What do I need to know about coronavirus?

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Could someone explain why the recent hard-on for remdesivir isn't the exact same thing as the promotion of HCQ without firm evidence? I was very surprised to hear Fauci describe the drug as a "game changer" when he has thus far been pretty measured. The evidence for efficacy of any sort is mixed at best, and the end-point of "quickened recovery" hardly seems relevant to anything at all. There has been very little coverage of the negative Lancet study. It's rather mind boggling how glowling the press coverage has been of this drug after making Trump out to be a peddler of snake oil with his plaquenil shtick.

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Could someone explain why the recent hard-on for remdesivir isn't the exact same thing as the promotion of HCQ without firm evidence?
Profit motive.

Remdesivir is on patent and stands to make billions of dollars profit for certain people if it gains traction, whether it works or not.
HCG is off patent and there's relatively little profit to be made from it, whether it works or not.
 
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Could someone explain why the recent hard-on for remdesivir isn't the exact same thing as the promotion of HCQ without firm evidence? I was very surprised to hear Fauci describe the drug as a "game changer" when he has thus far been pretty measured. The evidence for efficacy of any sort is mixed at best, and the end-point of "quickened recovery" hardly seems relevant to anything at all. There has been very little coverage of the negative Lancet study. It's rather mind boggling how glowling the press coverage has been of this drug after making Trump out to be a peddler of snake oil with his plaquenil shtick.

Yeah, the recent news was weird. A negative randomized study gets published then on the same day Gilead makes a press release citing 'promising data'. (which as far as I can tell is data showing a 5 day course is as effective as a 10 day course). I think it was mostly a play to keep their stock up...

Although, I think it's a big difference from the HCQ situation, which was just plain bizarre. One thing--I am glad that Trump promoted it like he did. The resulting negative media attention saved us all from being forced to prescribe this routinely. I still find in inexplicable how so many major institutions put it on their treatment protocols w/o any evidence whatsoever. (Duke, BWI, etc) Aren't they literally the exact same institutions that could've performed trials early on to see if it was efficacious?
 
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Important findings from Iran - random antibody sample of households finds 21-33% of people have been infected, true infection fatality rate roughly 1 in 1,000 - among the lowest figures yet published.

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Birdstrike, the Iran data basically just confirms what we've suspected based on the other studies. The overall fatality rate of 0.1%, which skews 80% to those over 65.

That means for all statistical purposes the fatality rate for those under 50 with no medical problems is zero.
 
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Birdstrike, the Iran data basically just confirms what we've suspected based on the other studies. The overall fatality rate of 0.1%, which skews 80% to those over 65.

That means for all statistical purposes the fatality rate for those under 50 with no medical problems is zero.
Yep.
 
Important findings from Iran - random antibody sample of households finds 21-33% of people have been infected, true infection fatality rate roughly 1 in 1,000 - among the lowest figures yet published.

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I call shenanigans on this. They tested about 500 people. Rapid testing sucks. This is statistical tomfoolery.

Plus People's Mojahedin Organization of Iran (PMOI/MEK) | Official website of MEK is reporting more than 38,000 deaths from coronavirus in Iran, not ~6,000 officially reported.
 
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Important findings from Iran - random antibody sample of households finds 21-33% of people have been infected, true infection fatality rate roughly 1 in 1,000 - among the lowest figures yet published.

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Antibodies that are positive to a virus doesn't mean you have been infected by that particular strain. There are many coronaviruses and they can induce immunity and generate cross-reactive antibodies.

This quarantine and ongoing paranoia about coughs and colds will likely decrease the circulating minor coronaviruses that have protected large swaths of the country by inducing immunity and cross-reactive antibodies.

It will be interesting to see if the circulating influenza viruses plummet, impairing the ability to predict prevalent strains and produce protective vaccines.

Could extended lockdowns impair our immunity to a host of unrelated viruses, inadvertently causing worse pandemics in the future?

Excessive use of antibiotics put an evolutionary pressure on bacteria towards the development of antibiotic resistance.

Could worldwide quarantines put an evolutionary pressure on viruses to develop high R naughts to overcome the social distancing?
 
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Antibodies that are positive to a virus doesn't mean you have been infected by that particular strain. There are many coronaviruses and they can induce immunity and generate cross-reactive antibodies.

This quarantine and ongoing paranoia about coughs and colds will likely decrease the circulating minor coronaviruses that have protected large swaths of the country by inducing immunity and cross-reactive antibodies.

It will be interesting to see if the circulating influenza viruses plummet, impairing the ability to predict prevalent strains and produce protective vaccines.

Could extended lockdowns impair our immunity to a host of unrelated viruses, inadvertently causing worse pandemics in the future?

