Heading into autumn - what next?

[Yew]

Isn't it time that we reevaluated that 'within 28 days' metric, as it was developed in a pre-vaccine world, and the cross-entropy equation is likely to have changed since then.

 

[DustyBin]

Isn't it time that we reevaluated that 'within 28 days' metric, as it was developed in a pre-vaccine world, and the cross-entropy equation is likely to have changed since then.

Well yes but they need to keep the pandemic going somehow!

 

[brad465]

We now have an approved antiviral, which really needs to cast out into the abyss the prospect of any measures continuing/returning:

Molnupiravir: First pill to treat Covid gets approval in UK

The tablet - molnupiravir - will be given twice a day to patients recently diagnosed with the disease.

www.bbc.co.uk

The first pill designed to treat symptomatic Covid has been approved by the UK medicines regulator.

The tablet - molnupiravir - will be given twice a day to vulnerable patients recently diagnosed with the disease.

In clinical trials the pill, originally developed to treat flu, cut the risk of hospitalisation or death by about half.

Health secretary Sajid Javid said the treatment was a "gamechanger" for the most frail and immunosuppressed.

In a statement he said: "Today is a historic day for our country, as the UK is now the first country in the world to approve an antiviral that can be taken at home for Covid."

 

[nlogax]

We now have an approved antiviral, which really needs to cast out into the abyss the prospect of any measures continuing/returning:

Really great news. The faster we can leave this unpleasantness behind, the better.

 

[Eyersey468]

Really great news. The faster we can leave this unpleasantness behind, the better.

Hear hear

 

[MikeWM]

We now have an approved antiviral, which really needs to cast out into the abyss the prospect of any measures continuing/returning:

Molnupiravir: First pill to treat Covid gets approval in UK

The tablet - molnupiravir - will be given twice a day to patients recently diagnosed with the disease.

www.bbc.co.uk

Well, I'm all for treatments - in fact I've mentioned a number of times that I believe we should have focused far more on treatments, and it was baffling to me why we had not done so - and if this leads to people thinking they can take a pill and treat the problem, that's a good thing psychologically and may help us to move on.

But I have to say that I'm not remotely convinced of the grounds that have led to this approval. That article says:

'The results {of a clinical trial on 775 people - is that the only trial they've done?} were published in a press release and have not yet been peer-reviewed.'

That sounds *incredibly* fragile grounds for any sort of approval of an entirely new drug.

I appreciate that this is perceived as an 'emergency', and therefore it isn't entirely unreasonable to put things to market faster than the usual process - but in that case I fail to understand why other, existing, well-understood and safe drugs, that have tended to show better results than this in RCTs throughout the world, have been ignored and ridiculed for over 18 months now, rather than actually being tried as treatments.

 

[Yew]

Such as?

 

[MikeWM]

Such as?

We had a discussion here on such matters back in January (!) and not much appears to have changed:

https://www.railforums.co.uk/threads/total-lack-of-attention-to-treatments.213257/

The data on HCQ (https://c19hcq.com/) and even better Ivermectin (https://c19ivermectin.com/) still look good. At worst, I don't see any real harm in trying them - they are well-established and we know the issues and potential side-effects of using them.

 

[The Ham]

We had a discussion here on such matters back in January (!) and not much appears to have changed:

https://www.railforums.co.uk/threads/total-lack-of-attention-to-treatments.213257/

The data on HCQ (https://c19hcq.com/) and even better Ivermectin (https://c19ivermectin.com/) still look good. At worst, I don't see any real harm in trying them - they are well-established and we know the issues and potential side-effects of using them.

Indeed, it's also worth remembering that these are existing treatments which have been identified as being useful in treating Covid. As such not really the same level of proof needed to show that they are safe (that's already been done), rather just to show that they reduce hospitalisations and deaths (by about 50%, which is good enough to roll it out).

 

[Yew]

I’m not sure that they have acquitted themselves in in vivo trials as in their earlier theoretical stages. The evidence for ivermectin doing anything is very dubious.

 

[MikeWM]

I’m not sure that they have acquitted themselves in in vivo trials as in their earlier theoretical stages. The evidence for ivermectin doing anything is very dubious.

