58 ms·

Covid: Remdesivir 'has little or no effect' on survival, says WHO

369 points by VieEnCode 6y ago

AbrahamParangi 6y ago
The null hypothesis is of course the most probable and bio is insanely hard. But it’s not clear to me that the WHO has any credibility left. Edit: This is not a coded American Politics statement. Here are examples of where the WHO provided directly counterproductive recommendations: 1. Don’t wear masks (https://www.google.com/amp/s/amp.cnn.com/cnn/2020/03/30/world/coronavirus-who-masks-recommendation-trnd/index.html https://www.google.com/amp/s/amp.cnn.com/cnn/2020/03/30/worl...) 2. Don’t close borders (https://www.reuters.com/article/us-china-health-who/who-says-countries-should-keep-borders-open-trade-people-moving-despite-coronavirus-idUKKBN1ZU1C2 https://www.reuters.com/article/us-china-health-who/who-says...) 3. COVID is not airborne (https://m.facebook.com/WHO/posts/3019704278074935 https://m.facebook.com/WHO/posts/3019704278074935) (pedantic takes aside you should obviously treat it is if it were)
- spuz 6y ago
  What does this mean?
  - hef19898 6y ago
    That he is one of the people that don't believe anything anymore the WHO says because they got the thing with the masks wrong.
    - rootusrootus 6y ago
      IIRC the 'masks wrong' accusation was more about the CDC than the WHO. As I recall, the WHO caught a lot of flak early on for press releases written in strict scientific language that were easily construed to mean something entirely different. They earned a bit of criticism for that, since they should have written those PR bits for the lay audience that it was intended for.
      - TaupeRanger 6y ago
        I fully realize this will incur a mob of downvotes, but the evidence on masks is still unsettled, despite clamoring on social media and some news media. I would encourage people to listen to a balanced view on doctor Vinay Prasad's excellent podcast "Plenary Session". Even mentioning the possibility that this might be true is enough to get shouted down and accused of supporting Trump. In fact, it is quite unclear whether widespread masking is a net positive for US populations. It hasn't been shown to be effective, and there are still many unstudied avenues that could lead to a negative result. Just a couple examples: 1. Giving people a false sense of security, causing them to go out when they feel sick when they otherwise wouldn't. 2. Causing more face-touching behavior while fiddling with the mask, making infection more likely. We just don't know the answer.
      - andybak 6y ago
        The sibling post was rather unjustly flagged. I'm often on the other side of the fence on this but in this case I think it was unfair.
      - vharuck 6y ago
        I've always thought of the WHO as serving an audience of public health experts for the member nations. Then those nations can decide what the best response is within their borders. When I remember back on the news about the other recent pandemic scares (ebola, swine flu, zika), I don't remember hearing any mention of the WHO. I'm sure it happened, but not nearly as much as CDC. We hear about their announcements a lot more often now, but how much is that due to being cast as antagonists by DC?
        vkou 6y ago
        If the Ebola epidemic killed 200,000 people in the United States, due to a completely bungled response by the CDC, you could bet that the supporters of the administration in power at the time would be burning effigies of the WHO.
        rsynnott 6y ago
        That is what the WHO used to do, certainly. It does seem to talk more directly to the press these days, and it's honestly probably not a great idea.
    - sova 6y ago
      Or, you know, this now infamous Tweet: https://twitter.com/who/status/1217043229427761152 https://twitter.com/who/status/1217043229427761152
      - ceejayoz 6y ago
        That's an entirely accurate tweet at the time. On Jan 14, 2020, the WHO had no clear evidence of human-to-human transmission yet. It came (to them) shortly afterwards. That China may have had such evidence and kept it private doesn't make the WHO's statement any less truthful at the time it was issued. They aren't an intelligence organization; they rely on cooperative member nations. https://www.factcheck.org/2020/04/factchecking-trumps-attack-on-the-who/ https://www.factcheck.org/2020/04/factchecking-trumps-attack... > While there is a debate about what was known when — and it seems clear that China knew more than what it reported — the WHO never said the virus was not communicable. Instead, the agency always considered the possibility, even if it also shared information from China that found no evidence of such transmission. > Lack of evidence, especially of “preliminary” results, does not mean the WHO was saying the novel coronavirus could not be spread between people. The same day as the tweet, the WHO cautioned that there might be some human-to-human transmission of the virus among family members in China. > According to a timeline of events, Van Kerkhove, who is also the WHO’s technical lead for the COVID-19 response, also said that human-to-human transmission wouldn’t be unexpected, since that is what occurs with SARS and MERS, which are also coronaviruses. Just a few days later: > By Jan. 19, the WHO was more definitive, saying in a tweet that there was “some limited human-to-human transmission occurring between close contacts.” Trying to use this tweet to justify US inaction months later is silly and transparent.
        hef19898 6y ago
        Thanks!
        nwienert 6y ago
        It wasn’t lacking evidence at all, want to know why? Because I read that headline at the time and thought it was ridiculous, I couldn’t believe they were saying something so backwards. If you had been paying attention, you knew already: 1. It was spreading rapidly in humans 2. It was a coronavirus and therefore was similar to other coronaviruses If you were following a precautionary principle, you’d have said “it likely is spreading between humans given we’ve never seen any other form of transmission this rapid in any virus that isn’t, and it’s a coronavirus”. If you think their “don’t wear masks” lie was ok because it was trying to keep medical workers from a shortage, then, how can you not see this as hypocritical? You can’t think the mask lie was ok, due to abundance of caution, and then a total disregard for caution at a much more crucial early stage as ok. But again, if you were paying attention, watching the WHO make statements like this was terrifying. Like driving in a car with a drunk driver who is stepping on the gas. Who in their right mind would make such a totally braindead, reckless press release like that. Technically there’s no direct evidence, but there’s a whole lot of reason to be worried it likely is airborne. So the headline should be “it’s highly possible it’s airborne, we are waiting for concrete data, but recommend caution given exponential spread within humans”. The WHO did things similarly shockingly bad three times or so during the pandemic. I was paying attention to all of them and couldn’t help but think something was up. Something was wrong with the WHO. Not just being conservative, but being totally negligent and backwards time and time again. It really seems they were playing either protection for China, or some sort of interference against a good chunk of the world. If they had done better, many many lives would have been saved. It was some internal politics that broke them. Any halfway sane person knew it at the time.
    - dqv 6y ago
      I don't remember that, but they got the thing about restricting travel wrong. https://www.reuters.com/article/us-china-health-who-idUSKBN1ZX1H3 https://www.reuters.com/article/us-china-health-who-idUSKBN1...
    - hnracer 6y ago
      It's not just the masks. They also got many other things wrong, and the leader of the WHO has a number of corruption allegations with some veracity to their name.
- QUPHAJS3V6 6y ago
  Why? I know WHO is now politically involved in the US elections and I presume that shapes many opinions. But, I did read recently about polio eradication from the African continent etc. Obviously not just by WHO but efforts by many organizations, but still a major achievement isnt it? Update: I actually would like to know why WHO is not credible any more for some. Honest question.
  - makomk 6y ago
    Unfortunately, the whole polio eradication thing is less of an clear-cut success story than the headlines made it seem - they only eradicated wild-type polio, there are still major outbreaks in Africa of vaccine-derived polioviruses that have lost the mutations which made them safe and started spreading in the community and paralyzing people, those have only been getting more widespread last I heard and there doesn't seem to be any clear route to a solution. Can't imagine that Covid has helped much with that either, given the disruption to vaccination programs worldwide - vaccine-derived poliovirus outbreaks thrive wherever vaccination is disrupted or incomplete, or there's a border between vaccinated and non-vaccinated regions. The original plan that the WHO and the rest of the global health community came up to deal with this also seems like total magical thinking to me - basically, everywhere would drop the type 2 poliovirus component (which corresponded to a virus whose wild type had been eliminated) from their live vaccines at once, which would leave none to turn into vaccine-derived poliovirus and type 2 woud just go away. It didn't work that way. I can't fathom why it even should. Nonetheless, there were lots of fancy documents and presentations from the WHO and other such organisations explaining this strategy very hopefully. The current ones don't have the same level of hope.
    - deleted 6y ago
      [deleted]
    - orwin 6y ago
      Please explain why you're downvoting, this is a fact, only wild polio is "eradicated" from africa, not vaccine-induced polio (type 1 and type 2 are often milder than wild polio however). And i think there was a polio outbreak in Soudan this year, so...
- QUPHAJS3V6 6y ago
  Fair enough. Who/what organizations do you trust then for public health and covid related recommendations?
  - pdonis 6y ago
    My short answer: there aren't any. Every source has shown itself willing to set truth aside in the interest of some political or ideological agenda. If your response is "well, that sucks", yes, I agree. It sucks to live in a world where people and institutions whose sole job is supposed to be making sure true information gets to the public, every time, no exceptions, are either unwilling or unable to do that job right.
    - BalinKing 6y ago
      This is where I also stand. I don't (a prior) trust the WHO, I don't (a priori) trust the CDC, I don't (a priori) trust the talk show hosts. (To be fair, I think this principle applies much more generally than public health matters.) That's not to say I behave irresponsibly: I wear a mask in public (because "better safe than sorry"), my family self-quarantined for two weeks when one of us got sick, etc. I just don't assume what "experts" say is necessarily the truth. (To be fair, I also don't trust myself to reach correct conclusions—hence my personal policy of "better safe than sorry.") I personally feel like too much of modern society involves idolizing experts and institutions—after all, it's nothing more than the argument-to-authority logical fallacy (admittedly, even if it's often a useful heuristic)... but that's a discussion for another time :-P
