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Tuesday, April 20, 2021

But could viral infection cause more deaths than ever?

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A study published Monday in the Lancet had its proponents more than a little giddy, taking root in the microbiology world and making the rounds on social media as “the cure” for the coronavirus that has killed at least 30 people in Saudi Arabia, and sown fear that it might kill millions in the United States.

In this article, Dr. Mark L. Moynahan, a scientific adviser at Oxford University, proposed that an antiseptic solution or placebo oral solution could be injected into the lungs of humans infected with the virus, which causes coughing, fever and in severe cases, pneumonia. This, the researchers argue, could help stave off those two deadly conditions.

The main thing that was wrong with the Lancet article, though, was the advice given by Dr. Lachlan Yates, a coronavirus expert at Birmingham University in England.

In an article titled “A patient’s respiratory tract can slow the effects of the coronavirus,” Dr. Yates outlines his research testing the idea of an antiseptic intervention in common patients with whooping cough and hospitalized patients with cor. He was so confident in the treatment that he pointed out that those who were given antiseptic began to breathe freely after only 24 hours of treatment.

Yet that was the wrong conclusion to draw from his study, in my view.

First, the most realistic way to assess how successful such a treatment would be was to assess if it would prevent a patient from developing an infection. There was no way to do this in the case of the coronavirus because the symptoms of the illness were still causing the virus to thrive. As a result, even if a person stopped developing the respiratory disease after receiving antiseptic, they could still develop the virus and make a relapse to pneumonia.

From the standpoint of risk reduction and mortality reduction, however, antiseptic certainly looked like a good idea, because it offered some measure of protection against two respiratory diseases that were likely to claim lives of vulnerable children, adults and the elderly.

As a result, many people could perceive this study as the crack that would finally show that a cure exists for the coronavirus, and potentially offer protection against serious infections elsewhere. Not only did they not vet Dr. Yates, and thus fail to discover that antiseptic would be useless for severe infections, but they also misunderstood how evidence is measured.

The Lancet article had a total of 190 pages, and contained four different links to the research reports and a multimedia site. It also included detailed graphs of the results over time, which included the number of outbreaks and patients who got sick.

Yet it was a mere four pages long, excluding the interactive graphs that did not apply to what the case described in the Lancet article was all about. This is a failure that led to people taking up Dr. Yates’ advice and suggesting that a poor therapy would provide protection.

If you need an example of how this epidemic came about, however, you could point to a 2016 study in the journal mBio that revealed that the CDC’s own data on the first 11 confirmed U.S. cases of the virus couldn’t reconcile their own data on all of the earlier cases. That, in fact, caused the CDC to close in on further cases in order to detect the virus.

Yet before that, a BBC investigation found that four out of the first nine British cases from the Middle East could not have had been coronavirus; and so, even that study’s own data could not make sense of what was going on.

The Lancet article, though, was literally a “climb” — in other words, an interpretation of the data — to see if there was any basis to making treatment more effective. It did not, and so people were even more left wondering what the real answer is to the case.

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