This Corona Virus Mania is Just Too Much, We All Need to Chill!

[Al M.]

A very good site. The graphics come live just with scrolling. Clever presentation but very good information as well.
The graph at the end of the article regarding spread is particularly revealing as to what may very well happen here in the next few months.

https://www.abc.net.au/news/2020-03-26/coronavirus-covid19-global-spread-data-explained/12089028

That is excellent indeed, thanks Marty!

 

[spiritofmusic]

One of the mysteries of the age will be how an island like UK allowed itself to keep it's airports and borders fully open, even when day to day we're losing 1k fatalities/day and 5k new cases/day.

And another island, NZ, shuts it all down, w casualties right down.

We are just not getting it over here. Crammed like sardines on planes into Heathrow, crammed like sardines on the Tube into central London. With just lip service paid to instructions to quarantine.

 

[rbbert]

Personally, I don’t care much for “experts” who claim to know things... I only listen to those “experts” who are humble and recognize the limitations of their own knowledge, who recognize humankind is embryonic in our knowledge, and a hundred years from now things we think we know are likely to be laughed at. It is the nature of scientific research and understanding to have paradigm changes. So when someone toots their own horn I usually stop listening and seek alternative explanations. I become the most skeptical when people start advocating for consensus... “I must be right, just look at this long list of people who agree with me.”

I don't think this applies to the scientists and physicians who are currently in the forefront, both in the direct fight against COVID19 disease and in modelling the epidemiology and steps to take to limit the impact of this event. If you feel differently, I'd be curious to hear why and about whom.

 

[Surfski]

My son in law also made the point that the most serious time when the virus is disseminated is at the time of intubation as the fomites are released into the air. As a result unless the OR has negative pressure room ventilation they will not do an intubation under those circumstances due to the high risk of them acquiring the virus. In the ICU the circulation is negative pressure and if a patient with covid requires emergency surgery the intubation is done in the ICU in a hazmat outfit and is then transported to the OR for surgery.

Interesting. I couldn't agree more. But we don't go to that extreme. If intubating a Covid for OR, rather than for ICU care, we limit the number of people in OR to 3 ( patient, anaesthesia and tech). The intubation are done by the MOST SENIOR anaesthetists available , and being done all with videoscope ( normally I almost never use them). Reason- trying to give the optimal chance of getting tube in right pipe first time. Theatre staff enter once tube in.As far as I know, the guys are using rocuronium for almost all intubations ( I just mention it because it causes more anaphylaxis cases than any agent I've ever used). I would also hazard a guess that your son in law is taking as much care at time of extubation- coughing there just as dangerous if not more so. the guys here are extubating all deep , or using remifentanil. In the unit, when I tube, I do something similar but not all done in negative pressure rooms. If I have one , I'll wear a N95 mask plus PPE but until yesterday we didn't have any N95's.
The renal failure is interesting- we're seeing it but we saw that with bad multi organ failure prior to Covid. If they need rinsing we just get on and do it.

 

[joaovieira]

From what I have read especially in the post yesterday by marty, the use of IL-6 inhibitors seem to be the most promising thing that will show up imminently. There seem to be many anecdotal stories of patients improving after everything else has failed

jaioviera posted yesterday that he has a friend who got worse with Plaquenil and Z-Pack and required intubation until he was given an IL-6 inhibitor and was improving within hours, enough to be extubated BUT he remains on renal dialysis.

I was speaking to my son in law this morning who is a very busy anesthesiologist in the SF Bay area. He enlightened me about several things. First he has used IL-6 inhibitors with good results and he states that these will be showing up in the next few months however the drugs were only made available in limited amounts for purposes of compassionate use. He did tell me the supply ran out almost immediately and over to get it now you have to correspond with the company on a case by case basis and if they make it available it is often too late

He also said that a contraindication is if the patient's serum creatinine is elevated which would suggest renal failure. This takes me back to wondering about jaoviera's friend who obviously has renal failure

My son in law also made the point that the most serious time when the virus is disseminated is at the time of intubation as the fomites are released into the air. As a result unless the OR has negative pressure room ventilation they will not do an intubation under those circumstances due to the high risk of them acquiring the virus. In the ICU the circulation is negative pressure and if a patient with covid requires emergency surgery the intubation is done in the ICU in a hazmat outfit and is then transported to the OR for surgery.

From what I have read vaccines may never prove to be the answer however the feeling is that although a vaccine may not prevent one from getting covid-19 in the future it will hopefully prevent deaths by mitigating development of ARDS.

