Wuhan Coronavirus Resource Thread

saip · Post by **saip** » 29 May 2020 07:37

NY Times allows five free articles per browser per computer. So if you have three browsers on two computers you have 30 free per month. Rarely you need that many to read anyway.

ricky_v · Post by **ricky_v** » 29 May 2020 07:44

if you do not want to patronize media but are curious as to what they say, save link with archive.is .Here is the entire article on http://archive.is/MV18A

mukkan · Post by **mukkan** » 29 May 2020 08:58

Yale study shows hydroxychloroquine effectively prevents Covid-19 in outpatients

Evidence about use of hydroxychloroquine alone, or of hydroxychloroquine+azithromycin in inpatients, is irrelevant concerning efficacy of the pair in early high-risk outpatient disease. Five studies, including two controlled clinical trials, have demonstrated significant major outpatient treatment efficacy. Hydroxychloroquine+azithromycin has been used as standard-of-care in more than 300,000 older adults with multicomorbidities, with estimated proportion diagnosed with cardiac arrhythmias attributable to the medications 47/100,000 users, of which estimated mortality is <20%, 9/100,000 users, compared to the 10,000 Americans now dying each week. These medications need to be widely available and promoted immediately for physicians to prescribe.

https://academic.oup.com/aje/advance-ar ... 93/5847586

anmol · Post by **anmol** » 29 May 2020 13:05

saip wrote:NY Times allows five free articles per browser per computer. So if you have three browsers on two computers you have 30 free per month. Rarely you need that many to read anyway.

Install this: https://github.com/iamadamdev/bypass-paywalls-chrome

Gyan · Post by **Gyan** » 29 May 2020 14:34

There were some Interviews of Oxford experts circulating on net, which if I understand, seem to say that some people have inherent immunity against coronavirus & they might not even produce (detectable) antibodies. Which means death rate would be very low, something like 0.5% (in UK??) as disease may have spread much much wider in the community and much earlier than we believe.

But Mumbai?

IndraD · Post by **IndraD** » 29 May 2020 16:27

ricky_v wrote:if you do not want to patronize media but are curious as to what they say, save link with archive.is .Here is the entire article on http://archive.is/MV18A

thank you so much, is it possible to read articles on WSJ, Telegraph UK using this method?

DavidD · Post by **DavidD** » 29 May 2020 16:41

disha wrote:
DavidD wrote:
The Chinese vaccine is the farthest along, the only one that has published peer-reviewed phase I results.
Of course! You had like 2 or 3 months headstart over others? That shows.

...Since it uses a live virus that's well known to cause the common cold as the vector, its most common side effect is those of a common cold, which I imagine will be very similar with the Oxford vaccine...
Are you a virologist experienced in vaccine development to comment confidently as above? I would believe that the body to develop antibodies requires a spike protein from coronavirus. And this spike protein will cause similar side effects as that of the WuhanVirus as the body defenses start building up.

If the above is not the case and if it is just like you said above, then why is not China going in for mass immunization and just get to Phase 4. Skip Phase 2 and 3 as well.

I don't know enough about virology and immunology to know the difference between the COVID spike protein inserted into the Adenovirus by each team. It's interesting though that 6/6 vaccinated monkeys in animal studies with the Oxford vaccine contracted COVID (compared to 3/3 unvaccinated monkeys), but only 1/8 of ferrets with the Chinese vaccine contracted it (compared to 7/8 in unvaccinated ferrets).
Maybe by accident an attenuated WuhanVirus was injected. How do you know that was not the case? Do you trust the data provided by the Communist dictatorship in China?

I'm not trying to rag on HCQ, I suspect it can show an efficacy when used early as well, but there's simply no scientifically significant data to prove that thus far.
But there is enough scientific data on the Chinese vaccine for WuhanVirus!

Studies after studies show that HCQ is safe prophylaxis against WuhanVirus and it can be provided to frontline as well as certain segments of immuno-compromised population or population with co-morbidities.

Just that China will not talk about HCQ since the honour and dignity will be accorded to India for restarting the world economy while internally it might even be giving out HCQ as prophylaxis and in the meantime again influencing WHO to tell lies.

I will leave it up to you to dig the scientific details.

Not an experienced virologist, just a board-certified physician in California.

You seem to have a predetermined notion that I'm trying to spin things, but I'll try to answer your questions in good faith. In science, you never know exactly what can happen, so phase 2/3 are still required. With that said, I imagine the Chinese team will fast track those steps, and I imagine most of the rest of the world will as well so we can proceed with phase 4 ASAP.

