Posts by Thomas Lumley
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There's now a publication in the Iranian trial, dated Feb 2022. It's negative (and this trial is, I think, bigger than all the positive trials combined):
open-access paper"Between July and October 2020, 1083 patients were randomized to either the sofosbuvir/daclatasvir arm (n = 541) or the placebo arm (n = 542). No significant difference was observed in the primary outcome of hospital discharge within 10 days, which was achieved by 415/541 (77%) in the sofosbuvir/daclatasvir arm and 411/542 (76%) in the placebo arm [risk ratio (RR) 1.01, 95% CI 0.95-1.08, P = 0.734]. In-hospital mortality was 60/541 (11%) in the sofosbuvir/daclatasvir arm versus 55/542 (10%) in the placebo arm (RR 1.09, 95% CI 0.77-1.54, P = 0.615). No differences were observed in time to hospital discharge or time to in-hospital mortality."
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I agree completely about the polling exegeses, but I'm going to complain about "admiring write-ups in publications like The Lancet."
That paper was in the journal The Lancet Public Health, which describes itself as " an online-only, open access title in The Lancet's growing family of specialty journals," not The Lancet (founded in 1823, world-famous even in New Zealand).
Also, the paper was written by a bunch of Kiwi scientists, at least some of whom were involved with the NZ Covid response as advisers. So while they're right that the NZ response was excellent, it's not really an independent external confirmation.
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Once again, it's just weird that the lab research finds it's daclatasvir that is the effective component and not sofosbuvir. Sofosbuvir is a nucleotide analogue, so you could easily imagine it inhibiting the RNA polymerase in other viruses the same way it does in HCV, but dataclatasvir binds in a very targeted way to an HCV protein, specifically enough that resistance occurs rapidly if it's used on its own.
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Yes, on re-reading, my comment also came out more conspiracy-theorist than was my intention. I do think the setting has meant people needed to be more anxious than the actual risk warrants, and this will carry over, but it should dissipate as things improve .
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I'm sure a lot of people will feel the same way -- partly because it's natural, but also partly because of the epidemic suppression efforts and accompanying advertising.
We collectively need to take more care about disease transmission than the current prevalence would warrant for any individual, because each transmission event increases everyone's risk. So, it's optimum from a public health point of view for everyone to overestimate the risk of catching the virus. Well, at least from a physical, rather than mental, public health point of view. And that's still going to be true in the near future.
But in the longer term, there are disadvantages. Reasonable people will be more than rationally concerned about travel. More importantly, though, the view of rule-breaking as risking contamination fits in with an attitude of fear and disgust towards rule-breakers, which I'm seeing on Twitter among people who didn't seem to have those sorts of attitudes before.
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I'd actually be less surprised if it was the sofosbuvir having an effect. Like remdesivir, it's a nucleotide analog (a fake RNA base), which you could easily imagine confusing RNA polymerases from a different virus. Daclatasvir, on the other hand, targets a specific site on Hep C's polymerase and since resistance develops easily, it must be fairly fussy about the details of that site.
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I think I've run into this with the Government Statistician getting legal advice from Crown Law and not being in a position to release it. I didn't understand the underlying principles then, though.
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A related question I've been wondering about: is a "citizen's arrest" of a tourist driver a three-strikes offence?
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The Dismissal.
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One of the big problems Auckland has compared to Melbourne (where I grew up) is that the old roads are much narrower. Melbourne has unnecessarily wide streets and so had no difficulty putting bike paths in all over the place, even in the non-grid areas around the CBD. It's harder here. Great South Rd could accommodate bike lanes, even if they're not currently planned, but Manukau Rd and Mt Eden Rd would have a lot more difficulty.
At least it's daylight saving time now, so Cornwall Park and One Tree Hill Domain are open later than 6pm, allowing me to avoid the Royal Oak roundabout and a lot of Manukau Rd in the evenings.
But while commuting to the city campus of UoA isn't too much of a pain, I have to go to the Tāmaki campus twice this week. It's about the same distance from Onehunga, but Google tells me the best transit options go via Newmarket or the CBD, and it's a pretty unfriendly cycle route.