白宫冠状病毒特别工作组成员布雷特·吉罗伊尔少将周日在美国全国广播公司上说，不建议使用羟氯喹作为Covid-19的治疗方法。

[lindamy]

3 min ago
Hydroxychloroquine is not recommended as a Covid-19 treatment, coronavirus testing czar says
From CNN's Naomi Thomas

Hydroxychloroquine is not recommended as a treatment for Covid-19, Adm. Brett Giroir, a member of the White House coronavirus task force said on NBC on Sunday.

“At this point in time, there’s been five randomized controlled, placebo controlled trials, that do not show any benefit to hydroxychloroquine,” Giroir said. “So, at this point in time, we don’t recommend that as a treatment.”

Giroir said that hydroxychloroquine needs to be prescribed by a physician, and there may be circumstances where it is prescribed, in response to a question about the potentially mixed messages that are being sent out about the drug.

“But I think most physicians and prescribers are evidence based and they’re not influenced by whatever is on Twitter or anything else,” he said. “And the evidence just doesn’t show that hydroxychloroquine is effective right now.”

Giroir said that he thinks “we need to move on from that and talk about what is effective.”

This includes public health measures like hand washing and mask wearing, and therapeutics and treatments that are known to be effective.

“We have many things that do work,” Giroir said. “Right now, hydroxychloroquine, I can’t recommend that."

More details: Giroir said that there were other therapeutics which have shown promise, such as remdesivir and steroids which have reduced mortality. He also said that while they still don’t know about immune plasma, there are trials and it has worked in other cases.

 

[lindamy]

Here's Why Hydroxychloroquine Doesn't Block The Coronavirus in Human Lung Cells

KATHERINE SELEY-RADTKE, THE CONVERSATION
1 AUGUST 2020

A paper came out in Nature on July 22 that further underscores earlier studies that show that neither the malaria drug hydroxychloroquine nor chloroquine prevents SARS-CoV-2 – the virus that causes COVID-19 – from replicating in lung cells.

Most Americans probably remember that hydroxychloroquine became the focus of numerous clinical trials following the president's statement that it could be a "game changer." At the time, he appeared to base this statement on anecdotal stories, as well as a few early and very limited studies that hydroxychloroquine seemed to help patients with COVID-19 recover.

Many in the antiviral field, including myself, questioned the validity of both, and in fact, one of the papers was later disparaged by the scientific society and the editor of the journal that published it.

Since then, HQC has had a bumpy ride. It was initially approved by the FDA for emergency use. The FDA then quickly reversed its decision when numerous reports of deaths caused by heart arrhythmias emerged. That news brought many clinical trials to a halt.

Regardless, some scientists continued to study it in hopes of finding a cure for this deadly virus.

How the work was done

The new study was carried out by scientists in Germany who tested HQC on a collection of different cell types to figure out why this drug doesn't prevent the virus from infecting humans.

Their findings clearly show that that HQC can block the coronavirus from infecting kidney cells from the African green monkey. But it does not inhibit the virus in human lung cells – the primary site of infection for the SARS-CoV-2 virus.

In order for the virus to enter a cell, it can do so by two mechanisms - one, when the SARS-CoV-2 spike protein attaches to the ACE2 receptor and inserts its genetic material into the cell. In the second mechanism, the virus is absorbed into some special compartments in cells called endosomes.

Depending on the cell type, some, like kidney cells, need an enzyme called cathepsin L for the virus to successfully infect them. In lung cells, however, an enzyme called TMPRSS2 (on the cell surface) is necessary. Cathepsin L requires an acidic environment to function and allow the virus to infect the cell, while TMPRSS2 does not.

In the green monkey kidney cells, both hydroxychloroquine and chloroquine decrease the acidity, which then disables the cathepsin L enzyme, blocking the virus from infecting the monkey cells. In human lung cells, which have very low levels of cathepsin L enzyme, the virus uses the enzyme TMPRSS2 to enter the cell.

But because that enzyme is not controlled by acidity, neither HCQ and CQ can block the SARS-CoV-2 from infecting the lungs or stop the virus from replicating.

Why it matters

This matters for several reasons. One, much time and money has been spent studying a drug that many scientists said from the very beginning was not going to be effective in killing the virus.

The second reason is that the studies that have reported antiviral activity for hydroxychloroquine were not in epithelial lung cells. Thus, their results are not relevant to properly studying SARS-CoV-2 infections in humans.

What's next?

As scientists proceed with investigating new drugs as well as trying to repurpose old ones, like hydroxychloroquine, it is critical that researchers take the time to think about their study design.