I do trust the data coming from Chinese research teams, some of them anyway. It seems like The Lancet does as well. Did you know that the reason the whole world is looking at HCQ because of data from China? It was in the aftermath of SARS that HCQ was discovered to have some in vitro effect against SARS, and the reason why it was one of the first medications tried against COVID. Some early positive results from China is also one of the main reasons people around the world started running trials with it.

As for your final point, I'm a little confused. I might not be keeping up with things as much as I'd like, but why would India be responsible for restarting the world economy if HCQ works? Either way, I hope it does work. A lot of lives can be saved and economy can flourish much more everywhere.

ricky_v · Post by **ricky_v** » 29 May 2020 17:59

IndraD wrote: thank you so much, is it possible to read articles on WSJ, Telegraph UK using this method?

Absolutely sir, just paste the url into the required area in archive.is and the entire article will he displayed.

vijayk · Post by **vijayk** » 29 May 2020 18:45

anyone with good phostoshop skills?

Womdering if anyone here with good phostoshop skills?

I want to create his image below with tiny corona virus pictures and put a title "FACE OF EVIL" and make it viral. Any help appreciated

darshan · Post by **darshan** » 29 May 2020 18:51

Rajasthan: Dr Ibrahim tests positive for coronavirus, continues to treat patients at his clinic in Jhalwar

The doctor runs a private clinic in Jhalrapatan are in Jhalawar.
https://www.opindia.com/2020/05/rajasth ... -arrested/

Zynda · Post by **Zynda** » 29 May 2020 18:54

Dr. Ratnadip, any weekly updates Sir? Any updates on the trials in India of Remdesivir and/or Favipiravir? It seems like community transmission has started in Chennai. Also the number of people testing positive in MH is mind bongling.

nvishal · Post by **nvishal** » 29 May 2020 20:46

Mumbai and surrounding distts should have been declared a containment zone(like Wuhan) a long time ago.

There is a steady outflow of people leaving Mumbai in their cars. Very soon, almost every dist in maha might become another mumbai.

People are fleeing towards the rural areas for safety. These places have very little healthcare and testing facilities. If rural Maharashtra gets infected, these people will be running back towards the cities looking for good hospitals. It is a double whammy.

Balasahebs dummy son Uddhav thackeray is about to be hit by a storm. His son aditya is a bigger dummy than him. Collapsing healthcare will start a domino effect.

Bart S · Post by **Bart S** » 29 May 2020 21:00

disha wrote: Also, why is the CFR in TN lower than MH and GJ?

Much better health system, also higher level of testing, i.e case tally while probably still about 20% of the actual infections is at least close to reality, whereas in Mah at least due to low levels of testing relatively speaking the undetected infections are likely to be a much larger pool.

GJ seems to have a severe administrative failure with one hospital alone having 800+ deaths.

darshan · Post by **darshan** » 29 May 2020 21:38

GJ could have solved everything but I hate to say it that in love of money and power BJP screwed it up. At this point, BJP should fall on moral ground as they deserve it. Not only they are incompetent administration wise but they have destroyed the built foundation where people don't see BJP that different from INC anymore. GJ BJP essentially revived and took over INC criminal mafia networks. Imagine if you're Ahmed Patel. Nothing but joy. Just see BJP fall and all your built assets return back to you. This liquor and drug running networks are one of the biggest factors, if not the main factor, for the virus spread post return of jamatis.

There was no shortage of liquor under lockdown in a dry state. No need to say anything further.

sampat · Post by **sampat** » 29 May 2020 21:48

There is varied recommendations on wearing masks. Finland didn't make masks compulsory and today government announced that masks provide negligible benefits. It doesn't provide wearer from getting infected. Theoretically masks could reduce the spread but only marginally.

I have been wearing masks during grocery trips. Thinking about stopping it now.

disha · Post by **disha** » 29 May 2020 23:17

Bart S wrote:GJ seems to have a severe administrative failure with one hospital alone having 800+ deaths.

This is a special community hospital. Special community needs to come out of their ghettoized outlook. 80% of GJ cases are in Ahmedabad and it is concentrated special community wards.

Sad reality, but once stones start flying., It is difficult to convince your local health worker to put their lives at risk against stones, thook (spits) to even test.

Question is why there is higher CFR in a special community.

Vivasvat · Post by **Vivasvat** » 30 May 2020 00:11

sampat wrote:There is varied recommendations on wearing masks. Finland didn't make masks compulsory and today government announced that masks provide negligible benefits. It doesn't provide wearer from getting infected. Theoretically masks could reduce the spread but only marginally.

I have been wearing masks during grocery trips. Thinking about stopping it now.

Are the population density and social habits of your place same as Finland for you to consider following their example?

