Coronavirus thread

[Wondering Beard]

Except the poster in question was "smelling horse shit" less on any ability to suss out errors in data collection and interpretation methods, but by vaguely implying a conspiracy in the medical-industrial complex to suppress HCL as a COVID-19 treatment. Right for the wrong reasons doesn't quite cut it.

Well: A mysterious company’s coronavirus papers in top medical journals may be unraveling

This part makes things look fishy:
"Surgisphere’s sparse online presence—the website doesn’t list any of its partner hospitals by name or identify its scientific advisory board, for example—have prompted intense skepticism. Physician and entrepreneur James Todaro of the investment fund Blocktown Capital wondered in a blog post why Surgisphere’s enormous database doesn’t appear to have been used in peer-reviewed research studies until May. Another post, from data scientist Peter Ellis of the management consulting firm Nous Group, questioned how LinkedIn could list only five Surgisphere employees—all but Desai apparently lacking a scientific or medical background—if the company really provides software to hundreds of hospitals to coordinate the collection of sensitive data from electronic health records. (This morning, the number of employees on LinkedIn had dropped to three.) And Chaccour wonders how such a tiny company was able to reach data-sharing agreements with hundreds of hospitals around the world that use many different languages and data recording systems, while adhering to the rules of 46 different countries on research ethics and data protection."


It may not at all be, for all I know, but when things get politicized (by everyone), it becomes harder to tell the good players from the bad.

[Wingate's Hairbrush]

Well: A mysterious company’s coronavirus papers in top medical journals may be unraveling

This part makes things look fishy:
"Surgisphere’s sparse online presence—the website doesn’t list any of its partner hospitals by name or identify its scientific advisory board, for example—have prompted intense skepticism. Physician and entrepreneur James Todaro of the investment fund Blocktown Capital wondered in a blog post why Surgisphere’s enormous database doesn’t appear to have been used in peer-reviewed research studies until May. Another post, from data scientist Peter Ellis of the management consulting firm Nous Group, questioned how LinkedIn could list only five Surgisphere employees—all but Desai apparently lacking a scientific or medical background—if the company really provides software to hundreds of hospitals to coordinate the collection of sensitive data from electronic health records. (This morning, the number of employees on LinkedIn had dropped to three.) And Chaccour wonders how such a tiny company was able to reach data-sharing agreements with hundreds of hospitals around the world that use many different languages and data recording systems, while adhering to the rules of 46 different countries on research ethics and data protection."


It may not at all be, for all I know, but when things get politicized (by everyone), it becomes harder to tell the good players from the bad.

Right on. But go back and look at the poster's complaint -- his takedown of the study has to do with the types of COVID-19 patients used in trials (specifically, severity of illness and presence of co-morbidities), and the previous use of HCL in treating other illnesses. This is one set of issues for which he had some good points (acknowledged by experts posting in the thread) and some points handicapped by a limited understanding of the subject matter.

But the point is, the issues becoming apparent in the HCL study aren't ones the poster was aware of or originally taking exception to, yet they're posted as evidence of his being correct.

Again, that's not how it works.

I'm mostly in agreement with Maple Syrup Actual's mountaineering analogy and a defense of the generally smart and perhaps informed layman's value in contributing, but at the end of the day, when it comes to serious technical matters, I'll take the experts; the race isn't always to the fastest, nor the battle to the strongest, but that's generally the way to bet.

[ccmdfd]

Climbing again.

We are now over the official limit previously set to cancel elective surgeries and go back into more of a lockdown. But absolutely no word from administration as to if any of that will happen.

I get the feeling that our nation's 6 second attention span has been reached and we're now focusing on other things (riots)

Oh, as to the topic of research.
People just need to take a chill pill. These things take time, and lots of it. Not saying results shouldn't be published, but it's going to be a while before we have solid answers.

