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MESO-Rx
Anabolic Steroids
Can touching a barbell in the gym get you sick with the coronavirus?
- Thread starter Michael Scally MD
- Start date
Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19
16 June 2020
Statement from the Chief Investigators of the Randomised Evaluation of COVid-19 thERapY (RECOVERY) Trial on dexamethasone, 16 June 2020
In March 2020, the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial was established as a randomised clinical trial to test a range of potential treatments for COVID-19, including low-dose dexamethasone (a steroid treatment). Over 11,500 patients have been enrolled from over 175 NHS hospitals in the UK.
On 8 June, recruitment to the dexamethasone arm was halted since, in the view of the trial Steering Committee, sufficient patients had been enrolled to establish whether or not the drug had a meaningful benefit.
A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).
Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75]; p=0.14).
Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone.
Given the public health importance of these results, we are now working to publish the full details as soon as possible.
Peter Horby, Professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford, and one of the Chief Investigators for the trial, said: ‘Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result. The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients. Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.’
Martin Landray, Professor of Medicine and Epidemiology at the Nuffield Department of Population Health, University of Oxford, one of the Chief Investigators, said: ‘Since the appearance of COVID-19 six months ago, the search has been on for treatments that can improve survival, particularly in the sickest patients. These preliminary results from the RECOVERY trial are very clear – dexamethasone reduces the risk of death among patients with severe respiratory complications. COVID-19 is a global disease – it is fantastic that the first treatment demonstrated to reduce mortality is one that is instantly available and affordable worldwide.’
The UK Government’s Chief Scientific Adviser, Sir Patrick Vallance, said: ‘This is tremendous news today from the Recovery trial showing that dexamethasone is the first drug to reduce mortality from COVID-19. It is particularly exciting as this is an inexpensive widely available medicine.
‘This is a ground-breaking development in our fight against the disease, and the speed at which researchers have progressed finding an effective treatment is truly remarkable. It shows the importance of doing high quality clinical trials and basing decisions on the results of those trials.’
Notes
For interview requests, please contact: Genevieve Juillet, Media Relations Manager (Research and Innovation), University of Oxford.
Full details of the study protocol and related materials are available at www.recoverytrial.net.
A range of potential treatments have been suggested for COVID-19 but it has been unclear whether any of them will turn out to be more effective in improving survival than the usual standard of hospital care which all patients will receive.
About the RECOVERY trial
The RECOVERY trial is a large, randomised controlled trial of possible treatments for patients admitted to hospital with COVID-19. Over 11,500 patients have been randomised to the following treatment arms, or no additional treatment:
- Lopinavir-Ritonavir (commonly used to treat HIV)
- Low-dose Dexamethasone (a type of steroid, which typically used to reduce inflammation)
- Hydroxychloroquine (which has now been stopped due to lack of efficacy)
- Azithromycin (a commonly used antibiotic)
- Tocilizumab (an anti-inflammatory treatment given by injection)
- Convalescent plasma (collected from donors who have recovered from COVID-19 and contains antibodies against the SARS-CoV-2 virus).
The RECOVERY Trial is conducted by the registered clinical trials units with the Nuffield Department of Population Health in partnership with the Nuffield Department of Medicine. The trial is supported by a grant to the University of Oxford from UK Research and Innovation/National Institute for Health Research (NIHR) and by core funding provided by NIHR Oxford Biomedical Research Centre, Wellcome, the Bill and Melinda Gates Foundation, the Department for International Development, Health Data Research UK, the Medical Research Council Population Health Research Unit, and NIHR Clinical Trials Unit Support Funding.
The RECOVERY trial involves many thousands of doctors, nurses, pharmacists, and research administrators at over 175 hospitals across the whole of the UK, supported by staff at the NIHR Clinical Research Network, NHS DigiTrials, Public Health England, Public Health Scotland, Department of Health & Social Care, and the NHS in England, Scotland, Wales and Northern Ireland.
Source: Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19 — RECOVERY Trial
A California gym reopens with bizarre looking plastic workout pods to enable customers to exercise in groups and maintain social distancing
A California gym reopens with bizarre looking plastic workout pods to enable customers to exercise in groups and maintain social distancing
• The owner of Inspire South Bay Fitness in Redondo Beach, California has set up individual plastic workout pods to enable customers to exercise in groups and maintain social distancing.
• Owner Peet Sapsin told Business Insider that the pods took three days to build and are made out of shower curtains and PVC pipes. There are nine pods in total.
• Each pod is enclosed on three sides but has an open back and open top, which has led some customers to question how safe they are as an alternative.
Here is what I'm more concerned about with Covid-19. I want to know the number of individuals being hospitalized for Covid and if the health care providers are being maxed out.
I could give two craps about the number of positive cases in the World. The mass majority that are testing positive are asymptomatic.
mands
I could give two craps about the number of positive cases in the World. The mass majority that are testing positive are asymptomatic.
mands
This site provides links to data including state-by-state hospitalizations (when available) for US cases:
The Covid Tracking Project
Also, some of the bigger hospital chains / medical groups publicly track stats like ICU bed capacity. For example, in Houston, there is https://www.tmc.edu/coronavirus-updates/tmc-icu-bed-capacity-modeling/
SteroidsBro
Banned
!) A question EVERYONE should be asking, since ensuring our health care system was not "over-run" was the reason for shutting down our economy!
