Coronavirus treatment options and the impact on public policy

Today marks the introduction of treatment options in the fight against covid -19 with the preliminary announcement by Dr. Fauci about remdesivir. Other treatment options available soon may also include convalescent plasma and there will be announcements on this soon too. There are a couple of other repurposed drugs that also show promise and these are being evaluated as well. The tool kit of treatment options available to doctors will continue to grow, as will their use. Hopefully by the end of summer these treatments used alone or in combination can help even the most severe cases to recover. If we can drive down the mortality rate and hospital resource requirements, we can open up the economy more. If these treatments are used with testing, limited contact tracing and appropriate NPI's, they offer a way forward, even to ethical herd immunity, if we can keep mortality rates low enough while doing it.
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NYT: FDA plans to issue emergency authorization for remdesivir


Fauci expresses optimism about 'significant, positive' data from a trial of the possible Covid-19 treatment remdesivir

(CNN)New data suggests patients with severe Covid-19 who took remdesivir could recover faster than patients who didn't take it, the National Institute of Allergy and Infectious Diseases said Wednesday.

"The data shows that remdesivir has a clear-cut, significant, positive effect in diminishing the time to recovery," said the institute's director, Dr. Anthony Fauci.
Results from the preliminary trial show remdesivir improved recovery time for coronavirus patients from 15 to 11 days.
"Although a 31% improvement doesn't seem like a knockout 100%, it is very important proof of concept," Fauci said. "What it has proven is that a drug can block this virus."
"Results also suggested a survival benefit, with a mortality rate of 8.0% for the group receiving remdesivir versus 11.6% for the placebo group," the NIAID said.

Normally, data about a drug's efficacy wouldn't be released this early from a preliminary trial.
But "whenever you have clear-cut evidence that a drug works, you have an ethical obligation to immediately let the people in the placebo group know so that they can have access," Fauci said.
The US Food and Drug Administration has not yet approved any drugs for the treatment of the coronavirus.
But the FDA plans to announce an emergency-use authorization for remdesivir, according to The New York Times. The authorization could come as soon as Wednesday, the Times reported, citing a senior administration official.

n a statement to CNN, the FDA said it is in talks with Gilead Sciences, the maker of remdesivir, about making the drug available to patients.
"As part of the FDA's commitment to expediting the development and availability of potential COVID-19 treatments, the agency has been engaged in ... discussions with Gilead Sciences regarding making remdesivir available to patients as quickly as possible, as appropriate," FDA spokesman Michael Felberbaum said in statement.
Track coronavirus cases and deaths in each state and across the US
The remdesivir trial marks the first clinical trial launched in the US to evaluate an experimental treatment for Covid-19.
About 1,090 people participated in the trial internationally, Fauci said, calling it "the first truly high-powered randomized placebo controlled trial."
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Fauci: Remdesivir Trial Is 'Opening The Door' To Possible Coronavirus Treatments | MSNBC

Dr. Anthony Fauci discussed the positive results for a drug trial on remdesivir, claiming the results were "opening the door" to possible coronavirus treatments. Aired on 4/29/2020.

I was hoping this thread would be advice on a wine that pairs well with clorox and uv light bulbs

srh88 said:

I was hoping this thread would be advice on a wine that pairs well with clorox and uv light bulbs

Click to expand...

Hydroxychloroquine and Clorox are a popular mix among the right, a dash of Lysol gives a little zest to the cocktail. I hear they call it the Dead Duck Donald, or D3 for short.

Meanwhile the struggle at the White House continues as the staff continue to try and remove Donald's head from his asshole

Dr Fauci seemed quite happy with the remdesivir preliminary report and there appears to be more optimistic news yet to be released on this trial. Hey, if little Tony is happy da boss Fat Donnie will roll out the medicine show! Now if they could talk the dumb bastard into testing and contact tracing, ya might have a fucking plan for recovery! Finally a glimmer of hope and more on the way in may with convalescent plasma therapy, we hope! Freeing up hospital resources and knocking down the mortality rate from .5% (best data I could find) to something a lot lower, would make reopening the economy much easier.

The debate might begin to shift to what is an acceptable mortality rate? If these treatments could drive the mortality rate down to flu like levels, could we treat it like the flu? These two treatments alone hold out the possibility of driving the mortality rate down to a fraction of what it currently is. We will still need to do testing, contact tracing and NPs though, as well as ban mass events, but we might be able to move towards herd immunity in an ethical way while protecting the vulnerable.

