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Corona Virus
Pudding Mittens Offline
#601 Posted:
Joined: 08-15-2016
Posts: 1,291
.
It's now April 1. Please, no April Fool's Day shenanigans about this particular topic.

There are lots of bodies. It's just not funny. Thank you in advance.
.
teedubbya Offline
#602 Posted:
Joined: 08-14-2003
Posts: 95,637
Ironically MACS Tucker Carlson was about the only one saying this was worse than the flu when the rest of the network was minimizing things as was Trump. Now the network had to flip and pretend it didn’t happen just like Trump. And their programming is still driven by the same motivations.

Ratings and political garbage drive these shows..... not facts. they will do whatever gets ratings. Not limited to fox.
teedubbya Offline
#603 Posted:
Joined: 08-14-2003
Posts: 95,637
I remember tucker Carlson when he first started guest hosting crossfire. I actually liked him then. He sure has changed.
MACS Offline
#604 Posted:
Joined: 02-26-2004
Posts: 79,599
So we all know the media is biased as a mofo... all of them are left. Fox is barely right. OAN is right.

We're able to process information, with that knowledge, and come to our own conclusions, yeah?? This was a dude who had the virus, took the effing meds and told us his experience. WTF does it matter what show he was on?
teedubbya Offline
#605 Posted:
Joined: 08-14-2003
Posts: 95,637
I already told my issue with it, to continue would serve no purpose. I don’t care if you believe me and vice verse I’m sure. Meh. It’s a small point of contention.

I’ll continue to be extremely dubious of anything on her show and others won’t. let’s not lose the fact that I am hopeful on these meds.. we can disagree on this stuff with little consequence.
tonygraz Offline
#606 Posted:
Joined: 08-11-2008
Posts: 20,175
teedubbya wrote:
I remember tucker Carlson when he first started guest hosting crossfire. I actually liked him then. He sure has changed.


So are you saying you really miss the bow ties ?
victor809 Offline
#607 Posted:
Joined: 10-14-2011
Posts: 23,866
Pudding Mittens wrote:
.
It seems you're saying that first-hand video testimony from people who have just lived through something is worthless as long as it appears on any program where decisions about content selection are made by any human being(s), which is all programs in the world. So basically no first-hand reports from anyone have any value, persumably unless you're actually face-to-face with them yourself, in person, completely without any media outlet where content selection is controlled by humans (which is every media outlet) being involved in transmitting the testimonial to you.

Got it! Sounds totally reasonable!
.


Hey Puddin',
I figured I'd take the time to break down exactly what TW was hinting at during this discussion. So you've got a news story about 1 guy who had COVID-19, who reported difficulty breathing, who was given these drugs, and then reports feeling better.

Here's the problem with that story as evidence.

We've got 150,000 people with COVID-19 (at the time, more now)
Of those 150,000 some of those people will get better every day. In fact, we know the disease has a wide range of severity, some don't even know they have it.
If you give someone any drug, and they happen to improve, that doesn't mean they improved because of the drug. It could have simply statistically been when they were going to improve.

That makes it VERY easy for a "news" show which intentionally wants to do a positive story on the drugs to look for someone who improved shortly after taking it. They ignore the total pool of patients given the drug (which would, we assume, include patients who continued to get worse while on the drug) and just selecting the one who showed improvement. We don't know if this guy got better because he was going to get better regardless.

Remember, 2% death rate. So for every 100 people, 98 are going to get better. that's a lot of people who are going to show signs of improvement regardless of what treatment you're giving them, and its very easy for a news show that may want to prop up a drug (because their favorite president seems to have decided to promote it) to find one person who may or may not of been that 98% who got better after being given this drug.

The work they need to do to prove the effectiveness of a drug is not easy stuff. And honestly, I think what the news shows and the president are doing is hampering them, but that's just my opinion
opelmanta1900 Offline
#608 Posted:
Joined: 01-10-2012
Posts: 13,954
If a prostitute gets corona and then does a bunch of prostitute things and then she recovers, does that mean the cure is to do prostitute things?
victor809 Offline
#609 Posted:
Joined: 10-14-2011
Posts: 23,866
opelmanta1900 wrote:
If a prostitute gets corona and then does a bunch of prostitute things and then she recovers, does that mean the cure is to do prostitute things?


Then you're in luck ya big whore!
teedubbya Offline
#610 Posted:
Joined: 08-14-2003
Posts: 95,637
^ correction.