In short, those of us involved in antiviral drug development should all take a lesson from this study. It is important not only to focus our efforts on pursuing drugs that will directly shut down viral replication, but also to study the virus in the primary site of infection.

Katherine Seley-Radtke, Professor of Chemistry and Biochemistry and President-Elect of the International Society for Antiviral Research, University of Maryland, Baltimore County.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Here's Why Hydroxychloroquine Doesn't Block The Coronavirus in Human Lung Cells

A paper came out in Nature on July 22 that further underscores earlier studies that show that neither the malaria drug hydroxychloroquine nor chloroquine prevents SARS-CoV-2 – the virus that causes COVID-19 – from replicating in lung cells.

www.sciencealert.com

这可能是氯喹和羟氯喹对新冠作用有限的原因：不能有效阻止病毒进入肺细胞 (链接)

 

[向问天]

好像在CFC有更牛逼的专家不服气。

 

[lindamy]

好像在CFC有更牛逼的专家不服气。

这药被共和党视为神药，民主党当作毒药。

有人只看一方面的吹嘘，凡是不同意见一律称为装睡，我收集两方面的证据。起码我看到中国就有几个支持此药的对照试验。初期，轻症，加锌，阿奇霉素，钟南山很早就说过: 这药有效，但非特效。

效果有限，有明显副作用。

 

[baima123]

这药被共和党视为神药，民主党当作毒药。

有人只看一方面的吹嘘，凡是不同意见一律称为装睡，我收集两方面的证据。起码我看到中国就有几个支持此药的对照试验。初期，轻症，加锌，阿奇霉素，钟南山很早就说过: 这药有效，但非特效。

效果有限，有明显副作用。

这对比。
有的人会说： 米国民主。每个人（党派）自由发声（真假不管，对自己有利的就是正义的）
中国专政，居然一个声音一种意见————重症不管用，轻症有一定疗效，有副作用。

 

[PAL]

2020神奇之一：药物疗效的政治化，开眼了

 

[lindamy]

2020神奇之一：药物疗效的政治化，开眼了

是啊，选举年奇观。

 

[lindamy]

9 min ago
A renewed focus on hydroxychloroquine wastes time and risks lives, 24 Yale faculty members say
From CNN's Maggie Fox

In this photo illustration a pack of Hydroxychloroquine Sulfate medication is held up on March 26 in London. John Phillips/Getty Images

A renewed focus on the potential use of the malarial drug hydroxychloroquine is taking time and resources away from the search for something that actually does work to help coronavirus patients and may end up costing lives, two dozen Yale University researchers said Tuesday.

Yale cancer epidemiologist Dr. Harvey Risch launched a new round of headlines when he wrote a commentary in Newsweek last month calling for renewed research on hydroxychloroquine as a treatment for coronavirus, despite multiple studies showing it doesn’t help and might harm patients, and decisions by the US Food and Drug Administration, National Institutes of Health, and the World Health Organization to stop further testing.

The White House, which had promoted the drug, was encouraged to renew its lobbying for the drug, even as coronavirus task force members, including Dr. Anthony Fauci, Dr. Deborah Birx and Adm. Brett Giroir, all said repeatedly the drug does not work and should be dropped.

“We write with grave concern that too many are being distracted by the ardent advocacy of our Yale colleague, Dr. Harvey Risch, to promote the assertion that hydroxychloroquine (HCQ) when given with antibiotics is effective in treating COVID-19, in particular as an early therapeutic intervention for the disease,” the 24 Yale staffers wrote in an open letter posted on Medium. “As his colleagues, we defend the right of Dr. Risch, a respected cancer epidemiologist, to voice his opinions. But he is not an expert in infectious disease epidemiology and he has not been swayed by the body of scientific evidence from rigorously conducted clinical trials, which refute the plausibility of his belief and arguments."

The Yale researchers said they all want the same thing: an effective treatment for coronavirus. But they said heavy pursuit of hydroxychloroquine took up resources that could be used elsewhere.

“The continuing advocacy on behalf of HCQ distracts us from advancing the science on Covid-19 and seeking more effective interventions in a time when more than 1,000 people are dying per day of this disease,” they wrote.

 

[向问天]

到现在还在争论羟禄溃，说明西方的医疗体系存在严重缺陷。

 

[lindamy]

4 hr 12 min ago
New study offers more evidence that hydroxychloroquine doesn't treat coronavirus
From CNN's Maggie Fox

Hydroxychloroquine is seen on a shelf at a pharmacy in Provo, Utah, on May 20. George Frey/AFP/Getty Images

A new report has added to the growing body of evidence that the malaria drug hydroxychloroquine does not help coronavirus patients get better. In fact, combining it with an antibiotic actually raises the risk of death by 27%, the study found.

