Coronavirus Health - Health and Wellbeing

[Itsallaguess]

If you have a drug that suddenly everyone wants to use then there is little doubt in my mind that some effect will be created that limits the availability of patients for testing with other medications since once someone is being treated with remdesivir they would not be eligible for a study of another drug except in combination.

That's a fair point, although I'd be interested in the conversation that you'd have with the families of someone where your tests of an unproven treatment might have taken priority over giving a treatment that has actually shown to deliver some benefits...

Cheers,

Itsallaguess

[redsturgeon]

I just find it a bit strange that you seem to think that the wider use of this particular treatment is such a negative thing to be doing, and that it's likely to affect other treatments 'getting support'.

Such is the huge global scientific effort in tackling this thing, I would find that simply astonishing if it were true...

If we were on another board, I'd probably ask if Gilead being a US company is influencing your view on this particular treatment at all, but that's probably a topic that's best left for the other place.

The idea that because Remdesivir has been approved that lots of other treatments will get less attention is pretty weird, especially because it isn't a magic bullet that stops it in its tracks. Governments, Universities and companies all over the world are working on a variety of treatments and the likelihood is that many will fail and some will work with varying degrees of success. The amount of prestige, goodwill and money to be made ensures this.

A lot of the negativity around Remdesivir is because Donald Trump recently praised it. Shortly afterwards a lot of negative articles and comments started to appear. Lots of people want it to fail now that Trump has spoken out in favour of it. Many of these are also desperate for the hydroxychloroquine-based treatments to fail. They don't want a successful drug if Trump has mentioned it. This isn't just loonies on Twitter; a lot of the media is highly negative because of Trump (and in part because many journalists are scientifically illiterate and innumerate).

There are also plenty of academics wanting research to fail. A good example is the women's studies lecturer at Oxford who recently wrote about not wanting the Oxford vaccine team to succeed because, erm, racism.

https://www.spiked-online.com/2020/04/24/wokeness-has-destroyed-the-university/

Naturally after Dr. Fauci praised Remdesivir lots of Trump supporters have started to oppose it. So we've got people on both sides condemning it for political reasons

"The first drug shown to help treat coronavirus patients is likely to get official permission to be used “really quickly,” Dr. Anthony Fauci said Thursday, calling it a “very important first step.”"

https://nypost.com/2020/04/30/dr-fauci-remdesivir-could-get-fda-approval-really-quickly/

There is of course a lot of politics going on. The fact that Trump wants to make pronouncements on everything and anything with no thought or expertise and little knowledge is not helpful. He said chloroquine was helpful and hydroxychloroquine and remdesividir and sunlight and disinfectant injected into the body.

He also said at the start that after 15 cases in the US that it would soon be down to zero. There are so many things that Trump has said that some of them may incidentally prove to be correct. I wouldn't however start trying to base anything on what he has or hasn't said though...although of course some people do, on both sides of the fence.

I am basing my comments on 25 years in the pharma industry looking at clinical studies just about every day I was there and I can tell you that it is possible to show a lot of things depending on how you both set up trials and how you interpret data as well as hiding any data that does not present the outcome you seek.

I am just advising caution, is that a bad thing?

John

[redsturgeon]

If you have a drug that suddenly everyone wants to use then there is little doubt in my mind that some effect will be created that limits the availability of patients for testing with other medications since once someone is being treated with remdesivir they would not be eligible for a study of another drug except in combination.

That's a fair point, although I'd be interested in the conversation that you'd have with the families of someone where your tests of an unproven treatment might have taken priority over giving a treatment that has actually shown to deliver some benefits...

Cheers,

Itsallaguess

Yes and that is precisely my point. I have sat in on ethics committee meetings, pre clinical trials and there are many questions that need to be answered, it is not easy to set up trials, certainly in this country. But of course unless you were able to set up such trials even with the existence of proven efficacious drugs then you would never have any new drugs developed once you'd found one drug that worked even marginally...see my point?

John

[Itsallaguess]

If you have a drug that suddenly everyone wants to use then there is little doubt in my mind that some effect will be created that limits the availability of patients for testing with other medications since once someone is being treated with remdesivir they would not be eligible for a study of another drug except in combination.

That's a fair point, although I'd be interested in the conversation that you'd have with the families of someone where your tests of an unproven treatment might have taken priority over giving a treatment that has actually shown to deliver some benefits...

Yes and that is precisely my point. I have sat in on ethics committee meetings, pre clinical trials and there are many questions that need to be answered, it is not easy to set up trials, certainly in this country. But of course unless you were able to set up such trials even with the existence of proven efficacious drugs then you would never have any new drugs developed once you'd found one drug that worked even marginally...see my point?

Well, yes, but I'll assume that there are standard and well-established methods and processes available that ensure that benefits can be taken now of new treatments that show new benefits, at the same time as allowing other potential treatments to continue to be developed and tested..

