Posted on 05/08/2020 10:27:39 AM PDT by SeekAndFind
Clinicians from two hospitals in Boston report that the majority of even the sickest patients with COVID-19—those who require ventilators in intensive care units—get better when they receive existing guideline-supported treatment for respiratory failure. The clinicians, who are from Massachusetts General Hospital and Beth Israel Deaconess Medical Center, published their findings in the American Journal of Respiratory and Critical Care Medicine.
During the COVID-19 pandemic, hospitals around the world have shared anecdotal experiences to help inform the care of affected patients, but such anecdotes do not always reveal the best treatment strategies, and they can even lead to harm. To provide more reliable information, a team led by C. Corey Hardin, MD, PhD, an Assistant Professor of Medicine at Mass General and Harvard Medical School, carefully examined the records of 66 critically ill patients with COVID-19 who experienced respiratory failure and were put on ventilators, making note of their responses to the care they received.
The investigators found that the most severe cases of COVID-19 result in a syndrome called Acute Respiratory Distress Syndrome (ARDS), a life-threatening lung condition that can be caused by a wide range of pathogens. “The good news is we have been studying ARDS for over 50 years and we have a number of effective evidenced-based therapies with which to treat it,” said Dr. Hardin. “We applied these treatments—such as prone ventilation where patients are turned onto their stomachs—to patients in our study and they responded to them as we would expect patients with ARDS to respond.”
Importantly, the death rate among critically ill patients with COVID-19 treated this way—16.7%—was not nearly as high as has been reported by other hospitals. Also, over a median follow-up of 34 days, 75.8% of patients who were on ventilators were discharged from the intensive care unit. “Based on this, we recommend that clinicians provide evidence-based ARDS treatments to patients with respiratory failure due to COVID-19 and await standardized clinical trials before contemplating novel therapies,” said co–lead author Jehan Alladina, MD, an Instructor in Medicine at Mass General.
Paper cited: Ziehr DR, Alladina J, Petri CR, et al. Respiratory Pathophysiology of Mechanically Ventilated Patients with COVID-19: A Cohort Study [published online ahead of print, 2020 Apr 29]. Am J Respir Crit Care Med. 2020;10.1164/rccm.202004-1163LE. doi:10.1164/rccm.202004-1163LE
About Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2019, Mass General was named #2 in the U.S. News & World Report list of "America’s Best Hospitals."
Figures don’t lie, but Liars Figure.
Who’s stats??
Death/cases is a moving target. There is no static measurement.
There is no way the Texas has a 2.8% death rate (deaths/cases).
The number is way below 1%
Looks like that protocol that you posted includes this:
Oral Hydroxychloroquine
a. 400 mg every 12 hours for one day
b. switch to 200 mg every 12 hours for a total of 4 days
Agreed, but these were patients already hospitalized, so way too late from the get go.
Notice that that much ME-dia touted failed VA clinical trials of hydroxy was designed to fail by dosing patients with triple this amount! Plus only using men over age 65 already in critical condition
And no zinc
Excellent. Those are better odds than surviving Remdesnivir without serious side effects or permanent liver damage (48% affected in so-called recent trial success)
RE: Notice that that much ME-dia touted failed VA clinical trials of hydroxy was designed to fail by dosing patients with triple this amount! Plus only using men over age 65 already in critical condition
And no zinc
________________________________
What about the latest study again fund by the NIH?
This was done at the New York–Presbyterian Hospital (NYP)–Columbia University Irving Medical Center (CUIMC), researchers examined 1,446 patients, 70 of whom were discharged, had passed away or were intubated too early in the study.
See here:
It concluded that there were lackluster results when coronavirus patients receive hydroxychloroquine as a treatment.
RE: It turns out that the CDC adjusts already-published figures for days or even weeks after they are originally posted, and the numbers I saw when I went back bore no resemblance to the original numbers I saw - they had doubled and even tripled.
______________________________
What does this mean? That for the short term, we cannot really take the CDC numbers as accurate? That’s the only conclusion I can make.
That is more credible.
Texas has done large amounts of testing.
We have a low known infection rate and a very low death rate.
Less than 1,000 total for the state. (last number I saw)
But the devil is in the details of the stats. There is no apples to apples rule about ruling if the cause of death is Covid19.
NY is playing big bold games with that. There are financial implications to that.
So, I don’t spend much time looking at the numbers. They simply aren’t consistent.
Designed to fail
Be wary of anything controlled by NIH ( Fauci)
There are now some and will be more entire countries using this safe drug as a frontline treatment.
Just compare their hospitalization and death rates to that of NY
They never seem to state what the “standard” medicines, or therapeutics that are given to Rona patients. Surely it’s not just “ventilators”. Injections? pills? transfusions? What? We’re raising a whole class of sloppy thinkers.
Sure it is...
So now I’m confused. Are they saying HCQ should be part of standard treatment? They also were giving statin drugs too. Wouldn’t this be more evidence that HCQ is effective?
Outcome of study of 66 patients? Authoritative!
Outcome of thousands of patient recoveries on HCQ? Anecdotal!
Bkmk
Well I just saw the tables in the back of the paper and I have to admit it’s very confusing.
According to the tables, most of the 66 were on HCQ/Zpak but then there is an overlap of remdsivir/placebo and none of this is discussed in the paper. Very strange.
Now we read the authors wrote their review covering March 11 through March 30 and they are studying EHR data.
We know that the FDA did not approve HCQ/Plaquenil for COVID-19 emergency treatment until 3/30/2020. So they weren’t using HCQ in the period they reviewed the EHR. Why they put it in the paper is a mystery. I’ll find out directly. Maybe after March 30 they began HCQ therapy but results are not in this paper at least not a primary aim of this paper.
No mention is made of HCQ/Zpak or remdesivir, etc. in the front end of the paper.
Here’s what the authors write in the front end:
“Detailed characterization of COVID-19 respiratory failure and its response to established ARDS therapies are needed before rigorous comparisons of established and new trategies are contemplated. We describe the respiratory athophysiology of patients with COVID-19 respiratory failure treated with invasive mechanical ventilation at two tertiary care hospitals in Boston, Massachusetts, USA.”
They were focusing on ventilation, intubation, and related outcomes involving treatment courses they are trained for. To me they are not administering HCQ therapy. Perhaps later they started HCQ therapy? But they are extracting EHR data to get a baseline on respiration therapy interventions and outcomes.
Zeloenko has had upwards of 1500 patients or so of which some needed hospitalization and survived and there were very few deaths (like 4). His report 2 weeks ago states there were 4 intubations and I think one of those died.
Yet this paper has 66 patient records reviewed of which 19 were intubated. That’s not surprising as it’s expected that ERs and ICUs see all the worst cases come through their doors.
As MassGen and Beth Israel are Harvard system hospitals, they receive patients from all over that require hospitalization. Why most of the patients appear to be on HCQ is perhaps there are no other ‘new therapies’. They put remdesivir/placebo in the table as if it’s a placeholder. It doesn’t make much sense. I may call them Monday and drill down on what their paper is trying to describe.
Other than that, this paper is valuable only in the sense that respiratory specialists treat patients with COVID-19 using ventilation/intubation. The EHR show a high fatality rate. I haven’t reviewed yet the fatality rate in the other referenced studies but I would expect MassGen is on par with Seattle and achieving better outcomes than Italy and China because of the system’s high degree of specialization.
RE: I may call them Monday and drill down on what their paper is trying to describe.
Thank you for this effort. I look forward to your comments regarding what you have found out from them in this thread.
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