COVID19 update, July 5, 2020: new large, successful hydroxychloroquine trial; China did not actually notify WHO of outbreak on 31 December 2019; vascular dementia sequelae in elderly survivors; aerosol transmission and why risk much less outdoors

Happy Fourth of July weekend to my American readers, and belated happy Canada Day to my Canadian ones.

(1)  (via Matt Margolis): New large-scale (over 2,500 patients) hydroxychloroquine (HOcq) trial in Henry Ford Health System (in the Detroit area) finds definite benefit to HOCQ. The paper was just published online, following peer review but prior to copy-editing, in the International Journal of Infectious Diseases.

https://doi.org/10.1016/j.ijid.2020.06.099

In a nutshell, 13% of patients who received HOcq alone died, compared to 20% of those who received the HOcq-azithromycin combo, 22% of those who received azithromycin alone and 26% of patients who received neither drug. The researchers then carried outr “propensity matching”  — that is, the creation of equal-sized “HOcq” and “non-HOcq” subsamples designed to be similar in terms of age distribution, race, pre-existing conditions, … to  create an “all else being equal” comparison. (This is known in the medical statistics lingo as “eliminating confounding factors”.) They then obtained  the following Kaplan-Meier  survival curve (Figure 2 of the paper):

Quoting from the article text:

“The benefits of hydroxychloroquine in our cohort as compared to previous studies may be related to its use early in the disease course with standardized, and safe dosing, inclusion criteria, comorbidities, or larger cohort. The postulated pathophysiology of COVID-19 of the initial viral infection phase followed by the hyperimmune response suggest potential benefit of early administration of hydroxychloroquine for its antiviral and antithrombotic properties. Later therapy in patients that have already experienced hyperimmune response or critical illness is less likely to be of benefit. […]
Limitations to our analysis include the retrospective, non-randomized, non-blinded study design. Also, information on duration of symptoms prior to hospitalization was not available for analysis. However, our study is notable for use of a cohort of consecutive patients from a multi-hospital institution, regularly updated and standardized institutional clinical treatment guidelines and a QTc interval-based algorithm specifically designed to ensure the safe use of hydroxychloroquine. To mitigate potential limitations associated with missing or inaccurate documentation in electronic medical records, we manually reviewed all deaths to confirm the primary mortality outcome and ascertain the cause of death. A review of our COVID-19 mortality data demonstrated no major cardiac arrhythmias; specifically, no torsades de pointes that has been observed with hydroxychloroquine treatment. This finding may be explained in two ways. First, our patient population received aggressive early medical intervention, and were less prone to development of myocarditis, and cardiac inflammation commonly seen in later stages of COVID-19 disease. Second, and importantly, inpatient telemetry with established electrolyte protocols were stringently applied to our population and monitoring for cardiac dysrhythmias was effective in controlling for adverse events. Additional strengths were the inclusion of a multi-racial patient composition, confirmation of all patients for infection with PCR, and control for various confounding factors including patient characteristics such as severity of illness by propensity matching.”

(2) Laura R. A geriatric nurse, messaged the following:

Mortality of COVID-19 is not my biggest worry. I’m a long-term and skilled care nurse, and hold a CDP (Certified Dementia Professional, which indicates some training, but much more experience). All indications show that COVID-19 can cause brain damage in survivors. Non-severe disease with simple anosmia may not cause long-term sequelae, but I fully expect there to be a huge wave for demand for memory care for people with vascular dementia in the next five years, as home caregivers become overwhelmed.

https://www.washingtonpost.com/health/2020/07/01/coronavirus-autopsies-findings/

https://doi.org/10.1016/S2215-0366(20)30287-X

“Neurobiology of COVID-19”, Journal of Alzheimer’s Disease, 76,(1), 3-19, (2020) http://doi.org/10.3233/JAD-200581

(3) (Via Instapundit) WHO Quietly Changes COVID Timeline following Republican Questioning. “The World Health Organization quietly changed its timeline of the coronavirus pandemic’s first days on Tuesday, clarifying that the Chinese Communist Party never informed the organization of the pandemic on December 31, despite previous claims to the contrary.” 

