If you don't already plan to do so, you should interview bob Nelson at ARCH venture partners. They are a top biotech VC and one of the few VCs that has been active in antivirals the last few years (confounded Vir Biotech which is working on covid among other things)
Bob has been on top of the crisis from the very beginning and has a lot of interesting insight
am i reading correctly that you packaged synthetic viral RNA into viral particles and then suspended in transport medium? do you plan on studying actual patient samples and comparing to gold standard tests?
patients in both tx and control arm fared better than in the french study from earlier this week, suggesting patients were healthier / lower risk at baseline
patients got slightly lower dose in this study (400 mg / day) vs the french study (600 mg / day)
No need to read Chinese, the abstract is on page 2. Conclusion: at current trial size no better than placebo. More study is needed to tease out an effect, if there is any.
By now everybody should know that the successful dosis is 2x500mg per day for 10 days. Not 1x 400mg per day, which is the old dosis for Malaria prevention. This dosis needs at least 2-3 weeks to be effective (saturate the cell membranes with zinc), and by then the infection is already over. And the Chinese treatment plan contained much more.
scientists have increasingly been doing this during covid by publishing on biorxiv and then discussing on other channels (twitter etc)
for ex, this paper [0] by UCSF analyzing 26 of the 29 viral proteins expressed by the virus was posted on biorxiv and publicized further via twitter [1]. they identified 69 FDA approved drugs that target these proteins, giving the medical and scientific community a massive head start on studying drugs that could potentially be near-term treatments
there are some parts of academic science that are stuck in the last century but scientists themselves are certainly not
for those interested in learning more about how science works and how scientists operate, the covid situation is a great way to see how its done. modern science is amazing
Yeah, I'm following a bunch of scientists on Twitter and have been watching from the sidelines with awe and admiration. The contrast to the seeming hordes of dumbfucks could hardly be more remarkable; sometimes it's hard to keep in mind the same platform is host to both sets of people.
This Doctor, Health Commissioner of NYC, Oxiris Barbot, seemed to take a lot of joy in proclaiming: Today our city is celebrating the #LunarNewYear parade in Chinatown, a beautiful cultural tradition with a rich history in our city. I want to remind everyone to enjoy the parade and not change any plans due to misinformation spreading about #coronavirus. https://on.nyc.gov/377LlcH
Either way no data is provided there, but the case fatality rate for folks under 10 is 0% and under 29 is between 0.1% and 0%. If this hypothetical doctor even exists, it wouldn't be hard to pick 350 people, give them some HCQ and Azithromycin and have 100% of them recover -- as they would have even if they hadn't received anything. That's more or less what this study shows.
In fact, as the fatality rate for under-29s is 0.1%, you have a 70% ((1-0.001)^12) chance that any randomly selected 350 of them will recover.
I don't really know what point you're trying to make here. Neither doctor would come anywhere near my list of experts. The real experts are highly critical of both those offering miracle cures and public health people who are slow to respond.
There are dumbfucks with MD after their name too, unfortunately.
Every single person on this list is brilliant at what they do and a good communicator, with excellent s/n in their tweets. I've also removed people (like Jeremy Konyndyk, who otherwise I would recommend highly) who have a lot of insight but also a high emotional tone or a tendency to lean into politics. I've also tried to represent a wide range of expertise, from immunology to sequencing-based virology to public health specialists to frontline ER doctors.
So it's as close to a golden source of information as I could make it. I hope it's useful to some people, though I know the reach of it is a tiny fraction as if I made some dumb clickbait that happened to go viral.
Wikipedia style is unreliable. I'm aware of quite a few errors. Why I don't fix them then? Because my edits would be reverted. Or because the page has been locked.
Academic literature in contrast, has multiple parallel journals. If one is suppressing you, you can go to the next. Of course if you go to a less reliable one, then people might not trust your research.
