Remdesivir and Possibility for Anti-Covid19 Drug Cocktail

It seems plausible that a near term cocktail of drug treatments might halve the fatality and halve the hospital times for coronavirus. This is just assuming the Remdesivir results could be improved with some other anti-virals or other drugs.

The preliminary data showed that the time to recovery was 11 days on remdesivir compared to 15 days for placebo, a 31% decrease. The mortality rate for the remdesivir group was 8%, compared to 11.6% for the placebo group; that mortality difference was not statistically significant.

Doctors have determined that a 5-day treatment with Remdesivir is as effective as 10-days. This means twice as many patients can get Remdesivir.

Brian Wang is a Futurist Thought Leader and a popular Science blogger with 1 million readers per month. His blog is ranked #1 Science News Blog. It covers many disruptive technology and trends including Space, Robotics, Artificial Intelligence, Medicine, Anti-aging Biotechnology, and Nanotechnology.

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65 thoughts on “Remdesivir and Possibility for Anti-Covid19 Drug Cocktail”

  1. Most of African slaves that came to America came from West Africa. East African slaves mostly went to the Middle East.

  2. Should also mention that Sub Saharan Africa is low in salt so most African love salt but can’t tolerate large quantities of it. The voyage on the slave ships just made things worst.

  3. Studies will typically try to sugar coat such findings non-significant findings by saying things like “treatment group x, while not statistically significant was trending towards significance” or something like that. There is actually no such thing as “trending towards significance”. You either reach statistical significance or you don’t. there is no in between. It is however possible for something to reach statistical significance but not be clinically significant or in other words, there is a real effect but it is so small that it is clinically meaningless.

    As for the small sample size and seeing such a “large effect”… Small sample sizes are tricky like that. Pure chance can make it seem like it is trending towards significance when it is just a fluke and later large sample studies find nothing. If this drug had any kind of worthwhile effect it would have reached significance and convincingly so.

    Lots of people fall prey to this mistake when looking at medical lit. It can be difficult if it is not something you are well versed in. There are many things that you can miss or misinterpret. having said all this, I can understand why you interpreted things as optimistically as you did. Thanks for the reply.

  4. Slave ships lost on average 15% of the slaves on the voyage to the new world. That is not enough, even if they all died of dehydration, which they didn’t, to account for the large fraction of African Americans with high blood pressure. Scurvy, and dysentery were likely the big killers.
    The main reason for high blood pressure I think is lead. Lead causes high blood pressure. And if you live in Detroit or any of the dense cities with a lot of traffic, and lived there for decades, chances are you have been exposed to a lot of lead, and accumulated a lot of it. Calcium helps remove lead, and being lactose intolerant reduces the likelihood of getting enough calcium to remove it. As one tends to consume less dairy when lactose intolerant. Further, it has already be determined by testing that African Americans had 2.2-3 times the lead level. And even low level lead causes high blood pressure:
    The lead stays in your system having been accumulated in your bones.

  5. I have a somewhat obvious hypothesis after reading this:
    It may be that the reason Parts of Africa, India and other countries have less coronavirus is because live vaccines, for polio and other diseases were used in many of these places. And as the theory goes in the article, such vaccines make the innate immune system more responsive and effective. “Research by Dr. Netea and others shows that live vaccines train the body’s immune system by initiating changes in some stem cells. Among other things, the vaccines initiate the creation of tiny marks that help cells turn on genes involved in immune protection against multiple pathogens.”
    So it may be the the Gates Foundation and others may have saved millions of lives from coronavirus already.
    Perhaps people in nursing homes should be given these live vaccines, so if they encounter coronavirus they will have a better chance of fighting it off. They are extremely vulnerable in these homes.

  6. I don’t recommend drinking dandruff shampoo.
    I suspect it would be even worse to fill a firehose and have a high pressure enema, though it worked in movie.

  7. Fish/shellfish and nuts/seeds are good sources of selenium. Meat and eggs can be OK.
    Many people don’t like fish/shellfish. Beef, chicken and such could have selenium or not. It depends on where the feed they ate came from. If the plants were not grown in soils with it, the animals would not have much. Same thing happens with iodine. Iodine is in dairy…but only if the feed they were fed grew in soils with iodine.
    Brazil nuts are the best selenium source. One nut a day is plenty generally. You could get plenty in the diet. Thing is, the Chinese in regions that had few fatalities had high levels of selenium not normal or deficient levels. The amount needed to reduce the chance of death is unknown (or even if it does). The safe daily upper limit is 400 micrograms (4-5 Brazil nuts) according to the FDA.