[Nephrology]

Well: A mysterious company’s coronavirus papers in top medical journals may be unraveling

This part makes things look fishy:
"Surgisphere’s sparse online presence—the website doesn’t list any of its partner hospitals by name or identify its scientific advisory board, for example—have prompted intense skepticism. Physician and entrepreneur James Todaro of the investment fund Blocktown Capital wondered in a blog post why Surgisphere’s enormous database doesn’t appear to have been used in peer-reviewed research studies until May. Another post, from data scientist Peter Ellis of the management consulting firm Nous Group, questioned how LinkedIn could list only five Surgisphere employees—all but Desai apparently lacking a scientific or medical background—if the company really provides software to hundreds of hospitals to coordinate the collection of sensitive data from electronic health records. (This morning, the number of employees on LinkedIn had dropped to three.) And Chaccour wonders how such a tiny company was able to reach data-sharing agreements with hundreds of hospitals around the world that use many different languages and data recording systems, while adhering to the rules of 46 different countries on research ethics and data protection."


It may not at all be, for all I know, but when things get politicized (by everyone), it becomes harder to tell the good players from the bad.

The Surgisphere stuff isn't looking great. Seems likely to be the product of a bad actor looking to unscrupulously advance his career.

Still, in the big picture, this won't really matter. Like I said, the scientific community can be pivoted in one direction or the other by individuals and their work, but they never constitute the entire field - particularly one as active as the COVID research sphere.

To put this in perspective, dozens and dozens of other groups have put out their own articles examining HCQ in COVID-19 and reached fairly similar conclusions as the authors of the now-disputed Lancet publication: HCQ is not protective against severe COVID-19 infection, and confers a small but measurable risk of cardiac dysrhythmia. The degree of this risk is ultimately not that important, as if it does not work, there is no reason to use it, regardless of risk profile.

That said, we are still investigating to see if HCQ works. The ORCHID trials are ongoing, along with analogous trials for other putative antivirals (e.g. remdesivir) and 'anti inflammatory' drugs (e.g. toculizumab) designed to combat the theoretically harmful response of the immune system. These are prospective RCTs that will give us much more information than any of the countless retrospective studies to date.

Let's zoom out even further. It is important to keep in mind that all of the drugs we are currently studying were never designed with the intent to treat COVID-19. All of the drugs under investigation to date (not including vaccines) were originally designed for another disease, and urgently repurposed based on varying degrees of theoretical support for their use in COVID-19. At one point, we were (and may still be) trialling estrogen therapy. Think about that shit for a second.

Zooming out even further, the patients that most matter to us are those who are very sick with COVID-19. While it would be nice if we knew who would progress from mild to severe illness and to be able to prevent that, we are lightyears away from this possibility, presuming it is possible to begin with. I will remind the audience that we have a drug with a very specific and well understood ability to prevent influenza infection (Tamiflu). It does not work very well, in part because viruses are, in general, much more difficult to kill than bacteria or fungi, and this is reflected by our relatively poor armamentarium of anti-viral medications. Tens of thousands of Americans still die of influenza every single year, and we have been studying influenza for literally centuries.

Zooming out even further than that. For those patient with severe COVID-19, the clinical problem quickly becomes one of multi organ dysfunction. What began with the "simple" problem of viral infection is quickly multiplied by the effects of respiratory failure and hemodynamic volatility, and other organ systems begin to suffer the knock-on consequences of poor perfusion/oxygenation. Additionally, many of these COVID patients also develop clotting disorders and other extra-pulmonary issues, including renal failure. Now, even assuming we have a good antiviral (we don't), this disease has started a number of other fires that now require treatment as well. Plenty of people get secondary bacterial pneumonia and, even with appropriate antibiotic coverage, will die for this reason.

So, with that all in mind... the very best we can hope for is either a. an inexpensive and widely available drug with minimal side effects that prevents patients with COVID-19 from developing severe disease (see: "magical thinking") or b. a vaccine.

This is why I absolutely do not understand the lay interest in HCQ, as it happens to be one of the shittiest candidates in an already underwhelming pool of drugs that were hastily and desperately repurposed for COVID-19. It truly misses the forest for the trees in the worst possible way, and has created a deeply ignorant debate among the lay public that adds more noise to the already unbearable cacaphony of angry shrieks that seems to have drowned out productive civil discourse in this godforsaken country.

[Wondering Beard]

The Surgisphere stuff isn't looking great. Seems likely to be the product of a bad actor looking to unscrupulously advance his career.

Still, in the big picture, this won't really matter. Like I said, the scientific community can be pivoted in one direction or the other by individuals and their work, but they never constitute the entire field - particularly one as active as the COVID research sphere.

