Interesting observation concerning hydroxychloroquine

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nrqed
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I find the following facts interesting.

Morocco and Algeria have been using hydroxychloroquine since the beginning, ignoring the WHO, who say that it is useless and dangerous.
By contrast, Canada and France follow the WHO and forbid the use of hydroxychloroquine for covid.
The numbers are

Morocco: 36 million
Population: about , number of covid deaths: 202

Algeria
Population: 42.2 million
Number of covid deaths: 623 deaths

Canada
Population: 37.6 million
Number of covid deaths: 6 762

France:
Population: 67 million
Number of covid deaths: 28 596

I have other interesting facts explained by the Dr Raoult, I could link to some interview but it is in French.
I will be happy to summarize his observations, but I will first see if I get censored for posting the above facts.
 

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  • #2
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Have you considered that good experiment design requires identifying and controlling or compensating for confounding factors?

Have you considered that there are people out there, some whom may consult with WHO, that know a lot more than we do about pharmacology, epidemiology, immunology, virology, and infectious diseases?

I certainly wouldn't ever censor you for posting facts, but recognize that there may be additional pertinent facts that you aren't posting.

OK, maybe it's fun to speculate. But don't fool yourself into thinking that anything you read here really matters, unless it's a link to someone that was thinking about this stuff long before anyone knew about SARS-COV-2.
 
  • #3
DrClaude
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Number of cases:
  • France: 145 746
  • Canada: 85 519
  • Algeria: 8 857
  • Morocco: 7 601
 
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  • #4
OmCheeto
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Nothing really jumps out as extraordinary about Algeria and Morocco when looking at case fatality rates.
Morocco is smack dab in the global midlings (rank-wise), and Algeria is quite high on the list.

Hydrox.blah.blah.usage 2020-05-28 at 3.55.55 AM.png


(Data source, Johns Hopkins)
 
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  • #5
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France has new cases and new deaths falling.
Canada has new cases and new deaths more or less flat, possibly slightly falling.
Algeria and Morocco have new cases rising and new deaths falling.

Given this, I would conclude that Algeria and Morocco have ramped up testing, and the CFR reflects that more than anything else, and that CFR is not appropriate to tell us anything. Probably the right denominator is the number of hospital admits, but even that will have country-to-country variations.
 
  • #6
jim mcnamara
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Probably the right denominator is the number of hospital admits, but even that will have country-to-country variations
This is spot on for clinical cases, the ones reported as confirmed. This also is lumping admits with physician diagnosis, in the absence of hospital/clinic facilities, i.e., rural Africa. Anywhere really.

These guys try to fill in the gaps:
https://www.msf.org/ <- interesting read BTW

"Confirmed" = both a qualified staff diagnosis and reporting it. Both of these steps may be weak links.

It is a safe bet that a substantial number of active case symptomatic Covid-19 patients go undetected, especially if the symptoms are minor.
USA report:
https://www.npr.org/sections/health...h-rate-for-the-coronavirus-than-first-thought

And as a note: the chloroquine based meds were originally developed and used as malaria treatment, and they work pretty well.. Since malaria has an 80%-90% mortality rate in children under age 5, the meds have been very available in North Africa. They are on the WHO list of essential medicines:
https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines

Malaria has currently "very limited risk" only in rural areas of Chefchaouen Province of Morocco. So the meds @nrqed cited earlier have been in use there for a long time. - per:

https://redplanet.travel/mdtravelhealth/destinations/morocco
Take this with a grain of salt, I believe it originates from the travel bureau in Morocco.

If you care to google malaria maps you will see most of Algeria and Morocco were "malarious" until recently.
 
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nrqed
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Nothing really jumps out as extraordinary about Algeria and Morocco when looking at case fatality rates.
Morocco is smack dab in the global midlings (rank-wise), and Algeria is quite high on the list.