Big sloppy whore
victor809 Offline
#611 Posted:
Joined: 10-14-2011
Posts: 23,866
My error.
opelmanta1900 Offline
#612 Posted:
Joined: 01-10-2012
Posts: 13,954
Bring on the *****!
opelmanta1900 Offline
#613 Posted:
Joined: 01-10-2012
Posts: 13,954
I feel like we really accomplished something here today... It's not quite "celebrities singing imagine" levels of accomplishment, but it's something..,
KingoftheCove Offline
#614 Posted:
Joined: 10-08-2011
Posts: 7,603
Opel is NOT big...........sloppy?.........well,....
tonygraz Offline
#615 Posted:
Joined: 08-11-2008
Posts: 20,175
Victor, you have exposed the conservative plan for convincing some people they are right. Find an example of something they want to prove and publicize it heavily. Now it has even been without an example, just by saying "people are saying..."
Mrs. dpnewell Offline
#616 Posted:
Joined: 08-23-2014
Posts: 1,373
I heard today that a new study that accounts for those who had mild symptoms, and those who had the virus with little or no symptoms has lowered the mortality rate of COVID19 to 0.6%. The study also suggests that as testing becomes wide spread, the number will drop even lower. I can't find the study online, so I have nothing to link to. If true, that's at least some good news.

Also heard today that a hospital in Texas was experimenting with giving patients in serious condition blood plasma from folks who have recovered. The hope being to infuse antibodies to the seriously ill. Kinda the old Omega Man thing. Of the 6 patients this was performed on, 5 have recovered, and the 6th is still alive. Again, I have nothing to link to, so take it with a grain of salt.

David
delta1 Offline
#617 Posted:
Joined: 11-23-2011
Posts: 28,754
I've also heard that medical researchers are harvesting antibodies from folks who test positive for the virus but suffered no ill effects, and using it in treatments for patients and also to develop vaccines...so there is some hope...we need more testing, even of asymptomatic folks...if only to find more people with anti-bodies


as for the controversy over the efficacy of hydrochloroquine and the anti-bacterial combo, is it an actual cure, meaning it reverses the damage done to the lungs?

or does it only work to prevent the lungs from getting damaged, meaning it has to be applied early?
teedubbya Offline
#618 Posted:
Joined: 08-14-2003
Posts: 95,637
Delta this is updated from what I posted the other day. This is from one of the primary resources clinicians use to identify treatment protocols and is geared towards them. It talks about the plasma.

This isn't the whole thing, which is volumes covering all aspects of covid19. It's just a snippet to give a flavor. It's all foot noted as usual.

I grabbed the part about glucocorticoids as well. at one point they were thought to be effective in previous epidemics so were prescribed heavily out of hope.



Limited role of glucocorticoids — The WHO and CDC recommend glucocorticoids not be used in patients with COVID-19 pneumonia unless there are other indications (eg, exacerbation of chronic obstructive pulmonary disease) [13,82]. Glucocorticoids have been associated with an increased risk for mortality in patients with influenza and delayed viral clearance in patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Although they were widely used in management of severe acute respiratory syndrome (SARS), there was no good evidence for benefit, and there was persuasive evidence of adverse short- and long-term harm [90]. (See "Treatment of seasonal influenza in adults", section on 'Adjunctive therapies' and "Middle East respiratory syndrome coronavirus: Treatment and prevention", section on 'Treatment'.)

The use of glucocorticoids among critically ill patients with COVID-19 is discussed elsewhere. (See "Coronavirus disease 2019 (COVID-19): Critical care issues", section on 'Glucocorticoids'.)

Uncertainty about NSAID use — Some clinicians have suggested the use of non-steroidal anti-inflammatory drugs (NSAIDs) early in the course of disease may have a negative impact on disease outcome [91,92]. These concerns are based on anecdotal reports of a few young patients who received NSAIDs early in the course of infection and experienced severe disease. However, there have been no clinical or population-based data that directly address the risk of NSAIDs. The European Medicines Agency (EMA) and the WHO do not recommend that NSAIDs be avoided when clinically indicated [93,94]. Given the uncertainty, we suggest acetaminophen as the preferred antipyretic agent, if possible, and if NSAIDs are needed, the lowest effective dose should be used. However, we do not suggest that NSAIDs be stopped in patients who are on them chronically for other conditions, unless there are other reasons to stop them (eg, renal injury, gastrointestinal bleeding).

Investigational approaches — A number of investigational approaches are being explored for antiviral treatment of COVID-19, and enrollment in clinical trials should be discussed with patients or their proxies. A registry of international clinical trials can be found on the WHO website and at clinicaltrials.gov.

Certain investigational agents have been described in observational series or are being used anecdotally based on in vitro or extrapolated evidence. It is important to acknowledge that there are no controlled data supporting the use of any of these agents, and their efficacy for COVID-19 is unknown.