That's the point of this thread, a lot of people will be looking at the implications of these treatment options and how they pertain to public policy, mathematical models are being built or modified to take these factors into account. Over the next several months other studies will be released on these treatments and more that are in the pipeline now and several of these are very promising too. Treatments might become an option to protect the most vulnerable as we move forward in a ethical way, herd immunity is achieved at around 70% of the population and we have a very long way to go to achieve that, though in NYC some studies say they are at around 25% now.

If Tony is happy I'm happy...

This new treatment is good news. Just keep in mind that in 8 of the last 8 pandemics (since 1850), the 2nd and 3rd wave killed more than the first wave. On average the 2nd wave is about 6 months after the first, so we are going to need some good news this fall.

injinji said:

This new treatment is good news. Just keep in mind that in 8 of the last 8 pandemics (since 1850), the 2nd and 3rd wave killed more than the first wave. On average the 2nd wave is about 6 months after the first, so we are going to need some good news this fall.

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Medical science has done very well in the few months they've had to confront the challenge, fortunately there are drugs already developed to treat viral infections that can be repurposed. They will whittle down the mortality rate over the coming months with treatments and nursing protocols, this is just the thin edge of the wedge that is being driven into this problem. We still need testing, contact tracing, isolation and NPIs (Non Pharmaceutical Interventions) too, but to control the contagion as we open the economy and work towards herd immunity and a vaccine. Treatments will be a big part of the mix in getting the economy up and running, folks can tolerate getting sick, but not being fucked for life or dying. The people will decide when its safe to come out and if this thing is no more dangerous than the flu (with treatments) they will crawl out of their hiding places and buy shit!

DIY-HP-LED said:

Dr Fauci seemed quite happy with the remdesivir preliminary report and there appears to be more optimistic news yet to be released on this trial. Hey, if little Tony is happy da boss Fat Donnie will roll out the medicine show! Now if they could talk the dumb bastard into testing and contact tracing, ya might have a fucking plan for recovery! Finally a glimmer of hope and more on the way in may with convalescent plasma, we hope! Freeing up hospital resources and knocking down the mortality rate from .5% (best data I could find) to something a lot lower, would make reopening the economy much easier.

The debate might begin to shift to what is an acceptable mortality rate? If these treatments could drive the mortality rate down to flu like levels, could we treat it like the flu? These two treatments alone hold out the possibility of driving the mortality rate down to a fraction of what it currently is. We will still need to do testing, contact tracing and NPs though, as well as ban mass events, but we might be able to move towards herd immunity in an ethical way while protecting the vulnerable.

That's the point of this thread, a lot of people will be looking at the implications of these treatment options and how they pertain to public policy, mathematical models are being built or modified to take these factors into account. Over the next several months other studies will be released on these treatments and more that are in the pipeline now and several of these are very promising too. Treatments might become an option to protect the most vulnerable as we move forward in a ethical way, herd immunity is achieved at around 70% of the population and we have a very long way to go to achieve that, though in NYC some studies say they are at around 25% now.

If Tony is happy I'm happy...

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It's been a few days, but a dude who wrote a couple of non-fiction books on the subject was on NPR last week. His prediction is the death rate is really 0.5%, but the lack of testing is keeping us from finding all the folks who don't know they have it. I looked back and couldn't figure out his name. But here is another writer who stumbled on a hit in the making.

injinji said:

It's been a few days, but a dude who wrote a couple of non-fiction books on the subject was on NPR last week. His prediction is the death rate is really 0.5%, but the lack of testing is keeping us from finding all the folks who don't know they have it. I looked back and couldn't figure out his name. But here is another writer who stumbled on a hit in the making.

This Is 'Creepy': Lawrence Wright Wishes His Pandemic Novel Had Gotten It Wrong

The End of October is about a mysterious virus that starts in Asia, sweeps across continents, cripples the health care system, wrecks the economy, and kills people worldwide.

www.npr.org

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It appears the R0 went from R0=7 to R0=1 after people were confined to their cabins and avoided direct contact, the ship's AC/ventilation system did not appear to spread the contagion either. NPIs worked spectacularly well in this petri dish of a situation and dropped the infection rate like a stone, so it's all about social discipline, distancing and enforcement.