To put this in perspective, dozens and dozens of other groups have put out their own articles examining HCQ in COVID-19 and reached fairly similar conclusions as the authors of the now-disputed Lancet publication: HCQ is not protective against severe COVID-19 infection, and confers a small but measurable risk of cardiac dysrhythmia. The degree of this risk is ultimately not that important, as if it does not work, there is no reason to use it, regardless of risk profile.

That said, we are still investigating to see if HCQ works. The ORCHID trials are ongoing, along with analogous trials for other putative antivirals (e.g. remdesivir) and 'anti inflammatory' drugs (e.g. toculizumab) designed to combat the theoretically harmful response of the immune system. These are prospective RCTs that will give us much more information than any of the countless retrospective studies to date.

Let's zoom out even further. It is important to keep in mind that all of the drugs we are currently studying were never designed with the intent to treat COVID-19. All of the drugs under investigation to date (not including vaccines) were originally designed for another disease, and urgently repurposed based on varying degrees of theoretical support for their use in COVID-19. At one point, we were (and may still be) trialling estrogen therapy. Think about that shit for a second.

Zooming out even further, the patients that most matter to us are those who are very sick with COVID-19. While it would be nice if we knew who would progress from mild to severe illness and to be able to prevent that, we are lightyears away from this possibility, presuming it is possible to begin with. I will remind the audience that we have a drug with a very specific and well understood ability to prevent influenza infection (Tamiflu). It does not work very well, in part because viruses are, in general, much more difficult to kill than bacteria or fungi, and this is reflected by our relatively poor armamentarium of anti-viral medications. Tens of thousands of Americans still die of influenza every single year, and we have been studying influenza for literally centuries.

Zooming out even further. For those patient with severe COVID-19, the clinical problem quickly becomes one of multi organ dysfunction. What began with the "simple" problem of viral infection is quickly multiplied by the effects of poor oxygenation and hemodynamic volatility, and other organ systems begin to suffer the knock-on consequences of respiratory failure. Additionally, many of these COVID patients also develop clotting disorders and other extra-pulmonary issues, including renal failure. Now, even assuming we have a good antiviral (we don't), this disease has started a number of other fires that now require treatment as well.

Zooming out even further than that. Big epidemiological picture. Even IF we can develop a good antiviral agent that reduces the severity of COVID-19 infection, this is effectively shutting the barn door once the horses are out. By the time you develop symptoms, you basically have two way to go: either mild symptoms with recovery at home (most people) or you get really sick and need hospitalization. By the time you've been admitted to the ICU, you are already in rough shape, and the very most you can hope for is survival without permanent deficit. For all the reasons described above, this will almost certainly never be something we can guarantee.

So, with that all in mind... the very best we can hope for is either a. an inexpensive and widely available drug with minimal side effects that prevents patients with COVID-19 from developing severe disease (see: "magical thinking") or b. a vaccine.

This is why I absolutely do not understand the lay interest in HCQ, as it happens to be one of the shittiest candidates in an already underwhelming pool of drugs that were hastily and desperately repurposed for COVID-19. It truly misses the forest for the trees in the worst possible way, and has created a deeply ignorant debate among the lay public that adds more noise to the already unbearable cacaphony of angry shrieks that seems to have drowned out productive civil discourse in this godforsaken country.

I'm in no position to discuss the validity of this or that medication for the treatment of COVID-19, but I think I can answer, at least a piece, of your last paragraph.

Wanting a magic bullet is natural, especially, when we, the lay public, have both no understanding of how complex that aspect of medicine is, and have a cultural impression (no doubt heavily influenced by movies, and the like and amplified by an equally ignorant media) that doctors and researchers can always whip up a cure in time. There is more trust than understanding about medicine and bio research in the public at large.

Add to that when a president (it doesn't matter who it is) says that this drug could be a very good drug and touts it, then the level of interest in that drug becomes much higher.

When President Trump is the one touting HCQ, with the much of the media responding to anything he does (rightly or wrongly -I'm not making a point about who is wrong, only observing the pattern) with pavlovian negativity, then we have a set up for for medical research to be, at least, perceived as skewed (it doesn't matter whether its for or against HCQ) and to have "important people" (i.e. blowhards of all political outlooks and quite a few scammers) who get to spout ignorance at an uncomprehending and increasingly frustrated public. This in turn probably heavily influences the amount of studies that are going to be made about HCQ because that's all anyone talks about, as well as have everyone suspicious of those same studies if they don't fall into the proper narrative (of any side).

