Science: So, did Hydroxychloroquine work against covid after all?

 I had a brief chat with someone who had not been vaccinated. He cited concerns for the side reactions and that covid kill only negligible percent. 

Well. ... Personally I think vaccine refusal is unwise, under the light of available vaccine and covid data by July 2021. But I'll let him live his way. No arguments. He does not work in medicine, so he has no professional obligation or requirement.

For me, vaccine refusal is categorized in the same place as blood transfusion refusal on religious ground. There may be some angels other than me or vaccine to rescue him (or not). 

He also mentioned that hydroxychloroquine is still a drug for covid, only shot down by political reasons.

I thought hydroxychloroquine for covid is a long dead approach. But to be sure, I checked recent publications.

To refresh the memory, hydroxychloroquine is mainly an anti-malaria drug and inhibit growth of malaria parasite. Additionally, hydroxychloroquine can modulate immune response, and occasionally used for autoimmune diseases (lupus, Rheumatoid Arthritis), which may have been a reason to be purported as effective for covid management. 

Downside of hydroxychloroquine use is its narrow range of optimal dosing. Because of that, clinicians are careful with dosing. Cardiac arrhythmia (erratic heartbeat) is commonly reported in clinical use. It is a prescription-only and is not a drug for self-medication.

In early phase of pandemic (early 2020), use of hydroxychloroquine with or without azithromycin, an antibiotic presumably for secondary bacterial pneumonia, was purported to be effective against covid19.

1.5 years later, scientific evidence has piled up.

In the field of medical science, not all evidence and reports are equal. Some evidence are more respected or taken more seriously than others. There is a hierarchy in evidence.

Lower tier evidence is preclinical studies with model systems, like cultured cells, lab animals, and computer modeling. They can provide proof of principle toward clinical trials, but the reports are taken with a grain of salt when questioned for human use.

Case reports and observations in small number of patients are also considered low-tier evidence. Numbers count in science.

Middle tier evidence is individual clinical trials. Clinical trials come in three phases. Phase I is basically toxicity test on small number of volunteers. Phase II is an expanded version of phase I. In phase III, the drug or treatment of interest may be applied on actual patients. Yet, various designs can be employed, and only a "randomized and controlled phase III clinical trial with large number of patients" provides scientifically sound data that can be interpreted and concluded.

But single "randomized and controlled phase III clinical trial" may still not be enough to conclude everything.

The highest tier evidence is meta analysis. In a meta analysis, researchers apply inclusion/exclusion criteria on many published clinical trials, and results from multiple clinical trials are evaluated. Meta analysis follows statistics and specific data handling. Basically, meta analysis can answer whether these clinical trials are indicating the same results, or not.

Someone once sent me a bunch of "covid19 and hydroxychloroquine" reports to comment. They were collated by some radio personality. It was a poor attempt to evaluate bunch of reports by a layman and was a mockery of meta-analysis. I did not want to touch it or deal with it. So I refused to see it.  ....I digress.

To make matters a little more complicated, journals for each tier publications come with high or low impact factor (IF), which is an averaged score indicating how many times papers appeared in the journal is cited by colleagues/peers. IF of a journal is a metric suggesting whether the paper is well-recognized among experts in the field. 

 IF 30-40 is the highest, attained by a few commercial and prestigious scientific journals. IF 8+ is quite decent, basically top ranked journals for the specific research field (like cancer research or immunology or aging). IF3-5 would make regular respectable research papers. I would read the papers with an assumption that they are not doing horrible job in the peer review process and the results can be taken seriously. 

If the paper concerns my own research, I will add extra caution. Even if it is not scientific misconduct, unintentional mistakes and misinterpretations can happen. And just trusting others' single report can mislead us, if their report contains errors. 

In addition to peer-reviewed publications, there are "preprints without peer review". They are more like press release of sorts, or preliminary results that may or may not be solid. As an evidence, they are not as strong or trustworthy as peer-reviewed papers.

Above is somewhat oversimplified way to view medical research evidence and papers.

That said, when I accessed Pubmed databese (https://pubmed.ncbi.nlm.nih.gov/) and typed in "covid hydroxychloroquine meta analysis", there were 103 hits (7/17/2021). 

I checked out several recent papers. ("Recent" is important, with relentless updating in science). They pointed toward the same conclusions. (No wonder. They are mostly based on the same clinical trials.)

In short, "Meta-analysis of included studies revealed no significant reduction in mortality with HCQ use, .....There was a higher risk of ECG abnormalities/arrhythmia ....The quality of evidence was graded as very low for these outcomes."

Hydroxychloroquine did not work against covid. It even increased risk for heart malfunctions.

I wouldn't take Hydroxychloroquine for covid. For malaria, I would, though.

[Hydroxychloroquine]

There may be a question, "what about combination of hydroxychloroquine with zinc, folate, etc?" 

In terms of publications, with limited evidence, efficacy of hydroxychloroquine and zinc combination remains hypothetical. Combination is difficult to properly compare. It remains to be seen if zinc by itself has better effects than hydroxychloroquine, for example.

Whataboutism do not mix well with clinical trials requiring solid rationales. May I remind you, clinical trials are experimentation on humans. If combination with X,Y and Z have theoretical support and show efficacy in preclinical models, combination may be considered. But when the main component X indicates little promise, it is dead end, at least in western clinical trial methodology. As of July 2021, FDA is recommending against use of hydroxychloroquine for covid.

