This is getting passed around a lot.
It is not a scientific report. I don't think numbers should be reported like this - they're uninterpretable/misleading without details (link doesn't really contain them either).
And what CAN be discerned.. is disappointing.
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It is not a scientific report. I don't think numbers should be reported like this - they're uninterpretable/misleading without details (link doesn't really contain them either).
And what CAN be discerned.. is disappointing.
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First, this is not a trial: no randomization, blinding, standardized protocols among groups, etc.
The treatment groups could be very different, confounded by indication/contraindication/severity etc.
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The treatment groups could be very different, confounded by indication/contraindication/severity etc.
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But you gotta see the glaring problem in the few data that are reported, too.
You can't tally all deaths and implicitly ascribe them to non-treatment group... and then only tally deaths that occurred after >3 days of treatment (but no earlier) in the intervention group.
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You can't tally all deaths and implicitly ascribe them to non-treatment group... and then only tally deaths that occurred after >3 days of treatment (but no earlier) in the intervention group.
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That hides potential deaths on days 0-3 in the HCQ/azithro group, occurring despite the treatment, or even attributable TO the treatment.
And since COVID can involve myocardium and cause ventricular arrhythmias, early harms from these two QT-prolonging drugs are plausible.
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And since COVID can involve myocardium and cause ventricular arrhythmias, early harms from these two QT-prolonging drugs are plausible.
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Remember the azithromycin ~ sudden cardiac papers in 2012...
Medicaid (and European) cohorts were studied. In the days following 100000s of prescriptions for azithro, amoxicillin, quinolones, or nothing - how many people died in each group?
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Medicaid (and European) cohorts were studied. In the days following 100000s of prescriptions for azithro, amoxicillin, quinolones, or nothing - how many people died in each group?
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These reports led to dramatic, disproportionate media coverage.
As compared with no antibiotic or with amoxicillin, there was excess mortality at day 5, attributable to cardiovascular death, and mostly in people with baseline risk. Compared with FLQ, outcomes similar.
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As compared with no antibiotic or with amoxicillin, there was excess mortality at day 5, attributable to cardiovascular death, and mostly in people with baseline risk. Compared with FLQ, outcomes similar.
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But the reasons I thought it was all overblown was that:
- absolute risk was very small
- we already knew azithro and FLQ affected heart/QT
- curves/outcomes equalized at day 10 (no antibiotic / amoxicillin deaths caught up)
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- absolute risk was very small
- we already knew azithro and FLQ affected heart/QT
- curves/outcomes equalized at day 10 (no antibiotic / amoxicillin deaths caught up)
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But I bring this up to underline that you can't ignore the first several days of effects of these drugs. Their adverse effects can be immediate and fatal in those predisposed.
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Another note: that hospital, IHU Méditerraneé Infection, is the institution of Didier Roault, the author of the viral load paper that was discussed by @rbganatra in the thread below. That's to say, these data are not coming from independent places.
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We don't know if HCQ and/or azithro are effective. I hope they are and I hope we find out soon.
But until we know:
- giving individuals treatments that have shaky support can do harm
- touting unproven treatments as amazing cures does do statistical harm
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But until we know:
- giving individuals treatments that have shaky support can do harm
- touting unproven treatments as amazing cures does do statistical harm
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If anyone else knows of more hopeful/convincing data, please share.
Again, I really hope we do prove benefit, since people are already getting this stuff and will get even more of it after today's announcement.
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Again, I really hope we do prove benefit, since people are already getting this stuff and will get even more of it after today's announcement.
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