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Day 115: COVID-19 How Are Treatments Coming?
Ricochet member @dong challenged me to do a post on the status of various treatments for COVID-19. As @bitcoin has said, “I am not a doctor or a virologist, but I play one on Ricochet.” So I accept @dong ‘s challenge welcoming all amendments and corrections by more knowledgeable people in the comments (most of whom undoubtedly are more knowledgeable.)
My reading of the internet is that there are four treatment paths: (1) prevent the body from getting infected, (2) attack the virus directly, (3) attack the virus indirectly, or (4) keep the body from killing itself in response to detecting the viral infection. In addition to these strategies, there are a variety of supportive therapies that are employed depending upon which organ(s) the virus is attacking. Of important note, full-intubation high-pressure ventilators may be doing more harm than good.
So let’s talk about each of the paths:
Preventing the body from getting infected
This is the vaccine approach. Making you immune from the virus itself. Totally aside from the fact that no vaccine has ever successfully been developed for any coronavirus, there are several trying to do it:
Moderna
- Vaccine: mRNA
- Development: Phase 1 trial near complete, phase 2 trial set to start
Johnson & Johnson
- Vaccine: Modified adenovirus
- Development: Preclinical
Inovio Pharmaceutical
- Vaccine: INO-4800
- Development: Phase 1 trials
Oxford University
- Vaccine: ChAdOx1 nCoV-19
- Development: Phase 1 trials
Pfizer
- Vaccine: BNT162
- Development: Clinical trials
Sanofi and GSK
- Vaccine: Unnamed
- Development: Preclinical
Novavax
- Vaccine: NVX-CoV2373
- Development: Preclinical
Just the sheer number of organizations in the hunt should give us some hope, but it is important to understand as you read the details of each of the vaccine plans that they are not all pursuing the same design. This is not a contest for how to get a piston engine producing the most revolutions per minute. This is designing a whole new engine with potentially different energy sources and means of converting one form of energy (heat) into another form (mechanical).
Attacking the virus directly
Remdesivir (Gilead Sciences)
Originally developed for Ebola, Remdesivir attacks the virus’s capability of replicating. Clinical data shows that it may shorten the recovery time but is not demonstrated to have saved anyone from dying. Remdesivir was granted FDA approval on May 1 for emergency use, but there are still several ongoing clinical trials testing whether it’s effective.
This was initially developed to treat influenza but is being clinically trialed against COVID-19 in China, Italy, and the United Kingdom. Trials are slated to begin in Massachusetts as well. It attacks the virus by forcing mutations as it replicates neutralizing the viral effect in the body. It may be this mutation-inducing aspect that makes it not for use in pregnant women.
Attacking the virus indirectly
In addition, there are two different blood therapies: convalescent plasma and healthy donor plasma. Convalescent plasma involves extracting blood plasma from recovered COVID-19 patients and infusing that plasma into active COVID-19 patients. Healthy donor plasma recently tried in Lexington, KY, has also had good clinical results. The significance of the latter is that it may be that there is a large source of life-saving substances available that are not dependent on China or a limited population of COVID-19 survivors.
Keeping the body from killing itself
Hydroxychloroquine (HCQ)
A generic malarial drug also used for treating lupus and rheumatoid arthritis. Treating COVID-19 is an “off label” application of the drug. It suppresses the body’s response to infection which in many cases is how COVID-19 kills you. Clinicians worldwide are reporting good results with HCQ in combination with zinc and azithromycin. But the drug’s effectiveness in treating COVID-19 has not been determined through traditional double-blind studies. And some worries exist that at least in some patients with heart disease, the side effects can be fatal. Its most likely success is when given early after systems present and not when someone has progressed to intensive care.
Kevzara (Regeneron and Sanofi)
Baricitinib (Eli Lilly)
Kevzara and Baricitinib are drugs currently used to treat rheumatoid arthritis. Their strategy is suppressing the body’s immune response. Clinical trials will be starting soon. In contrast to HCQ, these manufacturers see their drugs as potentially effective for patients who have progressed to intensive care.
This is the landscape at the moment. No doubt more news is to come.
[Note: Links to all my COVID-19 posts can be found here.]