      - pdonis 6y ago
        > That's not to say I behave irresponsibly: I wear a mask in public (because "better safe than sorry") Same here. My wife and I were wearing masks, social distancing, not going to public places like restaurants where there was a high risk of catching something, weeks before any public health authorities were recommending such measures, and before the case rate in our area started to spike. To us it was obvious common sense.
      - 6y ago
- anigbrowl 6y ago
  Has WHO lost some credibility through a combination of poor decisions, poor communications, and rapidly changing scientific understanding? For sure. Suggesting that WHO has no credibility left is hyperbolic and unhelpful.
- ksk 6y ago
  >1. Don’t wear masks False. They said - "There is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit" "In the community, we do not recommend the use of wearing masks unless you yourself are sick and as a measure to prevent onward spread from you if you are ill" "The masks that we recommend are for people who are at home and who are sick and for those individuals who are caring for those people who are home that are sick," These are completely normal statements. >2. Don’t close borders False. The said "There is a “huge reason to keep official border crossings open” to avoid people entering irregularly and going unchecked for symptoms, " "Certain containment measures will be appropriate, but widely banning travel, closing down cities, and hoarding resources are not realistic solutions for an outbreak that lasts years." >3. COVID is not airborne Please understand that airborne has a scientific meaning, and that is the terminology that scientists use. There is no actual clinical evidence of the airborne transmission of COVID.It is spread through large droplets. If it was airborne, those cloth and surgical masks that people wear would be useless, so you might as well not wear them. -- >But it’s not clear to me that the WHO has any credibility left. Maybe that is true for you, but ironically your wild accusations have let me wondering about your agenda here. :)
  - gridlockd 6y ago
    > Please understand that airborne has a scientific meaning, and that is the terminology that scientists use. There is no actual clinical evidence of the airborne transmission of COVID.It is spread through large droplets. At this point, it's expert consensus that airborne transmission of COVID is a significant if not the major route of transmission[1]. https://www.pnas.org/content/117/26/14857 https://www.pnas.org/content/117/26/14857 > If it was airborne, those cloth and surgical masks that people wear would be useless, so you might as well not wear them. Not quite useless, but nowhere near as effective as people would like to believe them to be.
    - ksk 6y ago
      Please explain on what basis you are assigning a paper "expert consensus" ? Are you an infectious diseases researcher? If so, your opinion would matter more to me than the paper. I read dozens of studies every day as part of my job in biotech, and most papers are junk and/or contain overly enthusiastic claims that few can replicate. I know somehow on HN linking to a paper is seen as a mic-drop, but that is not the case in the real world.
- cscurmudgeon 6y ago
  Remember, the WHO recommends traditional Chinese medicine. https://www.nature.com/articles/d41586-019-01726-1 https://www.nature.com/articles/d41586-019-01726-1 Edit: downvoted for stating facts and linking to a Nature article? I guess HN has a soft spot for peddlers of pseudoscience and rhino boner pills as long as it their side politically. https://www.nature.com/articles/d41586-018-06782-7 https://www.nature.com/articles/d41586-018-06782-7 This is where I draw the line.
  - triceratops 6y ago
    That's not what the article you linked says. It says the WHO includes the names of various ailments and diseases under traditional Chinese medicine (TCM) in its International Statistical Classification of Diseases and Related Health Problems (ICD). That's the not the same as recommending the use of TCM.
    - cscurmudgeon 6y ago
      False. It says right in the article that they also include treatments and medicines. Does it do that for Ayurveda and other traditional treatments? Why not? I guess Nature is worried for an irrational reason? https://www.nature.com/articles/d41586-018-06782-7 https://www.nature.com/articles/d41586-018-06782-7 Please don’t twist yourself batting for this nonsense.
      - triceratops 6y ago
        > It says right in the article that they also include treatments and medicines Can you please paste the relevant quote from the article? Because I'm not seeing that. The part I looked at was: "In a statement on 4 April, it insisted that the TCM chapter does not discuss particular remedies. Rather, it is meant to give doctors the chance to diagnose patients using both TCM and Western medicine — what it calls “optional dual coding”. These categories “do not refer to — or endorse — any form of treatment”, the statement says."
- hnracer 6y ago
  The individual that leads the WHO also has a number of corruption and cover-up allegations. Let's also not forget that they refused to declare a pandemic until weeks after there was evidence of global spread. The negligence (intentional or otherwise) is truly shocking.
  - papito 6y ago
    Donald Trump would have raised holy hell if a pandemic was declared earlier. It would have been a globalist plot to crash the markets and tank his presidency. He would have threatened to withdraw from the WHO entirely and pull U.S. funding. [Checks notes] Ah - he did anyway.
- Animats 6y ago
  The mask thing was a mess. But even back then, WHO was clear on why they said that: "We need to be clear. The world is facing a significant shortage of PPE for our frontline workers -- including masks and gloves and gowns and face shields -- and protecting our health care workers must be the top priority for use of this PPE." That's very World Health Organization, which is used to operating under scarcity. The embarrassing thing now is that, eight months on, we don't have a huge supply of N95 masks, which actually protect the wearer. On eBay, the price is starting to drop, from about $10 each to about $5 each. Normal price is about $1 each.
  - deleted 6y ago
    [deleted]
peterwoerner 6y ago
I thought most of the treatments were meant to help you recover faster, limit severity and feel better while you had the disease. I must be missing something.
- judofyr 6y ago
  > The results, which are yet to be peer-reviewed, suggest that none of these treatments has a substantial effect on mortality or on the length of time spent in hospital, the WHO said on Thursday. (Emphasis mine)
  - peterwoerner 6y ago
    Thanks
- TaupeRanger 6y ago
  Well...yes...all those things plus hopefully preventing you from dying. Not sure where your confusion is.
- vanderZwan 6y ago
  Unless those treatments also ensure you can't spread the disease while recovering that actually sounds like an absolutely terrible idea to me.
  - SketchySeaBeast 6y ago
    While that's true, we don't want people out and about while virulent, reducing severity and recovering faster doesn't sound like a terrible idea to me at all.
    - vanderZwan 6y ago
      My point is: what does "recovery" mean in this context? Feeling great but still being virulent during the same period? To give an analogy, I can take painkillers to suppress pain but my body is still as sick as before - it "only" affects my perception. Now, I'm not against easing symptoms in itself but given how many people I know who go to work while coughing I don't know how to feel about medication that only helps with perceived discomfort. (then again, I'm in Sweden where barely anyone seems to take covid seriously, sadly)
dessant 6y ago
Remember when the WHO and our governments around the world have deceived us that masks are not needed for the general population, instead of telling us to begin using makeshift masks until better ones become available? That's what white collar mass murder looks like.
- dx87 6y ago
  Yep, I also remember them saying that if you got sick and started showing symptoms, to stay at home instead of seeking medical care. Now that's considered misinformation though, and YouTube says they'll remove videos recommending you don't get medical care.
  - hef19898 6y ago
    Which still makes absolutely sense as long as symptoms aren't severe.
  - TaupeRanger 6y ago
    No. You are misrepresenting pretty much everything you're talking about. No one ever suggested avoiding medical care if you had symptoms of severe infection that would normally require hospitalization. YouTube is only saying they will remove videos with misinformation, such as recommending viewers avoid medical treatment for COVID, which is perfectly reasonable and not consistent with your conspiratorial tone.
    - dessant 6y ago
      There are dozens of reports about YouTube removing any video mentioning the virus, including videos that were warning about the importance of masks and surface disinfection. At one point they've been conveniently purging everything not coming from an official channel.
    - dx87 6y ago
      The CDC website says that unless you are having emergency symptoms, like trouble breathing, to stay at home until you feel better. How is a layman supposed to know the threshold of when they need hospitalization, vs when they should just tough it out and hope they get better? https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/st...
sto_hristo 6y ago
They can simply stop spawning more news on anything wuhan-virus related as this shit changes on daily basis.
bkovacev 6y ago
Neither do NAC (n-acetyl-cysteine) nor glutathione?
- karmasimida 6y ago
  Precisely. The available capacity is quite low. The media is saying there will be 1m treatments for US for next year, and 500k for whole EU. Which leads to an awkward situation: the availability right now probably only justifies to offer this drug to more severely ill patients, to whom this drug probably makes less impact anyway.
tboyd47 6y ago
Look at the timeline, people: > In a trial in China over February–March 2020, remdesivir was not effective in reducing the time for improvement from COVID‑19 or deaths, and caused various adverse effects, requiring the investigators to terminate the trial. [1] > On 17 March 2020, Didier Raoult announced in an online video that a trial involving 24 patients from southeast France supported the claim that hydroxychloroquine and azithromycin were effective in treating for COVID-19.[0] > On 18 March 2020, the World Health Organization (WHO) announced the launch of a trial that would include one group treated with remdesivir. [1] > As of April 2020, remdesivir was viewed as the most promising treatment for COVID‑19... [1] --- [0]: https://en.wikipedia.org/wiki/Hydroxychloroquine#COVID-19 https://en.wikipedia.org/wiki/Hydroxychloroquine#COVID-19 [1]: https://en.wikipedia.org/wiki/Remdesivir https://en.wikipedia.org/wiki/Remdesivir
- hef19898 6y ago
  I looked at the timeline. And now?
  - deleted 6y ago
    [deleted]
  - tboyd47 6y ago
    Well, don't you find it odd that Remdesivir was known to be a stinker in February, then got all this publicity and fanfare exactly one day after the hydroxychloroquine protocol was discovered, and now apparently it's back to being a stinker again?
