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MicrobiomDigest's profile
Elisabeth Bik
Elisabeth Bik
Elisabeth Bik
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@MicrobiomDigest

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Elisabeth BikVerified account

@MicrobiomDigest

Science consultant, PhD. Microbiome, science integrity, image forensics. Scientific discussions should not be held in the courtroom. She/Goat 🐢💻🔬😼🇳🇱🇺🇸

San Francisco, CA
scienceintegritydigest.com/about/
Joined October 2013

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    Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

    There is a new study from Brazil that reports significant effects of hydroxychloroquine/azithromycin on early-stage suspected COVID19 cases. https://www.dropbox.com/s/5qm58cd4fneeci2/2020.04.15%20journal%20manuscript%20final.pdf … Several people asked me to comment, so here is a short thread.

    7:40 PM - 18 Apr 2020
    • 207 Retweets
    • 477 Likes
    • camillinha Ale The Pedro Torres sarah dontFEARtheREAPER 🇧🇷-500.000🖤 +89.000🍊 cogito, ergo sum Naysou Francis Victoire TANGA
    29 replies 207 retweets 477 likes
      1. New conversation
      2. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        First thing to note: This was posted on Dropbox, not onto a regular preprint server such as @biorxivpreprint or @medrxivpreprint - not sure why. And also important to point out that this is NOT a peer-reviewed paper. It is draft meant for others to comment on.

        4 replies 9 retweets 117 likes
        Show this thread
      3. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        You can see that several people left comments on the Dropbox document. One of them is an emoji of a weird gnome stroking his beard. Not sure what that is supposed to mean.

        3 replies 7 retweets 101 likes
        Show this thread
      4. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        Short summary of the study: 636 patients were enrolled by "telemedicine" or by ER doctor. They were offered treatment with HCQ+AZM. If they accepted they were the treatment group. If they refused, they were the control group. That is a strange set up, not randomized at all.

        9 replies 14 retweets 152 likes
        Show this thread
      5. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        Patients were recruited if they had persistent flu-like symptoms for 2 or more days, with a suspicion for COVID-19 infection, but no PCR test was done. 🚩This is a big red flag. We are not sure if they had COVID-19 or if they had the sniffles.

        6 replies 13 retweets 151 likes
        Show this thread
      6. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        Typical symptoms for COVID-19 are fever and cough. 🤔Yet, at baseline, of these 636 patients only 6.6% had fever and 43% had a cough. These 2 symptoms also differed significantly between the 2 patients groups.

        1 reply 8 retweets 89 likes
        Show this thread
      7. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        This brings me to another interesting fact. There are significant differences between treatment and control group. In general treatment group had higher incidence of fever, cough, diarrhea, muscle aches, etc. They appeared to be a bit sicker at baseline than the controls.pic.twitter.com/hXgI3OPDsY

        5 replies 8 retweets 81 likes
        Show this thread
      8. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        In light of the findings of this paper, that the treatment group did better (fewer hospitalizations), it is interesting that the treatment group was sicker at the beginning. So treatment might help. But in general it is not good that treatment groups differ at baseline.

        6 replies 6 retweets 78 likes
        Show this thread
      9. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        There are some inconsistencies/unclarities in the paper that need to be fixed. * Methods (page 7) say that patients were recruited at 2 or more days of symptoms, but later (page 8) it says over 3 days (so presumably 4 or more).pic.twitter.com/faKHxlo8Bj

        3 replies 6 retweets 62 likes
        Show this thread
      10. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        In the Methods it is stated that patients were followed for 14 days after symptom onset (by telemedicine). The Results state that average follow up was 5.0 days - not sure how these two numbers match. The authors need to provide a bit more clarity in these numbers.pic.twitter.com/OpSJiMk13N

        4 replies 6 retweets 50 likes
        Show this thread
      11. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        It seems important to do a longer follow up on these patients. Five days seems very short. If they were already sick for 2-3 days, and you follow them for only 5 days, who knows if they maybe got sicker.

