Essentially, Dexamethasone is a steroid that has been in use for decades and is incredibly cheap with a well understood side effect profile.
In this study the mortality of ventilated patients dropped from 40% to 28%.
As I have said, the pathophysiology of Covid-19 is to a large extent due to the body's inflammatory response rather than the virus itself. Steroids are incredibly potent anti inflammatory drugs with very few side effects in short term use. So this result makes biological sense as well.
Most importantly, every intensive care unit in the world uses this drug frequently and thus it's incredibly easy to take this finding into routine clinical use.
This is definitely good news.
AFZ
Good possible news. As near as I can tell the information all comes from press releases, not a refereed paper. Caveat lector.
You're right of course in the strictest sense. However, whilst I want to read the data myself, I would be ABSOLUTELY STUNNED if this wasn't really clear cut. This is the government funded big study on Covid-19 with 6000 patients in this part of it. Looking at the research group, they would have done things properly and classic RCT failures like not randomising properly or loss to follow up of large numbers won't apply. The hardest thing with a RCT is recruiting enough participants. (From the research I've been doing, there will hopefully follow an international trial with maybe a couple of hundred patients if we can manage that). The paradox of Covid-19 is that the science has been rapid and very good. Finding thousands of participants will not have been that hard.
I will read the paper in full but I am confident that this group will not have made so confident a release of findings if they didn't have it cold.
AFZ
The full study has been released and it seems to come with some serious caveats.
Now the full study is posted online. It shows the drug may be risky for patients with milder illness & the timing of the treatment is critical.
24 June 2020
So potentially useful for serious cases but not a magic bullet. There's a link to a New York Times article with more details at that tweet, for those who want to use one of their monthly Times clicks to find out more.
I'm not convinced the person who wrote the Times article has really understood this.
The caveats are totally within normal clinical practice. Put simply in the early stage the virus is doing damage, later the immune system's 'overreaction' is the problem. Hence the place for what is basically a powerful immunosuppressent. The 'may be harmful' line should not be over interpreted. When respiratory distress is present, the steroid helps. In the absence of that, there is no benefit, hence the side effects will obviously outweigh any benefit. Moreover, there has always been caution about using steroids in infectious diseases.
The conclusions are sound. Seriously ill Covid-19 patients will benefit from steroids.
AFZ
P.s. there's an interesting point in the discussion about the use of steroids in other severe respiratory diseases caused by influenza etc. The evidence is lacking because the opportunity to do this kind of trial never existed. This will probably be transferable to other severe pneumonias.
You're assuming that people stupid enough to mob the beach are smart enough to apply sunscreen.
One wag suggested that the Dorset ambulance service had put out an appeal for IQ donors.
Makes me wonder if local lockdowns are feasible. I guess it depends on the area, the weather, the supply of alcohol, and lashings of British common sense. OK, doubtful.
What is this 'British Common Sense' of which Boris & Co. speak?
O - I know. The common sense that tells you to take a cardboard box with you, so that you can poo in it on the beach. And leave it there for the Cahncil to pick up...
Town Council (in this case actually the municipal refuse collectors, but paid for from local funds). Put through a representation of a stereotype accent.
I should think the police are praying for rain. Last night, our neighbours had a bikini party, which naturally enough, we couldn't help observing. However, the rain arrived in the middle of it, so the bikinis are drying off for a period.
Sorry to asking questions. A bikini party? Internet search indicates naked people or close to nude. And, apparently, it's a spectator sport. Sounds insane.
Sorry to asking questions. A bikini party? Internet search indicates naked people or close to nude. And, apparently, it's a spectator sport. Sounds insane.
And this is in London. It has been hot, but now cool and cloudy, no doubt police are delighted. Our local common has been swamped by bikini clad girls, of course, I take a purely anthropological view.
"You'd have to have blindfolds on not to see that we live in a very divisive society."
"Obviously we need to take the dynamics of the pandemic in different places into account, but in general we should try our best to keep schools open."
"As a country, I don't think you can say we're doing great. We're just not."
"(On banning travel from the USA). I think that's understandable."
"It's going to be very difficult to get back to a true normal".
"I think we can get it (the pandemic) under control. But keeping it under control is going to be difficult. It's difficult to see how we can get this under permanent control without a vaccine".
"My best advice is that we abide by the guidelines. For citizens, no matter where you are, physical distancing, wear masks, avoid crowds.
"We're right smack in the middle of the first wave".
It's a good interview. But the viewing numbers are underwhelming. It's hardly mainstream. Fauci hasn't been on CNN for some time. Apparently he doesn't have permission for that any more.
Fauci hasn't been on CNN for some time. Apparently he doesn't have permission for that any more.
Sorry, but is this a conclusion you've drawn on your own, or is it based on something factual? I realize my so-called government (US) has slipped several notches in recent months years, but I wasn't aware that our Dementor-in-Chief had acquired general censorship authority. Inquiring minds want to know!
