Covid 19

[WisconsinWildcard]

Re: Covid 19

As a neuropsychology professor and research scientist I'm quite aware of the critical nature and value of RCTs in clinical medicine and have documented RCTs in published peer reviewed literature over several years.

Documented? Do you mean you have published several RCTs? That is an odd way to phrase it. Link to any studies you find relevant to this and I am happy to read them. I am also a published scientist, and physician, so I guess we will have to go back to what is actually in the literature instead of having a degree ****ing contest.

However, the FDA is currently "fast tracking" several clinical trials of Hydroylchloroquine and Chloroquine in several regions.

Let's wait for those results so we actually know what we are doing.

As I've repeatedly said, I'm not getting my hopes up too high, but several clinical researchers concur there is more than "anecdotal" evidence here.

"Several clinical researchers" Please name them. As far as I can tell, there is one report, by Gautret et al. I will list my reservations about that below.

These drugs have a known profile with a concise review of the pharmacology, clinical efficacy and tolerability.

How may patients do you have on this? I have several and know how to monitor for the side effects. I assume you also know that the combination of Hydroxychloroquine and azithromycin can prolong your QT leading to fatal arrhythmia right? These are not medications used together frequently, or on a large scale.


Now some of the problems with the report:
1. Not randomized
2. They did not even look at any clinical outcome
3. Intent-to-treat analysis was not done (this leads to false outcomes and should basically invalidated the minimal conclusions from this study
4. No error bars on their data because only 4 out of the 16 controls had a proper measure of the viral load

As a neuropsychology professor...I am sure you identified all of these significant flaws and used appropriate clinical caution before spreading this misleading information like our president.

[Chuck Murray]

Re: Covid 19

Same poll that said 72% of those polled don’t fear dying from the virus.😱

I've said from the outset, I'm fine with taking my chances. I'm not in the high-risk category, I haven't had any symptoms, and I don't reside with or regularly socialize with anyone who is in the high-risk category. I'm doing the "physical distancing" thing, and will do it per the President's orders. I think I can say for many of the 72% that we don't think we'll get it in the first place … and if we do, we don't think we're going to die from it. And if I'm unlucky enough to get it and die … hey, I've had a great 58 year run, my country is listing towards socialism over the next generation, and (to quote Jim Morrison) "no one here gets out alive", so I'm not going to weep or go cower in a corner over any of this. Another quote, this one from Greg Lake (RIP) of ELP, taken from Pictures at an Exhibition, which concludes in The Great Gates of Kievwith the following:

There's no end to my life
No beginning to my death:
Death is life

https://www.youtube.com/watch?v=SZK_fFtwKs0 (short version starts @ 8:00 )

Another way to look at it is … 300 or so US deaths as of Sunday (the CDC website apparently takes weekends off, even in times of crisis), and there's 330 million or so US citizens. That's one in a million. Not the kind of lottery I want to "win", but that's where the numbers are. Will the numbers get worse? I'm sure they will. That this is "hot" near NYC obviously isn't a good thing. But my life doesn't involve me being in or near NYC with any real frequency to begin with. So if I had been asked, I'd probably have been a part of that 72% figure. No big deal really. And I can see why the other 28% might feel differently. It's a poll, and it reflects how a sample of individuals - probably located from all different parts of the country - feel right now. Not surprising.

[e.cat]

Re: Covid 19

The country will inevitably transition away from the war on the Chinese virus to the economy soon.

[NCAA watcher]

Re: Covid 19

Jim Morrison is trash. The Doors and Credence?Fogarty are the surest way for me to turn off the radio.

Another way to look at it is … 300 or so US deaths as of Sunday (the CDC website apparently takes weekends off, even in times of crisis), and there's 330 million or so US citizens. That's one in a million.

I'd spend the last few moments on understanding trends, and that a snapshot of today is irrelevant to understanding your risk Think of it as anti-Umile thinking -- I've won 20 games every year, so I will continue winning 20 games even though I've stopped recruiting any talent and so have no good players on my roster this coming year. Remember, there are always fans we railed against who just assumed things would remain as they always were.

[Darius]

Re: Covid 19

...my life doesn't involve me being in or near NYC with any real frequency to begin with...

Good for you.

[Chuck Murray]

Re: Covid 19

Umm...

I know, eh? The markets remain volatile. When I posted it, the Dow was up 500, when you posted, it was down 500, and now it looks like it's almost back to Friday's closing. Lesson learned.

Chuck, rather than repost your post...laughed about your "President Fauci" comment. Sorry he has to get up there and use science and facts to explain what's going on. I for one am not watching these things anymore as I need to know the basics around what's going on. I don't need to hear his personal pep rally for himself...What do you expect Fauci to do when the President is talking about things that, and with all due respect, aren't quite yet in the works? Fauci says the current ideas for drug therapies and possible results are anecdotal..there's nothing wrong with that, just like there's nothing wrong with the President offering hope to what could be possible. Fauci isn't going away. The President can kick him out of his group but he said in an interview over the weekend that 'while he doesn't expect to be fired, if he is, he'll keep on talking". Thank God for that.

