Total lack of attention to treatments

[MikeWM]

It seems there are three tools you can use when faced with an epidemic.

1. Stopping people catching the disease and passing it on to others.
2. Stopping people who have caught the disease from becoming seriously ill.
3. Stopping people who have caught the disease and have become seriously ill from dying.

In this case, we've gone to absolutely extraordinary and unprecedented lengths to try to achieve point 1. We've also made good progress in finding effective treatments for point 3. But we seem to have almost entirely ignored point 2. If you catch Covid, it seems the advice hasn't moved on from 'take some paracetamol and stay at home, and if you get terribly ill then call 111 or an ambulance and we'll work out if you're sufficiently ill enough to go to hospital'.

Does this seem really odd to anyone else?


We currently have at least three potential treatments which all look to have positive effects:


- Vitamin D - the evidence for this being helpful appeared clear very early on; sufficiently so that I've been taking a supplement since April. I've no idea why this wasn't tried earlier across the population - there's effectively zero risk, and a lot to gain if it does help.

- Ivermectin - people have been talking about this for months, and the results appear really positive, eg. see here or here, or here from all the way back last March.

- Hydroxychloroquine - perhaps alone on here, I've been convinced for some months that HCQ is a potentially good option too - of the two studies that 'discredited' it, one was outright fraudulent and the other was conducted using the wrong dose at the wrong time, and of course Donald Trump promoting it wasn't helpful. But there are many other studies that have shown a good effect - eg. see here, and here for a group of 'top' UK scientists who believe it was dismissed prematurely.


Now perhaps none of these actually do any good, or enough good to be worth putting too much effort into. But people have been mentioning them for 10 months now, and we don't have conclusive answers - though in all cases, the balance of evidence would appear to be that they have a positive effect. Shouldn't we know whether they are effective or not by this point? If any of them are, the effect on healthcare capacity (and serious injury and death) could be transformative.

It appears that vast amounts of effort and money have gone into vaccine development as the 'only option' to deal with the issue, with even vaster costs (both financial and human) incurred in ever-more-desperate attempts at trying to limit transmission until the vaccines are rolled out. Treatments have been almost entirely overlooked by comparison. Why? Does this make sense?

 

[Domh245]

It appears that vast amounts of effort and money have gone into vaccine development as the 'only option' to deal with the issue, with even vaster costs (both financial and human) incurred in ever-more-desperate attempts at trying to limit transmission until the vaccines are rolled out. Treatments have been almost entirely overlooked by comparison. Why? Does this make sense?

I suppose that vaccines may be quicker and easier to develop and bring to market than a new treatment. Whereas vaccine creation is 'simple' in that all you have to do is replicate the virus' signature in a safe format and then let the patient's immune system do the heavy lifting on how to deal with it, developing a treatment would involve having to understand what the virus effects inside the body, and how to best treat it which I would think requires far more research and development than the vaccines. After all, SARS-CoV-2 was first sequenced a year ago which provided an awful lot of the information needed to begin vaccine development (*so said one of the oxford researchers on the One Show last week), medically however we still knew comparatively little about it (and arguably still do!)

On that note though, there has been some success in trialling existing treatments on Covid patients with quite a good level of success at times (eg)

 

[Cdd89]

I’m never sure what to make of the HCQ stuff other than to note that the same arguments for masks (no evidence that they cause harm, may have a possible beneficial impact) are the inverse of the ones used to discredit HCQ (no evidence that they provide benefit, may have a possible negative impact) despite there being fairly weak evidence in either direction for both.

I’m tempted to go along with the “HCQ isn't worth it” line simply because if it were really any good the evidence would be more than marginal; but try applying that logic to masks and you’ll have people popping up telling you to have more faith...

 

[brad465]

This maybe drifting into conspiracy theory territory, but I wonder if there isn't so much money in point 2, but there is a lot in making and distributing a vaccine and loads of medical products that have to be mass produced (such as face coverings and hand cleaning products).

 

[takno]

I think the short answer is probably that we haven't had a lot of time to trial many drugs, and the earlier the stage of the illness a drug targets the harder it is to test. It's easier to clear ethics hurdles, and to find patients for last-throw-of-the-dice tests, and because the patient is usually in a hospital and hooked up to a lot of monitoring equipment you can get a lot of interesting data. For earlier interventions you tend to end up testing 1000s of people who had a bit of a cough, and if not many of them go on to get seriously ill then you are pretty much left haplessly asking questions about whether they feel better. Hydroxychloroquine in particular isn't nice stuff, and there are good reasons to question whether you want to feed it to well people in the name of science.

