Althouse: "Stocks surged after a report said a Gilead Sciences drug showed some effectiveness in treating the coronavirus..."

April 17, 2020

"Stocks surged after a report said a Gilead Sciences drug showed some effectiveness in treating the coronavirus..."

"... giving investors some hope there could be a treatment solution that helps the country reopen faster from the widespread shutdowns that have plunged the economy into a recession.... Gilead shares jumped more than 10% after STAT news reported that a Chicago hospital treating coronavirus patients with remdesivir in a trial were recovering rapidly from severe symptoms.... Gilead itself... cautioned that anecdotal reports are not enough to determine yet whether the drug will be an effective treatment."

CNBC reports.

There's also the Task Force plan — with the federal definition of "gates" and the "phases" and the Governors handling the details. Doesn't that generate hope of reopening?

63 comments:

Howard said...: Doc Mike called remdesivir very promising at least a month ago.; 4/17/20, 9:14 AM
narciso said...: The financial times tried to take it down.; 4/17/20, 9:15 AM
Lucid-Ideas said...: A classic example of the 'buy the news' hysteria we've had in markets for the last 15 years. When capitalism and sound investing and fundamentals have been made slaves to the news cycle...; 4/17/20, 9:16 AM
Bay Area Guy said...: "Stocks surged after a report said a Gilead Sciences drug showed some effectiveness in treating the coronavirus giving investors some hope there could be a treatment solution that helps the country reopen faster....."

Better headline:

"Stocks surged -- they often go up and down, but we really don't know why""; 4/17/20, 9:17 AM
Ken B said...: Howard
Yes he did.
Now we have to worry about the Bernie Bros demand Gilead give it away, thus destroying any hope of future drug development.; 4/17/20, 9:21 AM
Nonapod said...: With, what is it now, 22 million unemployed? I really don't cares what the market does in the near term.; 4/17/20, 9:24 AM
Wilbur said...: Headline: Stock Market Surges Back - Democrats Blame Trump; 4/17/20, 9:30 AM
Martin said...: We shall see. I do note from the STAT article that the drug is given by infusion. Anyone who has ever had a drug infusion knows that will NOT easily scale up, and doubly so if the person must be in hospital, even ICU, during the course of treatment.

It would be a great thing to have such a drug, compared to where we are now, but a 5-10 day course of infusions while hospitalized is far from a satisfactory answer.; 4/17/20, 9:31 AM
Maillard Reactionary said...: Data is not the plural of anecdote.; 4/17/20, 9:32 AM
West Texas Intermediate Crude said...: Following BAG-

"Stocks Surged After PDJT spends two days savaging Nancy Pelosi on Twitter!"; 4/17/20, 9:33 AM
Bay Area Guy said...: @Nonapod,

"With, what is it now, 22 million unemployed? I really don't cares what the market does in the near term."

Bingo. Need to get the workers back to work, and when productivity increases, and the stock market follows suit, based on said productivity, then we can celebrate a little.; 4/17/20, 9:34 AM
Josephbleau said...: I sure hope Trump does not come out in favor of remdesivir. It would be banned in half the states.; 4/17/20, 9:34 AM
West Texas Intermediate Crude said...: Martin-
You are correct that infusion treatments are costly in resources and difficult to scale up, but the numbers needed are not that large.
The articles notes that the patients had "severe symptoms," likely people in the ICU already. This is a small fraction of people with the virus, and should be manageable, with or without the currently unused surge capacity that has been made available in large cities.
Looks like HCQ-Z helps with early/mild symptoms and remdesivir helps with late/severe symptoms.
Put America back to work!; 4/17/20, 9:38 AM
rhhardin said...: Scott Adams says you could predict that the $1000 treatment would wind up testing better than the $25 treatment. Not that it isn't actually better but you could predict it.; 4/17/20, 9:39 AM
Michael K said...: It would be a great thing to have such a drug, compared to where we are now, but a 5-10 day course of infusions while hospitalized is far from a satisfactory answer.

That drug is available for those few cases where HCQ fails or where the case is seen too late for the oral treatment. Remember , somewhere between 20 and 30% of those exposed get infected and a small percentage of the infected require ICU. This is just psychological in the midst of enormous economic damage by hysteria. I also called for opening the economy several weeks ago. Trump has surrendered to the bureaucrats with this three phase plan. It's too slow unless he starts pushing.

