Investor20

I am not sure what you are trying to prove. The deaths are going down much more sharper than new cases. That shows CFR is going down. And Arizona deaths/million is 180. NY is 1598.

OK, I was assuming when on April 24, when you said, "Take Sweden with low mitigation efforts. They had 213 deaths/million or 72000 deaths for 340 million (US population)…. The 500K deaths prediction by Dr. Fauci is off with Sweden by 7 fold, let alone Japan by 500 fold, both countries with low mitigation efforts", it meant that you thought the Swedish approach was a good one. I guess maybe you threw it in there as random trivia, not to imply that their low mitigation approach was effective. Perhaps, though you were referencing Sweden and Japan in parallel ways in the same sentence, you simply just didn't get around to saying that the Swedish low mitigation approach would eventually prove a bad idea, while the Japan approach was actually the path that you preferred.... (I actually think the main reason for Japan's success relative to most other places is the culture.) Yeah, I think you have a different definition of "conservative approach" than me. I don't dispute that the costs of a lockdown are pretty high. However, I think that, when it becomes apparent that the worst pandemic in 100 years is hitting, I don't think the conservative approach is to ignore the people who have spent decades of their lives studying how it mitigate the problem, just to go with the same strategy that is used for diseases that aren't "once in a century" pandemics. Rather, I think that's the "gamble with other people's lives" approach. You are very good at taking a statement and giving completely wrong context. That was an argument against the hype of "greatest pandemic ever". Even if you (I was not advocating not doing anything) did not do anything like Sweden, the deaths are far less than hyped numbers. As I said 1.6 million people die EVERY YEAR from TB alone. So, enough of this "greatest panademic ever". No one even blinked their eyes for 1.6 million dying off TB every year and by the way, many TB deaths are children and otherwise healthy people. My argument was then and now too is hand washing, ventilaton, masks, safe distance is adequate measures and shutting down the economy is not needed. Many data points have since support my stand. In NY we have seen data that people staying at home are most infected as per antibody studies. Other studies also showed being outside is better than being inside. My view points have not changed with political conveniences. I did not advocate one day sending police with summons because their kids are playing outside and other day say its ok for protesters day after day, being close to each other, shouting slogans and people look at each other when they shout slogans....with direct droplets going from one person to other. There are many protesters without masks and no one is wearing masks continuously. It just too difficult to wear masks continuously all day.

Yeah, the problem is that this sort of reasoning is basically, "find the country whose outcome supports my thesis, then say that the outcome in that country was somewhat predictable in the early days", when that's not true at all. I mean, there's a reason that the "we shouldn't lockdown" people were talking about Sweden, and now they aren't. Basically, if you put your life savings on Red 17 on a roulette wheel, and it turns out that Red 17 comes up, that doesn't imply that it was a good decision to put your life savings on Red 17. During a pandemic, before you have knowledge, you should take the conservative approach because a non-conservative approach can potentially lead to massive numbers of deaths. Then, as you better understand the situation, you should revise your approach.) First of all I never supported Swedish approach. I always supported Japanese approach. I was following Japan for the following reasons. It is a country one would expect high death rate and yet they did not from beginning. Japan is highly crowded country with lot of very old people and cold. With all three together, one would expect high death rate. So I was following Japan on how they are managing it. Whats wrong with following a method that works? It is not true that lockdown is a conservative approach. Following existing protocols for other respiratory diseases is a conservative approach. Washing hands, masks, ventilation, safe distance are established methods for respiratory diseases. I never heard of lockingdown most of the world even for TB eventhough for TB Estimated: 10.0 million new TB cases. Estimated: 1.3 million HIV-negative people died from TB and 0.30 million HIV-positive people died from TB. https://www.who.int/gho/tb/epidemic/cases_deaths/en/ The difference between Coronavirus and TB is there is no daily counter for TB. The reason even for something that causes 1.6 million deaths a year people did not try lockdowns is because lockdowns have very high costs on society. Lockdown is not a conservative approach. Its costs on society are pretty high.

For those interested, here is a distilled list of best-evidence that has built up over the last few weeks versus prevention of transmission. https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaa189/5820886 https://www.ecdc.europa.eu/en/publications-data/using-face-masks-community-reducing-covid-19-transmission https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext From a humble perspective, a detached and rational approach tends to avoid running into sterile debates and tribal drift but i often feel like an idiot. It's fascinating that this virus, which is somewhat benign from an evolutionary standpoint, stirs so much reptilian instincts and one has to wonder about the host (and its institutions). Maybe i focus too much on governance issues. Here is another one : https://wwwnc.cdc.gov/eid/article/26/9/20-2272_article Runs a bit against my hypothesis that truly asymptomatic (And those that never show symptoms) younger people aren’t likely superspreaders. Well, it seem they can be. Whether one is truly asymptomatic or get some mild symptoms later is not that important. Its been clear for a while that there is asymptomatic transmission, which happens while talking. To some extent masks help but not eliminate small tiny droplets floating in air and its difficult to wear masks continuously. That is why Japanese say "ventilation is key". That makes everyone life easier. And now we know it works. I think we should copy what works. That is not to say not to use masks or stop washing hands or stop safe distance. But no need for enforced lockdowns.

