4 ms·

This is so infuriating. This might work. It might not. Data is still (and must be, really) still anecdotal. It will be a year or more before high quality st

This is so infuriating. This might work. It might not. Data is still (and must be, really) still anecdotal. It will be a year or more before high quality studies are done. Yet we have to argue about the ?!@#!$ thing repeatedly, because public figures (we all know who) decided to push this idea irresponsibly as a miracle cure. So now all the people on one side of the discussion have to crow about every positive result as if it vindicates the original rhetoric. It does not. I mean, this might work a little! It might save some lives at the margin. It's not going to significantly affect the course of the pandemic. It's just not.

klmadfejno 6y ago
> It does not. I mean, this might work a little! It might save some lives at the margin. It's not going to significantly affect the course of the pandemic. It's just not. This is a really good take on it for those who aren't into reading scientific papers. It's totally plausible HCQ does help a bit. If true, it changes virtually nothing about our current situation. The decision making is all the same.
- lbeltrame 6y ago
  > If true, it changes virtually nothing about our current situation. Honest question: why? (Note: my background includes pharmacology, so I am more interested in pharmacological options rather than vaccines)
  - mlyle 6y ago
    If we end up with a treatment that swings infection fatality rate from 0.6% to 0.55% and reduces hospital stay time by 15%-- and HCQ probably does less than this-- the public policy choices we'd want to make are basically identical. Peak hospital load for a wave is lowered by much less than 15%; body count is just about as bad. Yes, everyone who has their life saved by this treatment is happy, and it's worth chasing small improvements on the margin... but... (It's worth noting that the (very) little evidence from controlled trials that we have leans more in the direction of harm than benefit, too. But the same argument holds for e.g. remdesivir where we do have some decent evidence).
    - lbeltrame 6y ago
      > If we end up with a treatment that swings infection fatality rate from 0.6% to 0.55% and reduces hospital stay time by 15% Unsure about fatality (the data is a statistically insignificant trend), but the NIAID trial preliminary data points that remedesivir does cut recovery time by 30% (11 days vs 14 days) according to their interim report. I have to dig up the exact definition. Yes, not HCQ, but data on drugs exist. Too bad it's probably one of the hardest to manufacture.
      - mlyle 6y ago
        OK, but this has nothing to do with what I said. Even cutting recovery time by 22% doesn't lower peak ICU usage very much-- less than 22% because there's still the effect of the exponential peak. The point is it doesn't affect policy / the fundamentals of the situation in any way. It's something that individual patients are happy and thankful for, but the overall societal situation is the same. A treatment that reduced the chance of ending up in ICU by 50% would, but this isn't enough to move the needle.
lbeltrame 6y ago
> It will be a year or more before high quality studies are done. I beg to differ. At least on paper, there is at least one trial (target size 3000 individuals, but they claim they might have enough power with lower numbers): https://covidpep.umn.edu/ https://covidpep.umn.edu/
- jeffdavis 6y ago
  Why do you think that will be done sooner? (Sincere question; I just don't see any dates there and looks like they are still recruiting participants.)
  - lbeltrame 6y ago
    According to the updates page, they have a meeting of the DMSB today. In the previous interim report (April 22nd) they said they needed at least 200 more particpants to have sufficient statistical power.
    - jeffdavis 6y ago
      Cool! So results are maybe a few months out then? I am placing the odds of a positive result at around 25%. For vitamin D supplements to people who are deficient, I place the odds at 50%. Not that anyone cares what I think the odds are.
      - lbeltrame 6y ago
        Probably a few weeks more is likely (unless the primary endpoint is reached earlier, but I'm doubtful). So far they have enrolled about 790 people.

klmadfejno 6y ago

> It does not. I mean, this might work a little! It might save some lives at the margin. It's not going to significantly affect the course of the pandemic. It's just not. This is a really good take on it for those who aren't into reading scientific papers. It's totally plausible HCQ does help a bit. If true, it changes virtually nothing about our current situation. The decision making is all the same.

lbeltrame 6y ago
> If true, it changes virtually nothing about our current situation. Honest question: why? (Note: my background includes pharmacology, so I am more interested in pharmacological options rather than vaccines)
- mlyle 6y ago
  If we end up with a treatment that swings infection fatality rate from 0.6% to 0.55% and reduces hospital stay time by 15%-- and HCQ probably does less than this-- the public policy choices we'd want to make are basically identical. Peak hospital load for a wave is lowered by much less than 15%; body count is just about as bad. Yes, everyone who has their life saved by this treatment is happy, and it's worth chasing small improvements on the margin... but... (It's worth noting that the (very) little evidence from controlled trials that we have leans more in the direction of harm than benefit, too. But the same argument holds for e.g. remdesivir where we do have some decent evidence).
  - lbeltrame 6y ago
    > If we end up with a treatment that swings infection fatality rate from 0.6% to 0.55% and reduces hospital stay time by 15% Unsure about fatality (the data is a statistically insignificant trend), but the NIAID trial preliminary data points that remedesivir does cut recovery time by 30% (11 days vs 14 days) according to their interim report. I have to dig up the exact definition. Yes, not HCQ, but data on drugs exist. Too bad it's probably one of the hardest to manufacture.
    - mlyle 6y ago
      OK, but this has nothing to do with what I said. Even cutting recovery time by 22% doesn't lower peak ICU usage very much-- less than 22% because there's still the effect of the exponential peak. The point is it doesn't affect policy / the fundamentals of the situation in any way. It's something that individual patients are happy and thankful for, but the overall societal situation is the same. A treatment that reduced the chance of ending up in ICU by 50% would, but this isn't enough to move the needle.

lbeltrame 6y ago

> It will be a year or more before high quality studies are done. I beg to differ. At least on paper, there is at least one trial (target size 3000 individuals, but they claim they might have enough power with lower numbers): https://covidpep.umn.edu/ https://covidpep.umn.edu/

jeffdavis 6y ago
Why do you think that will be done sooner? (Sincere question; I just don't see any dates there and looks like they are still recruiting participants.)
- lbeltrame 6y ago
  According to the updates page, they have a meeting of the DMSB today. In the previous interim report (April 22nd) they said they needed at least 200 more particpants to have sufficient statistical power.
  - jeffdavis 6y ago
    Cool! So results are maybe a few months out then? I am placing the odds of a positive result at around 25%. For vitamin D supplements to people who are deficient, I place the odds at 50%. Not that anyone cares what I think the odds are.
    - lbeltrame 6y ago
      Probably a few weeks more is likely (unless the primary endpoint is reached earlier, but I'm doubtful). So far they have enrolled about 790 people.