State of the Pandemic

[Gadianton]

I was just noting that while ivermectin was undoubtedly politicized, and 3rd-party funding resources were likely diverted to it for too long because of that, it did have legitimate cause of study as a potential treatment. While RNA anti-viral abilities were only shown in vitro at the time, it did have in vivo evidence with DNA viruses.

From an evidence standpoint, ivermectin was a valid and hopeful candidate for study.

All true. But couldn't you say the same thing for vitamin D and zinc, which are even cheaper and more readily available?

[Doctor Steuss]

All true. But couldn't you say the same thing for vitamin D and zinc, which are even cheaper and more readily available?

Good point, duderino. Touché.

Unless I'm mistaken (which, I give 50/50 odds), hydroxychloroquine's spotty success was likely because it helped with zinc uptake into cells.

[Vēritās]

Turns out Clorox really does kill COVID... in vitro.

Lol. Reminds me of a cartoon I saw once of a researcher holding a gun to a petri dish.

I was just noting that while ivermectin was undoubtedly politicized, and 3rd-party funding resources were likely diverted to it for too long because of that, it did have legitimate cause of study as a potential treatment. While RNA anti-viral abilities were only shown in vitro at the time, it did have in vivo evidence with DNA viruses.

From an evidence standpoint, ivermectin was a valid and hopeful candidate for study.

But once the first legitimate, double-blind, randomized, controlled study proves it is ineffective, that should have been the end of it. Any legitimate cure isn't going to get ambiguous results even from the worst study.

[Res Ipsa]

Meanwhile, well known anti-virals like acyclovir haven't been studied much at all as a viable treatment for COVID. Why not? It seems like anti-virals designed to fight off viruses would be more useful in studies than anti-parasitics like Ivermectin. Well, because no one in Right Wing fake news land was promoting acyclovir as a cure.

for what it's worth, the downstream metabolite that is acyclovir's magic bullet inhibits DNA replication. COVID is an RNA virus.

Thanks, Steuss. You saved me the time I was going to spend trying to figure that out. I did find a retrospective study in Mexico City that included acyclovir as a COVID treatment, with the result one would expect.

Ivermectin had shown broad anti-viral capabilities in previous (in vitro) studies for RNA viruses.

Yes, but wasn't it also the the case that the pharmokinetics made it impossible to maintain the required concentration of the anti-viral agent at non-lethal doses? (Feel free to box my ears if I'm remembering this wrong.) The problem, as I see it, is making sure there is a strong Bayesian prior before spending the time and resources on RCTs. Evidence of correlation based on retrospective or small sample studies without a plausible mechanism of action is still just correlation.

It isn't like treatments have been ignored. One of WHO's early projects was coordinating trials of existing anti-virals to see if there was a quick and easy way to treat the virus. I'm thinking there were something like over 400 trials of what were considered to be the most promising anti-virals. Here's a literature review from January 2022 on anti-virals and COVIDD 19. https://bmcinfectdis.biomedcentral.com/ ... 22-07068-0 And here's one from February on three of the newer anti-virals being studied. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820829/ Finally, here's a literature review that discusses the problem with testing potential treatments without any evidence of a plausible causal mechanism. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8857759/

Good quality RCTs are time and resource intensive. It makes little sense to do them on things that have a low Bayesian prior. As you said in a different post: bleach kills viruses in vitro. But the Bayesian prior for turning bleach into a safe and effective in vivo treatment is effectively zero. Again, if I'm remembering correctly, the Bayesian prior on Ivermectin was so low that the time and resources spent on it was a waste. Without the initial push by anti-vaxxers and amplification by folks like Joe Rogan, those resources and time would have been available for investigating more plausible treatments. And the most tragic part is the folks who were convinced that Ivermectin so was cheap, effective, and harmless that they skipped vaccinations and delayed going to the hospital because it was too late.

[Doctor Steuss]

Yes, but wasn't it also the the case that the pharmokinetics made it impossible to maintain the required concentration of the anti-viral agent at non-lethal doses? (Feel free to box my ears if I'm remembering this wrong.)