Lockdown is very hard on many people. It is one thing to say open your shop and have good ventilation. Another to say shut your shop and sit at home. So, are you "pro-mask" then? You seem to change the subject whenever anyone mentions masks. IMO, shutting down was a no-brainer at the start, and now opening shops while requiring masks in public enclosed spaces (and ideally good ventilation) is also a no brainer. I have posted several times supporting using masks. That said, shutting down was not a no-brainer at any time for many reasons. The Japanese did not go into lockdowns for a very good reason. They got this ventilation aspect from WHO guidelines for other respiratory diseases such as Measles and Turberculosis. To me a no-brainer is to start with established protocols for other respiratory transmitted infections like Measles and Tuberculosis. That means use of masks and ventilation. Lockdown decreases ventilation. Having people go out increases ventilation. Lockdown has many other effects such as loss of jobs, other areas of healthcare being effected such as cancer screenings. Possibility of second waves after lockdowns. So, lockdowns were never a no-brainer. Following using of masks and ventilation which are protocols for TB and measles are. One should start exactly where Japanese started. Established protocols for similar infections. https://japan.kantei.go.jp/ongoingtopics/COVID19CASFlyer/PROffice3CGuide_en.pdf

Agreed. Anything that does not include lockdowns is waved away....with some non-explanation. The fact is what is proposed in US and western countries is much more difficult to follow by people than what Japan ever asked their citizens. How difficult is to change your car air to Fresh, or keep your window open once a while. Yes there may be some work involved in changing the settings of office ventilation systems but they made it part of the guidelines. How difficult is it to not talk in elevator or other crowded place? But US authorities never told people to even try them. Most of the things are not hard. How hard is it to put on a mask? Is it done? Lockdown is very hard on many people. It is one thing to say open your shop and have good ventilation. Another to say shut your shop and sit at home.

Agreed. Anything that does not include lockdowns is waved away....with some non-explanation. The fact is what is proposed in US and western countries is much more difficult to follow by people than what Japan ever asked their citizens. How difficult is to change your car air to Fresh, or keep your window open once a while. Yes there may be some work involved in changing the settings of office ventilation systems but they made it part of the guidelines. How difficult is it to not talk in elevator or other crowded place? But US authorities never told people to even try them.

Lockdowns were required due to incompetence. As Sweden shows, the economy is impacted by the virus whether you lockdown or not. The best way to reduce the economic impact is to take the virus seriously in the early stages. Lockdowns are a blunt, destructive force. They are the "break glass in case of emergency" option. Orthopa, Gregmal, Cubsfan, Trump, De Blasio, and the rest of the "it's just a flu crowd" are a big part of this problem. If everyone had overreacted in February, none of this would have happened. Now the US is in the worst possible spot, they acted just enough to destroy the economy but not enough to contain the virus. So what do you think the alternative would have been instead of an initial lockdown? We didn't have enough tests. We didn't have enough PPE. If you stop flights from the infected countries you're considered a "racist". I posted about Japan several times. In my last post (#6026 in this thread), I posted their guidelines which says "degree of ventilation is the key" Japan is interesting because it has 1) Very old population 2) Very crowded 3) Cold. All these stand against Japan and yet they had low Covid deaths. Particularly with very old population that is amazing result. They did not have mandated lockdowns. Their guidelines included keeping windows open, not to talk in elevators, keeping car heat/AC in fresh air..etc which are easy to practice without locking down. So, why look further? Japan found a way. All we have to do is follow. It does not require lockdown! http://japan.kantei.go.jp/ongoingtopics/COVID19CASFlyer/PROffice3CGuide_en.pdf

Japan had not just masks. They had 3Cs to avoid. That is to avoid Closed spaces, Crowded places, Close contact settings They reasoned, for example for Tuberculosis, ventilation has reduced TB transmission, another respiratory infection. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716713/ Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa So they had several guidelines with reference to increasing ventilation including office area HVAC settings to increase fresh air, car AC (recycle or fresh air), keeping windows, doors open, simply not to talk in certain circumstances, etc. http://japan.kantei.go.jp/ongoingtopics/COVID19CASFlyer/PROffice3CGuide_en.pdf

Now, the Harvard researcher who co-authored two articles on its research says he never saw the data and can’t verify its existence. https://www.wsj.com/articles/the-big-data-mystery-behind-retracted-covid-19-studies-of-hydroxychloroquine-other-drugs-11591867981 Its a subscription article, but this statement is sufficient to see the quality of "research" is so poor.

