Thread by @kurteichenwald

Pushing back on the tsunami of stupid from Trump is like battling ocean tides. But people need to know WHY it's stupid.

He just said the "survey" conducted that found no benefit & higher death from hydroxychloroquine was a "Trump enemy statement".../1 rawstory.com/2020/05/trump-…

...he also said it was an "enemy statement" because the researchers "were giving it to people in bad shape, they were very old, almost dead." All of this is stupid, lies, and - possibly - a complete lack of knowledge about what TYPE of study this is..../2

...while sloppy shorthand of "survey" - after calling the type of study the correct name - is used, Trump appears to have meant it was some kind of poll where the subjects were picked in advance to "get" Trump, because of course, in his mind, EVERYTHING is about Trump..../3

...the correct name for this is a retrospective chart review, or RCR. It has significant methodological requirements - not just asking people stuff - and involves a statistical analysis of a set of data that is selected as a cohort. There can be flaws in such studies BUT..../4

...the nonsense Trump babbles isnt one. Below is the methodological requirements & possible flaws, none of which are apparent in the actual study.

Take Trump's words as fact. He's saying that everyone treated at VA for COVID is "very old, almost dead"../5
ncbi.nlm.nih.gov/pmc/articles/P…

...this conclusion is inescapable because there was *no selection* of patients in the study. The retrospective selected as its cohort every person admitted to a VA hospital for COVID in 2020, up till April 11. ALL of them. (see study attached.../6

medrxiv.org/content/10.110…

...so, the researchers had the records of 368 patients in the VA with COVID. Why the VA? Because the government has access to the blinded charts from the VA (meaning names removed) which is typical for retrospective chart review because there are not the legal issues of.../7

...going hospital to hospital all around the country, getting different data and battling through the legal issues.

The patient charts showed that 97 received hydroxychloroquine alone, 113 used hydroxychloroquine with azithromycin, and 158 had no hydroxychloroquine.../8

...then, to make sure they just weren't testing whether the people receiving meds were sicker, and thus had worse outcomes, they did a competing risk hazard regression of the statistical outcomes, adjusting for clinical characteristics via propensity scores ( a $5 phrase.../9

...that means - in truly rough terms - that the outcomes were adjusted to account for the differing degree of sickness/treatments). So if Trump wants to say "they were sicker" then it has to be EVERY person in the study, since that was adjusted for. But then - why were..../10

...so many of these very very sick people better off without any of the medication? The results showed 27.8% on hydro died, on hydro, 22.1% on hydro and azithro died, and 11.4% of people with no drugs died..../11

...but they also showed that 13.3% on hydro were ventilated, compared to 6.9% on hydro and azithro, and 14.1% on no drugs. Again, if all of these people were dying, why is the percentage of people getting vented about the same reported in the general population? Because..../12

...Trump does not understand what any of this means.

On top of that, Trump (and Fox) dont even understand what the frigging study he thinks is great says. The French study, which was withdrawn for significant data and research flaws, did NOT show ANY of what Trump says.../13

...this flawed and withdrawn study advanced one theory (and I will put it that way, because the flaws do not allow it to be called a finding): That hydro could cut the viral load in people who were very sick with COVID. The SAME people Trump says makes the VA study invalid.../14

...because it didn't include healthier people. People who DIDNT get it, because the people who do not have bad cases do not need medical intervention. It'd be like performing CPR on someone with angina. Plus, the study says NOTHING - no completed study says anything - about.../15

...using it to prevent infection in the non-infected. It's like saying taking anti-virals that reduce the viral load for HIV prevent you from getting HIV. It is two different mechanisms that have nothing to do with each other.../16

...but I am only putting it out there for people who would never follow what Trump has to say so they know why, in this case, not to. Like I said, we can't fight the tsunami of stupid..../17

..So, if Trump wants to get enough hydro for people with lupus, etc who need this drug, then flood out more for his dumb cult to swallow as they worship him, go ahead. Im tired of fighting for them.

They wont be the 1st cult members who kill themselves in following their savior.