View attachment 263635

(Data source, Johns Hopkins)
How is "case fatality rate" defined here?
It is certainly not number of deaths relative to the number of infected (which I think is somewhere between 0.25% to 0.4%). If one takes for example the number of deaths relative to the number of hospitalization, then of course the percentage will shoot right up, but that would not make sense to me.
 
  • #8
OmCheeto
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How is "case fatality rate" defined here?
It is certainly not number of deaths relative to the number of infected (which I think is somewhere between 0.25% to 0.4%). If one takes for example the number of deaths relative to the number of hospitalization, then of course the percentage will shoot right up, but that would not make sense to me.
So far, I'm only comfortable with two types of fatality rates:
1. Mortality rate: number of deaths / total population​
2. Case fatality rate/ratio: number of deaths / number of people diagnosed with the disease​

A third, "Infection Fatality Rate (IFR)", has been pointed out to me, but 24 hours after I think I understand it, I have to go back and refresh my memory.

In any event, I'm fairly certain I used CFR correctly, at least as far as wikipedia is concerned.
It is the number of deaths divided by the number of reported cases.

All three types of rates are discussed on Wiki's CFR page.
I would suggest avoiding the video they're sharing there, as it appears to be spreading incorrect information:

01:45 infographic​
CFR = Number of people who died of COVID 19 / Total number of people who got infected​

They may go on to correct this later, but I'm not willing to sit through it to find out.
It's mostly very basic beginner stuff, for people who've never heard of any of this before.
 
  • #9
atyy
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It is a safe bet that a substantial number of active case symptomatic Covid-19 patients go undetected, especially if the symptoms are minor.
USA report:
https://www.npr.org/sections/health...h-rate-for-the-coronavirus-than-first-thought
The npr article is incorrect on that point the IFR estimates are now lower than originally thought. Here are early reports where the lower end of the IFR estimates are about 0.3% to 0.5%. (Note that the reports are not all independent from each other.)
https://www.imperial.ac.uk/mrc-glob...lysis/covid-19/report-4-severity-of-covid-19/ (10 Feb 2020)
https://www.who.int/docs/default-so...ation-reports/20200219-sitrep-30-covid-19.pdf (19 Feb 2020)
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30243-7/fulltext (30 March 2020)
 
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  • #10
atyy
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All three types of rates are discussed on Wiki's CFR page.
I would suggest avoiding the video they're sharing there, as it appears to be spreading incorrect information:

01:45 infographic​
CFR = Number of people who died of COVID 19 / Total number of people who got infected​
I agree that that is currently not the most common definition, and also agree that one should avoid using it. However, it is not completely incorrect, as one can see what we usually call CFR and IFR being distinguished here as two different types of "CFR" https://www.imperial.ac.uk/mrc-glob...lysis/covid-19/report-4-severity-of-covid-19/
 
  • #11
I find the following facts interesting.

Morocco and Algeria have been using hydroxychloroquine since the beginning, ignoring the WHO, who say that it is useless and dangerous.
By contrast, Canada and France follow the WHO and forbid the use of hydroxychloroquine for covid.
The numbers are

Morocco: 36 million
Population: about , number of covid deaths: 202

Algeria
Population: 42.2 million
Number of covid deaths: 623 deaths

Canada
Population: 37.6 million
Number of covid deaths: 6 762

France:
Population: 67 million
Number of covid deaths: 28 596

I have other interesting facts explained by the Dr Raoult, I could link to some interview but it is in French.
I will be happy to summarize his observations, but I will first see if I get censored for posting the above facts.
This medicine is NOT antiviral. It's basically used to treat malaria. Malaria is a blood disease caused by mosquitoes. You cannot use an antimalarial to treat an antiviral infection. This is like saying you will use apple seeds to grow a car. It doesn't make sense. I know in America everyone considers themselves scientists when it comes to everything, which is why I hate to talk about medical topics since I went to school for 6 years ( not in America, I actually studied medicine) and then practiced for 20 years, and with all that, people bring me a Wikipedia article and argue which is very stupid. I don't believe in pseudoscience or pseudomedicine. Using hydroxychloroquine for viral infection is the most stupid thing anyone could ever do. DO NOT believe those who are half scientists or half doctors. You are better than this.
 