Also multiply deaths by X20 to get a reasonable estimate of the true number of cases:

"The group also estimates that the infection fatality rate (IFR) in China — the proportion of all infections, including asymptomatic ones, that result in death — is even lower, at roughly 0.5%. The IFR is especially tricky to calculate in the population, because some deaths go undetected if the person didn’t show symptoms or get tested".
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What the cruise-ship outbreaks reveal about COVID-19
Close confines help the virus to spread, but closed environments are also an ideal place to study how the new coronavirus behaves.
www.nature.com

nature
NEWS
26 MARCH 2020

What the cruise-ship outbreaks reveal about COVID-19
Close confines help the virus to spread, but closed environments are also an ideal place to study how the new coronavirus behaves.

When COVID-19 was detected among passengers on the cruise ship Diamond Princess, the vessel offered a rare opportunity to understand features of the new coronavirus that are hard to investigate in the wider population. Some of the first studies from the ship — where some 700 people were infected — have revealed how easily the virus spreads, provided estimates of the disease’s severity and allowed researchers to investigate the share of infections with no symptoms.

Information gleaned from such outbreaks is crucial for people making decisions on how to manage the epidemic, say researchers.

“Cruise ships are like an ideal experiment of a closed population. You know exactly who is there and at risk and you can measure everyone,” says John Ioannidis, an epidemiologist at Stanford University in California. This is very different from trying to study the spread in a wider population, where only some people, typically those with severe symptoms, are tested and monitored.

Diamond Princess
On 1 February, a passenger who had disembarked from the Diamond Princess days earlier in Hong Kong tested positive for the COVID-19 coronavirus. The ship was quarantined immediately after it arrived in Japanese waters on 3 February, with 3,711 passengers and crew members on board. Over the next month, more than 700 people on board were infected — including a nurse — and for weeks the ship was the site of the largest outbreak outside China.

Outbreaks seed easily on the vessels because of the close confines and high proportions of older people who tend to be more vulnerable to the disease. Since the Diamond Princess, at least 25 other cruise ships have confirmed COVID-19 cases — including 78 cases on the Grand Princess, which was quarantined off the coast of California. Returned passengers have also seeded outbreaks in countries including the United States.

Japanese officials performed more than 3,000 tests on the Diamond Princess, starting with older passengers and those with symptoms. Some passengers were tested more than once, offering insight into the virus’s spread over time. Testing almost all of the passengers and crew helped researchers to understand a key blind spot in many infectious-disease outbreaks — how many people are actually infected, including those who have mild symptoms or none at all. These cases often go undetected in the general population.

Using the Diamond Princess data, a team reports in Eurosurveillance1 that by 20 February, 18% of all infected people on the ship had no symptoms. “That is a substantial number,” says co-author Gerardo Chowell, a mathematical epidemiologist at Georgia State University in Atlanta. But the passengers included a large number of elderly people, who are most likely to develop severe disease if infected, so the share of asymptomatic people in the general population is likely to be higher, he says.

Disease severity
Another team used data from the ship to estimate2 that the proportion of deaths among confirmed cases in China, the case fatality rate (CFR), was around 1.1% — much lower than the 3.8% estimated by the World Health Organization (WHO).

The WHO simply divided China’s total number of deaths by the total number of confirmed infections, says Timothy Russell, a mathematical epidemiologist at the London School of Hygiene and Tropical Medicine. That method does not take into account that only a fraction of infected people are actually tested, and so it makes the disease seem more deadly than it is, he says.

By contrast, Russell and his colleagues used data from the ship — where almost everyone was tested, and all seven deaths recorded — and combined it with more than 72,000 confirmed cases in China, making their CFR estimate more robust. The results have been posted on the biomedical preprint server medRxiv, and have not been peer-reviewed yet.

The group also estimates that the infection fatality rate (IFR) in China — the proportion of all infections, including asymptomatic ones, that result in death — is even lower, at roughly 0.5%. The IFR is especially tricky to calculate in the population, because some deaths go undetected if the person didn’t show symptoms or get tested.
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Play with the parameters to see what will happen if NPIs (Non Pharmaceutical Interventions) and social restrictions are eased, run the simulation for yourself. Wanna see if lock downs work?