My wife and I are high risk but we can self sequester with no harm to us.; 4/17/20, 9:42 AM
gilbar said...: I just want to say Thank You to Dr K; for being our Medical reference...
Having a reference that is a smart (or smarter) than the 'experts' is a real benefit

Now, If Only Dr K would take us sailing! (wish wish wish : ); 4/17/20, 10:05 AM
Kyzer SoSay said...: I have a question for Doc Mike - not sure if he'll know, but I am wondering what the mechanism of action of remdesivir is. I feel like I have a good grasp on how the HCQ+Zinc+ZPak treatment works, but I don't know anything about this other drug. I am very happy that it is also showing promise, it's nice to have more than one option for fighting this (or any) disease.; 4/17/20, 10:10 AM
RK said...: Having a reference that is a smart (or smarter) than the 'experts' is a real benefit

How many of our public health officials are just failed physicians in need of a job? I haven't forgotten about the "masks won't help" canard.; 4/17/20, 10:16 AM
TreeJoe said...: I've spent 18 years in clinical trials/clinical research. This is the most irresponsible reporting.

IT MEANS NOTHING. You don't approve a drug being studied all over the world based upon a random anecdote of a clinician talking at one investigative site about positive patient reaction. Nor would you at another site if a clinician talked about how none of the patients seemed to respond.

How many patients are enrolled in that trial at that site? How many are in the trial overall? What was their status prior to first treatment? How much improvement has been shown? How much have the patients NOT receiving treatment improved? How does it compare?

I can't stress it enough. While it's re-assuring to hear, this isn't even an anecdote. It's a useless data point.

P.s. This type of news report can skew an entire clinical trial and make the data useless. If I was involved in reviewing the research, I'd look to see if clinical outcomes were reported to have improved more dramatically right after this news cycle compared to data appearing beforehand. There is a non-zero chance that this news reports winds up screwing up the research and fucking up the drug review/approval process.; 4/17/20, 10:17 AM
hawkeyedjb said...: I'm sitting on a few shares of Gilead, which is up smartly today. My enthusiasm is tempered by the knowledge of my almost endless string of poor investment choices, stretching from the distant past to very recently.

I should have listened to the guy who said "Buy Vanguard mutual funds. And nothing else."; 4/17/20, 10:22 AM
Michael K said...: Now, If Only Dr K would take us sailing! (wish wish wish : )

Best I can do is vicarious.

Interesting article on using both HCQ and remdesivir together.

Here's one about the mechanism of inhibition by another drug of replication

Here we show that the anti-CoV activity of imatinib occurs at the early stages of infection, after internalization and endosomal trafficking, by inhibiting fusion of the virions at the endosomal membrane. We specifically identified the imatinib target, Abelson tyrosine-protein kinase 2 (Abl2), as required for efficient SARS-CoV and MERS-CoV replication in vitro

I think this is similar to the remdesivir mechanism.; 4/17/20, 10:42 AM
Maillard Reactionary said...: hawkeyedjb: I had to learn the hard way, too-- with me it was buying stock in some startup maker of 3" hard drives back in '79 or so. As though Seagate couldn't figure out how to do that. So much for trying to outsmart the market.

S&P 500 index funds. 0.25% or lower expense ratio. Buy and hold in good years and bad. Easy peasy.; 4/17/20, 10:43 AM
Andy said...: Boston Channel 25 reporting universal testing in homeless shelter.

The broad-scale testing took place at the shelter in Boston’s South End a week and a half ago because of a small cluster of cases there. Of the 397 people tested, 146 people tested positive. Not a single one had any symptoms.“It was like a double knockout punch. The number of positives was shocking, but the fact that 100 percent of the positives had no symptoms was equally shocking,” said Dr. Jim O’Connell, president of Boston Health Care for the Homeless Program, which provides medical care at the city’s shelters. O’Connell said that the findings have changed the future of COVID-19 screenings at Boston’s homeless shelters. “All the screening we were doing before this was based on whether you had a fever above 100.4 and whether you had symptoms,” said O’Connell. “How much of the COVID virus is being passed by people who don’t even know they have it?” The 146 people who tested positive were immediately moved to two different temporary isolation facilities in Boston. According to O’Connell, only one of those patients needed hospital care, and many continue to show no symptoms.

