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HCQ Trials
RVNC
COVID19.
Interesting twitter thread about the last author (ie probably PI) of the controversial/influential French study of HCQ in COVID19.
At the very least some of it looks very sloppy (hard to see how it could be by accident), but the thread also gets carried away w animus, which detracts from the pure science ethics topic. Nonetheless, I suspect we’ll see more in the next few days or weeks since that’s often how this goes.
https://twitter.com/schneiderleonid/status/1242889208651448322?s=21
Note that some of the papers are one in which we was a co-author. But the one at the top of the thread, with the most examples, is one for which he was last author.
Seen any other oral antivirals with promise?
(I ask because I expect antivirals to work much better when given right at the start of symptoms, and that would be hard to do with an IV drug)
Oh, and another reason masks in general are probably good: keeps dose lower and thus disease severity is probably lower (there is actually a moderate amount of literature on this across different diseases)
There was on in vivo paper on HCQ + zinc? Human? Do you know where you found it?
Or are you referring to the in vitro paper somewhere up this thread?
FWIW probably something you already know, but zinc has a long and controversial history as beneficial in common cold. Very mixed results in trials (but that would be expected if it only works on positive stranded RNA virus, which are only a fraction of all virus types). Even the trials in which it appears to work it needs to be given early (pretty common in antiviral therapies). Dose seems to be abt 100 mg per day.
Finally, I’m on the record as thinking that HCQ plus zinc has abt a 25% chance of having clinically meaningful activity (if given early). Eg HR<=0.80. With this data I’d move the needle to 30%. However if some of the facts are confirmed (eg total number infected, no absurd false positives, enuf time on treatment, ...), I’d say the odds go up a lot. Big impediment will be getting serious attention paid to it since the HCQ stuff got blown out of proportion and zinc is associated with quackery in medical circles.
Thx. Missed the (low) dose. It was overall mixed in trends
Another paper on zinc’s ability to slow positively stranded RNA virus (in vitro)
https://www.sciencedirect.com/science/article/pii/S0378113512003719
FYI it turns out that HCQ in acute virus therapy has a long, and utterly failed, history. It’s been done in 3 or 4 other viruses too: looks good in vitro, fails acute trial in vivo.
Also note that the was a much better, albeit small, RCT of HCQ out of China. However it didn’t show any difference in viral clearance or outcomes (not as bad as it sounds - too many of control group cleared etc. Nonetheless I’d have expected it to have at least trends)
Might it succeed as prophylaxis? Maybe. Might it be particularly bad in acute because it’s a body stressing drug at this dose and so is the disease? Maybe. But, honestly, were I asked if I wanted it, right now I’d say no.
Eg DeBlasio fought brutally against schools shutting down - there’s at least one published article on how hard he resisted this advisors. Similarly for businesses (They didn’t close until Cuomo closed them - and the young’s were famously out clubbing in them a little over a week ago).
He’s even got a tweet in mid Feb encouraging everyone to not be scared and come to the giant Chinese New Year parade. And it continues even v recently. A huge foot dragger.
Gottlieb was apparently considered early on for a Corona Tzar position (late Jan, early Feb?), but rejected as too likely to be apolitical. (From Josh Barrow)
It’s stunning what happens when ppl think that all problems are ppl related... and then they run into a problem that is not.