Thanks for sharing. He is very optimistic that the dance can be maintained at low cost indefinitely, until vaccines are available. If true, doesn’t this support the general market level now? The economy may function almost ok, barring some mass entertainment events which need >50/100 people together. Do you share such an optimistic view? Let’s say California and North east manage the dance, and the mid west, Texas, Arizona fail and need another hammer lockdown. How big an impact is that to the US economy? I just went thought the article and I think it is pretty good. It matches the info I could gather from various sources. The problem with the herd immunity is that it takes a long time, as the Swedes found out and in the case of the US, the current IFR numbers suggest it would cost a lot of lives. We have had 120k death so far caused by the disease and with herd immunity it could be 10x as much. A lot of European countries have already case numbers so low they they can open up and have schools up and running for example. So essentially, they are already ahead of the US in how the economy can operate. This is due to the more effective and stronger shutdown measures. As far as the impact of several states like Texas, AZ, AL and other having high infection rates for a long time and what it means for the economy it’s really hard to tell. Maybe the population in states themselves ignores this and carries on. However, what about travel into and from these states? It’s free movement generally, but will people from COVID-19 free states will want to travel into these states? It will cause some issues for sure. I think we will have to see how this works. I am sure that real virus containment in the US isn’t really an option any more. https://www.aa.com.tr/en/asia-pacific/no-new-coronavirus-cases-found-in-japan/1870548 No new coronavirus cases found in Japan Japan did not have mandatory lockdowns. Yet they went to zero. The other day Spekulatius was arguing about protests and saying because protestors wear masks so it should be ok. So.....why then stronger shutdown measures are needed? Wear a mask and you can do anything, per Spekulatius logic. I never said the protest are Ok. I did state there are 3 factors that mitigate infections - mask wearing ( mostly) , younger crowd and protest being outdoors. Japan did have shutdowns. The larger cities ( Tokyo) were shutdown fairly early. The did not have a countrywide shutdown however. Then stick to that. We dont need "strong shut down measures" in US if all we need according to you is people who are not vulnerable to wear masks and be outside or atleast avoid closed environments. Japan did not have mandatory shutdowns. Hear from the horses mouth, PM Abe himself on this PM's Office of Japan', @JPN_PMO, Apr 7 #COVID19 update (PM Abe’s remarks on April 6): “Allow me to make it clear once again. In Japan, even if we issue the declaration of a state of emergency, we will not enforce the lockdowns of cities as seen abroad. It is the view of the experts that that would not be necessary.

https://www.nejm.org/doi/full/10.1056/NEJMe2020388#article_references Hydroxychloroquine for the Prevention of Covid-19 — Searching for Evidence I was going through the article and they dont mention India's ICMR or Korean studies on use of HCQ for prophylaxis but only Boulware. Boulware administered the drug only for four days, while Korean study gave drug for full quarantine period of 14 days. ICMR gives once a week and found it is effective only after 4 weeks of administration. Also Boulware confirmed infection "by polymerase-chain-reaction assay in less than 3% of the participants. " They determined if someone is infected by email or phone by self diagnosis (I am not kidding....check it yourself). Can anyone here tell me there are more Covid infected in LA or NYC by talking to a few people over phone? But that is the only study they can write an article about HCQ in NEJM? Why so called "scientists" and top notch medical journals do this? See Below References on HCQ use for prophylaxis that NEJM apparently cannot find where below studies used PCR testing, not self diagnosis by phone & email. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162746/ Can post-exposure prophylaxis for COVID-19 be considered as an outbreak response strategy in long-term care hospitals? Many patients would be expected to become infected with COVID-19 in the setting of cluster outbreaks associated with LTCHs. In this study, there were no additional confirmed cases among exposed patients and caregivers; however, it is not clear whether PEP was effective because there was no control group. https://indianexpress.com/article/india/preventive-use-of-hcq-in-frontline-healthcare-workers-icmr-study-6442948/ A new study by the Indian Council of Medical research (ICMR), which examined the prophylactic role of Hydroxychloroquine (HCQ) to prevent SARS-nCOV2, found that the risk of healthcare workers (HCWs) contracting the infection was much lower if a sustained dose was taken along with use of personal protective equipment (PPE). .... “However, with the intake of four or more maintenance doses of HCQ, the protective effect started emerging,” Dr Samiran Panda, director of ICMR- National AIDS Research Institute (NARI) and one of the study authors, told The Indian Express. “A significant reduction (more than 80%) in the odds of SARS-CoV-2 infection in the HCWs was identified with the intake of six or more doses of HCQ prophylaxis,” Dr Panda added.