Fauci works for the government so the government can put some limits on his ability to speak (whether it should be limiting him is another matter). He is speaking online at the Stanford Medical School on Monday at 10:30am (Pacific Time, UTC−07:00) https://med.stanford.edu/about/events.html Since the main audience is medical, it may be a bit technical but it does seem it will be available to the general public.
Fauci hasn't been on CNN for some time. Apparently he doesn't have permission for that any more.
Sorry, but is this a conclusion you've drawn on your own, or is it based on something factual? I realize my so-called government (US) has slipped several notches in recent months years, but I wasn't aware that our Dementor-in-Chief had acquired general censorship authority. Inquiring minds want to know!
An administration official familiar with the situation said high-profile figures from the task force, including Fauci, have been unable to secure White House permission to appear on American TV networks.
As @Net Spinsternotes, if you work for the government then the government can control when and whether you make statements to the media on behalf of the government. Note how the source in Acosta's story is only identified as "[a]n administration official familiar with the situation", probably because he/she has not been authorized to speak to Acosta on this matter.
But I think it’s time for Debbie Birx to step up to the plate. The strategy of playing Trump soft so that you can continue to be an ameliorating voice has clearly failed. Time to speak clearly. When it comes to COVID-19 the President is totally bonkers. And dangerously so.
I wonder what would happen if everyone in the White House and cabinet quit at once?
If the cabinet were willing to quit at once they'd be willing to try the 25th amendment. But really given the supreme unlikelihood of it happening we're well into Alien Space Bat territory.
--Oooo, is an Alien Space Bat running for president? By any chance, was it born in the US? A president has to be a born citizen
--I disagree about the cabinet necessarily having to be willing to try the 25th. There'd have to be at least one doctor to certify T as unfit; and IIRC the VP and Congress would have to concur. But if all the administration staff quit at once, they could forego all that. People from that group do quit; and, of course, T fires them.
A number of the current cabinet members are "Acting Secretaries," meaning while they are occupying the chair of their department, they do not have the full authority of that position.
Personally, I think a law should be passed in the next administration to say a cabinet position must be filled by a Senate approved nominee within 90 days of the vacancy.
I gather this isn't (yet?) a matter of firing Fauci and putting former game show host Chuck Woolery in the job; but T is pretty much ignoring Fauci and listening to Woolery.
IIRC, Woolery is the game show host who claimed to have done CIA work or some such.
A number of the current cabinet members are "Acting Secretaries," meaning while they are occupying the chair of their department, they do not have the full authority of that position.
Personally, I think a law should be passed in the next administration to say a cabinet position must be filled by a Senate approved nominee within 90 days of the vacancy.
Or a candidate of the Senate's own choosing will be seated.
A number of the current cabinet members are "Acting Secretaries," meaning while they are occupying the chair of their department, they do not have the full authority of that position.
Personally, I think a law should be passed in the next administration to say a cabinet position must be filled by a Senate approved nominee within 90 days of the vacancy.
Or a candidate of the Senate's own choosing will be seated.
I gather this isn't (yet?) a matter of firing Fauci and putting former game show host Chuck Woolery in the job; but T is pretty much ignoring Fauci and listening to Woolery.
It is my understanding Fauci is under the Civil Service Administration, which means Trump cannot fire him even if he wanted to.
He’s 79. So they will play the ageist past-it card without actually saying so. And have already misrepresented him by selective quoting. Anything which moves discussion away from facts will do.
It is astonishing to me that there is anybody left who believes Trump has handled the pandemic well.
And also there has been the resistance to adopt the use of masks, the uncertainty of how long this will last means that large scale production might mean wasted effort, in some markets producing masks will be seen as political
Also, I think - certainly in Europe - they are rapidly becoming rethought as an item of clothing. You can by masks with Nike on them, but also ones made by famous brands intended to be stylish - but without the brand name emblazed across them.
The Oxford/Astra-Zenica vaccine is showing very good progress. It attacks the virus in two ways: first through producing antibodies that will attach themselves to the virus and T-cells that will kill infected cells (as I understand it).
Just been to get tested (doctors orders - no symptoms myself but the hatchling had a bit of a temperature). Shoving that swab up my nose was somewhat unpleasant. Should have the results (which will be negative) by the end of the week.
This wasn’t an antibody test, just one of the “do you have the virus right this minute” ones.
Yes - I hope you are virus free.
I just wonder about my friend. Her daughter is still nursing Covid19 patients, the rate is still pretty high in my town (no local lockdown - yet!) and has had the virus. Surely her Mum and Dad will have had it too? My friend washes her uniforms every day. 🦠
Comments
One wag suggested that the Dorset ambulance service had put out an appeal for IQ donors.
I'm not convinced the person who wrote the Times article has really understood this.
Full text of preliminary report here: https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1
Not as yet peer reviewed.