  • #12
atyy
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Morocco and Algeria have been using hydroxychloroquine since the beginning, ignoring the WHO, who say that it is useless and dangerous.
By contrast, Canada and France follow the WHO and forbid the use of hydroxychloroquine for covid.
The WHO has said that there is good reason to test hydroxycholoroquine for COVID-19, but that more data is needed to decide on its safety and efficacy in the context of COVID-19.

https://www.who.int/news-room/q-a-detail/q-a-hydroxychloroquine-and-covid-19
"WHO has cautioned physicians against recommending or administering unproven treatments to COVID-19 patients, and cautioned people against self-medicating with them. The consensus among world experts is that the potential exists but that far more studies are urgently needed to determine if existing antiviral drugs can be effective to treat COVID-19. If these treatments prove to be effective, they could reduce the burden of COVID-19."
 
  • #14
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The study that "proves" hydroxychloroquine is dangerous and should not be used is under some question. There's an open letter around - you can read it here https://zenodo.org/record/3865253 - complaining about the Mehra et al. study.

At least some of their complaints have held water - they claimed the numbers didn't add up for Australia and Mehra has provided new numbers that do. There larger complaint, though, is that neither the data nor the code used to draw the conclusions is made available. I believe that's a fair complaint.

The fact that this is dragging on tells us that hydroxychloroquine is neither a miracle drug nor a deadly poison. However, it has been politicized to the point where we are asked to pick one or the other.
 
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  • #15
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There is no one single study that proves or disproves the efficacy or safety of the drug. Hydroxychloroquine has long been used as a drug for various conditions (such as malaria and various autoimmune conditions), and it is well known to be associated with some severe side effects (though most associated with chronic use vs acute). As with all drugs, doctors and patients must perform a risk/benefit analysis to weigh whether the risks of the potential side effects outweigh the potential benefits.

Currently, there are a various studies showing efficacy of the drug and various studies showing no efficacy. A non-peer reviewed meta-analysis that combines the data from 11 studies (3 randomized controlled trials and eight observational studies, which do not include the Mehra et al. study) saw no evidence of improvement in clinical progression, mortality or viral clearance from those taking hydroxychloroquine.
 
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  • #16
nrqed
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01:45 infographic​
CFR = Number of people who died of COVID 19 / Total number of people who got infected​

They may go on to correct this later, but I'm not willing to sit through it to find out.
It's mostly very basic beginner stuff, for people who've never heard of any of this before.
Thanks for explaining it to people who are ignorant, like me.
This is indeed what I thought CFR meant. The problem is what I said in an earlier post: I have never seen anywhere that the CFR in Canada was anywhere near 7%. It i snot even 1%. So I wonder what numbers were used for that.
 
  • #17
OmCheeto
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Thanks for explaining it to people who are ignorant, like me.
It would fill a book if I listed every time someone educated me, here at PF.
This is indeed what I thought CFR meant. The problem is what I said in an earlier post: I have never seen anywhere that the CFR in Canada was anywhere near 7%. It i snot even 1%. So I wonder what numbers were used for that.
I'm afraid I don't understand your question.
 
  • #19
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"Scientists Question Validity of Major Hydroxychloroquine Study
Experts demanded verification of data and methods used in a study of drugs to treat Covid-19. The study suggested the drugs might have increased deaths."


https://www.nytimes.com/2020/05/29/health/coronavirus-hydroxychloroquine.html
Here is the open letter.

https://statmodeling.stat.columbia....and-data-integrity-of-Mehra-et-al_Final-1.pdf

It's an interesting case; a highly influential paper based on guarded, privately held data. There is a trend to demand open data and open code for these kind of studies. But it seems that due to privacy laws and other legal issues with sharing medical data, sometimes this might not be possible currently. Gathering large EHR data into databases has a lot of value, but data secrecy violates the integrity of the data. Apparently gathering EHR records normally is very complex and time consuming as well.
 
