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To get under your skin, under my skin, and under everyone’s skin.
Although on the above rant, I totally agree with he or she.
But usually, like you, I normally hate he/she.
Although on the above rant, I totally agree with he or she.
But usually, like you, I normally hate he/she.
let me guess, they took down your video about chemtrails again, or was it the one about the hoax of global warming....
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Clearly you haven’t been here long. I tend to speak my mind.
You are welcome.
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deleted171991
I must admit, it's the first time I heard of vWF being involved in inflammation-related thrombosis, including in Covid-19. It's an interesting thought, that has been gathering more and more evidence recently.
Regardless, it doesn't really matter, because we don't have any vWF-specific (inhibitor) medication AFAIK. And a number of good intensivists have been giving therapeutic heparin to patients with high D-dimers etc., for more than a month.
Kudos to Dr. Seheult. His presentations are always very informative.
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Observational study (pre-print) of n=786 Covid pts who received treatment dose anticoagulation vs n=1987 who did not. Anticoagulation associated w/ decreased mortality, particularly in intubated patients (29.1% vs 62.7%).
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deleted171991
Doctors lambaste federal process for distributing Covid-19 drug remdesivir
About two dozen hospitals are believed to have been chosen to receive the #Covid19 drug remdesivir so far, but it is unclear why some were chosen to receive coveted doses while others weren’t.
www.statnews.com
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The anticoagulation story with COVID is very interesting, will be fascinating to see what the pathophysiology of this virus is once we finally have it worked out.
I saw a poster somewhere (maybe the CCM forum) suggest something about vWF involvement in the prothrombitic state we’re seeing- haven’t looked into the details and it’s admittedly been a while since I reviewed the nitty gritty of the coagulation/platelet aggregation cascades, but I wonder if low dose gp2b3a inhibitors like tirofoban would have a beneficial effect. Not drugs most of us are overly familiar with, outside of the cath lab
I saw a poster somewhere (maybe the CCM forum) suggest something about vWF involvement in the prothrombitic state we’re seeing- haven’t looked into the details and it’s admittedly been a while since I reviewed the nitty gritty of the coagulation/platelet aggregation cascades, but I wonder if low dose gp2b3a inhibitors like tirofoban would have a beneficial effect. Not drugs most of us are overly familiar with, outside of the cath lab
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deleted171991
Remdesivir: The first real trial - First10EM
The first real trial of remdesivir shows that it does nothing to help COVID-19 patients. It should not be prescribed at this point.
first10em.com
"It would probably be silly to say anything too negative about remdesevir when we know a “positive” trial will be published any day. All the same, we need to consider our pretest probability. Although COVID-19 is new, viral pneumonia is a yearly scourge, and no therapy has ever been shown to improve important outcomes in viral pneumonia. (No, tamiflu doesn’t work.) For that reason, our pretest probability should be very low. It should take a lot to convince us that an intervention works for COVID-19. A single trial, especially if flawed, may not be enough to overcome the mountain of evidence thus far that our drugs don’t help viral pneumonias. Unfortunately, given the sheer number of studies underway (often with imperfect methodology), we are bound to see a few that look positive by chance alone, despite there being no real benefit. Considering how the media (and even many doctors) have responded to crappy observational data, I anticipate that people will similarly over-react to the first “positive” RCT. It is our job as science based doctors to reign in that insanity, and help people interpret the data for what it actually shows."
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Now they can repeat the same trial with Remdesivir and see if early treatment makes a difference in mortality.
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Remdesivir probably has some mild efficacy on Moderate cases on Covid 19. This means morbidity likely decreases and patients recover a bit faster. But, what about those who progress from moderate to critical? I’m pretty sure Remdesivir won’t be effective in that group.
I sometimes think people want to believe we have a treatment for Covid 19 more than the science behind the treatment itself.
I sometimes think people want to believe we have a treatment for Covid 19 more than the science behind the treatment itself.
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deleted162650
while ordering every pill online for the latest craze that some youtube doc once suggested had a positive effect in his last 3 patients treated
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is there a reason you keep posting these videos within minutes/hours of being uploaded to YouTube? Are they your videos?
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They're good reference for up to date stuff outside of posting journal articles. And also trying to update them here for FYI before they inevitably get taken down by Youtube censors.
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This RCT is actually pretty encouraging. A marked reduction in viral load, cytokine responses, symptoms, and hospital stay in the treatment group that had interferon + combination antiviral therapy compared to the control group that only had antiviral therapy. First time so far I've seen a therapy significantly reduce the viral load.
