Corona Virus #7

[rswyan]

I've been to a couple of grocery stores in the past couple of weeks. I don't see staff interacting with customers much at all. The deli counter and meat counter where you would have conversations with the staff have been shut down temporarily. The cashiers at check out are protected by a 4ft by 4ft plexiglass barrier. I imagine most restocking is still done at night when customers are gone. The staff at most "risk" of being close to customers are the produce guys who are constantly refilling bins of produce.

Look for online ordering and "call us when you're in the parking lot and we'll load your groceries" expedited pick up to become a much bigger deal in the months ahead ... might even become a thing ...

Order Acme

 

[rswyan]

Interesting ... there were just 5 threads outside of FP spammed with political content ... with links containing malware.

 

[RSR]

1) The key issue here is the value of an "open-label non-randomized clinical trial". FDA never accepts these as they are chock full of uncontrolled bias that can be difficult to weed out. It is a fancy way of saying "I gave the drug to whomever I wanted to and excluded patients I didn't want to get it for whatever reason". In addition, in this paper it is clear that they didn't even have a control group in their own hospital. They used a different hospital for controls. That is almost never acceptable as you don't know what the differences in patient populations are. For example, one hospital might be a middle class referral center (think Mayo Clinic) and the other might be an inner city gun and knife club filled with addicts and poorly nourished patients (this is obviously and extreme example). You simply cannot legitimately use a control from another facility unless you know the hospital populations are very similar and that the criteria for admission, testing, supportive care, laboratory quality etc etc are the same. The fact that the study wasn't randomized means that the investigators get to choose who they treat and that simple fact introduces another whole type of potential bias called selection bias. The type of study done by the French is equivalent to cherry picking opinions on the Internet without knowing anything about the people posting. Not a good idea. That's why FDA insists on double blind (investigator nor patient knows whether they get the experimental drug or placebo so there cannot be bias in assessing the effectiveness later) and randomized (investigator doesn't get to choose who gets put in which arm of the trial).

Regarding the journal International Journal of Antimicrobial Agents: not a top tier journal for starters. Not terrible but not read nearly as much as Lancet, NEJM or a couple of dozen infectious disease journals etc etc. Why not publish in a more widely read journal if you are trying to get the word out??? Several reasons. For starters it is the type of trial that rarely is published anymore for the reasons I just reviewed. Another reason is that that journal is run by an editor who is in Marseille the same city where the study is done. Home town advantage?? I would not consider this to have been a peer reviewed study based on what I can see. It is more likely an old boy's club review and as the senior author is a well known politically powerful character, I doubt it was a vigorous review at all.

I agree it isn't a complete study. In fact it needs to be completely redesigned in order to generate any useful data. Randomized double blinded controlled trial with external review. Fair enough to point out that such a trial would take more time (but not that much more) but knowing that an anecdotal report (which is all that an open-label non-randomized clinical trial is) is next to useless in making serious medical decisions, it should never have been presented as something that should be immediately adopted. I don't expect Trump to know that but Trump should know to listen to Fauci and Fauci knows exactly that which is why he refused to endorse chloroquine.

I was half joking about the appearance of the senior author and indeed I pointed out that I have worked with some pretty weird looking scientists who I hold in high regard. Einstein didn't announce his theories on YouTube!

I don't disagree at all with your points about selection bias, unmatched controls, etc. Those are certainly limitations of the study. But, ask yourself, then, why you didn't perform a better study?

Your answer may be quite revealing. I'm guessing it will be somewhat along the lines of, "I don't have the expertise", or "I don't have access to the needed patient population," or "I don't have the funding to run the study," etc. Quite frankly, I applaud the authors for doing what they could with the data they have. I find casting aspersions from afar detrimental, negative, and not helpful. If you don't think the study was done right, then do it yourself, correct the mistakes, and publish it.

Finally, the study also doesn't claim to be a final say on whether the approach is or is not effective. Quite the opposite, there are many comments along the lines of "Our preliminary results show ...", and "further studies on the combined effect are needed ..."

Again, the study has some serious flaws and shortcomings, but what it does do is provide compelling evidence that there may be targeted approaches that could lead to success.

 

[Jaylegger]

Interesting ... there were just 5 threads outside of FP spammed with political content ... with links containing malware.

I clicked on one of them but stopped before before it opened.

 

[dragoneggs]

Again, the study has some serious flaws and shortcomings, but what it does do is provide compelling evidence that there may be targeted approaches that could lead to success.

Especially considering the circumstances... seems quite a few people are facing a life threatening situation in the short term. It probably is not the long term solution but seems worth it to continue to explore and 'experiment' as a short term treatment.

 

[rswyan]

I clicked on one of them but stopped before before it opened.

I suspect you will see similar in the coming days ...

 

[CobyRupert]

Agree...but if they are looking for easy targets...they move on elsewhere. The public road dead ends at my gate. There is a turn off for a two track about 150 yards before my gate. So "traffic" is non existent except during snowmobile or off-roading seasons.

I have "met" trucks heading to our place before and always ask, "Are you lost? Do you need directions?"

Tell them a lot of your neighbors have been noticing them and one is always seeing the truck with his plate number on his camera.
If they’re trouble and their anonymity is gone and they know they’re being watched, they’ll move on to easier pickings.

 

[ruffdog]

A choir practices...out of 60 people, 45 sick and 2 dead. Did they think they were immune? Nursing homes around the country are infected. We are only getting started with this mess.

2 Choir Members Died Weeks After Rehearsal amid Coronavirus Spread | PEOPLE.com

 

[pennwalk]

How long do you think we can go before we have to restart the economy regardless of how many die?

Chris

 

[Gale Hawkins]

I don't disagree at all with your points about selection bias, unmatched controls, etc. Those are certainly limitations of the study. But, ask yourself, then, why you didn't perform a better study?

Your answer may be quite revealing. I'm guessing it will be somewhat along the lines of, "I don't have the expertise", or "I don't have access to the needed patient population," or "I don't have the funding to run the study," etc. Quite frankly, I applaud the authors for doing what they could with the data they have. I find casting aspersions from afar detrimental, negative, and not helpful. If you don't think the study was done right, then do it yourself, correct the mistakes, and publish it.

Finally, the study also doesn't claim to be a final say on whether the approach is or is not effective. Quite the opposite, there are many comments along the lines of "Our preliminary results show ...", and "further studies on the combined effect are needed ..."

Again, the study has some serious flaws and shortcomings, but what it does do is provide compelling evidence that there may be targeted approaches that could lead to success.

Keep in mind there are doers and there are others that focus on knocking the efforts of the doers. Every doctor knows the best sources from time to time print junk studies. Peer review is a good thing unless there are behind the scene agreements like you support my research and I will support your research so we both have a shot at another round of grants.