Ambar · Post by **Ambar** » 30 May 2020 00:19

Europe promises to reopen for summer tourism in wake of coronavirus

https://www.cnn.com/travel/article/euro ... index.html

Looks like the Europeans have learnt nothing from the pandemic and the following carnage this year.

IndraD · Post by **IndraD** » 30 May 2020 02:59

Someone show me the light! When entire West is trying to isolate China, SkyNews UK
is sending team to Chinese lab to mainstream Chinese vaccine, why? Don't they have confidence in Oxford vaccine? And why Chinese vaccine company wants to run phase III trial in UK/Europe?
https://news.sky.com/story/coronavirus- ... m-11996787

IndraD · Post by **IndraD** » 30 May 2020 03:12

https://www.bmj.com/content/369/bmj.m2170
No end to fake news!! BMJ claims Indian doctors told them they do not believe in ICMR

BMJ wants RCT from India to recommend HCQ but doesn't ask how was Remdesivir approved for UK without similar level evidence

DavidD · Post by **DavidD** » 30 May 2020 03:51

IndraD wrote:Someone show me the light! When entire West is trying to isolate China, SkyNews UK
is sending team to Chinese lab to mainstream Chinese vaccine, why? Don't they have confidence in Oxford vaccine? And why Chinese vaccine company wants to run phase III trial in UK/Europe?
https://news.sky.com/story/coronavirus- ... m-11996787

There aren't enough cases in China to run a phase 3 trial. Ideally it'd be run in the US, great healthcare and regulatory system with plenty of cases, but the current political climate probably won't allow that.

IndraD wrote:https://www.bmj.com/content/369/bmj.m2170
No end to fake news!! BMJ claims Indian doctors told them they do not believe in ICMR
BMJ wants RCT from India to recommend HCQ but doesn't ask how was Remdesivir approved for UK without similar level evidence

The RCT results for Remdesivir was published on NEJM last Friday.

DavidD · Post by **DavidD** » 30 May 2020 03:52

DavidD wrote:
IndraD wrote:Someone show me the light! When entire West is trying to isolate China, SkyNews UK
is sending team to Chinese lab to mainstream Chinese vaccine, why? Don't they have confidence in Oxford vaccine? And why Chinese vaccine company wants to run phase III trial in UK/Europe?
https://news.sky.com/story/coronavirus- ... m-11996787
There aren't enough cases in China to run a phase 3 trial. Ideally it'd be run in the US, great healthcare and regulatory system with plenty of cases, but the current political climate probably won't allow that.

IndraD wrote:https://www.bmj.com/content/369/bmj.m2170
No end to fake news!! BMJ claims Indian doctors told them they do not believe in ICMR
BMJ wants RCT from India to recommend HCQ but doesn't ask how was Remdesivir approved for UK without similar level evidence
The RCT results for Remdesivir was published on NEJM a few days ago

IndraD · Post by **IndraD** » 30 May 2020 03:59

DavidD wrote:The RCT results for Remdesivir was published on NEJM a few days ago

https://www.nejm.org/doi/full/10.1056/NEJMoa2015301

This paper will stand out as classic example of intellectual dishonesty!!

CONCLUSIONS
In patients with severe Covid-19 not requiring mechanical ventilation, our trial did not show a significant difference between a 5-day course and a 10-day course of remdesivir. With no placebo control, however, the magnitude of benefit cannot be determined. (Funded by Gilead Sciences; GS-US-540-5773 ClinicalTrials.gov number, NCT04292899. opens in new tab.)

TO be honest I am furious at the dishonesty of the study supported & funded by Remdesivir making company Gielad .
When advantage and benefit of Remdesivir is not known they are trying 5 & 10 days treatment, how lame is that!
There was no placebo group to compare, is this even a study>

Because our trial lacked a placebo control, it is not a test of the efficacy of remdesivir

Mechanically ventilated patients were excluded , well the mild to moderate illness doesn't need any drug anyway!!

DavidD · Post by **DavidD** » 30 May 2020 04:09

IndraD wrote:
DavidD wrote:The RCT results for Remdesivir was published on NEJM a few days ago
https://www.nejm.org/doi/full/10.1056/NEJMoa2015301

it doesn;t show any definite advantage either.
CONCLUSIONS
In patients with severe Covid-19 not requiring mechanical ventilation, our trial did not show a significant difference between a 5-day course and a 10-day course of remdesivir. With no placebo control, however, the magnitude of benefit cannot be determined. (Funded by Gilead Sciences; GS-US-540-5773 ClinicalTrials.gov number, NCT04292899. opens in new tab.)

