***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

61K down from 81K 2 days ago.

And 140K hospitalized down to 90K.

I mean...I guess they re-fixed their social distancing number. Again.

With all due respect, I don't understand what you're trying to accomplish in this thread.

This virus is unlike anything the world has seen. The best doctors in the world came up with a model and a plan. I don't think anyone would expect that the models wouldn't change on a weekly or even daily basis as more information becomes available.

It's really easy to debate whether or not state, local and foreign governments have made the correct decision in quarantines and lockdowns until after the spread of the disease is minimized or until a vaccine is readily available but until then, no one is either right or wrong.

Now, if this was the 5th or 6th time in the past 100 years or so that these measure were taken, I'd say that there would be far, far less room for error for everyone - governments, scientists, doctors, citizens, etc.

Until then, humans will continue to make mistakes because this is the first time the world has actively worked together to combat a single enemy and viruses don't infect on a straight line.

[BleedingRed]

Originally Posted by DJ's left nut

61K down from 81K 2 days ago.

And 140K hospitalized down to 90K.

I mean...I guess they re-fixed their social distancing number. Again.

It will keep dropping I think

[BleedingRed]

Originally Posted by Donger

Have they even released the details of their "studies" which show they were controlled and scientifically-valid?

https://pubmed.ncbi..nih.gov/32205204/

I dn if this is a valid website, but check it out.

[DaneMcCloud]

Originally Posted by BleedingRed

https://pubmed.ncbi..nih.gov/32205204/

I dn if this is a valid website, but check it out.

The headline says it all: Results of an Open-Label Non-Randomized Clinical Trial

They only had 28 participants, which were chosen by the clinicians, not randomized, so this report carries little weight.

[DJ's left nut]

Originally Posted by DaneMcCloud

With all due respect, I don't understand what you're trying to accomplish in this thread.

This virus is unlike anything the world has seen. The best doctors in the world came up with a model and a plan. I don't think anyone would expect that the models wouldn't change on a weekly or even daily basis as more information becomes available.

It's really easy to debate whether or not state, local and foreign governments have made the correct decision in quarantines and lockdowns until after the spread of the disease is minimized or until a vaccine is readily available but until then, no one is either right or wrong.

Now, if this was the 5th or 6th time in the past 100 years or so that these measure were taken, I'd say that there would be far, far less room for error for everyone - governments, scientists, doctors, citizens, etc.

Until then, humans will continue to make mistakes because this is the first time the world has actively worked together to combat a single enemy and viruses don't infect on a straight line.

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

There were obvious reasons at the beginning to look at those models and from their own stated presumptions say "hey guys, this doesn't look remotely right..."

And doing so got you called some sort of slobbering moron. It wasn't hindsight - these concerns were raised in real time and shouted down. By many of the same parties who are STILL shouting people down if you dare suggest something other than the company line.

I'm also trying to point out that making giant policy decisions based on projections and then not waiting for any data to actually flow from them (before doubling down on said projections) is a fools errand.

You can simply toss off the myriad of horrific leadership decisions made throughout this process at state and local levels if you'd like - I don't intend to do so.

Our leadership failed us badly, just not for the reasons so many are screaming about. And because of their overwhelming desire to defer to 'models' that had facially flawed premises, they're still no further along in determining what the appropriate response is.

[O.city]

The problem i'm seeing is that we locked everything down, it's slowing down. Great.

Now what?

['Hamas' Jenkins]

Originally Posted by DJ's left nut

Okay - presuming I flipped the 'why' on how the HCL works (or did a poor job of trying to synthesize my understanding of it) - do you not agree that the present theory requires all 3 components? Or at the very least, 2 of them (the zinc thing has always been more hit/miss; some think it's a bit of a red herring since it already exists in the body).

You can't just toss out a study that doses HCL on its own and say "look - proof this won't accomplish anything..."

The combined impact of HCL and Z-pack seems to be the focus, not just the idea that HCL on its own accomplishes anything. Thanks for clarification on the Z-Pack; my concern has been that the juice needs to be worth the squeeze on this thing. If it turns out we mass doze with azithromycin and in so doing create resistance to it that makes it less effective for those treatments its currently proven VERY good at, we've robbed peter to pay paul. I was hopeful that there were a myriad of broad-spectrum antibiotics that could be used in its stead to avoid that issue.

That's why I've been more than content holding back on using this as a wholesale treatment regiment. The juice has to be worth the squeeze. If it turns out the Z-pack is effective and is the ONLY effective complementary antiobiotic, then we need to make sure it's effective ENOUGH to justify the long-term risk that could come from significant distribution of an antibiotic that could then lead to resistance problems in areas it's effectively treated for years.

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.

[DJ's left nut]

Originally Posted by BleedingRed

It will keep dropping I think

I mean, they're almost out of room.

Sooner or later they'll just be giving you today's figures in real time and claiming they finally got the model figured out.

Give 'em another week and they'll be throwing out updates that have them coming in under the actuals and chalking it up to their own brilliance.

[O.city]

Hamas, i was listening to a recent Weinstein brothers pod cast and they were talking about how all the mice we use to run studies on come from a single lab in Maine and that they think they have increased Telomere length due to the genetic breeding they've done.

After reading about that, thats not ideal. Have you heard anything about that?

['Hamas' Jenkins]

Originally Posted by O.city

Hamas, i was listening to a recent Weinstein brothers pod cast and they were talking about how all the mice we use to run studies on come from a single lab in Maine and that they think they have increased Telomere length due to the genetic breeding they've done.

After reading about that, thats not ideal. Have you heard anything about that?

I have not. I wouldn't mind my telomeres being lengthened though.

[O.city]

Originally Posted by 'Hamas' Jenkins

I have not. I wouldn't mind my telomeres being lengthened though.

Well yeah, for sure.

But if the mice we're testing anti cancer drugs and such on have that....welll..thats not ideal

[PAChiefsGuy]

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.

There were obvious reasons at the beginning to look at those models and from their own stated presumptions say "hey guys, this doesn't look remotely right..."

And doing so got you called some sort of slobbering moron. It wasn't hindsight - these concerns were raised in real time and shouted down. By many of the same parties who are STILL shouting people down if you dare suggest something other than the company line.

I'm also trying to point out that making giant policy decisions based on projections and then not waiting for any data to actually flow from them (before doubling down on said projections) is a fools errand.

You can simply toss off the myriad of horrific leadership decisions made throughout this process at state and local levels if you'd like - I don't intend to do so.

Our leadership failed us badly, just not for the reasons so many are screaming about. And because of their overwhelming desire to defer to 'models' that had facially flawed premises, they're still no further along in determining what the appropriate response is.

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 that model we are practicing social distancing and we are saving countless lives.. I think that's a good thing don't you?

[DJ's left nut]

Originally Posted by 'Hamas' Jenkins

Spoiler!

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.

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.

['Hamas' Jenkins]

Originally Posted by O.city

Well yeah, for sure.

But if the mice we're testing anti cancer drugs and such on have that....welll..thats not ideal

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.

[eDave]

Pic from LA. That large sand pit is Dodger Stadium parking.