Contingency plans... (COVID-19 thread)

[taserlaser]

This paper doesn’t have a lot but I saw it making the rounds on Twitter this morning. Rad onc considerstions during SARS

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onlinelibrary.wiley.com

Also saw this making the rounds

Lessons Learned From Hurricane Maria in Puerto Rico: Practical Measures to Mitigate the Impact of a Catastrophic Natural Disaster on Radiation Oncology Patients

Although the wind, rain, and flooding of Hurricane Maria in Puerto Rico abated shortly after its landfall on September 20, 2017, the disruption of the…

www.sciencedirect.com

 

[taserlaser]

https://www.cbc.ca/news/canada/hamilton/covid19-first-case-doctor-hamilton-health-sciences-1.5493530

First rad onc I’m aware of that has a confirmed infection

 

[BobbyHeenan]

I feel like on the mednet there is a good post about rad onc policies. I have modeled ours on that and feel good about it. But one question I had was...

We are screening patients at check in (fever, cough, etc). What if someone has a + screen. Ideally you send them home and try to get them outpatient test...but if testing not available...????

Any suggestions?

 

[Palex80]

I feel like on the mednet there is a good post about rad onc policies. I have modeled ours on that and feel good about it. But one question I had was...

We are screening patients at check in (fever, cough, etc). What if someone has a + screen. Ideally you send them home and try to get them outpatient test...but if testing not available...????

Any suggestions?

I'm sorry, why is testing (if indicated) not available?

 

[BobbyHeenan]

I'm sorry, why is testing (if indicated) not available?

I *think* this week we will have more, but as of Friday our hospital only had state health dept testing, and they were prioritizing more symptomatic patients (ie those in the ER/inpatients) and patients with recent travel to high risk areas.

I'm told on Monday a private test *may* be available with a 3-4 day turn around.

I'm thinking about what to do with that low grade fever patient hacking in the waiting room. Ideally I'd put them on break/cancel their visit, get them tested, then go from there...just not sure if I will be able to test them.

 

[RickyScott]

I'm sorry, why is testing (if indicated) not available?

I think The WHO test had tiny false negative rate so the thinking was we are better off with no test whatsoever despite fact that makes monitoring and taking public health actions impossible.

Gov position was that we will develop one our own that may be able to decrease the already tiny false negative rate.
Steve Hahn a radiation oncologist is in charge of approving testing for the USA.

 

[Palex80]

I understand, that's sad. I read today that a Roche test gained rapid FDA clearance and should bring out results in less than 6 hours. Let's hope capacity for fast tests like this one becomes available fast.

We currently test locally and get the result within 24 hours. Then a confirmation test is carried out for all positive tests in the national test center.
This does take longer though.

 

[medgator]

I think The WHO test had tiny false negative rate so the thinking was we are better off with no test whatsoever despite fact that makes monitoring and taking public health actions impossible.

Doesn't sound like the CDC did any better by ignoring the WHO recs

Key Missteps at the CDC Have Set Back Its Ability to Detect the Potential Spread of Coronavirus

The CDC designed a flawed test for COVID-19, then took weeks to figure out a fix so state and local labs could use it. New York still doesn’t trust the test’s accuracy.

www.propublica.org

 

[metallica81788]

Interested to get opinions on here about different clinic policies as of now. Are you rescheduling follow-ups? Obviously prostate and breast are easy to push back but what about 3-4 month lung, H&N, etc? Move back 1 month post-treatment visits if doing okay? What about postponing early stage breast or prostate sims? Maybe moving from 5-10fx palliative regimens to 8Gy/1fx? Is now the time to start favoring 30Gy/5fx partial breast? Most of our patients are in the vulnerable population, so we should be exercising caution for their sake. The line needs to be drawn somewhere.

There could be some good discussion here without the extraneous self-promoting #radonc Twitter stuff.

 

[Palex80]

Are you rescheduling follow-ups?
Obviously prostate and breast are easy to push back but what about 3-4 month lung, H&N, etc? Move back 1 month post-treatment visits if doing okay?

Switched mostly to phone calls.