●Remdesivir – Several randomized trials are underway to evaluate the efficacy of remdesivir for moderate or severe COVID-19 [95]. Remdesivir is a novel nucleotide analogue that has activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro and related coronaviruses (including SARS and MERS-CoV) both in vitro and in animal studies [96,97]. Remdesivir is an intravenous agent; reported side effects include nausea, vomiting, and transaminase elevations. It is also prepared in a cyclodextrin vehicle, so there is concern for potentially toxic accumulation of the vehicle in renal impairment. Exclusion criteria vary by trials but include alanine aminotransferase level >5 times the upper limit of normal and chronic kidney disease (creatinine clearance <30 or <50 mL/min, depending on the trial); some trials also exclude use of a different COVID-19-targeted therapy within 24 hours prior to remdesivir initiation. The compassionate use of remdesivir through an investigational new drug application was described in a case report of one of the first patients with COVID-19 in the United States [98]. Any clinical impact of remdesivir on COVID-19 remains unknown.

●Chloroquine/hydroxychloroquine – Both chloroquine and hydroxychloroquine have been reported to inhibit SARS-CoV-2 in vitro, although hydroxychloroquine appears to have more potent antiviral activity [99].

Clinical data evaluating hydroxychloroquine or chloroquine are limited, and their efficacy against SARS-CoV-2 is unknown. Nevertheless, given the lack of clearly effective interventions and the in vitro antiviral activity, some clinicians think it is reasonable to use hydroxychloroquine in hospitalized patients with severe disease or risk for severe disease who are not eligible for clinical trials. In the United States, the FDA issued an emergency use authorization to allow the use of these agents in adolescents or adults hospitalized for COVID-19 when participation in clinical trials is not feasible [100]. However, if these agents are used outside of a clinical trial, the possibility of drug toxicity (including QTc prolongation, in particular, as well as cardiomyopathy and retinal toxicity) and drug interactions should be considered prior to use, especially in individuals who may be more susceptible to these effects, and the patients should be monitored closely for adverse effects during use. The American College of Cardiology has suggested QTc monitoring parameters in this setting [101]. Optimal dosing is uncertain; the FDA suggests hydroxychloroquine 800 mg on day 1 then 400 mg daily and chloroquine 1 g on day 1 then 500 mg daily, each for four to seven days total depending on clinical response [100]. Other hydroxychloroquine regimens used include 400 mg twice daily on day 1 then daily for five days, 400 mg twice daily on day 1 then 200 mg twice daily for four days, and 600 mg twice daily on day 1 then 400 mg daily for four days [102].

Use of chloroquine is included in treatment guidelines from China's National Health Commission and was reportedly associated with reduced progression of disease and decreased duration of symptoms [103,104]. However, primary data supporting these claims have not been published [105].

Other published clinical data on either of these agents are limited. In an open-label study of 36 patients with COVID-19, use of hydroxychloroquine (200 mg three times per day for 10 days) was associated with a higher rate of undetectable SARS-CoV-2 RNA on nasopharyngeal specimens at day 6 compared with no specific treatment (70 versus 12.5 percent) [106]. In this study, the use of azithromycin in combination with hydroxychloroquine appeared to have additional benefit, but there are methodologic concerns about the control groups for the study, and the biologic basis for using azithromycin in this setting is unclear. In a randomized trial of 30 adults with COVID-19 in Shanghai, the proportion of patients with nasopharyngeal viral clearance at day 7 was not different with hydroxychloroquine (400 mg daily for five days) compared with standard of care, and one patient in the hydroxychloroquine group progressed to severe disease; interferon and other antiviral agents were used in both arms, which could be confounding factors [107].

●IL-6 pathway inhibitors – Treatment guidelines from China's National Health Commission include the interleukin (IL)-6 receptor inhibitor tocilizumab for patients with severe COVID-19 and elevated IL-6 levels. This agent, as well as sarilumab and siltuximab, which also target the IL-6 pathway, are being evaluated in clinical trials [108].

●Convalescent plasma – In the United States, the Food and Drug Administration is accepting emergency investigational new drug applications for use of convalescent plasma for patients with severe or life-threatening COVID-19 [109]. A case series described administration of plasma from donors who had completely recovered from COVID-19 to five patients with severe COVID-19 on mechanical ventilation and persistently high viral titers despite investigational antiviral treatment [30]. The patients had decreased nasopharyngeal viral load, decreased disease severity score, and improved oxygenation by 12 days after transfusion, but these findings do not establish a causal effect. Finding appropriate donors and establishing testing to confirm neutralizing activity of plasma may be logistical challenges. (See "Clinical use of plasma components", section on 'Convalescent plasma'.)

●Favipiravir – Favipiravir is an RNA polymerase inhibitor that is available in some Asian countries for treatment of influenza and is being evaluated in clinical trials for treatment of COVID-19. In a study of patients with non-severe disease (including oxygen saturation >93 percent), use of favipiravir was associated with faster rates of viral clearance (median time to clearance 4 versus 11 days) and more frequent radiographic improvement (in 91 versus 62 percent by day 14) compared with lopinavir-ritonavir [110]. However, other therapies were administered in this non-randomized, open-label study, so the results should be interpreted with caution given potential confounders.