Thanks for sharing. He is very optimistic that the dance can be maintained at low cost indefinitely, until vaccines are available. If true, doesn’t this support the general market level now? The economy may function almost ok, barring some mass entertainment events which need >50/100 people together. Do you share such an optimistic view? Let’s say California and North east manage the dance, and the mid west, Texas, Arizona fail and need another hammer lockdown. How big an impact is that to the US economy? I just went thought the article and I think it is pretty good. It matches the info I could gather from various sources. The problem with the herd immunity is that it takes a long time, as the Swedes found out and in the case of the US, the current IFR numbers suggest it would cost a lot of lives. We have had 120k death so far caused by the disease and with herd immunity it could be 10x as much. A lot of European countries have already case numbers so low they they can open up and have schools up and running for example. So essentially, they are already ahead of the US in how the economy can operate. This is due to the more effective and stronger shutdown measures. As far as the impact of several states like Texas, AZ, AL and other having high infection rates for a long time and what it means for the economy it’s really hard to tell. Maybe the population in states themselves ignores this and carries on. However, what about travel into and from these states? It’s free movement generally, but will people from COVID-19 free states will want to travel into these states? It will cause some issues for sure. I think we will have to see how this works. I am sure that real virus containment in the US isn’t really an option any more. https://www.aa.com.tr/en/asia-pacific/no-new-coronavirus-cases-found-in-japan/1870548 No new coronavirus cases found in Japan Japan did not have mandatory lockdowns. Yet they went to zero. The other day Spekulatius was arguing about protests and saying because protestors wear masks so it should be ok. So.....why then stronger shutdown measures are needed? Wear a mask and you can do anything, per Spekulatius logic.

Yes, and that is why the WHO should Continue to perform a study (or at least finish it) even when the odds are long Remdesevir is not just expensive, but also a drug that needs to be Intravenously in 5 or ten rounds applied, which makes it unlikely a game changer even if it works. HCQ is cheap and even if it is only modestly effective might have a significant value especially for the many poorer countries, which are really the main focus of the WHO anyways. Why not add an arm with Zinc in the Solidarity study. I would prefer exactly same dosage regimen as done by NYU grossman study. Many doctors believe in this Zinc addition. I earlier cited a NY doctor and LA doctor. Here is another article, this from India. ...... Along with HCQ, zinc is also normally administered to Covid patients. Doctors said, “The virus is inside the cell and zinc cannot get inside the cell for biochemical reasons. HCQ opens the door and lets zinc in. That’s all it does in this context,” said Dr Praveen Kumar, a physician at a private hospital. "The antibiotic azithromycin protects the patient from secondary infections.” Meanwhile, another renowned cardiac surgeon said, “In Karnataka, the drug has cured many. Cardiac arrests have happened due to various other comorbidities and can’t be linked with this drug alone.” Doctors and medical researchers suspect that several drug companies in the US want to push new drugs that almost do the same work as HCQ and are lobbying for its ban. “But the central government being very firm on the usage of this drug, it’s highly unlikely that its usage will be stopped to treat Covid patients,” a senior doctor said. https://www.newindianexpress.com/cities/bengaluru/2020/may/27/karnataka-doctors-to-continue-hcq-for-treatment-2148433.html ....... When doctors from NY, LA and India saying Zinc helps with HCQ and HCQ and Zinc are very cheap and can be easily provided to a lot of people and HCQ at these doses is already approved for long term use for Lupus, isnt it proper to test that first? Note: Not a medical advise. These are prescription medicines. Consult your doctor. For discussion only.

Additional data is always welcome. The Lancet has made some corrections and it seems like the WHO decided to put lower weight on the specific new piece of 'evidence' so that more studies are on the way. FWIW, from my perspective, it's unlikely that hydroxychloroquine will come to anything even with supplements of various sorts. It's still possible and that's why venture capital-type ventures exist in normal times. But are we in normal times? Resources are limited. A healthy way to invest may include an attempt to kill the thesis from various angles. In science, it may also be healthy to come up with an idea and to devise an experiment whose goal is to try to disprove the idea. A large problem with a lot of publications (it's become more obvious with CV but this has been a growing problem especially in some sect-like branches of research) is that individuals start with an idea in which they have a strong belief and then try (from conscious to unconscious) to find corroborating evidence. It doesn't tend to be constructive. I wanted to post as separate post as it is a different argument. Remedesivir is very expensive. HCQ is cheap. Shouldn't governments and WHO leave Remedesivir where profit can be made to pharmaceutical companies and focus on HCQ which is cheap and no profit can be made?