        1 reply 4 retweets 46 likes
        Show this thread
      12. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        Here is a very interesting finding: the earlier patients were treated, the lower the chance they ended up in the hospital. However, it is not stated in Table 1 how/if the 2 treatment groups differed in days-of-symptoms at baseline. This is a big omission.pic.twitter.com/bRYJNUmNEP

        1 reply 6 retweets 49 likes
        Show this thread
      13. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        If the treatment group had a significantly shorter sick period than the control group, that could be an important, not disclosed, confounding factor. As of now, this important piece of data is missing.

        2 replies 5 retweets 47 likes
        Show this thread
      14. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        Table 2 shows findings of the CT scans done "according to medical judgement". WTF? 61% of the treatment group got a CT scan. Only 24% of the control group got a CT scan. This is fishy. If control group was more ill, why did only so few get a CT scan???pic.twitter.com/oNEzNkLbW6

        3 replies 5 retweets 60 likes
        Show this thread
      15. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        Also, looking at Table 2, it shows that the treatment group had more COVID-19 suggestive CT scans than the Control group. All these findings suggest that some people in the control group might have had an illness different than COVID-19.

        1 reply 4 retweets 44 likes
        Show this thread
      16. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        The paper is also very vague about why people were hospitalized. From Table 2 you could state that the Control group had fewer reasons to undergo a CT scan, and milder severity of lung involvement than the Treatment group. So why were so many Controls admitted to the hospital?

        1 reply 4 retweets 41 likes
        Show this thread
      17. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        Also of note, two patients in the Treatment group died, of underlying disease. Looking at that outcome, the Control group (no deaths noted) appeared to do much better.

        3 replies 3 retweets 41 likes
        Show this thread
      18. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        So let's recap. 1. No PCR confirmation, not clear how many people actually had COVID-19. 2. No randomization, patients could pick their group 3. Unclear if 2 groups differed in time between first onset and enrollment. 4. Treatment group appeared to be sicker/more COVID/deaths.

        4 replies 11 retweets 88 likes
        Show this thread
      19. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        Another weakness of the ms: @houndcl did a simple stat test to show that the p<0.0001 from Figure 1 is not quite true. But then, I am not familiar with the "qui-square test". https://twitter.com/houndcl/status/1251556044729315330 … HT: @FilipeDeVadder (I deleted an earlier tweet with the wrong p value).pic.twitter.com/9VcLV46gwp

        6 replies 4 retweets 40 likes
        Show this thread
      20. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        Elisabeth Bik Retweeted Dr Gaetan Burgio, MD, PhD.

        And to conclude, here is another takedown of the study by @GaetanBurgio , done earlier today: https://twitter.com/GaetanBurgio/status/1251476181989208066 … HT: @VerranDeborah and @tesoureiros (I hope I hat-tipped everyone appropriately; my notifications are going wild hahaha).

        Elisabeth Bik added,

        Dr Gaetan Burgio, MD, PhD. @GaetanBurgio
        Another study on #Hydroxycloroquine efficacy in #COVID19 patients from a Brazilian team has been shared widely this evening. Unfortunately I have to comment it because well it might have some public health implication & this study is atrocious https://www.dropbox.com/s/5qm58cd4fneeci2/2020.04.15%20journal%20manuscript%20final.pdf?dl=0 …
        Show this thread
        2 replies 8 retweets 51 likes
        Show this thread
      21. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        Ooooh, I just found another problem. Not everyone in the Control group appeared to have COVID-19. The percentages add up to only 71%. I am more and more convinced the control group on average was sick with something else. This stinks.pic.twitter.com/yYG7WwtMLA

        5 replies 17 retweets 103 likes
        Show this thread
      22. Elisabeth Bik‏Verified account @MicrobiomDigest 18 Apr 2020

        Here is a blogpost about the paper, which is basically a bit more polished version of this thread:https://scienceintegritydigest.com/2020/04/18/thoughts-on-the-prevent-senior-study/ …

        9 replies 12 retweets 72 likes
        Show this thread
      23. End of conversation

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