●Lopinavir-ritonavir – Lopinavir-ritonavir appears to have little to no role in the treatment of SARS-CoV-2 infection. This combined protease inhibitor, which has primarily been used for HIV infection, has in vitro activity against the SARS-CoV [111] and appears to have some activity against MERS-CoV in animal studies [112]. However, there was no difference in time to clinical improvement or mortality at 28 days in a randomized trial of 199 patients with severe COVID-19 given lopinavir-ritonavir (400/100 mg) twice daily for 14 days in addition to standard care versus those who received standard of care alone [113].
teedubbya Offline
#619 Posted:
Joined: 08-14-2003
Posts: 95,637
Plasma

https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/investigational-covid-19-convalescent-plasma-emergency-inds

https://jamanetwork.com/journals/jama/fullarticle/2763982

delta1 Offline
#620 Posted:
Joined: 11-23-2011
Posts: 28,754
thanks for the info, TW...seems there is a lot of medical research being done on this new virus...hopefully we'll be better prepared for the predicted next wave this Fall
teedubbya Offline
#621 Posted:
Joined: 08-14-2003
Posts: 95,637
Lets hope. There is some desperation involved but that's how things happen sometimes. Trial and error.

I just posted links to the plasma research. It's pretty limited at the moment but will grow quickly.
teedubbya Offline
#622 Posted:
Joined: 08-14-2003
Posts: 95,637
At the risk of info overload I found this interesting. It goes in to more detail but I will spare you

SUMMARY AND RECOMMENDATIONS

●Among patients hospitalized with coronavirus disease 2019 (COVID-19), up to one-quarter require intensive care unit (ICU) admission. (See 'Introduction' above and 'Epidemiology' above.)

●Profound hypoxemic respiratory failure from acute respiratory distress syndrome (ARDS) is the dominant finding in critically ill patients. Common complications include acute kidney injury (AKI), elevated liver enzymes, and the late development of cardiac injury, including sudden cardiac death. Sepsis, shock, and multi-organ failure are less common. (See 'Clinical features in critically ill patients' above.)

●For most critically ill patients with COVID-19, we prefer the lowest possible fraction of inspired oxygen (FiO2) necessary to meet oxygenation goals, ideally targeting a peripheral oxygen saturation between 90 and 96 percent. (See 'Respiratory care of the nonintubated patient' above and 'Oxygenation targets' above and 'Low flow oxygen' above.)

•The use of high-flow oxygen via nasal cannulae (HFNC) and noninvasive ventilation (NIV) is controversial based on infection control concerns and the frequent need for mechanical ventilation despite these measures. The decision to initiate noninvasive modalities requires balancing the risks and benefits to the patient, the risk of exposure to healthcare workers, and best use of resources; this approach should be reassessed as new data becomes available. (See 'Patients with higher oxygen requirements' above.)

•In patients with COVID-19 who have acute hypoxemic respiratory failure and higher oxygen needs than low flow oxygen can provide, we suggest selective use of noninvasive measures be used rather than routinely proceeding directly to intubation (Grade 2C). As an example we might trial HFNC in younger patients without comorbidities who can tolerate nasal cannulae. In contrast, we may proceed directly to early intubation in patients at higher risk (eg, elderly patients and patients with comorbidities or risk factors for progression).

•Among the noninvasive modalities we suggest HFNC rather than NIV (Grade 2C). Our preference for HFNC is based upon limited and inconsistent data, which, on balance, favors HFNC compared with NIV in HFNC in patients with non-COVID-19-related acute hypoxemic respiratory failure. NIV via a full face mask (with a good seal) may be appropriate in patients with indications that have proven efficacy including acute hypercapnic respiratory failure from an acute exacerbation of chronic obstructive pulmonary disease, acute cardiogenic pulmonary edema, and sleep disordered breathing. (See "Heated and humidified high-flow nasal oxygen in adults: Practical considerations and potential applications", section on 'Medical patients with severe hypoxemic respiratory failure' and "Noninvasive ventilation in acute respiratory failure in adults", section on 'Patient selection'.).

•For patients with COVID-19 who receive HFNC or NIV, vigilant monitoring is warranted for progression with frequent clinical and arterial blood gas evaluation every one to two hours to ensure efficacy and safe ventilation. The threshold to intubate such patients should be low.