I hope they are doing antibody testing for those who tested negative.; 4/17/20, 10:49 AM
Joe Biden, America's Putin said...: bad news for chi-com Hillary virus stock.; 4/17/20, 10:50 AM
D.D. Driver said...: As much of a clown car that government is, it is nice to remember that American industry is inventive and clever and hardworking. Then, after US industries literally saves civilization, Nancy and friends will hold their show trials to shame the evil capitalists that made a profit along the way.; 4/17/20, 10:55 AM
jim said...: Maybe I have not read closely enough, I don't see anything in reopening plans addressing the "real economy": guidelines for industry and transport; guidance for meat packing plants; reopening of ports.; 4/17/20, 11:00 AM
jim said...: One of my worries is a wave of liability lawsuits aimed at companies that stay open.

Friends own a medium sized machine shop, maybe 50 employees. They have remained open throughout because they make part for ventilators (and have radically amped up their production.) Are they going to lose it all in a year if one of their employees gets sick and dies?; 4/17/20, 11:05 AM
iowan2 said...: compared to where we are now, but a 5-10 day course of infusions while hospitalized is far from a satisfactory answer.

True, but.

We don't have to worry about the whole population. Just the few that have co-morbidities, and slip through the isolation protections in place. Should drastically reduce the leathality of covid; 4/17/20, 11:14 AM
Yancey Ward said...: "I've spent 18 years in clinical trials/clinical research. This is the most irresponsible reporting."

Yes, I spent my career in medicinal chemistry, Tree Joe, and I agree with you. People should pay attention to what Gilead itself had to say about this report.

The problem with this and other reports of treatments that work is that in pretty much all of them that I have seen, you don't really have a control group. If I were a doctor, I could create a "study" of COVID-19 patients where I kept 10 of them in the dark rooms, and 10 of them in room with lighting, and random variance could very easily lead to all 10 of the former living and 3 out of the latter ten dying- and this can happen even if I grant that the observer, knowing who is who, didn't fiddle with the results in some way.

There is no real statistical power in any of these "studies" that I have seen, and it is why I have been skeptical of these reports all along, including this one. I am not saying they shouldn't be tried, but I wouldn't bet on any of these treatments really being effective over placebo.; 4/17/20, 11:25 AM
hawkeyedjb said...: "One of my worries is a wave of liability lawsuits aimed at companies that stay open."

Liability lawyers are to the economy as vultures are to the natural world, except the vulture doesn't kill the prey before feeding on the carcass.; 4/17/20, 11:28 AM
Yancey Ward said...: A preliminary report from the anti-body study in Santa Clara County in California. The bottom line, 50-85 times as many people were infected with the virus than were identified by the RT-PCR tests. Adjust the mortality rates in Santa Clara County accordingly.; 4/17/20, 11:33 AM
BarrySanders20 said...: "Are they going to lose it all in a year if one of their employees gets sick and dies?"

Not from a lawsuit by the employee. Workers comp is the exclusive remedy.; 4/17/20, 11:41 AM
BarrySanders20 said...: "There is no real statistical power in any of these "studies" that I have seen, and it is why I have been skeptical of these reports all along, including this one."

People want to have hope, and these reports provide that. Maybe false hope . . .

If I was on a vent I would tell the doctor to try any and all of these anecdotal treatments. Including (and especially!) the ointment-on-the anus promoted by the Iranian cleric.; 4/17/20, 11:49 AM
Michael K said...: There is no real statistical power in any of these "studies" that I have seen, and it is why I have been skeptical of these reports all along, including this one. I am not saying they shouldn't be tried, but I wouldn't bet on any of these treatments really being effective over placebo.

There was a fraud in surgery many years ago called "The No touch Technique." It is still to be found in the surgical literature.

I did a quick internet search for the story and up came an old post from my own blog 12 years ago.

Basically, the son of the founder of the Cleveland Clinic, a great surgeon from the early 20th century, was trying to emulate his father but was using dubious methods to do so. This is how statistics lie.

