Senate Hearing on COVID-19 Outpatient Treatment (USA 2020-11-19) Dr. Harvey Risch: tens of thousands of randomized trials and their non-randomized counterparts arrived at virtually identical conclusions

[-] lemallette | 5 points | Nov 20 2020 21:09:56

• RCTs remain the gold standard. There are numerous examples where retrospective reviews of experience gave a false hope of efficacy, HCQ being the clearest example in recent memory.
• That being said, what do we do while awaiting the "gold standard" results. That depends on the seriousness of the situation, the cost of the proposed treatment, its potential risks and the degree of benefit suggested by the non-randomized data. For Covid-19 we can't afford to wait if we are talking about an inexpensive measure with low risk.
• We didn't need the NHS formal study of vitamin D supplements to tell us that EVERYONE (except maybe lifeguards) should be taking a vitamin D supplement to assure good vitamin D nutrition before even encountering the virus. Low cost, very low risk (in fact, improved longevity likely even without Covid). The retrospective reviews told us either that vitamin D reduces the risk of moderate or severe Covid by 90% (a huge effect) or that when your case of Covid is progressing rapidly, it will have already lowered your blood level of 25-hydroxyvitamin D, in which case the vitamin will do no harm.
• Same goes for high dose vitamin C, which was touted early from Wuhan. Very low cost. Essentially NO risk for basic maintenance of 500 to 1000 mg a day, and no risk to taking up to 20,000 - 30,000 mg a day in divided doses when symptomatic.
• For ivermectin we already have (at least) two RCTs that have been submitted for publication and are awaiting peer review, but that seem well done, if small. They both showed a huge benefit, with low cost and low risk. Sure, go ahead and complete any large trials that are well underway (but run it by your ethics committee first to be sure that further recruitment is ethical). The problem for now is supply of the drug: Not enough available to use for population prophylaxis. Until production can be ramped up, it should be used for prevention by front line workers and for treatment of symptomatic patients.
• PS This is my take as a physician and medical researcher who has followed developments closely.

[-] TrumpLyftAlles | 2 points | Dec 01 2020 02:37:38

Great comment! And nice to see you in the sub. It's been a while (or I missed it).

The problem for now is supply of the drug: Not enough available to use for population prophylaxis. Until production can be ramped up, it should be used for prevention by front line workers and for treatment of symptomatic patients.

The front-line workers will be the first to get the vaccines. 400K doses are supposed to arrive in Massachusetts this calendar year, all earmarked for HCWs.

I don't understand how ivermectin can go to asymptomatic patients in the absence of Michael Mina-style $1 at-home 10-minute paper tests. Under what circumstances to do the asymptomatic learn they have covid? I guess some schools and work places are doing weekly rapid tests. That will catch some. Are other people without symptoms getting tested just in case? The viral phase is pretty short, like 8 days, and not even a PCR test will reliably pick up the virus until day 3 or 4 IIRC. They'd have to be lucky, to get tested while the ivermectin can do them any good. More likely the random PCR test will turn up inert RNA after the viral period is passed, so the testee goes into quarantine for 2 weeks and it's a complete waste.

I think that after the HCWs, ivermectin should go to nursing home residents.

Then prison inmates.

What other populations are at especially high risk? Are there still any uninfected meat plant workers?

Are you taking ivermectin prophylactically, doctor? I am.

[-] TrumpLyftAlles | 1 points | Dec 01 2020 02:55:43

We didn't need the NHS formal study of vitamin D supplements to tell us that EVERYONE (except maybe lifeguards) should be taking a vitamin D supplement to assure good vitamin D nutrition before even encountering the virus. Low cost, very low risk (in fact, improved longevity likely even without Covid). The retrospective reviews told us either that vitamin D reduces the risk of moderate or severe Covid by 90% (a huge effect) or that when your case of Covid is progressing rapidly, it will have already lowered your blood level of 25-hydroxyvitamin D, in which case the vitamin will do no harm.

You're a smart, well-connected guy. I believe you said you know Dr. Fauci?

He's taking vitamin D.

Do you have any idea about why the CDC (or whichever agency) has not done a public service campaign urging everyone to take vitamin D? It seems like such an obvious smart thing to do, in the presence of covid19. As you say, it's a smart thing to do anyway.

[-] who_that_guy227 | 2 points | Nov 20 2020 14:37:45

TLDR ?

[-] TrumpLyftAlles | 2 points | Dec 01 2020 02:51:10

Patients should be treated early with HCQ as outpatients.

[-] Ok-Film-9049 | 1 points | Nov 20 2020 17:40:01

If a meta analysis of observation trials this is more likely to pull out the confounders that may exist in one setting or another Maybe that is what he is saying

[-] TrumpLyftAlles | 2 points | Dec 01 2020 02:52:06

Or he's saying there's enough evidence, and waiting for the perfect study (1) won't change the results of the research to date and (2) in the meanwhile people are dying unnecessarily.