Additional data is always welcome. The Lancet has made some corrections and it seems like the WHO decided to put lower weight on the specific new piece of 'evidence' so that more studies are on the way. FWIW, from my perspective, it's unlikely that hydroxychloroquine will come to anything even with supplements of various sorts. It's still possible and that's why venture capital-type ventures exist in normal times. But are we in normal times? Resources are limited. A healthy way to invest may include an attempt to kill the thesis from various angles. In science, it may also be healthy to come up with an idea and to devise an experiment whose goal is to try to disprove the idea. A large problem with a lot of publications (it's become more obvious with CV but this has been a growing problem especially in some sect-like branches of research) is that individuals start with an idea in which they have a strong belief and then try (from conscious to unconscious) to find corroborating evidence. It doesn't tend to be constructive. I agree with you. The NYU grossman study and other doctors experience tells us that it is HCQ with Zinc that might work but not HCQ alone. Its time to move on to HCQ+Zinc. But I see WHO in solidarity study still persisting with HCQ alone.

https://www.bbc.com/news/health-52937153 Coronavirus: Malaria drug hydroxychloroquine 'does not save lives' Above is from Recovery trial. https://www.ny1.com/nyc/all-boroughs/news/2020/05/12/nyu-study-looks-at-hydroxychloroquine-zinc-azithromycin-combo-on-decreasing-covid-19-deaths Researchers at NYU's Grossman School of Medicine found patients given the antimalarial drug hydroxychloroquine along with zinc sulphate and the antibiotic azithromycin were 44 percent less likely to die from the coronavirus. .......... So when a study showed HCQ+Zinc+Azithromycin might be effective, which is what other doctors such as Dr. Zelenko in NY and Dr. Cardillo in LA also say, why do a study without Zinc and say it does not work? The NYU Grossman study is HCQ+Zinc+Azithromycin vs HCQ+Azithromycin. Their study showed Zinc is needed for its efficacy. Why not just do a double blinded randomized study of exactly same dose regimen of HCQ+Zinc+Azithromycin as done by NYU Grossman and check if its working?

You seem to have high conviction about hydroxychloroquine. Just released, is a multi-center trial that appears to be very solid evidence in relation to the role as prevention post-exposure. Conclusion: it seems hydroxychloroquine, in that context, is neutral: no significant side effects and no benefit. https://www.nejm.org/doi/pdf/10.1056/NEJMoa2016638?articleTools=true The main investigator is based in Minneapolis. Not everything that comes out of that place is questionable. My main complaint is studies are not properly designed and yes I do think it works but cannot be sure till proper studies are done. What I mean proper studies? Studies that are designed based on prior studies on what is working. For example this study gave HCQ for five days "Within 4 days after exposure, we randomly assigned participants to receive either placebo or hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 additional days)." They had Covid 19 in 49 with HCQ and 58 with placebo (Table 2) but no statistical difference. So, it might be working but did not have enough power to have statistical difference. However earlier studies used lesser HCQ dose per day for longer periods. Why not replicate that dose regimen already shown that it might working? Korean Study: Korean study used "HCQ was administrated orally at a dose of 400mg daily until the completion of 14 days of quarantine." If you check FDA label for HCQ for Lupus, the approved dose is upto 400 mg for long term use. So one would expect low side effects at this dose. And even though for Korean study there is no placebo arm, "At the end of 14 days of quarantine, follow-up PCR tests were all negative." when tested on "After a large COVID-19 exposure event in a LTCH in Korea, PEP using hydroxychloroquine (HCQ) was conducted to 211 persons including 189 patients and 22 careworkers" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162746/ ICMR study in India: "simply initiating HCQ prophylaxis did not reduce the odds of acquiring Covid-19 infection among HCWs. However, with the intake of four or more maintenance doses of HCQ, the protective effect started emerging. A significant reduction of about 80 per cent in the odds of Covid-19 infection in the HCWs was identified with the intake of six or more doses of HCQ prophylaxis. This dose-response relationship added strength to the study outcomes." The National Task Force for coronavirus in India recommended once a week maintenance dose for seven weeks i.e., 400 mg once every week, following the loading dose of 400 mg. https://www.indiatoday.in/india/story/4-hydroxychloroquine-hcq-doses-coronavirus-healthcare-workers-icmr-1684112-2020-06-01 ........ So, when prior studies have shown longer term use of lower dose HCQ might be providing protection and these lower doses would be expected to give less side effects (400 mg per day is approved for long term Lupus and 400 mg per week is given as prophylaxis for malaria when people go to high malaria incident areas), why design a study with high dose HCQ for short period which would be expected to give more side effects and does not have literature suggestion of working? I am not even bringing in effect of Zinc. NYU grossman study and atleast two doctors (Dr. Zelenko in NY & Dr. Cardillo in LA) say HCQ works better with Zinc. Note: Not medical advise and these are prescription medications to be taken upon consulting a doctor. Only for discussion.