●For critically ill patients with COVID-19, intubation should not be delayed until the patient acutely decompensates since this is potentially harmful to both the patient and healthcare workers. We have a low threshold to intubate those who have (see 'Timing' above):

•Rapid progression over a few hours

•Failure to improve despite HFNC >40 L/min and FiO2 >0.6

•Development of hypercapnia

•Hemodynamic instability or multiorgan failure

●Intubation is a high risk procedure for aerosol dispersion in patients with COVID-19 and attention should be paid to donning full personal protective equipment (PPE) with airborne precautions (figure 1 and figure 2) as well using equipment that minimizes dispersion (eg, video laryngoscopy) and the development of protocols for the procedure (eg, check lists) (figure 5). (See 'Precautions' above and "Safety in the operating room", section on 'COVID-19'.)

●We use low tidal volume ventilation (LTVV) targeting ≤6 mL/kg predicted body weight (PBW) (range 4 to 8 mL/kg PBW (table 1 and table 2)) that targets a plateau pressure ≤30 cm H2O and applies positive end-expiratory pressure (PEEP) according to the strategy outlined in the table (table 3). For patients with COVID-19 that fail LTVV, prone ventilation is the preferred next step (table 4 and table 5). (See 'Ventilator management of acute respiratory distress syndrome' above and "Ventilator management strategies for adults with acute respiratory distress syndrome" and "Prone ventilation for adult patients with acute respiratory distress syndrome" and "Extracorporeal membrane oxygenation (ECMO) in adults".)

●Several procedures, including the collection of respiratory specimens, bronchoscopy, extubation, and cardiopulmonary resuscitation are aerosol-generating and should be avoided or minimized, if possible. All procedures should be grouped when possible. (See 'Interventions' above.)

●Patients with COVID-19 pneumonia who are mechanically ventilated for ARDS should receive the usual daily surveillance, and supportive care including conservative fluid management (unless patients have sepsis or volume depletion). Measurement of surveillance cardiac troponins and a low threshold to perform transthoracic echocardiography is appropriate for the early detection of cardiac injury. (See 'Supportive care' above and 'Surveillance' above.)

•In critically ill patients with COVID-19-induced ARDS who do not have a specific indication (eg, acute bronchospasm or refractory septic shock), we suggest not administering glucocorticoids (Grade 2C). The rationale for not administering glucocorticoids in this population is that the data supporting any benefit in the non-COVD-19 population did not include a sufficient proportion of patients with viral pneumonia to inform safety and that data in patients with ARDS due to viral pneumonia (eg, severe acute respiratory syndrome [SARS], Middle East respiratory syndrome [MERS], influenza) suggested harm. (See "Acute respiratory distress syndrome: Supportive care and oxygenation in adults", section on 'Glucocorticoids'.)

•For acute bronchodilation, we prefer the use of in-line metered dose inhalers (MDIs) rather than administration via a standard jet or vibrating mesh nebulizer due to the lower risk of aerosolization associated with MDIs. Individual institutions should work with their pharmacy regarding compassionate use of investigational medications and trial enrollment. We suggest the development of protocols by individual ICUs for the off-label use of investigational agents. (See 'Nebulized medication' above and "Coronavirus disease 2019 (COVID-19)", section on 'Investigational approaches'.)

●For patients with COVID-19 pneumonia who develop ARDS, the prognosis is poor with mortality ranging from 52 to 67 percent. The highest rates of death occur in those ≥64 years. (See 'Prognosis' above.)

●A greater level of anxiety and trauma among patients and families should be anticipated and combatted with clear communication strategies and early palliative care involvement. (See 'End of life issues' above.)

●Several measures should be adopted to accommodate a surge in COVID-19 cases including included expanding ICU care into non-ICU spaces, utilizing non-critical care trained staff to participate in delivering critical care, and innovative approaches to obtain, conserve, and increase the efficiency of physical equipment (eg, personal protective equipment and mechanical ventilators). (See 'Surge capacity and scarce resource allocation' above.)
victor809 Offline
#623 Posted:
Joined: 10-14-2011
Posts: 23,866
Interesting note about the intubation...
KingoftheCove Offline
#624 Posted:
Joined: 10-08-2011
Posts: 7,603
Lord help us...
Pudding Mittens Offline
#625 Posted:
Joined: 08-15-2016
Posts: 1,291
.
Okay, so citing an interview with a patient on, say, CNN, or printed in the New York Times or Washington Post etc., leads to nothing much here except maybe, "Interesting, thanks for the link Mittens".

Citing the same interview if it happened to be on Fox leads to me being insultingly lectured in incredibly obvious things like how sometimes people get better spontaneously so we need placebo controls (WOW, NO WAY, NEVER KNEW THAT!) and how the media sometimes cherry-picks what they cover and isn't entirely fair (WOW REALLY!?!?!?! THANK YOU FOR TELLING ME, I NEVER NOTICED!).

