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My Hydroxychloroquine Deep Dive - long thread
Gotta start with this chart many of you have seen by now
In early June after months of following articles, treatment protocols, declarations, etc. I was curious about how the countries lined up. For the most part, it's accurate
Gotta start with this chart many of you have seen by now
In early June after months of following articles, treatment protocols, declarations, etc. I was curious about how the countries lined up. For the most part, it's accurate
It's not perfect as HCQ was also used in Belgium and Spain and later in Italy, but the idea is that Western Europe as a whole never embraced the 'treat early and often' strategy. Mostly they tried it with sick patients, didn't work..moved on
They mainly followed the WHO position
They mainly followed the WHO position
I wanted to address the chart first, because its not a work of great science. It was meant to provoke thought and discussion.
Along the way, some saw it as proof. It's not, but it does make you say "hmm.."
In this thread, I'm going to try and go much deeper into the data
Along the way, some saw it as proof. It's not, but it does make you say "hmm.."
In this thread, I'm going to try and go much deeper into the data
Mainly I want to talk about two types of data:
Scientific Data: lots of studies on HCQ are out and you can find them here http://www.c19study.com @CovidAnalysis
Countrywide Data: country data is also very important for reasons I will explain shortly
Scientific Data: lots of studies on HCQ are out and you can find them here http://www.c19study.com @CovidAnalysis
Countrywide Data: country data is also very important for reasons I will explain shortly
The problem with proving that HCQ works is that 99.5% of people who get Covid do not die
The problem with Dr Raoult's early findings is that his patient base was fairly young so while his results were excellent, it was hard to evaluate them without a control
The problem with Dr Raoult's early findings is that his patient base was fairly young so while his results were excellent, it was hard to evaluate them without a control
The necessary study to do is testing HCQ with high risk outpatients - treat early and often
@zev_dr did this with good results, but unfortunately, it's not an RCT and small cohort https://www.preprints.org/manuscript/202007.0025/v1
@zev_dr did this with good results, but unfortunately, it's not an RCT and small cohort https://www.preprints.org/manuscript/202007.0025/v1
The NIH is currently conducting one such large scale RCT which should give us a pretty definitive answer, but so far I know nothing of its progress
If anybody knows more, please share https://clinicaltrials.gov/ct2/show/NCT04358068
If anybody knows more, please share https://clinicaltrials.gov/ct2/show/NCT04358068
Quick aside:
Nobody knows HCQ works - antiviral/anti-inflammatory, they are all theories
Zinc - I know the theory and its scientifically plausible but nobody knows the exact mechanism
Nobody knows HCQ works - antiviral/anti-inflammatory, they are all theories
Zinc - I know the theory and its scientifically plausible but nobody knows the exact mechanism
Here are some of the positive studies of note:
Michigan 2,541 patients retrospective
Treatment with HCQ cut the death rate significantly in sick hospitalized patients, no heart-related side-effects. HCQ decreases mortality from 26.4% to 13.5% (HCQ) https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext
Michigan 2,541 patients retrospective
Treatment with HCQ cut the death rate significantly in sick hospitalized patients, no heart-related side-effects. HCQ decreases mortality from 26.4% to 13.5% (HCQ) https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext
NYC Study - 6493 patients, laboratory-confirmed C19 w clinical outcomes between Mar 13 and Apr 17, 2020
Kaplan-Meier estimate showed lower mortality in hospitalized patients who received hydroxychloroquine (log rank Pvalue < 0.001) https://link.springer.com/article/10.1007/s11606-020-05983-z#MOESM1
Kaplan-Meier estimate showed lower mortality in hospitalized patients who received hydroxychloroquine (log rank Pvalue < 0.001) https://link.springer.com/article/10.1007/s11606-020-05983-z#MOESM1
Portugal Study
Results: 77 (0.29%) of 26,815 C19 positive patients and 1,215 (0.36%) of 333,489 negative patients were chronically treated with HCQ (P=0.04)
Conclusions: data suggest that chronic treatment with HCQ confer protection against C19 infection https://www.medrxiv.org/content/10.1101/2020.06.26.20056507v1
Results: 77 (0.29%) of 26,815 C19 positive patients and 1,215 (0.36%) of 333,489 negative patients were chronically treated with HCQ (P=0.04)
