• Coronavirus kills far more Hispanic and Black children than White youths, CDC study finds - The Washington Post
    https://www.washingtonpost.com/health/2020/09/15/covid-deaths-hispanic-black-children

    The coronavirus is killing Hispanic, Black and American Indian children at much higher numbers than their White peers, according to federal statistics released Tuesday.
    The numbers — the most comprehensive U.S. accounting to date of pediatric infections and fatalities — show there have been 391,814 known cases and 121 deaths among people under the age of 21 from February to July.Of those killed by covid-19, the illness caused by the coronavirus, more than 75 percent have been Hispanic, Black and American Indian children, even though they represent 41 percent of the U.S. population, according to the Centers for Disease Control and Prevention. The federal agency collected data from health departments throughout the country.The disproportionate deaths among youths echo pandemic disparities well-documented among adults. Previous studies have found the virus’s death toll is twice as high among people of color under age 65 as for White Americans. People of color also disproportionately make up “excess deaths” — those killed by the virus without being diagnosed or those killed indirectly by the virus’s wide effects on the health-care system. The racial disparities among children are in some ways even more stark. Of the children and teens killed, 45 percent were Hispanic, 29 Black and 4 percent American Indian. “This is the strongest evidence yet that there are deep racial disparities in children just like there are in adults,” said John Williams, chief of pediatric infectious diseases at UPMC Children’s Hospital of Pittsburgh. “What that should mean for people is steps like wearing a mask are not just about protecting your family and yourself. It is about racial equity.”

    #Covid-19#migrant#migration#etatsunis#sante#minorité#inegalite#accessante#race#surmortalite

  • Why U.S. hospitals don’t have enough ventilators - The Washington Post
    https://www.washingtonpost.com/health/2020/03/18/ventilator-shortage-hospital-icu-coronavirus

    Other governments have rushed to stock up on ventilators. The United Kingdom has asked Rolls-Royce Holdings, which makes jet engines, and other heavy manufacturers to make ventilators. Germany ordered 10,000 ventilators with Dragerwerk AG, which Dow Jones said was the company’s largest order ever.

    In the United States, Trump told state officials on a conference call that states and local governments should procure their own equipment. “Respirators, ventilators, all of the equipment — try getting it yourselves,” Trump told the governors, according to the New York Times, which first reported the call.

    #incurie #etats-unis #santé_publique #respirateurs

  • Shutdowns prevented 60 million coronavirus infections in the U.S., study finds - The Washington Post

    https://www.washingtonpost.com/health/2020/06/08/shutdowns-prevented-60-million-coronavirus-infections-us-study-finds

    Shutdown orders prevented about 60 million novel coronavirus infections in the United States and 285 million in China, according to a research study published Monday that examined how stay-at-home orders and other restrictions limited the spread of the contagion.

    A separate study from epidemiologists at Imperial College London estimated the shutdowns saved about 3.1 million lives in 11 European countries, including 500,000 in the United Kingdom, and dropped infection rates by an average of 82 percent, sufficient to drive the contagion well below epidemic levels.

    The two reports, published simultaneously Monday in the journal Nature, used completely different methods to reach similar conclusions. They suggest that the aggressive and unprecedented shutdowns, which caused massive economic disruptions and job losses, were effective at halting the exponential spread of the novel coronavirus.

    #coronavirus #confinement

  • Hydroxychloroquine drug touted by Trump linked to increased risk of death, study says - The Washington Post
    https://www.washingtonpost.com/health/2020/05/22/hydroxychloroquine-coronavirus-study

    A study of 96,000 hospitalized coronavirus patients on six continents found that those who received an antimalarial drug promoted by President Trump as a “game changer” in the fight against the virus had a significantly higher risk of death compared with those who did not.

    People treated with hydroxychloroquine, or the closely related drug chloroquine, were also more likely to develop a type of irregular heart rhythm, or arrhythmia, that can lead to sudden cardiac death, it concluded.

    The study, published Friday in the medical journal the Lancet, is the largest analysis to date of the risks and benefits of treating covid-19 patients with antimalarial drugs. It is based on a retrospective analysis of medical records, not a controlled study in which patients are divided randomly into treatment groups — a method considered the gold standard of medicine. But the sheer size of the study was convincing to some scientists.

    “It’s one thing not to have benefit, but this shows distinct harm,” said Eric Topol, a cardiologist and director of the Scripps Research Translational Institute. “If there was ever hope for this drug, this is the death of it.”

    Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis - The Lancet
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext

    96 032 patients (mean age 53·8 years, 46·3% women) with COVID-19 were hospitalised during the study period and met the inclusion criteria. Of these, 14 888 patients were in the treatment groups (1868 received chloroquine, 3783 received chloroquine with a macrolide, 3016 received hydroxychloroquine, and 6221 received hydroxychloroquine with a macrolide) and 81 144 patients were in the control group. 10 698 (11·1%) patients died in hospital. After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity), when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531), chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each independently associated with an increased risk of in-hospital mortality. Compared with the control group (0·3%), hydroxychloroquine (6·1%; 2·369, 1·935–2·900), hydroxychloroquine with a macrolide (8·1%; 5·106, 4·106–5·983), chloroquine (4·3%; 3·561, 2·760–4·596), and chloroquine with a macrolide (6·5%; 4·011, 3·344–4·812) were independently associated with an increased risk of de-novo ventricular arrhythmia during hospitalisation.

    #fin_de_partie

    • Medicus (@MedicusFR) sur Touiteur :

      https://threadreaderapp.com/thread/1263837955107565570.html

      L’étude observationnelle du Lancet est une mine d’or.
      J’ai beaucoup de choses à dire dessus. Le thread va être un peu long.
      Mais tout d’abord : IL FAUT ARRETER TOUS LES ESSAIS AVEC L’HYDROXYCHLOROQUINE.
      Il devient clair que ce traitement tue + de gens !

      https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext

      Je ne vais pas être le seul à le demander. Il n’est pas éthique de continuer un traitement qui augmente à ce point la mortalité et qui en plus n’a AUCUNE efficacité.
      Les autorités de santé doivent faire arrêter la majorité des essais avec ce produit.

      https://twitter.com/GaetanBurgio/status/1263820515891752960

      Tout d’abord sur la méthodologie. 96 000 patients. Les données viennent des registre de plusieurs centaines d’hôpitaux sur 6 continents. On a une étude en vie réelle.
      C’est une mine d’or pour la recherche.
      Publié dans le Lancet. Qui est un journal avec un haut facteur d’impact.

      C’est autre chose que les articles d’essai sauvage publié sur dropbox ou l’étude de Perrone retiré par les autres auteurs tellement ils avaient honte d’apparaître sur un tel torchon.

      L’étude donne beaucoup d’informations.
      Je ne pourrais pas tout expliquer. Mais je vais faire un résumé des points intéressants. D’autres comptes comme @FZores @SagittariusHH ou @Damkyan_Omega feront aussi des analyses je l’espère. Suivez les.

      Le critère principal de cette étude était de vérifier le taux de mortalité des patients prenant de l’HCQ seul ou avec l’AZTH. Et de vérifier l’impact sur les troubles du rythme cardiaque.

      L’étude va également permettre de donner plusieurs signaux d’intérêt. On ne peut pas conclure sur ces signaux mais ils devraient guider les prochains essais cliniques sur médicament.
      Essais qui ont été embolisés par la mystification hydroxychloroquine.

      On va donc parler du critère principal.
      L’hydroxychloroquine seul ou associé augmente la mortalité des patients covid19. Et pas qu’un peu.

      En données plus visuelles, on voit que l’hydroxychloroquine augmente nettement et significativement la mortalité. Et c’est encore pire en l’associant à un macrolide.
      Bravo la #FranceBasedMedicine.

      Le visuel montre également qu’une maladie cardiaque est un facteur de risque de surmortalité. Donc avoir donné un médicament ayant une toxicité cardiaque aux patients Covid19 ne vaudra pas le prix Nobel à EssaiClinix. Plutot le prix Darwin.

      Ca ne fera jamais que 2 mois que les scientifiques de ma TL alerte sur ce risque.
      La prochaine étape sera d’obtenir une étude pour connaitre la surmortalité chez les 10 000 patients ayant pris ce traitement en France.
      @ansm @ordre_medecins devront expliquer leur inaction

      L’étude montre également un augmentation significative du risque de troubles du rythme cardiaque avec ce médicament.
      Les centres de @Reseau_CRPV ont eu le même signal.
      @ansm ferme les yeux sur EssaiClinix depuis 2 mois, alors que @Reseau_CRPV tire la sonnette d’alarme.

      Il y a 2 mois, la première étude aurait du valoir un licenciement immédiat et un démantèlement de l’IHU de Marseille. Au lieu de cela, @EmmanuelMacron a été félicité EssaiClinix pour ses violations de protocole.

      https://twitter.com/MedicusFR/status/1241714810183655427

      Ne pas avoir réagi immédiatement en faisant respecter la Loi Jardé a pour conséquence une surmortalité.
      La crise Covid19 montre que la France se complait à tolérer les essais sauvages.
      La sécurité des patients n’est pas assuré par @ansm et @ordre_medecins

      Passons aux signaux d’intérêt.
      L’étude montre que les anticholestérols (les statines) et certains antihypertenseurs auraient un effet protecteur en stabilisant la fonction cardiaque.
      Ca fait 1 mois qu’on parle de ce signal avec @FZores @EricBillyFR et @Damkyan_Omega.