Conclusion -- citing Fox causes a knee-jerk reaction in certain people causing them to instantly assume you MUST BE a retarded simpleton and not, say, someone intelligent who understands statistical issues and study design and the history and practice of placebo controls, voraciously reads and watches information in tons of media outlets, notices and adjusts for their biases appropriately while integrating all that data from many many sources together for maximum understanding, but in this case SIMPLY WANTS TO POINT AT A DAMNED FIRST-PERSON ANECDOTAL INTERVIEW THAT IS SOMEWHAT INTERESTING!

Or as MACS put it:

MACS wrote:
So we all know the media is biased as a mofo... all of them are left. Fox is barely right. OAN is right.

We're able to process information, with that knowledge, and come to our own conclusions, yeah?? This was a dude who had the virus, took the effing meds and told us his experience. WTF does it matter what show he was on?

Bingo.
.
teedubbya Offline
#626 Posted:
Joined: 08-14-2003
Posts: 95,637
I’d say the same for cnn et al if I noticed it. I’ve seen plenty of first person anecdotal interviews however well intended that were bunk. Michael Moore makes a living off such things as does Alex Jones and Laura Ingram. It’s an age old tactic.

But why still argue about it? Disagreement isn’t personal or the end of the world. Believe what you want.
teedubbya Offline
#627 Posted:
Joined: 08-14-2003
Posts: 95,637
And don’t get lost in the tangent. That drug combination is hopeful but cautiously hopeful given the lack of clear data at the moment. Hopefully that last part changes.

I hope it’s so effective we all dose for a week and the whole thing goes away.
Pudding Mittens Offline
#628 Posted:
Joined: 08-15-2016
Posts: 1,291
Mrs. dpnewell wrote:
I heard today that a new study that accounts for those who had mild symptoms, and those who had the virus with little or no symptoms has lowered the mortality rate of COVID19 to 0.6%. The study also suggests that as testing becomes wide spread, the number will drop even lower. I can't find the study online, so I have nothing to link to. If true, that's at least some good news.

Yup. The denominator is getting bigger with mass testing, which means the death rate will hopefully keep dropping.

Quote:
Also heard today that a hospital in Texas was experimenting with giving patients in serious condition blood plasma from folks who have recovered. The hope being to infuse antibodies to the seriously ill. Kinda the old Omega Man thing. Of the 6 patients this was performed on, 5 have recovered, and the 6th is still alive. Again, I have nothing to link to, so take it with a grain of salt.

I mentioned this in an earlier post of mine in this thread. "Convalescent plasma therapy" it's called. VERY promising so far. Formal controlled studies pending of course. See also TW's pastes of info about it, above.

delta1 wrote:
as for the controversy over the efficacy of hydrochloroquine and the anti-bacterial combo, is it an actual cure, meaning it reverses the damage done to the lungs?

or does it only work to prevent the lungs from getting damaged, meaning it has to be applied early?

Well, forget about the drugs for a moment, and realize that COVID-19 has been observed to result in both reversible lung "damage" and irreversible damage. Some patients have lung scans full of nasty-looking "ground glass anomalies" as they're called (not real glass of course, just how they look on the images) but these often go away when the patient recovers, and this is what usually happens. Other anomalies never go away and are permanent, but this is relatively rare.

The drugs seem to inhibit the replication of the virus and/or help the body's immune system react to it better and in more productive and less damaging ways (e.g. probable prevention of damaging "cytokine storm" response by immune system, etc.)

Several prominent doctors using the 2-drug treatment or its zinc-sulfate-supplemented version say they DO NOT give the treatment to people with no/mild symptoms and no risk factors who will probably self-recover but will give the treatment to them if they worsen. They DO give the treatment to people with risk factors or who have more severe symptoms. That's the protocol for now among these guys. It's all "seat of the pants" of course, but they're doing what seems to work best and what seems most appropriate.

Dr. Vladimir Zelenko, who has treated 699 COVID-19 patients with very impressive results (0 died, 0 intubated, only 4 hospitalized), specified his actual dosing regimen recently, and it's 200mg of hyroxycholoroquine twice daily, 500mg of azithromycin once daily and 220mg of zinc sulfate once daily, FYI.

Not placebo-controlled of course, but still "wow" preliminary numbers and results. There's evidence that hydroxychloroquine helps zinc get inside human cells, where the zinc proceeds to seriously inhibit viral replication. So, the addition of zinc sulfate to the other two drugs may be why Dr. Zelenko is having such great success.

Stay tuned, as always.
.

.
teedubbya Offline
#629 Posted:
Joined: 08-14-2003
Posts: 95,637
See 621 and 622 for plasma
victor809 Offline
#630 Posted:
Joined: 10-14-2011
Posts: 23,866
Pudding Mittens wrote:
.
Okay, so citing an interview with a patient on, say, CNN, or printed in the New York Times or Washington Post etc., leads to nothing much here except maybe, "Interesting, thanks for the link Mittens".