The meta-analysis -- a study of studies -- looked at 29 different pieces of research on the drug, which was once heavily promoted by the White House and which Brazilian President Jair Bolsonaro still touts.

“Hydroxychloroquine alone was not associated with reduced mortality in hospitalized Covid-19 patients, but the combination of hydroxychloroquine and azithromycin significantly increased mortality,” said the study, which was published in the journal Clinical Microbiology and Infection.
“There is already a great number of studies that have evaluated hydroxychloroquine alone or in combination and it seems unlikely at this stage that any efficacy will ever emerge. Our results suggest that there is no need for further studies evaluating these molecules."

The research was conducted by scientists from France’s research institute INSERM.

The US Food and Drug Administration has reversed its emergency use authorization for hydroxychloroquine for use against coronavirus, and the National Institutes of Health, World Health Organization and European researchers have stopped supporting testing.

 

[lindamy]

羟氯喹大国昨天24小时新增75995，估计又是新世界记录。再发展下去，有一天超中国总数的可能性。

 

[向问天]

浏览附件923149

羟氯喹大国昨天24小时新增75995，估计又是新世界记录。再发展下去，有一天超中国总数的可能性。

羟氯喹跟增加多少感染没关系。
要看死亡率。

 

[lindamy]

羟氯喹跟增加多少感染没关系。
要看死亡率。

现在吹嘘的两大功能：
1. 防御（总统，没病先用，闫博士说中国领导都用它来防疫），
2. 减少轻症转重症。

 

[lindamy]

肺炎疫情：解读印度的死亡数据与“群体免疫”

• 2020年 8月 24日

图片版权GETTY IMAGESImage caption印度德里近期加强了新冠检测，发现女性患者多于男性。

印度的新冠病毒确诊人数为世界第3，但官方公布的死亡人数准确性受质疑。

到2020年8月下旬，印度已登记的新冠病毒感染病例数比全球第4多的俄国多出2百多万，新冠死亡病例从5万多例正向突破6万大关发展，早已超过了英国、在全球新冠死亡人数排名表位居第四。

但到了2020年8月下旬，印度每百万人平均感染死亡人数比率仅为大约40多例，远远低于欧洲或北美的比例。美国为每百万人平均感染死亡536例，英国609例，德国111例。

衡量新冠患者死亡的感染致死率CFR（确诊感染人数对比病例死亡人数）印度只有2%左右。即使在像马哈拉施特拉邦这样遭受严重打击的地区，死亡人数也只是在40天内翻了一番。

这种尽管病例大幅上升但死亡率一直保持很低的现象引起全球许多流行病学家的关注。

印度私人机构的一项研究称，该国可能有1/4的人曾感染新冠病毒，携带新冠病毒的抗体。7月间的其他研究也发现，孟买部分地区已经有过半居民获得新冠病毒抗体。

数字公布后有人质疑，这是否意味着印度可能在政府公共卫生能力不足的情况下，仍然寄希望于西方部分学者提出的群体免疫来抵挡新冠病毒的冲击？
印度官员说，这种现象只是结果、不是选择。

较低死亡率分析

许多流行病学家将印度相对较低的死亡率归因于印度人口更年轻，因为老年人通常在新冠病毒面前更脆弱。

目前尚不清楚这种低死亡率是否有其他因素，如以前来自其他冠状病毒感染获得的免疫力，是否也是造成这种结果的原因。

此外，他们还指出，南亚国家新冠病毒死亡率普遍较低，这些国家大多人口众多而年龄结构比较年青。平均每百万人口中感染新冠的死亡率在孟加拉国大约为25例，巴基斯坦大约不足30例。

显然，从人口规模上看，印度低死亡率显得其抗击新冠疫情似乎做得比欧洲和美国好得多。然而，正如世界银行前首席经济学家考希克·巴苏所说：“把这种数字当作自我安慰是不负责任的。”

巴苏教授表示，这种人口情况的比较意义有限。

他说，一旦你这样做，你就会意识到印度实际上的表现非常糟糕。在中国，平均每百万人口中，新冠病毒感染死亡率是3例，而在印度是40多例。

在南亚，印度是这方面表现最差的国家，其次才是阿富汗（约36例）。

巴苏教授指出，印度是全世界少数几个没有使新冠感染曲线的上升趋于平缓的国家之一。“从3月底到现在，病例和死亡人数不仅在上升，而且是不断加速上升。”

“新冠死亡数严重低估”