The Coronavirus Disease 2019 Simulator (COVID-19 Simulator) is a tool to help policy makers decide how to respond to the novel coronavirus pandemic. The tool evaluates the impact of different social-distancing interventions (by varying their intensity and timing) on reduction in the spread of coronavirus in 50 states and District of Columbia. The information presented can help policymakers understand consequences such as the rate of new cases, potential strain on the healthcare system, and projected deaths. The COVID-19 Simulator combines infectious disease modeling and statistical modeling to simulate the trajectory of COVID-19 at the state level from March 15, 2020 to August 31, 2020 in the United States. Utilizing the most recent reported data for each state, the COVID-19 Simulator considers state-specific disease spread dynamics.

stated on April 14, 2020 in a newspaper interview:
“Small trials” to test convalescent plasma therapy for coronavirus patients “seem to have had some degree of success.”

Convalescent plasma therapy showing promise against COVID-19

IF YOUR TIME IS SHORT
• At least two Chinese studies have found initial success with convalescent plasma therapy, a technique in which antibodies from recovered coronavirus patients are given to seriously ill patients in order to boost their immune response.
• The authors of these studies emphasize that more research is needed to confirm these results more broadly.
See the sources for this fact-check

As physicians grapple with the best ways to treat patients infected with the coronavirus, one treatment that has gained increasing attention is convalescent plasma therapy.

This therapy involves transfusing blood plasma from recovered coronavirus patients into a sick patient. The plasma contains a specific antibody that helps the immune system fight the virus. The idea is to help give seriously ill patients an immune-system boost so they can better fight off the virus.
COVID-19 convalescent plasma therapy is considered as an investigational product by the Food and Drug Administration.

Dr. Jamie N. Nadler, the medical director of quality and patient safety for Buffalo General Medical Center and Gates Vascular Institute in upstate New York, recently told the Buffalo News that there’s some evidence that it could be an effective way to treat COVID-19.
"There have been small trials and small attempts around the world that seem to have had some degree of success," Nadler said. "So it's worth trying as long as it's done correctly."

Nadler is right: We found two studies of convalescent plasma therapy that have shown at least initial promise with COVID-19 patients, although experts caution that more investigation is needed. (Nadler did not respond to an inquiry for this article.)
A brief history of convalescent plasma therapy

Convalescent plasma therapy has a long history. It was developed by Paul Ehrlich and Emil von Behring for treatment of diphtheria, a finding that was recognized in 1901 with the first Nobel Prize for medicine, epidemiologist Dr. Ian Lipkin, a professor at Columbia University’s Mailman School of Public Health, told CNBC.

More recently, it was used against Severe Acute Respiratory Syndrome, an infection with similarities to COVID-19 that emerged in Asia in the early 2000s.

In one study in Hong Kong during a SARS outbreak, a hospital treated 80 patients with convalescent plasma. Among the treated patients, the study showed a higher discharge rate prior to day 14 of the illness: 58.3% became well enough to be discharged, compared with 15.6% of those who did not receive the treatment.

However, patients suffering from Ebola — a different kind of virus in the filovirus family — did not experience positive results from convalescent plasma treatment.
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Plasma donor creates website to help COVID-19 patients in need
James Crocker hopes by personalizing convalescent plasma need, more donors will take action

how about that WHO "memo" that was "accidentally" put on their website and taken down

saying China says the placebo did the same thing?

"something is rotten in Denmark" and it is obvious WHO is rotten

srh88 said:

I was hoping this thread would be advice on a wine that pairs well with clorox and uv light bulbs

Click to expand...

Donate COVID-19 Plasma

If you have fully recovered from COVID-19, you may be able to help patients currently fighting the infection by donating your plasma. Because you fought the infection, your plasma now contains COVID-19 antibodies. These antibodies provided one way for your immune system to fight the virus when you were sick, so your plasma may be able to be used to help others fight off the disease.

Antiviral drug offers hope for COVID-19 treatment

U.S. officials say early results from a clinical trial on the antiviral drug remdesivir showed it helped certain patients recover more quickly from COVID-19. "We were looking for a win," said infectious disease specialist Dr. Isaac Bogoch, but urged caution.

I just found it funny.

"Trump’s Domestic Policy Chief Joe Grogan Is Resigning." "He was also a lobbyist for the pharmaceutical industry, including for Gilead Sciences Inc."

Time to cash in. Drain the swamp.