I thought I might get a laugh out of you with "President Fauci", HR.

To be clear, I don't have any problems with Dr. Fauci, but it's kind of silly to think both Cuomo and Trump - not exactly best pals - are just going off on a lark by themselves without some degree of medical support for it, do you? The President hasn't put a lid on him - unlike some people in some Far Eastern country (want to be careful not to be "racially insensitive" ) - so let's let Dr. Fauci talk about the medicine, let the guys who got elected make the decisions and craft the message, and assume no one is going "off the reservation" oops, going off on their own. I know, it can be fun with good guys vs. bad guys sometimes, but in this case a good guy and a bad guy have agreed to pursue this latest course as of Tuesday, and the non-partisan expert is not telling them not to pursue it, right? Unless I'm missing some secret Fauci-code …

Maybe its fatigue from dragging the "hoax" crowd into reality, and now being faced with the magical "there will be a cure in 15 days" response. Trying to devise a plan that does't rely upon the assumption that this will all go away seems reasonable, not gleeful. Not sure that the "this is just the flu" crowd is really in a position to chastize others for being too pesimistc.

That said, I remind my kids how this highlights the hardships of prior generations, be it the sacrifice of going to a war that suddenly ended, or the fear of contracting polio, which thanks to science, Mr. Salk, suddenly goes away.

Yes, there may be such ground-shifting vaccine, but until then, we should not be planning on anything other than Dr. Fauci's 12-18 month timeline.

What interim solutions there may be to mitigate the societal cost is a worthy discussion. I welcome that discussion stripped of the political prism that clouds many of the responses.

I probably agree with 90% of your post (which is usually the case), 'Watcher. I think the Cuomo-Trump "interim solution" should be rolled out, for that reason. Anything that helps is good. I don't read the 15 day period as a "cure", but I do think it's the first time we'll have to take a long hard look at whether the current strategy needs to be continued on a national basis, or not. There is no question the impact is worse in certain areas than others. But as I've raised a few times (mostly with Russell) on this thread … at some point, in some areas of the country, the "cure" is going to be worse than the disease. President Trump said that in last night's conference, possibly twice. At some point, I think it's fair to ask if different approaches need to be taken in different areas.

I don't want that to sound callous, but at some point, common sense says that responses and strategy may/should be different in Nebraska as opposed to California, or in Maine/NH/Vermont as opposed to New York - or even Upstate NY to New York City.

I think (hope) that's what might be coming up a week from today. But a lot of things can happen - negative OR positive - in the time in between. It certainly is a fluid situation ...

[DrDemento]

Re: Covid 19

Documented? Do you mean you have published several RCTs? That is an odd way to phrase it. Link to any studies you find relevant to this and I am happy to read them. I am also a published scientist, and physician, so I guess we will have to go back to what is actually in the literature instead of having a degree ****ing contest.



Let's wait for those results so we actually know what we are doing.



"Several clinical researchers" Please name them. As far as I can tell, there is one report, by Gautret et al. I will list my reservations about that below.


How may patients do you have on this? I have several and know how to monitor for the side effects. I assume you also know that the combination of Hydroxychloroquine and azithromycin can prolong your QT leading to fatal arrhythmia right? These are not medications used together frequently, or on a large scale.


Now some of the problems with the report:
1. Not randomized
2. They did not even look at any clinical outcome
3. Intent-to-treat analysis was not done (this leads to false outcomes and should basically invalidated the minimal conclusions from this study
4. No error bars on their data because only 4 out of the 16 controls had a proper measure of the viral load

As a neuropsychology professor...I am sure you identified all of these significant flaws and used appropriate clinical caution before spreading this misleading information like our president.

Having managed a great number of patients with both systemic and discoid lupus on Hydroxychloroquine over the past 50+ years, I could not agree with your post more. Virtually all of the patients i managed were instructed to see an Ophthalmologist every 6 months to detect any eye complications (corneal or retinal or other) and had annual or more frequent EKGs. Perhaps others have felt differently but this was not a drug that I just prescribed without careful follow up. i doubt that i had more than a couple ever taking the combination together (certainly I never wrote both at the same time for any patient). I am watching for the publication of controlled studies carefully. Perhaps this is all anecdotal, perhaps not. Obviously I have access to both drugs and could take them myself or prescribe them for my wife. I have not and will not until and unless we have far more evidence (emphasis on far and more). It is interesting to note tht on a world map of the cases of this virus, much of Subsaharan Africa has been relatively spared. Whether that is simply due to poor medical reporting (likely in my mind) or the widespread use of Chloroquine type drugs for malaria, or even a more wild suggestion that it may be due to malaria incidence itself (would that not be something truly weird?) is simply not know at this time.