此外，专家们说，印度的死亡率相对较低并不能说明问题的真实情况，一些人认为，在几个邦，新冠死亡人数被严重低估。

首先是，印度许多邦违反世界卫生组织（世卫组织）准则，没有在最后统计数字中算入新冠疑似病例。

其次，少数邦将新冠病例死亡人数众多归咎于患者自身的基础疾病或病发症。

印度医疗卫生事务记者普里扬卡·普拉（Priyanka Pulla）的调查显示，古吉拉特邦和特伦甘纳邦的统计数字似乎严重偏低。例如，在古吉拉特邦的瓦多达拉市，死亡人数过去两个月只增加了49%，而当地新冠病例数量同期猛增了329%。

第三，据报在一些印度城市，官方公布的新冠病毒造成的死亡人数与当地火葬场和墓地的计数存在差异。

图片版权GETTY IMAGESImage caption虽然印度新冠病毒正在扩散，政府又急于复产复工和恢复国内国际旅行。

统计不足

考虑到印度因为只有一小部分人接受了检测（到2020年8月下旬仅约2%），低检测率加上许多新冠死亡没有获得医学证实报告，那么，印度的统计数字是否错过了很多新冠死亡病例？

在印度，死亡人数中只有1/4的死因获得医学认证。

印度德里的智库“观察家研究基金会”的奥蒙·C·库里安说：“当然，由于我们的医疗卫生监测系统薄弱，统计不足人数遗漏是肯定的。但问题的关健是统计不足的规模有多大。”

美国密歇根大学生物统计学和流行病学印度裔教授布拉马尔·慕克吉表示：“如果没有历史数据，以及在此期间超额死亡水平的计算，很难衡量统计不足的量有多大。”

“超额死亡”是指高于正常水平的那部分死亡人群，其中一些可能是由新冠病毒造成的。

超过230名印度专业人士，包括医生、研究人员和学生，已经发出正式的申请，请求印度当局公布至少过去3年的死亡信息，以统计这次新冠的“超额死亡”数据。
他们希望将每年在印度发生的交通事故中死亡15万多人分别统计进行识别，以便发现新冠疾病造成的死亡更可靠的数据。

统计遗漏问题并非印度一国所特有。7月份，一项研究对28个国家的死亡率数据进行复核后发现，这28国在新冠病毒大流行期间死亡的人数，比其官方公布的死亡统计数报告至少多出16.1万人。印度不在接受调查的28个国家之一。

“百万级提前死亡研究项目”

图片版权GETTY IMAGESImage caption印度加强检测后，新冠病毒确诊人数开始大幅度上升。

加拿大多伦多大学的流行病学家普拉巴特·杰哈领导了印度雄心勃勃的“百万级提前死亡研究项目”，这是世界上最大规模的过早死亡研究之一。

杰哈博士说，即使在拥有良好医疗条件和提供死亡医学证明的高收入国家，数据分析显示，也存在约30%至60%的死亡人数没有准确反映在每日统计中。

他说，印度电信公司应该公布3月份的通话记录数据，以找出数百万印度人在被封锁后从城市工作场所迁往的地点。当政府宣布防疫封锁城市、这些人没有工作后，其中很多步行和乘火车回家，进一步传播了感染。

利用电信数据，政府可以派遣小组到热点地区记录隐藏的感染新冠成人死亡数据。他还建议各市政当局应公布与上年相比所有原因的总死亡人数统计，以了解“超额死亡”情况。

杰哈博士质疑，如果印度政府不能准确衡量死亡数据，它怎么能使新冠死亡曲线降低呢？

或许，当新冠大疫情彻底结束时，新冠病毒死亡人数将成为判断各国在控制感染方面表现的唯一指标。

恢复国内和国际旅行

印度作为世界上人口最多的国家之一（其官方人口数据为13.5亿，仅次于中国的14亿），新冠病毒正在向贫民窟和乡村扩散，印度政府又急于复产复工和恢复国内国际旅行。

印度民航部5月23号就宣布重启国内民航航班，7月份宣布恢复开通与美国的国际航班，随后印度还宣布正在与澳大利亚、日本、英国等13国谈判恢复国际航班的条件。

但香港特区政府8月19日表示，由于香港近期多起输入性新冠肺炎确诊病例为印度抵港人士，8月18日至31日期间，禁止印度航空运营的客机着陆香港。

因为印度的人口基数和它恢复国内国际旅行的努力，该国的疫情控制可能将影响到世界很多地方。

肺炎疫情：解读印度的死亡数据与“群体免疫” - BBC News 中文

印度的新冠病毒确诊人数居世界第3，但官方公布的死亡人数准确性受到质疑。

www.bbc.com

 

[lindamy]

印度昨天差5个到7万6，今天已经超过7万6千8.