If we hadn't had a reasonable degree of confidence that we had techniques for producing a vaccine, then the case for doing lots of tests on this kind of thing would have been better. We would probably also have been keener to get some answers if we'd taken a harder line against turning entire health service into a Corona Treatment Service to start with. If you decide on day one that these people must be treated in hospital whatever the consequences, then will just end up prioritising whatever will keep your ICU turning over at the fastest speed.

 

[Class 317]

Their has been some movement on vitamin d which is now more widely recommended and free supplements have been made available to care home residents and some older people.

I believe it's also become a well used treatment on hospital patients as a no harm treatment in higher doses.

I know some countries give free supplements to care home residents in normal times.

 

[Yew]

Their has been some movement on vitamin d which is now more widely recommended and free supplements have been made available to care home residents and some older people.

I believe it's also become a well used treatment on hospital patients as a no harm treatment in higher doses.

I know some countries give free supplements to care home residents in normal times.

Indeed, lots of us in the UK are probably deficient anyway, especially in the winter.

Hydroxychloroquine in particular isn't nice stuff, and there are good reasons to question whether you want to feed it to well people in the name of science.

It's not particularly nice, but it is generally safe as phophylaxis (against malaria, in the right areas of the world) in the medium term; and coupled with the high risk in some demographics, it'd certainly be interesting to do a study in it's role in protecting against Covid in the early stages, rather than as a treatment

 

[MikeWM]

I suppose that vaccines may be quicker and easier to develop and bring to market than a new treatment.

That is probably true nowadays, yes, but I'm querying why we don't know more about the effect of *existing* medicines.

I’m never sure what to make of the HCQ stuff other than to note that the same arguments for masks (no evidence that they cause harm, may have a possible beneficial impact) are the inverse of the ones used to discredit HCQ (no evidence that they provide benefit, may have a possible negative impact) despite there being fairly weak evidence in either direction for both.

When you dig into it, the evidence in favour of HCQ being helpful - to at least some degree - is *significantly* more substantive than for masks, in my opinion. Same for ivermectin - probably even more so. They don't get the same degree of publicity though - one may wonder why.

This maybe drifting into conspiracy theory territory, but I wonder if there isn't so much money in point 2, but there is a lot in making and distributing a vaccine and loads of medical products that have to be mass produced (such as face coverings and hand cleaning products).

If you look at the people promoting trying existing medicines as treatments, they're not going to make any money out of it, indeed many have lost their jobs and incomes for standing up against a 'consensus'. They seem to truly believe that they can save lives, and that appears to be what is driving them (as you would hope drives all medical professionals). They seem brave, principled people to me.

Conversely, the people promoting vaccines tend to be those who will make a lot of money from them - probably on an ongoing basis, as it seems unlikely vaccination for covid will be a one-time thing.

I don't think it is a conspiracy theory to point that out, or consider the possible implications of that.

Hydroxychloroquine in particular isn't nice stuff, and there are good reasons to question whether you want to feed it to well people in the name of science.

But surely that same argument applies (more so) to experimental mRNA vaccines? We don't seem to be voicing the same reservations about that (and/or those who do voice reservations are called 'anti-vax' or 'anti-science').

There's a lot of people that take HCQ short-term, and many others longer-term. We know who can safely take it, and the side-effects.

And (except in the very rare cases where people die) if people have a bad reaction to a medicine, they can stop taking it, and the bad effects usually stop. That's a lot more difficult with a vaccine.

Their has been some movement on vitamin d which is now more widely recommended and free supplements have been made available to care home residents and some older people.

Yes - but why didn't we do this 9 months ago? There is no downside with vitamin D, it is almost impossible to overdose on it, so why not try it? As I said, I found the evidence convincing very early on, and I'm sure people in government were seeing it too.

Indeed, lots of us in the UK are probably deficient anyway, especially in the winter.

And we were ordered to stay inside during the (sunniest ever!) spring, which will have added to D deficiency!

 

[Yew]

Yes - but why didn't we do this 9 months ago? There is no downside with vitamin D, it is almost impossible to overdose on it, so why not try it? As I said, I found the evidence convincing very early on, and I'm sure people in government were seeing it too.