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nrqed
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I'm afraid I don't understand your question.
My question was: where did they get a mortality rate of 7%?
At ther very beginning, the WHO vastly overestimated the mortality rate to be around 3.5%. Since then, all studies have shown that the real mortality rate is around 10 times smaller.
 
  • #21
atyy
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My question was: where did they get a mortality rate of 7%?
At ther very beginning, the WHO vastly overestimated the mortality rate to be around 3.5%. Since then, all studies have shown that the real mortality rate is around 10 times smaller.
The WHO's estimate was of the CFR [deaths/reported cases], and it also said that its estimate was provisional. It was not at the very beginning that the CFR was at 3.5% - that was after the start of the major outbreaks in Italy and Iran - while the major outbreak was in China estimates were around 2%. The WHO's early estimates of the IFR [deaths/all cases whether reported or not] was a range from about 0.3% to 1%, which remains reasonable, although still provisional.

Also, the IFR depends on how well patients can be treated. In an overwhelmed healthcare system, the fatalitry rate may be higher. But if patients are able to have resources devoted to them, the fatality rate may be lower. I heard a talk by Graeme MacLaren in which in the early phase of the outbreak 90% of extracorporeal membrane oxygenation (ECMO) attempts for COVID-19 in China died - was that because ECMO was not effective, or was it because the system was overwhelmed, and ECMO was not sufficiently optimized for each patient? In the time since then, worldwide estimates currently estimate that about 50% of COVID-19 patients who receive ECMO recover well enough to be discharged.
 
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I have never seen anywhere that the CFR in Canada was anywhere near 7%. It i snot even 1%. So I wonder what numbers were used for that.
From official government sources : currently it looks like 8% if you're comparing deaths to total cases ; 11% for deaths to recovered. I've watched both numbers slowly merge over the past couple of months as the statistics catch up with each other.

Where are you getting "'snot even 1%" ? Have you tried Google ?
 
  • #23
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From official government sources : currently it looks like 8% if you're comparing deaths to total cases ; 11% for deaths to recovered. I've watched both numbers slowly merge over the past couple of months as the statistics catch up with each other.

Where are you getting "'snot even 1%" ? Have you tried Google ?
Any quick search provides many references. Just one example: a meta-analysis finds an IFR ranging from 0.49% to 1.01%.
https://reason.com/wp-content/uploads/2020/05/COVID-19-IFR-estimates.pdf

Or "The CDC says that its best estimate is that 0.4% of people who show symptoms and have covid-19 will die",
https://boston.cbslocal.com/2020/05/22/coronavirus-cdc-symptoms-asymptomatic-mortality-rate/

I could literally provide dozens of sources. They are not hard to find.
 
  • #24
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The Lancet just published an "expression of concern" about the Mehra study:

Important scientific questions have been raised about data reported in the paper by Mandeep Mehra et al Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis published in The Lancet on May 22, 2020. Although an independent audit of the provenance and validity of the data has been commissioned by the authors not affiliated with Surgisphere and is ongoing,
with results expected very shortly, we are issuing an Expression of Concern to alert readers to the fact that serious scientific questions have been brought to our attention. We will update this notice as soon as we have further information.
This, of course, has no bearing on other papers.
 
  • #25
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I have never seen anywhere that the CFR in Canada was anywhere near 7%.
CFR is deaths/identified cases. For Canada that's 7395/92410 = 8%. The CFR is clearly a function of who you test and how much.

"The CDC also says its “best estimate” is that 0.4% of people who show symptoms and have Covid-19 will die" is not the CFR. It's not even the IFR, although when you couple that with 35% don't show symptoms, you can calculate it (2.7%).

Both of those numbers are strongly influenced by the number of elderly and extreme elderly in your population.
 

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