***NON-POLITICAL COVID-19 Discussion Thread***

[JakeF]

A couple of reminders...

Originally Posted by Bwana

Once again, don't come in this thread with some kind of political agenda, or you will be shown the door. If you want to go that route, there is a thread about this in DC.

Originally Posted by Dartgod

People, there is a lot of good information in this thread, let's try to keep the petty bickering to a minimum.

We all have varying opinions about the impact of this, the numbers, etc. We will all never agree with each other. But we can all keep it civil.

Thanks!

Click here for the original OP:

Spoiler!

Apparently the CoronaVirus can survive on a inanimate objects, such as door knobs, for 9 days.

California coronavirus case could be first spread within U.S. community, CDC says
By SOUMYA KARLAMANGLA, JACLYN COSGROVE
FEB. 26, 2020 8:04 PM

The Centers for Disease Control and Prevention is investigating what could be the first case of novel coronavirus in the United States involving a patient in California who neither recently traveled out of the country nor was in contact with someone who did.

“At this time, the patient’s exposure is unknown. It’s possible this could be an instance of community spread of COVID-19, which would be the first time this has happened in the United States,” the CDC said in a statement. “Community spread means spread of an illness for which the source of infection is unknown. It’s also possible, however, that the patient may have been exposed to a returned traveler who was infected.”

The individual is a resident of Solano County and is receiving medical care in Sacramento County, according to the state Department of Public Health.

The CDC said the “case was detected through the U.S. public health system — picked up by astute clinicians.”

Officials at UC Davis Medical Center expanded on what the federal agency might have meant by that in an email sent Wednesday, as reported by the Davis Enterprise newspaper.

The patient arrived at UC Davis Medical Center from another hospital Feb. 19 and “had already been intubated, was on a ventilator, and given droplet protection orders because of an undiagnosed and suspected viral condition,” according to an email sent by UC Davis officials that was obtained by the Davis Enterprise.

The staff at UC Davis requested COVID-19 testing by the CDC, but because the patient didn’t fit the CDC’s existing criteria for the virus, a test wasn’t immediately administered, according to the email. The CDC then ordered the test Sunday, and results were announced Wednesday. Hospital administrators reportedly said in the email that despite these issues, there has been minimal exposure at the hospital because of safety protocols they have in place.

A UC Davis Health spokesperson declined Wednesday evening to share the email with The Times.

Since Feb. 2, more than 8,400 returning travelers from China have entered California, according to the state health department. They have been advised to self-quarantine for 14 days and limit interactions with others as much as possible, officials said.

“This is a new virus, and while we are still learning about it, there is a lot we already know,” Dr. Sonia Angell, director of the California Department of Public Health, said in a statement. “We have been anticipating the potential for such a case in the U.S., and given our close familial, social and business relationships with China, it is not unexpected that the first case in the U.S. would be in California.”

It is not clear how the person became infected, but public health workers could not identify any contacts with people who had traveled to China or other areas where the virus is widespread. That raises concern that the virus is spreading in the United States, creating a challenge for public health officials, experts say.

“It’s the first signal that we could be having silent transmission in the community,” said Lawrence Gostin, director of the World Health Organization Collaborating Center on National and Global Health Law. “It probably means there are many more cases out there, and it probably means this individual has infected others, and now it’s a race to try to find out who that person has infected.”

On Tuesday, the CDC offered its most serious warning to date that the United States should expect and prepare for the coronavirus to become a more widespread health issue.

“Ultimately, we expect we will see coronavirus spread in this country,” said Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases. “It’s not so much a question of if, but a question of when.”

According to the CDC’s latest count Wednesday morning, 59 U.S. residents have tested positive for the new strain of coronavirus — 42 of whom are repatriated citizens from a Diamond Princess cruise. That number has grown by two since Messonnier’s last count Tuesday, although the CDC was not immediately available to offer details on the additional cases.

More than 82,000 cases of coronavirus have been reported globally, and more than 2,700 people have died, with the majority in mainland China, the epicenter of the outbreak.

But public health leaders have repeatedly reminded residents that the health risk from the novel coronavirus to the general public remains low.

“While COVID-19 has a high transmission rate, it has a low mortality rate,” the state Department of Public Health said in a statement Wednesday. “From the international data we have, of those who have tested positive for COVID-19, approximately 80% do not exhibit symptoms that would require hospitalization. There have been no confirmed deaths related to COVID-19 in the United States to date.”

CDC officials have also warned that although the virus is likely to spread in U.S. communities, the flu still poses a greater risk.

Gostin said the news of potential silent transmission does not eliminate the possibility of containing the virus in the U.S. and preventing an outbreak.

“There are few enough cases that we should at least try,” he said. “Most of us are not optimistic that that will be successful, but we’re still in the position to try.”

