The picture is from https://science.sciencemag.org/content/368/6493/829
published "22 May 2020" at the time when less was known about Chloroquine and hydroxychloroquine than today about treating Covid-19 (1). That's the needed perspective when watching the picture, where the rest is still relevant.
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1)
E.g. June 23, 2020 "NIH: Trial Investigating Hydroxychloroquine for COVID-19 Stopped"
Is any of these studies using Zinc? We know that a lot of people have both Vitamin D and Zinc deficiency. How HCQ works is to transport the Zinc into the cell so that Zinc can stop the RNA replication. (I’m a layman here, but it’s what I’ve managed to understand after deliberate research)
Thus, HCQ without Zinc is like using a bucket but forgetting the water to stop the fire. Just throwing buckets at the fire isn’t gonna work much when there’s no water in the bucket.
Have a look at this [1] studies that shows around a 9% less mortality when treated with Zinc and a even more when treated EARLY with HCQ PLUS Zinc. (Please take a look at the numbers in the last table, it’s very clear that HCQ + Zinc reduces mortality)
I think there are 2 hypothesis for HCQ. One is that it blocks autophagosome-lysosome fusion. The second is that it is a Zinc ionophore, which enables Zinc to enter cells to stop viral replication. It seems that almost all the studies are not using Zinc. Here is a retrospective observational study showing effectiveness of HCQ+Zinc. It is a mystery to me why this second path doesn’t get more attention. Quercetin is also a Zinc ionophore. So Quercetin+Zinc should also be studied.
From the very paper linked by the parent and the parent-parent:
"This was an observational retrospective analysis
that could be impacted by confounding variables"; "We also do not have data on the time at which the patients included
in the study initiated therapy with hydroxychloroquine, azithromycin, and zinc." "The cohorts were identified based on medications
ordered rather than confirmed administration, which may bias findings towards favoring
equipoise between the two groups." "In light of these limitations, this study should not be
used to guide clinical practice."
So, good reason to have a more clinical trial for testing HCQ + ZINC + Azitromycin vs HCQ alone (vs NO Medicine). But that's something I'm not seeing at the moment, which is a shame.
"AAPS files with the court a chart showing how countries that encourage HCQ use, such as South Korea, India, Turkey, Russia, and Israel, have been far more successful in combatting COVID-19 than countries that have banned or discouraged early HCQ use, as the FDA has."
However: that chart is totally misleading, it's a typical "non sequitur". "Case fatality rate" is just a ratio "death" through "cases". Where those with weaker symptoms are recognized as "cases" the rate is lower. How they are recognized is not the same across different countries.
> you seem to be posting studies that did not pair HCQ with zinc
I'm just posting studies that were the basis for what FDA decided June 15, 2020 (1):
"FDA has revoked the emergency use authorization (EUA) to use hydroxychloroquine and chloroquine to treat COVID-19 in certain hospitalized patients when a clinical trial is unavailable or participation is not feasible. We made this determination based on recent results from a large, randomized clinical trial in hospitalized patients that found these medicines showed no benefit for decreasing the likelihood of death or speeding recovery."
Note that while AAPS presents as a proper organisation, its previous greatest hits include HIV denialism, vaccine/autism conspiracy theory pushing and “smoking is fine actually” stuff. It’s not a proper medical organisation. If it said water was wet, I would be checking.
"The Association of American Physicians and Surgeons (AAPS) is a conservative non-profit association founded in 1943. The group was reported to have about 5,000 members in 2014. The association has promoted a range of scientifically discredited hypotheses, including the belief that HIV does not cause AIDS, that being gay reduces life expectancy, that there is a link between abortion and breast cancer, and that there is a causal relationship between vaccines and autism. It is opposed to the Affordable Care Act and other forms of universal health insurance."
The first week or two, your immune system ramps up to fight the infection. During this battle, the collateral damage is what gives you symptoms like joint pain, runny nose, sore throat, etc. Near the 3rd week of infection, 85% of patients are recovering and feeling better because their immune response has naturally turned itself off. For some reason, this doesn't happen in about 15% of patients. We call this a 'cytokine storm'. This is where your immune system has gone nuclear and is still destroying anything and everything it sees, including normal healthy tissue. This can ultimately lead to multi-organ failure and death if it can't be stopped. Dexamethasone tamps down that immune response, allowing your body to heal. Obviously it has to be timed right. It doesn't do anything to the virus, only your immune response.
To connects the dots, pathological cytokine release syndrome is highly likely to be causing the (extremely rare) instances of stroke in non-elderly COVID-19 patients, organ damage, etc.
I get incredibly annoyed when people act like (a) these strokes / organ damage are happening in significant quantities and (b) that it’s unique to SARS-2
Is it? From all lab confirmed cases in USA until end of May, almost every 200th in age group 20-29 was admitted to ICU. Almost every 100th in age group 30-39. (1)
Admitted to ICU means "probably considered intubation (or received it immediately)" Which is very, very unpleasant thing:
(In the USA there are 7.2% inhabitants aged 20-29, 6.7% aged 30-39. Even if the number of "unconfirmed but infected" is 10 times higher, that still gives around 24000 people in the USA aged 20-39 needing ICU, or 8 times more than died on 9/11. And those are just provably "non-elderly". All those 40 and older would need even much more ICU beds. I hope it's obvious that if there are not enough ICU beds much more people would die.)