      Malheureusement cet axe de recherche est complètement noyé par la mystification chloroquine. Il n’y aura donc pas eu d’essais cliniques sur ces axes alors que les signaux sont d’intérêt.
      Parfait exemple que la chloroquine nous a fait perdre du temps et des ressources.

      Cette étude confirme aussi l’intérêt de développer des intelligences artificielles pour passer au crible en temps réel les données des hôpitaux afin de dégager le plus rapidement possible des signaux et axes de recherche.
      Cette étude, intéressante, arrive tard.

      Sur la base de ces résultats, il y a des questions que les cardiologues et les médecins vont devoir se poser :
      – Intérêt de remplacer les antihypertenseurs par des IEC (autre hypertenseurs) durant l’épidémie chez les patients prenant ces traitements.
      – Intérêt de mettre les patients à risque (notamment selon l’âge) sous statines en prévention primaire.
      – Intérêt d’utiliser une association statines-IEC chez les patients admis à l’hôpital
      Attention : ce sont des pistes de réflexion. Il faut des essais cliniques pour confirmer

      Enfin, compte tenu de la porte d’entrée du virus, la question d’utiliser les IEC en prévention doit aussi être analysé. Une poignée d’étude est en cours.
      https://twitter.com/MedicusFR/status/1256698468699078661

      Bilan ? La méthode scientifique est l’outil le plus performant pour nous protéger et éviter de prendre de mauvaises décisions.
      Court-circuiter la méthode est le plus sûr moyen de compter des morts.

      Epilogue (je vous l’ai dit, l’étude est dense).
      Vous vous souvenez aussi peut être de ces Pr de Médecine en France expliquant que la cigarette protégeait contre covid19. Cette annonce a créé une ruée sur les patchs Nicotine.
      L’étude montre que les fumeurs sont en surmortalité.

    • Eric Topol sur Touiteur :
      https://twitter.com/EricTopol/status/1263811764287725574

      Just published @TheLancet
      The largest study of hydroxychloroquine shows a significant increase in death (~35%) and >2-fold increase of serious heart arrhythmias. ~96,000 patients, ~15,000 on HCQ or CQ from 671 hospitals, 6 continents.
      https://marlin-prod.literatumonline.com/pb-assets/Lancet/pdfs/S0140673620311806.pdf

      It’s no longer that hydroxychloroquine has no sign of efficacy—it is associated with an increase in mortality.
      This is not a randomized trial but larger than all the preceding 10 studies and 3 randomized trials in aggregate.
      Chloroquine was even worse for risk than HCQ.

      The significant increase in deaths among HCQ of CQ treated patients cannot be directly attributed to the 2-5 fold increase in ventricular tachycardia (a malignant arrhythmia) but that must be playing a role.

      Extensive coverage of the results @washingtonpost
      https://washingtonpost.com/health/2020/05/22/hydroxychloroquine-coronavirus-study… by
      @arianaeunjung and @lauriemcginley2

      HCQ failed efficacy in the spectrum of mild to severe #COVID19, but now the higher mortality & VT in hospitalized patients (where arrhythmias get Dx’d and treated) raises 2 questions:
      1. Is it ethical to proceed with ongoing RCTs?
      2. How can the drug be given to outpatients?

      Just 2 footnotes
      1. This report is >6X the N of Rx’d patients cumulatively reported on cf prior studies (includes 3=RCTs)
      2. The addition of a macrolide antibiotic (1 of which was azithromycin) added substantially to risk of ventricular tachycardia: HCQ 2.3X-> H+M 5.1X risk

    • Eric Feigl-Ding sur touiteur (je ne mets que les paragraphes les plus intéressants, il y a évidemment beaucoup de redites avec les threads précédents) :
      https://twitter.com/DrEricDing/status/1263814135818719236

      11) For those given hydroxychloroquine, there was 34% increase in risk of mortality & 137% increased risk of serious heart arrhythmias. For those receiving hydroxychloroquine +antibiotic — there was 45% increased risk of death & 411% increased risk of serious heart arrhythmias.

      12) “Those given chloroquine had a 37% increased risk of death and a 256% increased risk of serious heart arrhythmias. For those taking chloroquine and an antibiotic, there was a 37% increased risk of death and a 301% increased risk of serious heart arrhythmias.”

