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Sovereignty

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Conducting proper double-blind tests rather than flinging everything at the patient and hoping something works would be a good idea, too.


One of the issues that Christopher D. Barrett and Michael B. Yaffe bring up in their editorial (reviewed on TWIV) is that pathways (approved treatment protocols) do not exist for COVID-19 because it is a new disease. They report that the recent cohort of doctors don't know how to respond in this situation. There is no approved treatment protocol based on evidence to go by, and they are not comfortable going back to the science and making decisions.

If Trump's doctors relied strictly on evidence, it is not clear they would be able to do anything for him. There have been no successful RCT's for patients with only mild or moderate illness as far as I know.

The only drug they've given him that surprises me is the dexamethasone. Of course, I am not a doctor, but without approved treatment protocols what good are doctors??? (sardonic question)
 

Innula Zenovka

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One of the issues that Christopher D. Barrett and Michael B. Yaffe bring up in their editorial (reviewed on TWIV) is that pathways (approved treatment protocols) do not exist for COVID-19 because it is a new disease. They report that the recent cohort of doctors don't know how to respond in this situation. There is no approved treatment protocol based on evidence to go by, and they are not comfortable going back to the science and making decisions.

If Trump's doctors relied strictly on evidence, it is not clear they would be able to do anything for him. There have been no successful RCT's for patients with only mild or moderate illness as far as I know.

The only drug they've given him that surprises me is the dexamethasone. Of course, I am not a doctor, but without approved treatment protocols what good are doctors??? (sardonic question)
Here's the UK guidance


 

Sovereignty

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Yep. Does not say anything about what helps people with moderate symptoms, the context of my remarks. This is all "after the horse has left the barn" basically. For the sake of comparison, there is not much doctors can do with influenza either. Tamiflu reduces symptoms if given in the first three days, but getting diagnosed by a doctor in that time is problematic. Even flu vaccines are not all that effective in preventing flu though they still can help reduce the severity of flu symptoms. No magic bullets.
 

Innula Zenovka

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Yep. Does not say anything about what helps people with moderate symptoms, the context of my remarks. This is all "after the horse has left the barn" basically. For the sake of comparison, there is not much doctors can do with influenza either. Tamiflu reduces symptoms if given in the first three days, but getting diagnosed by a doctor in that time is problematic. Even flu vaccines are not all that effective in preventing flu though they still can help reduce the severity of flu symptoms. No magic bullets.
I think the advice here is that, if you have moderate symptoms, stay at home, drink plenty of fluids and take something to keep your temperature down, and phone the main NHS advice line if things take a turn for the worse, so they can take it from there and send an ambulance if necessary. We're not supposed to turn up at the ER complaining of Covid-19.
 

Sovereignty

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I think the advice here is that, if you have moderate symptoms, stay at home, drink plenty of fluids and take something to keep your temperature down, and phone the main NHS advice line if things take a turn for the worse, so they can take it from there and send an ambulance if necessary. We're not supposed to turn up at the ER complaining of Covid-19.
Even though drugs like Remdesivir and Regeneron would likely be most effective precisely at early stages of the disease. Like Tamiflu with influenza.

There is a problem with RCT's in that they are often limited to people already in the hospital. They don't collect evidence of what could help people they not admitted to the hospital. (I don't think Trump was ever in need of that.) That's not an issue with the concept of an RCT, it's just the execution.

There's an inherent problem with doing RCT's on non-hospitalized patients because so many will get better anyway. It requires a very large study to determine if a drug is useful in that situation. That's expensive. Much cheaper to test on people with more severe disease and hope for insights.

Meanwhile, we lack useful evidence for this stage of the disease, and we won't do anything without evidence. Nothing wrong with [the concept of] evidence, just not collecting it effectively.

IIRC, a WHO official was complaining recently that we are drowning in a sea of useless data. Wish I had the link.
 
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Innula Zenovka

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Even though drugs like Remdesivir and Regeneron would likely be most effective precisely at early stages of the disease. Like Tamiflu with influenza.

There is a problem with RCT's in that they are often limited to people already in the hospital. They don't collect evidence of what could help people they not admitted to the hospital. (I don't think Trump was ever in need of that.) That's not an issue with the concept of an RCT, it's just the execution.

There's an inherent problem with doing RCT's on non-hospitalized patients because so many will get better anyway. It requires a very large study to determine if a drug is useful in that situation. That's expensive. Much cheaper to test on people with more severe disease and hope for insights.