He published a series of cases of surgery for colon cancer that "proved" his method, which involved not touching the tumor until its veins were interrupted, resulted in a higher cure rate.

He published the “no-touch technique” study when I was a resident in surgery and we all immediately adopted the method as Crile’s study suggested a significant improvement in survival of the patients. Years after it was shown to be a fraud, it is still being studied. It is difficult to find the original paper anymore but it is still being referred to proudly in Cleveland Clinic literature. In that account, Rupert Turnbull is credited with the development of the technique, which involved isolating and ligating the veins from the colon before the tumor bearing area was touched or dissected. It made sense logically in that tumor cells were thought to flow in the venous blood to the liver where they lodged and became metastases. By ligating the veins first, tumor cells disturbed by manipulating the tumor would not escape and flow to the liver. Every surgeon who did colon cancer surgery adopted it.

The problem with the paper, as later revealed, was that the author used time-life tables to correct for survival in the treated cases but not in the controls. Thus, the treated cases had a better 5 year survival than the controls.

This is how science can cheat. That technique is still recommended in the literature 50 years after it was proven to be false.; 4/17/20, 11:59 AM
jim said...: "Liability lawyers are to the economy as vultures are to the natural world, except the vulture doesn't kill the prey before feeding on the carcass."

Not to rush to the defense of lawyers, but if my employer keeps the factory open and I go to work and end up dying, isn't that a damage to me/my family. There is a reason to keep the place open, a benefit to the owner and to society at large, but who will make my family whole or partially whole.

Is risking my life an obligation I take on because of my "choice" of where to work?

Multiply this question a hundred time for hospitals.

I think we'll probably end up with compensation fund(s) for the people who kept doing their jobs and died, or are permanently impaired..; 4/17/20, 12:02 PM
Tomcc said...: Having existed on this planet for a number of decades, I understand that there is no incentive for news organizations to report bland news. They need a hook and at the moment that hook is the fear of the unknown. For over six weeks, we've been subjected to reports of bad, bad, very dangerous things lurking in the vaporous breath of our friends and neighbors. Catastrophic death rates, unimaginable rates of infection...
And yet, with the exception of some very large, densely populated eastern cities, it's been an unfortunate event; certainly not catastrophic. At the moment, I'm satisfied that the initial shelter-in-place orders (along with social distancing) were helpful. But I fear that our political leaders are now facing a conundrum: if they lift restrictions and there is no significant re-bound of cases then they will seem to have over-reacted. The longer they keep the restrictions in place, the longer they can say that the strategy is working.
I may be too cynical, but, anymore that's almost impossible.; 4/17/20, 12:19 PM
Tomcc said...: jim @ 12:02:
I could imagine that there could be some kind of a fund set up. Personally, I'd like it to be supported by individual donations rather than government funded.
It will be interesting to see how "risky" working during this pandemic turns out to be relative to a "normal" year. I work in retail and manage to get two to three cold/flu events each year. I suppose that if I were already in less-than-good health that a bad outcome would be more likely.
A friend and colleague of mine with chronic lung problems had a bad illness (flu/bronchitis?) in December. She took a leave of absence for a month to recover. She was relieved when our employer closed.; 4/17/20, 12:34 PM
Michael K said...: For those of you interested in how viruses adapt and mutate, Here is a pretty interesting thread at Greg Cochran's blog,

The size of the asymptomatic infected population is going to be very important. Maybe it is mutating to be a better parasite.; 4/17/20, 1:11 PM
Andy said...: via Instapundit

ABC News

The first large-scale community test of 3,300 people in Santa Clara County found that 2.5 to 4.2% of those tested were positive for antibodies -- a number suggesting a far higher past infection rate than the official count. Based on the initial data, researchers estimate that the range of people who may have had the virus to be between 48,000 and 81,000 in the county of 2 million -- as opposed to the approximately 1,000 in the county's official tally at the time the samples were taken.

Interesting Indeed; 4/17/20, 1:13 PM
Michael K said...: More on the evolution of the Corona viruses and this might explain why blacks are at higher risk.