https://www.washingtonexaminer.com/news/influential-hydroxychloroquine-study-used-suspect-data-from-company-run-by-pornographic-model-and-sci-fi-author A study showing that the anti-malaria drug touted by President Trump, hydroxychloroquine, harmed COVID-19 patients is likely based on fabricated data. An investigation by the Guardian found that the study, published in the Lancet (a prestigious medical journal), relied on data from a company called Surgisphere that appears to be highly suspect. The Lancet released an "expression of concern" about the study during the investigation. https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine Governments and WHO changed Covid-19 policy based on suspect data from tiny US company Surgisphere, whose employees appear to include a sci-fi writer and adult content model, provided database behind Lancet and New England Journal of Medicine hydroxychloroquine studies ......................................... While proper studies by NYU Grossman using HCQ, Zinc and Azithromycin showing 44% less deaths in certain Covid patient population and Indian ICMR studies of prophylactic use of HCQ have been ignored.

The sad thing about Hydroxychloroquine is the doses and patients proposed to be treated by the proponents were never properly tested in a randomized blinded studies. But for virus which is non-living, and hence cannot be killed unlike bacteria, one would expect it to work when given early before it replicated and spread through the body. Here is a new study that is supporting this: https://www.indiatoday.in/india/story/4-hydroxychloroquine-hcq-doses-coronavirus-healthcare-workers-icmr-1684112-2020-06-01 The National Task Force for coronavirus in India recommended once a week maintenance dose for seven weeks i.e., 400 mg once every week, following the loading dose of 400 mg. Adherence to this recommended regimen is underlined by the findings of the study, researchers said. Scientists who co-authored the study said, "It has been noticed that 4th week onwards there is a risk reduction of contracting the Covid-19 virus if the maintenance dosage is being taken as prescribed for seven weeks. Of course, this doesn't rule out the risk minimisation of those frontline workers who are treating Covid-19 patients while wearing PPEs and taking further precautions." CDC recommended prophylactic dose for malaria: Both adults and children should take one dose of hydroxychloroquine per week starting at least 1 week before traveling to the area where malaria transmission occurs. They should take one dose per week while there, and for 4 consecutive weeks after leaving. The weekly dosage for adults is 310mg base (400mg salt). How long is it safe to usehydroxychloroquine? CDC has no limits on the use of hydroxychloroquine for the prevention of malaria. When hydroxychloroquine is used at higher doses for many years, a rare eye condition called retinopathy has occurred. People who take hydroxychloroquine for more than five years should get regular eye exams. https://www.cdc.gov/malaria/resources/pdf/fsp/drugs/Hydroxychloroquine.pdf Comparison with Lancet study: The Lancet study of nearly 100,000 coronavirus patients had shown no benefit in treating them with anti-viral drugs hydroxychloroquine and chloroquine and even increased the likelihood of them dying in hospital. "This apparent disparity with the findings of the current investigation could be explained by the two different application contexts. While the observational study involving registry-analysis focussed on the treatment of hospitalised COVID-19 patients, our emphasis was on the prevention of infections among healthcare workers. In treatment settings, severe COVID-19 patients are likely to have a very high viral load and cytokine levels, which may not be improved by HCQ therapy," the study said. "Biologically, it appears plausible that HCQ prophylaxis may inhibit the virus from gaining a foothold," the study said. In the absence of clinical trial results on safety and efficacy of HCQ chemoprophylaxis in healthcare workers, this study offers evidence of public health importance. https://www.news18.com/news/india/icmr-says-hcq-reducing-risk-among-healthcare-workers-even-as-lancet-study-questions-drug-benefits-2647007.html How effective HCQ is in prophylactic use: Fifty % of those not on HCQ tested positive and upto 70% of those who’d taken a weekly dose of 400 mg of HCQ for three week tested positive. However, only 40% of those who’d taken 4-5 doses tested positive and—only 10% of those on the drug for six weeks or more reported testing positive. https://www.thehindu.com/news/national/coronavirus-hydroxychloroquine-with-ppe-reduces-odds-of-covid-19-in-health-workers-icmr-researchers/article31724680.ece

How can WHO be useful in containing the pandemic while they still showing this guideline: If you are healthy, you only need to wear a mask if you are taking care of a person with COVID-19. Wear a mask if you are coughing or sneezing. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

