It’s frustrating, because remdesivir in theory would be a lot better as a treatment in early disease, and if you used it on high-risk patients you’d save a lot of lives. In contrast, even the positive remdesivir results so far have shown no effect on mortality.
I hear you. But, we are a long way from having prophylaxis data.
And when you are talking high risk people, there need to be many safety studies making sure that remdesivir would be safe when administered along side all of the drugs that high risk people would be taking. High blood pressure meds. Chemo drugs. Biologics. Immunesuppressants. Etc.
Next, where would people get the IV prophylaxis treatment? Having to go to the hospital or infusion center is a tough sell for prophylaxis, and will be expensive. There is also risk in sending vulnerable (or really any) patients into environments that have all the bad germs. Home health companies could administer it in the home, but that would be even more $.
Remdesivir did show an effect on the mortality endpoint, but it was not statistically significant in the NIAID trial of 1,063 severe patients.
@BunsenBurner not sure what you are referring to, and don’t want to be argumentative, but the Sofia 2 device is made to be used at the POC setting
https://www.quidel.com/sites/default/files/Sofia%202%20Demo%20Video_Web.mp4
No offense. Let me explain a bit more what I mean. POC setting (clinic or hospital) is not the same as airport screening setting. A device for the latter needs to be as idiot-proof as possible.
While the Sofia is easy to operate, it still requires minimal manual sample prep.
A device for TSA use needs to be absolutely simple and absolutely non-invasive. No swabs. No pipetting. No buffers to add anywhere. Spit into a cup, shove the cup into the machine, and the machine does the rest. We are not there yet.
If the IV prophylaxis was used for nursing home residents who tested positive, and it had a significant effect on mortality or even morbidity, it would pay for itself. One out of ten people in nursing homes in NJ have died of covid.
@BunsenBurner totally agree, the quality of the sample used for any laboratory testing is of paramount importance for accurate test results!
The example you give would be using remdesivir as treatment for already infected patients, which is not prophylaxis. Prophylaxis studies and data are a long ways away, and require much more in terms of performance.
I agree that if remdesivir works in early stage disease to prevent progression in nursing home patients that would be great and would pay for itself. Again, a long way from that data.
Relatively there is still not that much data on this drug, so it’s being reserved for the sickest of patients who have no other options. We don’t know enough about its safety, or interactions with other drugs (of which at risk patients all take) to expand its use in the absence of data.
Well, hydroxychloroquine turns out to be a big bust.
Published today online at JAMA (open source):
Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State
https://jamanetwork.com/journals/jama/fullarticle/2766117
Retrospective study of more than 1400 patients hospitalized in NY, looking at mortality rates. Basically it made no difference at all in outcomes if they received hydroxychloroquine alone; patients who received hydroxychloroquine together with azithromycin were more likely to suffer cardiac arrest.
Maybe this will stick a fork in the much touted panacea, so these other trials will be shelved.
Sad news from UW Medicine…
Have there been any studies about how commonly and how much SARS-CoV-2 can be found on commonly touched things, such as grocery store shopping carts and pay consoles that people touch?
I thought hydroxychloroquine was supposed to be effective if taken early (before hospitalization was needed, to prevent hospitalization), not after patients were sick enough to be admitted. That was the early information, at least. Has that been studied? Still might not work, I just haven’t heard any study results.
Early on I was hearing about great results with giving hydroxychloroquine **early on in combination with NOT azithromyicin, but with ZINC. Zinc “kills” this virus if it can get inside the cell, and the hydroxychloroquine is what facilitates it.
I haven’t heard about any of the trials that used these drugs in combination. I wonder why that is, or if in fact this is just something individual physicians were trying out of desperation and therefore the results are not documented.
@MomofJandL There are still a number (>100) of ongoing studies on HQ, many in comparison to, and in combination with, other medications. My impression is not that it’s never helpful, just not in all situations. Optimal situation, timing, and dose, and med combination(s), need to be determined, of course along with consideration of contraindications. Like most meds, it is not one-size-fits-all, and considering the anecdotes from docs who like using HQ just that I’ve seen in news articles, it is unlikely that any single study will be dispositive on the utility of HQ in COVID.
