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Comment by stephc_int13 | Hacker News Reader

This can't be serious.

"mortality by Day 29 for these patients was 11.4% with remdesivir therapy as compared to 15.2% with the controls."

"HCQ-treated patients did not survive better than those not getting the drug: 27% of them died within 28 days, versus 25% in the standard of care group."

Those mortality rates are clearly indicative of a strongly biased test group, even if they call it randomized.

The normal mortalit rate for Covid-19 is about 0.5% for the general population, and even if you can discuss that and say that is is closer to 3% in some areas, it is not 15% and not 25%.

Those studies are about the effect of remdesivir and HCQ for terminally ill patients.

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From the methods summaries:

"We conducted a double-blind, randomized, placebo-controlled trial of intravenous remdesivir in adults who were hospitalized with Covid-19 and had evidence of lower respiratory tract infection." [1]

"In this randomized, controlled, open-label platform trial comparing a range of possible treatments with usual care in patients hospitalized with Covid-19, we randomly assigned 1561 patients to receive hydroxychloroquine and 3155 to receive usual care. The primary outcome was 28-day mortality." [2]

These trials are explicitly about treating hospitalized patients, which is of course a group with a higher mortality than the general population. Nobody is saying otherwise. Remdesivir is administered intravenously, so it is unlikely you would try to deliver it to people with mild or asymptomatic infections. The comparison between the drugs in the general population would be very hard to do for that reason. Severe illness due to SARS-CoV-2 is such a huge problem that I'm not sure who would instead investigate a drug specifically for mild cases.

[1] https://www.nejm.org/doi/full/10.1056/NEJMoa2007764?query=fe...

[2] https://www.nejm.org/doi/full/10.1056/NEJMoa2022926?query=fe...

You investigate drugs for mild cases for the same reason you give Tamiflu within 48 hours of symptoms, that you excise malignant lesions before they metastasize, and that you put out a fire with an extinguisher instead of waiting it for it to burn down half the house so you can call the fire department.

Right, I didn't phrase that well. It would be nice to be able to treat covid early in the infection. However, research time and resources are limited. To work with your analogy, at the moment we are trying to put out the active fire of people at risk of death, rather than installing fire extinguishers and smoke alarms in an actively burning building.

Not if the drug costs US$2000-$3000 per treatment.

Do you know that tamiflu doesn't do much either?

https://www.nhs.uk/news/medication/effectiveness-of-tamiflu-...

> It found that both drugs shorten the symptoms of influenza-like illness by about half a day in adults (but not in asthmatic children), compared to a placebo. There was no reliable evidence that either drug reduces the risk of people with flu being admitted to hospital or developing serious complications such as pneumonia, bronchitis, sinusitis or ear infection. Used as a preventative measure, Tamiflu and Relenza slightly reduced the risk of developing the symptoms of flu. The review also found no evidence that these drugs can stop people carrying the influenza virus and spreading it to others.

> The study also found that Tamiflu slightly increases the risk of adverse effects such as nausea, vomiting, psychiatric and kidney problems in adults, and vomiting in children.

Randomized means that the decision about who receives the drug and who receives the placebo is done randomly. Not that the participants are a random subset of society.

The trial was done on hospitalized patients who obviously have a much higher mortality rate than patients overall. That’s the correct population to be studying, because that is the population that would receive the drug. It is administered intravenously.

None of this is indicative of bias on the results. It is the correct way to do clinical trials.

This way to studying the effect of a molecule is very narrow.

The problem is that they are implying that absence of positive effect on a late treatment on very ill patients can be extrapolated.

This is not the case.

They are implying no such thing.

Most people are not reading the papers. Not stating that the randomized target is a specific subset is misleading.

I don’t see what is misleading. The drug trial was done on the target population of the drug. That is how drug trials work.

I don’t see any reason for anyone to assume that the trial was done on a random subset of the population. That would be a irrational way to do drug trials, and it makes no sense to assume they are done that way.

HCQ needs to be administered early before symptoms are severe and with zinc and azithromycin.

This is not what is being tested here, and this is why studies like this one are misleading.

The title should be explicit: HCQ does not show better outcome for patients when administered late.

HCQ is most expected to work at low doses on mild cases.

So this is NOT the correct population to be studying.

This is clearly stated in the article:

"You can see that these were indeed at-risk patients – the overall mortality rate in the general population for coronavirus infections is nowhere near those rates, and it’s a damn good thing it isn’t. The mean age of the patients was 59 years, 64% male, with 50% of them having hypertension, 45% of them obese, and 30% with Type 2 diabetes. So even though they were characterized as mild-to-moderate on enrollment, this was just the sort of group that you’d worry about as a physician."

It is still a valuable study even if it is not a study done on the general population.

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