I think they might regret not waiting for treatment options at least.
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Deaths soar in country that didn't lock down. Officials identify big reason why
Erin Burnett Out Front

Unlike its European neighbors, Swedish officials did not institute lock down measures to combat the Covid-19 epidemic. CNN's Phil Black takes a look at how that has affected the country's outbreak.
Source: CNN

NEWS
29 APRIL 2020
Hopes rise for coronavirus drug remdesivir
Despite conflicting studies, results from largest trial yet show the antiviral speeds up recovery, putting it on track to become a standard of care in the United States.

An experimental drug — and one of the world’s best hopes for treating COVID-19 — could shorten the time to recovery from coronavirus infection, according to the largest and most rigorous clinical trial of the compound yet.

The drug, called remdesivir, interferes with the replication of some viruses, including SARS-CoV-2, which is responsible for the current pandemic. On 29 April, Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases (NIAID), announced that a clinical trial in more than 1,000 people had showed that those taking remdesivir recovered in 11 days on average, compared with 15 days for those on a placebo.

“Although a 31% improvement doesn’t seem like a knockout 100%, it is a very important proof of concept,” Fauci said. “What it has proven is that a drug can block this virus.”

There were also fewer deaths among trial participants who received the drug, he said, but that trend was not statistically significant. The shortened recovery time, however, was significant, and was enough of a benefit that investigators decided to stop the trial early, he said, to ensure that those participants who were receiving placebo could now access the drug. Fauci added that remdesivir would become a standard treatment for COVID-19.

The news comes after weeks of data leaks and on a day of mixed results from clinical trials of the drug. The drug’s maker, Gilead Sciences of Foster City, California, announced on the same day that in its own trial, more than half of 400 participants with severe COVID-19 had recovered from their illness within two weeks of receiving treatment. But the study lacked a placebo-controlled arm, making the results difficult to interpret. Also on 29 April, a smaller trial run in China announced that it had found1 no benefits from remdesivir when compared with a placebo. But that trial was stopped early owing to difficulty in enrolling participants as the outbreak subsided in China. Nevertheless, onlookers are hopeful that the large NIAID trial provides the first glimmer of promise in a race to find a drug that works against the coronavirus, which has infected more than three million people worldwide.

“There is a lot of focus on remdesivir because it’s potentially the best shot we have,” says virologist Stephen Griffin at the University of Leeds, UK.

Small trials
Fast-flowing, conflicting information on remdesivir in the past few weeks has left people reeling. In the rush to find therapies to combat COVID-19, small clinical trials without control groups have been common. “I’m just very annoyed by all of these non-controlled studies,” says Geoffrey Porges, a biotechnology analyst for the investment bank SVB Leerink in New York City. “It’s reassuring that 50–60% of patients are discharged from the hospital, but this is a disease that mostly gets better anyway.”

With so much uncertainty, the remdesivir-watchers were waiting anxiously for final results from the NIAID trial, which were not expected until the end of May. In lieu of a vaccine, which could still be more than a year away, effective therapies are crucial in reducing deaths and limiting economic damage from the pandemic. Yet, despite the flood of small clinical trials, no therapy has been convincingly shown to boost survival in people with COVID-19.

The NIAID results put a new sheen on remdesivir.The NIAID did not release detailed safety data. The study in China found no significant difference between remdesivir and placebo in the frequency of adverse events, but 12% of people who received remdesivir dropped out of the study due to side effects including nausea and cardiopulmonary failure, compared to only 5% on placebo.

“It may not be the wonder drug that everyone’s looking for, but if you can stop some patients from becoming critically ill, that’s good enough,” says Griffin.

Fauci said the finding reminded him of the discovery in the 1980s that the drug AZT helped to combat HIV infection. The first randomized, controlled clinical trial showed only a modest improvement, he said, but researchers continued to build on that success, eventually developing highly effective therapies.

Remdesivir works by gumming up an enzyme that some viruses, including SARS-CoV-2, use to replicate. In February, researchers showed2 that the drug reduces viral infection in human cells grown in a laboratory.

Gilead began to ramp up production of remdesivir well before the NIAID results came out. By the end of March, the company had produced enough to treat 30,000 patients. And by streamlining its manufacturing process and finding new sources of raw materials, Gilead announced, it hopes to produce enough remdesivir to treat more than one million people by the end of the year.

That calculation was based on the assumption that people would take the drug for ten days, but the results announced from Gilead’s trial on 29 April suggest that a five-day course of treatment could work just as well. If so, that would effectively double the number of people who could be treated, says Porges.
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