I think there is so much noise around the issue that it is rather difficult to tell much concrete anymore - which appears entirely deliberate, which is concerning in itself - but the studies at the link I mentioned appear to show a decent effect when used early and with correct dosage.

At the very least, this far into the pandemic, we should have much better information about whether it works.

Based on what I've seen, at this stage I'd far rather try Ivermectin - if I were allowed to - if I caught Covid, then some entirely new drug whose clinical trial data apparently hasn't even been peer-reviewed yet.

 

[Cdd89]

The arguments around ivermectin remind me of the arguments around masks. It’s not a perfect analogy as one may be more effective than the other, but it is still a lot of fuss around a marginal benefit.

I could understand this in the pre-vaccine world, but it doesn’t make sense to me in the post vaccine world. If someone is concerned about giving their immune system the best chance against Covid, vaccines are the proven tool.

 

[brad465]

The WHO are now saying Europe is the epicentre once more, and highlighting how other European countries are starting to see cases rise:

https://www.bbc.co.uk/news/world-europe-59160525

Europe is once again "at the epicentre" of the Covid pandemic, the World Health Organization (WHO) has warned, as cases soar across the continent.
At a press conference WHO Europe head Hans Kluge said the continent could see half a million more deaths by February.
He blamed insufficient vaccine take-up for the rise.
"We must change our tactics, from reacting to surges of Covid-19 to preventing them from happening in the first place," he said.
The rate of vaccination has slowed across the continent in recent months. While some 80% of people in Spain are double jabbed, in Germany it is as low as 66% - and far lower in some Eastern European countries. Only 32% of Russians were fully vaccinated by October 2021.
Mr Kluge also blamed a relaxation of public health measures for rising infections in the WHO's European region, which covers 53 countries including parts of Central Asia. So far the WHO has recorded 1.4 million deaths across the region.
The WHO's technical lead on Covid-19, Maria Van Kerkhove, said over the past four weeks cases across Europe had soared over 55%, despite an "ample supply of vaccines and tools", and colleague Dr Mike Ryan said Europe's experience was a "warning shot for the world".
It came as Germany recorded more than 37,000 daily Covid cases on Friday, a record high for the second day running. The incidence rate per 100,000 people is now higher than it was in April, at 169,9, but well below the level in the UK.
German public health officials are worried that a fourth wave of infection could lead to a large number of deaths and pressure on the health system. In the past 24 hours 154 deaths have been recorded, up from 121 a week ago.
Lothar Wieler of Germany's RKI institute spoke on Thursday of terrifying numbers. "If we don't take counter-measures now, this fourth wave will bring yet more suffering," he said. Among the many Germans who have not been vaccinated are more than three million over-60s, seen at particular risk.

But as Hans Kluge pointed out, the surge in cases is not confined to Germany.
The most dramatic rises in fatalities have been in the past week in Russia, where more than 8,100 deaths were recorded, and Ukraine, with 3,800 deaths. Both countries have very low rates of vaccination and Ukraine announced a record 27,377 new cases in the past 24 hours.

This should (but will probably be denied), debunk any notion that our strategy is somehow more reckless, when even the best intentions cannot contain covid long term.

 

[DustyBin]

The WHO are now saying Europe is the epicentre once more, and highlighting how other European countries are starting to see cases rise:

https://www.bbc.co.uk/news/world-europe-59160525

This should (but will probably be denied), debunk any notion that our strategy is somehow more reckless, when even the best intentions cannot contain covid long term.

I live in hope that at some point the penny will drop for the majority: WE CANNOT CONTROL THE VIRUS! We can temporarily slow down infections, but they'll simply resurge later on. What we can do, and have done, is prevent the majority of people from becoming seriously ill when they (inevitably) become infected. When are we going to accept this and move on?

 

[MikeWM]

The arguments around ivermectin remind me of the arguments around masks. It’s not a perfect analogy as one may be more effective than the other, but it is still a lot of fuss around a marginal benefit.

I'm not sure that 67% improvement in outcome (as the latest meta-analysis has at my link above (yes, I know the problems with meta-analyses, I've mentioned them before!)) given early treatment is 'marginal'. Given the data we're getting from PHE about hospitalisation/deaths in unvaccinated/vaccinated, 67% (if true) is fairly on par with the effect of vaccination, and unlike vaccination is (a) something you can do once you've actually got the disease, and (b) really, really cheap.

