3 ms·

This morning we had: France ex-IHU Marseille/AP-HP: 79160 cases, 7527 dead, mortality rate 9.5% IHU Marseille/AP-HP: 3005 cases, 33 dead, mortality rate 1.1%

by ucha 7y ago

This morning we had: France ex-IHU Marseille/AP-HP: 79160 cases, 7527 dead, mortality rate 9.5% IHU Marseille/AP-HP: 3005 cases, 33 dead, mortality rate 1.1% France doesn't use HCQ consistently yet. Didier Raoult who heads the IHU in Marseille has been using it systematically on all cases, even mild ones for more than 2 weeks. I doubt such a difference in mortality rate could be explained by a difference in number of tests performed or other parameters. Everyone can have all sorts of opinions on the efficacy of the treatment but in the end, mortality rates don't lie. And no, differences in the level of care, health or other smaller factors cannot explain an 8x difference. In addition to that, most patients seem to have elevated ferritin which would be a side effect of consuming too much iron. In this case, it is theorized that when the virus replicates, it creates non-essential proteins that take place of the iron in hemoglobin thus preventing red blood cell from carrying O2 and CO2 from and back to the lungs. Based on molecular simulations, it seems that HCQ can bond to those viral proteins preventing them from expelling iron from hemoglobin. It would also explain why it's useful to treat someone early on rather than later when their hemoglobin lost their iron... Source here: https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173 https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...

inamberclad 7y ago
It also doesn't count for confounding factors. Were all the patients of the same health? Did they all have the same supportive equipment? Did they all begin treatment at the same time after symptom onset? These are all questions that need to be addressed, the sooner the better.
- ucha 7y ago
  It doesn't. We have to make a decision with uncertainty unfortunately. However, I don't think any of those questions could explain an 8x difference apart from the time of treatment. In Marseille, they treat you immediately independently of the severity of symptoms.
wolco 7y ago
Each of the 3005 had proper full care and were closely watched. We don't know about the 79160. The difference in mortality could be a number of factors.
cma 7y ago
Does Marseille test more than France? It is expected no one is hitting a 9.5% death rate unless they quit testing almost all but the severe or dead.
- jojo2000 7y ago
  It's the most heavily tested area of the world [0], and also the only place where everyone who is positive gets a treatment (hydroxychloroquine + azithromycine). Other protocols are listed here [1] Regarding status, it seems the peak is being reached there [2] [0] https://twitter.com/raoult_didier/status/1245978149206228992/photo/1 https://twitter.com/raoult_didier/status/1245978149206228992... [1] https://twitter.com/raoult_didier/status/1242808646997880832/photo/1 https://twitter.com/raoult_didier/status/1242808646997880832... [1] https://twitter.com/raoult_didier/status/1246003916325748736/photo/1 https://twitter.com/raoult_didier/status/1246003916325748736...
  - cma 7y ago
    1% is about expected at that point, since there is a 14 day lag on average and CFR can only go up over time after new cases trail off, it should end up higher. Look how South Korea eventually rose from .7% to 1.8% (somewhat biased by lots of young people infected early, but most of the rise at least from 1% to 1.8% was just due to the lags involved). Maybe it is still a good number for their population age demographics and the treatment helps a lot, but it doesn't seem to be showing it to be anything like a game changer.
    - jojo2000 7y ago
      It's a narrow viewpoint to only see it through the lens of death percentage. Of course it is a game-changer. You eradicate the viral load after 6 days instead of 20+. Meaning : - reduced contagion (avoiding big peak of infections), no confinement needed, so the better for the economy - you avoid complications, meaning less load on hospital, so you can save a lot of people who would have died otherwise. - people get better in less time so less damage to their finances.
rrss 7y ago
Seems like those statistics would be pretty easily explained by Marseille being a week or two behind other areas in France on the epidemic curve. Pennsylvania: 11510 cases, 150 deaths, mortality rate 1.3% Is Pennsylvania also using HCQ systematically on all cases? I don't think these crude CFRs are useful.
- ucha 7y ago
  That's the most interesting rebuttal I've heard but I don't think it's true. Everything else being equal, you could estimate the stage of the epidemic by the number of cases per capita. The Marseille department, Bouches-du-Rhône, has 3% of the French population and about 4% of cases. Also, in your example, the crude CFR for the US is 2.9% right now, so only 2.2x that of Pennsylvania. We're talking about 8+ here.
  - rrss 7y ago
    You didn't finish the comparison for cases for capita. Bouches-du-Rhône has ~3% of the French population and ~4% of the covid-19 hospitalizations. The department of Paris has ~3% of the French population and ~10% of the hospitalizations. That seems to indicate that Bouches-du-Rhône is behind Paris. (used hospitalizations instead of cases only because I couldn't find a good source for case breakdown by department. numbers from https://dashboard.covid19.data.gouv.fr/ https://dashboard.covid19.data.gouv.fr/)

