mattb65

You do understand the dosing for hydroxychloroquine is different from chloroquine, right? .... Right? You understand the UK study wasn't looking at chloroquine at all, right? Your concerns about toxic doses of a drug not even being studied makes you look like an idiot. You understand this? The drug doesn't work, it just doesn't, sorry. I prescribe hydroxychloroquine for a handful of neurologic diseases it can be a useful drug and generally well tolerated. It just doesn't work against covid. There isn't enough zinc and ionophore magic that you can wish upon it for it to work. Give it up. Move on.

Just as a correction, there have been no RCT studies that have proven usefulness in any way for hydroxychloroquine. None. Not early, not during the inflammatory phase, not as a prophylactic. None. Never. No benefit. This dude popping in here criticizing the UK study that was just published in the nejm has no clue what he's talking about at all. He's completely wrong about their methodology and is equating the first of hydroxychloroquine with chloroquine. They are different drugs, dosed differently. Here's a link to the UK study https://www.nejm.org/doi/full/10.1056/NEJMoa2022926

These are all unfortunately joyous times in normal circumstances that you rightly point out will almost certainly drive increased spread of this virus. I made a post a little over a week ago predicting over 100k new cases a day by the end of this month and unfortunately feel this is likely to become reality. And this is before the holidays that you mention. I do think there will need to be some sort of policy response to the worst areas affected. I know the covid fatigue is strong at this point especially in some areas. Here in Hawaii, our county went back to stay at home type restrictions about a month ago due to a big spike in cases/hospitalizations and it bent back the outbreak significantly and have put forward a tiered opening plan with gates based on per capita daily infection and on % positive rate. The building outbreaks especially across the Midwest are going to be a big challenge because the message from the leadership in the federal government is still essentially anti restriction and let people do what they want. The task force and CDC have other recommendations but those are not being amplified by the president or VP Tough times ahead.

That's the flight level, the surface some were still around 90 kt. Need dropsonde to get a better idea on the winds. Nevertheless recon verified what is obvious on visible and IR that the storm is clearly strengthening.

This thread has consistently avoided the politics of covid up until the president got sick with the virus. I can't speak for the last few pages because inevitably politics have become a major point of discussion. It is very very very very very telling that an apolitical discussion about what is happening with the virus to you is a "giant echo chamber for the left". You've got some serious blinders on my friend.

These items will help your health looking forward over the next couple years and beyond. If one hasn't been doing these things already then I am sorry to say that I doubt they'll have much impact if one contract Covids in the next month or two. It's never wrong to encourage those things but speaking specifically about Covid, the emphasis should be on what can help in the coming days/weeks/months.

Early guidance on masking was filled with mixed messages and confusion. (Talking March/April). Since that time a scientific consensus has emerged that widespread mask usage has a myriad of benefits to include: 1. Prevents the infected individual from transmitting the virus whether they be presymptomatic, asymptomatic or symptomatic - remember many are unaware of their infection but still highly infectious for a couple days 2. Protects the person wearing the mask - there's a variance based on the type of mask in terms of how effective the mask is in terms of prevention but even double layer cloth masks at a minimum provide some level of prevention and also likely reduce the dose of virus that the wearer recieves which likely also reduces the severity of their infection These factors have been communicated pretty consistently since at least June however mask wearing has unfortunately been subject to widespread misinformation campaigns. These are good general advice for health and well being but there is no good evidence that any of these prevent covid infection. Diet, exercise, good sleep habits, stress reduction among a number of other factors are important for everyone to follow but not really relevant here. There's a lot of command and control happening behind the scenes that is not being communicated very well and there is a significant lack of transparency. There have been intermittent leaks of internal documents with the specific risk levels and recommendations provided by the task force to different localities. There should be a level of transparency from the federal government. There should be much better articulated best practices and overarching strategy coming from the federal government. There should be honesty and clarity about the facts. I could go on but all of this and more have been lacking from the federal government In fact, incredibly, the number one source of misinformation about this virus has come from the president. https://www.nytimes.com/2020/09/30/us/politics/trump-coronavirus-misinformation.html

Absolutely, there are so many senior members of the adminstration who are at risk. The web of individuals potentially exposed in the Republican hierarchy could be pretty vast.

