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TL;DR: President Trump keeps hyping a potential coronavirus treatment — a "cocktail" of hydroxychloroquine and azithromycin. Does it work? Well, it doesn't appear to be a miracle cure, but some early evidence suggests it might help. South Korea and China recommend it. Lots of doctors are prescribing it. There are risks, of course, and it might not actually help. More tests are needed.
The coronavirus drug cocktail Trump is obsessed with
In late March, President Trump tweeted excitedly about a potential drug treatment for the coronavirus.
"HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine," the president tweeted.
Since then, Trump has extolled the virtues of this cocktail, even as his medical advisers and other experts have urged caution. There's no proof that the drugs are effective, the experts have said. There are risks and potential side effects. And the rush on the drug in the wake of the presidential endorsement has tightened supplies for people who depend on it to treat other conditions.
As with most things Trump, the discussion about HCQ has gotten passionate and politicized. Fans rally around a creative new use of an old drug, and cast anyone urging caution as an obstructionist bureaucrat. Meanwhile, others blast the president as a reckless charlatan.
So what's the truth?
Is the hydroxychloroquine-azithromycin cocktail a coronavirus wonder drug?
Or does it do nothing?
Or worse?
With the help of Andy Dunn, Insider's pharma and biotech reporter, I spent the past two days trying to figure that out. I also tried to answer a specific question: If I get sick, and my doctor recommends trying it, would I try it?
Here's what I learned ...
What is it?
As Andy explains, hydroxychloroquine is an old antimalarial drug that's been around since the 1950s. It's a "generic" medication also used to treat lupus and arthritis. It's cheap. It's widely available (at least when people aren't hoarding it). And it comes in a simple pill.
Hydroxychloroquine works by slowing the rate at which a virus reproduces itself. This, the theory goes, buys time for a person's immune system to build up its own defenses to take on the coronavirus.
Does it work?
In some small, early, and subsequently criticized trials, hydroxychloroquine and a hydroxychloroquine-azithromycin cocktail appear to have helped people recover faster and avoid the most severe symptoms of COVID-19.
Medical experts, including Trump adviser Dr. Anthony Fauci, caution that this evidence is anecdotal and that further studies are needed.
Well, what's the evidence?
It's mixed.
On the positive side, lab experiments have concluded that hydroxychloroquine (HCQ) has some antiviral effect on the coronavirus.
A study of 62 patients in China who were treated for COVID-19 in February concluded that patients treated with HCQ recovered faster than a control group. Thirty-one patients who took the drug stopped coughing and reduced fevers earlier than 31 patients in a control group. The four patients of the 62 who got seriously sick were in the control group. But two patients in the HCQ group had "adverse reactions."
The French team studied 42 patients with moderate to mild symptoms. Twenty-six received hydroxychloroquine, and 16 were in a control group. The study described a startling "100%" recovery rate among the patients who took hydroxychloroquine.
But while personalities such as the celebrity physician Dr. Oz soon celebrated this apparently amazing success, there were a number of significant issues with the study.
First, the recovery rate of patients who took HCQ actually wasn't 100%. That was just the percentage of patients who took HCQ and completed the study.
As Michael Hiltzik of the Los Angeles Times has meticulously reported — and as the study itself says — six of the patients who took HCQ didn't finish the study. One dropped out because he or she died. (!) Three dropped out because their symptoms worsened and they were moved to intensive care. A fifth stopped taking the medication because it made him or her sick. The last left the hospital on day three of the study and went home, after testing negative for the virus on the previous two days.
The doctor who led the French study is himself no stranger to controversy. He was once temporarily barred from publishing research in a medical journal after a paper with his name on it contained misleading data. He has ridiculed climate change. In January, he scoffed at the idea that the coronavirus was a global health hazard, calling the idea "crazy."
Other studies, meanwhile, have found HCQ to be less effective or ineffective.
A small study of 30 patients published by the Journal of Zhejiang University, in China, found the hydroxychloroquine to be no more effective than treatment without the drug.
A second study in France found "no evidence" of benefit in patients with severe COVID-19 symptoms. So if the HCQ-azithromycin cocktail does help patients early on, by the time the infection has progressed it may be too late.
Overall, there seems to be a consensus that hydroxychloroquine shows enough promise to at least move forward with more trials. A "study of studies" concluded this. More studies are now underway.
What about the risks?
Chloroquine is considered a relatively "safe" drug, at least when used as directed. But that doesn't mean it doesn't have some nasty potential side effects.
These side effects aren't just irrelevant "fine print." Hospitals in Sweden, in fact, have stopped using hydroxychloroquine to treat COVID-19 because the side effects have been so strong.
In addition to nausea, some of the complications experienced by patients cited in the FDA's write-up of Plaquenil, a branded version of the drug, include:
- "Irreversible retinal damage."
- "Life-threatening and fatal cardiomyopathy."
- "Skeletal muscle myopathy or neuropathy leading to progressive weakness and atrophy of proximal muscle groups, depressed tendon reflexes, and abnormal nerve conduction."
