House arrest!

[JimT]

I'm saying that:

1) the credibility of news sources matters, so don't waste time reading non-credible sources
2) any drug intervention study is preliminary, and will require many months of validation -- months that we do not have in the exponential growth phase of COVID-19. It took more than 20 years to develop and deploy a drug cocktail that made HIV-AIDS a treatable disease. Antiviral drug therapies have a terrible track record. For instance, other than HIV-AIDS, name a single viral disease that is successfully treated with drugs.

We will either contain the first wave of SARS-CoV-2 by social distancing, keeping the health care system afloat until a vaccine is developed, or we will have double-digit percentages of the population infected by mid-summer. East Asia showed that the virus can be contained, but the west ignored the lesson and is paying the price.

Is this a credible source?

https://www.sciencemag.org/news/202...al-four-most-promising-coronavirus-treatments

Not one major US media outlet appears to have reported on this, how can that be???

 

[SGK]

While I can't comment on "major US media outlet(s)" I've seen plenty of discussion on these. A larger excerpt from the GS report I mentioned is helpful - note the timescales mentioned (click the box to read):

Therapies and Vaccines

The Milken Institute has been tracking the number of institutions working on therapies and vaccines in different stages of development all over the world: the current estimate is 58 treatment therapies and 43 vaccines.1

Regeneron shared their two-pronged approach to dealing with Covid-19. The first approach is to leverage what is already “on the shelf.” For example, Kevzara is an already approved drug that is used to treat rheumatoid arthritis by creating a fully human antibody that blocks a receptor called cytokine interleukin-6 that causes inflammation. Regeneron shared that this drug has been used in China in an “uncontrolled” approach, but has had some encouraging results. Regeneron has initiated a phase 2/3 trial to properly test the efficacy of this drug. If successful, it would be used to reduce lung inflammation arising from Covid-19 for the critically ill.

The second approach is to recreate antibodies that one would ordinarily get from a vaccine. Regeneron has isolated virus-neutralizing, fully human antibodies that have been developed in their Velocimmune mice; these antibodies are then manufactured through recombinant DNA. This approach was used to fight Ebola successfully in the Congo. Regeneron expects to begin testing in June and producing the antibodies on a larger scale in late summer.

There is also considerable work being done on vaccines using more innovative biotechnology. The National Institute of Health dosed its first participant in a Phase 1 study with Moderna’s messengerRNA-1273 vaccine (mRNA) on March 16. In this new class of medicine, the mRNA is injected in the muscle to instruct human cells to produce the virus protein which will, in turn, teach the body to make a productive antibody, thereby mimicking a natural infection. Phase 1 is expected to enroll 45 healthy adult volunteers between the ages of 18 to 55 over approximately six weeks. The goal of the Phase 1 study is to gather data on the safety and immunogenicity (ability of the vaccine to induce an immune response in participants). If Phase 1 and the subsequent Phase 2 demonstrate safety and good immunogenicity, Moderna is optimistic that they may be able to provide vaccinations by the fall of 2020 for emergency personnel, doctors, nurses, and others on the front line of defense against the pandemic. Broader-based availability would be in the fall of 2021.

Interestingly, if the virus mutates, Moderna believes that they can easily adapt their vaccine to the new genetic sequence of the virus.

Inovio is working on a similar concept, but based on a DNA vaccine rather than an mRNA-based one. They expect to start clinical trials in a few weeks. However, as pointed out by Dr. Tebas, Phase 1 trials look at safety and immunogenicity, but Phase 3 trials measure efficacy of the vaccine over a larger group of people to see if the vaccine actually prevents people from getting Covid-19. He reiterated the time table suggested by other speakers: Phase 1 in multiple organizations has already started or is starting soon, Phase 2 with larger trials possibly including high-risk populations and first responders, and Phase 3 expected in the fall of 2020.

One of the very interesting points raised by Leonard Schleifer of Regeneron was one of serological testing, which is used to determine who has already had an infection. On March 17, a team of scientists, led by Dr. Florian Krammer of the Icahn School of Medicine at Mount Sinai in New York, published a paper showing how their test can measure the level of antibodies in a patient.2 This test can be used to identify recovered patients who could then donate their SARS-CoV-2 antibody-rich serum to help treat critically ill patients. According to Dr. Krammer, another key application of these tests would be to identify people who have likely developed immunity to the virus, especially among hospital staff. These virus-resistant staff could then take on front-line jobs during the pandemic by delivering care to patients with minimal risk to themselves or others.

