexamethasone probably would start somewhere between late Phase II and Phase III. The chart shows that Phase II is associated with some lab markers that could help narrow who to give it to and how to time it if there's benefit in detecting the leading edge of the crash. There's quite a bit of international evidence to support application of zn/hcq/az as early as possible to reduce illness severity and need for hospitalization, but in the US today, most of the data that would speak to that is sequestered away in private practices. Even in countries where early application is the current national standard of care, late application has been formally abandoned due to lack of benefit and potentially greater metabolic risk for an adverse event.

"They" are acting out of self preservation, not re-election. Who wouldn't leap at anything that would make a single day of handling him more bearable. Rallies are his milk and cookies.

I think Oregon has a pretty intact contact tracing effort underway. I know the state put out a notice of recruitment to fill 600 newly created positions for statewide tracing the other month. The days in the last week that have spiked are associated with discovering clusters at food processing plants (Bob's Red Mill near PDX and one or two fish canneries near Newport and Lincoln City on the coast. Now there's the bunch of singing Pentecostals at the church way out in La Grande. Multnomah County (Portland) has been steadily in the 20-40 new cases per day for a couple months. So it's in the community, just not blowing up (yet). Widespread mask wearing around here has to be helping. Also, Gov. Kate Brown postponed shut down restrictions for PDX to enter Phase 1 re-opening. Not much protest over that that I can see.

It's not fantasy and it's not twisting data. See my post above yours. My condolences on the tragic loss of your close friend to this plague. To your other point, direct some of your attention to those on this thread who continue to talk about it while sending me notifications indicating they're drawing a disagreement. I'm responding, not randomly showing up to lob shit.