That's an earlier trial, this is the latest one.

https://www.nejm.org/doi/full/10.1056/NEJMoa2007764

It shows a decrease in recovery time and a trend toward decrese in mortality mostly driven by the less severe cases.

IndraD · Post by **IndraD** » 30 May 2020 04:20

DavidD wrote:That's an earlier trial, this is the latest one.

https://www.nejm.org/doi/full/10.1056/NEJMoa2007764

It shows a decrease in recovery time and a trend toward decrese in mortality mostly driven by the less severe cases.

sir 4 days recovery benefit but no mortality benefit is very unimpressive for $600/dose. In all high risk groups (which matters most including mechanically ventilated) there is no benefit. Refer to figure 3 there lies the expose. Drug works in whites who are anyway low risk. this is all pharmaceutical mafia collaborating with researchers. If you see the result they have hidden the p value for mortality

can't believe these studies are getting published in nejm, lancet etc. They used to have a standard.

DavidD · Post by **DavidD** » 30 May 2020 04:40

IndraD wrote:
DavidD wrote:That's an earlier trial, this is the latest one.

https://www.nejm.org/doi/full/10.1056/NEJMoa2007764

It shows a decrease in recovery time and a trend toward decrese in mortality mostly driven by the less severe cases.
sir 4 days recovery benefit but no mortality benefit is very unimpressive for $600/dose. In all high risk groups (which matters most including mechanically ventilated) there is no benefit. Refer to figure 3 there lies the expose. Drug works in whites who are anyway low risk. this is all pharmaceutical mafia collaborating with researchers. If you see the result they have hidden the p value for mortality

can't believe these studies are getting published in nejm, lancet etc. They used to have a standard.

I agree the results are not very impressive, but it's the only drug that's shown to have any positive effect in a RCT.

Also, I don't know how familiar you are with drug studies, but having little to no mortality benefit in the sickest group is very common. In fact, many drug trials specifically exclude this population. I'm actually mildly surprised that this trial included them.

Again, I don't want you to think I'm trying to pump up Remdesivir. The results are rather unimpressive and I sure as heck hope there are better medications out there or in the pipelines.

As for the cost, I thought Indian law allows for generics to be made available so it shouldn't cost that much for India right? I know the Chinese have started generic Remdesivir for months now when the first incomplete Chinese study showed some early benefit (final results also did not show a mortality benefit in the Chinese study).

yensoy · Post by **yensoy** » 30 May 2020 09:26

DavidD wrote:
IndraD wrote:Someone show me the light! When entire West is trying to isolate China, SkyNews UK
is sending team to Chinese lab to mainstream Chinese vaccine, why? Don't they have confidence in Oxford vaccine? And why Chinese vaccine company wants to run phase III trial in UK/Europe?
https://news.sky.com/story/coronavirus- ... m-11996787
There aren't enough cases in China to run a phase 3 trial. Ideally it'd be run in the US, great healthcare and regulatory system with plenty of cases, but the current political climate probably won't allow that.

Knowing that, the Chinese already lined up their guinea pigs ahead of time https://www.dawn.com/news/1551432.

chola · Post by **chola** » 30 May 2020 10:44

^^^ Emphasis on pigs.

srai · Post by **srai** » 30 May 2020 11:08

srai wrote:

https://www.worldometers.info/coronavirus/

Date: April 2, 2020
1 million cases
50,000 deaths

5% death rate average
...

Date: April 15, 2020
Over 2 million cases today
134,000 deaths

6.7% death rate average (known cases and deaths)

Known cases doubled in two weeks.

Date: April 27, 2020
Coronavirus Cases: 3,055,498
Deaths: 211,035
Recovered: 918,184

6.9% death rate average (known cases and deaths)
30% Recovery average

Another million in 12-days. Recovered inching towards a million (1/3 of known infections).

Date: May 9, 2020
Coronavirus Cases: 4,032,763
Deaths: 276,677
Recovered: 1,399,718

6.86% death rate average (known cases and deaths)
34.7% recovery average (known cases and recovery)

Three times in a row ... 12-to-14 days another million case

Date: May 20, 2020
Coronavirus Cases: 5,000,599
Deaths: 325,156
Recovered: 1,970,918

11-days to another million
6.5% death rate average (known cases and deaths)
39.4% recovery average (known cases and recovery)

Date: May 30, 2020
Coronavirus Cases: 6,033,835
Deaths: 366,891
Recovered: 2,661,163

10-days to another million
6.08% death rate average (known cases and deaths)
44.10% recovery average (known cases and recovery)

Recovery inching upwards while death rate dropping down.

