COVID Transmissions for 7-16-2021

One year of COVID Transmissions

Jul 16, 2021

Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions, now entering its second year.

It has been 607 days since the first documented human case of COVID-19. In 607, the papacy had been vacant for about a year when Pope Boniface III was finally selected. He instituted two important decrees about papal succession, and then promptly tested these decrees by dying in November of that same year at the age of 67.

Unrelated, today I discuss a shocking fraud in COVID-19 research. Well, not so shocking; when there’s a disease, there’s someone who tries to set themselves up as having “the” cure, whether it’s snake oil or vitamins. However the sheer audacity of this fraud is really something.

And then I spend some time reflecting on what one year of COVID Transmissions has meant for me. If it’s meant something to you, I’d love to hear about it. Have a great weekend!

Bolded terms are linked to the running newsletter glossary.

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Now, let’s talk COVID.

Ivermectin study retracted due to accusations of fraud

I have been avoiding talking about ivermectin, an antiparasitic drug that has been investigated for COVID-19, in this newsletter because the evidence supporting its use has been, in a word, extremely low-quality.

What I have just said is something that, were I a more influential communicator about COVID-19, would lead to an army of people harassing me on Twitter. Ivermectin, like hydroxychloroquine before it, has a substantial number of die-hard supporters who believe that it is “the answer” to COVID-19. They are a diverse bunch of people—those who simply believe it is important to have more pharmacological therapies for COVID-19, those who saw early data and became enamored with idea, and some people who hold up ivermectin as though it has prophylactic properties that make it a reasonable alternative to vaccination.

The reality is, I am just not impressed by any data I have seen regarding ivermectin in the treatment of COVID-19. This does not mean that ivermectin is not a viable treatment for COVID-19. I understand that it is being used in clinical trials to assess its value in that indication, and when there is a convincing readout from those clinical trials, I will report it here. Until then, absence of evidence means absence of statements from me on ivermectin. I have not been convinced by any study that it has any prophylactic or therapeutic effect in COVID-19.

It is, however, pretty excellent at treating certain parasitic infections, like Strongyloides stercoralis, a type of roundworm that I recommend avoiding.

Unfortunately, in the COVID-19 setting we have been beset with misinformation about ivermectin, and this story represents the latest chapter in that saga. Last year, a preprint claiming to be a randomized controlled trial, with multiple healthcare centers involved, was uploaded to a preprint site called Research Square. This preprint was never peer-reviewed and never published in any journal, reputable or otherwise. However, because preprints have become “the” source for COVID-19 news, it was still cited in numerous articles. It was the largest study of ivermectin conducted. It had stunning results, suggesting that ivermectin could prevent upwards of 90% of COVID-19 deaths and could also substantially reduce transmission of COVID-19. This one article has been used to justify the use of ivermectin to treat COVID-19 cases all over the world. At one point Indian health authorities were publicly recommending the use of ivermectin.

Well, an epidemiology master’s degree student named Jack Lawrence pulled at one thread in this preprint, and the whole thing has unraveled. Lawrence noticed that much of the preprint’s introduction was plagiarized from other sources, with the act of plagiarism ineptly concealed through the use of a thesaurus. This led to a deeper investigation into the underlying data in the preprint, which revealed tremendous problems.

Data were inconsistent between the underlying data and what was reported in the paper. In some cases, there were fewer deaths in the “standard care” arm as reported in the underlying data than in the ivermectin arm. I put “standard care” in quotes, by the way, because the “standard care” approach suggested in the preprint does not represent any reasonable standard. It includes supplements like vitamin C and zinc, which I do not feel have been adequately demonstrated to have meaningful impacts on COVID-19, as well as azithromycin, an antibiotic that was combined with hydroxychloroquine in early clinical trials. Antibiotics, including azithromycin, do not have any effect on viral infections. Azithromycin does not have any effect on COVID-19.1 If you are a physician giving patients azithromycin for COVID-19 routinely, you should stop doing that right now. You should be using proven alternatives like monoclonal antibody cocktails, when indicated. Additionally, this “standard care” included a milk protein called lactoferrin which also has no meaningful evidence supporting its routine use in COVID-19.

Look, I just want to be totally clear: physicians should not be giving random, unproven treatments to COVID-19 patients. We know very little about COVID-19 even now. There is substantial risk of doing harm by just throwing different options at a wall and seeing what will stick. It is an immediate red flag that this study included, as “standard care,” a laundry list of supplements and drugs with dubious evidence supporting their use. This is not evidence-based medicine.

Anyway, they added ivermectin to this mix, and then, seemingly, reported results that were not actually in line with their underlying data. Not a good sign.

Grftr News, a site that exposes online disinformation, worked with Lawrence to ask a scientific fraud investigator to look into that underlying data. That investigator, Nick Brown, found evidence of brazen fabrication in the underlying data sources. Individual patient information was provided, already something a bit sketchy in reporting clinical trial evidence, but that information included numerous obvious duplicates. Entire patients were duplicated, including typos in their patient information. Data recording was not to a reasonable standard, with errors and formatting problems abounding.

Other researchers identified other issues—such as inconsistent or even statistically impossible ranges of numbers reported within the paper itself.

Add that to the plagiarism and it becomes clear that this is not a paper that should be used to make any kind of medical care decision. Research Square withdrew the paper, though earlier revisions are still available (albeit with flags that the paper has been withdrawn).