Citing the same interview if it happened to be on Fox leads to me being insultingly lectured in incredibly obvious things like how sometimes people get better spontaneously so we need placebo controls (WOW, NO WAY, NEVER KNEW THAT!) and how the media sometimes cherry-picks what they cover and isn't entirely fair (WOW REALLY!?!?!?! THANK YOU FOR TELLING ME, I NEVER NOTICED!).

Conclusion -- citing Fox causes a knee-jerk reaction in certain people causing them to instantly assume you MUST BE a retarded simpleton and not, say, someone intelligent who understands statistical issues and study design and the history and practice of placebo controls, voraciously reads and watches information in tons of media outlets, notices and adjusts for their biases appropriately while integrating all that data from many many sources together for maximum understanding, but in this case SIMPLY WANTS TO POINT AT A DAMNED FIRST-PERSON ANECDOTAL INTERVIEW THAT IS SOMEWHAT INTERESTING!


I mean.... you can say that.
But I did a search for your name and "interview" over the last month and not a single post using the term "interview" indicates the interview was from CNN or the New York Times etc... the only ones you identified by source were Fox news.

Maybe a more likely answer is the first time an interview got posted it got "interesting" because it's an interesting anecdote.
The 3rd and 4th time it has not added any actual additional statistical evidence, so people started pointing out that posting individual cherry picked interviews stops being "interesting" after the first. After that the next step that would be "interesting" would be double blinded studies.

But I'm just speaking for myself.
Pudding Mittens Offline
#631 Posted:
Joined: 08-15-2016
Posts: 1,291
.
TW, great big-ass pastes of good, detailed info. Keep 'em coming.
.
frankj1 Offline
#632 Posted:
Joined: 02-08-2007
Posts: 44,211
Pudding Mittens wrote:
I've given references to quite a number of these, concerning these two drugs used together. Look back in this thread.
.

point taken.
Pudding Mittens Offline
#633 Posted:
Joined: 08-15-2016
Posts: 1,291
.
Supposedly there's a new study on hydroxychloroquine for COVID-19 that is randomized and placebo-controlled, but has a small sample size of 62 and is out of China, so it might not be accurate, or might simply be all lies. But for what it's worth, assuming they're not lying, it found statistically-significant reductions versus control/placebo in symptoms duration and pneumonia. No mention of azithromycin or zinc sulfate, I think they only used hydroxychloroquine. This would fit the initial French study that showed hydroxychloroquine helping significantly but not nearly as much as hydroxychloroquine and azithromycin together

Also Dr. Steve Smith, an infectious disease specialist near NYC, again reported that he and his group have been treating all their COVID-19 patients with hydroxychloroquine and azithromycin, and have had to intubate zero patients after Day 2 of the treatment. He acknowledged this data is not controlled, but even still, he pointed out the odds of this being by chance are very, very tiny. He went out on a limb and said that he believes that this treatment is, quote, "the beginning of the end of this pandemic."

His words not mine, don't shoot the messenger. I'm just passing this along. Let's hope he's right.
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KingoftheCove Offline
#634 Posted:
Joined: 10-08-2011
Posts: 7,603
This is the kind of miracle we need....
delta1 Offline
#635 Posted:
Joined: 11-23-2011
Posts: 28,754
meanwhile some reports that lupus patients and others that need the hydrochloroquine meds can't get their prescriptions filled...

many doctors are reported to be buying up supplies, writing off label scripts, and hording them for possible use for infected family and friends
Pudding Mittens Offline
#636 Posted:
Joined: 08-15-2016
Posts: 1,291
.
The widespread current in-field use of hydroxychloroquine and azithromycin for COVID-19 worldwide, even with a severe lack of large, controlled studies on its effectiveness, somewhat reminds me of the famous Cocoanut Grove nightclub fire in Boston on November 28, 1942.

They had lots of people with really bad burns. Some of them became some of the first humans to ever be treated with penicillin, which Merck rushed from New Jersey to Boston. The idea was that these people were likely to die anyway, so there was nothing to lose. The result was impressive, and actually convinced the US military to authorize use of penicillin for the armed forces, and of course widespread civilian use followed too.

Here we have a leg up on that historical example though, because while they had to worry about penicillin possibly hurting the patients it was used on, hundreds of millions have already been treated with hydroxychloroquine and azithromycin separately, so their safety separately is very thoroughly understood and has been for decades. The only issue here is safety when combined (which seems fine, plus there's an initial study showing no incremental risk with them used together) and of course effectiveness for this new use against COVID-19, which we'll find out soon.

The overall common element is, "Screw it, we have little to lose and much to gain, let's give it and do the big formal controlled studies later, this is wartime!"
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victor809 Offline
#637 Posted:
Joined: 10-14-2011
Posts: 23,866
So this is interesting.
I think this is a great example of interpretation of scientific information.