Presently if one is intubated and on a ventilator for more than 24 hours the death rate is significant.

So the way I see it, the virus is never going to be vanquished in the foreseeable future so by doing what we are doing however by flattening the curve and reducing the number of cases, the hope is that in a few months drugs will be available to minimize the severity of ARDS and organ failure such that there will be far fewer deaths

hi Steve, the news about my friend is that he was successfully extubated. His renal situation is much better, and there is a the decrease of blood pressure medication.
looks like he is going to make it.

 

[tima]

There are no "experts" advocating the use of hydroxychloroquine; these proponents are either practicing physicians or (discredited, for the most part) researchers.

Physicians are not experts? People with direct experiential evidence and related training are not experts? I understand the medical world has thick layers of bureaucracy and guild-speak, but excluding physicians who have positive results with HCQ from the expert class seems reflective of more than scientific bias.

Btw, the American Thoracic Society issued guidelines April 6 that suggest COVID-19 patients with pneumonia get doses of the anti-malaria drug. Are they discredited?

 

[joaovieira]

By the way: in Brazil the Actemra can only be bought and stocked by each state.
state hospitals have it.

I dont know why.

 

[Surfski]

Physicians are not experts? People with direct experiential evidence and related training are not experts? I understand the medical world has thick layers of bureaucracy and guild-speak, but excluding physicians who have positive results with HCQ from the expert class seems reflective of more than scientific bias.

Btw, the American Thoracic Society issued guidelines April 6 that suggest COVID-19 patients with pneumonia get doses of the anti-malaria drug. Are they discredited?

FYI, the Society of Critical Care Medicine, in guidelines just published in conjunction with the European Society of Intensive Care, specifially stated insufficient evidence to recommend use of said drug. Note that this is not to say it shouldn't be used, just that it isn't regarded by those groups as recommended treatment. Yet.

 

[Folsom]

FYI, the Society of Critical Care Medicine, in guidelines just published in conjunction with the European Society of Intensive Care, specifially stated insufficient evidence to recommend use of said drug. Note that this is not to say it shouldn't be used, just that it isn't regarded by those groups as recommended treatment. Yet.

I read something by an unknown person that thinks the virus attacks red blood cells. Maybe they thought that because of increased ferritin, I'm not sure. It makes me wonder if people think that's what the malaria drug is about, something to do with red blood cells. I find it a bit hard to believe that you wouldn't start seeing hypoxia symptoms without CVD/lung symptoms in at least someone. Maybe you have Surfski?

 

[joaovieira]

The article in the NYT that explains about cyclotine storm says ferritin level should be used to determine if it is the storm.

 

[tima]

FYI, the Society of Critical Care Medicine, in guidelines just published in conjunction with the European Society of Intensive Care, specifially stated insufficient evidence to recommend use of said drug. Note that this is not to say it shouldn't be used, just that it isn't regarded by those groups as recommended treatment. Yet.

What I take away from that is experts are not in concordance.

What I have not read is incidents of it causing harm or death or percentage of failure from its use. I'm sure someone could come up with such but it's usually the "insufficient evidence" claim vs efficacy in the field.

Formal claim of 'proof' comes with a lot of liability. I wonder what role insurance plays in such.

 

[ddk]

I never claimed your sites for statistics aren't credible, only your interpretation of them. I will (and do) use some of the same sites.

O? You have a short memory grasshopper and this wasn't the only time you said it.

The solution to this would be for you to stop posting inaccurate and unverifiable "data", and your inaccurate interpretations of reliable data. Unfortunately, I don't expect this to occur.

As far as enlightenment, if you actually read my posts, you should come away with an increased understanding of what is happening and why.

Ha ha ha! Be careful grasshopper the last guy this full of himself blew up like a 2nd hand shared condom! He had the same over inflated sense of self importance!

david

 

[Folsom]

The article in the NYT that explains about cyclotine storm says ferritin level should be used to determine if it is the storm.

There's evidence that ferritin is used for certain more processes with T cells than we fully understand yet - even though it can be an indicator. It looks like it may be used to bypass a process with T cells, which seems likely for the body to take a shortcut in order mount a storm (kill everything, ask questions later?). It seems more likely that's why you see a rise in it, than hypoxia/iron overload from dead red blood cells. Although malaria does look a lot like the initial stages of cv19, so alternate theories should continue to flow...