Those well-established processes can't be anything new John, and yet you seem to have some specific concern around this new treatment getting in the way of those processes, and it's not clear why that should be the case in this particular instance, over and above the situation that any new beneficial treatment must find itself..

Why single it out?

Cheers,

Itsallaguess

[sg31]

Remdesivir is getting publicity because it is one of the first therapeutics to provide positive results. It's not a silver bullet but it does seem to help in reducing hospital stays. Although the improvement in outcomes wasn't statistically significant, maybe, just maybe it will help in that respect. Larger scale studies will follow which might give a better idea of how effective it is

So far so good, it helps, now we need to find something better. There's a lot of scope for that. Remdesivir is given intravenously which limits it's utility. The ideal drug would be effective and be taken orally. I can't see a shortage of people willing to sign up to drug studies, this virus isn't going away for a while and the relaxing of movement restrictions is going to increase infection rates. There will be no shortage if sick people.

Vaccines are the big hope. Modena has signed up with Lonza to poroduce 1Billion doses within a year, Oxford are aiming for 3-600,000 doses over the next year. 2 Chinese manufacturers have candidates in phase 2 trials with plans to start production. None of them are guaranteed to work, maybe they won't but the pace things are moving ahead is astounding.

[redsturgeon]

Those well-established processes can't be anything new John, and yet you seem to have some specific concern around this new treatment getting in the way of those processes, and it's not clear why that should be the case in this particular instance, over and above the situation that any new beneficial treatment must find itself..

Why single it out?

Cheers,

Itsallaguess

Well-established processes are rarely new.

My concern is the amount of publicity, politics and money riding on this. These things are much better left to be proven (or not) away from the full glare of public expectation and hope in ways which have been set up over the last decades of drug development. Bear in mind that 90% of new drugs fail at some stage in the approval process and of those that are approved some still end up being withdrawn over safety concerns.

Not really singling it out, it's just the only one to that has FDA fast track approval in a way that I believe in unheard of (unprecedented even).

John

[Itsallaguess]

My concern is the amount of publicity, politics and money riding on this.

All the things that helped push for, and win, the race to the Moon then John...

Cheers,

Itsallaguess

[redsturgeon]

My concern is the amount of publicity, politics and money riding on this.

All the things that helped push for, and win, the race to the Moon then John...

Cheers,

Itsallaguess

Yup...and start the second world war I guess.

[ReformedCharacter]

Interesting article in the Telegraph today:

Elderly coronavirus patients could be given drugs to make their immune system "younger" so they respond better to treatments and vaccines, a Harvard study has suggested.

Scientists say one way of protecting older people against some of the worst symptoms of Covid-19 is to give them 'NAD boosters' - supplements which contain a form of Vitamin B3.

https://www.telegraph.co.uk/news/2020/0 ... ne-system/

AFAIK the form of Vitamin B3 mentioned is Nicotinamide Riboside:

Nicotinamide riboside (NR) is claimed to be a new form pyridine-nucleoside of vitamin B3 that functions as a precursor to nicotinamide adenine dinucleotide or NAD+

https://en.wikipedia.org/wiki/Nicotinamide_riboside

In recent years, NAD+ has also been recognized as an extracellular signaling molecule involved in cell-to-cell communication.[36][70][71] NAD+ is released from neurons in blood vessels,[35] urinary bladder,[35][72] large intestine,[73][74] from neurosecretory cells,[75] and from brain synaptosomes,[76] and is proposed to be a novel neurotransmitter that transmits information from nerves to effector cells in smooth muscle organs.[73][74] In plants, the extracellular nicotinamide adenine dinucleotide induces resistance to pathogen infection and the first extracellular NAD receptor has been identified.[77] Further studies are needed to determine the underlying mechanisms of its extracellular actions and their importance for human health and life processes in other organisms.

https://en.wikipedia.org/wiki/Nicotinam ... nucleotide

RC

[look]

There's ivermectin. some guys think it could be used as a prevention.

A good guy is supporting tests in my region.

I think that medicines that already are in the market, the doctors could (should have the right) recommend to patients for other malaises based only on his opinion.


https://www.monash.edu/discovery-instit ... n-48-hours

[look]

i think this CPAP machine is very interesting

https://edition.cnn.com/2020/05/02/heal ... index.html

[servodude]

i think this CPAP machine is very interesting

https://edition.cnn.com/2020/05/02/heal ... index.html

the FDA approved CPAP use for COVID-19 in march (https://www.fda.gov/medical-devices/eme ... entilators)
- they can help buy time for the immune system to work
- and for help in the weaning off of an invasive ventilator

They're likely to be helpful in dealing with residual damage in recovered patients
- there are reports of recovered COVID patients left with fibrosis (and i expect it to increase the chance of COPD)

you have to be careful if you are going to do it yourself as they increase the risk of infection to others in the room due to their air path not being self contained

- sd

[redsturgeon]

There's ivermectin. some guys think it could be used as a prevention.

