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Here is the relevant file to comb over for today's dexamethasone result:

⁶ https://www.recoverytrial.net/files/recovery_dexamethasone_s...

Relevant passage:

> A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).

Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75]; p=0.14).

Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone.

Given the public health importance of these results, we are now working to publish the full details as soon as possible.

Can we please stop these histrionic comments.... that was a bad human mistake, and your comment reads like you are screaming on top of your lungs to throw all the results away.

But, does it invalidate the results of this trial at all?

If these results hold (by other studies), cutting death rates by 1/3rd is a huge positive result...

I clearly said draw no conclusions. I don't do histrionic. I have been following and archiving the pandemic the entire year.

Your post started with:

> This is the RECOVERY trial. They have already likely killed patients through gross incompetence

That could be used as the dictionary definition of histrionical. "They" meaning an entire study group killed people? Well, no, actually a single doctor MIGHT have, during a single incident. You've over dramatised reality to the point of absurdity, thus histrionical.

The person responsible for the initial error is quoted in today's article. I singled him out in my comment. It takes more than one researcher to ignore a protocol calling for a dosage 3x in excess of that used by any other study, then paper over the fact that this happened.

>Well, no, actually a single doctor MIGHT have, during a single incident.

You'll find that I used the word "likely", indicating a lack of absolute certitude. This is a statistically reasonable statement based on their dismal HCQ results.

Please stick to material critique of the informational content conveyed.

What does this have to do with Dexamethasone?

They might have made that mistake. Humans make mistakes. afair 30% of all human death in hospital are caused by incompetence or a mistake.

UK covid handlig/research is full of grossly incompetent things. First they went for herd immunity because their flawed models predicted that it'll be okay, then they backtracked the last moment. Then they announced that their vaccine will be ready by fall when every other respected scientist said that it'll take a year. Something if off to me with the UK academic standards in medicine.

I don’t follow British corona policy closely, but as far as I can tell, the they in those sentences, in most cases, were politicians (that also _had_ to make choices based on very much incomplete information, but that’s a different subject). You can’t blame UK academic standards for that.

The herd immunity thing was the UK’s admittedly shambolic government; scientists and the medical profession immediately raised concerns. And I don’t think anyone’s saying the Oxford candidate vaccine will actually be available and approved for mass use this year?

> And I don’t think anyone’s saying the Oxford candidate vaccine will actually be available and approved for mass use this year?

That genuinely is the goal. The current aim is October I believe. A quote from their website says "deliveries starting by the end of 2020".

https://www.ovg.ox.ac.uk/news/astrazeneca-to-supply-europe-w...

That assumes everything goes well, which is a big if, but seems possible. The fact we've had no bad news so far despite the advanced trials is good news.

Theirs is AZD1222, fka ChAdOx1 nCoV-19. It has goofy delivery dates for multiple markets.

We've had no bad news because it's a simple design that bets on robust immune response doing the job. It's in contractors' interest to push ferocious timetables regardless of whether this vaccine strategy is viable: if it isn't, payouts are still secured prior to evidence of this coming to light, so they don't get stuck holding the bag. If it is, they're getting to market by next flu season.

https://www.precisionvaccinations.com/vaccines/azd1222-sars-...

It's in everyone's interest to make any vaccine available as soon as possible if shown to be both safe and efficacious.

The vaccine is being produced at no-profit: https://www.precisionvaccinations.com/400-million-coronaviru...

> We've had no bad news because it's a simple design

That makes no sense. We will have news if it fails to stop people getting badly ill, in which case they'd have to go back to the drawing board.

>a simple design that bets on robust immune response doing the job.

That means greater surveillance time, because so little has been established about activity thresholds that might be deemed properly immunizing. Greater reliance on strong immune response than more complex designs means greater uncertainty with respect to each step of the trials, including projecting general population results from challenge trial results.