In this study, we have shown that SARS-CoV-2 exhibits much higher capacity of membrane fusion than SARS-CoV, suggesting that the fusion machinery of SARS-CoV-2 is an important target for development of coronavirus fusion inhibitors. We have solved the X-ray crystal structure of SARS-CoV-2’s 6-HB core and identified several mutated amino acid residues in HR1 domain responsible for its enhanced interactions with HR2 domain. By conjugating the cholesterol molecule to the EK1 peptide, we found that one of the lipopeptides, EK1C4, exhibited highly potent inhibitory activity against SARS-CoV-2 S-mediated membrane fusion and PsV infection, about 240- and 150-fold more potent than EK1 peptide, respectively. EK1C4 is also highly effective against in vitro and in vivo infection of some live HCoVs, such as SARS-CoV-2, HCoV-OC43 and MERS-CoV, suggesting potential for further development as pan-CoV fusion inhibitor-based therapeutics and prophylactics for treatment and prevention of infection by the currently circulating SARS-CoV-2 and MERS-CoV, as well as future reemerging SARS-CoV and emerging SARSr-CoVs.

ACE2 receptors are the target for the virus spike protein and there is some variation of black's ACE receptor.

Also EK1C4 is also highly effective against in vitro and in vivo infection of some live HCoVs, such as SARS-CoV-2, HCoV-OC43 and MERS-CoV, suggesting potential for further development as pan-CoV fusion inhibitor-based therapeutics and prophylactics for treatment and prevention of infection by the currently circulating SARS-CoV-2

Now, we need to find out what EK1C4 is, and how to make it.; 4/17/20, 1:26 PM
mandrewa said...: I've been thinking about the pattern of Covid-19 deaths.

What if, along with climate, in other words this virus spreads slowly in places that are hot, what if these true Covid-19 deaths (necessary to emphasize true because we are now getting a lot of bullshit numbers) have a strong correlation with the amount of virus that the person was initially exposed to?

Imagine Bill is in a crowded subway car. Suppose a quarter of the people around him have the virus and so Bill's first exposure to the coronavirus is a quite large dose.

Imagine George goes to play tennis with his friend, Tom, who happens to have the coronavirus. Tom infects George but the initial amount that George takes in is tiny compared to what Bill was exposed to.

Infections are an exponential race. The virus multiplies at an exponential rate and the immune system's makes immune cells to counter the virus at an exponential rate.

But normally it takes quite a few hours or even days for the immune system to get triggered.

Suppose what happens in that initial interval, before the immune system is triggered, is what explains most of the difference in outcome for different people?

If so, this might explain what we have been seeing: sudden, rapid rises in coronavirus deaths from almost nothing in crowded cities in the temperate zone followed by drops in the daily death counts that are as rapid as the initial rise. The drop in death rate may be caused by people no longer using the subway system or perhaps simply that there aren't as many people that are actively shedding the virus by that point.

And we now know that this virus in large amounts switches off part of the immune system, in
particular the lymphocytes carrying CD147 receptors. Suppose that in those receiving a large initial dose these lymphocytes get deactivated before the immune response seriously gets going.

Remember that the spread of the virus is exponential. In the early stages of the epidemic
almost everyone that is exposed the virus gets it from a one-on-one encounter. But because
this is an exponential explosion, the transition from only a few people having it to a large number of people having it is quite sudden. If the seriousness of the resulting illness varies with the initial dose, then a very high proportion of the people getting it from one-on-one encounters will overcome it, and without getting seriously ill. (And thus we aren't aware that it's happening.)

But the virus keeps spreading. At a certain stage there will be a large number of people
walking around with the virus. Some people, as in for instance those on a subway at the right time, would be breathing air that is full of droplets containing the virus. If death or hospitalization is correlated with the size of the initial dose, it's only at this stage, when there are so many people at the same time releasing the virus, that we would expect to see a large number of deaths.; 4/17/20, 1:29 PM
Ingachuck'stoothlessARM said...: "Balm", from Gilead!!; 4/17/20, 1:43 PM
Bob Boyd said...: For those of you interested in how viruses adapt and mutate, Here is a pretty interesting thread at Greg Cochran's blog

Doc, does what Cochran said hold true for a synthetic virus? Or would the man-made changes be eliminated over time?; 4/17/20, 1:50 PM
TreeJoe said...: Yancey said, "There is no real statistical power in any of these "studies" that I have seen, and it is why I have been skeptical of these reports all along, including this one. I am not saying they shouldn't be tried, but I wouldn't bet on any of these treatments really being effective over placebo."