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Decent, but open label study
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Sure, it needs a bigger RCT. What's interesting here is that NEJM lopinavir-ritonavir trial showed no change in viral load. The dual therapy control group here doesn't appear to show benefit as well. Remdesivir showed no impact on viral load. But this is showing that the interferon in this study is what's having a significant impact. That's why i said encouraging.
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deleted162650
Surprised there hasn’t been a post from Blade urging us all to stockpile interferon yet.
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deleted171991
Maybe it was the ribavirin plus interferon, like the old Hep C treatment.
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deleted59964
he's wised up, quietly buying up - will only give us the tip once he's bought up
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I really don't know enough about these drugs but if that were the case, wouldn't we see some effect w ribavirin alone or combined w lopi-rito? There have been various studies looking at these. There is also a subgroup of ribavirin+lopi-rito within the combination group in this study that showed no impact.
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deleted171991
Apparently they worked much better together, that was the interesting thing. I don't know why; I'm not sure we had figured out how they did their magic together.
Effects of Adding Ribavirin to Interferon to Treat Chronic Hepatitis C Infection
Evidence shows that a combination therapy of ribavirin plus interferon clears hepatitis C virus from the blood in about 40% of patients with chronic hepatitis C infection, but the effects on clinical outcomes are unclear. We evaluated the beneficial and harmful effects of ribavirin plus...
In the Covid study, it may have been just the ribavirin, because 34 out of the 86 patients in the combination group (those admitted after 7 days of symptoms) did not receive interferon.
Last edited by a moderator:
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The dual therapy in this study basically looks like it did nothing. The NEJM lop-rit study showed no impact on viral load. So it seems that if anything is working here, it’s the interferon. That’s what ppl who know much more about these drugs than me seem to be suggesting as well. Anyways, i think the fact something has been found to reduce viral load is encouraging. More studies can be done from this. Inhaled interferon has also been shown to reduce viral load and cytokine response in the lungs: https://www.medrxiv.org/content/10.1101/2020.04.06.20042580v1.full.pdfApparently they worked much better together, that was the interesting thing. I don't know why; I'm not sure we had figured out how they did their magic together.
Effects of Adding Ribavirin to Interferon to Treat Chronic Hepatitis C Infection
Evidence shows that a combination therapy of ribavirin plus interferon clears hepatitis C virus from the blood in about 40% of patients with chronic hepatitis C infection, but the effects on clinical outcomes are unclear. We evaluated the beneficial and harmful effects of ribavirin plus...jamanetwork.com
In the Covid study, it may have been just the ribavirin, because 34 out of the 86 patients in the combination group (those admitted after 7 days of symptoms) did not receive interferon.
Also, looks like there’s a multi center RCT underway to give us answers about anticoagulation in these patients. The jacc study really wasn’t definitive.
CTG Labs - NCBI
clinicaltrials.gov
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The lesson from Sweden may be that we will get through this pandemic as we reopen schools and stores. Yes, the number of deaths will continue to increase but the health system should be able to handle the cases going forward.
www.cnbc.com
Sweden's chief scientist admits lessons have been learned over no-lockdown policy
Sweden's decision to avoid a strict lockdown like its European neighbors drew global attention and was not without controversy, but its chief epidemiologist says there are few things he would have done differently.
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Severe Covid causes Acute Kidney Injury in 80% of patients 20% need dialysis and 3% have glycosuria. Results of the first European cohort study in critically ill patients.
www.medrxiv.org
Characterisation of Acute Kidney Injury in Critically Ill Patients with Severe Coronavirus Disease-2019 (COVID-19)
Background COVID-19-associated acute kidney injury frequency, severity and characterisation in critically ill patients has not been reported. Methods Single-center cohort performed from March 3, 2020, to April 14, 2020 in 4 intensive care units in Bordeaux University Hospital, France. All...
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The lesson from Sweden may be that we will get through this pandemic as we reopen schools and stores. Yes, the number of deaths will continue to increase but the health system should be able to handle the cases going forward.
Sweden's chief scientist admits lessons have been learned over no-lockdown policy
Sweden's decision to avoid a strict lockdown like its European neighbors drew global attention and was not without controversy, but its chief epidemiologist says there are few things he would have done differently.
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Well, Sweden is probably where we end up at after a full re-open. Deaths go up, economy still weak, social distancing, etc. The unemployment in the USA is likely to hit 30 million, IMHO, that is unsustainable and will destroy the nation.