DrRatnadip · Post by **DrRatnadip** » 30 May 2020 11:23

Zynda wrote:Dr. Ratnadip, any weekly updates Sir? Any updates on the trials in India of Remdesivir and/or Favipiravir? It seems like community transmission has started in Chennai. Also the number of people testing positive in MH is mind bongling.

- Situation in Mumbai is very bad.. This probably because they never had any additional capacity to handle.. BMC corporation hospitals are ALWAYS full and floor beds were common even before pandemic..

- Junior and senior residents from peripheral medical colleges are being sent to Mumbai for compulsory deputation.. Govt has also promised pay hike to doctors..

- PPE kits are very widely available now in govt hospitals.. Triage has improved.. Pts are stratified according to severity of symptoms.. process is streamlined now.. This has helped in preventing salvagable deaths..

- Antibody tests are slowly getting available in private hospitals and labs.. At aroung 800 rs / kit , they are significantly cheaper ( Got tested myself, process is easy and results in 15 mins)..

- Overall ventilator requirement is much less than initially anticipated .. Majority of symptomatic pts are improving on supplimental Oxygen therapy..

- Contact tracing in MH is extremely rigorous.. Everything possible including cellphone location is used to detect allmost all positive cases.. This is one of reason Mh has many more cases..

- I am not aware of remdesivir trials in India.. Tocilizumab is undergoing multicentric trials and is proving effective in younger pts with cytokine storm..Criteria for inclusion are
1) Patient less than 50 years of age, extendable to 60 in desired cases,
2)Patient admitted in ICU
3)Patient having evidence of cytokine storm as described below :
a) Serum Ferritin level more than 300 and rising
b) CRP level more than 20 and rising
c) IL6 level more than 20 and rising- especially more than
100
4) Rising ofoxygen requirement more than 6 Itrs. per minute to maintain Sa02 more than 90.
5) Persistent f'ever more than 10 I degree F.
Two of the above 3,4,5 should be present..

Zynda · Post by **Zynda** » 30 May 2020 11:50

Thanks for providing the updates. Really appreciate it. Good to know AB tests are now being made available. Hopefully, we will ramp up the availability in the coming weeks.

arshyam · Post by **arshyam** » 30 May 2020 12:20

Many heartfelt thanks for sharing such details regularly, Doctor, the rest of us are truly grateful for the service your fraternity has been giving to society.

DrRatnadip wrote:- Situation in Mumbai is very bad.. This probably because they never had any additional capacity to handle.. BMC corporation hospitals are ALWAYS full and floor beds were common even before pandemic..

Are government hospitals like JJ not treating corona patients?

DrRatnadip wrote:- PPE kits are very widely available now in govt hospitals.. Triage has improved.. Pts are stratified according to severity of symptoms.. process is streamlined now.. This has helped in preventing salvagable deaths..

This is heartening to hear. At least we seem to have made the most of the lockdown to prepare.

DrRatnadip wrote:- Contact tracing in MH is extremely rigorous.. Everything possible including cellphone location is used to detect allmost all positive cases.. This is one of reason Mh has many more cases..

Interesting, the general perception in media reports seem to be of lethargy. But good if they are doing it.

With the latest ICMR guidelines about giving HCQ to immediate family of infected people, I hope they also re-start the plan for giving HCQ as a prophylactic to the general population in hotspots, otherwise the cases are going to keep increasing and eventually, the govt would abandon tracing and any other proactive actions. Given Mumbai's density and super-dense crush loads, this should be a no-brainer. Not sure why it hasn't happened though - surely it's worth the cost given that one pill seems to be around ₹5, and we need to take one tablet a week or so?

Zynda wrote:It seems like community transmission has started in Chennai.

Any reliable sources for this?

DrRatnadip · Post by **DrRatnadip** » 30 May 2020 13:43

- All govt hospitaLs including JJ are treating Covid pts.. They are severely lacking beds.. Hence they are reluctant to admit asymptomatic pts.. There is problem in transporting pts too , as many ambulance drivers are unwilling to do so..

- I know people who are doing contact tracing.. I can asure you that no stone is left unturned to ensure all contacts are traced.. Recall bias and voluntary reluctance to share information is a problem.. Huge data is gathered daily and people are working 24/7 to make sense of it and identify hotspots.. problem is in slum areas where majority of pts are asymptomatic and young.. They are working in service industries like malls and come in contact with large number of people..It is difficult to home quarantine them..

- Regarding Hcq I am pretty sure that there are international efforts to damage its image.. Side effects are known since decades and we are managing them.. I am sure if there is uncontrollable outbreak then we will be left with no option other than mass administration of prophylactic HCQ.. HCQ is good in preventing multiplication of virus.. It wont help if virus is already multiplied.. Cardiac side effects will be more in pts with ARDS and myocarditis.. Key is to give it before virus has multiplied to unmanagable level..

