Thread by @ProfDFrancis

Ah, now I know what FHRS means.

"Fooled by Horseshit Regarding 'Severe' "

(I am reliably informed by @vish_luther one of our EP clever-docs that Felix Yang has a good sense of humour, so won't mind me using his tweet as a stepping-off point)

You know how sometimes companies pay you to be in an experiment?

If you are super-keen, YOU can pay THEM.

Well, thanks to thousands of affluent and mostly elderly sponsors, we have the wonderful Diamond Princess dataset.

EVERY PASSENGER was tested, some several times.

301 were found to have the coronavirus.

Let's see now.

Cruise ship passengers, eh?

Are they

The Japanese authorities did the testing.

Do you think they were

What do you think they did with severe cases?

What do you think they did with moderate cases?

What do you think they did with mild cases? (Mild, symptomatic cases; not asymptomatic)

And now ASYMPTOMATIC infected people?

People who felt completely well and on top of the world, but were found on testing to have the virus.

What do you think the authorities did with the ASYMPTOMATIC Covid-positive people?

OK so we have established that the Diamond Princess Research Funding Cooperative is generally elderly and the virus-positive patients contain which subgroups, out of:

Asymptomatic
Mildly symptomatic
Moderately symptomatic
Severely symptomatic

Well, you can read the paper here. We saw it in pre-print form a couple weeks ago, and it is now through in print.

eurosurveillance.org/content/10.280…

Due to my advanced knowledge of epidemiology, epistemology and erudition

... and unrelated to the ORBITA HQ PhD fellows whatsapping me when I talked crap about it ...

I know that:

INFECTION Fatality Fate (IFR) is the probability of dying, of EVERYONE who is infected, regardless of symptoms

CASE Fatality Rate (CFR) is the probability of dying, of ONLY the people with SYMPTOMS.

So in the great Diamond Princess Fund-Your-Own-Medical-Research experiment:

... if a person had symptoms (mild, moderate or severe) what was the probability of dying?

Remind me, were these predominantly young, fit people? Or old people with background medical conditions?

What was the chance of getting home alive, then, for people developing SYMPTOMS from Covid, on Diamond Princess?

Now, let's have a look at the half-assed Remdesivir "trial", widely touted.

All the Feuerstein & Herper *facts and figures* were correct, as we would expect for good journalists.

The criteria for entry into the Katherine Mullane study were as follows, according to @sameerbansilal

There are 4 requirements for entrance.

The first three are obvious:

Adult
In hospital
Got Covid

Here is the 4th: the index of severity.

"Requiring supplemental oxygen" at time of screening
*OR*
SpO2 94% or under

So, one way to get in to the "trial" is that a doctor or nurse gave you some O2.

Hmmmm.... If you got admitted to hospital with breathlessness, what would you get?

Quite right!

In fact, it is so obvious that it took us many years to STOP giving oxygen routinely to patients with MI's.

I think it took 2 trials that showed it kills you, before we reluctantly removed it from being our first action in STEMI.

From this, I conclude that the "severe" so-called-trial, was addressing "people admitted with breathlessness".

I am not sure what other symptom would cause people to be admitted.

If I had fever alone? No breathlessness?

I would probably stay at home, and hope it was just a random fever. Rather than stick my face into the town's seething mass of Covid, namely the hospital.

So I reason that, unless people LIKE being in hospital during an infectious disease pandemic, they would ONLY go to hospital because of breathlessness.

And unless the hospital is short of oxygen or something, they would give you a nasal prong or mask or something.

In which case,

WELCOME TO THE "SEVERE" COVID TRIAL!

8-)

How many of these survived in the Kathleen Mullane dataset?

Two out of 125 died.

And, do you remember, on the Diamond Princess, what proportion of SYMPTOMATIC patients survived?

Is this evidence of a miracle drug?

Now you know why I had a little outburst at Felix Yang's expense. Sorry old chap, you can ablate my heart rhythms any time. 8-)

Oops - thank you to @cf_johnsson for pointing out an error in my calculation.

125 patients in the Mullane half-trial, but only 113 had severe disease.

So the 2 deaths are 2 in 113, not 2 in 125.

Oh dear.

What is the survival in the Remdesivir patients?

And the survival in the Diamond Princess symptomatic patients was 97.4%.

So it is

98.2% with miracle drug,

versus

97.4% sitting on a cruise ship, being rebuffed by every country you come across.

Now one last kicking for the idiots at Gilead.

You might think they have no idea about placebo control, and why it is important. That would be because you are a big softie like @drjohnm, and you probably believe in Santa Claus etc.

In fact they know very well about placebo.

Not only heard of it, actually DONE a trial.

A real phase 3 trial, in the sense of having 2 arms, not 1.

Progress...

And the results? Ask them. See what they say.

All we know is that they have now embarked on UNBLINDED research, presumably displeased with the experience of placebo-controlled?

Placebo controlled trials are best, aren't they?
Scientifically good.
We're used to doing them.

But....

Yeah, about our big trial? About that...
I think we're gonna have to just go ahead and ask you to do it without placebo .