Excessive use of antibiotics put an evolutionary pressure on bacteria towards the development of antibiotic resistance.

Could worldwide quarantines put an evolutionary pressure on viruses to develop high R naughts to overcome the social distancing?

Pretty good questions.

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I call shenanigans on this. They tested about 500 people. Rapid testing sucks. This is statistical tomfoolery.
If the sample is random, which it they claim it was, you can test only 500-1000 people and get an estimate of prevalence for a nation of millions. This is why Gallup and other polling companies sample only 500-1500 people to estimate preferences in a nation of 300 million.
 
Antibodies that are positive to a virus doesn't mean you have been infected by that particular strain. There are many coronaviruses and they can induce immunity and generate cross-reactive antibodies.
The specifically tested for SARS-COV-2 antibodies, not any old virus or generic coronavirus antibodies.

Could extended lockdowns impair our immunity to a host of unrelated viruses, inadvertently causing worse pandemics in the future?

Could worldwide quarantines put an evolutionary pressure on viruses to develop high R naughts to overcome the social distancing?
Very good questions.
 
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If the sample is random, which it they claim it was, you can test only 500-1000 people and get an estimate of prevalence for a nation of millions. This is why Gallup and other polling companies sample only 500-1500 people to estimate preferences in a nation of 300 million.

I hear ya. I dispute
1) anything that comes from Iran. Official count is 6K dead, actual count is 38K or more
2) that there is an even spread of COVID in the community
3) the tests themselves. Although did you read that they took 50 ml of blood per person. To run a rapid test?

I don't know if you read, there was a huge uproar in the statistics community when stanford announced the Santa Clara had 10% antibodies in the population or whatever the percentage was. Here was the link, among others. Concerns with that Stanford study of coronavirus prevalence « Statistical Modeling, Causal Inference, and Social Science

I certainly believe there are more real COVID cases than actual reported cases. Without question. Just like I believe there are more real COVID deaths than reported deaths. In my mind real cases > real deaths most likely.
 
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The specifically tested for SARS-COV-2 antibodies, not any old virus or generic coronavirus antibodies.

I'm not so sure. Many of the kits of which there are dozens and dozens have in their disclaimers that they might be picking up Abs cross-reacting from other similar strained corona viruses (229E, HKU1, etc). Its in the disclaimer themselves. I posted one of them about a month ago.

I wondered how they do quality control on these antibody tests. Then I read into it some more. Some companies I think have stored blood in a warehouse somewhere. Dated. Because they will say "Our product was tested on 100 blood samples before October 2019" and had...you know...zero or 1 positive test result. Where did they get that blood from?
 
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It all doesn't really matter that much anyway. Whether 2%, 5%, 10% or 15% have been infected, at some point it's going to be a lot of people. That's what we want. And we still need to figure out how immune you become and how long it lasts. My guess is it probably has much to do with viral load. I bet a lot of these asymptomatic carriers have an abysmal, wimpy immune response and give them a few good coughs from a highly infected person they are going to end up in the hospital.

These antibody tests at some point will become better. But I were in a position of power I would not make "opening up society" decisions based on antibody testing results. Not right now.
 
It all doesn't really matter that much anyway. Whether 2%, 5%, 10% or 15% have been infected, at some point it's going to be a lot of people. That's what we want. And we still need to figure out how immune you become and how long it lasts. My guess is it probably has much to do with viral load. I bet a lot of these asymptomatic carriers have an abysmal, wimpy immune response and give them a few good coughs from a highly infected person they are going to end up in the hospital.

These antibody tests at some point will become better. But I were in a position of power I would not make "opening up society" decisions based on antibody testing results. Not right now.

From a purely clinical perspective, I was discharging 7-8 COVID patients with COVID-like symptoms without testing for every one that I admitted. What percentage of likely COVID patients have you all been discharging?
 
From a purely clinical perspective, I was discharging 7-8 COVID patients with COVID-like symptoms without testing for every one that I admitted. What percentage of likely COVID patients have you all been discharging?

In my case, the vast majority. I have intubated a grand total of 1 COVID patient so far. She was in her late 60s, an asthmatic, travelled from spain, and while alive, didn't have a great outcome. Maybe 2 people covid positive that went to the floor and did fine. The rest all went home, which was the biggest cohort of covid patients.
 
From a purely clinical perspective, I was discharging 7-8 COVID patients with COVID-like symptoms without testing for every one that I admitted. What percentage of likely COVID patients have you all been discharging?

About that same percentage. Where I am in CA I’m just not getting that many patients with symptoms. Maybe 5 a day?

Plus, every rapid test I’ve run has come back negative. Makes me think it’s a useless test.
 