Probably shouldn’t trust a source that doesn’t know what “data” means. 0.4% is lower than the estimates I have seen (~0.75x), but it still would mean 800k death if we go all the way to herd immunity and get 200M Americans infected Ted. This would mean that we are about 1/8 through with this epidemic. Just saying. The numbers from Quebec vs. other Canadian provinces looks interesting, due to the huge difference in outcome compared to other provinces. It’s clear that relatively small differences in starting points lead to vastly different results in outcome. Perhaps not so surprising, considering the math behind epidemics and the nature of logistics function. The CDC website link given in article says "Symptomatic Case Fatality Ratio," in Column Scenario 5:Current Best Estimate 0.004. Percent of infections that are asymptomatic 35% That gives 0.4%*0.65 = 0.26% Infection fatality rate.

https://news.yahoo.com/declining-infection-rate-provides-challenge-143700638.html Declining infection rate provides challenge for Oxford coronavirus vaccine Professor Adrian Hill, director of the University's Jenner Institute, said what was formerly an 80 percent chance of developing an effective vaccine by September — possibly in time for a potential second wave of infections — has dwindled to 50 percent. That's not because the team no longer believes in its work, which is reportedly still going well. Instead, the U.K.'s infection rate decline may make it tough to gauge the vaccine's efficacy. "It's a race against the virus disappearing, and against time," Hill said. Hill only expects fewer than 50 of the 10,000 trial volunteers to catch the virus, which has faded since the U.K. and other countries implemented strict lockdowns, and if it turns out that fewer than 20 test positive, the study's results may be useless. https://www.bloomberg.com/news/articles/2020-05-06/infecting-subjects-may-speed-covid-19-vaccine-studies-who-says Infecting Subjects May Speed Covid Vaccine Studies, WHO Says Deliberately infecting healthy volunteers with the virus that causes Covid-19 may speed studies of vaccines against the deadly pathogen, the World Health Organization said. Such studies, which pose significant potential dangers to subjects, may be considered in dire situations and with certain disclosures and protections, a working group of the United Nations health agency said in a report posted Wednesday on its website. In the traditional approach, the potential vaccine or placebo will be given to healthy volunteers, who will then be assessed for safety and efficacy through natural or community infection. This takes a lot of time. History suggests the fastest time taken to develop a vaccine has been five years, but it usually takes double that time to bring vaccine from the lab to the market. In a human challenge trial since volunteers are exposed to the virus, it is possible to quickly find out the safety and efficacy of the vaccine, and weed out disappointing vaccine candidates. ......................................................................... Can anyone explain the logic here? "It's a race against the virus disappearing, and against time," "Deliberately infecting healthy volunteers with the virus that causes Covid-19 may speed studies of vaccines "

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/009768s037s045s047lbl.pdf Hydroxychloroquine dosage recommendations by FDA approved label: Rheumatoid Arthritis The action of hydroxychloroquine is cumulative and may require weeks to months to achieve the maximum therapeutic effect (see CLINICAL PHARMACOLOGY). Initial adult dosage: 400 mg to 600 mg (310 to 465 mg base) daily, administered as a single daily dose or in two divided doses. In a small percentage of patients, side effects may require temporary reduction of the initial dosage. Maintenance adult dosage: When a good response is obtained, the dosage may be reduced by 50 percent and continued at a maintenance level of 200 mg to 400 mg (155 to 310 mg base) daily, administered as a single daily dose or in two divided doses. Do not exceed 600 mg or 6.5 mg/kg (5 mg/kg base) per day, whichever is lower, as the incidence of retinopathy has been reported to be higher when this maintenance dose is exceeded. Corticosteroids and salicylates may be used in conjunction with PLAQUENIL, and they can generally be decreased gradually in dosage or eliminated after a maintenance dose of PLAQUENIL has been achieved. Lupus Erythematosus The recommended adult dosage is 200 to 400 mg (155 to 310 mg base) daily, administered as a single daily dose or in two divided doses. Doses above 400 mg a day are not recommended. The incidence of retinopathy has been reported to be higher when this maintenance dose is exceeded. John Hopkins article on Lupus treatment: Lastly, remember that even though you may feel the benefits of anti-malarial therapy after about a month of treatment, it may take up to three months for the full benefits of the drug to manifest. If you experience any serious adverse effects, notify your doctor. Can I stop taking anti-malarials suddenly? Long-term anti-malarial use is normally safe. However, if you stop taking your anti-malarial drugs, you may experience a lupus flare. https://www.hopkinslupus.org/lupus-treatment/lupus-medications/antimalarial-drugs/ NYU Grossman study dose: Patients were categorized based on their exposure to hydroxychloroquine (400 mg load followed by 200 mg twice daily for five days) and azithromycin (500 mg once daily) alone or with zinc sulfate (220 mg capsule containing 50 mg elemental zinc twice daily for five days) as treatment in addition to standard supportive care. https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v1.full.pdf Please explain the problem. For discussion only. Not medical advise. Please consult your doctor. These are prescription only medicines.