Conclusions: data suggest that chronic treatment with HCQ confer protection against C19 infection https://www.medrxiv.org/content/10.1101/2020.06.26.20056507v1
And for you Zincophiles, there is a study showing that the addition of Zinc does indeed help over just HCQ+AZ https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v1
Negative Studies:
This is the infamous VA retrospective study where the HCQ arm was significantly sicker
This got huge headlines https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v2
This is the infamous VA retrospective study where the HCQ arm was significantly sicker
This got huge headlines https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v2
Then came the NEJM study where they
1) did a crazy propensity matching to align two arms which barely overlapped https://twitter.com/BranchWestyn/status/1258538499134742528?s=20
2) conflated intubation or death into a single outcome but didn't provide seperate numbers https://twitter.com/dperetti/status/1259154540630364162?s=20
https://www.nejm.org/doi/full/10.1056/NEJMoa2012410?query=featured_home
1) did a crazy propensity matching to align two arms which barely overlapped https://twitter.com/BranchWestyn/status/1258538499134742528?s=20
2) conflated intubation or death into a single outcome but didn't provide seperate numbers https://twitter.com/dperetti/status/1259154540630364162?s=20
https://www.nejm.org/doi/full/10.1056/NEJMoa2012410?query=featured_home
Then there was the Lancet study which was based on the implausible Surgisphere database compliments of Sapan S Desai, MD
WHO recommended an end to HCQ use based on this study which later had to be retracted, because the data was allegedly fake https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext
WHO recommended an end to HCQ use based on this study which later had to be retracted, because the data was allegedly fake https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext
The famous RECOVERY RCT trial which showed no benefit in late use. Around 25% died in
There were however some strange dosing issues covered extensively by @JamesTodaroMD
https://twitter.com/JamesTodaroMD/status/1272661099985481733?s=20
https://www.medrxiv.org/content/10.1101/2020.07.15.20151852v1
There were however some strange dosing issues covered extensively by @JamesTodaroMD
https://twitter.com/JamesTodaroMD/status/1272661099985481733?s=20
https://www.medrxiv.org/content/10.1101/2020.07.15.20151852v1
Overall, there are more positive than negative studies
The negative studies are mostly about treating very sick patients with HCQ which is known not 2 work
I believe there is some amount of bad faith involved here
It has been 4 months and we do not have one proper RCT study...
The negative studies are mostly about treating very sick patients with HCQ which is known not 2 work
I believe there is some amount of bad faith involved here
It has been 4 months and we do not have one proper RCT study...
For country data there are two types of analysis
1) differences caused by the introduction of HCQ into a population previously not receiving it
2) early treatment protocols in countries that significantly outperform other countries with similar age pyramids
1) differences caused by the introduction of HCQ into a population previously not receiving it
2) early treatment protocols in countries that significantly outperform other countries with similar age pyramids
Country data is important because it allows you to resolve the 99.5% will live problem
If comparing countries with similar age pyramids and testing, significant differences can indicate that treatment is a significant factor
If comparing countries with similar age pyramids and testing, significant differences can indicate that treatment is a significant factor
Algeria - Started using Chloroquine in late March. Results came very soon
According to one infectious disease specialist, "near-total effectiveness."
https://translate.google.com/translate?sl=fr&tl=en&u=https%3A%2F%2Fwww.observalgerie.com%2Fcoronavirus-les-specialistes-font-le-bilan-du-traitement-a-la-chloroquine%2F2020%2F
According to one infectious disease specialist, "near-total effectiveness."
https://translate.google.com/translate?sl=fr&tl=en&u=https%3A%2F%2Fwww.observalgerie.com%2Fcoronavirus-les-specialistes-font-le-bilan-du-traitement-a-la-chloroquine%2F2020%2F
Morocco - Also started treating in late March
Again, almost immediate results
Fun fact: more people have died of COVID in the Moroccan diaspora than in Morocco! Think about that for a second...
I tried to find that article where I read that but couldn't
Again, almost immediate results
Fun fact: more people have died of COVID in the Moroccan diaspora than in Morocco! Think about that for a second...
