Hi, I joined here after I saw this study-a-thon video https://www.youtube.com/watch?v=VDsZiSzfgqM. I had introduced myself here: Welcome to OHDSI! - Please introduce yourself. But now I was able to look around here in the forum a little more and I am wondering if this is indeed the right place. I think it can be. But I don’t see my topics discussed.
I am not here because of biomedical informatics stuff. I do that professionally, and I have my share of merits in the area. I am not that much interested in data models or vocabulary, all that I do in peace time. But right now, this is war and I feel there is other stuff that needs to be pushed.
We have an urgent need to devise a complete “nuking” strategy of this pandemic. I don’t even care much about the latest life-saving ICU treatment, anti-IL-6, cytokine adsorption columns, whatever. What I think needs to be done urgently is to stop the pandemic. And we cannot wait for a vaccine, we don’t even know if there will be a good one at all. And this social distancing is killing the world economy, that not just the stock market and money, it is is people’s very livelihoods. Every day of delay counts. And I am annoyed with all that time that has already been lost! We knew that hydroxychloroquine (HCQ) was active in vitro against SARS-CoV-1 and yet it took 4 freaking months of the raging epidemic to have some feeble results? And we have all sorts of places, including NYC+FDA beat their chest about starting a trial, that was two (2) weeks ago, and there are no preliminary results? You gotta be kidding me!
HCQ+azithromycin (HCQ+Azm) in all trials is dosed too low, it should at least be starting up the way the malaria treatment is dosed as per label: 800 mg once, 400 mg after 6 hours, then 400 mg after 18 hours. then again after 24 hours, and it could probably go on for a few more days. But ideally dosed even higher in the early phase. Because if you don’t do that, you just end up with the highest dose at the end of the treatment, which makes no sense! Some docs see this, and would want to do a quick trial, but to set it up can be daunting. The whole IRB stuff is completely crazy right now. If I am a doc, I can decide how I want to treat patients, and it is my duty as a scientist to keep records and to learn from my experience. To impede docs from gathering evidence while treating patients is absolutely crazy. We need to facilitate practice trials that do not require a hassle and delay of IRBs.
HCQ is also in a world shortage. We would need 92 tons (and counting) to nuke the disease now, if we knew it works. And we should know by now if NYC didn’t delay the release of the evidence. I don’t know WTH these people think they are doing! Anyway, the world doesn’t have 92 tons and Governments sit on stockpiles and there is just not enough to go around. Synthesis of HCQ is difficult. If you have 4,7-dichloroquinoline and the HCQ side chain all ready, you can make it, but these source materials are also short. And if you try to make everything de novo, it’s like a couple of dozen steps, tedious even to write it all up, let alone actually doing it.
Ivermectin was announced yesterday [https://www.sciencedirect.com/science/article/pii/S0166354220302011] as a very interesting option. In vitro around 5 μM would nail it, which is about 10 times less than HCQ. Problem is that ivermectine is a large molecule, 875 g/mol, and the usual doses are just 6 or 12 g. You would have to drive a high dose above 600 μg/kg or up to 2000 μg/kg, something like 160 mg, which is like 20 times the standard dose! This sounds scary but it is not so much outside the possible, as such high doses have been tried and were generally well tolerated. What’s more, they have been tried in Africa on malaria patients, who were given this dose of ivermectin with anti-malarial for the purpose not to help the patient get better, but to kill mosquitos and thus stop the spread of malaria onto others! My point: there seems to be no ethical problem using ivermectine in higher dose to stop the spread, so what are we waiting for to use it in that dose to both heal the patient AND stop the spread? It will take far too long to get this followed up in the usual slow moving gears of clinical research.
Someone should go out now and look in Africa for people who are already taking high dose ivermectin and see if exposed people get infected. (The HCQ findings on rheumatology patients unfortunately are not so rosy, which is why it’s important to push ivermectin ASAP.) I guess you might even have contacts through the OpenMRS folks that started out in Eldoret, Kenya.
Finally there is Favipiravir. It has shown good promise, better than the lopinavir/ritonavir and should be easier to make (even if not that easy.) Japan is doing study, but it again is taking far too long. What’s the point of coming out with results in June? We need something now.
I feel we must radically change the approach and start rolling out the treatments now for a curative and public health intent and study the outcomes as we go. If it works well, we need to know on a weekly basis. If there are problems we need to know quickly. This paper writing is just bullshit! We need real time data as we move 3 waves of treatment throughout the world and then switch to what is most effective, safe, and available, which attacking the spread of this pandemic at full speed.
So I am here to talk about that. Support it. We can help with software, staff, data, making connections, stirring the pot, fund-raising, collaborating, heck I even have a little foundation of my own to put some money up. I am particularly looking at poor neighborhoods in Brazil where I have friends and I know they have growing numbers of occult cases and a totally defunct public health care system. These people have nothing and nowhere to go. I find it crazy not to go in hard with whatever possibly works and get ahead of this. But you bet the government makes this next to impossible, heck, they aren’t even interested in stopping the disease. So it’s the people who need to do it without the government. If we could make favipiravir we would. If we could figure out a way how to do evidence guided public health intervention by the people, for the people, we would start buying gallons of ivermectin from veterinary stock where it is relatively abundant and still available.
I have contacts to one of the largest Favelas of Latin America. I am really wondering how we could help there with an intervention that might bypass the government red tape. We might even get the “regional government” (= drug lords) involved. I have no scruples because I know that the official government is also full of murderous corrupt mafiosi. What I do care about is being effective and ethical given the real emergent situation.
IMO, the only treatment that will work to stop this is one that can be traded on the free (even if black) market at sufficient quality for cheap. The only other alternative is a massive action by Trump and Modi forcing the hand of the WHO to deliver masses of product into all the world and hand it out in ad hoc roadside health clinics. Going the government chain of command will not work in a timely fashion.
OK, this is what I am here for. Who wants to help? How can I help the effort that leads to this goal?
. No,