    - buzzerbetrayed 6y ago
      Can you just explicitly state what you're implying? For those of us who aren't getting it.
      - me_me_me 6y ago
        Have you tried to add the numerical values of Remdesivir letters? And multipled it by the sum of the numbers from those dates?? No? Me neither. He implies some conspiracy is at play, rather people desperately trying to draw conclusions or gain 5 min of fame.
jeremyjh 6y ago
If this study was only conducted on patients who were already hospitalized I don't think it is a cohort that represents Remdesivir's intended users. My understanding is the medication is intended to be given soon after a diagnosis is confirmed, before there are serious symptoms. That may make it unusable in practice due to cost and availability issues but doesn't mean it doesn't work as expected.
- dragonwriter 6y ago
  > If this study was only conducted on patients who were already hospitalized I don't think it is a cohort that represents Remdesivir's intended users. That's the scope of the authorized investigatory use in the US, so unless you think the Trump Administration is simultaneously promoting and sabotaging it, I think it's the intended target: “VEKLURY® (remdesivir) is authorized for use under an EUA only for the treatment of adult and pediatric patients hospitalized with suspected or laboratory-confirmed COVID-19, and for whom use of an intravenous (IV) agent is clinically appropriate. VEKLURY must be administered via IV infusion.” https://www.remdesivir.com/us/?gclsrc=aw.ds&&gclid=CjwKCAjwiaX8BRBZEiwAQQxGx0qZJ4gcfBAsoD6SEvIXJ8FCtbbH5OKmE0lm_1LY1Gy9j-L6h9AcjBoCUEcQAvD_BwE https://www.remdesivir.com/us/?gclsrc=aw.ds&&gclid=CjwKCAjwi...
  - NicolasGorden 6y ago
    Define 'hospitalized'. I think two realities are being discussed under the same term. The way I see it, hospitalized can mean: I have great insurance and I went into the hospital for treatment because I felt some symptoms. I was feeling 80% well when I went in, I was only there because the doctors wanted to be thorough and check my vitals overnight. It can also mean: I don't have insurance and I waited until I was half past dead to go to the hospital because I have bad/no insurance. By the time I got to the hospital I couldn't even breath. I went straight to the ICU. Both are 'hospitalized'. But I don't think the two examples represent the same reality. I'd imagine Remdesivir working very well on the first and not very well on the second due to viral load concerns mentioned in other parts of the commentary to this article.
    - 6y ago
loxs 6y ago
At this point every statement by the WHO makes me question it very seriously and think about their political agenda in announcing it. Something like Betteridge's law of headlines. So probably Remdesivir has very good effect on COVID-19 outcomes. If I can extrapolate from cases in my surrounding, this seems to be true.
andy_ppp 6y ago
Well it’s just a good job as there isn’t enough remdesivir to go around...
lhorie 6y ago
Not specifically about remdesivir, but I saw a video by medlifecrisis channel on youtube[1] recently that talks a bit about hydroxychloroquine research, and goes a bit more in depth about the state of medical research quality and peer review (or lack of thereof, in the case of the surge of covid related papers) I thought that was some interesting food for thought there. [1] https://www.youtube.com/watch?v=7leWXMr3ayk https://www.youtube.com/watch?v=7leWXMr3ayk
claudeganon 6y ago
The WHO accidentally released the data back in April showing Remdesivir ineffective, but that story seemed to have been quickly forgotten (or ignored): https://www.statnews.com/2020/04/23/data-on-gileads-remdesivir-released-by-accident-show-no-benefit-for-coronavirus-patients/ https://www.statnews.com/2020/04/23/data-on-gileads-remdesiv...
- h2odragon 6y ago
  "Remdesivir" was a word i kept seeing for a decent time before Covid, too; they've been pushing that snake for a while. I gather it's a meta-scam, it's nearly impossible to make the stuff right and the "next miracle drug" noise is a means of getting funding for the ludicrous synthesis which is where the money is actually being made.
  - javagram 6y ago
    Remdesivir was tested and found to be effective against Ebola. It just wasn’t as effective as antibody treatments so got shelved in favor of them.
gregwebs 6y ago
The original Remdesivir trial by the drug company was a high quality RCT (randomized control trial) - except that they stopped it early once they saw a statistically significant positive effect (even though the effect was somewhat underwhelming: just fewer days of recovery). To me this moving of the goal posts invalidates the quality of the RCT. This study from an independent body without a moving of the goal posts is a more trustworthy result. With that being said, anti-virals often only work well when given very early (sometimes even as a preventative) and right now from looking at this study it doesn't seem like this was done. So this study may only be confirming what we already know about how anti-virals should be used (at a very early stage) but it will hopefully have the good effect of stopping improper usage.
- cyphar 6y ago
  > The original Remdesivir trial by the drug company was a high quality RCT (randomized control trial) - except that they stopped it early once they saw a statistically significant positive effect (even though the effect was somewhat underwhelming: just a couple fewer days of illness). To me this moving of the goal posts invalidates the quality of the RCT. Based on what I've seen discussed, ending trials early is a fairly common (though admittedly contentious) practice in medical RCTs when you're dealing with very serious illnesses, especially when there are no alternative effective treatments[1]. The issue is that there is a tradeoff between an abundance of caution to procure conclusive results and giving patients access to medicine which "clearly helps". In an ideal world you would run every RCT for several years to figure out any possible long term effects and accurately determine efficacy, but there are many circumstances where you could argue doing so (if it's clear the medicine works during the early stages of the trial) is more unethical than giving people medicine which shows some promise to work. But it should be noted that such trials are still solid science (the trial was an RCT), it just means you cannot take them as evidence of long-term efficacy. [1]: https://www.ahajournals.org/doi/full/10.1161/circheartfailure.111.965707 https://www.ahajournals.org/doi/full/10.1161/circheartfailur...
  - pen2l 6y ago
    What is the _reason_ for ending it early? Is it the cost? I imagine it must be high enough because then they're gonna have to fight with this very criticism later on: RCT ended prematurely, therefore it is not as reliable. A question to you and grandparent post: what are the things that distinguish a high quality RCT from a poor one? The number of participants, the design study, etc.? Any links/resources that discuss this would be appreciated. edit: ok, I found a paper on this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429837/#:~:text=Randomized%20controlled%20trials%20(RCTs)%20have,of%20medical%20treatments%20(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429837/#:~:tex.... I am super curious now about any discussion that reveals why the WHO study was less-than-stellar, and why the original RCT was considered high-quality.
adictator 6y ago
Whoever follows WHO in the context of pandemics, especially for Covid! WHO has been guilty, without any doubt, of spreading mass misinformation since March 2020.
varispeed 6y ago
Little to no effect, but for some individual that "little" could mean being alive. Just because majority don't find a benefit it shouldn't mean that someone who actually benefit shouldn't use this. But regardless, corrupt organisations like WHO should have no say in these matters or at least shouldn't be listened to. You don't know if that release wasn't paid by competing pharmaceutical companies.
EasyTiger_ 6y ago
Why are treatments that are effective in some way never discussed?
- collyw 6y ago
  This pandemic has become ridiculously political. I was all onboard with "Hydroxychloroqine doesn't work" until I watched this, based on a large scale trial in Belgium. https://www.youtube.com/watch?v=2uzXHnUViro&feature=emb_logo https://www.youtube.com/watch?v=2uzXHnUViro&feature=emb_logo Now I want to see more information, as he points out the early trails used to dismiss it used a dangerously high doses.
  - hef19898 6y ago
    I said in February, I will say it again. Facebook, Twitter and YouTube are sources to be avoided when we can also look at prime sources or more reputable ones that "a guy on YouTube". If anything, YouTube was too late to block certain content.
    - collyw 6y ago
      You should probably take a look at the video before you dismiss it in the way you have - based on the source rather than the content. He is a nursing teacher and his videos basically take up to date research and news on covid as he explains it to a non technical audience. Personally I rally appreciate that he takes the time filter out what appears to be interesting / important and presents it in a way that is easy for the general public to understand. If you still can't be bothered to do that then the paper he is discussing is here (I assume that a peer reviewed paper is up to your high standards) but you will be missing out on a lot of information about dosages that John adds: https://doi.org/10.1016/j.ijantimicag.2020.106144 https://doi.org/10.1016/j.ijantimicag.2020.106144 >I said in February, I will say it again Repetition doesn't make your argument any more valid.
nathias 6y ago
Time to buy Remdesivir.
thehappypm 6y ago
Remdesivir interferes with the virus's ability to make copies of itself. If a patient is already in the hospital, their viral load is insanely high. Remdesivir may slow down the growth rate but for a lot of patients it's already just too late, the virus's effects on the body have already taken too much of a toll.
- ssully 6y ago
  I would be curious to see a study on how it impacts patients before they go to the hospital. Specifically, if they test positive, they start treatment within days of their result.
  - thehappypm 6y ago
    That's what Donald Trump received and look how fast he recovered.
    - hnracer 6y ago
      Not disputing the point here, but he also had Regeneron and Vitamin D both which have shown promising results
    - beagle3 6y ago
      He also ate a hamburger and wrote his name on an empty piece of paper in a photo-op. How do you know it was remdesivir rather than the photo-op, hamberder, dexamethasone or regeneron, all of which he got as well?
zalkota 6y ago
It seems as if all of these articles just won’t go discredit Donald Trump.
gregwebs 6y ago
At this point to my knowledge there is only one treatment that have been shown in an RCT trial to have a large effect: that is giving bolus dosages of vitamin D. [1] The effect was that only 1 (2%) of 50 patients needed ICU admission whereas the control had 50% ICU admission. In contrast the Remdesivir effect found was just fewer days of recovery. So we can contrast the vitamin D result with how much effort is going on to determine whether there are marginal improvements from anti-virals. The trial is small (100 participants), so we should be doing a larger one now, but I don't think there is a down-side to adopting this as a standard of care. [1] https://www.sciencedirect.com/science/article/pii/S0960076020302764?via%3Dihub https://www.sciencedirect.com/science/article/pii/S096007602...
