Covid 19

[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 <s>"off the reservation"</s> 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/music-news/jim-morrison-hes-hot-hes-****-and-hes-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/africa/chloroquine-trump-nigeria-intl/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.

 

[MadCityRich]

Re: Covid 19

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

Maybe. &#55358;&#56611; My brother tells me the hoarders are out already. People are weird. Just relax and stop the panic buying; just get what you normally need and everybody else will be able to get what they need. Let's ride this out with common sense.

 

[Bonin21]

Re: Covid 19

Maybe. �� My brother tells me the hoarders are out already. People are weird. Just relax and stop the panic buying; just get what you normally need and everybody else will be able to get what they need. Let's ride this out with common sense.

I think what you meant to say is, "People are stupid". Not necessarily just the hoarders, but the people that only know how to be selfish and not think how their actions impact others. Our country is embarrassing itself at the moment.

 

[DrDemento]

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.

At a time like this we begin to see that there truly is a difference in medical practice. There are providers (I suppose that is anyone connected in any way to medicine). There are doctors (and that includes many of those talking heads given TV time - people should really Google some of their credentials as many of them are simply not qualified to be taken seriously and should not be called 'expert' on TV). And then there are physicians. I think at a time like this we need to hear a bit more from the last group. Those who are adequately trained and who actually diagnose and treat patients in the real world. These are the ones who have to use all their scientific knowledge (about 75% of medical practice) and all of the 'Art' of medicine (about 20% of medical practice) and all of the just plain 'luck'(the last 5% of medical practice. I consider myself as well trained and with as much experience as anyone in the medical world. I am board certified in 3 specialties and have over 50 years of medical practice experience. I must admit though with all of that behind me, I am simply at the beginning of understanding what we are facing. I can only offer advice based on the earliest information that we are seeing. And i certainly am not in the business of predictions. At this stage we need to take a step back, take a few deep breaths (perhaps with a mask on), and allow the days to pass so we can accumulate the information and numbers we need to make valid decisions on treatment and prevention.

 

[ExileOnDaytonStreet]

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

Grocery stores (amongst other things) are still going to be open.

Wait and see what the actual policy is before griping about it. I’ll wager that it won’t be much different from what’s been going on already. Grocery stores still open, restaurants still doing takeout, etc.

 

[Chuck Murray]

Re: Covid 19

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.

This is all still theoretical stuff, HR. Maybe it's the prevailing wisdom of the day, and I certainly understand "flattening the curve" conceptually … but it's not like any of this is precedented, at least not in the US. When all is said and done, it's just an unproven theory that seems to make sense, and we're giving it a two-week try, but there is no guarantee it is yielding positive results. It's the same as some folks on here with opinions about the Cuomo-Trump treatment experiment, and how it's not guaranteed to yield positive results. Yet some believe the "social distancing" or "lockdowns" or "shelter in place" approaches are proven. They're not.

Another one of our fellow posters got a little preachy the other day on another thread on the "don't be stupid - stay home" thing, and I got after him at the time. I know that's not where you're coming from, but it's important to remember that "just stay home" works better for some folks than it does for others. I'm not talking about irresponsible kids on Spring break in FLA. People's jobs, careers, businesses are at stake. Blithely telling them to "just stay home" can be a tough sell, especially when doing so could mean those jobs, careers and/or businesses aren't there when someone giving orders tell then it's OK to go back.

I'm not picking on you or anyone else, but the reality of work life and ramifications of this situation is VERY different in the private and public sectors. We have two adult children - one is a teacher, like you, and the other is 3rd in line in what until recently has been a thriving and successful small business with a statewide footprint. Predictably, the former is pretty chill with the situation, while the latter is literally fighting day-to-day for the survival of their business. Night and day.

+++++++++++++++

I'm enjoying the back-and-forth between the doctor-types on our thread. As someone who's gotten a glimpse of the defense side of med malpractice litigation, I'm familiar with the First, do no harm oath. If there is some tension between the medical professionals and the politicians, I think it's down to the physicians rightly viewing First, do no harm from the perspective of their patients, whereas with the President and governors, the "patient" is their overall constituency, its economy, and everyday life as normal. This is the fault line over which there will likely be lots of struggles and heated discussions, and it doesn't mean one side is ignoring or not listening to the other. They simply have different jobs, and different constituencies. Physicians are not here to worry about the health of the overall economy, and only in a preventive sense for the "well" population.