1) It can be calculated from https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm For 20-29 182469 confirmed, 864 ICU, for 30-39 214849 confirmed, 1879 ICU. (Additionally, males were admitted to ICU almost twice as much as females)
This is a thread about dexamethasone, not "strokes", and we also know that from 8 patients that are intubated the treatment with dexamethasone saves one, compared to those intubated never treated with dexamethasone. We also know that dexamethasone is at best not helping if given outside of ICU.
Once again, dexamethasone has to be given to 8 intubated people to save one, and that's considered the drug with the most visible effect in fighting Covid-19 up to now -- i.e. the most successful drug up to now! You can imagine how little effect other drugs produced in the verified trials.
In that context, talking about ICU and intubated is exactly on topic, hand-waving "strokes" isn't.
Moreover, the comment actually said "strokes / organ damage" not "strokes." Nevertheless, the main effect of dexamethasone is on the intubated patients.
Regardless of what the thread is or isn't about, the comment you quoted made specific claims:
- Strokes (and organ damage) are the result of cytokine storms
- Strokes (and organ damage) in COVID-19 are "extremely rare"
That may be true or untrue, but you are not responding to those claims, you are responding to something else. I'm not even sure what that is, because nobody actually wrote it down.
The comment tried by introducing "strokes" to distract from the topic: dexamethasone which helps intubated patients. Insisting on that non-topic here just doesn't improve the discussion. Discussing "strokes" by "non-elderly" as the special case of all intubated patients as somehow relevant for dexamethasone isn't supported by any research, as far as I know.
And I claim that the number of patients that could be saved using dexamethasone even in the age groups 20-39, if they get infected, is nothing "extremely rare" among "non-elderly": only before end of May, surely more than 100 US patients aged 20-39 could have been saved. If "non-elderly" means "still working" the number is even much higher.
> The comment tried by introducing "strokes" to distract from the topic: dexamethasone which helps intubated patients.
The comment is about what causes strokes: Is it the virus itself, or the cytokine storm? If it is the virus itself, that would be rather unique. The comment argues that it is the cytokine storm.
This is relevant because there is a hypothesis that COVID-19 is uniquely dangerous because the virus itself directly attacks organs and causes strokes.
Furthermore, if Dexamethasone helps with the cytokine storms and the cytokine storms cause strokes/organ damage, it only follows that it also helps with the strokes/organ damage.
Therefore, nothing in the comment suggests that Dexamethasone wouldn't help patients, regardless of age. To the contrary. You appear to be fighting windmills.
No. I responded to user's very clear claims, where he wrote (emphasis mine):
"cytokine release syndrome is highly likely to be causing the (extremely rare) instances of stroke in non-elderly"; "I get incredibly annoyed when people act like (a) these strokes / organ damage are happening in significant quantities"
in his comment replying to dexamethasone effects and I have shown that the "quantities" of those who are helped by dexamethasone are significant. I started by quoting his "extremely rare" and replying "Is it?" (as is "is that really extremely rare" because he is as he writes "incredibly annoyed" in his comment to dexamethasone effects) and showed the numbers.
And you haven't shown anything else.
Note that it was never about "strokes" alone, which was your original claim, but about dexamethasone. For him was "extremely rare": "stroke in non-elderly COVID-19 patients, organ damage, etc." Note the "etc." too. Only you and nobody else here reduced that to "strokes" alone in your first response. Let me state it again, I don't see your comments contributing anything here.
> I started by quoting his "extremely rare" and replying "Is it?" (as is "is that really extremely rare" because he is as he writes "incredibly annoyed" in his comment to dexamethasone effects) and showed the numbers.
He said "strokes are extremely rare", you showed numbers on ICU admissions. Those are obviously two very different things.
> Note that it was never about "strokes" alone, which was your original claim, but about dexamethasone.
The words "extremely rare" only appear in conjunction with strokes. The word "organ damage" also appears later, as "not significant quantities", which is still different. Dexamethasone does not appear in the comment at all.
I don't know where to go from here. This seems to be the hill you want to die on. May you rest in peace.
Are you saying cytokine storms are the only mechanism causing thrombosis in COVID-19? I was under the impression that SARS-2 itself also had the ability to cause clots. Is that incorrect?
"The [steroid] drugs suppress the immune system, which could provide some relief for patients whose lungs are ravaged by an overactive immune response that sometimes manifests in severe cases of COVID-19. But such patients may still need a fully functioning immune system to fend off the virus itself."
"no effect on mild infections"
Basically if taken too early it does the wrong action, but it helps some of those already on oxygen. And it's cheap.