DominikPeters 6y ago
Derek Lowe recently discussed results from a different trial that were more positive. https://blogs.sciencemag.org/pipeline/archives/2020/10/09/hard-data https://blogs.sciencemag.org/pipeline/archives/2020/10/09/ha... > The good news is that the patients receiving the drug had a shorter time to recovery (9 to 11 days, in the 95% confidence interval, versus 13 to 18 days with non-remdesivir standard of care. That’s real, but it’s not real dramatic, either, which is what you would realistically expect from a single broad-spectrum antiviral drug. This ain’t sofosbuvir clearing out hepatitis C, and even that one doesn’t do the job by itself. As for the hardest endpoint of all, mortality by Day 29 for these patients was 11.4% with remdesivir therapy as compared to 15.2% with the controls. So again, that’s a real improvement and very much worth having, but it’s not a Miracle Drug, either. Adverse events were actually lower in the treatment group, which is of course good news.
- boomboomsubban 6y ago
  The BBC article mentions that study and says it was conducted by Gilead. The study itself says that Gilead employees took part, but I am unable to figure out what role they actuality played.
- hhs 6y ago
  If interested, he posted an updated comment that takes into account today’s news of the Solidarity trial: https://blogs.sciencemag.org/pipeline/archives/2020/10/16/the-solidarity-data https://blogs.sciencemag.org/pipeline/archives/2020/10/16/th...
  - Balgair 6y ago
    "It looks like there is no case at all to be made for some of these therapies, and for remdesivir, it looks like the argument now is “Does it help a bit or just not at all?” The only thing that I’ve seen that really seems to be making a big difference now is dexamethasone, and we may soon (I hope) be adding the monoclonal antibodies to that list. The SOLIDARITY enrollment is still moving along at 2000 patients/month, and will be looking at these and other newer ideas as it continues. And that means abandoning the older ideas, because – as we’re finding out – they’re not much help. It’s time to move on." Just so everyone knows, this is the same guy that writes the 'Things I Won't Work With" blog. It's all about insane chemical compounds and is very much one of the best blogs ever written. https://blogs.sciencemag.org/pipeline/?s=things+I+won%27t+work+with https://blogs.sciencemag.org/pipeline/?s=things+I+won%27t+wo...
cm2187 6y ago
Time to flag and ban all youtube videos that present the drug as potentially effective, including from mainstream media, in accordance with youtube’s policy.
hristov 6y ago
It may still have an effect in time to recovery, which is important, both in reducing suffering and helping hospital capacity. Of course that has to be weighed against the side effects. In any event, I do not think that the $3K per treatment price is justified. By the way, there is a supplement that is far far cheaper than remdesivir and is available over the counter which has also shown to reduce time to recovery by about as much as remdesivir. See: https://investors.chromadex.com/news/news-details/2020/ChromaDex-Announces-Study-Results-Showing-Nutritional-Protocol-Including-Nicotinamide-Riboside-Plus-Standard-of-Care-Reduces-Recovery-Time-in-COVID-19-Patients-by-Nearly-30/default.aspx https://investors.chromadex.com/news/news-details/2020/Chrom... This is a 100 person trial, which is much less than the remdisivir trials, but still statistically significant. In any event, the risk is much lower, according to the study "adverse events were uncommon, benign, and self-limiting." The supplement is sold as truniagen.
bitwize 6y ago
Hackernews School of Medicine taught me to doubt the efficacy of anything except fasting, rolfing, and Wim Hof breathing. In particular, drugs, except for psychedelics, are not to be trusted.
collyw 6y ago
Could there be other factors affecting the outcome? Hydrochloroquine seems to have been dismissed, but watching this video he makes a a good case for it working at low dose - it seems like a lot of the trials involved too high a dose. (He talks about a relatively large scale study in Belgian hospitals). There seems to have been multiple studies done, some giving good results some not. I am curious if the ones at the lower dosage were separated out would they all gave more positive results. Unfortunately I don't have time to check through them all myself. https://www.youtube.com/watch?v=2uzXHnUViro&feature=emb_logo https://www.youtube.com/watch?v=2uzXHnUViro&feature=emb_logo
Scene_Cast2 6y ago
Meta-comment about medical studies. Suppose that an intervention's effect is contingent on some variable. For high-profile treatments, wouldn't it make sense to isolate those variables (for the cases where it did help, but the overall result over the entire population was neutral) and run a second trial?
zyxzevn 6y ago
The first study that was heavily promoted used a randomized trial, and showed shorter stays in the hospital. But looking at the real data, the study was not completely randomized as they had removed some patients. Patients that had died. So it was essentially a P-hack to sell us a worthless but expensive product. So I stopped believing that Big Pharma would save us, and that their science-journals were giving honest reports. In the mean time I see reports of different very cheap medicines that give a 10x reduction in death-rates. From 500 to 50 and such. That is extremely hard to hack because these death numbers would show up elsewhere. From the reports it appears that the virus is very vulnerable to some cheap anti-viral medicine. But there is no money in that, so it will not be promoted that heavily. Here are some videos where the science papers are explained by an expert. https://www.youtube.com/watch?v=98RQ3QK-yCc https://www.youtube.com/watch?v=98RQ3QK-yCc https://youtu.be/bbGG79WGmu4?t=800 https://youtu.be/bbGG79WGmu4?t=800
vanilla-almond 6y ago
Gilead signed a billion dollar deal with the EU Commission for Remdesivir on the 8 October. However, Gilead apparently received the WHO study on 28 September and so were aware of the conclusions of the study before they signed a deal with the EU Commission. This naturally leads to further questions, as discussed in this tweet thread: https://twitter.com/kakape/status/1317042940825436162 https://twitter.com/kakape/status/1317042940825436162 Edit: Martin Landray, professor of medicine and epidemiology at the University of Oxford and leader of the UK-based Recovery trial also has a good summary of the WHO trial: https://twitter.com/MartinLandray/status/1316989951297396736 https://twitter.com/MartinLandray/status/1316989951297396736
- ucha 6y ago
  Martin Landry: "People will argue about the need for earlier use (possibly) or that with even more data there may be a benefit (possibly - but where are those trials going to come from). But the effect is modest at best - and so far there is no strong evidence it is there at all." But it doesn't follow at all that because there is no effect when administered late, the effect, if administered early, is modest as best. In fact, there are many medication that are very effective if administered before the first symptoms appear and are completely useless after. If you get exposed to rabies, you can get a rabies vaccine and have close to no chance of contracting it, whereas if you get a vaccine after you develop symptoms, you're almost certain to die. Similarly, the flu antivirals are somewhat helpful if taken early but have no effect if taken too late.
  - m0zg 6y ago
    It's as if they're doing this on purpose. It is quite obviously pointless to administer antiviral drugs _after_ the cytokine storm sets in and the person is already dying.
  - vanilla-almond 6y ago
    Landray says in the same twitter thread: "...Remdesevir is given by intravenous infusion for 5-10 days. It is not cheap. And supplies are limited (not surprising given scale of epidemic)." This means anyone showing early symptoms is likely to require a stay in hospital for early administration of the intravenous infusion. There are questions about how scalable this is. Landray again: "COVID affects millions of people & their families around the world. It is not a rare disease and we need scalable, affordable, and equitable treatment solutions."
remote_phone 6y ago
Giving anti-vitals early is a significant problem for covid-19 because such a significant numbers of patients will have no or mild symptoms (85%). So it’s really a no-win situation because if you give it early, not many people will look like they’re getting better relative to control. But if you give it too late to those who have severe symptoms it will be too late. What they need to do is figure out a way to identify who will get severe symptoms and give remdesivir to them early. That’s probably the only way you will see a benefit, If there’s even a benefit at all.
papito 6y ago
Oh why does the whole thing feel like a grifting and a profiteering operation?
stevespang 6y ago
Remdesivir is crap. From the very beginning, the Russian protocol included interferon, nasal application 3x per day. Then, coincidentally, a week or so ago the American medical establishment wakes up and concludes that covid19 has a propensity to deactivate inteferon production or usefulness in the human body. As always, American medicine has a "conflict of interest" in keeping hospital patients as long as possible, as sick as possible to maximize billing. Go Figure.
bitL 6y ago
I am missing results for Favipiravir that was the most promising of them all. For some reason WHO didn't include it in their test at the beginning nor at any later point of time. Almost one year later still no news?! Also, why don't the governments just distribute elderly and weak vitamin D and zinc to take everyday? There's not much harm that can be done with those and could potentially offset lack of sunlight that might have kept COVID-19 in check during the summer. A low-risk low-cost solution that could potentially yield enormous health and economic benefits if the link between vitamin D and zinc deficiency on the severe outcome of COVID-19 is proved later.
- pezo1919 6y ago
  Favipiravir is far less promising than ivermectin with ~100% cure rate if treated early. It is peer-reviewed now (ivermectin ICON study, single dose late stage 40% mortality reduction.) I don't get why people on HN are not aware of it.
  - hef19898 6y ago
    Because HN is nit primarily populated by medical experts specialized in Virology? Just a guess.
pezo1919 6y ago
Why no one talks about ivermectin? I don't get that.
jeffnappi 6y ago
Remdesivir is also apparently insanely difficult and expensive to synthesize as well - for a humorous take on it see https://www.acsh.org/news/2020/03/26/problem-remdesivir-making-it-14665 https://www.acsh.org/news/2020/03/26/problem-remdesivir-maki... if you haven't already.
getlawgdon 6y ago
When is Ampion going to be int the discussion? it's an anti-inflammatory and there is some study showing rendemisvir is effective when used in conjunction with Ampion. Or, it might be entirely the Amount helping patients in a therapeutic scenario. All this focus on an antiviral when an anti-inflammatory might have an immediate impact as cases ramp up...