[DaneMcCloud]

Originally Posted by DJ's left nut

To point out that slavish deference to 'experts' will oftentimes have you being fed nothing more than dressier horseshit.

So, if you don't believe in experts in a field, why even comment in this thread? To throw shade at them for being "experts"?

We're all following the advice of experts in order to save lives. And not just any life but the lives of our friends, parents, grandparents, partners and associates.

And once again, there is room for error because this is the very first time in world history that we're able to collectively react against a deadly enemy.

It seems to me that you're just ****ing pissed off at, literally, the world, for making these rules, so you're looking for anything thread, any modicum of substance, in order to disprove them because of your anger.

This post isn't personal towards you, as I like you very, very much and greatly value our private conversations over the years but man, that anger is displaced.

[SupDock]

Originally Posted by 'Hamas' Jenkins

1) Don't worry. Azithromycin is not going to be the only useful antibiotic. It's in a class of antibiotics called macrolides. Macrolides as a general rule have immunomodulatory effects across the entire class, and other macrolides have been long used for lung infections (erythromycin, clarithomycin, etc). The reason why azithromycin is used so commonly has to do with infrequency of dose (five days once daily is better than 7 days of BID or 10-14 days of daily dosing) and that it does not have sufficient inhibition of CYP3A4, which will alter levels of other drugs in the body and can lead to toxicity.

2) In most cases, drugs are chosen not because they are absolutely known to be the best shot but because they are the ones that have been previously studied. We use three evidence-based beta blockers to treat HFrEF because they are shown to have a mortality benefit in clinical trials. It doesn't mean that others wouldn't have a mortality benefit, but that there is little point in constructing a large, randomized clinical trial to prove a mortality benefit for something else when we already have numerous other options.

3) The horse is already out of the barn with azithromycin and overprescribing to a degree (high rates of strep pneumo resistance)--that's why the recent IDSA guidelines added beta-lactams (or doxycycline) onto it for any type of complicated community-acquired pneumonia--but it could be mitigated with a different approach. Prophylactic dosing also wouldn't serve much good. You'd be better off saving the doses for those that were infected if the immunomodulatory and antimicrobial effects were actually beneficial. Otherwise, then you are just creating resistance for the hell of it, because azithromycin isn't going to prevent infection (and likely infectiousness) just disease severity once contracted.

4) You are definitely right in that we can't evaluate the efficacy of the therapy without looking at all aspects of the therapy as it was applied rather than piecemeal. At the same time, we can't assume that all "legs" as you put them are equally valid, or that one of the three legs doesn't increase risk (less likely here in acute treatment due to therapy likely being less than a week or so, much more problematic if given prophylactically). Example: triple therapy with anticoagulants/antiplatelets is sometimes used after an MI in patients that are at high risk of stroke due to A-fib and who have recently had a stent. However, bleeding risks are extremely high, and potentially so high that one is better off omitting aspirin and using two other agents with a lower bleed risk because the number that you would harm with to prevent bleeds exceeds the number you would help (called number needed to treat) by preventing a clot.

What should be done in this scenario: Critically evaluate the trial you want to investigate--look at where its shortcomings are--does it have an attrition bias, are the groups truly homogeneous (and appropriately randomized), how effective is the therapy in question even?

Not many people are equipped to do that. I will tell you, having sat in on several journal clubs during rotations and having given many of those presentations myself that preceptors can really drill down and find flaws in studies that one would not expect, and it is a tremendously humbling experience to go through one.

A lot of people can read abstracts, discussions, and commentary. Far fewer can actually find the bodies when sifting through the data.

I'll echo your sentiment regarding journal review. The holes that can be found in clinical trials are remarkable at times, even ones published in journals with great reputations.

A lot of people are also shocked when they see data regarding number needed to treat, and number needed to harm for well established therapies.

[DJ's left nut]

Originally Posted by PAChiefsGuy

What would you change? You wouldn't practice social distancing because not enough ppl are dying like the model said they would? Almost 2k deaths today. I dont understand your point here.

Our medical professionals made a model and due to social distancing we are saving more lives than we thought. I think that's a good thing don't you?

Because you haven't read my point. Ever. I've made it. I've specifically addressed YOU in your ridiculous "you wouldn't practice social distancing" nonsense.

I've explained to you where/how targeted outcomes need to be considered as part of a long term plan. And the drawbacks both near and long term as they relate not just to financial issues but to specific health outcomes. I've spoken to the potential utility of Variolation, which has yet to be explored. To needing to focus on the most far-reaching benefits while determining which negatives we can tolerate. I've discussed how failure to consider baseline sociology could yield GREATER deaths in addition to societal suffering and long-term instability that will impact health, education, etc... for decades.

I've. Explained. All. Of. This. To. YOU. Specifically.