A good guy is supporting tests in my region.

I think that medicines that already are in the market, the doctors could (should have the right) recommend to patients for other malaises based only on his opinion.


https://www.monash.edu/discovery-instit ... n-48-hours

From the article:

Do NOT self-medicate with Ivermectin and do NOT use Ivermectin intended for animals.
Read the FDA caution online.
Whilst shown to be effective in the lab environment, Ivermectin cannot be used in humans for COVID-19 until further testing and clinical trials have been completed to establish the effectiveness of the drug at levels safe for human dosing.
For any medical questions you have about your health, please consult your health care provider.
The potential use of Ivermectin to combat COVID-19 remains unproven, and depends on pre-clinical testing and clinical trials to progress the work.

[ReformedCharacter]

I note that some here, including IIRC Uncle Ebenezer have reported feeling unwell last December with a 'lurgy', interesting to read today:

Yves Cohen, head of intensive care at the Avicenne hospital in Paris, caused a stir by telling BFM TV that tests had been repeated on samples from 24 patients admitted to the hospital for pneumonia in December and January, and that one from December 27 was positive. The patient, a 53-year-old man, had not travelled to China.

https://www.telegraph.co.uk/news/2020/0 ... can-eased/

RC

[look]

According my readings, Neil Fergusson lost his prestige.

[redsturgeon]

https://off-guardian.org/2020/05/06/cov ... ng-people/

It seems that ventilators for Covid 19 might do more harm than good.

John

[servodude]

https://off-guardian.org/2020/05/06/covid19-are-ventilators-killing-people/

It seems that ventilators for Covid 19 might do more harm than good.

John

That seems like a bit of a shock piece; none of it's particularly wrong, but it's written to beg the question

I'll agree that ventilators are rough on you, but so is having your brain starved of oxygen
- and that unfortunately is the choice if this disease takes sufficient hold
- NIVs are just not up to the job for everyone

Used at the right time, with the correct prescription and titrated for the patient a ventilator will buy time.

With most respiratory disorders there will normally be intravenous treatments in parallel to address the cause, but this is unfortunately lacking with COVID-19 at present, and you're relying on the immune system to do its job; a job that it has been failing at up to that point.
This might go some way to explaining why the recovery rates once on a ventilator are relatively low; or it might also be doing a number on the blood (https://chemrxiv.org/articles/COVID-19_ ... n/11938173)

- sd

[redsturgeon]

https://off-guardian.org/2020/05/06/covid19-are-ventilators-killing-people/

It seems that ventilators for Covid 19 might do more harm than good.

John

That seems like a bit of a shock piece; none of it's particularly wrong, but it's written to beg the question

I'll agree that ventilators are rough on you, but so is having your brain starved of oxygen
- and that unfortunately is the choice if this disease takes sufficient hold
- NIVs are just not up to the job for everyone

Used at the right time, with the correct prescription and titrated for the patient a ventilator will buy time.

With most respiratory disorders there will normally be intravenous treatments in parallel to address the cause, but this is unfortunately lacking with COVID-19 at present, and you're relying on the immune system to do its job; a job that it has been failing at up to that point.
This might go some way to explaining why the recovery rates once on a ventilator are relatively low; or it might also be doing a number on the blood (https://chemrxiv.org/articles/COVID-19_ ... n/11938173)

- sd

It seems like a question that needs to be answered.

John

[servodude]

https://off-guardian.org/2020/05/06/covid19-are-ventilators-killing-people/

It seems that ventilators for Covid 19 might do more harm than good.

John

That seems like a bit of a shock piece; none of it's particularly wrong, but it's written to beg the question

I'll agree that ventilators are rough on you, but so is having your brain starved of oxygen
- and that unfortunately is the choice if this disease takes sufficient hold
- NIVs are just not up to the job for everyone

Used at the right time, with the correct prescription and titrated for the patient a ventilator will buy time.

With most respiratory disorders there will normally be intravenous treatments in parallel to address the cause, but this is unfortunately lacking with COVID-19 at present, and you're relying on the immune system to do its job; a job that it has been failing at up to that point.
This might go some way to explaining why the recovery rates once on a ventilator are relatively low; or it might also be doing a number on the blood (https://chemrxiv.org/articles/COVID-19_ ... n/11938173)

- sd

It seems like a question that needs to be answered.

John

Indeed. It could have been a decent article on the risks and efficacy of ventilators with the info it contains, as people's expectations should be realistic; but it got a bit Daily Mail and indignant.
FWIW How to adapt and improve BiPAP NIV to be effective and safe for COVID treatment has been keeping me busy for a few weeks.

-sd

[redsturgeon]

FWIW How to adapt and improve BiPAP NIV to be effective and safe for COVID treatment has been keeping me busy for a few weeks.

-sd

Well done you. Is that similar to the Mercedes device?

Seems like a much more worthwhile exercise that the very visible but ultimately failed government push with ventilators.

John