369 points by VieEnCode 6y ago

The null hypothesis is of course the most probable and bio is insanely hard. But it’s not clear to me that the WHO has any credibility left. Edit: This is not a coded American Politics statement. Here are examples of where the WHO provided directly counterproductive recommendations: 1. Don’t wear masks (https://www.google.com/amp/s/amp.cnn.com/cnn/2020/03/30/world/coronavirus-who-masks-recommendation-trnd/index.html https://www.google.com/amp/s/amp.cnn.com/cnn/2020/03/30/worl...) 2. Don’t close borders (https://www.reuters.com/article/us-china-health-who/who-says-countries-should-keep-borders-open-trade-people-moving-despite-coronavirus-idUKKBN1ZU1C2 https://www.reuters.com/article/us-china-health-who/who-says...) 3. COVID is not airborne (https://m.facebook.com/WHO/posts/3019704278074935 https://m.facebook.com/WHO/posts/3019704278074935) (pedantic takes aside you should obviously treat it is if it were)

spuz 6y ago
What does this mean?
- hef19898 6y ago
  That he is one of the people that don't believe anything anymore the WHO says because they got the thing with the masks wrong.
  - rootusrootus 6y ago
    IIRC the 'masks wrong' accusation was more about the CDC than the WHO. As I recall, the WHO caught a lot of flak early on for press releases written in strict scientific language that were easily construed to mean something entirely different. They earned a bit of criticism for that, since they should have written those PR bits for the lay audience that it was intended for.
    - TaupeRanger 6y ago
      I fully realize this will incur a mob of downvotes, but the evidence on masks is still unsettled, despite clamoring on social media and some news media. I would encourage people to listen to a balanced view on doctor Vinay Prasad's excellent podcast "Plenary Session". Even mentioning the possibility that this might be true is enough to get shouted down and accused of supporting Trump. In fact, it is quite unclear whether widespread masking is a net positive for US populations. It hasn't been shown to be effective, and there are still many unstudied avenues that could lead to a negative result. Just a couple examples: 1. Giving people a false sense of security, causing them to go out when they feel sick when they otherwise wouldn't. 2. Causing more face-touching behavior while fiddling with the mask, making infection more likely. We just don't know the answer.
    - andybak 6y ago
      The sibling post was rather unjustly flagged. I'm often on the other side of the fence on this but in this case I think it was unfair.
    - vharuck 6y ago
      I've always thought of the WHO as serving an audience of public health experts for the member nations. Then those nations can decide what the best response is within their borders. When I remember back on the news about the other recent pandemic scares (ebola, swine flu, zika), I don't remember hearing any mention of the WHO. I'm sure it happened, but not nearly as much as CDC. We hear about their announcements a lot more often now, but how much is that due to being cast as antagonists by DC?
      - vkou 6y ago
        If the Ebola epidemic killed 200,000 people in the United States, due to a completely bungled response by the CDC, you could bet that the supporters of the administration in power at the time would be burning effigies of the WHO.
      - rsynnott 6y ago
        That is what the WHO used to do, certainly. It does seem to talk more directly to the press these days, and it's honestly probably not a great idea.
  - sova 6y ago
    Or, you know, this now infamous Tweet: https://twitter.com/who/status/1217043229427761152 https://twitter.com/who/status/1217043229427761152
    - ceejayoz 6y ago
      That's an entirely accurate tweet at the time. On Jan 14, 2020, the WHO had no clear evidence of human-to-human transmission yet. It came (to them) shortly afterwards. That China may have had such evidence and kept it private doesn't make the WHO's statement any less truthful at the time it was issued. They aren't an intelligence organization; they rely on cooperative member nations. https://www.factcheck.org/2020/04/factchecking-trumps-attack-on-the-who/ https://www.factcheck.org/2020/04/factchecking-trumps-attack... > While there is a debate about what was known when — and it seems clear that China knew more than what it reported — the WHO never said the virus was not communicable. Instead, the agency always considered the possibility, even if it also shared information from China that found no evidence of such transmission. > Lack of evidence, especially of “preliminary” results, does not mean the WHO was saying the novel coronavirus could not be spread between people. The same day as the tweet, the WHO cautioned that there might be some human-to-human transmission of the virus among family members in China. > According to a timeline of events, Van Kerkhove, who is also the WHO’s technical lead for the COVID-19 response, also said that human-to-human transmission wouldn’t be unexpected, since that is what occurs with SARS and MERS, which are also coronaviruses. Just a few days later: > By Jan. 19, the WHO was more definitive, saying in a tweet that there was “some limited human-to-human transmission occurring between close contacts.” Trying to use this tweet to justify US inaction months later is silly and transparent.
      - hef19898 6y ago
        Thanks!
      - nwienert 6y ago
        It wasn’t lacking evidence at all, want to know why? Because I read that headline at the time and thought it was ridiculous, I couldn’t believe they were saying something so backwards. If you had been paying attention, you knew already: 1. It was spreading rapidly in humans 2. It was a coronavirus and therefore was similar to other coronaviruses If you were following a precautionary principle, you’d have said “it likely is spreading between humans given we’ve never seen any other form of transmission this rapid in any virus that isn’t, and it’s a coronavirus”. If you think their “don’t wear masks” lie was ok because it was trying to keep medical workers from a shortage, then, how can you not see this as hypocritical? You can’t think the mask lie was ok, due to abundance of caution, and then a total disregard for caution at a much more crucial early stage as ok. But again, if you were paying attention, watching the WHO make statements like this was terrifying. Like driving in a car with a drunk driver who is stepping on the gas. Who in their right mind would make such a totally braindead, reckless press release like that. Technically there’s no direct evidence, but there’s a whole lot of reason to be worried it likely is airborne. So the headline should be “it’s highly possible it’s airborne, we are waiting for concrete data, but recommend caution given exponential spread within humans”. The WHO did things similarly shockingly bad three times or so during the pandemic. I was paying attention to all of them and couldn’t help but think something was up. Something was wrong with the WHO. Not just being conservative, but being totally negligent and backwards time and time again. It really seems they were playing either protection for China, or some sort of interference against a good chunk of the world. If they had done better, many many lives would have been saved. It was some internal politics that broke them. Any halfway sane person knew it at the time.
  - dqv 6y ago
    I don't remember that, but they got the thing about restricting travel wrong. https://www.reuters.com/article/us-china-health-who-idUSKBN1ZX1H3 https://www.reuters.com/article/us-china-health-who-idUSKBN1...
  - hnracer 6y ago
    It's not just the masks. They also got many other things wrong, and the leader of the WHO has a number of corruption allegations with some veracity to their name.
QUPHAJS3V6 6y ago
Why? I know WHO is now politically involved in the US elections and I presume that shapes many opinions. But, I did read recently about polio eradication from the African continent etc. Obviously not just by WHO but efforts by many organizations, but still a major achievement isnt it? Update: I actually would like to know why WHO is not credible any more for some. Honest question.
- makomk 6y ago
  Unfortunately, the whole polio eradication thing is less of an clear-cut success story than the headlines made it seem - they only eradicated wild-type polio, there are still major outbreaks in Africa of vaccine-derived polioviruses that have lost the mutations which made them safe and started spreading in the community and paralyzing people, those have only been getting more widespread last I heard and there doesn't seem to be any clear route to a solution. Can't imagine that Covid has helped much with that either, given the disruption to vaccination programs worldwide - vaccine-derived poliovirus outbreaks thrive wherever vaccination is disrupted or incomplete, or there's a border between vaccinated and non-vaccinated regions. The original plan that the WHO and the rest of the global health community came up to deal with this also seems like total magical thinking to me - basically, everywhere would drop the type 2 poliovirus component (which corresponded to a virus whose wild type had been eliminated) from their live vaccines at once, which would leave none to turn into vaccine-derived poliovirus and type 2 woud just go away. It didn't work that way. I can't fathom why it even should. Nonetheless, there were lots of fancy documents and presentations from the WHO and other such organisations explaining this strategy very hopefully. The current ones don't have the same level of hope.
  - deleted 6y ago
    [deleted]
  - orwin 6y ago
    Please explain why you're downvoting, this is a fact, only wild polio is "eradicated" from africa, not vaccine-induced polio (type 1 and type 2 are often milder than wild polio however). And i think there was a polio outbreak in Soudan this year, so...
QUPHAJS3V6 6y ago
Fair enough. Who/what organizations do you trust then for public health and covid related recommendations?
- pdonis 6y ago
  My short answer: there aren't any. Every source has shown itself willing to set truth aside in the interest of some political or ideological agenda. If your response is "well, that sucks", yes, I agree. It sucks to live in a world where people and institutions whose sole job is supposed to be making sure true information gets to the public, every time, no exceptions, are either unwilling or unable to do that job right.
  - BalinKing 6y ago
    This is where I also stand. I don't (a prior) trust the WHO, I don't (a priori) trust the CDC, I don't (a priori) trust the talk show hosts. (To be fair, I think this principle applies much more generally than public health matters.) That's not to say I behave irresponsibly: I wear a mask in public (because "better safe than sorry"), my family self-quarantined for two weeks when one of us got sick, etc. I just don't assume what "experts" say is necessarily the truth. (To be fair, I also don't trust myself to reach correct conclusions—hence my personal policy of "better safe than sorry.") I personally feel like too much of modern society involves idolizing experts and institutions—after all, it's nothing more than the argument-to-authority logical fallacy (admittedly, even if it's often a useful heuristic)... but that's a discussion for another time :-P
    - pdonis 6y ago
      > That's not to say I behave irresponsibly: I wear a mask in public (because "better safe than sorry") Same here. My wife and I were wearing masks, social distancing, not going to public places like restaurants where there was a high risk of catching something, weeks before any public health authorities were recommending such measures, and before the case rate in our area started to spike. To us it was obvious common sense.
    - 6y ago
anigbrowl 6y ago
Has WHO lost some credibility through a combination of poor decisions, poor communications, and rapidly changing scientific understanding? For sure. Suggesting that WHO has no credibility left is hyperbolic and unhelpful.
ksk 6y ago
>1. Don’t wear masks False. They said - "There is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit" "In the community, we do not recommend the use of wearing masks unless you yourself are sick and as a measure to prevent onward spread from you if you are ill" "The masks that we recommend are for people who are at home and who are sick and for those individuals who are caring for those people who are home that are sick," These are completely normal statements. >2. Don’t close borders False. The said "There is a “huge reason to keep official border crossings open” to avoid people entering irregularly and going unchecked for symptoms, " "Certain containment measures will be appropriate, but widely banning travel, closing down cities, and hoarding resources are not realistic solutions for an outbreak that lasts years." >3. COVID is not airborne Please understand that airborne has a scientific meaning, and that is the terminology that scientists use. There is no actual clinical evidence of the airborne transmission of COVID.It is spread through large droplets. If it was airborne, those cloth and surgical masks that people wear would be useless, so you might as well not wear them. -- >But it’s not clear to me that the WHO has any credibility left. Maybe that is true for you, but ironically your wild accusations have let me wondering about your agenda here. :)
- gridlockd 6y ago
  > Please understand that airborne has a scientific meaning, and that is the terminology that scientists use. There is no actual clinical evidence of the airborne transmission of COVID.It is spread through large droplets. At this point, it's expert consensus that airborne transmission of COVID is a significant if not the major route of transmission[1]. https://www.pnas.org/content/117/26/14857 https://www.pnas.org/content/117/26/14857 > If it was airborne, those cloth and surgical masks that people wear would be useless, so you might as well not wear them. Not quite useless, but nowhere near as effective as people would like to believe them to be.
  - ksk 6y ago
    Please explain on what basis you are assigning a paper "expert consensus" ? Are you an infectious diseases researcher? If so, your opinion would matter more to me than the paper. I read dozens of studies every day as part of my job in biotech, and most papers are junk and/or contain overly enthusiastic claims that few can replicate. I know somehow on HN linking to a paper is seen as a mic-drop, but that is not the case in the real world.
cscurmudgeon 6y ago
Remember, the WHO recommends traditional Chinese medicine. https://www.nature.com/articles/d41586-019-01726-1 https://www.nature.com/articles/d41586-019-01726-1 Edit: downvoted for stating facts and linking to a Nature article? I guess HN has a soft spot for peddlers of pseudoscience and rhino boner pills as long as it their side politically. https://www.nature.com/articles/d41586-018-06782-7 https://www.nature.com/articles/d41586-018-06782-7 This is where I draw the line.
- triceratops 6y ago
  That's not what the article you linked says. It says the WHO includes the names of various ailments and diseases under traditional Chinese medicine (TCM) in its International Statistical Classification of Diseases and Related Health Problems (ICD). That's the not the same as recommending the use of TCM.
  - cscurmudgeon 6y ago
    False. It says right in the article that they also include treatments and medicines. Does it do that for Ayurveda and other traditional treatments? Why not? I guess Nature is worried for an irrational reason? https://www.nature.com/articles/d41586-018-06782-7 https://www.nature.com/articles/d41586-018-06782-7 Please don’t twist yourself batting for this nonsense.
    - triceratops 6y ago
      > It says right in the article that they also include treatments and medicines Can you please paste the relevant quote from the article? Because I'm not seeing that. The part I looked at was: "In a statement on 4 April, it insisted that the TCM chapter does not discuss particular remedies. Rather, it is meant to give doctors the chance to diagnose patients using both TCM and Western medicine — what it calls “optional dual coding”. These categories “do not refer to — or endorse — any form of treatment”, the statement says."
hnracer 6y ago
The individual that leads the WHO also has a number of corruption and cover-up allegations. Let's also not forget that they refused to declare a pandemic until weeks after there was evidence of global spread. The negligence (intentional or otherwise) is truly shocking.
- papito 6y ago
  Donald Trump would have raised holy hell if a pandemic was declared earlier. It would have been a globalist plot to crash the markets and tank his presidency. He would have threatened to withdraw from the WHO entirely and pull U.S. funding. [Checks notes] Ah - he did anyway.
Animats 6y ago
The mask thing was a mess. But even back then, WHO was clear on why they said that: "We need to be clear. The world is facing a significant shortage of PPE for our frontline workers -- including masks and gloves and gowns and face shields -- and protecting our health care workers must be the top priority for use of this PPE." That's very World Health Organization, which is used to operating under scarcity. The embarrassing thing now is that, eight months on, we don't have a huge supply of N95 masks, which actually protect the wearer. On eBay, the price is starting to drop, from about $10 each to about $5 each. Normal price is about $1 each.
- deleted 6y ago
  [deleted]