Jesus Christ, would you PLEASE just put me on ignore. You are shockingly ignorant and completely unwilling to absorb any responses put to you. There is no way for me to further distill this for you. I am incapable of thinking as fundamentally idiotically as I would need to think for you to finally grasp any of this. No matter how many ****ing books I put before you, you will just eat the goddamn pages.

You are an idiot. I have lost my patience with you. Go away.

[PAChiefsGuy]

Originally Posted by DJ's left nut

Because you haven't read my point. Ever. I've made it. I've specifically addressed YOU in your ridiculous "you wouldn't practice social distancing" nonsense.

I've explained to you where/how targeted outcomes need to be considered as part of a long term plan. And the drawbacks both near and long term as they relate not just to financial issues but to specific health outcomes. I've spoken to the potential utility of Variolation, which has yet to be explored. To needing to focus on the most far-reaching benefits while determining which negatives we can tolerate. I've discussed how failure to consider baseline sociology could yield GREATER deaths in addition to societal suffering and long-term instability that will impact health, education, etc... for decades.

I've. Explained. All. Of. This. To. YOU. Specifically.

Jesus Christ, would you PLEASE just put me on ignore. You are shockingly ignorant and completely unwilling to absorb any responses put to you. There is no way for me to further distill this for you. I am incapable of thinking as fundamentally idiotically as I would need to think for you to finally grasp any of this. No matter how many ****ing books I put before you, you will just eat the goddamn pages.

You are an idiot. I have lost my patience with you. Go away.

Well there you have it guys. Trump shouldn't be listening to Fauci and his team he should be listening to DJ's Left Nut.

[O.city]

Originally Posted by 'Hamas' Jenkins

You always need human population studies for FDA approval, and approval is going to come from Kaplan-Meier survival curves and PFS, anyway.

Send me the link, though. It sounds interesting.

It's on Eric's "THe Portal" podcast with his brother Brett. I'll see if i can find it.

[SupDock]

Originally Posted by DJ's left nut

Because you haven't read my point. Ever. I've made it. I've specifically addressed YOU in your ridiculous "you wouldn't practice social distancing" nonsense.

I've explained to you where/how targeted outcomes need to be considered as part of a long term plan. And the drawbacks both near and long term as they relate not just to financial issues but to specific health outcomes. I've spoken to the potential utility of Variolation, which has yet to be explored. To needing to focus on the most far-reaching benefits while determining which negatives we can tolerate. I've discussed how failure to consider baseline sociology could yield GREATER deaths in addition to societal suffering and long-term instability that will impact health, education, etc... for decades.

I've. Explained. All. Of. This. To. YOU. Specifically.

Jesus Christ, would you PLEASE just put me on ignore. You are shockingly ignorant and completely unwilling to absorb any responses put to you. There is no way for me to further distill this for you. I am incapable of thinking as fundamentally idiotically as I would need to think for you to finally grasp any of this. No matter how many ****ing books I put before you, you will just eat the goddamn pages.

You are an idiot. I have lost my patience with you. Go away.

Your suggestions are reasonable, but I don't think we had nearly enough time to analyze the sociological repercussions of isolation.

I have no doubt that the data we collect will impact societal response to pandemics for eternity

[DJ's left nut]

Originally Posted by SupDock

Your suggestions are reasonable, but I don't think we had nearly enough time to analyze the sociological repercussions of isolation.

I have no doubt that the data we collect will impact societal response to pandemics for eternity

In NY? Close question.

But Christ man, we have 8 active cases in Boone County right now. 8.

Yes, for the VAST majority of this country we had that kind of time. Because we could've had answers to a lot of it by today. By last week.

There's now a cry to 'find a middle ground' but it sure would've been nice if we'd have actually tried before we burned 6 weeks. And no, not every building was on fire. You shut down 8-10 major choke-points and I wouldn't have said boo. I still ultimately think that CA jumped early but as a point of comparison (near and long term) they'd be a useful datapoint.

We could be nearer a solution. And instead we're still gonna have to learn these lessons and in ways that are going to be no less palatable in 2 months than they are today. Especially if the "God, why are we even paying attention to hydroxychloroquine?" crowd proves to be prophetic.

[limested]

Originally Posted by DJ's left nut

In NY? Close question.

But Christ man, we have 8 active cases in Boone County right now. 8.

Yes, for the VAST majority of this country we had that kind of time. Because we could've had answers to a lot of it by today. By last week.

There's now a cry to 'find a middle ground' but it sure would've been nice if we'd have actually tried before we burned 6 weeks. And no, not every building was on fire. You shut down 8-10 major choke-points and I wouldn't have said boo. I still ultimately think that CA jumped early but as a point of comparison (near and long term) they'd be a useful datapoint.