- "Suicidal behavior."
- If you take too much of it — unsurprisingly — it can kill you.
Also, as with other substances, you have to be certain you're taking the right drug. After Trump recommended hydroxychloroquine, a couple in Phoenix took some chloroquine phosphate — aka fish-tank cleaner. The husband died and his wife was hospitalized.
So, what to conclude?
But South Korea and China have already recommended that doctors use the drug to treat COVID-19. Doctors in France have been prescribing it. And many US doctors seem persuaded that hydroxychloroquine is at least worth trying.
Insider's Andy Dunn shared a recent survey of 6,227 physicians conducted by the research firm Sermo. It found that they already consider hydroxychloroquine the most effective treatment of COVID-19.
Andy also passed on a chart from the investment advisory firm Raymond James showing that prescriptions for the drug began surging even before Trump's breathless tweet.
Even the US Food and Drug Administration has gotten on board, issuing an emergency-use authorization to allow prescriptions of HCQ for COVID-19 — prescriptions that doctors have apparently already been writing for weeks.
So it seems a lot of medical experts agree with the conclusion of the authors of the Chinese study from February: "Considering that there is no better option at present, it is a promising practice to apply HCQ to COVID-19 under reasonable management."
Would I take it?
Yes. Based on what I've learned, if I got COVID-19 tomorrow and my doctor suggested I try HCQ, I'd take it. I wouldn't have high hopes that it would help. And I'd expect it might make me feel nauseated, or worse. But I'd probably give it a try. (That's not advice to you or anyone else, obviously.)
Thank you!
Huge thanks to my colleagues (pharma and biotech reporter) Andy Dunn and (healthcare editor) Zach Tracer, without whom I — and now you — would be much less informed. Thanks again to all of you for reading this second edition of Insider Today. Please feel free to share your thoughts by writing to me at henry@insider.com.
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This from a very credible source and fellow memo reader.
Why Italy?
Italy has been ravaged by the Wuhan Coronavirus, but the reasons why are linked more closely to globalism than the age of the infected.
- Hundreds of thousands of Chinese immigrants now live both legally and illegally in Italy, with 300K legally registered and many more illegal.
- Italy recently entered into a new economic partnership with China called “One belt, One road”
- China has revitalized northern Italian ports in order to transport goods more efficiently to the rest of Europe
- The mayor of Florence initiated a social media campaign called “Hug a Chinese” using Chinese produced video as an engine to dispel the “racism” against the Chinese in Italy
Thirty years ago, Italy saw the beginnings of what would become a serious issue with illegal immigration. What was surprising, was that the immigrants couldn’t just walk over a border to enter the country, they had to flock from China. It began with Italians hiring the Chinese off the books at cheap wages to work making garments in towns and villages renowned for their craftmanship, and morphed into Italians seeing the Chinese learn how to do it faster and cheaper; often times watching as their family owned businesses were shuttered because they were outbid. The Chinese took over the Italian craft and made it their own. What didn’t change was the coveted “Made in Italy” label. The NY Times began documenting the trend in 2010 writing:
Over the years, Italy learned the difficult lesson that it could no longer compete with China on price. And so, its business class dreamed, Italy would sell quality, not quantity. For centuries, this walled medieval city just outside of Florence has produced some of the world’s finest fabrics, becoming a powerhouse for “Made in Italy” chic.
And then, China came here.
Chinese laborers, first a few immigrants, then tens of thousands, began settling in Prato in the late 1980s. They transformed the textile hub into a low-end garment manufacturing capital, enriching many, stoking resentment and prompting recent crackdowns that in turn have brought cries of bigotry and hypocrisy.
The city is now home to the largest concentration of Chinese in Europe; some legal, many more not. Here in the heart of Tuscany, Chinese laborers work round the clock in some 3,200 businesses making low-end clothes, shoes and accessories, often with materials imported from China, for sale at midprice and low-end retailers worldwide.
The trend continued as whole villages in Italy became Chinese villages, with the Chinese displacing the Italians who lived there, creating their own neighborhoods, and pushing out decades of Italian family owned business. They weren’t known for following the rules. It caused much local consternation; the Italians were forced to pay their taxes and follow the employment guidelines, while the Chinese seemed to have built flourishing enterprises by skirting the rules, treating their people poorly, and engaging in rich human smuggling operations, to boot. There was little accountability for the Chinese, and much for the native Italians.
Outside of the typical problems one would see with such an influx of immigrants from a far-off land, were also other, more scandalous ones.
In 2017, the Bank of China agreed to pay a 600,000 euro fine to settle a money laundering case involving its Milan branch, court documents showed. The Florence court hearing the case gave four employees of the Milan branch of China’s fourth biggest bank a suspended two-year prison sentence for failing to report illicit money transfers. Florence prosecutors leading the so-called “River of Money” investigation alleged that more than 4.5 billion euros ($4.78 billion) was smuggled to China from Italy between 2006 and 2010 by Chinese people living mainly in Florence and nearby Prato. About half of the money was sent via BOC, the prosecutors said. The court also ordered BOC to pay back 980,000 euros which it said it had earned through the illegal operations. According to the prosecutors, the proceeds sent to China came from a series of illegal activities, including counterfeiting, embezzlement, exploitation of illegal labour and tax evasion. Bank of China said in a statement it had not committed any crime and was not admitting guilt by agreeing to pay the fine, which was a way of closing the case and saving time.