I tried to find that article where I read that but couldn't
Russia - has an incredible CFR of 1.6% and does fewer tests per million than the UK which was a CFR of 15% percent. That's a 10 fold difference
Russia's treatment protocol: Treat early and often with HCQ
https://translate.googleusercontent.com/translate_c?depth=1&pto=aue&rurl=translate.google.com&sl=ru&sp=nmt4&tl=en&u=https://fmbaros.ru/upload/medialibrary/53f/Nikiforov-_-Sovremennye-podkhody-etiotr.-i-patogeneticheskoy-terapii-_2_.pptx&usg=ALkJrhjd2iOarWuo3nFiN3vog_qD4COJmg
Russia's treatment protocol: Treat early and often with HCQ
https://translate.googleusercontent.com/translate_c?depth=1&pto=aue&rurl=translate.google.com&sl=ru&sp=nmt4&tl=en&u=https://fmbaros.ru/upload/medialibrary/53f/Nikiforov-_-Sovremennye-podkhody-etiotr.-i-patogeneticheskoy-terapii-_2_.pptx&usg=ALkJrhjd2iOarWuo3nFiN3vog_qD4COJmg
Ukraine, similar to Russia, has a low CFR of 2.5% CFR but unlike Russia it has 1/10th the testing of the UK
This was hard to find, but here are Ukraine's treatment protocols - immediate treatment upon suspicion of Covid
https://translate.google.com/translate?hl=en&sl=uk&u=https://dec.gov.ua/mtd/koronavirusna-hvoroba-2019-covid-19/&prev=search&pto=aue
https://translate.googleusercontent.com/translate_c?depth=1&hl=en&prev=search&pto=aue&rurl=translate.google.com&sl=uk&sp=nmt4&u=https://www.dec.gov.ua/wp-content/uploads/2020/04/2020_762_protokol_covid19-f.pdf&usg=ALkJrhhmq4D5Qm8wqPdhZKmnjvYixZXwnw
This was hard to find, but here are Ukraine's treatment protocols - immediate treatment upon suspicion of Covid
https://translate.google.com/translate?hl=en&sl=uk&u=https://dec.gov.ua/mtd/koronavirusna-hvoroba-2019-covid-19/&prev=search&pto=aue
https://translate.googleusercontent.com/translate_c?depth=1&hl=en&prev=search&pto=aue&rurl=translate.google.com&sl=uk&sp=nmt4&u=https://www.dec.gov.ua/wp-content/uploads/2020/04/2020_762_protokol_covid19-f.pdf&usg=ALkJrhhmq4D5Qm8wqPdhZKmnjvYixZXwnw
Conclusions:
HCQ Studies are overwhelmingly positive
Negative studies get lots of attention but have some serious flaws
Country data offers some convincing arguments
Need to wait for RCTs to be proven
If you liked this deep dive please RT the first tweet in this thread!
HCQ Studies are overwhelmingly positive
Negative studies get lots of attention but have some serious flaws
Country data offers some convincing arguments
Need to wait for RCTs to be proven
If you liked this deep dive please RT the first tweet in this thread!
Data out of Mumbai slums
https://twitter.com/gummibear737/status/1288165035471253505?s=21 https://twitter.com/gummibear737/status/1288165035471253505
https://twitter.com/gummibear737/status/1288165035471253505?s=21 https://twitter.com/gummibear737/status/1288165035471253505
So this happened, the only RCT which could settle the debate on early use HCQ was shut down because they only have 20 subjects since May
Draw your own conclusions
I hear there are plenty of volunteers to populate (30k) Moderna’s mRNA vaccine trial
https://twitter.com/gummibear737/status/1289263452574355459?s=21 https://twitter.com/gummibear737/status/1289263452574355459
Draw your own conclusions
I hear there are plenty of volunteers to populate (30k) Moderna’s mRNA vaccine trial
https://twitter.com/gummibear737/status/1289263452574355459?s=21 https://twitter.com/gummibear737/status/1289263452574355459
https://twitter.com/gummibear737/status/1291007011166081025?s=21 https://twitter.com/gummibear737/status/1291007011166081025
Finally, my prediction on HCQ
https://twitter.com/gummibear737/status/1292572424844845057?s=21 https://twitter.com/gummibear737/status/1292572424844845057
https://twitter.com/gummibear737/status/1292572424844845057?s=21 https://twitter.com/gummibear737/status/1292572424844845057