    Iodine deficiency however, is very common in the US and all over the world. Countries that eat seaweed, or have a system that insures there is iodine in the salt (iodized salt) are less likely to have deficiencies. Iodized salt is not mandated or regulated in the US.
    Kelp is by far the richest source of iodine. But it is an acquired taste. I have a bottle of “Lugol’s iodine solution”. That is not a brand. There are many brands and different concentrations. I put a drop in my eggs when I am cooking scrambled eggs. Taste better even. One drop a week is all you need. I have been taking 2 drops a week lately, because of my suspicion that this might help to protect me.

  8. Even that Veteran’s study – if that’s the one you mean – was admitted to be flawed by its own authors. The two groups were not evenly matched for background conditions, and the patients were started on treatment in some cases where they were already on ventilators, which even hydroxy proponents say can’t be treated this way. It only works with early stage patients whose lungs have not yet been damaged.

  9. That is pretty much what the above study outlines – a statistically insignificant change in mortality. Merely a positive change in speed of recovery, not an actual increased chance of recovery in the first place.

  10. Wait, where does selenium come from in the diet that you would have a deficiency?!

    Not being combative, genuinely interested considering it’s a plot point in the film Evolution.

  11. There has already been a trial with Hydroxychloroquine – more people died, the end. Stop pushing it already.

  12. I would suspect that both intrinsic medical differences and socio economic issues are in play here – sadly it’s already too late to fix the latter now and will likely be pushed under the rug soon after the pandemic subsides – alas US politics is a frequently disturbing thing to witness as an outsider.

  13. Unlikely if it was a lvl 4 bio containment lab as the oft mentioned one in Wuhan is – they have very stringent protocols to prevent contamination from the outside getting in and interfering with experiments, and more so to prevent the spread of biological agents beyond lab premises.

  14. It has to do with Vitamin D and the genetics of a population. Africans that are now situated in northern/temperate climates have known vitamin D deficiency as the high melanin in the skin of darker peoples hinders vitamin D production, while protecting against a vast number of sun exposure related illness as intense sun exposure can deplete a variety of different vitamins and create a number of other problems. Europeans lost that melanin due to evolution as they needed a mechanism for increasing vitamin D production with reduced sun exposure. Neanderthals make up a decent portion of Euro genetics and are a cold weather adapted Hominid very close to modern humans. Funny thing, Gingers are actually the closest genetically to Neanderthals.

  15. It was a bit of sarcasm from the research that shows smokers are getting COVID less severe. A pick your poison/Catch 22 sort of statement.

  16. I’m intrigued about your fish comment. Why do you think fish were a relevant factor?

  17. And how about skipping the hydrochloroquine and trying the zinc? I think they should be trying zinc, selenium, iodine, and SOD (superoxide dismutase). They should be looking for deficiencies. Some nutrients might be being used up trying to fight this thing. Maybe start with big vitamin and mineral shots with just about everything even in consideration as possibly necessary for human nutrition. Take hair, urine, and blood samples too, to look for deficiencies and toxins. We need to know why the ones really struggling are struggling. Underlying conditions maybe…but more needs looked at, because obviously not everyone with these conditions that catches the virus ends up in the hospital.

  18. I don’t think the virus is racist and I never meant to imply that.
    The argument was that dark skin absorbs sunlight and creates vitamin D differently from white skin. My ancestors evolved a white hide solely for the purpose to create vit. D more efficiently at the latitudes they lived. So black people living in northern Europe or the US should probably take a vitamin D supplement.

  19. You are partially right about the lactose intolerance, African Americans have intolerance as most are of West African origin, while many East Africans have tolerance for lactose since many of the populations descend from herding tribes. West Africa had more of an agriculture dominant economy pre-colonization and slave trade.

  20. The virus isn’t racist, just that hypertension, obesity, and diabetes are more common in black vs white.

    The #1 thing people can do to help their chances of surviving this virus (once they catch it) is to lose weight.

  21. Other studies show that Remdesivir drug does not work against covid-19 AT ALL, is particularly expensive, and show 60% of very serious side effects. But hey, sure, let’s use it.
    Where are your other analyses about cheap and effective hydroxychloroquine+azithromycin bitherapy?

  22. You should read over the comments in the first link you provide – they point out all sorts of issues in that study, such as not combining HCQ/AZ with Zinc, applying it to already very sick patients (instead of early on to reduce viral load), including some compassionately moved over from the supportive-care-only side only when they were near dying.