[Chuck Murray]

Re: Covid 19

Jim Morrison is trash. The Doors and Credence?Fogarty are the surest way for me to turn off the radio.

We agree again, 'Watcher. I do recall reading a book by that name back when I was in college, and Morrison was enjoying a little revival in popularity (remember the mag cover - "He's Hot, He's ****, and He's Dead"?). My best pal growing up loved The Doors and I never quite understood it (ditto The Grateful Dead). Here's something you probably never expected to see me ever link to:

https://www.rollingstone.com/music/m...s-dead-113162/

I'd spend the last few moments on understanding trends, and that a snapshot of today is irrelevant to understanding your risk Think of it as anti-Umile thinking -- I've won 20 games every year, so I will continue winning 20 games even though I've stopped recruiting any talent and so have no good players on my roster this coming year. Remember, there are always fans we railed against who just assumed things would remain as they always were.

[WisconsinWildcard]

Re: Covid 19

Having managed a great number of patients with both systemic and discoid lupus on Hydroxychloroquine over the past 50+ years, I could not agree with your post more. Virtually all of the patients i managed were instructed to see an Ophthalmologist every 6 months to detect any eye complications (corneal or retinal or other) and had annual or more frequent EKGs. Perhaps others have felt differently but this was not a drug that I just prescribed without careful follow up. i doubt that i had more than a couple ever taking the combination together (certainly I never wrote both at the same time for any patient). I am watching for the publication of controlled studies carefully.

Absolutely. It seems that our practice with the medication is basically the same, as I also very closely monitor my patients who are on it and carefully discuss with the patient what to watch for and the known risk profile.

You and I have talked about it in the past but it is easy for everyone to have an opinion on stuff like this, but very few understand the actual decision making process that should take place in medicine. Also, first do no harm.

Stay safe Dr.

[Wayuphere]

Re: Covid 19

Quoting ELP is always a good thing in my book. They were at another level. Big fan..
That said, I still say fear is good, panic not good at all.

As I write this my RN daughter is being tested at a drive through remote site after being sent home from work at the hospital after doing many screenings last week.. she, myself and grandson all have symptoms with only her being tested due to her job. Wife no symptoms. Slight fever, sore throats and cough. Most likely cold virus or even flu virus with vaccine protection helping. Really not a big deal so far and I fully expect negative test results. We will see.

[Darius]

Re: Covid 19

Absolutely. It seems that our practice with the medication is basically the same, as I also very closely monitor my patients who are on it and carefully discuss with the patient what to watch for and the known risk profile.

You and I have talked about it in the past but it is easy for everyone to have an opinion on stuff like this, but very few understand the actual decision making process that should take place in medicine. Also, first do no harm.

Stay safe Dr.

I get the sense that at some point, or maybe all along and I was fortunate*, our schools stopped teaching biology.

* - At the time, I considered myself unfortunate. Chemistry, with Bunsen burners and pieces of magnesium was much more fun. Looking back, I am glad to have used a microscope to see what goes on in a Petri dish.

[BassAle]

Re: Covid 19

https://www.cnn.com/2020/03/23/afric...ntl/index.html

[HockeyRef]

Re: Covid 19

Cuomo's presser today: When do we start the 'pivot' to open up the lock downs...getting those who are not infected back into circulation (companies, businesses). Found it fascinating to read how other countries, namely, China, literally took people who were positive, even those with fevers, off the grid. They could not isolate at home...they were put into hospitals, largely make shift ones because that was ALOT of people...until they were cleared. That's a tall order, because it takes massive testing efforts; this can't be done I believe just a thought. Cuomo...'this can go on for several months'; 'that is a new reality'. If people would just get it through their heads they can't congregate, the sooner this will pass. STAY HOME!!!

You can't go back too soon. We have not done what we need to do, which, IMHO...is a total stay at home everywhere. It's not easy...today my school charged our staff to call every family by noon. We each were to call any 5 students to see if they are ready to go with the remote learning we've set up. One parent told me flat out "my child is not planning to do any of the work because they do not like this idea'. Going to be very interesting to say the least. Me? I'm keeping it very, very simple for my 80 students I am getting shortly. Everyone feels the stress...can't even imagine what the medical workers are going through.

Be well all...keep the faith!

[MadCityRich]

Re: Covid 19

Gov PeeWee Evers is shutting down WI. I better go stock up on Korbel brandy, cheese curds, brats, and cream puffs.

[Bonin21]

Re: Covid 19

Gov PeeWee Evers is shutting down WI. I better go stock up on Korbel brandy, cheese curds, brats, and cream puffs.

You'll still be able to go get your wisconsin staples during shelter in place.

I've been hearing herd immunity thrown out so I went to the wiki page and learned how it relies on the vaccine completely. Yikes. To me it feels like we will all be waiting for the vaccine, and then it will be a rush to test everyone that hasn't gotten it (checking for asymptomatic) and then give everyone the vaccine.