Published in General
This makes perfect sense. I think where this got started is people were mentioning zinc as a general anti viral prophylactic and then when Hydroxychloroquine appeared the assumption was made that the dedicated zinc channel was the magic bullet. Depending on how certain individuals present it may be for certain people, but I think the latest protocols show much more promise for the vast swath of patients.
What are those latest protocols?
It could be that the thinking that HCQ for us Americans must be further proven as well as all else implied in your point 3 and 4 that has allowed for Costa Rico to have seriously far fewer deaths due to COVID than here in the USA.
There are after all decent enough groups of older people in countries like Costa Rico that the data could be gathered. (In fact, that Central American nation has colonies of older Americans who have moved there, as it is a cheaper, safer and saner society than for instance, Los Angeles is right now.) For people to just say “Well Costa Rico has younger median age overall” so “let’s not even think about HCQ” seems like an unsatisfactory response.
If there was a will to sort this out, using research to answer the needed questions, it would be happening right now. But with The Emperor of The World being the one who usually makes such grant monies available, I doubt we will see any such examinations of whether or not HCQ is reliable.
There’s a common phenomenon: an observation is made, a hypothetical mechanism is pasted onto it, then the mechanism is treated as the reason for the observation and other things that fit the hypothesis are looked for. The first thing to do is to try and confirm the initial effect if you can.
The classic example from the history of homeopathy is quinine. The literature of the day ascribed its efficacy in malaria to its bitterness; Hahnemann said that he knew of other things that were more bitter and didn’t do anything for malaria. He then worked to establish an experimental method to determine drug action (he felt it was unethical to experiment on the sick) by closely observed administration to healthy volunteers.
He also looked through the medical literature of the day (he was a polyglot, too) and found examples in which drugs–which physicians would use because they were what they had but didn’t really expect real cures from–occasionally did produce dramatic cures, sometimes for things that weren’t the condition being treated; he also noted cases in which an recovering from an acute illness resulted in a lasting cure or improvement in a chronic disease. He then asked an interesting question: Is there a way to do this on purpose?
It shorten hospital stay by about 1/3-that is significant, especially if you are trying to avoid overwhelming the system. Furthermore, while the study failed to reach statistical significance the death rate in treated patients was 1/3 lower. It is quite possible that the lower death rate would’ve been Statistical significant in a larger study-but prolonging the study would’ve meant not going ahead and treating a large number of patients-who could benefit from therapy. Better can be the enemy of good.
Most excellent: Laura Ingraham’s new take on COVID: Truth Lies and Fraud
First moment in: a new report showing that patients who had access to HCQ were 48% less likely to be affected by COVID.
Third item discussed: The situation in Pennsylvania where the state’s Health Secretary had issued an edict that nursing homes must admit COVID patients into their populations! So families end up watching their elderly relatives get sick and die due to this ridiculous edict.
I know it would be really CT to suggest that so many of our Democrat rulers really want the numbers of deaths to surge so that the lockdowns and tyranny can continue. But is sure seems like that is what is going on.
https://youtu.be/djhCbZn7sjE
Oh my goodness, I’m sure I’ve mentioned it in one of my last 600 posts in the last few days. Look up Math+ Protocol.
I don’t think you have to be a conspiracy theorist to suggest the Democrats want to destroy the economy via a never ending lockdown
I think the 2 page summary by https://www.evms.edu/covid-19/medical_information_resources/#covidcare nails it
From the WSJ: A new study coming out next week re: methotrexate as a treatment for severe cases. Methotrexate is prescribed for autoimmune diseases such as rheumatoid arthritis (for which I take it),MS and others.
(WSJ is behind a paywall, but I think this link will work. Sorry if it doesn’t.)
excerpt from article:
“What can I do to keep this from progressing?” I asked my doctor, in a state of diagnosis shock.
“Avoid viruses,” he said simply. “If someone coughs on an elevator, get off on the next floor. Wear masks on airplanes. Wash your hands frequently. If close friends have colds, ask them to stay away.” In other words, follow a regimen that even the healthiest people must now adhere to.
My specialist, Elliot Frohman, now director of neuroimmunology at the University of Texas medical center in Austin, gave me a sage piece of advice. “The guns are lined up on your horizon,” he said. “You better get a cannon on board.” He meant a drug able to guard my immune system from morphing into a marauding enemy army.