    If those comments are correct, the study doesn’t seem to justify the conclusions.

  23. But then, do you want to live forever? But, having seen my wife succumb to COPD it is a terrible way to go.

  24. Apparently the black – white thing is happening in England as well. Of course the first thing one would suspect is socioeconomic circumstances. But colour seems to be a factor.

  25. Just bust out some vitamin D, zinc, iron and ascorbic acid supplements, then hit yourself with a nicotine patch. You should be good to go so says the French.

    Then if you are a Trump cultist, lock yourself in a closet with a bottle of ammonia and a bottle of bleach, mix in a bucket, put face over said bucket and inhale deeply for 30 seconds. It should disinfect you.

  26. I hadn’t heard anything about different rates for white vs. black (I assume you mean American negroes, not southern Indians or whatever).

    Once I LOOK for that information, it turns up fairly quickly, but it’s interesting that nobody ever mentioned it before.

  27. Because p=0.059 that survival went from 8% to 11.6% is “no statistically significant mortality reduction”? That’s definitely high enough to take notice with such a small sample (something like 80 dead). Yes it isn’t definitive but it is very good reason to expand the study size by as much as you can afford to.

  28. Many descendants of slaves in the USA genetically have very high sodium retention which leads to hypertension. This is a result of dehydration being the number one cause of death on slave ship trips. It’s very negative to outcome chances to have high blood pressure with this virus due to it blocking up all of the ACE2 receptors leading to bradykinin induced vascular leakage. So that AND vitamin D. Ouch.

  29. Actually,the second cite is kind of old news too. It is basically a CYA announcment to prevent people taking it on their own, which someone did and died from – fish medication! We’re not talking about that. Since 100s of doctors have been prescribing it for <1 week out of office, and so far it’s been manageable with well known side effects, it still seems like the best idea in what the article says is a field with “no treatments” for Covid-19. That is frankly not an acceptable answer.

  30. They are injecting allogenic cardio-derived cells? This is a cardiovascular drug meant to help with remodeling after an MI. Quite interesting. I was thinking to myself, why on earth would this work or would they even consider it. It appears these cells and this injection produce an immunomodulatory effect. Several immunomodulatory drugs have been trialed for COVID 19 including hydroxychloroquine. The small number of patient they have treated so far leaves me unimpressed. Very interesting but we cannot tell anything yet due to the incredibly small number of patients who have trialed it so far. Thanks for sharing, very interesting treatment.

  31. That is old news. Things are developing rapidly.
    Supportive care is as good as HCQ + AZ and superior to HCQ alone (P=0.03).

    The free for all with HCQ has caused unnecessary deaths. The authors of the article you cited have underestimated the potential severity of toxicities and ADEs to HCQ, as many in the health care field did.

    I do appreciate you linking those articles though. Thumbs up for citing evidence

  32. The 1968 Hong Kong flu was a bad one, with over 100,000 flu deaths in the US and over a million worldwide. No stockmarket crash, though. No months-long home arrest policies. A completely different approach, perhaps a different breed of person.

    Today’s person demands absolute security and expects the government to provide all. No self efficacy whatsoever. If it were not covid it would have been something else. This is their ultimate goal, stuck in pajamas at home 24/7.

    Even if a lot of people were not dying from covid, they would have to pretend that they were. Exaggerate the numbers somehow.

  33. Remdesivir isn’t that good. The study indicate that it would only enhance survival by 5%. That’s lousy. We need to continue looking for a better drug maybe using remdesivir as a start. Every single COVID-19 patient should be in a clinical trial. We should be testing anything that may look promising. And the Federal government should be paying for it because the drug companies are only interested in testing something they own.

  34. It seems that most of the people dying from COVID are Vitamin D deficient. Vitamin D supplement may be the prophylactic everyone is looking for. Vitamin D deficiency might also explain why blacks are dying from COVID-19 at a higher rate than whites. Blacks suffer from Vitamin D deficiency at a much higher rates than white due to being more lactose intolerant and having darker skin especially during the low light intensity of the winter months in the North.

  35. Well, I wouldn’t buy unlabeled bats from a trenchcoated guy in a dark alley either – but it sure looks like someone did something shady.