Placebo is a high bar to beat.; 4/17/20, 1:50 PM
Howard said...: It's funny seeing how you are so much more cynical about this drug given that Trump hasn't touted it.; 4/17/20, 1:57 PM
Francisco D said...: Howard said... It's funny seeing how you are so much more cynical about this drug given that Trump hasn't touted it.

You are conveniently missing the point, Howard.

Michael K. was talking about remdesivir on this site almost two months ago. He was also touting HCQ before the Dems condemned it. Mike and Trump were hopefulnot cynical about the drugs. We were cynical about the Democrats condemning drugs that they knew nothing about.; 4/17/20, 2:06 PM
BillieBob Thorton said...: What if all the assumptions the experts about the virus are wrong?
What if it turns out that it burns itself out after seventy days?

https://www.manhattancontrarian.com/blog/2020-4-15-what-is-the-proof-that-this-covid-19-thing-really-is-a-crisis

http://www.homelandsecuritynewswire.com/dr20200415-top-israeli-prof-claims-simple-stats-show-virus-plays-itself-out-after-70-days

Homeland Security News Wire

"PerspectiveTop Israeli Prof Claims Simple Stats Show Virus Plays Itself Out after 70 Days
Published 15 April 2020
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A prominent Israeli mathematician, analyst, and former general claims simple statistical analysis demonstrates that the spread of COVID-19 peaks after about 40 days and declines to almost zero after 70 days — no matter where it strikes, and no matter what measures governments impose to try to thwart it. Prof. Isaac Ben-Israel, head of the Security Studies program in Tel Aviv University and the chairman of the National Council for Research and Development, told Israel’s Channel 12 that in Israel, about 140 people normally die every day. To have shuttered much of the economy because of a virus that is killing one or two a day is a radical error that is unnecessarily costing Israel 20 percent of its GDP, he charged. He said the policy of lockdowns and closures was a case of “mass hysteria.” Simple social distancing would be sufficient, he said."; 4/17/20, 2:12 PM
LA_Bob said...: https://seekingalpha.com/news/3561767-stanford-study-points-to-far-higher-rate-of-covidminus-19-infection

"The public policy implications are enormous in that they would change by a mile the denominator when figuring out the fatality rate. The study authors figure the rate would be something closer to 0.12%-0.2%, or in the same area as normal flu levels."

Click through to the study, and note that John Ioannidis is a senior author. If this holds up, it really becomes a head-scratcher why we crippled the economy.

Maybe this is where prevention efforts should be (or have been).; 4/17/20, 2:12 PM
Jamie said...: A friend texted me earlier about remdesivir's being shown to be effective in a large study by UChicago (pretty sure she was talking about this very sturdy, because she walked it back later, saying it was only reported in a UChicago newsletter). The funniest thing was her statement, "No placebo for humanitarian reasons but it’s UChicago and large trial so reliable."

As if appeal-to-authority negates bad study design.

That said, I'd venture that the vast majority of commenters herein are happy to have both HCQ-Z and remdesivir out in the world being used, despite the lack of good study protocols - and we know that there aren't good study protocols. Our point is that when anecdotal evidence from many places suggests that an inexpensive, readily available, well understood drug appears to show good results when prescribed off-label for C-19, the howling about "good studies needed before off-label use" and "Trump touts unapproved malaria drug as 'miracle cure'" seems... politically motivated. Doesn't it? Especially considering that there are also no "good studies" yet for this off-label use of remdesivir?

I hope all these therapies work. I really hope HCQ-Z works, since it's so much cheaper and easier for patients to take. And if I find myself in the hospital with C-19, I will absolutely ask for it first, and then remdesivir if I worsen, and I will absolutely give permission for every detail of my case to be used in a future lookback study.; 4/17/20, 2:15 PM
Kirk Parker said...: gilbar,

"If Only Dr K would take us sailing!"

I think you're a bit late... not sure he has a boat any longer.

Neither do I, but if anyone is within driving distance of Commencement Bay I could probably find you a race-crew spot.; 4/17/20, 2:32 PM
mandrewa said...: Howard said,

"It's funny seeing how you are so much more cynical about this drug given that Trump hasn't touted it."

