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Discussion in 'General OT' started by imart, Jan 28, 2020.
cinema still not allowed on GCQ.
Home Theater, pare.
This Is How Deeply the Coronavirus Changed Our Behavior
Twenty graphics that show how fear transformed human activity in 2020.
Zoe Schneeweiss, Dan Murtaugh, and Bloomberg Economics
May 28, 2020, 12:01 AM EDT
In early 2020 a deadly microscopic predator sent humans into hiding and slammed the brakes on global commerce. Economic destruction like this hasn’t been seen since the Great Depression. Here we illustrate the new coronavirus’s effects on basic metrics such as gross domestic product and unemployment, the collapse in demand for fuel, the rapid adoption of telehealth, and the surge in liquor purchases. This is a new economy built on fear.
From what I’ve gathered, the Lancet study while (probably) randomized, did not control for the timing of the administration of the drug (early onset or last stages) so it is not “gold standard” study. It did stir a hornet's nest especially that WHO picked it up and suspended their own trials based on those (Lancet) findings, and from there, some countries (like France) banned the use of HCQ for use on Covid19. Some, like Costa Rica, will continue using HCQ, but will be re-evaluating their use of it.
By the way, Costa Rica seemed to have had great success in using HCQ because they have a low case fatality rate. All patients there are given the option to use HCQ, as long as they don’t have any contraindications to it.
Going back, that's how influential that study, or how influential WHO is, that countries (still) listen. Even Malaysia from hereon will use HCQ “cautiously”. Now this is the disservice I was talking about. All of a sudden, HCQ seems to be dangerous to use because of WHO’s announcement to suspend trials. Yes, they may not have given a formal advisory to stop using it, but the damage was still done anyway.
Now, some people are beginning questioning the data (provided by Chicago based Surgisphere) used by the Lancet study. From the onset, there’s this doctor in France who twitted that the data was “manipulated”. Then we have this news article:
From the article:
Scientists question validity of major hydroxychloroquine study
““Data from Africa indicate that nearly 25% of all COVID-19 cases and 40% of all deaths in the continent occurred in Surgisphere-associated hospitals, which had sophisticated electronic patient data recording,” the scientists wrote. “Both the numbers of cases and deaths, and the detailed data collection, seem unlikely.”
Another of the critics’ concerns was that the data about COVID-19 cases in Australia was incompatible with government reports and included “more in-hospital deaths than than had occurred in the entire country during the study period.””
“One of the signatories, Dr. Adrian Hernandez, who heads the Duke Clinical Research Institute, said the paper contained many troubling anomalies, “but the biggest thing that raised a red flag was that here was such a large database across more than 600 hospitals, and no one had really known about its existence. That was quite remarkable.””
Whether there was manipulation and/or the data used in the Lancet study was shady to begin with, adds to the controversy. The motives of the shakers and the movers (against) HCQ are being questioned, to say the least. Only RCT findings may stop all this.
In the end, why not give doctors and patients the freedom to decide on whether HCQ will be beneficial for them or not? Like they do in Costa Rica? I’m glad the Philippines is still OK with HCQ use. And I hope those RCT trials will come out soon and put an end to the controversy one way or the other.
I'd like to this same deep dive presentation for the Philippines and specific to the city we all live in
In the wake of that Lancet study, and WHO's announcement that they will "pause" trials on HCQ:
Spain will not stop use of HCQ to treat COVID-19 patients, unlike other European nations
1) "Several European nations, including France, Italy and Belgium, followed a World Health Organisation decision on Monday to pause a large trial of hydroxychloroquine due to safety concerns."
(there you go, followed WHO decision)
2) "A UK regulator said on Wednesday that a separate trial was also being put on hold, less than a week after it started."
(uh-oh, UK too)
3) "Spanish health watchdog, AEMPS, said the paper published by Lancet was not conclusive enough to stop testing it at Spanish hospitals."
(good for them)
4) "Germany is looking at The Lancet study and the WHO's decision but has not made any decision about new guidance on hydroxychloroquine."
(let's wait and see what happens next)
5)"The US Food and Drug Administration has allowed healthcare providers to use hydroxychloroquine for COVID-19 through an emergency-use authorisation, but has not approved them to treat it."
(what more can I say?)
How did Vietnam manage to avoid even one coronavirus death?
Containing the coronavirus (COVID-19): Lessons from Vietnam
Figure 1: Prevalence of COVID-19 infections in Vietnam and selected countries
First, we have to establish the distinction between randomized control trials (RCT) and an observational study which cohort studies fall under, simply to iron out some details for the sake of the discussion. These two types of research, although different, are notably integral to the field of quantitative medical research.
An example of RCT is WHO's solidarity trial, involves experimentation of a drug intervention in comparison with another drug or lack-thereof (control or placebo) in which you compare and measure each drug’s effectiveness in regards to the expected outcome. There is randomization in terms of how you allocate the drug and the placebo to the enrolled population. In summary of the basic framework of an RCT, there is a randomization, an experimental group (the treatment) and a control group.
Observational studies, like the one published by Lancet ( a cohort study), entails retrospective analysis of existing data to make a conclusion involving a subset of a population with the same characteristics (confirmed COVID-19) and try to tease out and establish risk factors/exposure associated with the disease/outcome. In this case, the link between HCQ (the exposure) and death (the outcome) is examined which Lancet was able to conclude that COVID-19 patients taking HCQ had a higher rate of dying compared to those who didn’t.
In summary of the two types of research study,
RCT (Solidarity trial) = there is randomization, there is an experimental and control group. It is prospective as you need to generate original clinical data derived from the experiment.
Observational study/Cohort study (Lancet) = there is no randomization hence it’s not probable as you claim it is, no experimental group (no treatment) and no defined control group. It is retrospective as used by Lancet (can be prospective depending the on the study’s design) requiring examination of prior clinical data.