    “Psst… Hey, buddy – want some live wingrat? Prime stuff, just fell out of the sky…”

  36. That is my best guess. That study clearly states there was no statistically significant mortality reduction. The drug appears to work much like Tamiflu “works” for influenza which is why I made my initial analogy; if you get infulenza and are treated with tamiflu, you will recover a couple days early however if fate dictated that you were going to die form influenza, being treated with tamiflu will not save you. Remdesivir appears to be having the same type of effect. Sorry if this was not clear before. This system does not give me enough space to write enough to adequately explain some of the nuances involved in this sort of thing.

    thank’s for the reply and link

  37. Continuation form above….Given the way COVID19 mortality is very unfavorable in our elderly population and the reports of what it is doing when it gets into a nursing home, a prophylactic agent that could be temporarily used in a nursing home or other closed environment to quash an outbreak within the facility would save a lot of lives (in addition to isolation and and restricted access measures).

  38. Sorry for not being more clear. This system kept limiting my entries so I could not fully elaborate. I did not look up the cost but did realize it was IV. Yeah, IV is not so great for prophylaxis but if that is all you had and it was effective then it would not be an insurmountable barrier. The cost however is pretty prohibitive. The company behind this drug is who has been funding the research articles regarding its used for COVID19. I was not critical enough about this initially due to time constraints (don’t have a lot of time to mess with this) and ignorance of the cost. Due to the high cost, there will be a lot of motivation for the drug company and people under their influence to paint results in as rosy a color as they can to encourage as much use as they can. That is not to say this did or will happen; there is just a significant risk of misrepresentation that you need to be aware of when scrutinizing research.

    Anyway, I would love for them to find something that tips the odds in our favor because as a healthcare professional, I am in the middle of this every day (not complaining or looking for sympathy or praise. this is our job). My experience and knowledge on the topic says that the chance for finding an effective drug treatment for this type of viral infection is very low however, the chance for finding an effective prophylactic agent is pretty good. Given the way COVID19 mortality is very unfavorable in our elderly population …continued below

  39. I think there is a good chance we will learn the origin:
    My leading hypothesis is that it came from an agricultural trucker. He likely hauled some bat guano to some farm from a cave as fertilizer, and later hauled animals to the market without cleaning it out very well, just shoveled not swept and hosed down. He may have caught it directly or from the animals he was hauling exposed to the guano. When he sold the animals or did the paperwork for the delivery, the buyer got something extra. And the driver probably did not go home immediately and infected other people before he left Wuhan.

  40. There is a far cheaper, and also more effective, cocktail of drugs involving hydroxychloroquine, azrithrimycin, and zinc (not a drug but lethal to CV). But so-called Modern Medicine has become captive to modern politics, like everything else, so only doctors who support president Trump, or who aren’t in bed with expensive biotech solutions – maybe even have stock in such companies – will administer it. The doctors who are treating patients with this cocktail early in the illness – it does not good against lung damage later – are seeing over a 90% cure rate in days. Who says? They do:
    Science ought to be above politics. Sadly, it’s not, especially in America, which is one reason we have the worst health outcomes in the industrialized world, one third of all cases of Covid-19, and one of the highest death to hospitalization ratios 1:2:

  41. This a good start. Doctors still have quite a way to go before they can say there is an effective treatment for COVID-19. We still need to minimize the number of infections. I for one don’t expect to be back to my job (working on developing compiler optimizations) in an office anytime soon.

  42. Selenium appears to be associated with better outcomes:
    I was thinking iodine as that is in fish. But selenium is also in fish. We need to get everyone selenium pills before they catch this. The main thing is avoiding deaths…this will likely help. And as I said before, we need to be looking at all the vitamins and minerals. These things are cheap.
    Selenium is also in dairy. African Americans don’t consume much dairy, as they tend to be lactose intolerant. And that dang pseudo milk stuff…forget it. No selenium unless it is added. This may in part explain why African Americans are having a worse time with the virus. Though I tend to think lead exposure over decades, as lead raises blood pressure. There is also more lead in places like Detroit, San Francisco, Chicago, New York and Los Angeles because they have a lot of traffic and cars sitting in traffic emitted a lot of pollutants including lead for decades.
    Places that have historically had few cars, cars with better efficiency or never put lead in the fuel, do appear to be less effected by the virus. But there are enough exceptions to make that anything but clear cut.
    We need to take hair samples of thousands of people with coronavirus in the US to see if we have this same pattern. But get people selenium now. If the association is a flop, then stop giving people selenium…no harm done.

  43. Or as somebody else suggested on this site: A lab worker sold some of the lab animals to a market trader. Apparently it has happened before.

  44. I am not sure whether you are suggesting that remdesivir could be used as a prophylactic for Covid-19, or are just suggesting that it would be good to have a drug that could be used as such.

