I have an acquaintance here in our expat community in Boquete, Panamá who is a bit older than me (81 y/o) who is a hard-core conspiracist/denialist. We went back and forth via email a few years ago about anthropogenic global warming and associated climate change. He is a hard-core conspiracist, and I knew that I would never change his mind based on my replies to his emails, but his emails offered me a challenge to verify and improve my own knowledge on the subject.
Now the same pattern is happening with the Covid-19. “Bob” also makes and sells nano-colloidal silver solution, and promotes it plus hydroxychloroquine plus zinc and vitamin D as a Covid-19 prophylactic and cure.) He is rabidly anti-mask, but has to wear one in public here because of our government rules.)
Being retired and mobility-limited, I have time to activate my gray-matter, do some research and respond. He seldom disputes my debunking replies, but often replies back with a gish-gallop of both relevant and irrelevant conspiricist/denialist quotations — which I ignore, because you can seldom win against a gish-galloper because of the sheer volume of b.s.
Having joined Daily Kos in 2005, and returned for daily reading during the Trump era, I know that there are many intelligent and informed people here. So I would appreciate any feedback — comments or criticism — about my reply to “Bob”.
(The two papers I cite are very recent — published in the past month, and are among the very first on the efficacy of hydroxychloroquine with and without the zinc supplement.)
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On 12/2/2020, BOB sent this link to me:
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My reply to Bob:
I watched the video, and I cannot believe how someone smart enough to be a doctor and a lawyer can be so misguided and/or wrong! Here are some issues I take with Dr. Gold's claims:
Note: Dr. Gold may be a good doctor, but I have seen no evidence that indicates she is considered to be a "top" doctor by anyone other than the video maker and his/her associates and fans.
1. She is against the lock-downs and mask/distancing/gathering rules, but does not appear to understand their purpose. Such restrictions are not about preventing deaths of young Covid-19 spreaders, but slowing the spread of the disease by reducing the number of asymptomatic young people who can infect their parents, grandparents and other older adults, especially those with co-morbidities, who are much more likely to have acute symptoms and are much more likely to die.
2. She is apparently also ignorant of the fact that while masks don't stop the very tiny virus particles, but good masks that are properly worn do stop most of the droplets that carry the Covid-19 virus particles. These virus-laden droplets are the primary method by which Covid-19 spreads - and why we have a pandemic.
3. Her statement on being against the testing of asymptomatic persons is a red herring, because the unique nature of Covid-19 with it's high viral shedding and infectious nature during the first 5 days of the disease being active in a victim. Indeed, for most diseases and medical conditions, testing is only done after symptoms appear. Unfortunately, the nasty characteristic of early asymptomatic spreading means that such spreading can only be controlled/reduced by testing people with likely exposure. (No one is telling me that I should be tested up here in Boquete, because control measures here seem to have been effective in our little national/international tourist destination.)
4. Dr. Gold, like you, is a big proponent of hydroxychloroquine plus zinc, positions you both take without controlled evaluations to determine actual efficacy.
Below are the results - not yet peer-reviewed - of two very recent controlled studies on hydroxychloroquine as therapy for Covid-19, one each with and without supplemental zinc. The rigorous science dedicated to evaluating possible Covid-19 treatment is still in its infancy, but the initial results with hydroxychloroquine are not promising. If these initial findings are overturned with additional research over time, I will be most pleased.
Springer Journals
Do Zinc Supplements Enhance the Clinical Efficacy of Hydroxychloroquine?: a Randomized, Multicenter Trial — LINK
Discussion
In Egypt, there have been an increasing number of cases with COVID-19 infection since March 2020. Many treatment protocols were updated to treat the coronavirus infection based on the evidence available at this time. The initial protocols were primarily dependent on hydroxychloroquine. In the Egyptian leading university hospitals, we aimed to evaluate the effect of combining CQ/HCQ and zinc in treating COVID-19 patients.
The treatment teams in the Egyptian universities, which incorporated infectious diseases consultants and clinical pharmacists, adopted the importance of integration of zinc into the treatment protocol of treatment. To the best of our knowledge, this is the first clinical trial investigating the role of the addition of zinc to hydroxychloroquine in the treatment of COVID 19 patients.
The main hypothesis behind this approach was the fact that zinc was proven to have an inhibitory effect on the RNA-dependent RNA polymerase of SARS-CoV in cell culture [17, 18]. Moreover, CQ and HCQ are known to increase the intracellular concentrations of zinc and thus enhance its effect [18].
Despite these proved benefits of zinc in the literature, this study found that zinc supplements did not enhance the clinical efficacy of HCQ.
There are a lot of questions now about the efficacy of CQ or HCQ in the treatment of COVID 19 patients. A recent randomized study found that adding HCQ to standard care did not add significant benefit, did not decrease the need for ventilation, and did not reduce mortality rates in COVID-19 patients [11]. A recent meta-analysis found that hydroxychloroquine alone did not reduce mortality in hospitalized COVID-19 patients, and even when added to azithromycin, this was significantly associated with increased mortality [28].
This study’s major strength is that being the first randomized study to evaluate the effect of combining hydroxychloroquine (HCQ) and zinc in the treatment of COVID-19 patients.
On the other hand, the study’s limitations may be depending mainly on the patients’ clinical outcomes and not the viremic response. However, this is due to the limited resources in such a developing country. Another limitation is that zinc absorption may be limited with high phytate diet, and other medications and serum zinc were not measured before, during, or after treatment in this clinical trial.
In conclusion, zinc supplements did not add value or enhance the clinical efficacy of HCQ. Zinc supplementation may be studied further with other drug regimens for COVID 19, but it did not add any clinical values when added to HCQ.
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Here's the abstract from another study, published by medRxiv November 25, 2020. (medRxiv was founded by Cold Spring Harbor Laboratory (CSHL), a not-for-profit research and educational institution, Yale University, and BMJ, a global healthcare knowledge provider.)
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ABSTRACT
Background Hydroxychloroquine is an antimalarial drug that received worldwide news and media attention in the treatment of COVID-19 patients. This drug was used based on its antimicrobial and antiviral properties despite lack of definite evidence of clinical efficacy. In this study, we aim to assess the efficacy and safety of using Hydroxychloroquine in treatment of COVID-19 patients who are admitted in acute care hospitals in Bahrain.
Methodology We conducted retrospective cohort study on a random sample of admitted COVID19 patients between 24 February and 31 July 2020. The study was conducted in four acute care COVID19 hospitals in Bahrain. Data was extracted from the medical records. The primary endpoint was the requirement of non-invasive ventilation, intubation or death. Secondary endpoint was length of hospitalization for survivors. Three methods of analysis were used to control for confounding factors: logistic multivariate regression, propensity score adjusted regression and matched propensity score analysis.
Results A random sample of 1571 patients were included, 440 of which received HCQ (treatment group) and 1131 did not receive it (control group). Our results showed that HCQ did not have a significant effect on primary outcomes due to COVID-19 infection when compared to controls after adjusting for confounders (OR 1.43 95% CI 0.85 to 2.37, P value=0.17).