Post #701: Spike in Virginia cases, and other things the media have gotten wrong

No spike in cases

Source:  Analysis of data from the Virginia Department of Health.

You may have read that Virginia reported a big spike in coronavirus cases yesterday.  Reported is the operative word there.  The “spike” is an artifact of data reporting, not an actual uptick in cases.

Note that the next-to-last bar above is very short, and the last one (the “spike”) is very long.  That’s because most of the cases, for both days , were reported on 5/25/2020.

The Virginia Department of health says this:

VDH Statement on May 25th COVID-19 Data - VDH performed maintenance on its disease reporting system yesterday. COVID-19 data reported during that time were added to today's numbers.

The reality of it is far more boring:  Fairfax keeps producing 200 to 300 new cases a day, and Virginia keeps producing 800 to 1000 new cases a day.  And Vienna (ZIP 22180) keeps producing maybe 4 or 5 a day, on average.

 


Hydroxycholorquine plus zinc cut death rate in half in one large observational study.

In all of the chaos surrounding the President, people have lost sight of the fact that hydrocychlorioquine was being studied as a COVID-19 treatment for some very good reasons.  I’m not not to do citation of sources here (because I already did an entire post on this drug), but in a nutshell:

  • It was shown to be effective in vitro (in a test tube) against the first SARS outbreak (SARS 2003).
  • It was then tested and shown to be very effective in vitro against the current SARS (SARS-CoV-2, or COVID-19).
  • It was already in NIH-registered clinical trials as a prophylactic (preventative) against COVID-19, for health care workers, combining a low dose of hydrocychloroquine with zinc supplements.
  • There were seemingly credible case reports from widely-separated US physicians, to the effect that early treatment with the combination of zinc and hydroxychloroquine seemed effective.
  • The presumed mechanism of action was that hydroxychloroquine was one of just a handful of zinc “ionophores”, substances that allow zinc to cross cell membranes.  High intra-cellular zinc levels were shown to suppress replication of the virus.

You’ve all now seen the results of a large scale “observational data” study, showing that hospitalized patients who were given hydroxychloroquine did remarkably worse than those who weren’t given it.  My recollection is that those who were given hydroxychloroquine had a death rate that was almost 50% higher than those who weren’t.

In my career, I probably did 30 or 40 such observational studies — when I couldn’t talk my clients out of it.  And without notable exception, they always showed that people who were given the drug (device, treatment, etc.) did worse that those who weren’t.  For the simple reason that you only give the drug (device, treatment, etc.) to very sick people.

In these observational studies, the overwhelming direction of causation runs from severity of illness to the treatment given.  Any modest effect that the treatment may have had, on severity of illness, gets swamped by that.

In all likelihood, that observational study reflects the fact that hydroxychloroquine — an unproven drug with significant side effects — was only used as a last resort.  Doctors took a flyer on that, on average, for patients who were at considerable risk of death.  Further, the studies didn’t use the drug in combination with zinc, which, per physician case reports, is the combination that works.

And now there’s a different observational study out, this time comparing hydroxychloroquine plus zinc to hydroxychloroquine alone or in combination with other drugs.  In other words, this is a look with a population that was sick enough that the physicians decided to take a chance on hydroxychoroquine.  While the use of zinc supplements or not was not randomized, the comparison of treatment and control arms certainly makes it look as if they were pretty much chosen at random — no difference between the two.  Reading between the lines, the necessity of supplementing with zinc only became public half-way though their study, so they added it to the protocol.  So this is more-or-less a pre-post comparison of patients, in a single hospital, where zinc was added to the hydroxychloroquine protocol.

This study — not yet peer-reviewed, but available as a pre-print — concludes the following:

After adjusting for the time at which zinc sulfate was added to our protocol, an increased frequency of being discharged home (OR 1.53, 95% CI 1.12-2.09) reduction in mortality or transfer to hospice remained significant (OR 0.449, 95% CI 0.271-0.744). Conclusion: This study provides the first in vivo evidence that zinc sulfate in combination with hydroxychloroquine may play a role in therapeutic management for COVID-19.

In a nutshell, the odds ratio (OR) for dying/going to hospice (0.449) means that  those who were given the zinc were half as likely to die.  The odds ratio for being transferred to home (meaning, well enough to get by without post-acute care, and not dying in the hospital) show that those given zinc were about 50% more likely to be able to go home unaided.

I get the feeling that this study isn’t going to get much press, so I thought I would bring it forward here.

Fact is, this is an exceptionally cheap treatment.  And, from what I’ve seen, those odds ratios are better than what you can achieve with the best anti-virals.  Those anti-virals cost, oh, thousands of times more than the combination of zinc and hydroxychloroquine.

Because no drug manufacturer stands to profit from this treatment, any tests of efficacy will have to be done outside of the drug industry.  And any push to get results made public, ditto.