peterwoerner 6y ago

I thought most of the treatments were meant to help you recover faster, limit severity and feel better while you had the disease. I must be missing something.

judofyr 6y ago
> The results, which are yet to be peer-reviewed, suggest that none of these treatments has a substantial effect on mortality or on the length of time spent in hospital, the WHO said on Thursday. (Emphasis mine)
- peterwoerner 6y ago
  Thanks
TaupeRanger 6y ago
Well...yes...all those things plus hopefully preventing you from dying. Not sure where your confusion is.
vanderZwan 6y ago
Unless those treatments also ensure you can't spread the disease while recovering that actually sounds like an absolutely terrible idea to me.
- SketchySeaBeast 6y ago
  While that's true, we don't want people out and about while virulent, reducing severity and recovering faster doesn't sound like a terrible idea to me at all.
  - vanderZwan 6y ago
    My point is: what does "recovery" mean in this context? Feeling great but still being virulent during the same period? To give an analogy, I can take painkillers to suppress pain but my body is still as sick as before - it "only" affects my perception. Now, I'm not against easing symptoms in itself but given how many people I know who go to work while coughing I don't know how to feel about medication that only helps with perceived discomfort. (then again, I'm in Sweden where barely anyone seems to take covid seriously, sadly)

dessant 6y ago

Remember when the WHO and our governments around the world have deceived us that masks are not needed for the general population, instead of telling us to begin using makeshift masks until better ones become available? That's what white collar mass murder looks like.

dx87 6y ago
Yep, I also remember them saying that if you got sick and started showing symptoms, to stay at home instead of seeking medical care. Now that's considered misinformation though, and YouTube says they'll remove videos recommending you don't get medical care.
- hef19898 6y ago
  Which still makes absolutely sense as long as symptoms aren't severe.
- TaupeRanger 6y ago
  No. You are misrepresenting pretty much everything you're talking about. No one ever suggested avoiding medical care if you had symptoms of severe infection that would normally require hospitalization. YouTube is only saying they will remove videos with misinformation, such as recommending viewers avoid medical treatment for COVID, which is perfectly reasonable and not consistent with your conspiratorial tone.
  - dessant 6y ago
    There are dozens of reports about YouTube removing any video mentioning the virus, including videos that were warning about the importance of masks and surface disinfection. At one point they've been conveniently purging everything not coming from an official channel.
  - dx87 6y ago
    The CDC website says that unless you are having emergency symptoms, like trouble breathing, to stay at home until you feel better. How is a layman supposed to know the threshold of when they need hospitalization, vs when they should just tough it out and hope they get better? https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/st...

sto_hristo 6y ago

They can simply stop spawning more news on anything wuhan-virus related as this shit changes on daily basis.

bkovacev 6y ago

Neither do NAC (n-acetyl-cysteine) nor glutathione?

karmasimida 6y ago
Precisely. The available capacity is quite low. The media is saying there will be 1m treatments for US for next year, and 500k for whole EU. Which leads to an awkward situation: the availability right now probably only justifies to offer this drug to more severely ill patients, to whom this drug probably makes less impact anyway.

tboyd47 6y ago

Look at the timeline, people: > In a trial in China over February–March 2020, remdesivir was not effective in reducing the time for improvement from COVID‑19 or deaths, and caused various adverse effects, requiring the investigators to terminate the trial. [1] > On 17 March 2020, Didier Raoult announced in an online video that a trial involving 24 patients from southeast France supported the claim that hydroxychloroquine and azithromycin were effective in treating for COVID-19.[0] > On 18 March 2020, the World Health Organization (WHO) announced the launch of a trial that would include one group treated with remdesivir. [1] > As of April 2020, remdesivir was viewed as the most promising treatment for COVID‑19... [1] --- [0]: https://en.wikipedia.org/wiki/Hydroxychloroquine#COVID-19 https://en.wikipedia.org/wiki/Hydroxychloroquine#COVID-19 [1]: https://en.wikipedia.org/wiki/Remdesivir https://en.wikipedia.org/wiki/Remdesivir

hef19898 6y ago
I looked at the timeline. And now?
- deleted 6y ago
  [deleted]
- tboyd47 6y ago
  Well, don't you find it odd that Remdesivir was known to be a stinker in February, then got all this publicity and fanfare exactly one day after the hydroxychloroquine protocol was discovered, and now apparently it's back to being a stinker again?
  - buzzerbetrayed 6y ago
    Can you just explicitly state what you're implying? For those of us who aren't getting it.
    - me_me_me 6y ago
      Have you tried to add the numerical values of Remdesivir letters? And multipled it by the sum of the numbers from those dates?? No? Me neither. He implies some conspiracy is at play, rather people desperately trying to draw conclusions or gain 5 min of fame.