Today Dr. Frohman and his team of researchers believe one treatment for MS could do the same for seriously ill Covid-19 patients.
The drug is called methotrexate, and it’s already proven to calm the chaotic responses of panicked immune systems. “A blast of this drug, over a matter of hours . . . pulls the cord on the panic button and resets the immune system,” Dr. Frohman tells me.
I agree with the sentiment, but in my opinion it doesn’t hold for the case of remdesivir. The NIAID botched this one on numerous levels:
This is not good science or medicine, and makes a mockery of Fauci’s previous exhortations for the urgent need to adhere to best scientific practices.
Given the fact that one published randomized trial (albeit with its own weaknesses) showed no benefit for remdesivir, an ongoing large trial in France has yet to show any major benefit, and even the benefit in the NIAID trial was modest at best, I don’t think we have strong evidence that remdesivir will make any meaningful difference in population-wide treatment outcomes.
And the fact that Mr. “I Speak For Science” is now saying “don’t worry about seeing the data, just trust me on this” is undercutting the reputation of the scientific establishment at a time when it’s already struggling for acceptance among a large swath of society.
The other (Sabin) polio vaccine is a “live” vaccine, meaning it contains a version of the polio virus that is still infectious (albeit engineered to be much less so). For obvious safety reasons, that type of vaccine requires a lot longer to develop and test before it can be released for widespread use, so it’s not really an option in a time-sensitive situation. The Salk technique kills the virus good and dead* so it bypasses those concerns completely.
*There was one outbreak in the 1950s when a batch of vaccine was improperly inactivated. Since then, numerous safety features have been introduced into the manufacturing process to reduce the probability of this ever happening again to essentially zero.
More important than potentially killing their patients?
That was my recommendation for a best practice. Other physicians could make choose to monitor less closely.
Or you could get proactive and solve the problem yourself.
30 seconds to grab my EKG.
Calculation of QTC is a simple process from here for your physician.
Do you know when that occurred? It may be part of the explanation as to why I’ve never had a polio vaccination while my younger siblings all did. Irony: Then I married a woman whose father had had polio when he was 12. He recovered but it had a lasting effect on him. We have on our living room wall an old photo portrait of the younger sister who died from it in the same outbreak (around 1912).
Well played Doc. Thank you.
I recall President Trump endorsed some of these treatments so we can no longer believe they are efficacious. Two nice ladies at the Washington Post wrote a long article on why HCQ is useless. If a highly respected publication like the WaPo can’t find any evidence favorable to its use as an early treatment or prophylactic, then such evidence must not exist.
In fact, without long-term studies leading to peer-reviewed treatments and technologies, we must stay with social distancing and a full lockdown indefinitely. Those who believe that we can address this crisis in any other way other than a safe path to full dependence on federal aid and gubernatorial edict just want women and minorities to die.
Also, virtually all of the research, development, and production of treatments mentioned in the post came from the private sector and not under federal grants or directives so how can we trust them?
Excellent summation @oldbathos. If we don’t do as we are told. PEOPLE WILL DIE!!
Great Chart, CarolJoy. It’s a keeper.
My wife cannot take Methotrexate or any of the other immune suppression drugs you see advertised on TV. She has High IgE immune deficiency. HCQ is safe for her and we have a supply for the family, including my fireman/paramedic son who is an insulin dependent diabetic. It was one of the early cancer drugs. It is nothing to mess with.
Very Unlikely that stat holds up- our testing regime isn’t robust enough to make such conclusions. With so many asymptomatic cases it will take a large study to prove HCQ works- either as therapy or prophylaxis.
Thank you. The Wapo won’t let me in, but given the year I can take it from there.
“With so many asymptomatic cases it will take a large study to prove HCQ works- either as therapy or prophylaxis.”