Yes. I highlighted. I won’t do it again, officer.

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Umm...Just the way they worded the conclusion makes me doubt the veracity of this paper....
I wonder how that goes over at journal club, when you dismiss an article in its entirety because when you skip over the facts and analysis and jump right to the conclusion, which is translated from a foreign language, you don’t like “the way they worded” it.
 
And we still need to figure out how immune you become and how long it lasts. My guess is it probably has much to do with viral load. I bet a lot of these asymptomatic carriers have an abysmal, wimpy immune response and give them a few good coughs from a highly infected person they are going to end up in the hospital.

I would assume the opposite. If somebody is shedding virus but having few if any symptoms, I would think that they have some innate immunity that is protecting them. The most obvious explanation would be that they have encountered a similar virus in the past that their immune system has memory T cell memory against or antibodies against.

Why would a person who is shedding trillions of viral particles, with the entire respiratory tract being coated in virus be suddenly overwhelmed by a few hundred thousand viral particles inhaled from another person? Those few thousand viral particles are like pissing in the ocean compared to what the lungs have already gone through.

The antibody testing is never going to be able to measure the full response against a particular virus as an antibody test, by definition is only testing against one specific antibody. The average immune response likely generates dozens of species of IgG to various parts of a virus, not just a single antibody.
 
I wonder how that goes over at journal club, when you dismiss an article in its entirety because when you skip over the facts and analysis and jump right to the conclusion, which is translated from a foreign language, you don’t like “the way they worded” it.
Don't journal clubs usually stick to peer reviewed journals?
 
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I would assume the opposite. If somebody is shedding virus but having few if any symptoms, I would think that they have some innate immunity that is protecting them. The most obvious explanation would be that they have encountered a similar virus in the past that their immune system has memory T cell memory against or antibodies against.

Why would a person who is shedding trillions of viral particles, with the entire respiratory tract being coated in virus be suddenly overwhelmed by a few hundred thousand viral particles inhaled from another person? Those few thousand viral particles are like pissing in the ocean compared to what the lungs have already gone through.

The antibody testing is never going to be able to measure the full response against a particular virus as an antibody test, by definition is only testing against one specific antibody. The average immune response likely generates dozens of species of IgG to various parts of a virus, not just a single antibody.

Agreed. I thought that comment was odd. The asymptomatic person should be more resistant to re-infection.

Do we know for a fact that this virus is transmitted by simple breathing (without close contact)?
 
Don't journal clubs usually stick to peer reviewed journals?
Yes, when the subject is not a pandemic happening faster than they can print the journals. We are part of the larger peer review process, whether on a formal journal review board or not. We need to be adept at reviewing and analyzing. When a study passess initial "peer review" and is published, the peer review process doesn't stop. We in the community have the final say if what a study concludes is true. There have been many studies that conclude one thing, that don't pan out in practice.
 
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Yes, when the subject is not a pandemic happening faster than they can print the journals. We are part of the larger peer review process, whether on a formal journal review board or not. We need to be adept at reviewing and analyzing. When a study passess initial "peer review" and is published, the peer review process doesn't stop. We in the community have the final say if what a study concludes is true. There have been many studies that conclude one thing, that don't pan out in practice.

So, we should be skeptical about everything except hydroxychloroquine?
 
So, we should be skeptical about everything except hydroxychloroquine?
Your words, not mine. I don't have an opinion on hydroxychloroquine. I've read positive studies and negative and posted about both.
 
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Quick look at it...only 48 people received HCQ out of 550+, no criteria given for why they received it over the others, of those in the NHCQ group 10% received interferon therapy which was not given to the HCQ group. More peeps received abx in the NHCQ group as well, makes one wonder if there was an underlying bacterial infection versus just demonstrating treatment practice variation
 
I wonder how that goes over at journal club, when you dismiss an article in its entirety because when you skip over the facts and analysis and jump right to the conclusion, which is translated from a foreign language, you don’t like “the way they worded” it.

Goes over well. We all pick up our beers, drink a little more, throw the paper into the trash, and move on to the next paper. LOL
 
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I would assume the opposite. If somebody is shedding virus but having few if any symptoms, I would think that they have some innate immunity that is protecting them. The most obvious explanation would be that they have encountered a similar virus in the past that their immune system has memory T cell memory against or antibodies against.

Why would a person who is shedding trillions of viral particles, with the entire respiratory tract being coated in virus be suddenly overwhelmed by a few hundred thousand viral particles inhaled from another person? Those few thousand viral particles are like pissing in the ocean compared to what the lungs have already gone through.

The antibody testing is never going to be able to measure the full response against a particular virus as an antibody test, by definition is only testing against one specific antibody. The average immune response likely generates dozens of species of IgG to various parts of a virus, not just a single antibody.