What about postponing early stage breast or prostate sims?

Yes.

Maybe moving from 5-10fx palliative regimens to 8Gy/1fx? Is now the time to start favoring 30Gy/5fx partial breast?

Yes!
The COVID-outbreak will allow EVIDENCE BASED radiation oncology to hit mainstream!

 

[BobbyHeenan]

I'm switching to follow up phone calls for vast majority of patients. I have a couple of fresh out of head/neck radiation and lung radiation that I need to check on, so they're coming in.

I already do a lot of 30/5 breast, so sticking with that.

Had a favorable int risk prostate age 76 on for CT sim this week and I'm pushing him back 3 months.

What I'm really concerned about it as mentioned earlier in this thread - that mildly symptomatic under treat patient that I can't get testing for yet. Or a + patient that I want to treat and my admin is telling me right now they won't give us N95 masks (seriously) as they're saving them for pulm/ED/Resp therapy.

 

[RickyScott]

Switched mostly to phone calls.


Yes.


Yes!
The COVID-outbreak will allow EVIDENCE BASED radiation oncology to hit mainstream!

I am not a well connected renaissance pan humanist like subatomicdoc but here is what we decided this am: we are delaying new prostate and breast and routine routine follow ups for 2 weeks until we know more. Screening all new pts and fus to see if we can delay

2)any pt with exposure etc treated at end of day with minimum staff.

 

[BobbyHeenan]

I am not a well connected renaissance pan humanist like subatomicdoc but here is what we decided this am: we are delaying new prostate and breast and routine routine follow ups for 2 weeks until we know more. Screening all new pts and fus to see if we can delay

2)any pt with exposure etc treated at end of day with minimum staff.

If you treat a patient with exposure or with symptoms/positive test...what type of PPE are you having staff wear?

 

[GapCalc]

If you treat a patient with exposure or with symptoms/positive test...what type of PPE are you having staff wear?

We are planning these patients (if/when they materialize) to go at the end of the day. Gown, gloves, surgical mask, eye shield. Housekeeping does a special “deep clean” that takes ~2 hours, hence end of day treatment time.

 

[taserlaser]

One thing I haven’t seen discussed yet is the delay in study data. Our very academic site has taken the policy of not enrolling patients on trial for the time being to avoid extra appointments, etc unless there is a clear demonstrable benefit to the patient. I’m not sure how other sites are approaching this. But this may very well pause people from enrolling onto prospective trials for a period of months to a year or more perhaps, which will delay new trials for a good while. Patients already enrolled I imagine we will still accrue data on. But this will disrupt and complicate analyses for patient cohorts during this time I suspect. In my main site that I treatwe are now going by latest phase 2 and site experience data to hypofractionate as much as possible off protocol.

What are others’ thoughts on this and how are you approaching trial enrollment/recruitment?

 

[evilbooyaa]

One thing I haven’t seen discussed yet is the delay in study data. Our very academic site has taken the policy of not enrolling patients on trial for the time being to avoid extra appointments, etc unless there is a clear demonstrable benefit to the patient. I’m not sure how other sites are approaching this. But this may very well pause people from enrolling onto prospective trials for a period of months to a year or more perhaps, which will delay new trials for a good while. Patients already enrolled I imagine we will still accrue data on. But this will disrupt and complicate analyses for patient cohorts during this time I suspect. In my main site that I treatwe are now going by latest phase 2 and site experience data to hypofractionate as much as possible off protocol.

What are others’ thoughts on this and how are you approaching trial enrollment/recruitment?

Our consult volume is way down, but I personally wouldn't stop enrolling somebody on a national protocol if I was going to treat them anyway (say like NRG HN-005 or something).

Little institutional stuff that requires extra biopsies, extra blood tests, etc. yeah maybe not unreasonable to pause anything that requires additional procedures.

 

[Palex80]

Little institutional stuff that requires extra biopsies, extra blood tests, etc. yeah maybe not unreasonable to pause anything that requires additional procedures.

I agree.