You can't assume the top line effect size is real without critiquing the study design in detail. A lot of experienced drug developer think the data suggests that HCQ may be marginally effective, but Azt + HCQ seems promising. THere are others who are more skepticl
HCQ is already the recommended treatment for certain cases in many countries, including the US. Here is a super interesting conference call from UCSF: https://youtu.be/bt-BzEve46Y?t=3194
because nothing is known to work yet for covid-19, doctors are doing the best they can with limited data. this means using unproven drugs for which, to the best of our knowledge, the risk-beneift is favorable. HCQ for covid-19 is an exampel of this: we dont know if it works, but it might, and it seems safe enough
the goal of studies like this are to strengthen the evidence base and remove those unknowns, so physicians can make evidence-based decisions. if the study is sufficiently poorly designed, it does not accomplish this goal, and can even lead to misinformation
Many doctors are already actively prescrbign this. I heard that it is basically de facto standard of care in France. Doctors recognize that when eveidence based medicine doesn't provide an adequate treatment, they need to improvise. Off-label prescribing is very common
The point of these studies is to help the evidence catch up to improvised clinical practice. If the studies are poorly designed, that goal is not achieved
Agree & upvoted; this needs to be better understood. Especially noteworthy is the section you linked to is written for health-care workers, and they’re confirming that a homemade mask is better than nothing (while also recommending the homemade mask dead last.)
Unfortuately, the CDC really is giving out conflicting guidance here. For example, higher up in the section for lay-people is this: “You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers.” https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention... (In “How to Prepare | Protect Yourself”)
I don't see a contradiction. The CDC is trying to maximize public health benefit. They recommend stronger protection for people with more exposure to higher levels of the virus. Coincidentally, the people with higher levels of exposure also happen to be health care workers, who need the best available protection to save lives
If you are not exposed to high levels and are not required to put yourself at risk to care for patients, you are at low risk. You can protect yourself with milder measures like social distancing and face protection that is not as effective but not in such short supply
Maybe I misread your intent. I thought you were mostly pointing out the section titled “When No Facemasks Are Available, Options Include”, which would mean we’re talking about something that is not in short supply. I thought you were pointing out that, among other things, the CDC is saying that home-made masks are better than nothing, even for health care professionals, and even if it’s a last resort.
I mean I agree, of course, that they’re trying to maximize public health benefit, I just don’t think the guidance is at all clear to the public. The idea that anything less than N95 is useless is pervasive, you can see it right here on HN. My parents and co-workers believe it because it’s been reported in the mass media in the last weeks: “the CDC said masks don’t protect you!”.
For people who need to work or shop in public places, any kind of masks at all might well be statistically significant alternatives for people who are unable to practice social distancing. China seems to be doing it effectively right now; people are required to wear masks to go to work. They’re not telling the public to avoid masks because doctors need them, they’re telling the public not to leave the house and not to enter a work building without something over your face. It seems like the CDC is saying the opposite, you should not wear a mask unless you’re a doctor. If a bandana is even 50% or 30% or even 5% effective, and they want to maximize public health benefit, why aren’t they recommending people start with what they have at home for times when public exposure is necessary? Seems like that would both increase public health and deflect demand for surgical masks & N95 masks at the same time, no?