Sounds like Trump considers himself eligible for the study and participates voluntary. Trump probably isn't even really taking Hydroxychloroquine. He and others in the chain of command and military have probably been secretly receiving prophylactic treatments of plasma for months. It's a great explanation for why he has been his normal self and has shown no signs of his supposedly legendary Germaphobia. If you've forgotten, supposedly he couldn't have stumpfed the Russian prostitutes at the pee palace because he's so Germaphobic it would have been out of character. I'm left to conclude that either there are pee tapes out there or he's been getting convalescent plasma for months. This is also a good explanation for why we did those repatriation flights to military bases and got people to volunteer for military-led "research". Also, not a bad explanation why we allowed for cruise ships to become Petri dishes. You've got to get the plasma from somewhere and you probably want to get it early and from a verifiable source. Importation from Wuhan is a great technique for that. If anything the HCQ (Optionally with Zinc) will work earlier its given. Viruses are not living things. So they cannot be killed. Read about late diagnosis HIV. So we can only stop replication of viruses - hence if they work, they should work better earlier they are given. https://www.ny1.com/nyc/all-boroughs/news/2020/05/12/nyu-study-looks-at-hydroxychloroquine-zinc-azithromycin-combo-on-decreasing-covid-19-deaths NEW YORK - Researchers at NYU's Grossman School of Medicine found patients given the antimalarial drug hydroxychloroquine along with zinc sulphate and the antibiotic azithromycin were 44 percent less likely to die from the coronavirus. Trump took HCQ+Zinc. In above study they said it did not work in ICU but worked before ICU. That is it worked before the virus multiplied in the body extensively. So, one would expect it to work at the earliest stage - prophylactic. Trump had come in contact with Covid positives. So, his doctors gave him the medicine. It is a prescription medicine. The Indian govt has recently expanded its use https://www.msn.com/en-in/news/other/govt-expands-hydroxychloroquine-as-prophylactic-for-asymptomatic-health-workers-fighting-covid-19/ar-BB14u2ZN Govt expands Hydroxychloroquine as prophylactic for asymptomatic health workers fighting COVID-19 https://theprint.in/health/hcq-breakthrough-icmr-finds-its-effective-in-preventing-coronavirus-expands-its-use/427583/ HCQ breakthrough: ICMR finds it’s effective in preventing coronavirus, expands its use They are reporting further clinical studies of this prophylactic use and results are expected in July. S. Korea also they used it as prophylactic and even though its not a randomized double blind study, again there were encouraging results https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162746/ Can post-exposure prophylaxis for COVID-19 be considered as one of outbreak response strategies in long-term care hospitals? Because the exposed patients had to remain in multi-bed rooms receiving the care of similarly exposed careworkers and some of them might be in incubation periods, we concerned repetitive exposure episodes to newly developing patients. We started PEP with HCQ for patients and careworkers, on February 26 (Supplement Fig. 1). Physicians and pharmacists were educated about potential adverse events. HCQ was administrated orally at a dose of 400mg daily until the completion of 14 days of quarantine. A checklist for common adverse events was distributed (Supplement Fig. 2). The study was approved and informed consent was waived by the Institutional Review Board of Pusan National University Hospital (H-2003-014-089). ..... It is usual that many patients are infected with COVID-19 in the setting of cluster outbreaks associated with LTCHs. In contrast, we had no additional confirmed cases among exposed patients and caregivers. However, it is not sure if PEP was effective because there was no control group. Both chloroquine and HCQ had antiviral activity against SARS-CoV-2 in vitro [3], [4], [5], [6]. Clinical data from China and France showed chloroquine was superior to the control treatment, leading to recommend chloroquine in patients with mild to severe COVID-19 pneumonia [7], [8], [9], [10]. ...... In this study, HCQ was associated with mild adverse events. One patient having skin rash needed steroid for control without discontinuation. PEP was discontinued in 5 patients due to gastrointestinal upset, bradycardia, and for fasting. ...... There is a doctor in NY (Dr. Zelinco) and another doctor in LA who also say that this medicine (HCQ with ZINC and Azithromycin) works if given early based on their experience with patients. You can easily search and read about that. So, that White House doctor would give Trump as prophylactic HCQ+Zinc because he came in contact with Covid+ is in line with both S.Korea and Indian approaches. NYU grossman study also supports this use. This is not a medical advise. Only for discussion. Please consult your doctor. These are prescription drugs not intended for self administration