The short answer is few hospitals are breaching capacity and NONE are even close to approximating what occurred in NYC.
Moreover a variety of measures have been undertaken in hospitals abroad to accommodate the needs of our patients if volume adjustments are required in the near future --- see below.
To that end it should also be noted, because not all patients in the ICU are on ventilators, and since many hospitals are now admitting patients with "slightly moderate" disease bed utilization tends to be exaggerated.
2) Rest assured HCP availability is NOT a problem that I'm aware of.
3) While a considerable number of "positives" are asymptomatic or mildly symptomatic, vastly expanded testing accounts for the higher prevalence of COVID-19 in MANY regions.
JIM
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Another sepsis/steroid trial with preliminary results that are truly remarkable an NNT ratio of 1:8 !
Is COVID-19 really that much different than every other infectious disease from Bacterial infections, MERS, SARS-COV to HIV and beyond in which steroids not only FAILED to show a difference in mortality, they actually INCREASED it.
Yet compared to other respiratory Corona viruses the relatively prolonged latency, incubation and inflammatory periods of COVID-19 may help explain why steroids may be useful in some instances.
Nonetheless, I'll await the data review.
JIM
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SteroidsBro
Banned
Everybody ready for the second wave of the lockdown this fall/winter now that everyone's burned up all their unemployment money? Wwwiiiiiiiiiiiiiiiiiiiiiiii!
And then people will start actually getting sick and showing flu symptoms from being fried with 5g and people will think it's the non-existent "covid19"
Lock it down punks!
And then people will start actually getting sick and showing flu symptoms from being fried with 5g and people will think it's the non-existent "covid19"
Lock it down punks!
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This virus lurks in crowded areas so maintain a reasonable distance as much as possible.
JIM
In almost every COVID-19 cluster where contact tracing has been methodical a SYMPTOMATIC index case was identified.
Who are the current super-spreaders of this disease? Relatively healthy folk who ignore URI type symptoms (cough, nasal congestion, rhinorrhea, malaise, etc) and attend gatherings in spite of feeling; "a little under the weather".
JIM
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Good luck with that model, and those who question safety can stay home or work out after donning a PAPR.
Clearly, disasters aren’t necessarily devastating to financial markets. That’s worth bearing in mind when considering a new report from Deutsche Bank that looked at the next massive tail risk for markets.
Analysts, led by Henry Allen, say there is at least a one-in-three chance that at least one of four major tail risks will occur within the next decade:
- a major influenza pandemic killing more than two million people;
- a globally catastrophic volcanic eruption;
- a major solar flare; or
- a global war.
If the time frame is two decades, then there is a 56% chance of one of these disasters occurring, the analysts say, based on various studies and risk assessments. Earthquakes were omitted from the numbers on the grounds that they are more local events.
Want to Socialize? Learn the Rules of the “Ethical Sluts.”
How polyamory’s core tenets can help us navigate moving forward post-pandemic
These are not my lovers, but my two best girlfriends. The three of us are single and live away from our families, which is why we decided to ride the pandemic together. Our situation is unique, and very privileged. We don’t live together. None of us have roommates and we’re not essential workers. We are a social bubble, a pod, a triad, a quarantine family, a “quaranteam.” Since shelter-in-place was first declared in March, we made a pact to collectively prioritize the health and well-being of the pod, which meant following the guidelines of the “ethical slut.”
Ethical Slut” is a term coined in the 90s by Dossie Easton and Janet Hardy to reclaim the word “slut” as a term of approval, even endearment. The authors lay out the models that inspired a set of ethics around the physical risks of intimacy in order to date multiple people. Now we need to take a page out of their book while we all consider extended adventures in “social intercourse,” a.k.a. hanging out with outsiders in the middle of a pandemic.
Who are we allowed to see now? How do we keep the pod healthy? Can we do so without obsessively surveilling the behavior of our loved ones? Who are we collectively willing to exchange germs with? How transparent should we be about it with each other?
There are many types of poly relationships, but during shelter-in-place, my friends and I found in ethical hierarchical polyamory a navigation tool for our newly found agreement. The Ethical Slut breaks it down for us: “people who live in a marriage-like arrangement are primaries, the people they love but don’t live with are secondaries, the people they enjoy spending (often sexual) time with, but often with less commitment, are tertiaries.”
In other words: prioritize your pod.
Source:
Oldschool
Member
I can see the increased cases in Mexico causing a serious second wave for Texas and other states that border with Mexico. I hope I'm wrong but I doubt it. Over 100,000 deaths wasn't enough to make people believe this is a real thing. Going to take a few more hundred thousand deaths to get the point across.