Ever heard of the Hong Kong Flu? This nation NEVER shut down and despite the deaths WOODSTOCK was still a "go." That generation was willing to deal with risk and death at a far greater level than we are today. Perhaps, the new "NORM" is understanding that Covid 19 or Covid 21 is here to stay and perhaps NO vaccine will be more than 70% effective in any one season. Are we willing to stay in lock down mode? I think not.
www.cdc.gov
I think we will get to the point in 2021 that Covid 19 or Covid 21 will be treated like the FLU in that we get our vaccine with limited effectiveness and move on with our lives.
Ever heard of the Hong Kong Flu? This nation NEVER shut down and despite the deaths WOODSTOCK was still a "go." That generation was willing to deal with risk and death at a far greater level than we are today. Perhaps, the new "NORM" is understanding that Covid 19 or Covid 21 is here to stay and perhaps NO vaccine will be more than 70% effective in any one season. Are we willing to stay in lock down mode? I think not.
1968 Pandemic (H3N2 virus) | Pandemic Influenza (Flu) | CDC
Everything you need to know about the flu illness, including symptoms, treatment and prevention.
I think we will get to the point in 2021 that Covid 19 or Covid 21 will be treated like the FLU in that we get our vaccine with limited effectiveness and move on with our lives.
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The Forgotten Hong Kong Flu Pandemic of 1968 Has Lessons for Today | National Review
Americans were more resilient, less vulnerable to social-media groupthink, and committed to going to work and washing their hands.
www.nationalreview.com
In Sweden, in line with national traditions and the culture there, scientists rather than politicians take the lead and establish pandemic policy. Swedish scientists also take responsibility for their decisions and speak honestly of tradeoffs. Johan Giesecke, the country’s former chief epidemiologist, bluntly said on Swedish radio recently that harsh lockdowns make little sense and that it’s the rest of the world that’s conducting an experiment in lockdowns based on shaky models. In Sweden, people are encouraged to stay home, but stores, restaurants, and offices remain open. “Better to have social distancing people can live with for months than severe lockdowns that get reimposed if cases rise once they are lifted,” Giesecke said.
But the rest of the world has chosen the lockdown path, and I fear the upper hand belongs to those who wish to reduce the risk of infection regardless of the high associated costs to the overall health or society.
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“20,329 new cases and 750 new deaths in the United States
Lowest number of new cases and lowest number of new deaths since the end of March”
Big drops in NY and elsewhere. Our hospital COVID census has been holding steady at 30-32 for the past week.
www.worldometers.info
Big drops in NY and elsewhere. Our hospital COVID census has been holding steady at 30-32 for the past week.
United States COVID - Coronavirus Statistics - Worldometer
United States Coronavirus update with statistics and graphs: total and new cases, deaths per day, mortality and recovery rates, current active cases, recoveries, trends and timeline.
www.worldometers.info
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“20,329 new cases and 750 new deaths in the United States
Lowest number of new cases and lowest number of new deaths since the end of March”
Big drops in NY and elsewhere. Our hospital COVID census has been holding steady at 30-32 for the past week.
United States COVID - Coronavirus Statistics - Worldometer
United States Coronavirus update with statistics and graphs: total and new cases, deaths per day, mortality and recovery rates, current active cases, recoveries, trends and timeline.
yes, aside from some exceptions, most of NY is still way emptier than pre pandemic. time square is not crowded at all. probably because most of the retail stores are closed.
“20,329 new cases and 750 new deaths in the United States
Lowest number of new cases and lowest number of new deaths since the end of March”
Big drops in NY and elsewhere. Our hospital COVID census has been holding steady at 30-32 for the past week.
United States COVID - Coronavirus Statistics - Worldometer
United States Coronavirus update with statistics and graphs: total and new cases, deaths per day, mortality and recovery rates, current active cases, recoveries, trends and timeline.
we've had lows on almost every Sunday, although this is lower than previous Sundays, probably because of how things get reported on weekends. Let's just say government agencies aren't all exactly working on the weekend.
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N-acetylcysteine could be promising
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I'm sure many are aware by now of how the timeline of this works. For example, the results of decisions made this past week won't be seen until the month of June.“20,329 new cases and 750 new deaths in the United States
Lowest number of new cases and lowest number of new deaths since the end of March”
Big drops in NY and elsewhere. Our hospital COVID census has been holding steady at 30-32 for the past week.
United States COVID - Coronavirus Statistics - Worldometer
United States Coronavirus update with statistics and graphs: total and new cases, deaths per day, mortality and recovery rates, current active cases, recoveries, trends and timeline.