One of the most frequently asked questions is the efficacy of chloroquine or hydro chloroquine combined with the antibiotic azithromycin in treating the virus. The inquiry is the result of a mid-January report from China translated into English with no data, and a subsequent report by a group of French doctors with 36 patients. According to Dr. Barry Bloom, these drugs are currently being investigated in a more systematic scientific manner, but the current data is more anecdotal. Dr. Leonard Schleifer, M.D., also cautioned our clients “not to jump on late night infomercial equivalents,” referring to therapies that have not yet been rigorously tested.

While the light at the end of the therapies and vaccines tunnel is not shining brightly, it is still visible. The amount of talent and resources devoted to addressing both the virus and the disease is immense, and it is hard to imagine that these efforts, as discussed by our panel of experts, will not yield any successful results in the near future. We believe there is room for a modicum of optimism.

 

[JimT]

Jim T did you read that the Nigerians OverDose it's Prescription Drug. They used to much. When reading the news read between the lines. And my old Science teacher away said believe nothing of what you read and half of what you see.

Joe Salt

Yes I did. The point of my post was to illustrate how two media outlets can choose to report an interwoven set of facts in a totally different manner, one negative one positive. Of course we know why.

 

[SGK]

Here is the Milken tracker with lots of info:

https://milkeninstitute.org/sites/default/files/2020-03/Covid19 Tracker_WEB.pdf

For now, NPI suppression is the only game in town

 

[SGK]

Of course we know why.

Why? Maybe this behavior reinforces that behavior.

 

[JimT]

While I can't comment on "major US media outlet(s)" I've seen plenty of discussion on these. A larger excerpt from the GS report I mentioned is helpful - note the timescales mentioned (click the box to read):

Thanks for the information!! It’s a shame that the Washington Post and New York Times does not seem to feel any of it is newsworthy!

 

[JimT]

Why? Maybe this behavior reinforces that behavior.

????

 

[SGK]

????

Of course we know why

I don't. Why do you think it is?

 

[338 dude]

Thanks for the information!! It’s a shame that the Washington Post and New York Times does not seem to feel any of it is newsworthy!

The real question is could you trust either one if they did report on it I personally wouldn’t believe anything I read there but then of course I wouldn’t be reading anything there so it kind of takes care of itself

 

[338 dude]

For truthful reporting try one America news or the Epoch Times

 

[SGK]

Who is most active in fostering public mistrust in "the media" in the US?

 

[JimT]

I don't. Why do you think it is?

So the CNN story was written today and seems to want us to dwell on the fact that some ignorant Nigerians are overdosing on Chloroquine based solely on the recommendation of Trump. I just hope it’s the ones who keep calling me and want to send me checks for $20,000 if I wire them cash in the amount of $5,000.

They mention the WHO, but conveniently DON’T mention that on Friday the WHO launched a “mega trial” concerning this same drug. And, of course, they make no mention of the published French study.

I’m way past using this crisis for political purposes and I wish the media would do the same for the good of our country!!

 

[JimT]

Who is most active in fostering public mistrust in "the media" in the US?

The media???!!

 

[thejamesd]

Who is most active in fostering public mistrust in "the media" in the US?

Why don’t you tell us.

 

[Toby Bradshaw]

Is this a credible source?

https://www.sciencemag.org/news/202...al-four-most-promising-coronavirus-treatments

Very.

Remdesivir: "Such evidence from individual cases doesn’t prove a drug is safe and effective. Still, from the drugs in the SOLIDARITY trial, “remdesivir has the best potential to be used in clinics” says Jiang Shibo of Fudan University, who has long worked on coronavirus therapeutics. Jiang particularly likes that high doses of the drug can likely be given without causing toxicities.

However, it may be much more potent if given early in an infection, like most other drugs, says Stanley Perlman, a coronavirus researcher at the University of Iowa. “What you really want to do is give a drug like that to people who walk in with mild symptoms,” he says. “And you can’t do that because it’s an [intravenous] drug, it’s expensive and 85 out of 100 people don’t need it.”"