That is a misleading statement. The CDC has in fact changed its recommendations to recommend in a crises, even HCPs use home-made masks [0]
Health care providers, scientists and health officials are rapidly changing and adapting to the situation. It probably is a good idea for all people to wear homemade / improvised masks to reduce R0
But I'd still hope that civilians with large stores of N95 masks or other PPE would consider donating them to healthcare workers. The optimal scenario seems to be that non-HCPs stay home as much as possible, wash hands, sanitize and wear improvised masks when leaving home, and donate PPE to healthcare workers
Fwiw, Plaquenil is hydroxychloroquine, a less toxic derivative of chloroquine. It has a different safety profile than chloroquine
The French study of HCQ had several limitations. Including that it was very small and some patients who got HCQ and progressed to go to the ICU were excluded from the study. Thus making the drug look better than it is
HCQ is not likely to be a miracle cure. It may be useful in combo with other drugs
It's easy to make not great data look like great data to untrained eyes. And it's tempting to cut scientific corners to bring forward a drug for covid-19. But if the drug doesn't work, we should be honest about that and look for better drugs
Should at risk people take HCQ as a precaution until something better comes along? Definitely. but we need to be careful in talking about its potential
The azithromycin was given to some of the patients with viral pneumonia as there is a chance of reinfection with bacterial pneumonia. Astonishing and unexpectedly, the covid19 virus was completely wiped out in all the HCQ+azithromycin patients but only in a bit over half the HCQ alone patients. So just as an antiparasite drug surprisingly once was found to also work as an antiviral, azithromycin has unexpectedly been found to have some sort of a complementary amplifying or catalyzing effect with the hydrochloroquine. Of unknown mechanism and no doubt this will be explored in great detail in future research. For now it's known that putting the two together looks to be a good thing to do.
It may be early to conclude that azithromycin has a complementary mechanism with HCQ, the study was too small and there are too many confounding factors. It is possible there is some synergy but also possible that there is not
Azithromycin has been shown to have some antiviral effect though it has not been characterized and the mechanism of action is unknown.
I assume they chose that as a broad spectrum prophylaxis for and opportunistic concurrent infection but perhaps they chose it specifically for this reason.
All of the things you've said about mask functionality, reusability and sterilization are very interesting. As is your experience with in-home caregiving.
Is there a quick, effective and easy sanitizing protocol for N95 masks that you think would work for hospitals that are short on masks?
One of the first articles that I read mentioned the use of autoclaves, essentially steamers used for sterilizing surgical tools, etc. I think it was a NIOSH article. These are already in use in hospitals.
That led me to the article I linked about using microwaves. Microwave ovens excite water molecules to cook and the creation of steam from the cooking process should kill the pathogens.
I have family members who need some protection from this threat and that is why I went down this rabbit hole in the first place.
Based on everything I read I am comfortable concluding that masks can be reused if they are sanitized by microwaving with a small amount of water to create steam.
The methods tested in the paper appear to show effectiveness that maintains N95 rating and kills pathogens in the process.
I am not a doctor and in fact I spend too much of my time trying to avoid ever seeing one.
Perhaps you or someone else out there can recreate these tests or conduct similar tests to determine whether this is viable.
An autoclave is more like a pressure cooker than a steamer.
You need temperatures well in excess of 100 degrees Celsius to reliably kill everything, especially bacterial spores (which, admittedly, are not the major issue here).
To do so, autoclave use high pressure steam (121C at 15 psi) for long enough that everything reaches that temperature. A microwave won’t even get close to that, though it can disinfect, rather the sterilize, just like boiling water can. You also need to be careful that the entire object gets heat-treated; home microwaves often have hot and cold spots and one missed spot can spoil everything.
This stuff is fairly complicated and I’d encourage you stick with established methods if you can, which I think is currently treatment with a UVC lamp.
Thanks for the information. I agree that home microwaves heat unevenly but I think that is one of the reasons that the authors in the article went with bagging the masks. The steam would be trapped in the bags and the masks would get treatment at a more consistent temperature making the process more effective at killing the pathogens.
I think that microwaving the masks accomplishes the task using tools that an ordinary person may already have on hand and tools which require almost no training. UV sterilization is complicated by the need to avoid exposure to UV light and the fact that most people don't have a suitable UV lamp available. Hospitals may already have those tools on hand and in that case they probably have trained users who can disinfect masks with them. That seems to be the best way for them to reuse masks.
I'm sure hospitals in Seattle, new Rochelle, Santa Clara and San Mateo counties, and LA county could use them. Really any county. 10 masks would be really helpful
Bob has been on top of the crisis from the very beginning and has a lot of interesting insight