1. I would stop enrolling on trials with "extra" visits and postopone off any "extra" visits for patients already on trial, who will not benefit the patient (like having them come in for some quality of life or functional test). Even if it jeopardizes the trial endpoints, it's still necessary not to expose the patient to extra risk.

2. I would strongly advise against having patients travel long distances in order to enter a trial, especially if that means them coming in contact with more people while travelling.

3. Any treatment escalation trial which can potentially mean a worse immune system for the patient or result in AEs requiring hospitalization and where escalated treatment has not been proven superior to standard of care should be very carefully considered. Hospitalization due to AEs cause by an unproven treatment escalation can mean the patient will a) need a bed on the wards that may be needed for a COVID patient b) will get COVID because of being hospitalized.

 

[evilbooyaa]

Uh, please do not post links that are NSFW. A link about public sex in the time of Coronavirus with references to porn websites and gratuitious use of the F-word counts as NSFW.

 

[BobbyHeenan]

One thing I haven’t seen discussed yet is the delay in study data. Our very academic site has taken the policy of not enrolling patients on trial for the time being to avoid extra appointments, etc unless there is a clear demonstrable benefit to the patient. I’m not sure how other sites are approaching this. But this may very well pause people from enrolling onto prospective trials for a period of months to a year or more perhaps, which will delay new trials for a good while. Patients already enrolled I imagine we will still accrue data on. But this will disrupt and complicate analyses for patient cohorts during this time I suspect. In my main site that I treatwe are now going by latest phase 2 and site experience data to hypofractionate as much as possible off protocol.

What are others’ thoughts on this and how are you approaching trial enrollment/recruitment?

Im not in academics but enroll in trials. Definitely not enrolling right now. Just too cumbersome.

I did have an NSABP B51 follow up I canceled. Research /Trials Nurse said we’d prob get a demerit for a missed visit and I said screw it. I’ll try to look at her via Skype (aside - do I need a nurse chaperone for these things? Probably so, but don’t want to be in close quarters with nursing either).

 

[Palex80]

Study nurses are being pulled off departments to help out in wards.
This is to allow more "skilled" nurses from the wards to transfer to the ER departments.

Carrying on research is going to be troublesome. On the bright side, however, all monitoring visits have also been postponed!

 

[deleted1002574]

This is why politicizing the name is so stupid. It has a name, Mr. President. The rest of the world agrees with the name. Science has given it a name. He makes us look childish.

 

[RadOncDoc21]

Since we got more cases than China now can we call the “Chinese Virus” the “Merica Virus” now?

 

[RickyScott]

Not a trump supporter here, but this epidemic is due to Chinese negligence in not shutting down wet markets after prior SARS epidemics. Don’t have an issue with anyone attributing blame to them.

 

[deleted1002574]

The wet markets are an issue. It was their fault.

It's just odd to call something a name that isn't its name that already has a name. It's weird. And, he's stopped doing it. I never even brought it up or thought about it until it was brought up, and then I just didn't get the point.

 

[RadOncDoc21]

The wet markets are an issue. It was their fault.

It's just odd to call something a name that isn't its name that already has a name. It's weird. And, he's stopped doing it. I never even brought it up or thought about it until it was brought up, and then I just didn't get the point.

No doubt that China didn’t do their part to help in controlling the outbreak along with their practice. I even saw that hantavirus was recently in the news there. But to suddenly start calling the virus a “Chinese virus” or “kung flu” is the typical deflection we’ve seen time and time again and is truly unnecessary.

Maybe we should look into the origins of all diseases and start renaming them. We could start with smallpox, the bubonic plague, chickenpox, influenza, malaria, measles, scarlet fever, tuberculosis, etc.

Bottom line is that It doesn’t help nor does it add any value to what we already know. The focus should be on saving lives.

 

[chemsmith]

No doubt that China didn’t do their part to help controlling the outbreak along with the practice. I even saw the hatavirus was recently in the news there. But to suddenly start calling the virus a “Chinese virus” or “kung flu” is the typical deflection we’ve seen time and time again and is unnecessary.