- Considering our huge population, slowed economy and possible border skirmish with china , costly drugs like tocilzumab etc (40k / dose) will not be solution.. We must find optimum prophylaxis using cheaper options like HCQ, Vitamins, BCG etc..I am sure ICMR is going in right direction.. recent publication from ICMR is in favour of using HCQ..

Zynda · Post by **Zynda** » 30 May 2020 14:48

arshyam wrote:Any reliable sources for this?

COVID-19: Community transmission widespread in Chennai, say doctors

Dr. Ratnadip, is HCQ being administered (or being considered) to populace in Mumbai (in places where population density is very high and chances of transmission is quite likely) to see if it can slow down or cut down the number of cases? So far I believe ICMR recommends HCQ only for front line & healthcare workers but not for general populace.

DrRatnadip · Post by **DrRatnadip** » 30 May 2020 15:31

Zynda wrote:
arshyam wrote:Any reliable sources for this?
COVID-19: Community transmission widespread in Chennai, say doctors

Dr. Ratnadip, is HCQ being administered (or being considered) to populace in Mumbai (in places where population density is very high and chances of transmission is quite likely) to see if it can slow down or cut down the number of cases? So far I believe ICMR recommends HCQ only for front line & healthcare workers but not for general populace.

No sir.. Right now it is given to healthcare workers only.. Not used in general population.. It was considered initially but plan was later dropped due to possible cardiac side effect.. I think govt will reconsider it if situation goes out of hand..

MH has asked for additional doctors and nursing staff from kerala.. Many private doctors are mobilized for covid duty.. opting for Public insurance like PMJAY/ MPJAY is made mandatory for large private hospitals.. 100 percent population in MH has been included in these health scheme to provide them free of cost treatment .. These are good measures.. But packages offered under these schemes for each pt are grossly inadequate and quality of care in private hospital will hamper.. Admitting covid pts means it is guaranteed that all other non covid pts will try to avoid that hospital..

One more thing I observed that fear of covid in general population is decreasing.. even Smallest OPDs are strictly following Sanitization protocols.. Chemicals like hypochloride required for hospital disinfection are now freely available and at cheaper rate.. Many hospitals have started doing elective and semi emergency procedures with adequate Availability of PPE..Except in Mumbai where dense population and inadequate beds is major problem , situation elswhere is managable..

kvraghav · Post by **kvraghav** » 30 May 2020 16:25

DrRatnadip wrote:
- Contact tracing in MH is extremely rigorous.. Everything possible including cellphone location is used to detect allmost all positive cases.. This is one of reason Mh has many more cases..

But both Karnataka and Maharashtra have almost same number of tests done daily. I saw Karnataka at 13000 tests per day and Maharashtra at 14000 tests per day yet Maharashtra has 20% infection rate whereas Karnataka has less than 1%

IndraD · Post by **IndraD** » 30 May 2020 17:17

A Study Out of Thin Air

Misinformation is bad. Misinformation in medicine is worse. Misinformation from a prestigious medical journal is the worst. Herein is a detailed look at the controversial Lancet study that resulted in the World Health Organization ending worldwide clinical trials on hydroxychloroquine in order to focus on patented therapeutics.

Study Overview

In brief, the Lancet study is a multinational registry analysis assessing the effectiveness of hydroxychloroquine or chloroquine with or without macrolide therapy (e.g. azithromycin) in treatment of COVID-19 in hospitalized patients. The study was very large (perhaps impossibly so, but we will address that later) and included 96,032 patients, of which 14,888 were in treatment groups. The study found that hydroxychloroquine and chloroquine with or without macrolide therapy resulted in significantly increased risk of both in-hospital mortality and de-novo ventricular arrhythmia during hospitalization. In summary, the authors concluded that hydroxychloroquine and chloroquine are actually harmful and increase risk of death when used for in-hospital treatment of COVID-19.

The Lancet study was released on Friday, May 22. After deliberating over a weekend, on Monday, May 25, the World Health Organization hastily announced the cessation of all COVID-19 clinical trials on hydroxychloroquine in 17 different countries. Instead of performing its own due diligence, the WHO immediately relied on an observational study cloaked in the reputation of the nearly 200-year old medical journal The Lancet.

After its publication, a grass-roots investigation by hundreds of physicians and researchers worldwide revealed irreconcilable inconsistencies in the data that The Lancet’s peer-review process overlooked. The study is now found to have inconsistencies with data from national registries of hospitalized COVID-19 patients. The authors continue to hide data sources in a black box controlled by an unknown corporation called Surgisphere.