Meanwhile, we lack useful evidence for this stage of the disease, and we won't do anything without evidence. Nothing wrong with evidence, just not collecting it effectively.

IIRC, a WHO official was complaining recently that we are drowning in a sea of useless data. Wish I had the link.
According to this, the problem with Remdesivir is that supplies are limited, so it's being given (in the UK) to the people most in need


Regeneron is still undergoing phase 3 trials

 

Sovereignty

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According to this, the problem with Remdesivir is that supplies are limited, so it's being given (in the UK) to the people most in need


Regeneron is still undergoing phase 3 trials

But we really are talking about Trump. It's just one person. That was the reference in what you quoted in post 3639. So shortages are not a valid issue in this context.

We are still in kitchen sink mode with COVID-19 even if we pretend otherwise especially for people with moderate symptoms. Looking at clinicaltrials.gov I see Regeneron is recruiting for a large trial for ambulatory patients. That's good. Since they are onto phase III, safety is less of a concern. I see nothing wrong with trying it even if it proves nothing and does nothing.

But....

... ideally, they should not have publicized giving him Regeneron. As it is, the publicity surrounding our celebrity patient may give people a false impression. But dammit, the news media insisted on getting as much detail as possible. You'd think Brittney Spears had shaved her head.
 

Innula Zenovka

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But we really are talking about Trump. It's just one person. That was the reference in what you quoted in post 3639. So shortages are not a valid issue in this context.

We are still in kitchen sink mode with COVID-19 even if we pretend otherwise especially for people with moderate symptoms. Looking at clinicaltrials.gov I see Regeneron is recruiting for a large trial for ambulatory patients. That's good. Since they are onto phase III, safety is less of a concern. I see nothing wrong with trying it even if it proves nothing and does nothing.

But....

... ideally, they should not have publicized giving him Regeneron. As it is, the publicity surrounding our celebrity patient may give people a false impression. But dammit, the news media insisted on getting as much detail as possible. You'd think Brittney Spears had shaved her head.
What's wrong with trying it, outside a clinical trial, is that you don't know what effect -- if any -- it has on the outcome.

I'm just reporting on what's happening the NHS, where they do evidence-based medicine.
 
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Sovereignty

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What's wrong with trying it, outside a clinical trial, is that you don't know what effect -- if any -- it has on the outcome.

I'm just reporting on what's happening the NHS, where they do evidence-based medicine.
You can't do evidence-based medicine on a population for which you never/rarely collect evidence, i.e., people not in hospitals.

If they are doing only evidence-based medicine (which is the standard approach around the world) for people who don't need to be hospitalized (Trump), then you must be excluding these people from your medical practice. (I'm basically repeating myself from earlier posts.)

That in fact has happened with COVID-19. People not needing to be hospitalized have been told, "Go home, come back when you are sicker."

If you have acces to a drug like remdesivir and/or regeneron, it is okay to give it to people in the viral stage of the disease even if no one has tested it on those patients. No insurance company will pay for it in the U.S. (They perform the function of defining approved treatment protocols here.), but it's possible the patient may not care.
 

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Another "tracker," this with some more inclusive, global focus.

 
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Innula Zenovka

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You can't do evidence-based medicine on a population for which you never/rarely collect evidence, i.e., people not in hospitals.
Really? I've already volunteered for this trial, should I become infected

 
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Sovereignty

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Really? I've already volunteered for this trial, should I become infected

Results aren't in. Still don't have data.

We're waiting on you specifically. Hurry up and get infected so we can get some data!!!!!!! :)

ETA: Hurray for our citizen scientist, Innula!
 
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Innula Zenovka

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Results aren't in. Still don't have data.

We're waiting on you specifically. Hurry up and get infected so we can get some data!!!!!!! :)

ETA: Hurray for our citizen scientist, Innula!
Thanks, though I must confess I'm doing my best to ensure that I don't actually have to participate, as I'm sure you'll understand!
 

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Great...

China has now signed on to a massive, global alliance to develop and equitably distribute a coronavirus vaccine—putting the United States’ absence from the pact into yet sharper relief.

With its late entry announced Friday, China joins around 170 other countries in the pact, called the COVAX Facility. The effort is being spearheaded by the World Health Organization and co-led along with the Coalition for Epidemic Preparedness Innovations (CEPI) and Gavi, the Vaccine Alliance.
 

Sovereignty

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Innula, did you score some swag? Novavax was giving this out. What are ginger nuts???