Hydroxychloroquine: "Researchers in France have published a study in which they treated 20 COVID-19 patients with hydroxychloroquine. They concluded that the drug significantly reduced viral load in nasal swabs. But it was not a randomized controlled trial and it didn’t report clinical outcomes such as deaths. In guidance published on Friday, the U.S. Society of Critical Care Medicine said “there is insufficient evidence to issue a recommendation on the use of chloroquine or hydroxychloroquine in critically ill adults with COVID-19.”

Hydroxychloroquine, in particular, might do more harm than good. The drug has a variety of side effects and can in rare cases harm the heart. Because people with heart conditions are at higher risk of severe COVID-19, that is a concern, says David Smith, an infectious disease physician at the University of California, San Diego. “This is a warning signal, but we still need to do the trial,” he says. What’s more, a rush to use the drug for COVID-19 might make it harder for the people who need it to treat their rheumatoid arthritis or malaria."

And the others mentioned in the Science article are even less promising (if that's possible).

Not one major US media outlet appears to have reported on this, how can that be???

Here's one hypothesis: Because none of the proposed drug interventions work, or work at scale.

Alternate hypothesis (not mutually exclusive with the other hypothesis): Because most of our media (not to mention politicians) are scientifically illiterate and innumerate.

 

[SGK]

So the CNN story was written today and seems to want us to dwell on the fact that some ignorant Nigerians are overdosing on Chloroquine based solely on the recommendation of Trump. I just hope it’s the ones who keep calling me and want to send me checks for $20,000 if I wire them cash in the amount of $5,000.

They mention the WHO, but conveniently DON’T mention that on Friday the WHO launched a “mega trial” concerning this same drug. And, of course, they make no mention of the published French study.

I’m way past using this crisis for political purposes and I wish the media would do the same for the good of our country!!

I dunno. But I do believe he can be his own worst enemy. (Correct, I'm not a fan. Not at all. Yet I consider myself centre-right in politics/economics - a position no longer possible in the US.) Saying at a televised press conference that a drug was FDA approved only to be (rightly) corrected immediately by the head of the FDA does cause confusion.

Re Solidarity, I'm not sure why it isn't getting greater press here but there should be no expectation by the public that it will lead to quick results and in any way diminish the need for the non pharmaceutical interventions such as we are starting to see in the US now.

 

[dc.fireman]

Some of us, as essential personnel, don't have too many options.

We have modified some of our methods, and have been given extreme leeway in our ability to self-quarantine. The Fire Chief has abated the policy of reporting to the Police & Fire Clinic for sick leave; now we telephone the on duty platoon commander, and stay home for 14 days.

The Spanish Flu from 1917-18 cost 14 members of the Department their lives - we're not looking for a repeat performance. We currently have 9 members who have tested positive after patient interactions. We now have 200 members who are self quarantining for the next 14 days. That's almost an entire battalion off work.

While I thoroughly respect that the Constitution is the supreme law of the land, it doesn't outweigh common sense, biology, or karma.

My father is in his late '80's, a career Marine, lifelong smoker, who is now battling lung cancer, and melanoma. He is definitely at risk. He ordinarily eats dinner with us 2-3 nights per week. With everything going on, he and I both agree that him staying home is best.

I completely agree with the OP, that he has the right to go out, and do 'his thing', I just don't think this is a situation where he should act on it for a few weeks.

 

[Ned Ludd]

So how should I weight these two pieces?

https://apple.news/AT8dd4pswS7WldMfs5TLdGQ
https://apple.news/Ar8NDN9QfQ5qrf2e5GK1Wig

The first report suggests there may be some therapeutic benefit with the chloroquine + azithromycin drug combination for those infected with coronavirus, the second report is sensationalistic nonsense. Almost any drug has the potential for side effects and/or overdose, and we have no way to know how much those individuals actually took. I wouldn't be too concerned about the reporter mistakenly identified the FDA as the "Federal Drug Administration". It is regrettable, but the reporter wasn't carrying out the testing of the drugs. The link to the paper describing the results of the tests in Intl J Antimicrobial Agents contains the critical and pertinent information.