Oh wow, thank you Res. I either didn't know this, or had forgotten it (coin-flip nowadays).

Looks like to reach needed plasma concentrations, it would translate to a up to a 100-fold dose of what is FDA approved.

Great googely-moogely.


One of the safety concerns in the paper, about higher concentrations:

First, ivermectin, which targets glutamate-gated chlorine channels in invertebrates, may cross-target the GABA-gated chlorine channels present in the mammalian central nervous system (CNS) and cause neurotoxicity.19 This is normally prevented by an intact blood–brain barrier (BBB), but in patients with a hyperinflammatory state, endothelial permeability at the BBB may be increased and cause leaking of drugs into the CNS, potentially causing harm.20,21

They also note that the metabolic pathway that ivermectin uses for potential antiviral effects is inhibited by some other COVID treatments.

[Res Ipsa]

Moreover, if you don't understand the difference between vaccine and treatment, you will continue to believe that ALL we need is vaccines. That's just not true. We also need therapeutics like Paxlovid.

Trump and the ivermectin/HCQ/bleach debacle have made people think that vaccines are the ONLY way to deal with COVID and that's just not the case. Paxlovid is a great new therapeutic, but it's not perfect and we need to keep developing more. And we need to give people advice on how to prevent mild COVID from turning into pneumonia. Most hospitals don't even recommend an expectorant like Mucinex. Patients are just on their own googling and redditing to find what works for others. We need a standardized treatment protocol other than "drink water and sleep."

I don't think there is anyone on this board that doesn't understand the difference. The question is whether the difference is relevant to the point Gadianton was making.

I haven't seen any evidence of people claiming that all we need is vaccines. The problem I've observed is that the antivaxx movement has convinced large numbers of Americans that all they need are treatments that are already safe, effective and cheap. As a result, we're something like 167th in the world for percentage of people fully vaccinated (not including boosters).

I'm in full agreement with you that both vaccines and treatments are necessary. But your description of the situation in terms of what hospitals are doing and what advice is being given don't match with what I read when I dig into the information. Here's WHO's latest treatment recommendations. https://www.who.int/publications/i/item ... ics-2022.4

As for Mucinex preventing COVID pneumonia, you'll have to show me some science on that. Right now, the recommendations for COVID that doesn't require medical attention are rest, fluids, and OTC pain relievers for discomfort. There isn't a "need" to do something unless there is evidence that there is something that is safe and effective that reduces the odds of a COVID infection progressing to the point where medical protection is needed.

[drumdude]

As a result, we're something like 167th in the world for percentage of people fully vaccinated (not including boosters).

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https://coronavirus.jhu.edu/vaccines/international


Where did you get 167th?? The amount of misinformation on BOTH sides is incredible.

[Vēritās]

As a result, we're something like 167th in the world for percentage of people fully vaccinated (not including boosters).

Capture.JPG

https://coronavirus.jhu.edu/vaccines/international


Where did you get 167th?? The amount of misinformation on BOTH sides is incredible.

Probably a typo, meant 67th. But the point still stands either way. There are 66 countries with higher vaccination rates.

[drumdude]

Capture.JPG

https://coronavirus.jhu.edu/vaccines/international


Where did you get 167th?? The amount of misinformation on BOTH sides is incredible.

Probably a typo, meant 67th. But the point still stands either way. There are 66 countries with higher vaccination rates.

And how much does that matter right now?

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https://www.cdc.gov/nchs/nvss/vsrr/covi ... deaths.htm

[Res Ipsa]

As a result, we're something like 167th in the world for percentage of people fully vaccinated (not including boosters).

Capture.JPG

https://coronavirus.jhu.edu/vaccines/international


Where did you get 167th?? The amount of misinformation on BOTH sides is incredible.

My mistake. I should have double checked what I thought I tendered before posting.

What “side” are you claiming I’m on?