No way those people are asymptomatic though. Your body is full of trillions (or billions) of virons and they don’t know it? Nah. Highly unlikely.
 
We don't have any good medications to treat respiratory viruses (Tamiflu is barely better than placebo) so why do we think that we can suddenly develop one?
 
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There might be a role for the BCG vaccine. It seems it does offer some protection against respiratory viruses. I'm sure the Birdman can dig something up, but countries with mandatory BCG vaccination policies apparently have lower coronavirus infections.
 
We (my partner) today admitted a guy with severe respiratory distress.
Temp 102.8
RR 40-45
HR 130 - 155 SR, even slightest movement his HR changes rapidly.
BP OK
SpO2 92%

CXR show little b/l pneumonia, the chest CT looked much worse.

COVID + on rapid test
Wife was positive with COVID 2 wks ago. He had symptoms for the last 5-7 days.
He was admitted, given O2 support, and I think they are going to start him on remdesivir. He is extremely sick.

Lastly...
... he is 28.
 
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There might be a role for the BCG vaccine. It seems it does offer some protection against respiratory viruses. I'm sure the Birdman can dig something up, but countries with mandatory BCG vaccination policies apparently have lower coronavirus infections.

Yea I read that too. Certainly no panacea but I guess it could work.
 
We (my partner) today admitted a guy with severe respiratory distress.
Temp 102.8
RR 40-45
HR 130 - 155 SR, even slightest movement his HR changes rapidly.
BP OK
SpO2 92%

CXR show little b/l pneumonia, the chest CT looked much worse.

COVID + on rapid test
Wife was positive with COVID 2 wks ago. He had symptoms for the last 5-7 days.
He was admitted, given O2 support, and I think they are going to start him on remdesivir. He is extremely sick.

Lastly...
... he is 28.

Comorbidities? Asthma, diabetes, obese?


Sent from my iPhone using Tapatalk
 
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Just looked at his chart. Weight 55 kg, BMI 22.7, no PMH, stopped smoking about 6 months ago. No other medical history.
 
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So he’s in first percentile for men in terms of height to generate that BMI. Not saying height is anything like weight in terms of signifying health but a 28yo 5’1 121lb male doesn’t sound to be the healthiest individual.
 
I never saw him. Nurses tend to record weights and estimate everything else. It appears he is healthy, but I never spoke or saw him.
 
Great. 28 year old seriously ill with COVID? This anecdote calls for another 18 months of lockdown until we get a vaccine.
 
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You’re a monster.

#ifitsavesjustonelife
#betterhomelessthandead
#betteryourkidsstarvetodeaththangetmildurisymptoms

No, just dispassionate. We have tough trade-offs to make and emotion gets in the way. I mean we gotta keep the kids out of school so they don't get mild URI symptoms.
 
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Great. 28 year old seriously ill with COVID? This anecdote calls for another 18 months of lockdown until we get a vaccine.
Exception that proves the rule to my mind. People remember the stories of the young folks getting sick and dying because it is so rare.

No one is coming in here posting about the 70 year old who died while they were working yesterday.
 
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Exception that proves the rule to my mind. People remember the stories of the young folks getting sick and dying because it is so rare.

No one is coming in here posting about the 70 year old who died while they were working yesterday.

Exception that proves what rule? CDC has data themselves on HCPs that show 99.9% of several thousand Covid positive under ages 55 survived.

It's an exception that gets clickbait articles on CNN.

I had four under 40 ODs myself alone in my past four shifts that we could not resuscitate. Should I write Congress and CNN
 
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Exception that proves the rule to my mind. People remember the stories of the young folks getting sick and dying because it is so rare.

No one is coming in here posting about the 70 year old who died while they were working yesterday.
Yep. It's like the 28 year old that dies while running the marathon, and gets the news story, not the last 5,000 fat sedentary people that died of heart attacks while being sedentary eating buckets of fried chicken. Therefore, "Exercise will kill you, I'm safer on my couch eating a cheeseburger."
 
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You’re a monster.

#ifitsavesjustonelife
#betterhomelessthandead
#betteryourkidsstarvetodeaththangetmildurisymptoms
Yes, Veers is a monster. In the same way as the Muppets. On the other hand, I've only seen true monsters abuse hashtags like that.
 
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Exception that proves the rule to my mind. People remember the stories of the young folks getting sick and dying because it is so rare.

No one is coming in here posting about the 70 year old who died while they were working yesterday.

Right, but it's these anecdotes that drive the fear, and panic. The media grasps onto every one of these, and irrationally terrifies people without any context, or any of the statistics.
 
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