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Articles on the interferon-ribavirin-lop-rit study I posted a few days ago. Looks like others think it's definitely promising.
emcrit.org
- Hung et al. demonstrates biological and clinical efficacy using combination therapy with lopinavir/ritonavir, ribavirin, and interferon-1b early in the course of COVID-19. This study is consistent with some prior evidence using combinations of lopinavir/ritonavir plus ribavirin with SARS and MERS.1,4
- This study illustrates that moderate-sized RCTs can reveal differences in viral load and clinical course, potentially serving as a benchmark for study design. In comparison, the recent trial on remdesivir included more patients – without showing persuasive signs of efficacy.3
- Based on the combination design of this trial, further studies are urgently needed to validate this medication combination and determine which components are necessary for efficacy (e.g. is interferon-1b truly required for efficacy?).
- It’s unclear whether early anti-viral therapy could pragmatically be implemented within the United States. For example, if this therapy were currently made available, it might be largely utilized among patients presenting with late-stage disease, yielding minimal benefit.
PulmCrit- Virus Wars: Return of Lopinavir/Ritonavir (along with ribavirin and interferon)
Background Where were we with the Lopinavir/Ritonavir story? Let’s backtrack for a moment. Lopinavir/Ritonavir showed some efficacy against SARS,
Brief19 - Daily Review of Covid-19 Research and Policy
Brief19 is a daily executive summary of covid-19-related medical research, news, and public policy. It was founded and created by frontline emergency medicine physicians with expertise in medical research critique, health policy, and public policy.
brief19.com
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deleted697127
Yeup. Going to be playing a game of chicken with the numbers on the rebound.
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I agree. Opening things up now may mean we will be wasting the past 8 weeks of pain.
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Articles on the interferon-ribavirin-lop-rit study I posted a few days ago. Looks like others think it's definitely promising.
- Hung et al. demonstrates biological and clinical efficacy using combination therapy with lopinavir/ritonavir, ribavirin, and interferon-1b early in the course of COVID-19. This study is consistent with some prior evidence using combinations of lopinavir/ritonavir plus ribavirin with SARS and MERS.1,4
- This study illustrates that moderate-sized RCTs can reveal differences in viral load and clinical course, potentially serving as a benchmark for study design. In comparison, the recent trial on remdesivir included more patients – without showing persuasive signs of efficacy.3
- Based on the combination design of this trial, further studies are urgently needed to validate this medication combination and determine which components are necessary for efficacy (e.g. is interferon-1b truly required for efficacy?).
- It’s unclear whether early anti-viral therapy could pragmatically be implemented within the United States. For example, if this therapy were currently made available, it might be largely utilized among patients presenting with late-stage disease, yielding minimal benefit.
PulmCrit- Virus Wars: Return of Lopinavir/Ritonavir (along with ribavirin and interferon)
Background Where were we with the Lopinavir/Ritonavir story? Let’s backtrack for a moment. Lopinavir/Ritonavir showed some efficacy against SARS,Brief19 - Daily Review of Covid-19 Research and Policy
Brief19 is a daily executive summary of covid-19-related medical research, news, and public policy. It was founded and created by frontline emergency medicine physicians with expertise in medical research critique, health policy, and public policy.brief19.com
I'm still confused what lopinavir/ritonavir is doing?
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deleted171991
Moral support.
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deleted171991
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Just read this from NPR.
TL;DR: They are reporting the the sensitivity of the Abbott ID test could be as low as 52%.
www.npr.org
TL;DR: They are reporting the the sensitivity of the Abbott ID test could be as low as 52%.
FDA Cautions About Accuracy Of Widely Used Abbott Coronavirus Test
The test has been promoted by the Trump administration as a key factor in controlling the epidemic in the U.S. and is used for daily testing at the White House.
www.npr.org
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deleted126335
“20,329 new cases and 750 new deaths in the United States
Lowest number of new cases and lowest number of new deaths since the end of March”
Big drops in NY and elsewhere.
There is a way that we can do even better:
“When you test, you have a case. When you test you find something is wrong with people. If we didn’t do any testing, we would have very few cases.”
— President Donald Trump
Not the Onion.
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He probably just had someone read him the House of God rules.
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deleted171991
He IS The Onion. He makes you cry inside (for the country) every single day.
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Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients
Background COVID-19 has rapidly emerged as a pandemic infection that has caused significant mortality and economic losses. Potential therapies and means of prophylaxis against COVID-19 are urgently needed to combat this novel infection. As a result of in vitro evidence suggesting zinc sulfate...
Feel free to rip this study apart
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Great overview in NEJM on management of ICU patients
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deleted697127
What’s the context? People complain about too much testing, too little testing, the risks of testing, all while clamoring about the high number of asymptomatic carriers.
He says a lot of questionable stuff, but this quote is reasonable. What’s your point.