Maybe MiMac you and a few others need to take a good hard look at CarolJoy’s chart again. Six major Countries that have used HCQ early on a consistent basis have had less than one seventh ( and most much less even) the deaths per capita that we have had. One seventh. Get that into your dense head. That chart destroys any notion that HCQ doesn’t work because we now have real live studies of millions of people that says it does work miraculously so and that real life evidence trumps any of the corrupt studies that the NIH or FDA are doing by a long shot. That worldwide evidence is a stunning indictment of our Government endowed Health”experts” like Dr Fauci and Dr Bright. It would seem that over 40,000 Americans would be alive today if America had not listened to these power mad, arrogant and corrupt Ghouls.
In a better world, Dr Fauci would be indicted for mass murder. This situation is an unbelievable scandal. With their evidence in hand, that people like you still flog that idea that HCQ doesn’t work is beyond the pale. It is essentially murder.
The world has found a cure, but it would seem that our government’s “Health Experts” won’t allow it’s use because it’s use would render the need for a quarantine to be incredibly pointless and then heaven forbid, for all you dyed in the wool Leftists out there your commie inspired Leftist takeover the Radical Democrats have dreamed about forever would be then stuffed back down that dark hole of hell where it belongs.
That’s pretty strong @unsk, but I don’t trust Fauci either, nor Bright. As the President says, “What have we got to lose?” by trying it. Yes, there are some side effects that can be serious in rare cases but even those side effects are normally caused by constant use, rather than a one-time treatment and they can be monitored as Kozak has proposed. HCQ’s success may be anecdotal, but after a million or so anecdotal successes one tends to not be as concerned about any double flipflop blind studies with a backward twist and a triple lutz. Did I mix my metaphors?
“That’s pretty strong”
Yes cdor it is, but it is true. Tens of thousands of Americans are dead due to the duplicity of Fauci and his gang of corrupt bureaucrats at the NIH, and that result was almost certainly a given when Fauci waged his campaign against HCQ. He knew what he was doing. You talk now to almost any hard core Leftie and they will repeat the mantra that HCQ is “dangerous” and will kill people. That mantra is a result of what Fauci and his gang did.
In addition to that, Fauci rigged both the VA HCQ and Remsdivir tests to get the results he wanted. The NIH and the FDA have become complete frauds. HCQ has been known to be effective against SARs type viruses since 2005 and yet the FDA or the NIH never have gotten around to study it. Gee I wonder why? Maybe it had to do with the fact that there wasn’t much money in it for Fauci’s masters at Big Pharma. For all those hoping for some fair “double flipflop blind studies with a backward twist and a triple lutz” tests on HCQ you will be waiting forever. It will be like waiting for Godot. Won’t ever show up. Fauci will see to it. Right now they are not now seriously testing HCQ and certainly won’t be giving HCQ the rush job treatment they did for Remsdivir. Meanwhile thousands more will die.
The facts don’t support your paranoia.
Numerous US studies have already been published on HCQ treatment. A few of them even showed potential benefits of HCQ. For example, one retrospective study at NYU (in Manhattan) hinted that HCQ+zinc might indeed be more beneficial than HCQ alone.
Another study with over 1,3000 patients from a Weill-Cornell hospital (again in Manhattan) reported that they had given well over half of their hospitalized patients HCQ.
Yet another study – this time, a randomized controlled trial – has been testing HCQ as prophylaxis. It’s main researcher just announced that the study was complete and they’re writing up the results right now. Many other mainstream researchers have already announced that they’re looking forward to the results of the study. So if they aren’t published in the coming weeks, red flags will definitely go up.
Here’s one aspect your conspiracy theories are blinding you to: many doctors, even lefty doctors in places like Manhattan, don’t like watching patients die. And if there’s any hope an untested drug might help those patients, they don’t withhold the drug just because some old codger in DC told them to. Imagine that: even lefty doctors sometimes put trying to save patients’ lives over politics.
The other real kicker is that the NIH itself just announced that it is kicking off a randomized clinical trial not just of HCQ, but of HCQ+azithromycin. That’s not something that would happen if the entire NIH was a cabal run by the politically-vengeful Fauci.
The announcement definitely took the research world by surprise, especially given that HCQ+AZ appears to have genuinely dangerous side effects if given to the wrong patients. There is speculation about whether the HCQ prophylaxis clinical trial might indeed show positive results for HCQ so the NIH is re-tooling to test the HCQ/AZ combination earlier in the course of disease, as many people have long been calling for.