We could be nearer a solution. And instead we're still gonna have to learn these lessons and in ways that are going to be no less palatable in 2 months than they are today. Especially if the "God, why are we even paying attention to hydroxychloroquine?" crowd proves to be prophetic.

What is your expertise in this?

[PAChiefsGuy]

I think the response to the CoronaVirus has been warranted considering there were LIVES at stake here. I'd rather be safe than sorry when it comes to countless people potentially dying.

Fauci and his team were put in a tough position. So many unknowns with this virus. They did the best they could. I appreciate what the did for the American people as it seems social distancing is working better than anyone could have predicted.

['Hamas' Jenkins]

Originally Posted by DJ's left nut

Yeah, the prophylactic use seemed reeeaaaallll spotty to me. Didn't like that idea at all.

And regarding the respective component parts, I'm not at all suggesting that each one of them are equally important...at least not in terms of the 'ratios' or whatever kind of attempts to rank order them one would try. But if HCL is Patrick Mahomes, it stands to reason that the Z-Pack could be his OL? The heavy hitter can't do its thing if it doesn't have the supporting cast in place. So in the end, the heavy hitter...isn't.

But yes, as part of studying all that, you need to confirm every component part doesn't create a problem in its own right. Which is ultimately what I'm most concerned about with this cocktail (Zinc, whether it matters or not, doesn't worry me).

But NONE of that is to say that this thing isn't worth continued pursuit. There seems to be definite signs that it's doing something more than Mentos and bag of Cheetos would.

It is worth continued pursuit, but there are numerous examples of supposed panaceas tried for a long period of time in desperate situations that showed little or no clinical benefits. The first decade of AIDS is a shining example of that.

Regarding the efficacy of the combination: it ultimately depends on if the effects are synergistic, additive, or unrelated. In some cases, 2+2=9, which is what a lot of combination, curative chemo regimens are based on, or modern HAART utilizes (one protease inhibitor to boost another, multiple mechanisms of action to reduce resistance). In some cases, you get that with antibiotics as well. Other times, 2+2=1, because one drug inhibits another and you end up with far worse performance.

I'm sure it seems to some like I'm poo-pooing measures or being doom-and-gloom at times. That's not my intent, even if I haven't been the best at it. The point I want to get across, that I probably don't always get across very well, is that the process of properly evaluating medication use in an evidence-based fashion is both extremely complicated and difficult. Anecdotes aren't guidelines, and studies aren't always as good, bad, or definitive as their headlines make it seem.

There is a good chance a study comes out that shows a modest benefit with HCQ+azithromycin and that we rush headlong into giving it to every COVID patient when just the azithromycin alone would have sufficed, or that the benefit was in morbidity or duration, but not mortality (still good, but not a life-saver). This can break a lot of ways. There also exists a possibility where there is a small, but significant mortality benefit from giving this combination. However, giving the drug to every patient before said benefit was derived, especially if they aren't serious, doesn't mean the clinician always made the right decision either.

[DaFace]

Originally Posted by PAChiefsGuy

I think the response to the CoronaVirus has been warranted considering there were LIVES at stake here. I'd rather be safe than sorry when it comes to countless people potentially dying.

I don't think there will ever be an easy answer to what the "right" approach is here. It's basically a question of how much economic damage a life is worth. So good luck with that one.

[PAChiefsGuy]

Originally Posted by limested

What is your expertise in this?

He has none. He's a lawyer posting on a Chiefs message board with no experience dealing with viruses. He's entitled to his opinion just like the rest of us but he's no expert even though he tries to act like one.

[PAChiefsGuy]

Originally Posted by DaFace

I don't think there will ever be an easy answer to what the "right" approach is here. It's basically a question of how much economic damage a life is worth. So good luck with that one.

Yeah that's true. Fauci isn't an economist he is trying to fight this through an physician and immunologist's eyes. that's where Trump and his team have to make some tough decisions and find the right middle ground.

I just always believe it is important to remember economy will come back but when someone is dead there is no coming back from that.

[petegz28]

Originally Posted by DaFace

I don't think there will ever be an easy answer to what the "right" approach is here. It's basically a question of how much economic damage a life is worth. So good luck with that one.

Exactly. We are being very reactionary in our response and justifiably so to a degree. But we cannot pretend there isn't a cost. For every action there is an equal and opposite reaction, right? "Shelter in place" cannot be the answer going forward after we get out of this phase.

['Hamas' Jenkins]

Originally Posted by DaFace

I don't think there will ever be an easy answer to what the "right" approach is here. It's basically a question of how much economic damage a life is worth. So good luck with that one.

I'll just throw a third way out there: while you can't shut it down forever and you can't let it run unchecked, perhaps a full shut down was needed to grasp the extent of the problem which can then be followed by more targeted shut downs so that you avoid a runaway pandemic while also providing targeted containment on the other side.