jeremyjh 6y ago

If this study was only conducted on patients who were already hospitalized I don't think it is a cohort that represents Remdesivir's intended users. My understanding is the medication is intended to be given soon after a diagnosis is confirmed, before there are serious symptoms. That may make it unusable in practice due to cost and availability issues but doesn't mean it doesn't work as expected.

dragonwriter 6y ago
> If this study was only conducted on patients who were already hospitalized I don't think it is a cohort that represents Remdesivir's intended users. That's the scope of the authorized investigatory use in the US, so unless you think the Trump Administration is simultaneously promoting and sabotaging it, I think it's the intended target: “VEKLURY® (remdesivir) is authorized for use under an EUA only for the treatment of adult and pediatric patients hospitalized with suspected or laboratory-confirmed COVID-19, and for whom use of an intravenous (IV) agent is clinically appropriate. VEKLURY must be administered via IV infusion.” https://www.remdesivir.com/us/?gclsrc=aw.ds&&gclid=CjwKCAjwiaX8BRBZEiwAQQxGx0qZJ4gcfBAsoD6SEvIXJ8FCtbbH5OKmE0lm_1LY1Gy9j-L6h9AcjBoCUEcQAvD_BwE https://www.remdesivir.com/us/?gclsrc=aw.ds&&gclid=CjwKCAjwi...
- NicolasGorden 6y ago
  Define 'hospitalized'. I think two realities are being discussed under the same term. The way I see it, hospitalized can mean: I have great insurance and I went into the hospital for treatment because I felt some symptoms. I was feeling 80% well when I went in, I was only there because the doctors wanted to be thorough and check my vitals overnight. It can also mean: I don't have insurance and I waited until I was half past dead to go to the hospital because I have bad/no insurance. By the time I got to the hospital I couldn't even breath. I went straight to the ICU. Both are 'hospitalized'. But I don't think the two examples represent the same reality. I'd imagine Remdesivir working very well on the first and not very well on the second due to viral load concerns mentioned in other parts of the commentary to this article.
  - 6y ago

loxs 6y ago

At this point every statement by the WHO makes me question it very seriously and think about their political agenda in announcing it. Something like Betteridge's law of headlines. So probably Remdesivir has very good effect on COVID-19 outcomes. If I can extrapolate from cases in my surrounding, this seems to be true.

andy_ppp 6y ago

Well it’s just a good job as there isn’t enough remdesivir to go around...

lhorie 6y ago

Not specifically about remdesivir, but I saw a video by medlifecrisis channel on youtube[1] recently that talks a bit about hydroxychloroquine research, and goes a bit more in depth about the state of medical research quality and peer review (or lack of thereof, in the case of the surge of covid related papers) I thought that was some interesting food for thought there. [1] https://www.youtube.com/watch?v=7leWXMr3ayk https://www.youtube.com/watch?v=7leWXMr3ayk

claudeganon 6y ago

The WHO accidentally released the data back in April showing Remdesivir ineffective, but that story seemed to have been quickly forgotten (or ignored): https://www.statnews.com/2020/04/23/data-on-gileads-remdesivir-released-by-accident-show-no-benefit-for-coronavirus-patients/ https://www.statnews.com/2020/04/23/data-on-gileads-remdesiv...

h2odragon 6y ago
"Remdesivir" was a word i kept seeing for a decent time before Covid, too; they've been pushing that snake for a while. I gather it's a meta-scam, it's nearly impossible to make the stuff right and the "next miracle drug" noise is a means of getting funding for the ludicrous synthesis which is where the money is actually being made.
- javagram 6y ago
  Remdesivir was tested and found to be effective against Ebola. It just wasn’t as effective as antibody treatments so got shelved in favor of them.

gregwebs 6y ago

The original Remdesivir trial by the drug company was a high quality RCT (randomized control trial) - except that they stopped it early once they saw a statistically significant positive effect (even though the effect was somewhat underwhelming: just fewer days of recovery). To me this moving of the goal posts invalidates the quality of the RCT. This study from an independent body without a moving of the goal posts is a more trustworthy result. With that being said, anti-virals often only work well when given very early (sometimes even as a preventative) and right now from looking at this study it doesn't seem like this was done. So this study may only be confirming what we already know about how anti-virals should be used (at a very early stage) but it will hopefully have the good effect of stopping improper usage.

cyphar 6y ago
> The original Remdesivir trial by the drug company was a high quality RCT (randomized control trial) - except that they stopped it early once they saw a statistically significant positive effect (even though the effect was somewhat underwhelming: just a couple fewer days of illness). To me this moving of the goal posts invalidates the quality of the RCT. Based on what I've seen discussed, ending trials early is a fairly common (though admittedly contentious) practice in medical RCTs when you're dealing with very serious illnesses, especially when there are no alternative effective treatments[1]. The issue is that there is a tradeoff between an abundance of caution to procure conclusive results and giving patients access to medicine which "clearly helps". In an ideal world you would run every RCT for several years to figure out any possible long term effects and accurately determine efficacy, but there are many circumstances where you could argue doing so (if it's clear the medicine works during the early stages of the trial) is more unethical than giving people medicine which shows some promise to work. But it should be noted that such trials are still solid science (the trial was an RCT), it just means you cannot take them as evidence of long-term efficacy. [1]: https://www.ahajournals.org/doi/full/10.1161/circheartfailure.111.965707 https://www.ahajournals.org/doi/full/10.1161/circheartfailur...
- pen2l 6y ago
  What is the _reason_ for ending it early? Is it the cost? I imagine it must be high enough because then they're gonna have to fight with this very criticism later on: RCT ended prematurely, therefore it is not as reliable. A question to you and grandparent post: what are the things that distinguish a high quality RCT from a poor one? The number of participants, the design study, etc.? Any links/resources that discuss this would be appreciated. edit: ok, I found a paper on this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429837/#:~:text=Randomized%20controlled%20trials%20(RCTs)%20have,of%20medical%20treatments%20(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429837/#:~:tex.... I am super curious now about any discussion that reveals why the WHO study was less-than-stellar, and why the original RCT was considered high-quality.

adictator 6y ago

Whoever follows WHO in the context of pandemics, especially for Covid! WHO has been guilty, without any doubt, of spreading mass misinformation since March 2020.

varispeed 6y ago

Little to no effect, but for some individual that "little" could mean being alive. Just because majority don't find a benefit it shouldn't mean that someone who actually benefit shouldn't use this. But regardless, corrupt organisations like WHO should have no say in these matters or at least shouldn't be listened to. You don't know if that release wasn't paid by competing pharmaceutical companies.

EasyTiger_ 6y ago

Why are treatments that are effective in some way never discussed?

collyw 6y ago
This pandemic has become ridiculously political. I was all onboard with "Hydroxychloroqine doesn't work" until I watched this, based on a large scale trial in Belgium. https://www.youtube.com/watch?v=2uzXHnUViro&feature=emb_logo https://www.youtube.com/watch?v=2uzXHnUViro&feature=emb_logo Now I want to see more information, as he points out the early trails used to dismiss it used a dangerously high doses.
- hef19898 6y ago
  I said in February, I will say it again. Facebook, Twitter and YouTube are sources to be avoided when we can also look at prime sources or more reputable ones that "a guy on YouTube". If anything, YouTube was too late to block certain content.
  - collyw 6y ago
    You should probably take a look at the video before you dismiss it in the way you have - based on the source rather than the content. He is a nursing teacher and his videos basically take up to date research and news on covid as he explains it to a non technical audience. Personally I rally appreciate that he takes the time filter out what appears to be interesting / important and presents it in a way that is easy for the general public to understand. If you still can't be bothered to do that then the paper he is discussing is here (I assume that a peer reviewed paper is up to your high standards) but you will be missing out on a lot of information about dosages that John adds: https://doi.org/10.1016/j.ijantimicag.2020.106144 https://doi.org/10.1016/j.ijantimicag.2020.106144 >I said in February, I will say it again Repetition doesn't make your argument any more valid.

nathias 6y ago

Time to buy Remdesivir.

thehappypm 6y ago

Remdesivir interferes with the virus's ability to make copies of itself. If a patient is already in the hospital, their viral load is insanely high. Remdesivir may slow down the growth rate but for a lot of patients it's already just too late, the virus's effects on the body have already taken too much of a toll.

ssully 6y ago
I would be curious to see a study on how it impacts patients before they go to the hospital. Specifically, if they test positive, they start treatment within days of their result.
- thehappypm 6y ago
  That's what Donald Trump received and look how fast he recovered.
  - hnracer 6y ago
    Not disputing the point here, but he also had Regeneron and Vitamin D both which have shown promising results
  - beagle3 6y ago
    He also ate a hamburger and wrote his name on an empty piece of paper in a photo-op. How do you know it was remdesivir rather than the photo-op, hamberder, dexamethasone or regeneron, all of which he got as well?

zalkota 6y ago

It seems as if all of these articles just won’t go discredit Donald Trump.

gregwebs 6y ago

At this point to my knowledge there is only one treatment that have been shown in an RCT trial to have a large effect: that is giving bolus dosages of vitamin D. [1] The effect was that only 1 (2%) of 50 patients needed ICU admission whereas the control had 50% ICU admission. In contrast the Remdesivir effect found was just fewer days of recovery. So we can contrast the vitamin D result with how much effort is going on to determine whether there are marginal improvements from anti-virals. The trial is small (100 participants), so we should be doing a larger one now, but I don't think there is a down-side to adopting this as a standard of care. [1] https://www.sciencedirect.com/science/article/pii/S0960076020302764?via%3Dihub https://www.sciencedirect.com/science/article/pii/S096007602...