A french study of 80 patients was released... preliminary data. I think this came out a few days ago.

The daily wire (a conservative site) touts this as great news.

Here's the study:
https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-IHU-2-1.pdf

and while the study wants to be positive, we need to look at this critically.
80 patients entered the study. All patients received hospitalization-level medical care for the entire 6 days they were in the study.
Average time from symptoms to entering the study was a little over 5 days

Of these 80 patients, 1 dropped out of the study because of medication conflicts... ok
Of the remaining 79 patients, 1 died. So there's your >1% death rate right there. They've almost reached the expected mortality rate of the virus right off the bat.
They then continue to treat until 65 patients are released. Ok, great.

I can't figure out what happened to the others exactly. But at the time this was put out at least 2 were still in the infectious disease unit, and 1 was in the ICU.

I simply don't see how this is beating the numbers we hear about already. Again, this is why you need control groups.

We'll see what happens when a study with controls is released.
victor809 Offline
#638 Posted:
Joined: 10-14-2011
Posts: 23,866
Pudding, I think the china study with 62 patients was done in Feb.
https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2

full text
https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2.full.pdf
tonygraz Offline
#639 Posted:
Joined: 08-11-2008
Posts: 20,175
Well, if they find the cure, how long will we have to wait or the medications. Give our current record of necessary supply, it could be a long wait.
MACS Offline
#640 Posted:
Joined: 02-26-2004
Posts: 79,599
Lost one of our own because of this... may he Rest in Peace. Pray
delta1 Offline
#641 Posted:
Joined: 11-23-2011
Posts: 28,754
yeah I heard...you ever work with him?

RIP Deputy Young
Palama Offline
#642 Posted:
Joined: 02-05-2013
Posts: 23,463
MACS wrote:
Lost one of our own because of this... may he Rest in Peace. Pray


Sorry to hear Shawn.

Prayers out for his family, friends and co-workers. Pray
MACS Offline
#643 Posted:
Joined: 02-26-2004
Posts: 79,599
delta1 wrote:
yeah I heard...you ever work with him?

RIP Deputy Young


He was one of my guys on my last team.
delta1 Offline
#644 Posted:
Joined: 11-23-2011
Posts: 28,754
extra hard...

best wishes to you, your team and the department...

hope the other two deputies have speedy and full recoveries and the virus has been eradicated from the RCSD Corrections Facilities
Pudding Mittens Offline
#645 Posted:
Joined: 08-15-2016
Posts: 1,291
.
Thanks for the info and tracking that down, Victor. I had heard it was new (apparently erroneously).

The great thing not to lose sight of is that, despite all the buzz about hydroxychloroquine and azithromycin (and sometimes zinc sulfate too), America and the world are doing a "shotgun blast" approach to this, trying not just one "bullet" but many, greatly increasing the chances that one or several will be a full cure or a serious symptom-reducer and mortality-reducer.

We're also shotgunning production of ventilators and PPE, many many companies churning out huge numbers of them, with more coming every day.

Parallel processing, baby. Just like in computing, it can work miracles of speed-to-results that "one at a time" serial methods can't touch.

There's a big pile of reasons to be hopeful and optimstic. Stay positive, fellas.

RIP Deputy Young and everyone else who's no longer with us. Let's think of them all when we can finally give the middle finger to this virus and beat it for good.

Silver lining in the dark cloud is that the world will be far better prepared for the next one, although I hope it's after I'm dead of old age. Probably won't be, but I can hope.
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USNGunner Offline
#646 Posted:
Joined: 05-17-2019
Posts: 4,402
Wow. So sorry for your Deputy MACS. Prayers out.
Speyside Offline
#647 Posted:
Joined: 03-16-2015
Posts: 13,106
Sad to hear this MACS. Unfortunatly it's going to get worse before it gets better. Due to my pre semi retired career, my world is rather large. 14 people I knew are dead of COVID 19.
MACS Offline
#648 Posted:
Joined: 02-26-2004
Posts: 79,599
Nothing like losing someone you know to this virus to make you reconsider your stance on it.

F---.

Think we're at 25 now... 3 serious. A handful not showing symptoms but tested because they were exposed and do have it. I'm certain I've been exposed. This place is ground zero for the dept.

F---.

Should have stayed home. Too late now.
teedubbya Offline
#649 Posted:
Joined: 08-14-2003
Posts: 95,637
Sorry brother. Hate to hear about your friend and situation. Be well and try to keep from others. You’ll be ok. You and Keith Richards will be the last men walking.
MACS Offline
#650 Posted:
Joined: 02-26-2004
Posts: 79,599
https://www.youtube.com/watch?v=6WS85Vdj3aA
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