Surgisphere

Only one peer-reviewed publication prior to the Lancet study.

Surgisphere appears to be the sole provider of the data for the Lancet study, and boasts itself to be a real-time global research network that "performs cloud-based healthcare data analytics" using machine learning and artificial intelligence.

Based on the Lancet study, it must be a very large, sophisticated network indeed to have partnered with hundreds of hospitals worldwide with the capability of retrieving detailed patient data in real-time.

One would expect a multinational database such as this to be a treasure trove coveted by researchers. Strangely, this is not so. Surgisphere has a razor thin folder of contributions to past publications. Besides the Lancet publication, Surgisphere’s only other peer-reviewed publication is one entitled Cardiovascular, Drug Therapy, and Mortality in Covid-19 that was published on May 1, 2020 in The New England Journal of Medicine.

The Research section of Surgisphere's website features twenty-three “Case Studies from Around the World” as evidence of their prior work and product features. The vast majority of these “case studies” lack scientific substance and actually consist of short letters, press releases or potential use-cases for its database.

In place of actual research, the website appears primarily promotional and gives the impression of an immature tech company with lofty goals as opposed to a global database with real-time data on millions of patients.

A company with only five employees, most of which joined only two months ago.
According to LinkedIn, Surgisphere has five employees, only one of which has a medical degree—the founder Dr. Sapan Desai. The remaining four employees appear to have little to no science or medical background, but with a plethora of experience in business development and sales & marketing. The team's personnel consist of a VP of Business Development and Strategy, VP of Sales and Marketing and two freelance writers creating content for Surgisphere.

With the exception of the founder, the entire Surgisphere team joined the corporation only 2-3 months ago. Actually, according to LinkedIn, the VP of Sales & Marketing is still employed by another tech company, W.L. Gore & Associates. Prior to February 2020, Surgisphere appears to have had a single employee, the founder.

A shrouded internet history.

The internet trail behind Surgisphere is peculiar to say the least. Mostly because it isn’t there. The Internet Archive (Wayback Machine) has records on more than 439 billion web pages and has long served as a tool to view webpages as they existed in the past. I’ve used the tool hundreds of times and am frequently surprised by the breadth of its database. Even some of the most obscure webpages have historical snapshots available. In the rare circumstances where a historical snapshot is not available, the Wayback Machine’s response is “Wayback Machine doesn't have that page archived.” A far less common response—one I’ve never seen before—is “Sorry. This URL has been excluded from the Wayback Machine.”

It’s this last response that is delivered when searching https://surgisphere.com/ in the Wayback Machine.

There are primarily two ways for companies to hide internet histories. First, they can insert special codes into their websites to hide from the Wayback Machine’s automated crawlers. Secondly, companies can request the removal of their historical snapshots, but there’s no guarantee the Internet Archive will honor these requests. Both of these practices are highly unusual and almost exclusively used for obscuring nefarious activities.

A list of subsidiary companies without substance.

A deeper dive into Surgisphere reveals three subsidiary companies: Surgical Outcomes Collaborative, Vascular Outcomes and Quartz Clinical. On each of the homepages of these three websites, the Surgisphere copyright is publicly visible near the bottom of the page.

Surgical Outcomes Collaborative has almost no internet history and the page does not appear in the Internet Archive until 2019, in which it just redirects to the webpage for Vascular Outcomes.

A search of https://vascularoutcomes.com in the Internet Archive returns one snapshot from December 2019. The snapshot shows a webpage that is largely similar to that of Surgical Outcomes Collaborative and does not include any details about a team or published research.

Similarly, Quartz Clinical, another healthcare data analytics branch of Surgisphere, also appears to be devoid of published research and without a publicly visible team.

Each of the company webpages above provide a LinkedIn link. Instead of showing company profiles with track records, however, the links all direct to the profile of just one person, Dr. Sapan Desai.

Forming partnerships with hundreds of hospitals, formatting electronic medical records in dozens of different languages and pushing the forefront of technology in machine learning and AI is an insurmountable task for a large multi-talented team over many months, let alone one person in a few weeks.

"Get in touch with us"

Just yesterday, the Get in touch with us link on Surgisphere’s homepage redirected to a strange WordPress template for cryptocurrency. The Surgisphere website has since been changed and the link deleted; however, this serves as just another example of incompleteness and unprofessionalism from a company supposedly holding highly sensitive records on millions of patients.