I have no idea if Surgisphere is just an incompetent organization, a bad actor, or even a group paid to be a bad actor (when you live near DC, paranoia about such things is the norm. Hell I'd say it's the culture), but sloppy science (as this is what the original Lancet article appears to have been -though I could be wrong) makes it even harder, I imagine, to do proper science.

[Wondering Beard]

Right on. But go back and look at the poster's complaint -- his takedown of the study has to do with the types of COVID-19 patients used in trials (specifically, severity of illness and presence of co-morbidities), and the previous use of HCL in treating other illnesses. This is one set of issues for which he had some good points (acknowledged by experts posting in the thread) and some points handicapped by a limited understanding of the subject matter.

But the point is, the issues becoming apparent in the HCL study aren't ones the poster was aware of or originally taking exception to, yet they're posted as evidence of his being correct.

Again, that's not how it works.

I'm mostly in agreement with Maple Syrup Actual's mountaineering analogy and a defense of the generally smart and perhaps informed layman's value in contributing, but at the end of the day, when it comes to serious technical matters, I'll take the experts; the race isn't always to the fastest, nor the battle to the strongest, but that's generally the way to bet.

I wasn't making a comment about what the poster was stating or even implying. I actually don't even remember what he posted or who it was. Only that this is looking more fishy than innocent sloppy science and it sure doesn't help anything or anyone.

The sad thing is that too many people touted as experts (and whom we see on TV every night and write articles in the media) actually aren't at all but rather tend to be people who made to the top of their organizations in the same way that too many police chiefs did. That has created a mistrust in true expertise that will take a long time to overcome.

[UNM1136]

Really pissed. ED staff calls 911 for a shithead theatening their staff, and I roll up with my face covering as per State .gov orders, and medical students are gonna stop me at the door to take my temp. Bet their tune will be different when their asses are on the line. Now, it didn't take long, but they were all diplomatic, explaining the process and why it was important. But what if the delay meant something? A coworker getting hurt. Something like that. Then I took too long to get there. And this shithead was a valid, violent patient that needed me to remove him.

One hand doesn't know what the other is doing.

pat

[RoyGBiv]

Really pissed. ED staff calls 911 for a shithead theatening their staff, and I roll up with my face covering as per State .gov orders, and medical students are gonna stop me at the door to take my temp. Bet their tune will be different when their asses are on the line. Now, it didn't take long, but they were all diplomatic, explaining the process and why it was important. But what if the delay meant something? A coworker getting hurt. Something like that. Then I took too long to get there. And this shithead was a valid, violent patient that needed me to remove him.

One hand doesn't know what the other is doing.

pat

Process before priorities.

Did the patient sign a HIPAA form before the staff spoke to 911? Tisk, tisk.

[UNM1136]

Process before priorities.

Did the patient sign a HIPAA form before the staff spoke to 911? Tisk, tisk.

Exactly.

pat

[Nephrology]

Really pissed. ED staff calls 911 for a shithead theatening their staff, and I roll up with my face covering as per State .gov orders, and medical students are gonna stop me at the door to take my temp. Bet their tune will be different when their asses are on the line. Now, it didn't take long, but they were all diplomatic, explaining the process and why it was important. But what if the delay meant something? A coworker getting hurt. Something like that. Then I took too long to get there. And this shithead was a valid, violent patient that needed me to remove him.

One hand doesn't know what the other is doing.

pat

Lol, you should always expect medical students to have no idea what they are doing

They're at the bottom of a big scary totem poll where shit doesn't just roll down hill, it is fired out of a cannon.

I'd say their attending owns at least 50% of this for giving them rigid instructions without specific exceptions. The other 50% is on the medical students for having zero fucking common sense, which often goes out the window when you are scared of making your attending mad. I've been that guy countless times in my life.

edit: for what it's worth, if this happens in the future, you can always say something to the effect of "I know you mean well, but I have to respond to an emergency. If I am late because you stopped me I will be certain to inform your supervisor." Guarantee they will disappear like Houdini before you can finish the sentence.