Maybe we should look into the origins of all diseases and start renaming them including smallpox, bubonic plague, chickenpox, influenza, malaria, measles, scarlet fever, tuberculosis, etc. It doesn’t help with anything nor adds value to what we already know. We should be focusing more on saving lives.

To be fair most of those other diseases you mentioned have been around as long as we have as a species and would be very difficult to pin to a geographic origin. I also don't view it as fair to tie a country or group of people to the common name of a pathogen, for obvious reasons, but China kinda did already get a pass with "Avian Influenza" and they did kind of screw us all over with their handling on this one. It also seems to piss of their nefarious upper-level leadership which is kind of funny.

 

[DebtRising]

No doubt that China didn’t do their part to help in controlling the outbreak along with their practice. I even saw that hantavirus was recently in the news there. But to suddenly start calling the virus a “Chinese virus” or “kung flu” is the typical deflection we’ve seen time and time again and is truly unnecessary.

Maybe we should look into the origins of all diseases and start renaming them. We could start with smallpox, the bubonic plague, chickenpox, influenza, malaria, measles, scarlet fever, tuberculosis, etc.

Bottom line is that It doesn’t help nor does it add any value to what we already know. The focus should be on saving lives.

There is a difference between all those situations and the current.

This isthe second completely new URI virus to cause human deaths and come out of China in the last 20 years. SARS was the first. This seems to be due to their open market and animal practices. This is an astounding and alarming rate.

Politicians will be political. That does not mean we can ignore Chinas role in creating these novel viruses by allowing lax health practices, which seems more egregious since we went down this path with SARS in 2003. 2 new ones in 20 years is crazy. We don’t need to be racist, we don’t need to hurt Asian Americans, or use derogatory terms, but to not attribute these facts to China, or there initial cover up which could have contained it from the rest of the world (not just America, see Europe, Russia, India, Asia pacific) is dangerous.

 

[RadOncDoc21]

There is a difference between all those situations and the current.

This isthe second completely new URI virus to cause human deaths and come out of China in the last 20 years. SARS was the first. This seems to be due to their open market and animal practices. This is an astounding and alarming rate.

Politicians will be political. That does not mean we can ignore Chinas role in creating these novel viruses by allowing lax health practices, which seems more egregious since we went down this path with SARS in 2003. 2 new ones in 20 years is crazy. We don’t need to be racist, we don’t need to hurt Asian Americans, or use derogatory terms, but to not attribute these facts to China, or there initial cover up which could have contained it from the rest of the world (not just America, see Europe, Russia, India, Asia pacific) is dangerous.

Yes, this is all true, but as a professional we should address the problem and offer a solution.

I could easily call one of my lung cancer patients that smoked 2 packs per day for 50 years and drinks a 12 pack a day “Hill-Billy Bob from West VA” but why? He already has a name and it does nothing for him, his family or other people.

 

[DebtRising]

Yes, this is all true, but as a professional we should address the problem and offer a solution.

I could easily call one of my lung cancer patients that smoked 2 packs per day for 50 years and drinks a 12 pack a day “Hill-Billy Bob from West VA” but why? He already has a name and it does nothing for him, his family or other people.

You miss the point entirely.

the goal isn’t to label a country or a people for the sake of insult - it is to recognize that the root cause of 2 completely new viruses that kill people come from a country that happens to be China, and that without focusing on this we risk more and more being created.

and in direct reply to your analogy, we have had a huge effort to decrease smoking and label it as harmful because addressing the root cause of illness (prevention) is the right thing to do for humanity, of any origin.

The right thing to do as professionals is to appropriately respond to data and offer a solution. Since I cannot personally stop open air animal markets the least I can, and feel I should, do is to highlight the risk in a non racial or political way. The solution can only come from China changing its practices. If you can change them in another way please tell me and I will be happy to help

 

[Neuronix]

It's always so easy to point the finger at the outside. That's how it is in every country, every election. For us, it was Russian election interference, Latin American illegal immigrants, Chinese intellectual property theft, and now Chinese viruses. If only those crude Chinese could stop eating bats in open air markets, we wouldn't have these problems.