There is actually a lot more to this story—all bad—that I haven’t included here, so if you want to read all about it, head over to Grftr News for the full piece by Jack Lawrence: https://grftr.news/why-was-a-major-study-on-ivermectin-for-covid-19-just-retracted/

The take-home here is this: in a time of emergency, there are a lot of people who wish to appear to have all the answers. Some of them will grandstand and overstate their credentials, like a certain nutrition epidemiologist who has rebranded himself as a COVID-19 expert without the credentials to back it up. That is merely distasteful. Others will fabricate data to try to make themselves appear to be influential researchers in the study of the disease. That is not just distasteful, it is harmful fraud. It is wrong to fabricate evidence that causes physicians to administer a drug to actual living people. However, there are always people who do it. Even in normal times, there are unscrupulous researchers and complete charlatans who will play on public ignorance or use fraud and lies to try and make themselves wealthy or famous.

The bottom line is, you have to be on your guard. Not everything you read is true. Hell, I try very hard to be accurate and I still make mistakes, so there’s really no source I would point to that I would say you can unequivocally trust. While this paper contained outright lies, it fooled a lot of people. Those people could have avoided being fooled if they had done their homework and looked at other studies of ivermectin where the results were a lot less stunning. Before putting something into your body, evaluate everything. Question everything that is presented to you. Read it deeply and look for inconsistencies. Don’t just read the conclusions or the news story. Read everything you can, and decide for yourself if you should be convinced.

When it comes to vaccines, that is exactly what I did, personally and in this newsletter. I devoted multiple issues to the press releases, the FDA briefings, and the final publications for each of the major vaccines. Often this meant presenting redundant information, but I did that for a reason—the fact that all of these sources were consistent, reliable, and stood up to scrutiny mattered to me. Multiple vaccines using the same technologies but from different companies worked with similar levels of efficacy. The safety profiles were consistent. The experts who evaluated them and had access to underlying data also stated they were convinced. The real-world data from the initial rollout and beyond, in countries of varying population demographics and geography, indicated that these products worked as described. A totality of evidence supported that the risk-benefit profile of each marketed vaccine was unquestionably favorable. That is what you should look for.

Treatments that work don’t have a few preprints showing they do something, along with a bunch of other papers showing that they don’t. Those kinds of mixed results means something odd is going on. In this case, it turns out that some fraud was happening. That isn’t always the case. But no matter the situation, when it comes to your health, it’s as I said before: be on your guard.

What am I doing to cope with the pandemic? This:

Reflecting on one year

Allow me to get personal for a moment.

When I started writing this newsletter, it was a choice made for expediency and my own peace of mind.

At the start of the pandemic, I experienced a whirlwind of emotions. When I was a virology PhD student, I was at a large medical center—Mount Sinai Hospital in New York City. I was studying emerging viruses that enter humans from bats, and when people asked me if I was involved in patient care (most folks don’t understand that hospitals do lab research too), I would tell them, “Look, if I ever see a patient, things have gone really wrong.”

In March 2021, friends started coming to me looking for advice. A lot of misinformation about COVID-19 was being posted on the Internet and also, unfortunately, shared by government officials the world over in press briefings. In New York, where I still live, a cresting wave of cases led to shortages of critical medical supplies.

I threw myself at all of these situations in between trying to adjust to a new job—in liver disease, started two months prior—and also to doing that job during a pandemic. I ended up spending a fair amount of time trying to connect local hospitals with various suppliers of medical equipment, something I fell into in such a convoluted and outlandish way that I almost cannot believe it happened. You see, a colleague of Elon Musk had access to some ventilators, and he wanted connections with NYC physicians to get them to our city. These ventilators were not everything that was hoped, but they did provide some respiratory support, and the healthcare providers I connected with were grateful. They were also curious what else I might be able to get access to. So I kept asking around, trying to connect people who had supply to people with needs.

Eventually, the chaos died down, but the questions about how to navigate the pandemic kept coming. I realized I was answering the same questions frequently for different people, and despite my years of writing things both fiction and nonfiction on the Internet, I somehow hadn’t thought of becoming a public COVID-19 communicator. I realized it was time to create something unified that would help people I knew navigate what was going on, in a way that would give me centralized links I could send when the same question came up from multiple sources. You’re reading that something.

Since the first issue, COVID Transmissions has grown to reach hundreds of people. It is not some massive viral success, but I never wanted it to be that, either. I’ve had my massive viral successes in the past—both literal successes in viral studies, and writing that has reached millions of people—and that wasn’t what I was looking for here. I just wanted to make some kind of impact, particularly by connecting with friends and family who needed information about COVID-19.

Regardless of what I wanted, COVID Transmissions has become a massive success in many ways. It has kept me in touch with family who I might not speak to on a regular basis. It has helped friends to inform themselves so they can make better decisions. It has helped me to make new friends, all of them genuinely incredible people, in the midst of a global catastrophe. Those friends are you—particularly those of you who comment, who share the work with others, who boost my tweets about this newsletter, and who I see quoting from it, engaging with it, and sometimes finding things that I need to correct. You all matter to me, and frankly, connecting with you every issue has helped me to stay grounded during this disaster. Thank you for being here.

You might have some questions or comments! Send them in. As several folks have figured out, you can also email me if you have a comment that you don’t want to share with the whole group.

Join the conversation, and what you say will impact what I talk about in the next issue.

Also, let me know any other thoughts you might have about the newsletter. I’d like to make sure you’re getting what you want out of this.

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