    An article I read about remdesivir said that it was given intravenously, and also was expected to be very expensive (about $1000 per dose, I believe was mentioned). Neither of those characteristics make it very suitable as a prophylactic.

  45. So why not say that you have a problem with my analogy instead of your rude comment? I will admit that the analogy is not perfect but it is never the less a very good analogy. I think I was very clear that I was theorizing and giving predictions however I also said in a reply to myself that there was still hope and these things should still be tested.

    Seriously, please point me to the article where this drug has statistically significant mortality benefit. I have done a fairly thorough search of Pubmed several times now looking for such an article and I cannot find one. As far as I can tell, we currently have the same evidence for this drug’s effectiveness as we had for hydroxychloroquine in the preliminary stages and that treatment turned out to be ineffective to detrimental depending on who was treated and what other agents were used in combination. The wholesale and sometimes inappropriate use of hydroxychloroquine has caused several deaths due to various adverse drug events. I am all for compassionate use but people on this forum do not understand the risks associated with these medications. I am trying to offer some expert advice and temper people’s enthusiasm for the next big thing that is going to save us from COVID. you don’t have to agree with me and I welcome discussion however we need to be respectful of one another.

    This drug is bad about causing liver and renal damage. It is not benign or without it’s own significant risks. Have reached max characters

  46. Remdesivir seems to be more effective with mild/moderate cases than with bad ones, where the chain of damage often resulting in bad outcomes has already kicked in.

    For those, it seems some anticoagulants could be of assistance, to avoid the formation of micro blood clots in the lungs capillaries, something that often results in people with hypoxia but that can breathe apparently fine (delaying medical attention until it’s too late).

    Surprisingly, things like nicotine are being investigated too, given it binds to the same cell molecules the virus does and could slow down the spread. It true, nicotine patches could become far more popular all of a sudden.

  47. There are natural occurring viruses that are very close to this one. So there is a natural explanation for it.

    Nature is the biggest bioterrorist, no need of our help.

    What could actually have happened, is a escape of a sample from a lab. Or not, I guess we’ll never know for sure.

  48. Your prose is fine.

    The problem is that you are reasoning by analogy and using Tamiflu to evaluate Remdesivir. It is like saying that Acetaminophen won’t stop a headache because Asprin has let you down.

    The mortality reduction is there. The placebo test was terminated early because the success of Remdesivir meant that the doctors had an ethical obligation to stop giving Placebos and to provide Remdesivir.

  49. Please cite the study you are referring to that shows statistically significant mortality reduction. Everything I have seen shows no statistically significant mortality reduction.

    PS. You appear to have a problem with reading comprehension as there is nothing wrong with my writing.

  50. So many characters, so little formatting, so little content.

    Remdesivir has shown statistically significant improvements in seriously ill patients. So much so that it is now the standard for care and other drugs will be compared to it. It showed statistically significant decreases in the duration of ccpflu as well as decreased mortality.

    Further studies are ongoing where earlier stage patients with far less severe symptoms are being given Remdesivir. We will have to see how those studies pan out but given that it does work for serious cases it seems reasonable to expect that it will help with less serious cases.

  51. Not to say that these things should not be investigated. I just wouldn’t get any hopes up for us to figure out a drug cocktail that works any better for COVID than what we have been able to figure out with many years and millions of dollars spent trying to figure out a cocktail for influenza. But heck, for the price of an economy car we can cure hepatitis C now (with several months of treatment) which was previously unthinkable so there is still some hope. Again, the problem lies in the acuity of COVID and influenza infections.

  52. We are still trying to figure out how COVID 19 is even killing people. Many antivirals have not panned out for COVID 19 however this is not so surprising given what we know about antivirals effectiveness against other acute, short lived viruses. The best example I can think of is a drug many here have probably heard of, Tamiflu (oseltamivir). This is a HIGHLY OVERRATED treatment for influenza. For it to even hope to have any effect it has to be started within 48 hours of the onset of symptoms. Even if you start it within this short window, the best you can hope for it that you will recover 2 to 3 days earlier than if you had not taken the drug at all and maybe have more mild symptoms. There is no significant effect on mortality. As a treatment it is pretty worthless. It is useful and effective however as a prophylactic agent (not as useful as a vaccine). This is where antivirals could be effective, Use them like you would use oseltamivir in nursing homes that are having outbreaks in order to stop the spread/outbreak. Otherwise you are wasting time and more importantly resources with antivirals for this type of infection.

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