I started this post 2 hours ago, I'm dreading checking out what I may have missed in the interim …

 

[DrDemento]

Re: Covid 19

Chuck M: here is one physician who is not only worried about the health of the patient, but also in some ways the health of the economy. My practice has taken a beating. My savings along with any retirement accounts being mostly invested on Wall Street are, shall we say, now sort of minimal. i agree with much of what you have posted. i do not see a hard and fast set of rules or guidelines that really could apply to everyone. With 50% of the cases now seen in NY I think the city of NY itself has more cases than most countries. With West Virginia having perhaps 12 cases, obviously no one size fits all. But i think we are still in the first inning of this game and have a long way to go to find out the result. And it may end up as one of those marathon extra inning affairs.
Then again, someone may come up to bat and hit a home run with men on base to end this thing in regulation.

 

[HockeyRef]

Chuck M: here is one physician who is not only worried about the health of the patient, but also in some ways the health of the economy. My practice has taken a beating. My savings along with any retirement accounts being mostly invested on Wall Street are, shall we say, now sort of minimal. i agree with much of what you have posted. i do not see a hard and fast set of rules or guidelines that really could apply to everyone. With 50% of the cases now seen in NY I think the city of NY itself has more cases than most countries. With West Virginia having perhaps 12 cases, obviously no one size fits all. But i think we are still in the first inning of this game and have a long way to go to find out the result. And it may end up as one of those marathon extra inning affairs.
Then again, someone may come up to bat and hit a home run with men on base to end this thing in regulation.

Sensible post and my feelings exactly. We have just begun like you said. This has to shake out abit...or, alot. Surgeon Gen said this morning this week will be bad as that 2 week window will bring alot of cases (as we have seen already)..nope I think it's way too soon to entertain an easing back (although hey plenty of people are still working in our area thank goodness) just yet. I have mentioned already how the Chinese handled it to get it locked down fast and back to no cases (so they report). We won't go to those extremes. I am surprised this talk of just practically going back to normal next week, etc...is happening when we really don't know the scope of how it will be playing our for us.

Chuck I don't know what your time table is for 'going back to work' etc or just who you think should go back to work. If you are talking about full scale dive in, business as usual in say, 2 weeks, man, I just don't know about that. Not sure if that's your feeling on it but I'm highly doubtful it would be prudent. Again, thanking those who are still out there trying to provide health care, retail, and other things we need to keep moving. Be well.


Like you (or anyone else) I don't have a time table and pray it's over sooner than later without a catastrophic amount of harm to people and our economy

 

[DrDemento]

Re: Covid 19

Not sure how much stock I put in the numbers reported from Asia in general. China? Who knows, they are so concerned about putting out the proper spin on things. My other concern is India. They report fewer cases than virtually any other large country. But they share a border with China and have a population of almost the same magnitude. If India had reported zero cases, i would have felt better even if it was an underestimate. But in a country that has their population, crammed into a small living space with huge congested cities and admittedly not the best sanitation, if they report 300 or more cases, then they have a boatload more than that are we are not even scratching the surface.

 

[HockeyRef]

Re: Covid 19

My remote learning assignment for the day: Followed Twitter for the latest presser; just can't listen to the sycophants...Missing was noted scientist, eminent disease specialist Anthony Fauci but they trotted out Bill Barr who talked about price gouging. Going to evaluate next week how much we should still be 'social distancing' next week. The quote of the day was "lots of people died from the flu today, as you know" the President replied dryly when it was brought to his attention? as we experienced our very first day of 100 dead in a single day MK. Also a bit of other stuff that didn't really matter. The End. -HockeyRef

Extra Credit Assignment: I really liked this quote from Twitter, too:

Trump to a question about the rising death toll: "It's bad, and obviously the numbers are going to increase with time, and they're going to start to decrease, and we're going to be opening our country up for business, because our country was meant to be open." Yep, just like a business. To heck with those that have died and will continue to die. Does he care about people?

 

[Wayuphere]

My remote learning assignment for the day: Followed Twitter for the latest presser; just can't listen to the sycophants...Missing was noted scientist, eminent disease specialist Anthony Fauci but they trotted out Bill Barr who talked about price gouging. Going to evaluate next week how much we should still be 'social distancing' next week. The quote of the day was "lots of people died from the flu today, as you know" the President replied dryly when it was brought to his attention? as we experienced our very first day of 100 dead in a single day MK. Also a bit of other stuff that didn't really matter. The End. -HockeyRef

Extra Credit Assignment: I really liked this quote from Twitter, too:

Trump to a question about the rising death toll: "It's bad, and obviously the numbers are going to increase with time, and they're going to start to decrease, and we're going to be opening our country up for business, because our country was meant to be open." Yep, just like a business. To heck with those that have died and will continue to die. Does he care about people?

No. Reelection