So instead of saying the US has totally botched the response to Coronavirus, it's so easy to just point the finger at China. If only China hadn't unleashed this on the world. Ok, great. The virus is out there. What have we done? Delayed and half hearted responses to prevent spread, lack of testing, inadequate hospital resources, and a completely inadequate social safety net. Great, we cut everyone a $1,000 check. Ok, so what happens when all these people who don't have or lost their health insurance start getting sick with Coronavirus or anything else? You think $1,000 or whatever is going to cut it? You think all these jobs that were just lost are going to magically reappear at Easter? Lalalalala fingers in ears it's the Chinese people's fault.

Nevermind, back to blaming the Chinese. It's too difficult and complicated to look inside our own borders. Jingoism wins the day, as always.

 

[w00tz]

Agree China needs to be held accountable to some degree.
But I believe that POTUS calling it the Chinese virus is his way of deflecting accountability in his mismanagement of this disaster.

 

[Neuronix]

The right thing to do as professionals is to appropriately respond to data and offer a solution. Since I cannot personally stop open air animal markets the least I can, and feel I should, do is to highlight the risk in a non racial or political way. The solution can only come from China changing its practices. If you can change them in another way please tell me and I will be happy to help

The reservoir was always there and continues to be there. At some point this would have likely jumped from bats to people by some other circumstances. And if it wasn't coronavirus, it would be something else. For example, ebola came from a different source and a different place entirely.

We have to be prepared for pandemics. People knew this was coming at some point. Epidemics have happened throughout human history, and the ability to jump on an airplane in modern times just makes it easier to spread novel pathogens. The fact that we were caught unprepared and unable to respond to a known threat in our modern world after such a huge economic boom time just shows the weaknesses in our society to be prepared for and manage foreseeable crises.

I am grateful that the fatality rate for this bug is low. If this had been as fatal as ebola or smallpox there would be total chaos--in the USA especially with hundreds of millions of guns and everyone stocking up on assault rifles and ammo. Hooooo boy.

 

[RickyScott]

It's always so easy to point the finger at the outside. That's how it is in every country, every election. For us, it was Russian election interference, Latin American illegal immigrants, Chinese intellectual property theft, and now Chinese viruses. If only those crude Chinese could stop eating bats in open air markets, we wouldn't have these problems.

So instead of saying the US has totally botched the response to Coronavirus, it's so easy to just point the finger at China. If only China hadn't unleashed this on the world. Ok, great. The virus is out there. What have we done? Delayed and half hearted responses to prevent spread, inadequate hospital resources, and maintained a completely inadequate social safety net. Great, we cut everyone a $1,000 check. Ok, so what happens when all these people who don't have or lost their health insurance start getting sick with Coronavirus or anything else? You think $1,000 or whatever is going to cut it? You think all these jobs that were just lost are going to magically reappear at Easter? Lalalalala fingers in ears it's the Chinese people's fault.

Nevermind, back to blaming the Chinese. It's too difficult and complicated to look inside our own borders. Jingoism wins the day, as always.

Our government response to pandemic has been disgusting, but It has long been known that wet markets are the source of these disease. After the first SARS -caused by civets cat-chinese promised to shut down the markets but looked the other way 6 months later. I am of opinion that disease has such a high asymptomatic spread that even a well coordinated response would have a limited impact. Would love to translate my hate for trump into responsibility for this mayhem, but honestly am not sure. Certainly trump and our own( Hahn) delayed deployment of testing but ferreting out 30% symptomatic cases while the other huge asymptomatic portion expands exponentially may not have had much curve flattening.

Relativists would have you believe “Multiculturalism” gives you a free pass to hurt the rest of humanity and destroy the worlds wildlife. No one would say that we should accept Nazi culture? What if Chinese don’t shutdown wet markets after this - how would that not be an act of war?
Not closing wet markets (or only 6 month shutdown) after SARS led to this manslaughter. It is not about feeding the population because these live exotic animals are actually quite expensive.

 

[Mandelin Rain]

Cultural relativism is not a thing. We are one big connected world. Actions in any place, impact us all.