I don't think Trump has a thing to do with it. First of all, there are only a few people that are expressing skepticism about remdesivir here, namely in this thread TreeJoe and Yancey Ward. And both TreeJoe and Yancey Ward have worked in the field and know the long history of treatments with evidence much better for them that what remdesivir has for it so far that have failed.

Second, Yancey Ward has also repeatedly expressed doubts about the evidence for hydroxychloroquine.

Third, a number of us, I'm for certain about me and Michael K., were advocating for the use of hydroxychloroquine before Trump said a thing about it.

Fourth, there is a lot more evidence for hydroxychloroquine than there is for remdesivir. It's a bit unconventional but it's nonetheless real evidence. Part of the unconventional evidence for hydroxychloroquine is that the South Korean medical establishment advocated for it quite early. It sounds like almost everyone in South Korea that got Covid-19 was treated with hydroxychloroquine and that might be part of why their mortality numbers were relatively low.

Fifth, China claims to have also used hydroxychloroquine thing after a certain point. But the problem with evaluating China is we know a lot of their numbers are wrong.

Sixth, hydroxychloroquine is safe. We know this because it has been used for a long time and in fact there are something like 5 million people in the United States that were using it before the epidemic. There is a small group of people that can't take it. But for everyone else the side-effects are quite modest. This means the worst that can happen is that it doesn't do anything.

Seventh, hydroxychloroquine is also inexpensive and already approved for other uses. That means that as a practical matter it's one of the very few things that can be actually used at this time for a large proportion of the population.

Eighth, in contrast, we know far less about the safety of remdesivir. We have as of yet no evidence it is any better than hydroxychloroquine. And it is very expensive and can only be used in the intensive care context, and cannot be widely applied.

Nineth, it's going to take quite a while to get valid double-blind, placebo-controlled trials for anything completed, and actually these trials may be occurring only in places like China (which should raise a question about their believability right there), and the number of people involved may be so few that it will always be statistically questionable what they mean anyway, and then finally there's an ethical problem with giving placebo to Covid-19 patients.

So what this boils down to is that there are very good reasons for advocating for hydroxychloroquine use right now even if we are not certain it is accomplishing what we want.; 4/17/20, 2:33 PM
LA_Bob said...: Jamie said, "...seems... politically motivated. Doesn't it?'

Oh, Jamie, no, no way, never.....nooooooooooooooo...

Also, it may be NIH - Not Invented Here -- so no good.; 4/17/20, 2:33 PM
Michael K said...: And if I find myself in the hospital with C-19, I will absolutely ask for it first, and then remdesivir if I worsen, and I will absolutely give permission for every detail of my case to be used in a future lookback study.

You might also want a relative who is a doctor and not infected with TDS, like this Orange County couple, 90 and 88, whose son, an MD, prescribed it for them. He started them on it before they were admitted to the hospital.

They both had pneumonia and positive tests. They were admitted to Hoag Hospital in Newport Beach CA and discharged as cured in 5 days in spite of the dope of an infectious disease MD at Hoag saying he would not prescribe it if the next cases comes in.

I made sure my kids got a supply while the pharmacies still had stock.; 4/17/20, 3:09 PM
Ingachuck'stoothlessARM said...: any further buzz re Pluristem’s allogeneic placental expanded (PLX) cells?

will there be an "official" covid drug/vaccine?

HCQ off-patent, no big $$ ?

WHO makes the call?; 4/17/20, 3:16 PM
Brian said...: I should have listened to the guy who said "Buy Vanguard mutual funds. And nothing else."

Slow and steady wins the race.

As to the Gilead Patent. Patents are defined by Congress. Couldn't Congress pass a law undoing the patent?

An exaggeration of course, but if 300 million people need a drug that costs $1k/dose because of its patent, then that drug won't be patented much longer.

I am not a law student, but is that a "takings clause" issue under the Constitution?

I seem to remember reading somewhere that the Constitution isn't a suicide pact.; 4/17/20, 3:50 PM
mandrewa said...: Germany is reporting that only 0.24% of the people that they have confirmed to have Covid-19 virus infections are dying.

They have tested 1% of their population.

