For those interested, results from COVID-OUT being reported at 1 EDT. Zoom link for the meeting can be found at the link below. For those that can't make it, I'll tweet out the highlights.

rethinkingclinicaltrials.org/event/grand-ro… Here is the study design. 14 days of everything other than ivermectin (3 days). Shared placebo.

There is an incredible amount of weight being put on flawed observational analyses w/ respect to "waning" immunity. I would encourage you to read the crossover portion of the Moderna RCT as it is a much stronger analysis and paints a more complete picture

nejm.org/doi/full/10.10… The focus here is on patients who were either initially given moderna (the "e" group) or those given the vaccine after EUA and unblinding (the "p" group). Median follow up time was 13 months in the early (e) group and 8 months in the late (p) group. Pretty long follow up!

This viewpoint in Lancet (which is awesome BTW) is highlighting the need for robust data AND analysis before publicly stating a definite need (and timing) for additional doses. Unfortunately, this thread highlights exactly why this is important. Allow me to explain.

https://twitter.com/EricTopol/status/1437540952072081411

I want to start by saying it is not my intention to be disrespectful. I think big audiences come w/ big responsibility, and these experts surely considered these data. I welcome thoughtful pushback, but I disagree that the CDC reports show waning efficacy vs. severe dz in >65.

It didn't get the same level of attention but I think the OTHER report in the latest MMWR cdc.gov/mmwr/volumes/7… is quite informative on the efficacy of vaccination against Delta and the need to fine tune our messaging The study was from the LA County Department of Public Health over a 12 week period, which started with alpha dominance and ended with Delta dominance. They assessed age adjusted impact of vaccination on incidence of infection and hospitalization as 7-day rolling averages.

I see many bad actors on here stating that the latest numbers from the UK are bad - more cases, hospitalizations, and deaths seen with Delta in vaccinated patients compared to unvaccinated & hence vaccines don’t work, nihilism is great, etc. This is bullshit. Let me show you why. The obvious issue is that there is no attempt to control for number of vaccinated people in the population, which is quite high. I am going to attempt to correct for this in a down and dirty way – please await PHE data for more exact numbers – but this should get us close.

For those interested, the position of @MMAbxstew @umichmedicine is that the slight bump in etesevimab IC50 values in the California (L452R) or New York (E484K) variants is not impactful and therefore outside of B.1.351/P.1 both combo mAbs are appropriate. (1/4) In fact, despite increasing local rates of L452 and E484K (~15% of viruses between the two) we currently preferentially use BAM-ETE to reserve CAS-IMD in case B.1.351 or P.1 become more prevalent. We also think it important that this product be available for areas w/ ⬆️rates.

This is a great read on the nuance/trying to make sense of the remdesivir data! I highly respect @PaulSaxMD and his interpretation and clinical experience. This is how I want to feel about it too, but if I am being honest with myself the data do not really support it (1/7).

https://twitter.com/PaulSaxMD/status/1317840625794940928

If time from onset of symptoms was the driver here, the difference seen in <=10 days, shouldn’t go away when we split it at 9 days. In fact, the shortest time to recovery was driven by the group days 10-12 From onset (<=6 days was no better). From supplement of ACTT-1

It has been pointed out that my thread yesterday omitted observational data, most notably the Henry Ford study. This was done intentionally, because the observational data for (and against) hydroxychloroquine is honestly confounded beyond salvaging. Allow me to explain. Those who know me are aware I am highly supportive of well performed retrospective observational studies. It is actually the focus of my research career to date and will continue to be moving forward

I promise that if #hydroxychloroquine was an effective therapy for #covid19 we would tell you. Many of us (myself definitely included) were hopeful that it would be at the onset of the pandemic. We now know definitively that it doesn’t work. A (long) thread The initial hope for HCQ stemmed from in vitro work in Vero (kidney) Cells that showed potent inhibitory activity of CQ (and subsequently HCQ).

Welcome new followers. I wanted to pause and reflect before further commenting – which is something I would highly recommend we all do. With that, another brief thread First off, for those asking, I'm an infectious diseases clinical pharmacist.Critically assessing the totality of evidence and working w/ physician colleagues to make patient care decisions is quite literally what we do. We are drug therapy experts and always work to optimize care

Guys. We need to talk about this Hydroxychloroquine + Azithromycin thing. It is out of hand. It all stems from this study that came out today. The study design: Comparative viral eradication on day 6 between HCQ, HCQ + Azithro, and control (not treated) COVID-19 patients. The gist of the excitement is this figure describing viral "eradication" rates between the groups at day 6:
HCQ + Azithro group 6/6 (100%) by day 6
HCQ mono therapy 8/14 (57%)
Control 2/16 (13%)
Sounds amazing right? I mean this kinda stuff gets Dr. Oz all worked up.