COVID: readers' comments: retracted articles, mask decontamination cost, how virus spreads, vaccines

I would like to bring up a few issues brought by some blog readers (with their permission), as well as a couple of recent articles on vaccines

 

Anita Ung suggested that I should have included the controversy over the large database used in the Lancet article on hydroxychloroquine that I mentioned in my recent blog (see http://gmodestmedblogs.blogspot.com/2020/06/covid-hydroxychloroquine-post-exposure.html ). This article led to the WHO and several governments to alter their approach to treating Covid-19, as well as to the WHO and several research groups globally to halt all ongoing hydroxychloroquine trials (last week the WHO announced it would resume these trials)

 

There were a couple of sources cited:

--one is from The Guardian: see https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine?CMP=share_btn_tw&fbclid=IwAR075mGPh7Xpl6R0GdqVCYz0sZulGsPgC_tGyyW77MRlAOfoJzQaeF3zW7Q

--one from Retraction Watch: https://retractionwatch.com/2020/06/02/nejm-places-expression-of-concern-on-controversial-study-of-drugs-for-covid-19/

--also, there was a good article from Bloomberg, printed in the Boston Globe: https://www.bostonglobe.com/2020/06/04/business/researchers-retract-lancet-study-linking-hydroxychloroquine-risks/

 

--The Guardian newspaper did impressive investigative reporting on this issue

-- the basic issue leading to retraction of the Lancet article: The data came from Surgisphere Corp, a US company that claimed it had data from >1000 hospitals worldwide, with recent articles both in the New England Journal of Medicine and Lancet based on this data

-- the Guardian investigation found:

    -- Surgisphere have several employees without appropriate data analysis or scientific backgrounds

    -- their LinkedIn page had fewer than 100 followers and listed just 6 employees (changed to 3 employees as of last Wednesday)

    -- though Surgisphere claims to have one of the largest and fastest hospital databases in the world, their twitter handle has <170 followers, with no posts between October 2017 and March 2020

    -- the Guardian attempted to ”get in touch” with Surgisphere from their homepage, but were redirected to a cryptocurrency website

    -- the head of Surgisphere, Sapan Desai, has some questionable practices: he has 3 medical malpractice suits (unrelated to Surgisphere), he promoted a wearable “next generation human augmentation device that can help you achieve what you never thought was possible” that never materialized (and, i suppose correctly was never thought possible); and his Wikipedia page has been deleted following questions about Surgisphere and his history

    -- concerns were raised about their Australian data, and the Guardian found that 7 Australian hospitals supposedly in the database denied any role in the database

    -- other data from Surgisphere have also been suspect: including the relationship between Covid -19 and ACE inhibitors/ARBs published in the New England Journal (the leading authors requested retraction; Desai is a signatory though only after initially refusing to allow any of their data to be reviewed by others), and a prior article on ivermectin decreasing death rates in severely ill Covid-19 patients

 

-- One thing I would add is that there have been concerns raised about the quality of data from other sources as well. For example, there was initial concern that the Chinese studies, especially regarding Covid-19 and health care workers there, may have been somewhat distorted/understated, perhaps to avoid scaring away the many healthcare workers deployed to Wuhan at Covid’s outbreak.

-- and, another thing: there is such a high throughput of articles on Covid-19 because of the intensity of the pandemic and our lack of understanding. so many studies (many not great), many viewed pre-publication/pre-peer review and not printed formally for many weeks later, if at all. not surprising there are errors related to such a large volume and desire to get information out (ie, not malfeasance, as likely with Surgisphere). for example, there was a small study on masks in the highly peer-reviewed Annals of Internal Medicine that was just retracted (see https://www.acpjournals.org/doi/10.7326/L20-0745 ), where the authors included incorrect data, not understanding that some of their cited values for PCR results were actually below the limits of detection of actual virus (ie, may have been false positives)

 

Jon Pincus also found an article on Battelle Memorial Institute, the nonprofit that is making lots of respirator mask decontamination systems that got >$400 million in federal aid, and is decontaminating masks at a cost of $110/mask (see https://www.wsj.com/articles/warnings-surface-about-new-system-to-disinfect-n95-masks-11591026809 ). pretty striking how consistent trump is: lots of federal money being spent (ie taxpayer money) to help with Covid-19 as well as stimulate the economy, yet the vast majority seems to wind up in the pockets of big business... And, yet again, not sure that trickle-down will work this time, since it has pretty much never worked in the past (again: that great quote from Einstein: “insanity is doing the same thing over and over and expecting different results”; though I supposed that could be morphed a bit into: “insanity is having to repeatedly quote Einstein on the definition of insanity as it applies to the current situation and expecting Trump to act differently”)

 

 

 

Emily Lowenberg forwarded to me an article on how the coronavirus spreads, which includes a graphic on a restaurant and the spread of the virus (this may be a useful graphic and information for patient education), as well as some useful information on actual viral transmission in workplaces. particularly relevant as we head into rolling back restrictions on decreasing Covid transmission: see https://commonwealthmagazine.org/environment/coronavirus-risks-know-them-avoid-them/

 

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The NY Times had an article on a British lab at Imperial College in London developing a vaccine that sidesteps (and is anathema to) the usual drug industry approach: a low cost vaccine that would be distributed to people on the basis of need instead of profit, with price varying from very low for low-income countries and increasing for more affluent ones. clinical trials are about to start. They are using a highly scalable technique with an RNA-ampifying vaccine hopefully leading to the development of effective antibodies against the spike protein of SAS-CoV-2, similar to what Moderna is trying to do (with huge US governmental subsidy) but with 50-100 times smaller dose and lower cost (for the NY Times article: see https://www.nytimes.com/2020/06/07/world/europe/imperial-college-uk-vaccine-coronavirus.html?referringSource=articleShare ). For a prior blog on Moderna: see  http://gmodestmedblogs.blogspot.com/2020/05/covid-new-vaccine-trial.html

 

The Boston Globe had a poignant article on the dangers of rushing a vaccine: see https://linkprotect.cudasvc.com/url?a=https%3a%2f%2fedition.pagesuite.com%2fpopovers%2fdynamic_article_popover.aspx%3fartguid%3d1faa5dfc-0936-495c-a5aa-5757c5897995%26appid%3d1165&c=E,1,UaZAlbHtZ-g5smmyGiqAklp6lnrK2qCMIV-Z_5ryp_wuaylAhphsVl6d7ZLHaZMx4WE05dg4Ks7JyNpilzNZ4IFz4D7Cs-nMHq37_8sfpzh1Ajg,&typo=1

geoff

 

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