What I don't get is why we aren't seeing any results for many of these antioxidant trials.
We see this kind of thing not infrequently in medicine, and even more so in critical care. Drugs or treatments which show promising results
in vitro, show promising results in rodent models, maybe even show promising results in healthy volunteers, but when we apply them to critically ill patients, they either don't work or even make things worse.
Take colloids for example. They were going to be the next big thing and replace crystalloids for treating septic shock. They provided a bigger increase in blood pressure than crystalloids, and this increase lasted longer. They stayed in the intravascular space longer, they caused less peripheral and pulmonary edema and fewer third space losses. They allowed us to wean vasopressors more quickly. They made all our numbers and parameters better. And then the studies came out which showed that actually they were pro-inflammatory, they were bad for the kidneys, and they worsened mortality. So we are back with crystalloids except in very specific cases.
Take ventilation for example. When we first ventilated patients, we used large tidal volumes and high respiratory rates to help clear CO
2. We did this to get their PaCO
2 down to a physiological level, which helped to correct the acidosis associated with sepsis and bring their pH back to a normal level, which definitely improved things in the short term, stabilized the patient, reduced the requirement for inotropes and vasopressors, etc. And then the studies likes ARDSnet came out which showed we were causing volutrauma and barotrauma and allowing what we call "permissive hypercapnia" with lower tidal volumes improved mortality.
So then we get a treatment like antioxidants, which logically should work, and which give good looking data in rodents or healthy volunteers, but when applied to a critically ill population, simply don't work.
Micronutrient deficiency is endemic throughout the developed world. Given that 40% of Americans are Vitamin D deficient, some critically so (this gets worse the darker your skin is, with as many as 60% of Hispanics and 80% of African-Americans being Vitamin D deficient), there's no way that one Vitamin D pill a day could hurt. It could only help. Vitamin D helps lower anxiety, too.
I don't disagree at all, and have said as much myself before:
The evidence I have seen seems to suggest that a deficiency in vitamin D can make COVID worse, rather than extra vitamin D being protective against COVID, but I haven't spent a huge amount of time reading around this topic. Regardless, the majority of Americans are deficient in vitamin D, especially those in more northern states, and should be taking a vitamin D supplement anyway.
Emphasis mine. These people would have had a near 100% mortality rate without intubation. I've intubated a lot of people with COVID, and in every single one they were critically hypoxic and, at most, a couple of hours from dying without intervention. It's also worth noting that the article with a mortality rate of 88% was published in April 2020, during the first wave, when we had no specific treatments for this disease. Less than a year later and the mortality rate is now down at 45% precisely because we have evidence showing us which "adjuncy therapy", as you put it, is effective.
What frustrates me is the lack of mainstream media coverage of the deeper complexities of COVID-19's pathology.
The public don't care. What can they do with knowledge that COVID causes severe DIC or pericarditis? They want to know when they can go on vacation again or go to a concert.
A good friend of mine died on one of those ventilators. I hadn't seen him in a few years and I was hoping to meet up with him. This is kind of personal for me, and I may have gotten a little heated up.
My condolences, sincerely. It's personal for a lot of us.
Why do I keep seeing studies showing a benefit, then?
Mostly low quality evidence. Cohort studies or self selecting studies, low number of patients, confounding factors, etc. One of those studies even found that physical activity was a risk factor for COVID. If you take high quality meta-analysis which only include high quality RTCs, such as the one I linked previously or this one -
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2 - we generally find very sporadic and inconclusive evidence. I'm not saying there definitely isn't something there, but there is no good quality evidence to support it at present.
Almost all anti-vaxxers deliberately just turn a blind eye to published data and trials. I'm curious as to how you can understand how trials like these are the only way to reach firm conclusions and build an evidence base, but then simultaneously choose to ignore the evidence that the vaccine is reducing symptoms, reducing critical care admissions, and saving lives.