Vaccine was the game changer. But we still await for anti-covid med, something like Tamiflu or Relenza to influenza. Hydroxychloroquine was not it. OTC anti-covid med remains as a gap in medicine.

Dance: Bonnie Cannon Subey WCS workshop 07/06/2021

There was West Coast Swing (WCS) dance workshop/dance at the Oklahoma City swing dance club on 7/6/2021 (Tue).

The instructor, Bonnie, is a dance professional with 17 years of WCS experience. Her competition record includes Champions J&J winning at Madjam 2019 with Benji Schwimmer (or should I say the Benji Schwimmer? It takes really strong a dancer to match up with a dancer like him.) She was attending Wild Wild Westie 2021 event in Dallas on the July 4th weekend, working as a judge etc, and stopping by her hometown OKC.


Indeed, Bonnie was and still is one of us. She started WCS in the OKC swing dance club and was dancing there with us until she graduated high school and moved out.

Like any other dance places, the club was closed for some time during 2020/2021 for covid. I was only coming back recently. Yet, I wanted to attend her homecoming workshop for a welcome. It was nice to see familiar faces at the workshop.



The workshop was about styling of push spin. Two versions (short/fast and long/slow) were introduced. I find them quite useful for all levels and for both lead and follow.

You can appeal on the dance floor in three ways; (i) body itself/physical ability/functionality, (ii) body usage/artistic use of the body, and (iii) knowledge on the dance. Styling can cover (ii) and (iii).


It was a nice class. Demonstration was clear. I enjoy the difference before and after the class, which is important.



Afterwards, there was social dance, and I danced with Bonnie after these years. As I remember, from the beginning Bonnie was a smooth mover, and had the “hunch” for dancing already. She could move with light feet and position herself in a way that is correct for WCS. “Naturals” do exist in any game, and in sports it can be evident.

Her possible weakness, I thought back then, was dancing. Even with the same song, fast/smooth movers can have extra time to “dance”. If you are fast and can position yourself fast, then, how do you use the extra moment? How do you add “dance” to it? Great dancers know how to hold the moment and show their “dance” (or, more like presence) even when they are not moving. They can command attention. For dancers who don’t know it, the dance can look drafty (add no dance) or forced (too busy).

For a partner dance, especially Latin, the question will be expanded; how do you achieve the best dance with your current partner?

This time, Bonnie came back as a professional, and showed her version of answer. Her smoothness and good hunch were nicely integrated with styling (which can tell you ways to dance) and added dance. I guess that the integration was achieved by professional demand to constantly conceptualize, explain and demonstrate the dance. Pros need to have many variations and tricks that they can explain and use as a part of the profession, after all.


The dance felt quite right. I was very happy to be able to have such an awesome dance. Thank you.

7/6/2021

Good dance is addictive. To have good dances, my body needs to stay in good shape. I am more motivated to be able to move as I want. Firstly, I’ll start from losing several pounds to be kind to my knees. Thank you for this motivation, too.

Dance: Big dance events are coming back. Are you ready?

 As vaccination campaign making progress and covid-related restrictions getting eased in many states, big dance events are coming back, at least in some parts of the US.

I'd define a big dance event as "national (or international)-level and large (hundreds) attendance, fairly full contents (social dance, contests, shows, workshops), with solid management (event organizers and staff running scheduled agenda), and long time (2-3 days minimum)."

For upcoming July 4th holiday weekend, some people I know headed to Chicago for Tango event. Some others are going to Dallas for Wild Wild Westie, a West Coast Swing event with 600 attendance cap for this year.

Now is a transition time from closed to opening up. Depending on event organizers and their policies, precautions for covid vary among events. Some events are "vaccinated only". Mask requirements policies are different. You need to read their policies and announcements, and accept them to attend. You may or may not be happy about these policies, but in this case it is event organizers who have to make tough call. Respect their call, or just stay out until later.

That said, are you ready to go back to a big dance event?

Here is a short checklist.

(i) Do you want it? Do you have the desire to get back on the dance floor, now?

You can weigh in covid situation and your status here.

(ii) Is your body ready? 

Are you physically in good shape enough to dance many social dance or perform on stage? You might want to test your body out first.

(iii) Do you remember the dance? 

All these moves and patterns, and dance-specific valued issues like connection and feels (tango), or correct use of compression to position properly and look right (WCS)?

(iv) Do you have the time? 

You may need to free up a good chunk of time (2-4 days). Big dance event is by itself a vacation.

(v) Do you have the money? 

Bluntly, big event attendance costs transportation, accommodation, event ticket, and food/drink, at least. You can easily add sightseeing and shopping on top of it. It isn't cheap. 

You may get discount for being junior/student or working for the event. You may work as an invited professional or a vendor/service provider and get income through teaching and/or selling at the event. Award money might be applicable to dance professionals in some events.

Yet, most people are there as amateurs. Don't worry about making money. (You know the difference between pros and amateurs? You are a pro if you dance and get paid. You are an amateur if you pay to dance.) ...all these considered, do you have the money for the event?

(vi) Are you ready to have fun?

There are different dances and they have different cultures. But people come to an event to have their own version of fun. The "fun" can be to meet new and old friends, to see familiar faces, to enjoy watching performances, to dance socially, to dance for connection or for show-off, or to compete. 

By giving some thoughts on your "fun" and the reason, it may give you some insight on yourself; what gives you most fun, and why you dance.

We all got those 15 months off. How was your time?