COVID-19: Blood Type / Mavrilimumab / Prone Position
https://www.jwatch.org/fw116746/2020/06/17/covid-19-blood-type-mavrilimumab-prone-position
Blood type and risk: A genome-wide association study in the New England Journal of Medicine finds that patients with blood type A are at increased risk for COVID-19-induced respiratory failure than other blood groups. Researchers compared the genomes of roughly 1600 people with severe COVID-19 in Italy and Spain with over 2200 uninfected population-based controls. Two chromosomal loci were associated with COVID-19-induced respiratory failure. One of these is also the ABO blood group locus. Blood group A was associated with a 45% increased risk for COVID-19 respiratory failure, while blood group O was associated with a 35% lower risk, relative to other blood groups. The other affected locus covered genes that have functions that could be relevant to severe COVID-19, such as interacting with the SARS-CoV-2 cell-surface receptor. https://www.nejm.org/doi/full/10.1056/NEJMoa2020283
Mavrilimumab: The monoclonal antibody mavrilimumab, an investigational treatment that's been studied for rheumatoid arthritis, is associated with improved clinical outcomes among patients with severe COVID-19 in Italy, suggests a small study in The Lancet Rheumatology. Thirteen non-mechanically ventilated patients with systemic hyperinflammation who received an intravenous dose of mavrilimumab were compared with 26 patients given usual care. Mortality at 28 days was lower in the mavrilimumab group (0% vs. 27%), but the difference was not statistically significant. The mean time to clinical improvement (i.e., improving two points on a seven-point scale) was significantly faster in the treatment group (8 vs. 19 days). The authors acknowledge that the results need to be confirmed in a large, randomized, placebo-controlled trial. https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30170-3/fulltext
Prone positioning: Another study has found improved oxygenation in awake, nonintubated patients with COVID-19 after lying in the prone position. In JAMA Internal Medicine, researchers instructed 25 hospitalized COVID-19 patients who were receiving supplemental oxygen and had an oxyhemoglobin saturation (SpO2) of 93% or less to lie on their stomachs for as long as they could each day. One hour after proning, SpO2 levels increased modestly by a median of 7%. Nineteen of the 25 patients had an SpO2 of at least 95% after 1 hour. Intubation rates were lower among patients who achieved an SpO2 of at least 95% (37% vs. 83%). Commentators note: "The optimal timing of intubation and mechanical ventilation for patients with [acute respiratory distress syndrome] is not known, but delayed intubation has been associated with increased mortality in patients with ARDS." Prone Positioning in Awake, Nonintubated Patients With COVID-19 Hypoxemic Respiratory Failure
https://www.jwatch.org/fw116746/2020/06/17/covid-19-blood-type-mavrilimumab-prone-position
Blood type and risk: A genome-wide association study in the New England Journal of Medicine finds that patients with blood type A are at increased risk for COVID-19-induced respiratory failure than other blood groups. Researchers compared the genomes of roughly 1600 people with severe COVID-19 in Italy and Spain with over 2200 uninfected population-based controls. Two chromosomal loci were associated with COVID-19-induced respiratory failure. One of these is also the ABO blood group locus. Blood group A was associated with a 45% increased risk for COVID-19 respiratory failure, while blood group O was associated with a 35% lower risk, relative to other blood groups. The other affected locus covered genes that have functions that could be relevant to severe COVID-19, such as interacting with the SARS-CoV-2 cell-surface receptor. https://www.nejm.org/doi/full/10.1056/NEJMoa2020283
Mavrilimumab: The monoclonal antibody mavrilimumab, an investigational treatment that's been studied for rheumatoid arthritis, is associated with improved clinical outcomes among patients with severe COVID-19 in Italy, suggests a small study in The Lancet Rheumatology. Thirteen non-mechanically ventilated patients with systemic hyperinflammation who received an intravenous dose of mavrilimumab were compared with 26 patients given usual care. Mortality at 28 days was lower in the mavrilimumab group (0% vs. 27%), but the difference was not statistically significant. The mean time to clinical improvement (i.e., improving two points on a seven-point scale) was significantly faster in the treatment group (8 vs. 19 days). The authors acknowledge that the results need to be confirmed in a large, randomized, placebo-controlled trial. https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30170-3/fulltext
Prone positioning: Another study has found improved oxygenation in awake, nonintubated patients with COVID-19 after lying in the prone position. In JAMA Internal Medicine, researchers instructed 25 hospitalized COVID-19 patients who were receiving supplemental oxygen and had an oxyhemoglobin saturation (SpO2) of 93% or less to lie on their stomachs for as long as they could each day. One hour after proning, SpO2 levels increased modestly by a median of 7%. Nineteen of the 25 patients had an SpO2 of at least 95% after 1 hour. Intubation rates were lower among patients who achieved an SpO2 of at least 95% (37% vs. 83%). Commentators note: "The optimal timing of intubation and mechanical ventilation for patients with [acute respiratory distress syndrome] is not known, but delayed intubation has been associated with increased mortality in patients with ARDS." Prone Positioning in Awake, Nonintubated Patients With COVID-19 Hypoxemic Respiratory Failure
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