DominikPeters 6y ago

Derek Lowe recently discussed results from a different trial that were more positive. https://blogs.sciencemag.org/pipeline/archives/2020/10/09/hard-data https://blogs.sciencemag.org/pipeline/archives/2020/10/09/ha... > The good news is that the patients receiving the drug had a shorter time to recovery (9 to 11 days, in the 95% confidence interval, versus 13 to 18 days with non-remdesivir standard of care. That’s real, but it’s not real dramatic, either, which is what you would realistically expect from a single broad-spectrum antiviral drug. This ain’t sofosbuvir clearing out hepatitis C, and even that one doesn’t do the job by itself. As for the hardest endpoint of all, mortality by Day 29 for these patients was 11.4% with remdesivir therapy as compared to 15.2% with the controls. So again, that’s a real improvement and very much worth having, but it’s not a Miracle Drug, either. Adverse events were actually lower in the treatment group, which is of course good news.

boomboomsubban 6y ago
The BBC article mentions that study and says it was conducted by Gilead. The study itself says that Gilead employees took part, but I am unable to figure out what role they actuality played.
hhs 6y ago
If interested, he posted an updated comment that takes into account today’s news of the Solidarity trial: https://blogs.sciencemag.org/pipeline/archives/2020/10/16/the-solidarity-data https://blogs.sciencemag.org/pipeline/archives/2020/10/16/th...
- Balgair 6y ago
  "It looks like there is no case at all to be made for some of these therapies, and for remdesivir, it looks like the argument now is “Does it help a bit or just not at all?” The only thing that I’ve seen that really seems to be making a big difference now is dexamethasone, and we may soon (I hope) be adding the monoclonal antibodies to that list. The SOLIDARITY enrollment is still moving along at 2000 patients/month, and will be looking at these and other newer ideas as it continues. And that means abandoning the older ideas, because – as we’re finding out – they’re not much help. It’s time to move on." Just so everyone knows, this is the same guy that writes the 'Things I Won't Work With" blog. It's all about insane chemical compounds and is very much one of the best blogs ever written. https://blogs.sciencemag.org/pipeline/?s=things+I+won%27t+work+with https://blogs.sciencemag.org/pipeline/?s=things+I+won%27t+wo...

cm2187 6y ago

Time to flag and ban all youtube videos that present the drug as potentially effective, including from mainstream media, in accordance with youtube’s policy.

hristov 6y ago

It may still have an effect in time to recovery, which is important, both in reducing suffering and helping hospital capacity. Of course that has to be weighed against the side effects. In any event, I do not think that the $3K per treatment price is justified. By the way, there is a supplement that is far far cheaper than remdesivir and is available over the counter which has also shown to reduce time to recovery by about as much as remdesivir. See: https://investors.chromadex.com/news/news-details/2020/ChromaDex-Announces-Study-Results-Showing-Nutritional-Protocol-Including-Nicotinamide-Riboside-Plus-Standard-of-Care-Reduces-Recovery-Time-in-COVID-19-Patients-by-Nearly-30/default.aspx https://investors.chromadex.com/news/news-details/2020/Chrom... This is a 100 person trial, which is much less than the remdisivir trials, but still statistically significant. In any event, the risk is much lower, according to the study "adverse events were uncommon, benign, and self-limiting." The supplement is sold as truniagen.

bitwize 6y ago

Hackernews School of Medicine taught me to doubt the efficacy of anything except fasting, rolfing, and Wim Hof breathing. In particular, drugs, except for psychedelics, are not to be trusted.

collyw 6y ago

Could there be other factors affecting the outcome? Hydrochloroquine seems to have been dismissed, but watching this video he makes a a good case for it working at low dose - it seems like a lot of the trials involved too high a dose. (He talks about a relatively large scale study in Belgian hospitals). There seems to have been multiple studies done, some giving good results some not. I am curious if the ones at the lower dosage were separated out would they all gave more positive results. Unfortunately I don't have time to check through them all myself. https://www.youtube.com/watch?v=2uzXHnUViro&feature=emb_logo https://www.youtube.com/watch?v=2uzXHnUViro&feature=emb_logo

Scene_Cast2 6y ago

Meta-comment about medical studies. Suppose that an intervention's effect is contingent on some variable. For high-profile treatments, wouldn't it make sense to isolate those variables (for the cases where it did help, but the overall result over the entire population was neutral) and run a second trial?

zyxzevn 6y ago

The first study that was heavily promoted used a randomized trial, and showed shorter stays in the hospital. But looking at the real data, the study was not completely randomized as they had removed some patients. Patients that had died. So it was essentially a P-hack to sell us a worthless but expensive product. So I stopped believing that Big Pharma would save us, and that their science-journals were giving honest reports. In the mean time I see reports of different very cheap medicines that give a 10x reduction in death-rates. From 500 to 50 and such. That is extremely hard to hack because these death numbers would show up elsewhere. From the reports it appears that the virus is very vulnerable to some cheap anti-viral medicine. But there is no money in that, so it will not be promoted that heavily. Here are some videos where the science papers are explained by an expert. https://www.youtube.com/watch?v=98RQ3QK-yCc https://www.youtube.com/watch?v=98RQ3QK-yCc https://youtu.be/bbGG79WGmu4?t=800 https://youtu.be/bbGG79WGmu4?t=800

vanilla-almond 6y ago

Gilead signed a billion dollar deal with the EU Commission for Remdesivir on the 8 October. However, Gilead apparently received the WHO study on 28 September and so were aware of the conclusions of the study before they signed a deal with the EU Commission. This naturally leads to further questions, as discussed in this tweet thread: https://twitter.com/kakape/status/1317042940825436162 https://twitter.com/kakape/status/1317042940825436162 Edit: Martin Landray, professor of medicine and epidemiology at the University of Oxford and leader of the UK-based Recovery trial also has a good summary of the WHO trial: https://twitter.com/MartinLandray/status/1316989951297396736 https://twitter.com/MartinLandray/status/1316989951297396736

ucha 6y ago
Martin Landry: "People will argue about the need for earlier use (possibly) or that with even more data there may be a benefit (possibly - but where are those trials going to come from). But the effect is modest at best - and so far there is no strong evidence it is there at all." But it doesn't follow at all that because there is no effect when administered late, the effect, if administered early, is modest as best. In fact, there are many medication that are very effective if administered before the first symptoms appear and are completely useless after. If you get exposed to rabies, you can get a rabies vaccine and have close to no chance of contracting it, whereas if you get a vaccine after you develop symptoms, you're almost certain to die. Similarly, the flu antivirals are somewhat helpful if taken early but have no effect if taken too late.
- m0zg 6y ago
  It's as if they're doing this on purpose. It is quite obviously pointless to administer antiviral drugs _after_ the cytokine storm sets in and the person is already dying.
- vanilla-almond 6y ago
  Landray says in the same twitter thread: "...Remdesevir is given by intravenous infusion for 5-10 days. It is not cheap. And supplies are limited (not surprising given scale of epidemic)." This means anyone showing early symptoms is likely to require a stay in hospital for early administration of the intravenous infusion. There are questions about how scalable this is. Landray again: "COVID affects millions of people & their families around the world. It is not a rare disease and we need scalable, affordable, and equitable treatment solutions."

remote_phone 6y ago

Giving anti-vitals early is a significant problem for covid-19 because such a significant numbers of patients will have no or mild symptoms (85%). So it’s really a no-win situation because if you give it early, not many people will look like they’re getting better relative to control. But if you give it too late to those who have severe symptoms it will be too late. What they need to do is figure out a way to identify who will get severe symptoms and give remdesivir to them early. That’s probably the only way you will see a benefit, If there’s even a benefit at all.

papito 6y ago

Oh why does the whole thing feel like a grifting and a profiteering operation?

stevespang 6y ago

Remdesivir is crap. From the very beginning, the Russian protocol included interferon, nasal application 3x per day. Then, coincidentally, a week or so ago the American medical establishment wakes up and concludes that covid19 has a propensity to deactivate inteferon production or usefulness in the human body. As always, American medicine has a "conflict of interest" in keeping hospital patients as long as possible, as sick as possible to maximize billing. Go Figure.

bitL 6y ago

I am missing results for Favipiravir that was the most promising of them all. For some reason WHO didn't include it in their test at the beginning nor at any later point of time. Almost one year later still no news?! Also, why don't the governments just distribute elderly and weak vitamin D and zinc to take everyday? There's not much harm that can be done with those and could potentially offset lack of sunlight that might have kept COVID-19 in check during the summer. A low-risk low-cost solution that could potentially yield enormous health and economic benefits if the link between vitamin D and zinc deficiency on the severe outcome of COVID-19 is proved later.

pezo1919 6y ago
Favipiravir is far less promising than ivermectin with ~100% cure rate if treated early. It is peer-reviewed now (ivermectin ICON study, single dose late stage 40% mortality reduction.) I don't get why people on HN are not aware of it.
- hef19898 6y ago
  Because HN is nit primarily populated by medical experts specialized in Virology? Just a guess.

pezo1919 6y ago

Why no one talks about ivermectin? I don't get that.

jeffnappi 6y ago

Remdesivir is also apparently insanely difficult and expensive to synthesize as well - for a humorous take on it see https://www.acsh.org/news/2020/03/26/problem-remdesivir-making-it-14665 https://www.acsh.org/news/2020/03/26/problem-remdesivir-maki... if you haven't already.

getlawgdon 6y ago

When is Ampion going to be int the discussion? it's an anti-inflammatory and there is some study showing rendemisvir is effective when used in conjunction with Ampion. Or, it might be entirely the Amount helping patients in a therapeutic scenario. All this focus on an antiviral when an anti-inflammatory might have an immediate impact as cases ramp up...