Because there are regulations covering drug usage, but non concerning non-pharmaceutical interventions; so all scientific principles of medicine and public health have been abandoned in favour of faith and memes.

 

[kristiang85]

I've read quite a bit about Ivermectin, which looks very positive. There seems to be a movement from various scientists to get the British goverment to use it in treatment; a press release summary can be found here: https://b3d2650e-e929-4448-a527-4ee...d/593c4f_dd211f8ce1a5493eacc37aa0824d82a4.pdf

The evidence from six randomized controlled trials suggests that using ivermectin to prevent or treat
COVID-19 reduces deaths by an average of 83% (somewhere between 67% to 92%) compared with no
ivermectin treatment. For people being treated for COVID-19 in hospital, the risk of death was 1.3% for
people in the ivermectin group compared with 8.3% among those in the control group. The findings were
assessed as being of moderate certainty as some of the included studies were at moderate risk of bias.
Following Dr. Lawrie’s presentation, participants discussed the findings, and shared their observations and
experiences as clinicians on the front line of the battle against COVID-19, in the USA and in the UK. Several
of the American clinicians are part of Front Line COVID-19 Critical Care Alliance (FLCCC), which earlier on in
the pandemic reviewed the evidence on the effects of ivermectin on SARS-CoV-2 virus and COVID-19
infections. They concluded that the evidence on ivermectin “demonstrates a strong signal of therapeutic
efficacy” and recommended that ivermectin is adopted globally and systematically for the prophylaxis and
treatment of COVID-19.
Given the urgency of the situation, as the daily death toll rises, the question arises: Why is Ivermectin not
yet widely prescribed by UK GPs as a preventative measure, and used by hospital clinicians to treat those
hospitalized? Compelling evidence exists as shown by Dr Lawrie’s and the FLCCC’s reviews, and clinicians in
many countries are using Ivermectin, and have reported on the positive results they’ve observed. To think
that with every day that passes the death toll of this pandemic grows, when an effective treatment might
have, all along, been right under our noses.

 

[ainsworth74]

Surely the main issue with HCQ, whether or not it's good/bad for you as an individual taking it, is that we risk causing shortages of it for people who definitely do need it and definitely do get some significant benefit from it? I recall reading earlier in the pandemic, for instance, that people who use it to help control their Lupus were finding it harder to get hold of (or in somewhere like the US more expensive to get hold of). If you ramp up production of HCQ to avoid those issues does that then not take away productive capacity from other medications with potential ripple effects in the supply chain? All in order to give people a medication that we don't actually know if it does any good anyway in regards of Covid-19?

I'm quite happy that we shouldn't just ditch looking into something because Trump said it was good therefore it must be bad or because a couple of studies but equally I'm not sure it's wise to go whole hog on something that we don't know if it actually helps and there are potential downsides if we mess with the supply of HCQ for those who definitely do need it.

 

[MikeWM]

Surely the main issue with HCQ, whether or not it's good/bad for you as an individual taking it, is that we risk causing shortages of it for people who definitely do need it and definitely do get some significant benefit from it? I recall reading earlier in the pandemic, for instance, that people who use it to help control their Lupus were finding it harder to get hold of (or in somewhere like the US more expensive to get hold of). If you ramp up production of HCQ to avoid those issues does that then not take away productive capacity from other medications with potential ripple effects in the supply chain?

Is it that difficult to manufacture? Could we not ramp up manufacturing if it may be useful? Seems that would be easier and more efficient to try than a lot of the actions that we *are* taking.

All in order to give people a medication that we don't actually know if it does any good anyway in regards of Covid-19?

I think there is sufficient evidence at this point to say that it does help.

This is an interesting resource that summarises the current studies on HCQ, Vitamin D, Ivermectin, and others including remdesivir, with links to all the studies:

https://c19study.com/

I don't know if there is any cherry-picking going on in the selection of studies, but those listed there show a very positive effect from early treatment with HCQ and an even more positive effect from early and/or prophylactic treatment with ivermectin.