So the bad news can't come as fast as it might for other designs. So far, the main worry has been poor activity in monkey challenge testing. But that's not enough to call "bad news" yet. https://doi.org/10.1101/2020.05.13.093195

There's no downside to proceeding with manufacturing at full speed provided the financing is secured, yes. That's what I was getting at. "Produced at no-profit" still comes with significant opportunities for contractors and liabilities if they haven't been paid yet. It would be a nightmare for a public-private partnership to fall apart with manufacturing costs left uncovered because a vaccine platform has fallen out of favor. At the scale of multinationals, even issues like brexit having been pseudo-postponed until the end of 2020 right before all of this stuff hit might have something to do with how they're trying to structure delivery timetables. It's hard to say how any particular firm structures multiple deals with billion dollar pricetags.

That's deliveries of a vaccine which may never be usable. Is there any indication that it'll actually be _approved_ by then?

Manufacture of this promising candidate in advance of full trials and approval probably isn't the craziest thing to do, but my understanding was that there was a significant risk that it would never be approved, never mind by October.

I'm in the Phase 2/3 trial for the Oxford vaccine. They really are doing everything possible to have it ready ASAP (as early as October) if they can. They are reviewing trial results in real time and have scaled the trial to many cities in the UK. They quiz us on exposure and test us for COVID weekly. But they are also clear that the vaccine might not work at all or that it might take longer to find out.

One big issue is that the rate of the virus is the community is dropping quickly in the UK. We are down to less than 1 in ~1,700 having it. So with a trial size of 10-20k people, you can see that the whole trial hangs on a single digit number of people who will be exposed, hence the constant testing to flag those people.

To increase the chances of getting a result, they have stood up a new wing of the trial in Brazil where the virus is more prevalent now.

>What does this have to do with Dexamethasone?

- Shared personnel are hot on the heels of a deeply dubious result and attempted damage control that has involved an outlandish claim of misrepresentation in an interview.

- This has all the right smells so far to expect further questionable research practices.

- A press release was prioritized over a preprint, even though the authors absolutely know that readily-available drugs will be taken up as primary treatment methods as soon as this news meme spreads. They have given the research community zero time to double-check.

- Wildly sensationalist claims made to the press.

>They might have made that mistake.

This wasn't a simple mistake. Look at ice9's exploration on twitter (see [2]). The whole thing's quite damning.

While this mistake by one person may have happened, you cannot really use that to dismiss the whole trial.

Be aware that FranceSoir is not a reputable source, you could liken it to the UK's Daily Mail. And Covexit also looks like a French conspiracist website set up by Pr Raoult's fans.

Sources matter in this debate because populists across the world (and especially in France with controversial Pr. Raoult) are championing hydroxychloroquine with inexplicable passion.

It fits their conspiracist view that the truth about cheap, easily accessible treatments has been hidden so that big pharma could sell more expensive drugs (the news about dexamethasone destroys that argument)

Much like for climate change deniers, you always see the same few rogue scientists and news outlets, and I could immediately spot which side your comment was on just by looking at the links.

New day, new chance to read the article.

Are you ready to read the ref?

I did not dismiss the whole trial.

They were first to this scandal precisely because they are conspiracists. A website with a name like covexit is nothing I would normally link. ice9, who has been a very solid twitter-lit-reviewer on repurposing candidates for quite a while, started the discussion in the anglosphere via primary sources and these tertiary sources. That better sources hadn't covered the topic yet is unfortunate, but time waits for no one and their claims are independently verifiable.

I reviewed covexit's apologia for Raoult, including his absurd response to RECOVERY's HCQ news, before making any post with the link mentioned. The 2020-06-15 paste was imported straight from one of my social accounts. Friends there already have context spread across many months from me re: topics like HCQ and Raoult.

Today's BBC article on dex is spreading like wildfire, exactly like the HCQ meme did. It has great potential to inflict damage. Better sources had to wait.

>I could immediately spot which side your comment was on just by looking at the links.

You presume too much. I work on web archival and synthetic biology. I'm not a fanboy of celebrity doctors/medical research cranks.

Please read [2], understand it, and see if you still have a need to reply.

> The amoebic dysentery answer in this exchange⁽⁵⁾ indicates the confusion with hydroxyquinoline

Why would this answer indicates such a confusion ?