The wheel of corruption kept spinning, and the Italian people became more and more angry. Sometimes, this led to violence. It also led to a nationwide sentiment that something needed to change, and the populist uprising we have been seeing across the globe also began to take a foothold in Italy.
At a time when Europe is filled with anti-immigrant rhetoric, political extremists have pointed to the demographic shifts in Prato as proof that Italy is under siege. In February, Patrizio La Pietra, a right-wing senator, told a Prato newspaper that the city needed to confront “Chinese economic illegality,” and that the underground economy had “brought the district to its knees, eliminated thousands of jobs, and exposed countless families to hunger.” Such assertions have been effective: in Italy’s recent national elections, Tuscany, which since the end of the Second World War had consistently supported leftist parties, gave twice as many votes to right-wing and populist parties as it did to those on the left. Giovanni Donzelli, a member of the quasi-Fascist Fratelli d’Italia party, who last month was elected a national representative, told me, “The Chinese have their own restaurants and their own banks—even their own police force. You damage the economy twice. Once, because you compete unfairly with the other businesses in the area, and the second time because the money doesn’t go back into the Tuscan economic fabric.”
In March of 2019, Italy entered into a new agreement with China, part of its “one belt, one road” initiative, a sweeping economic agreement with the country that saw the port of Triesta in northern Italy “revitalized” and managed by The PRC.
The project makes enormous infrastructure investments to move Chinese goods and resources. Italy became the first of the Group of 7 nations that once dominated the global economy to take part in China’s “One Belt One Road” throughout Asia, Africa and Europe.
The Trump administration, which tried and failed to stop the deal, focused in the days leading up to Mr. Xi’s visit on blocking any Italian use of 5G wireless networks developed by the Chinese electronics giant Huawei, which Washington warned could be used by Beijing to spy on communications networks.
Italy, which is saddled with crushing debt, hopes to lift its lagging economy by exporting goods to China and inviting more Chinese investment
But opponents of the project in the Trump administration and in the European Union worry that Italy has turned itself into a Trojan Horse, allowing China’s economic — and potentially military and political — expansion to reach into the heart of Europe.
The detailed reporting on this slow takeover is expansive, and we could continue here for many paragraphs, but let us fast forward to early 2020. As China withheld information about the seriousness and spread of Wuhan corona-virus, many of these immigrants were returning- and arriving – from China. Once news of the virus became mainstream and China felt increasing backlash over the handling of the crisis, they turned to one of their major economic hubs for some help.
It wasn’t chance. It wasn’t age. It wasn’t overall health, and it wasn’t the good-hearted nature of the Italian people that caused the virus to ravage their nation. It was a leadership who are now under the thumb of the Chinese government.
On February 1, 2020, the mayor of Florence initiated something called “Hug a Chinese” day.
This video was released on February 4, and was produced by the Chinese government. Under the guise of being “woke”, the Italian government prodded their citizens to erase the stigma surrounding the virus, and hug one of the hundreds of thousands of Chinese who had been living, recently returned, or recently arrived in Italy. Italy had become dependent on China, and their capital is a large percentage of the Italian economy. When “One Belt One Road” began early in 2019, the Italians made clear they were willing to partner with China in their quest for global dominance, and sadly it appears in their attempt to please the purse strings, they put a large percentage of their citizens in harms way.
This may also explain the enormous amount of aid and assistance flowing into Italy now by way of China. Far from being compassionate, the Chinese are likely looking to protect their investment.
So when folks ask, “Why Italy?” the reasons are clear. Along with an ageing population who may not be the healthiest, there is also a government now beholden to China, who acting at their behest, took extreme measures to the opposite of social distancing. For an in depth look at the cluster history inside Italy, please see here.
China’s global dominance has become clear even to the average observer in recent months, as Americans have become aware of the supply line dependence on China for even our most vital commodity; medicine. UncoverDC columnist Carol King detailed some of those issues in a piece that you can read here. We have even witnessed the legacy media seemingly hold water for the communist nation, choosing to parrot the claim of “racism” against China because our President has chosen to correctly name the virus what it is, the Chinese virus – rather than bow to the propaganda of a foreign nation hell bent on our destruction.
If one positive thing can come of the Wuhan corona-virus, maybe it will be that the world will finally open its eyes to just how sinister China has been over the past few decades, slithering in to our households, seemingly unbeknownst to us, and co-opting even our most basic necessities. Time will tell, but one thing is clear- it appears that “Why Italy?” is more nefarious than anyone could have initially thought.
Tracy Beanz is the Founder and Editor in Chief at UncoverDC. You can follow her on Twitter @TracyBeanz
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