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What prevents #COVID19 spread?
And to what extent?
An exceptional systematic analysis of 172 global studies in ~26,000 people (not randomized trials)
—Physical distancing > 1 m; & more the better
—Masks (N95 > surgical/cotton)
—Eye protection
thelancet.com/journals/lance… @TheLancet
Accompanying editorial "the best specific evidence for #COVID19 prevention"
@KirbyInstitute's MacIntyre and Wang @UNSW
Unfortunately, both @WHO & @CDCgov have given very poor guidance for both the #healthcare workforce and the public on masks (and have not emphasized eye protection to date)
+ coverage @nytimes by @apoorva_nyc nytimes.com/2020/06/01/hea…
Good infographic summary of the large body of data reviewed
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Eric Topol
@EricTopol
The 1st pandemic research scandal, as @ScienceMagazine aptly puts it, now leads to a retraction of @TheLancet hydroxychloroquine paper by its non-@Surgisphere authors
science.sciencemag.org/content/sci/36…
What still remains unclear is whether the 3 authors, who have now retracted the paper, had access to the primary data that was published. It looks as though they did not. And if so, that violates journal requirements and was a setup for what occurred.
The "only" major difference from the retracted paper v. prior/other 14 studies (10 observational, 4 RCTs) was the ~35% increase in mortality. Otherwise, there was consistency in lack of efficacy (and risk of heart arrhythmias in many).
Now there's no data to support ⬆️ mortality
Read 7 tweets
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Eric Topol
@EricTopol
Remote, siteless, virtual, digitized clinical trials are taking hold, even for drug interventions
Lots of buzz yesterday about the @NEJM hydroxychloroquine trial without noting it was done remotely
nejm.org/doi/10.1056/NE…
And a feature @NatureNews
nature.com/articles/d4158…
This succinct essay @TheLancet provides perspective on this model of clinical trials, by @SteveSteinhubl @ScrippsRTI @scrippsresearch
thelancet.com/journals/lance…
The 1st published siteless clinical trial at scale
jamanetwork.com/journals/jama/… @JAMA_current @ScrippsRTI
Read 3 tweets
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Eric Topol
@EricTopol
We just published a review of 16 cohorts w/ #COVID19 + data for asymptomatic infections
@AnnalsofIM
great work by @danieloran @ScrippsRTI @scrippsresearch
acpjournals.org/doi/10.7326/M2…
Bottom line: the rate is high, perhaps ~40% or greater, even taking into account presymptomatic Δ
Besides the high rate of people infected but lacking symptoms, it is noteworthy what is going on beneath the surface. For example:
1 cohort of 331 (46.5%) were asymptomatic. But CT scans in 76 of these individuals, 54% showed significant abnormalities c/w #COVID19.
There's also a lot of data about children from the 16 cohorts.
One of the most careful studies was in Vo, Italy:
“No infections were detected in either survey in 234 tested children ranging from 0 to 10 years, despite some of them living in the same household as infected people”
Read 4 tweets

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