The caveats are totally within normal clinical practice. Put simply in the early stage the virus is doing damage, later the immune system's 'overreaction' is the problem. Hence the place for what is basically a powerful immunosuppressent. The 'may be harmful' line should not be over interpreted. When respiratory distress is present, the steroid helps. In the absence of that, there is no benefit, hence the side effects will obviously outweigh any benefit. Moreover, there has always been caution about using steroids in infectious diseases.
The conclusions are sound. Seriously ill Covid-19 patients will benefit from steroids.
AFZ
P.s. there's an interesting point in the discussion about the use of steroids in other severe respiratory diseases caused by influenza etc. The evidence is lacking because the opportunity to do this kind of trial never existed. This will probably be transferable to other severe pneumonias.
Makes me wonder if local lockdowns are feasible. I guess it depends on the area, the weather, the supply of alcohol, and lashings of British common sense. OK, doubtful.
O - I know. The common sense that tells you to take a cardboard box with you, so that you can poo in it on the beach. And leave it there for the Cahncil to pick up...
No, people here don't talk like that or like country yokels (mostly).
I think bikinis should expect to get wet sometimes but it did rain heavily last night for the second time in many weeks.
And this is in London. It has been hot, but now cool and cloudy, no doubt police are delighted. Our local common has been swamped by bikini clad girls, of course, I take a purely anthropological view.
Trump is too scared to fire Fauci. I think T wants to, but he knows if he does it will shake what little confidence the nation has in him.
And Fauci does a 538 podcast interview.
A few highlights from the podcast.
"You'd have to have blindfolds on not to see that we live in a very divisive society."
"Obviously we need to take the dynamics of the pandemic in different places into account, but in general we should try our best to keep schools open."
"As a country, I don't think you can say we're doing great. We're just not."
"(On banning travel from the USA). I think that's understandable."
"It's going to be very difficult to get back to a true normal".
"I think we can get it (the pandemic) under control. But keeping it under control is going to be difficult. It's difficult to see how we can get this under permanent control without a vaccine".
"My best advice is that we abide by the guidelines. For citizens, no matter where you are, physical distancing, wear masks, avoid crowds.
"We're right smack in the middle of the first wave".
It's a good interview. But the viewing numbers are underwhelming. It's hardly mainstream. Fauci hasn't been on CNN for some time. Apparently he doesn't have permission for that any more.
Sorry, but is this a conclusion you've drawn on your own, or is it based on something factual? I realize my so-called government (US) has slipped several notches in recent months years, but I wasn't aware that our Dementor-in-Chief had acquired general censorship authority. Inquiring minds want to know!
Here's CNN's Jim Acosta with the same story last week.
As @Net Spinster notes, if you work for the government then the government can control when and whether you make statements to the media on behalf of the government. Note how the source in Acosta's story is only identified as "[a]n administration official familiar with the situation", probably because he/she has not been authorized to speak to Acosta on this matter.
It’s the classic playbook.
But I think it’s time for Debbie Birx to step up to the plate. The strategy of playing Trump soft so that you can continue to be an ameliorating voice has clearly failed. Time to speak clearly. When it comes to COVID-19 the President is totally bonkers. And dangerously so.
:boggle: :shock:
I wonder what would happen if everyone in the White House and cabinet quit at once?
If the cabinet were willing to quit at once they'd be willing to try the 25th amendment. But really given the supreme unlikelihood of it happening we're well into Alien Space Bat territory.
--I disagree about the cabinet necessarily having to be willing to try the 25th. There'd have to be at least one doctor to certify T as unfit; and IIRC the VP and Congress would have to concur. But if all the administration staff quit at once, they could forego all that. People from that group do quit; and, of course, T fires them.
Personally, I think a law should be passed in the next administration to say a cabinet position must be filled by a Senate approved nominee within 90 days of the vacancy.
ETA: Sorry, the CIA claim was about Chuck Barris.
Or a candidate of the Senate's own choosing will be seated.
Problematic absent a Constitutional amendment, given the Constitution's clarity that only the president may appoint such officials and that he may do so without Senate consent during Congressional recesses. A revisiting of the Federal Vacancies Reform Act would seem to be in order, though.
It is my understanding Fauci is under the Civil Service Administration, which means Trump cannot fire him even if he wanted to.
Lindsey Graham has come out defending Fauci now.
There is now a movement to get Time Magazine to name Fauci the Person of the Year. That would really flip Trump off.
It is astonishing to me that there is anybody left who believes Trump has handled the pandemic well.
ETA: E.g., they put their faith in Trump, and thinking that he's failing on the Covid (or any other) front throws that into question.
"It comes on a day that UK-wide infections also saw their largest daily rise since 1 July, with 827 new cases."
(Source BBC live feed.)
Fingers crossed.
Yes - I hope you are virus free.
I just wonder about my friend. Her daughter is still nursing Covid19 patients, the rate is still pretty high in my town (no local lockdown - yet!) and has had the virus. Surely her Mum and Dad will have had it too? My friend washes her uniforms every day. 🦠
Good! I hope that remains and continues to be the case.