Hunting species to extinction, while putting the Earth at risk of pandemic is just plain wrong and must be stopped.

Doesn't make our response to the crisis any better, but China has to address this or the world has to address it for them.

We can't have hundreds of thousands (or worse) people die and economic collapse every ten years because the people of one country want to pretend that grinding up endangered animals makes them more potent or whatever.

 

[Neuronix]

Do you guys travel at all? Butchering of live animals in markets is common all over the world. This is in no way exclusively Chinese. Many of the things people eat around the world would be disgusting to you.

Edit: I will write that 1. Sanitation in these markets need to be brought to modern standards and enforced and 2. Sale of endangered species or species linked to human diseases needs to stop. Still, even if we're perfect in this, I don't think this will stop this from happening again. How exactly will that stop us from getting another swine flu variant? Or a mosquito borne disease? Etc etc etc ...

 

[RickyScott]

Cultural relativism is not a thing. We are one big connected world. Actions in any place, impact us all.

Hunting species to extinction, while putting the Earth at risk of pandemic is just plain wrong and must be stopped.

Doesn't make our response to the crisis any better, but China has to address this or the world has to address it for them.

We can't have hundreds of thousands (or worse) people die and economic collapse every ten years because the people of one country want to pretend that grinding up endangered animals makes them more potent or whatever.

What should we do if they refuse to shutdown the wet markets and we have another epidemic. How is that not total war?

 

[RickyScott]

Do you guys travel at all? Butchering of live animals in markets is common all over the world. This is in no way exclusively Chinese. Many of the things people eat around the world would be disgusting to you.



This is a completely separate issue. Grinding up endangered animals for what we call "alternative medicine" isn't really what goes on at "wet markets" and isn't linked to the epidemic.

I think the extent/number of species in a Chinese wet market is unique as well as the size and scope of the markets and crowds. Cages of live Pangolins stacked on top of live monkeys on top of live bats, all defecating and being slaughtered together.

They recognized this and that is why the Chinese government passed laws shutting them down in early 2000s. CDC and epidemiologists have been sounding alarm about wet markets for years.

 

[RadOncDoc21]

We can go all day long regarding other country’s practices. It’s not like we are actively trying to save the environment either but that’s another topic.

The facts are we were not prepared for a pandemic and calling the virus a different name does not solve any issues.

 

[OTN]

We can go all day long regarding other country’s practices. It’s not like we are actively trying to save the environment either but that’s another topic.

The facts are we were not prepared for a pandemic and calling the virus a different name does not solve any issues.

The SE Asian countries were not prepared for SARS1 in 2003. They're prepared this time around because of that experience. I'm sure we will be better prepared for next time as well.

Wet markets with exotic animals create this problem, full stop. I don't care what country they're in, after all this is over the world needs to shut them down.

 

[RickyScott]

The SE Asian countries were not prepared for SARS1 in 2003. They're prepared this time around because of that experience. I'm sure we will be better prepared for next time as well.

Wet markets with exotic animals create this problem, full stop. I don't care what country they're in, after all this is over the world needs to shut them down.

There is something to this. If a country sell gasoline and fire starting kits in toy stores, I bet you they would have great fire departments.

 

[RadOncDoc21]

You miss the point entirely.

the goal isn’t to label a country or a people for the sake of insult - it is to recognize that the root cause of 2 completely new viruses that kill people come from a country that happens to be China, and that without focusing on this we risk more and more being created.

and in direct reply to your analogy, we have had a huge effort to decrease smoking and label it as harmful because addressing the root cause of illness (prevention) is the right thing to do for humanity, of any origin.

The right thing to do as professionals is to appropriately respond to data and offer a solution. Since I cannot personally stop open air animal markets the least I can, and feel I should, do is to highlight the risk in a non racial or political way. The solution can only come from China changing its practices. If you can change them in another way please tell me and I will be happy to help

Actually, you just proved my point. Calling my patient “Hill-Billy Bob from West VA” was not helpful but educating him on smoking cessation was far more valuable to him, his family and to the rest of the world.