by ucha 7y ago

inamberclad 7y ago

It also doesn't count for confounding factors. Were all the patients of the same health? Did they all have the same supportive equipment? Did they all begin treatment at the same time after symptom onset? These are all questions that need to be addressed, the sooner the better.

ucha 7y ago
It doesn't. We have to make a decision with uncertainty unfortunately. However, I don't think any of those questions could explain an 8x difference apart from the time of treatment. In Marseille, they treat you immediately independently of the severity of symptoms.

wolco 7y ago

Each of the 3005 had proper full care and were closely watched. We don't know about the 79160. The difference in mortality could be a number of factors.

cma 7y ago

Does Marseille test more than France? It is expected no one is hitting a 9.5% death rate unless they quit testing almost all but the severe or dead.

jojo2000 7y ago
It's the most heavily tested area of the world [0], and also the only place where everyone who is positive gets a treatment (hydroxychloroquine + azithromycine). Other protocols are listed here [1] Regarding status, it seems the peak is being reached there [2] [0] https://twitter.com/raoult_didier/status/1245978149206228992/photo/1 https://twitter.com/raoult_didier/status/1245978149206228992... [1] https://twitter.com/raoult_didier/status/1242808646997880832/photo/1 https://twitter.com/raoult_didier/status/1242808646997880832... [1] https://twitter.com/raoult_didier/status/1246003916325748736/photo/1 https://twitter.com/raoult_didier/status/1246003916325748736...
- cma 7y ago
  1% is about expected at that point, since there is a 14 day lag on average and CFR can only go up over time after new cases trail off, it should end up higher. Look how South Korea eventually rose from .7% to 1.8% (somewhat biased by lots of young people infected early, but most of the rise at least from 1% to 1.8% was just due to the lags involved). Maybe it is still a good number for their population age demographics and the treatment helps a lot, but it doesn't seem to be showing it to be anything like a game changer.
  - jojo2000 7y ago
    It's a narrow viewpoint to only see it through the lens of death percentage. Of course it is a game-changer. You eradicate the viral load after 6 days instead of 20+. Meaning : - reduced contagion (avoiding big peak of infections), no confinement needed, so the better for the economy - you avoid complications, meaning less load on hospital, so you can save a lot of people who would have died otherwise. - people get better in less time so less damage to their finances.

rrss 7y ago

Seems like those statistics would be pretty easily explained by Marseille being a week or two behind other areas in France on the epidemic curve. Pennsylvania: 11510 cases, 150 deaths, mortality rate 1.3% Is Pennsylvania also using HCQ systematically on all cases? I don't think these crude CFRs are useful.

ucha 7y ago
That's the most interesting rebuttal I've heard but I don't think it's true. Everything else being equal, you could estimate the stage of the epidemic by the number of cases per capita. The Marseille department, Bouches-du-Rhône, has 3% of the French population and about 4% of cases. Also, in your example, the crude CFR for the US is 2.9% right now, so only 2.2x that of Pennsylvania. We're talking about 8+ here.
- rrss 7y ago
  You didn't finish the comparison for cases for capita. Bouches-du-Rhône has ~3% of the French population and ~4% of the covid-19 hospitalizations. The department of Paris has ~3% of the French population and ~10% of the hospitalizations. That seems to indicate that Bouches-du-Rhône is behind Paris. (used hospitalizations instead of cases only because I couldn't find a good source for case breakdown by department. numbers from https://dashboard.covid19.data.gouv.fr/ https://dashboard.covid19.data.gouv.fr/)