Granted that RCT is the gold standard by which a drug’s effectiveness is measured and established. Would an observational study be less valid or important in the current circumstances? Absolutely not.
Observational studies (OS) are important as RCTs as OS allows you to look back in time, examine a specific subset of population who are exposed to a drug versus those who weren’t to define the incidence of adverse drug events (harm) and/or measures of effectiveness of the drug (benefit). OS is less cumbersome compared to RCT wherein in normal circumstances, RCT takes years and requires an exorbitant amount of money to produce results.
In any case, there is room for both studies in the current times and no need to discredit one over the other. RCTs of COVID-9 drugs however are still ultimately needed, which will support or disfavor the findings of OS such as that of Lancet’s but it doesn’t make the OS less valid in comparison with RCTs.
Good for Costa Rica. The question here is how can you make the claim it’s successful due to HCQ? Care to elaborate your basis as to why you attribute HCQ to Costa Rica’s low case fatality rate? Keyword here is optional; not all patients are required to take the drug anyways so how come you’re certain that HCQ lowered the case fatality rate when not everyone is taking the drug? Show me the data please, if you have any.
What damage? Care to elaborate. How does WHO’s temporary suspension of its HCQ trial has inflicted, in any form, be damaging? I am interested in hearing your opinion concerning a drug that has yet to establish its evidence of sufficient effectiveness.
The issue apparently involves some discrepancy in their data collection and content, nevertheless the authors expressed their intent to be fully transparent and are willing to be independently audited by third party assessors including by WHO.
I quote: “A spokeswoman for Dr. Mandeep Mehra, the Harvard professor who was the paper’s lead author, said Friday that the study’s authors had asked for an independent academic review and audit of their work.”
Kudos to them for standing up to their work.
I think this freedom is hinged upon whether there is evidence of benefit at all before considering the drug for routine use. I wouldn’t be surprised to see HCQ having no benefit at all in the upcoming trials but we’ll see.
In a related note, the Recovery trial in UK will publish its findings as early as this upcoming June, 2020. An RCT that will assess the some of the following treatment modalities:
· Lopinavir-Ritonavir (commonly used to treat HIV)
· Low-dose Dexamethasone (a type of steroid, which is used in a range of conditions typically to reduce inflammation).
· Hydroxychloroquine (related to an anti-malarial drug)
· Azithromycin (a commonly used antibiotic)
· Tocilizumab (an anti-inflammatory treatment given by injection)
· Convalescent plasma (collected from donors who have recovered from COVID-19 and contains antibodies against the SARS-CoV-2 virus.
I think we should just wait for the findings of ongoing RCTs (especially if there is distrust of observational studies) before jumping into conclusion that drug X is beneficial, when evidence supporting its effectiveness has yet to be available.
Considering the WHO made erroneous calls in the past that possibly cost lives of thousands of people and trillions of economic damage around the world:
(WHO: Travel Ban is not Necessary)
(WHO ignored Taiwan's warning)
(WHO: Masks are not necessary for healthy people)
I can understand why medical professional everywhere are beginning to take WHO's guidelines and advice with a grain of salt.
It’s Not Whether You Were Exposed to the Virus. It’s How Much.
The pathogen is proving a familiar adage: The dose makes the poison.
“This is not a virus for which hand washing seems like it will be enough,” Dr. Rabinowitz said. “We have to limit crowds, we have to wear masks.”
Especially anything coming from that Manchurian Candidate, Tedros Adhanom Ghebreyesus. Yesus Christ, this guy is not even a medical doctor. That's like getting on a plane being flown by a guy who has heard of pilots. That's like betting on a racecar driver who's had only half a day of Socialite's driving school and he was absent on that day.
His only background was that he was the Health Secretary in his native Ethiopia, when several cholera epidemics broke out (which doesn't seem much of a plus).
His other noteworthy qualification is that China did all of his campaigning, financially backed him and railroaded him to be the head of WHO.
If the Covid19 is being treated in wartime terms like frontliners and casualties, Tedros should be tried as a war criminal.
mm...who is following DOH data? Up until a few days ago, DOH was reporting daily new infections. Now, they decided to bifurcate the data by inventing two, new categories: old cases and fresh cases. Excuse me?!! This confusing way of reporting the progress of covid 19 predictably caused mass confusion. I can’t figure out the rationale for this. What was the DOH doing before this change in reporting? Did the DOH under report cases for the previous weeks?
I am ignoring it and will just consider both numbers are daily new cases.
As it stands:
Really makes no sense.
more like "bending it like beckam" to me.. not in football but with DATA..
One of our employees passed away due to COVID-19. He was diagnosed early before the lockdown. Contact tracing was done, and no other employees who worked with him was affected.
Monster or Machine? A Profile of the Coronavirus at 6 Months
Our “hidden enemy,” in plain sight.
SARS-CoV-2 virus has no plan. It doesn’t need one; absent a vaccine, the virus is here to stay. “This is a pretty efficient pathogen,” Dr. Garry said. “It’s very good at what it does.”
Not sure if this was discussed already.
What will happen if you tested positive but asymptomatic? Do you still need to go to the hospital and get picked up by LGU?
Can't you stay home instead and quarantine?
Mm....important to coordinate with the barangay first for proper referral. Some LGUs have quarantine facilities, some do not have. It depends on the LGU. If you are not comfortable dealing with the barangay, call the city hotline or the DOH hotline for proper advice. Important to self-isolate in the meantime. This applies to every member of your household (likely exposed and may or may not develop symptoms).
2 months ago, I've had 2 colleagues infected and upon hearing the news each time it shook me a bit. I can only imagine what it must be like to hear someone actually die close to you.