It's also the exact opposite from masks, because with masks the argument now seems to be 'well, it may help (despite all the evidence to the contrary), so we'd better do it', whereas with ivermectin it is 'it can't possibly help (despite all the evidence to the contrary) and is extremely dangerous (though no-one explains why, because it isn't) and you'll be censored off social media if you mention it (why? At *worst* you'd take it and it wouldn't work) and doctors will be struck off for trying to prescribe it or recommend it (why?)'

There is really something extremely odd about the arguments over ivermectin (and HCQ before it), and the attempts to silence and ridicule those who suggest it is worth trying. If any of these treatments do work, our refusal to embrace them has resulted in the deaths of hundreds of thousands of people, which would be the biggest medical scandal in recent history. I still believe the attitude we have had to potential treatments for this virus is the clearest evidence that shows there is something really not quite right about our response, and that 'it isn't just about a virus'.

 

[DustyBin]

I'm not sure that 67% improvement in outcome (as the latest meta-analysis has at my link above (yes, I know the problems with meta-analyses, I've mentioned them before!)) given early treatment is 'marginal'. Given the data we're getting from PHE about hospitalisation/deaths in unvaccinated/vaccinated, 67% (if true) is fairly on par with the effect of vaccination, and unlike vaccination is (a) something you can do once you've actually got the disease, and (b) really, really cheap.

It's also the exact opposite from masks, because with masks the argument now seems to be 'well, it may help (despite all the evidence to the contrary), so we'd better do it', whereas with ivermectin it is 'it can't possibly help (despite all the evidence to the contrary) and is extremely dangerous (though no-one explains why, because it isn't) and you'll be censored off social media if you mention it (why? At *worst* you'd take it and it wouldn't work) and doctors will be struck off for trying to prescribe it or recommend it (why?)'

There is really something extremely odd about the arguments over ivermectin (and HCQ before it), and the attempts to silence and ridicule those who suggest it is worth trying. If any of these treatments do work, our refusal to embrace them has resulted in the deaths of hundreds of thousands of people, which would be the biggest medical scandal in recent history. I still believe the attitude we have had to potential treatments for this virus is the clearest evidence that shows there is something really not quite right about our response, and that 'it isn't just about a virus'.

Call me cynical but could at least part of the "problem" with ivermectin be that it's a common drug with very little profit potential? Taking this a step further, how closely is this new wonder drug (molnupiravir) related to say ivermectin (or any other common anti-viral)? Could it be a case of rebranding (perhaps with minor tweaks) an existing drug and patenting it in order to maximise profits? This is total conjecture, but reflects the level of trust I have in "big pharma", the experts and the government when it comes to covid!

 

[MikeWM]

Call me cynical but could at least part of the "problem" with ivermectin be that it's a common drug with very little profit potential? Taking this a step further, how closely is this new wonder drug (molnupiravir) related to say ivermectin (or any other common anti-viral)? Could it be a case of rebranding (perhaps with minor tweaks) an existing drug and patenting it in order to maximise profits? This is total conjecture, but reflects the level of trust I have in "big pharma", the experts and the government when it comes to covid!

I don't think molnupiravir is related to ivermectin, though the 'new' Pfizer drug that they're going on about today ('90% effective') is apparently very similar to it {edit : actually I see that it is reported that this new drug is a protease inhibitor, in which case that's not like ivermectin either, sorry}, and will no doubt cost many many times more.

'Follow the money' and working out cui bono? is always good advice in these cases to work out what is going on - though in this case I'm not sure that it is the whole story, but just a convenient side-effect. (If I had to decide on one thing that I suspect it is all about, I'd still say it was to introduce social credit via vaccine passports, which requires vaccines, which requires no effective treatments to exist. So any effective treatment that was found 'early' had to be ruthlessly and efficiently suppressed).

 

[kristiang85]

The WHO are now saying Europe is the epicentre once more, and highlighting how other European countries are starting to see cases rise:

https://www.bbc.co.uk/news/world-europe-59160525

This should (but will probably be denied), debunk any notion that our strategy is somehow more reckless, when even the best intentions cannot contain covid long term.