I can say that alternate theory I read might be all blah, but did recommend more O2 over just pressure by ventilators. At the point of intubation I don't know if that's the right call, but a little O2 bump for pre-intubation patients probably would be a good way to reduce some inflammation. I don't have any kind of a clue how much O2 is available at hospitals.

 

[ack]

More Evidence Suggests Pangolins May Have Passed Coronavirus From Bats to Humans

https://www.sciencealert.com/more-e...y-have-passed-coronavirus-from-bats-to-humans

 

[Bobvin]

More Evidence Suggests Pangolins May Have Passed Coronavirus From Bats to Humans

https://www.sciencealert.com/more-e...y-have-passed-coronavirus-from-bats-to-humans

Damn, I was looking forward to pangolin dinner!

 

[BlueFox]

LOL. I had to Google pangolin. Learn something everyday.

 

[the sound of Tao]

More Evidence Suggests Pangolins May Have Passed Coronavirus From Bats to Humans

https://www.sciencealert.com/more-e...y-have-passed-coronavirus-from-bats-to-humans

David Attenborough did an extraordinary documentary a few years back on this wonderful creature that has been illegally harvested out of the wild to near extinction level across several continents.

The most illegally traded animal in the world the gentle pangolin, the world’s only keratin scaled mammal is slow moving and an easy target, it’s only defence is curving itself into a ball. Watching the huge illegal trade in live wet markets for its meat and the scales for medicine in the documentary was just very touching and sad.

In the documentary David Attenborough called for this illegal trade to end. If this harmless gentle mammal was indeed the ultimate transmission route for the Covid-19 virus to humankind perhaps it would have been good if we had listened .

 

[rbbert]

O? You have a short memory grasshopper and this wasn't the only time you said it.

Just one glaring example; in the last thread (the closed one) you attempted to blame the poor response of our government to the COVID threat on Obama (!) and some of his appointments at the FDA and CDC. Any of the few Obama appointees left in high positions in those agencies have been re-appointed and in some cases promoted by the current administration. Moreover, during the Obama administration there was a Pandemic Response Team formed, since defunded and disbanded (again by the current administration.)

Your posting a link to a website is not what I refer to as representative of your disinformation; rather, as I posted, it is your misinterpretation of data from those websites, as well as egregious falsehoods such as the one I mentioned above. You keep trying to derail this thread, claiming that the current US social distancing guidelines and economic shutdown are unnecessary, attempting to support this opinion both by saying other countries are not doing it (totally false, at most a handful of countries are not shut down or shutting down as the virus hits them) and then claiming that like all pandemics this one will follow a Bell curve of cases and deaths without any special measures (there is not a shred of historical or epidemiologic evidence to support this). So yes, I said it, and I will continue to say it as long as you keep posting demonstrable falsehoods. No one is well served by your actions of this kind. Keep it honest and verifiable and I will "lay off".

 

[Al M.]

Physicians are not experts? People with direct experiential evidence and related training are not experts? I understand the medical world has thick layers of bureaucracy and guild-speak, but excluding physicians who have positive results with HCQ from the expert class seems reflective of more than scientific bias.

Firmly establishing the efficacy of drugs beyond anecdotal evidence requires large, randomized, usually placebo controlled, scientific studies. This is beyond the realm of what individual physicians can do, which are experts on patient care but mostly not on drug development. There are countless drugs that had to be discarded as promising candidates after large, randomized scientific studies.

 

[rbbert]

Physicians are not experts? People with direct experiential evidence and related training are not experts? I understand the medical world has thick layers of bureaucracy and guild-speak, but excluding physicians who have positive results with HCQ from the expert class seems reflective of more than scientific bias.

Btw, the American Thoracic Society issued guidelines April 6 that suggest COVID-19 patients with pneumonia get doses of the anti-malaria drug. Are they discredited?

I missed the ATS recommendation, although perhaps it is the exception that supports the generalization. As far as practicing physicians being experts, I can assure you that most or all currently treating COVID patients in the ICU are not and would not claim to be experts; at this point they are mostly desperate, and as one recently said they are basically "throwing the kitchen sink" at these patients. If you think that is an expert recommendation, well...

Empiric data is not what we need to develop effective treatment strategies. Empiric data is useful to formulate a hypothesis to be tested experimentally. Medical history is full of promising empiric treatments that turned out to be ineffective or harmful (steroids for fulminant hepatitis, steroids for spinal cord injuries, dopamine for shock, anti-endotoxins for shock, etc)