There are several reasons those drugs and others like them are being fast-tracked for use in treating coronavirus infection. First and foremost, they both have a lengthy track record for safe use in humans. For that reason, they were approved years ago by the FDA for specific use in the treatment of other disorders. Applying an FDA-approved drug that is readily available to the treatment of a new disease is by definition going to dramatically shorten the amount of time it takes to get it out to the public. Once a drug has proven to be generally safe for one particular use, the odds are very good it can be safely used for another, because the toxicity studies have already been done. Whether it actually works for the new purpose is not guaranteed, but its general safety for use patients will have already been rigorously studied.

Our cells possess a mechanism for internalizing objects too large to pass through the membrane by simple diffusion, or that aren't actively transported. Known as endocytic trafficking, this pathway allows for larger objects that bind to some receptor on the outside of the cell to be transported inside the cell in a small "bubble", which is made of a patch outer membrane that pinches off as it internalizes, and which then contains on the inside of the bubble whatever was previously stuck to outside of that patch of membrane. The contents of these bubbles, or "endocytic vesicles", can then be transported to various locations within the cell, whereupon the contents are usually broken down into small molecules that can easily be re-used by the cells. You might think of it as a trash recycling mechanism.

Unfortunately, a number of human pathogens have hijacked this pathway as a mechanism to gain entry into our cells. If they are unable to gain entry, they cannot gain access to the cellular machinery that they ultimately take over and use to replicate themselves. Chloroquine inhibits the modification and trafficking of these endocytic vesicles within the cell, thereby preventing the hijackers from reaching their destination. The Plasmodium parasite that causes malaria also uses this pathway to gain entry into cells, and chloroquine has proven effective at preventing its entry and subsequent replication. The whole point of using drugs that inhibit endocytic trafficking is to prevent the pathogens from replicating, thus slowing the infection process and giving the patient's immune system time to mount an effective defense. That's all. It's basically like locking the front door. Unlike the antiviral drugs, the effect is indirect. It's no guarantee that something won't get in, but more of a means to keep the total number of invaders to some minimum level that the body can deal with.

Because of its well-studied and documented effectiveness in treating malaria, there is every reason to believe that chloroquine may also slow or impair the entry of coronavirus into cells. It has a well-established record of being relatively benign in terms of side-effects when used in the treatment of malaria, and it is readily available. So it has been fast-tracked as a potential treatment for coronavirus patients. Other drugs that have previously proven safe and effective will be fast-tracked for potential use in treating coronavirus for the same reason. Until some minimum number of people have been treated with these drugs, we will not know how effective they might be in terms of treating coronavirus infection, but their safety for use in humans has already been established. It will take far longer to develop new drugs and/or effective vaccines for coronavirus, because the researchers basically started from scratch a few weeks ago in most cases. In the meantime, testing drugs already tested and approved for some other affliction is a very smart thing to do.

 

[JimT]

I dunno. But I do believe he can be his own worst enemy. (Correct, I'm not a fan. Not at all. Yet I consider myself centre-right in politics/economics - a position no longer possible in the US.) Saying at a televised press conference that a drug was FDA approved only to be (rightly) corrected immediately by the head of the FDA does cause confusion.

Re Solidarity, I'm not sure why it isn't getting greater press here but there should be no expectation by the public that it will lead to quick results and in any way diminish the need for the non pharmaceutical interventions such as we are starting to see in the US now.

Your first paragraph describes me exactly!!! We are on the same page. I also agree with your second paragraph. I guess I’m looking for any ray of hope to help me stay positive and not get overwhelmed with the negative.

 

[divingin]

I say the boomers are the most entitled spoiled people there are. they think nothing of getting a ton of operations knee hip replacements needless surgeries whereas the cost of this is bankrupting the system then when something like this happens it cant handle 10% of it.

I don't know of anyone who has a had a hip or knee replacement who didn't need it. They probably could have survived without having it done, but at what cost to their quality of life?

when I was in Bklyn NY I do not remember one old guy including my 9 uncles and father ever got any shoulder surgery and the other one mile long list of operations done today.

When you were a kid in Bklyn, medicine likely wasn't advanced to the point where it was possible to do those operations on a daily basis. There's a process of advancement; in the same light that a coronary bypass that meant weeks in the hospital back then now sees the patient at home that evening.

all my uncles an old men I knew worked as masons longshoremen carpenters plumbers. I am 67 worked 50 years framing houses roofing and concrete never needed surgery

You're lucky (as am I.) That doesn't mean that others are.