And a lot of these countries are still mad on masks and vaccine passports. It shows how futile it all is.

 

[brad465]

Interestingly the number of people in hospital with covid is around the same level it was last year when the decision for lockdown 2 was being made (albeit flatlining rather than increasing markedly). Fast forward to now and despite the same levels there's almost no restrictions, masks are guidance only in most places in England, calls for lockdown are almost non-existent, and above all perhaps, there's very little media coverage of the whole situation.

 

[DustyBin]

I don't think molnupiravir is related to ivermectin, though the 'new' Pfizer drug that they're going on about today ('90% effective') is apparently very similar to it {edit : actually I see that it is reported that this new drug is a protease inhibitor, in which case that's not like ivermectin either, sorry}, and will no doubt cost many many times more.

'Follow the money' and working out cui bono? is always good advice in these cases to work out what is going on - though in this case I'm not sure that it is the whole story, but just a convenient side-effect. (If I had to decide on one thing that I suspect it is all about, I'd still say it was to introduce social credit via vaccine passports, which requires vaccines, which requires no effective treatments to exist. So any effective treatment that was found 'early' had to be ruthlessly and efficiently suppressed).

Thanks Mike, I'll give them the benefit of the doubt then on this occasion!

 

[initiation]

Interestingly the number of people in hospital with covid is around the same level it was last year when the decision for lockdown 2 was being made (albeit flatlining rather than increasing markedly). Fast forward to now and despite the same levels there's almost no restrictions, masks are guidance only in most places in England, calls for lockdown are almost non-existent, and above all perhaps, there's very little media coverage of the whole situation.

I can't quite tell if this is happiness on the current situation, or complaining we don't have restrictions.

If the former:
Great.

If the latter:
We have the majority of the population vaccinated (and exceptionally high take up in more at risk groups). It is no surprise then, unless you are an anti-vaxxer, that hospitalisations and deaths are lower than last year. The devolved nations have run with varying levels of restrictions and delayed unlockings to no consistant noticable benefit. This is an endemic virus and those advocating restrictions, particularly when 90%+ of the adult population carries antibodies, are essentially saying restrictions should be in place forever.

 

[317 forever]

Interestingly the number of people in hospital with covid is around the same level it was last year when the decision for lockdown 2 was being made (albeit flatlining rather than increasing markedly). Fast forward to now and despite the same levels there's almost no restrictions, masks are guidance only in most places in England, calls for lockdown are almost non-existent, and above all perhaps, there's very little media coverage of the whole situation.

Furthermore, cases are currently declining. Mind you, this could in part be because we have just had half term, thereby suppressing any spread resulting directly or indirectly through children and teachers having to be at school.

 

[Pete_uk]

My niece's secondary school had to cancel years 8,9 & 10 several days this past week as they had so many teachers out. The stand in teachers are busy around here.

 

[35B]

Call me cynical but could at least part of the "problem" with ivermectin be that it's a common drug with very little profit potential? Taking this a step further, how closely is this new wonder drug (molnupiravir) related to say ivermectin (or any other common anti-viral)? Could it be a case of rebranding (perhaps with minor tweaks) an existing drug and patenting it in order to maximise profits? This is total conjecture, but reflects the level of trust I have in "big pharma", the experts and the government when it comes to covid!

Remdesivir is also a repurposed, low cost, drug - and has been found to be effective through proper research. The studies looking at Ivermectin have been consistently poor, with very significant signs of outright fraud in the studies that have been consolidated into the meta-analyses. There have also been strong suggestions that, while Merck stand to gain little from sales of Ivermectin, proponents of Ivermectin have been found selling it at significant profit.

 

[MikeWM]

Remdesivir is also a repurposed, low cost, drug

It costs about £2,000 for a 5-day course. That doesn't qualify as 'low cost' in my book. Ivermectin - by comparison - costs pennies.

- and has been found to be effective through proper research.