      13) Clarification of “increased risk” nomenclature: hazard ratio of 5.0 denotes “inc risk by 5x” (drug user risk = 5*non user risk), or can also be described as a “400% increased risk of outcome”. In 1st post, I used the 5x language, which is same as 400% inc risk of X language.

      […]

      19) BOTTOMLINE: this study demonstrating CQ & HCQ increasing risk of death is an epic body of work representing amazing collaboration of 671 hospitals. Though not trial, it’s hospital registry data that is quite strong longitudinal design.

      ⇨ Do NOT take HCQ or CQ at this time!

    • quelques calculs de coin de table :
      • un IMC augmenté de 5, c’est comme être noir par rapport à être blanc : +35% de risque
      • 20 ans de plus, c’est un peu moins qu’être fumeur actif : +22% (+27%)
      • 40 ans de plus, c’être être hispano-américain par rapport à être blanc : +48% de risque
      • le plus gros effet qualitatif (en dehors d’âge et IMC qui sont quantitatifs continus) et de loin ! : être sous IEC (inhibiteur de l’enzyme de conversion, médicament contre l’hypertension), ça rajeunit de 57 ans…, ou ça fait perdre 9,3 points d’IMC…

  • Researchers find that more people died from opioid deaths than reported - The Washington Post
    https://www.washingtonpost.com/health/2020/02/28/opioid-deaths

    Opioid-related overdoses could be 28 percent higher than reported because of incomplete death records, researchers found in a study published Thursday.

    More than 400,000 people in the United States have died of opioid overdoses since the turn of the century, a quarter of them in just the past six years. But University of Rochester researchers found that between 1999 and 2016, about 100,000 more people died from opioids who were not accounted for — potentially obscuring the scope of the opioid epidemic and affecting funding for government programs intended to confront it, Elaine Hill, an economist and senior author of the study, told The Washington Post.

    The discrepancies were most pronounced in several states, including Alabama, Mississippi, Pennsylvania, Louisiana and Indiana.
    We thought we would find underreporting, but we were definitely not prepared to find how spatially determined it is,” Hill said.

    • The researchers found that the records were least consistent in poorer communities. On average, the people whose records were not counted were white females in the 30 to 60 age range.
      The incorrect records could be attributed to several factors, Hill said. Limited resources in counties can delay toxicology reports, limit drug testing and even prevent the completion of autopsies.

    • Seul le résumé est accessible

      Using contributing causes of death improves prediction of opioid involvement in unclassified drug overdoses in US death records - Boslett - - Addiction - Wiley Online Library
      https://onlinelibrary.wiley.com/doi/10.1111/add.14943

      Abstract
      Background and Aims

      A substantial share of fatal drug overdoses is missing information on specific drug involvement, leading to under‐reporting of opioid‐related death rates and a misrepresentation of the extent of the opioid epidemic. We aimed to compare methodological approaches to predicting opioid involvement in unclassified drug overdoses in US death records and to estimate the number of fatal opioid overdoses from 1999 to 2016 using the best‐performing method.

      Design
      This was a secondary data analysis of the universe of drug overdoses in 1999–2016 obtained from the National Center for Health Statistics Detailed Multiple Cause of Death records.

      Setting
      United States.

      Cases
      A total of 632 331 drug overdose decedents. Drug overdoses with known drug classification comprised 78.2% of the cases (n = 494 316) and unclassified drug overdoses (ICD‐10 T50.9) comprised 21.8% (n = 138 015).

      Measurements
      Known opioid involvement was defined using ICD‐10 codes T40.0–40.4 and T40.6, recorded in the set of contributing causes. Opioid involvement in unclassified drug overdoses was predicted using multiple methodological approaches: logistic regression and machine learning techniques, inclusion/exclusion of contributing causes of death and inclusion/exclusion of county‐level characteristics. Having selected the model with the highest predictive ability, we calculated corrected estimates of opioid‐related mortality.

      Findings
      Logistic regression and random forest models performed similarly. Including contributing causes substantially improved predictive accuracy, while including county characteristics did not. Using a superior prediction model, we found that 71.8% of unclassified drug overdoses in 1999–2016 involved opioids, translating into 99 160 additional opioid‐related deaths, or approximately 28% more than reported. Importantly, there was a striking geographic variation in undercounting of opioid overdoses.

      Conclusions
      In modeling opioid involvement in unclassified drug overdoses, highest predictive accuracy is achieved using a statistical model—either logistic regression or a random forest ensemble—with decedent characteristics and contributing causes of death as predictors.