If we ignore the image of multiple shell corporations enshrouding a hastily organized Surgisphere Corporation and stick to analyzing the COVID-19 data from the Lancet study, the findings are even less reassuring.
The Data
Surgisphere provides scant detail on their data sources. Not only does Surgisphere omit which hospitals supposedly contributed, but they will not even specify the contributing countries. Instead, they categorize hospitals and patient numbers by continent. Notably, the larger the pool of data, the easier it is to obfuscate false data.

Data inconsistencies were found nonetheless.

Strike #1. Australia is unique because it is both a country and continent, which makes data obfuscation more challenging. Thus, it is no surprise that false data was first discovered in Australia. The Guardian reported yesterday that the number of COVID-19 deaths included in the Lancet study for Australia exceeded the total nationally recorded number of COVID-19 deaths. The Lancet study reported 73 deaths from the continent of Australia, but records show that Australia had only a total of 67 COVID-19 deaths by April 21. When confronted with this inconsistency, the lead author of the study, Dr. Mandeep Mehra, admitted the error but dismissed it as simply a single hospital that was accidentally designated to the wrong continent.

Strike #2. North American data from the study is highly suspicious. The study reports that 63,315 hospitalized patients with COVID-19 met inclusion criteria prior to April 14, 2020. A review of the well-curated data from the COVID Tracking Project by The Atlantic shows that there were only 63,276 patients hospitalized with COVID-19 by April 14. It is theoretically possible that Surgisphere also collected patient data from Canada and Mexico. However, both of these countries had a tiny number of COVID-19 hospitalizations in comparison to the USA. On April 16, Canada reported 2,019 COVID-19 hospitalizations. Although data is not readily available on COVID-19 hospitalizations in Mexico, the country had only 5,014 positive cases and 332 deaths by April 14. Based on common rates of case-to-hospitalization ratios, it is likely that Mexico had fewer than 1,000 COVID-19 hospitalizations. Thus, the total number of COVID-19 hospitalizations in North America (USA, Canada and Mexico) by April 14 is about 66,000.

Are we to believe that Surgisphere truly had relationships and data exchange agreements with 559 hospitals in the USA, Canada and Mexico that captured detailed patient records for 63,315 COVID-19 patients out of a total of 66,000 patients? These figures do not even include the 2,230 patients with COVID-19 who did not meet the inclusion criteria, meaning that Surgisphere is claiming they have patient data on even a greater number than 63,315 patients.

Strike #3. The study reports patient data from Africa that requires sophisticated patient monitoring technology and electronic medical record systems. An open letter to The Lancet signed by 146 physicians and medical researchers believes this to be unlikely. For the data to be valid, nearly 25% of all COVID-19 cases and 40% of all deaths in the continent would have occurred in Surgisphere-affiliated hospitals with sophisticated electronic patient data recording and monitoring capable of detecting and recording “nonsustained [at least 6 sec] or sustained ventricular tachycardia or ventricular fibrillation.” In the setting of a highly contagious virus, continuous cardiac monitoring is not always utilized as it increases high-risk patient contact for healthcare workers. A combination of cardiac monitoring practices during COVID-19 and the sophisticated equipment necessary to do so make it highly unlikely that cardiac arrhythmia data is available for such a large percentage of patients in Africa.

There are additional data oddities not mentioned above which include unusually small variances in patient baseline characteristics, interventions and outcomes among continents.
Any one of the above findings warrants closer inspection of data for a study of this importance and with such global implications on patient care.

Surgisphere Responds

Surgisphere responded to inquiries by refusing to provide any additional details on the data sources and instead asking physicians and researchers to trust them.

Does a corporation that appeared out of thin air two months ago deserve this trust?

arshyam · Post by **arshyam** » 30 May 2020 17:37

^^ So basically a hit job on HCQ. Big Pharma strikes, again.

IndraD · Post by **IndraD** » 30 May 2020 18:24

https://www.theguardian.com/science/202 ... r-covid-19

Questions raised over hydroxychloroquine study which caused WHO to halt trials for Covid-19

ghost data, sites used to make up details for dubious study against HCQ which prompted WHO to stop HCQ trial.
Lancet has contacted lead author Mandeep Mehra (a cardiologist based at Boston) to come clean.

DavidD · Post by **DavidD** » 30 May 2020 18:48

Sounds fishy as hell, and I think it's way too premature for WHO to halt HCQ trials. Are there any HCQ RCTs running in India? I highly suspect that it's effective when given early and perhaps even as a prophylaxis, but a lack of evidence is both frustrating and puzzling. While I can see how in the US it can be politicized since Trump touted it and the Dems are determined to strike down anything Trump says, what's going on in the rest of the world? I don't really buy the big pharma thing, the world has literally lost trillions of dollars already and is on track to lose trillions more. More than the worth of the entire pharmaceutical industry.