There seem to be a few ongoing ones, such as this new one: https://clinicaltrials.gov/ct2/show/NCT04377646?term=hydroxychloroquine+zinc&cond=COVID&draw=2&rank=1
@Nrdsb4 You might also be interested in this discussion: “Improving the efficacy of chloroquine and hydroxychloroquine against SARS-CoV-2 may require zinc additives - A better synergy for future COVID-19 clinical trials” https://www.infezmed.it/media/journal/Vol_28_2_2020_9.pdf “Chloroquine can induce the uptake of zinc into the cytosol of the cell, which is capable of inhibiting RNA-dependent RNA polymerase and ultimately halting the replication of coronavirus in the host cell.” Calling for more trials…
If I had a wish list for clinical trials, it would also include non-pharmaceuticals like isatis, ginger, s. baicalensis, lumbrokinase, etc. Maybe someone will get around to it eventually, though it’s a can of worms until someone starts poking around in plant constituents in such a way as to make it profitable, i.e., plant constituent-turned-pharmaceutical, like what happened with artemisinin. And maybe some additional supplements like glutathione and various forms of electrolytes.
I’d add the BEMER electro magnetic therapy system to your list @evergreen5. Shown to increase microvascular circulation.
@3SailAway, @evergreen5 and @MomofJandL and others, thank you for the info and your thoughts in this thread. I agree with so many of the points you listed above @3SailAway but I didn’t want to bold your whole post, lol.
I’m also hoping for more of those studies where HCQ is given early and in combo with Zinc and/or Ivermectin. From what I gather, and correct me if I’m wrong, Zinc is an integral part in the use of HCQ to treat CV 19 as the HCQ helps to get the Zinc into the cell to disrupt viral replication. @3SailAway, wondering if you or your H has any insight into this thought.
Tamiflu is most effective if given within 48 hrs of the onset of flu symptoms. I would imagine the same would be true for HCQ not once patients are hospitalized and in dire straits. Also, the QT side effect that is being seen with HCQ in some of the hospital trials could be due to a heart that has already been compromised since we know the virus can affect the heart.
I work in Open Heart Surgery and we intubate/extubate, do bronchoscopies along with other lung procedures, use cautery and a sternal saw - just to name some of the aerosolizing procedures we are exposed to. It’s nerve-wracking, to be sure, and some docs and staff are not being as careful and respectful of this virus as they should.
I’m interested to see the results of prophylaxis HCQ with HCWs that you mentioned above @3SailAway. I worry about accidental exposure and am hoping for a protocol for HCWs and others, like AL patients and staff, for PREP (pre exposure prophylaxis) or PEP (post exposure prophylaxis) to stop this virus before the viral load gets too high and requires more complex treatment. This would require quick and accurate testing, contact tracing, and easy-to-acquire-and-administer oral drug therapies to keep patients out of the hospital setting to begin with.
@evergreen5 and @Nrdsb4, I didn’t see your posts before I posted mine earlier. Thank you for verifying the importance of Zinc with the early use of HCQ.
My H is high risk with multiple comorbidities (and we are both in our 50s) and with me working in OH Surgery, I am extremely worried about bringing the virus home to him. He would, I’m afraid, not fair very well.
I don’t dare go in our lunch room - too many people at once and not socially distancing at all and I don’t see where frequent cleaning of high touchpoints is being done in there. I also get frustrated with some of the impatient surgeons and anesthesiologists who at times will flout the hospital CV 19 guidelines to get out of doing things that is best and safe practice to save on time! Staff have on occasion either been naive to the risks or are worried about ramifications if they speak up.
I’m sure I’m not the only HCW who feels the way I do. That’s why prophylaxis and/or early treatment is so important for so many, not just HCWs but those we take care of, live with and encounter in our daily lives within our communities.