Seven point five percent of the 1% of the German population tested has the virus.

This is not a random sampling as the testing was disproportionately concentrated on those that were ill, but 1% is still a large enough number that this must be largely people that are not ill, and therefore these numbers must be starting to approach the real infection and mortality rates.

I'm not clear on whether these numbers include people that do not currently have the infection, but have previously had it, as would be evidenced by antibodies to the virus present in their blood.

If these numbers do not include the antibody group, then the mortality rate will drop dramatically once they are included.

Regardless either way, from a mortality perspective, the German numbers are looking no worse than either a bad or a normal flu epidemic.

Also as I understand it the German medical community is resisting the tendency to label every death that occurs now as a coronavirus death.

See Germany announces significant progress as coronavirus reproduction rate falls below 1.; 4/17/20, 4:11 PM
Big Mike said...: To take a page from Althouse’s hippie chick phase:

“What do we want?”

”A normal life!”

“When do we want it?”

”We want it NOW!!!”; 4/17/20, 4:46 PM
Big Mike said...: Data is not the plural of anecdote.

@Phidippus, actually, yes it is.

BTW, one of your namesakes was in my powder room last night. I stepped on it. Tell all your eight-legged, eight-eyed, green-jawed buddies to do their jumping outdoors, thank you.; 4/17/20, 5:03 PM
Michael K said...: The problem is that remdesivir has a company and patent behind it driving testing, etc.

Hydroxychloroquine is off patent and cheap. Who wants to pay for clinical trials ?; 4/17/20, 6:15 PM
mandrewa said...: CardioGauge (on YouTube) posted the second part of his commentary on the Marseille hdryoxychloroquine/azithromycin trial on over a 1,000 people.

The basic issue with the study is that most of these people were not seriously ill.

That means it is quite different than for instance the remdesivir study where remdesivir is being used on people that are all very sick.

CardioGauge observes that in his personal experience in New York with very sick Covid-19 patients the hydroxychloroquine combo just doesn't do that much.

And I think the fact that the Marseille study included anyone that had a symptom, even if minor, is implicitly possibly an admission that they also don't think it's relevant to the very sick.

Of course this is exactly where I personally think the hydroxychloroquine + azithromycin + zinc should be applied, as soon as possible in the infection, before people get sick, although in this study the mean patient was given treatment 5 to 6 days after their first symptom, which, of course, is not ideal.

So it's hard to compare the Marseille study to other studies, because for instance in New York they aren't even testing, let alone treating, most people that have symptoms, but
that are not close to being hospitalized, for the virus!

So whether or not this shows the hydroxychloroquine treatment was effective depends on comparisons to similar groups being treated at the same early stage elsewhere, something that there isn't much data on. Although again maybe there is, because if I understand correctly, South Korea did a very similar thing and reported a similar mortality figure since they treated everyone they found with the virus that showed symptoms regardless of whether they were seriously ill or not.

There's also a question of context. France overall is reporting a mortality rate of 15.0%. This study reported 0.5%. So obviously it was a radical improvement.

Except the French mortality numbers aren't believable. They are simply way to high and they are surely an artifact of not testing and not detecting most of the people that are infected.; 4/17/20, 6:25 PM
mandrewa said...: "Hydroxychloroquine is off patent and cheap. Who wants to pay for clinical trials ?"

No can afford to pay for the clinical trials.

The FDA demands that someone spend a billion dollars, more or less, to jump through the hoops they require before they will approve something.

Since there is no way to recover the money that means there is no rational path to getting an off-patent treatment approved.; 4/17/20, 6:30 PM
Josephbleau said...: "You are correct that infusion treatments are costly in resources and difficult to scale up, but the numbers needed are not that large."

There used to be a floor on hospitals called "Skilled Care" where patients who needed technical care could go without really being a hospital patient. My father in law needed morphine treatment for a while due to an illness so he went there because they were not going to just let him have a bunch and send him home. Folks could go there to be infused but I think Obamacare eliminated them.. You can tell me if I am mistaken.; 4/17/20, 6:40 PM
Skippy Tisdale said...: Right now, my brother is working on this at Gilead. He's a brilliant scientist as are his colleagues. I take comfort in that.; 4/17/20, 9:08 PM