It is worth pointing out that the WHO's large 'solidarity' trial found that it had no effect whatever - see eg. https://www.bmj.com/content/371/bmj.m4057 ('The largest trial to date of treatments repurposed for use in the covid-19 pandemic has shown that none of the four drugs studied produced any measurable benefit in mortality or disease course. This includes remdesivir—a drug already recommended by several guidelines and pre-ordered by numerous governments around the world.')

But then that trial also showed HCQ to be ineffective too, so maybe the WHO are wrong! It would hardly be the first time.

The studies looking at Ivermectin have been consistently poor, with very significant signs of outright fraud in the studies that have been consolidated into the meta-analyses.

The problem is that fraud seems remarkably prevalent in the area of clinical trials - an issue that some people have been raising with increasing urgency for years - and it is increasingly hard to determine what is true and what is not. See for example the Surgisphere scandal from last year regarding HCQ, or indeed the Oxford 'Recovery' trial which used insanely high doses of HCQ, given far too late, which was then presented as 'conclusive proof' that it didn't work.

There have also been strong suggestions that, while Merck stand to gain little from sales of Ivermectin, proponents of Ivermectin have been found selling it at significant profit.

No doubt, given that it has been made extremely difficult to obtain otherwise, which some would find rather interesting in itself. There are always those who will try to take advantage of any situation.

 

[Yew]

As an aside, I would be interested in seeing some proper studies into some of these drugs as a phophylais, something which seems to have been forgotten about in favour of treatments. I'd imagine that if an antiviral were to be useful, it would be most useful in the early, pre-symptomatic stages.

 

[MikeWM]

As an aside, I would be interested in seeing some proper studies into some of these drugs as a phophylais, something which seems to have been forgotten about in favour of treatments. I'd imagine that if an antiviral were to be useful, it would be most useful in the early, pre-symptomatic stages.

Some of the ivermectin trials at the site I linked to above showed good results from prophylactic use, though whether they qualify as 'proper' or not is probably up for debate. That said, I'm not sure you'd want to be taking it for any length of time 'just in case', but perhaps it may be useful if you know you've recently been in contact with the virus, or someone in your home has it.

I think the evidence for the best 'prophylactic' at this point points to ensuring you have adequate vitamin D levels. Again there are a lot of studies at https://c19vitamind.com/ that appear to show a significant link between low vitamin D levels and poor outcome from Covid. Certainly since seeing fairly convincing evidence in spring last year that this was probably a good plan, I've been taking vitamin D supplements daily.

 

[HSTEd]

Saturating the population with antivirals would be a good way to train other viral infections to bypass them.

We don't have many that are any good at all so I'd rather not risk that.

 

[Bantamzen]

Saturating the population with antivirals would be a good way to train other viral infections to bypass them.

We don't have many that are any good at all so I'd rather not risk that.

I agree with this, anti-virals can hopefully play an important role in treating the most seriously ill & vulnerable from the worst effects. But they are not a magic cure-all pill, and should not be treated as such.

 

[DustyBin]

As an aside, I would be interested in seeing some proper studies into some of these drugs as a phophylais, something which seems to have been forgotten about in favour of treatments. I'd imagine that if an antiviral were to be useful, it would be most useful in the early, pre-symptomatic stages.

As per my post further up I believe this is how molnupiravir proved most effective. Whether it will be used as such however I’ve no idea.

Some of the ivermectin trials at the site I linked to above showed good results from prophylactic use, though whether they qualify as 'proper' or not is probably up for debate. That said, I'm not sure you'd want to be taking it for any length of time 'just in case', but perhaps it may be useful if you know you've recently been in contact with the virus, or someone in your home has it.

I think the evidence for the best 'prophylactic' at this point points to ensuring you have adequate vitamin D levels. Again there are a lot of studies at https://c19vitamind.com/ that appear to show a significant link between low vitamin D levels and poor outcome from Covid. Certainly since seeing fairly convincing evidence in spring last year that this was probably a good plan, I've been taking vitamin D supplements daily.

I agree. I take vitamins C and D daily and have done for many years. A lot of people see this kind of thing as quackery unfortunately. (I’d best not mention my cold remedy!)

Saturating the population with antivirals would be a good way to train other viral infections to bypass them.

We don't have many that are any good at all so I'd rather not risk that.

Also agreed, this kind of thing worries me.