“In the new timeline, which the WHO says has been updated “in light of evolving events and new information,” the organization reveals that its Chinese Office “picked up” an online statement — which has since been deleted — made by the Wuhan Municipal Health Commission describing cases of “viral pneumonia.” The WHO says it also received open-source intelligence suggesting there was “pneumonia of unknown cause” in Wuhan.

The additions clarify the WHO’s previous timeline, which simply stated that on December 31, “Wuhan Municipal Health Commission, China, reported a cluster of cases of pneumonia in Wuhan” — implying the report was made to the WHO. In its initial report on the outbreak, the WHO said its China office “was informed” of the unknown pneumonia cases, without clarifying that the information was not provided by the Chinese Communist Party.

The lack of clarity led multiple outlets — including Axios, the Washington Post, and the BBC — to report that Chinese authorities told the WHO’s China office about the outbreak on December 31. ” 

Quite erroneously, as it turned out. 

(4) My Belgian correspondent “Y.” sent me this Dutch informational video from the advocacy group SmartExit.nu. (The top level domain for Niue also happens to mean “now” in Dutch.)

(English translation: https://www.youtube.com/watch?v=asjKXK44fN4  )

In brief: it discusses the main ways for the virus to spread, and places most of the blame on aerosols. Garden-variety masks are not terribly useful against aerosols, and neither is keeping a 1.5m distance, but… good air circulation and vigorous air refreshing help a lot. Best of all is to be outside.

Y. comments: “This explains why various mass outdoor parties and events in Brussels, as well as massive demonstrations, did not trigger renewed outbreaks here. And the whole ‘climate’ push for ‘passive buildings’ with almost zero ventilation turns out to be a bad idea.”

(Apropos the Washington State choir rehearsal that became a super spreader event, a (critical) commenter to the video adds this CDC link.)

Related, this just in via Instapundit: 239 experts with 1 big claim: the virus is airborne

(5) https://www.jpost.com/health-science/how-to-avoid-catching-coronavirus-633952

The Coronavirus National Information and Knowledge Center, which is overseen by the IDF Intelligence Corps in cooperation with the Health Ministry, released a report Sunday that reviews international recommendations for the kinds of activities that are high- to low-risk. The punch line is to “avoid the ‘three Cs,’” as a poster in Japan offers: closed spaces with poor ventilation, crowded places with many people nearby and close-contact settings such as close-range conversations.
 
The Jerusalem Post has put together a priority list of “safe” and “less safe” activities based on lists published by international health networks and publications that were used by the IDF to compile Sunday’s report.

The full report is here (in Hebrew). The following infographic taken from  it might be useful

(6) Naftali Bennett, former Minister of Defense, leader of the Yamina party and a successful hitech executive before entering politics, published an open letter with a 15-point plan to revamp Israel’s coronavirus response.

3 thoughts on “COVID19 update, July 5, 2020: new large, successful hydroxychloroquine trial; China did not actually notify WHO of outbreak on 31 December 2019; vascular dementia sequelae in elderly survivors; aerosol transmission and why risk much less outdoors

  1. “This explains why various mass outdoor parties and events in Brussels, as well as massive demonstrations, did not trigger renewed outbreaks here”

    Hmm. I’ve also seen reports which claim new spikes in Cases is NOT due to increased testing but instead to events like BLM protests or the reopening of “Red” states.

    Is it fair to say that the jury is still out?

    Here in California there is a strong push to browbeat people into wearing masks as soon as they step outside. Scolding Karens go on the NextDoor app to complain of neighbors who are outside sans mask, even if the neighbor is far from any other person.
    So far, legally, you are only required to wear masks when inside a building while shopping and so on.

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