 

[RickyScott]

Do you guys travel at all? Butchering of live animals in markets is common all over the world. This is in no way exclusively Chinese. Many of the things people eat around the world would be disgusting to you.

Edit: I will write that 1. Sanitation in these markets need to be brought to modern standards and enforced and 2. Sale of endangered species or species linked to human diseases needs to stop. Still, even if we're perfect in this, I don't think this will stop this from happening again. How exactly will that stop us from getting another swine flu variant? Or a mosquito borne disease? Etc etc etc ...

As a trump hater, I honestly worry that he will turn out to be right and gain electoral support. 1) death rate may not be high and a very high Asymptomatic spread may push down the death rate. 2)testing just won’t help in that scenario unless everyone is tested.

 

[Mandelin Rain]

Calling it the China Virus is stupid. Having massive wet markets that endanger species and have started global pandemics is also stupid.

Not mutually exclusive ideas.

Nor is.... factory farming animals (like pigs, cows, and chickens that we do here) is stupid.

Or eating meat at all.... but I won't touch that.

My suggestion is that we start treating all species with respect. But alas, we can't even treat humans with respect so what chance does a pig or pangolin have?

 

[DebtRising]

This the problem with Trump, everything he touches becomes so toxic it changes meaning.

can be both. Our response has been horrendous, and should be criticized. by that logic, while also accepting our responsibility, it is logical to say China initial response was worse due to coverup and allowing it to get out to the rest of the world. If the role is to critique government response, then we should be equal. I don’t see how that Needs to be an equivalence or discount the other. Take trump and America out of it and pose the question to Italy and spain. All governments globally have let us down tremendously, and in this case the host country of the virus let the global community down the most by not containing it.

And again, data is data. Two completely new, fatal, viruses in under 20 years from one country. Take out politics. Source control and prevention is important, not as a politicalor racial tool, but as a matter of principle. To say we should forget that, or to say that is only an excuse to be used by our own government, is discordant with the facts that lead us to this situation.

 

[medgator]

As a trump hater, I honestly worry that he will turn out to be right and gain electoral support. 1) death rate may not be high and a very high Asymptomatic spread may push down the death rate. 2)testing just won’t help in that scenario unless everyone is tested.

His popularity is near an all time high, i don't think the rubber will hit the road until we start getting closer to summer and the body count goes up, esp as he tries to reopen things early which paradoxically could really screw up the economy down the road

 

[RickyScott]

His popularity is near an all time high, i don't think the rubber will hit the road until we start getting closer to summer and the body count goes up, esp as he tries to reopen things early which paradoxically could really screw up the economy down the road

Today in nejm Fauci says case fatality rate is much less than 1% and akin to bad flu. Trump is going to emerge from this in a stronger position. He very well may turn out to be more correct than leading medical thought leaders and influences like Eric Topol, Etc who would love for it turn out that he was personally responsible for massive loss of American lives.

 

[RadOncDoc21]

Today in nejm Fauci says case fatality rate is much less than 1% and akin to bad flu. Trump is going to emerge from this in a stronger position.

We still haven’t reached the peak yet and what happens when the hospitals start to overflow? I hope this is the case but I wouldn’t start counting my Chickens (eggs) just yet. Speaking of which, why are people hoarding eggs!

 

[deleted1002574]

We still haven’t reached the peak yet and what happens when the hospitals start to overflow? I hope this is the case but I wouldn’t start counting my Chickens (eggs) just yet. Speaking of which, why are people hoarding eggs!

And garlic. Can’t get fresh garlic for the life of me

 

[medgator]

And garlic. Can’t get fresh garlic for the life of me

Frozen pizzas seem to be gold down here....

 

[RickyScott]

And garlic. Can’t get fresh garlic for the life of me

We still haven’t reached the peak yet and what happens when the hospitals start to overflow? I hope this is the case but I wouldn’t start counting my eggs just yet. Speaking of which, why are people hoarding eggs!

Speaking of garlic, for last 2 years, l have taken kyolic aged garlic pills and never gotten sick.
There is actually some decent literature on this