 

[cuccir]

I think the short answer is probably that we haven't had a lot of time to trial many drugs, and the earlier the stage of the illness a drug targets the harder it is to test. It's easier to clear ethics hurdles, and to find patients for last-throw-of-the-dice tests, and because the patient is usually in a hospital and hooked up to a lot of monitoring equipment you can get a lot of interesting data. For earlier interventions you tend to end up testing 1000s of people who had a bit of a cough, and if not many of them go on to get seriously ill then you are pretty much left haplessly asking questions about whether they feel better. Hydroxychloroquine in particular isn't nice stuff, and there are good reasons to question whether you want to feed it to well people in the name of science.

I suspect that this hits the nail on the head. The practicalities and ethics of testing a treatment on people with mild symptoms, when those symptoms (a) look like those of a lot of other illnesses and (b) often don't require other treatments is probably the main reason for this stage of treatment getting much less attention than in-hospital treatment.

 

[Phil R]

It seems there are three tools you can use when faced with an epidemic.

1. Stopping people catching the disease and passing it on to others.
2. Stopping people who have caught the disease from becoming seriously ill.
3. Stopping people who have caught the disease and have become seriously ill from dying.

Arguably 1 could be split in two discrete parts:
1a - stopping people catching the disesase
and
1b - stopping people passing it on to others

Since separate actions can be taken to try to avoid each.

The Vitamin D point is one that has frustrated me for a long time, given the reasonable amount of evidence there is for it as being a support for the immune system. The Spanish and Indian studies for two give good support that it's worth a bash. Yet the medical profession still seem to be stuck in 1970s 'O' Level texts and think it's only good for bones and rickets, whilst any recommendations are for very low doses (400 IU), which probably don't help much. The medical industry does seem geared to cure rather than prevention. Meanwhile we are all being locked down and having to wear masks with little evidence that those do any net good, although the former may at last be serving a useful purpose as a postponement tool with the vaccines riding to the rescue.

David Davies MP is a long term supporter of Vitamin D and has been active on the subject recently, in parliament last Thursday:

and this lengthy but worth watching interview this week:

Phil (4000 IUs a day)

 

[Class 317]

Not sure if people count this as a treatment but driving tonight listening to five live they had a report about a study into providing those who are more vulnerable to Covid and have tested positive for Covid a £20 oximeter that measures blood oxygen levels.

The gist of what he was saying is that by making an early intervention when Oxygen levels drop a little it reduces severe hospital cases and also the length of hospital stays.

Seems to me to be a very low cost intervention worth rolling out.

 

[takno]

Not sure if people count this as a treatment but driving tonight listening to five live they had a report about a study into providing those who are more vulnerable to Covid and have tested positive for Covid a £20 oximeter that measures blood oxygen levels.

The gist of what he was saying is that by making an early intervention when Oxygen levels drop a little it reduces severe hospital cases and also the length of hospital stays.

Seems to me to be a very low cost intervention worth rolling out.

I've had one for a few years - they seem like a pretty obvious thing to include in a basic household first aid kit. In terms of Covid though I was seeing them as a good way for people reassure themselves that aren't particularly sick and better look after themselves at home. The idea that they'd be used to bring even more people into the hospital system even earlier doesn't seem all that helpful to me.

 

[MikeWM]

David Davies MP is a long term supporter of Vitamin D and has been active on the subject recently, in parliament last Thursday:

I see he asked the PM about ivermectin on Wednesday, too. Good!

I still don't begin to understand why we have known about these things being potentially very effective for many months but have done nothing useful with them. I hope the eventual explanation is rather better than 'big pharma won't make any money out of them, so they push far more expensive treatments and vaccines instead', but I'm really struggling to see other reasons that make sense.

 

[ainsworth74]

I've had one for a few years - they seem like a pretty obvious thing to include in a basic household first aid kit. In terms of Covid though I was seeing them as a good way for people reassure themselves that aren't particularly sick and better look after themselves at home. The idea that they'd be used to bring even more people into the hospital system even earlier doesn't seem all that helpful to me.

I'm not sure it's about carting them off to hospital immediately but getting people who might have a problem in contact with the health service more quickly than otherwise might be the case. There's a fair bit of documentation on the NHS page here (focused on primary and community care settings). They suggest if it's 92% or less you retest yourself immediately and if it's still 92% or lower then you should ring 999 or attend A&E immediately. If it's 93% or 94% you should recheck yourself after an hour and then ring 111 or your GP for advice and assistance if it hasn't improved. Equally it can provide reassurance to people who might think they have a problem that they probably don't so avoid them clogging up the health service.

Seems a fairly sensible measure to me overall!