The amount of contact the president was having in person with lots of different people and very few people wearing masks. It was a matter of time. That this happened a month before the election is insane. I know this isn't a thread for politics but this is obviously going to be the major covid story for the coming weeks. In terms of time frames, there is usually a 3 to 7 day incubation before symptoms develop, once/if they develop, the duration of fever is often an indication of severity. If the disease takes a bad turn it is usually 7-14 days after symptom onset when the inflammatory storm starts causing the major problems.

Unfortunately, is becoming more apparent by the day that we are heading into a third wave of this virus. The summer wave cage off of a plateau of roughly 20,000 positive cases per day and this one appears to be launching off a plateau of 40,000 cases per day. I wouldn't be surprised if we jump up to 100,000 cases per day by November. Watching the hospitalization trends over the coming weeks well give a clue about how much of a rise in deaths we'll see in this wave. Not sure how much this is registering with the general public at this point. The experts have been issuing stern warnings for months about their worries for fall/winter and those worries are all starting to show concerning signs of becoming reality.

Pretty embarrassing post here. For both you and the fox news network. Yikes.

Looking nationwide, according to the covid simulations the declines in cases we have seen over the last couple months appear to be leveling off and cases are predicted to start rising again in the next 1-2 weeks. Deaths should continue a trend of declining for another approximately 5-6 weeks given the 4 week lag between new cases and new deaths. If things pan out like this, it is a bad sign heading into winter. The number of active circulating cases could portend a third wave larger than all the rest. Having said this, there could be some protection from the existing prevalence of people who have immunity which is estimated at around 15% nationwide. I'm hopeful that we will have an effective vaccine with good data soon but I believe the timeline from the CDC director of availability more likely after fall/winter and more likely widely available in spring/summer next year. So whatever happens with this next wave of infections will only be contained with mitigation efforts.

Not sure why but the first thing that came to mind when you posted this was...

This is from a colleague who is an Army ICU doctor who has been deployed to a hard hit region of Texas. Pretty powerful perspective on why it's important for everyone to keep doing their part. It feels like we are near the finish line hopefully. Everything below are my colleagues words: I was lucky enough to spend the last seven weeks augmenting a civilian hospital in South Texas that was overwhelmed by COVID-19 cases. I traveled and practiced with an outstanding team of Army physicians, nurses, respiratory therapists, medics, and other medical staff. Here are a few things I learned that I believe are worth sharing: 1. COVID-19 makes people sicker, in more bizarre ways, for longer, and is more challenging to treat, than any other medical condition I have encountered in a decade of critical care. Our most effective therapies have a moderate effect in some patients but no effect at all in others. The best supportive care we can offer is extraordinarily labor-intensive. 2. It doesn’t matter how statistically unlikely a bad outcome is for a person in your demographic; if you happen to be the 1 in 1000, you wind up just as dead. Cavalier dismissal of the problem makes my blood boil even more than it did before. 3. The human cost of this crisis is far worse than the statistics, which are bad enough themselves. Every death has a ripple effect in a close knit community. Every success story of a patient surviving to hospital discharge comes with a caveat: they still have a long road to return to normal, if they are fortunate enough to ever get there. 4. Our fractured healthcare system is failing whole communities. From employer “sponsored” for-profit health insurance that disappears with an economic downturn; to the systematic neglect of primary and preventive care that yields an obese and unhealthy population at great risk for severe disease; to rapacious for-profit hospital systems that somehow beat EPS estimates last fiscal quarter; to bloated administrative staffs who continue to push unsafe staffing ratios even with an incredibly complex disease — COVID-19 is exposing the fundamental truth of American healthcare: that even with the best minds, best hands, and best tools, a system primarily designed to generate profit is profoundly unfit to provide healthcare. 5. The only thing holding the system together and offering any hope of good outcomes to hospitalized patients is the heroic work and sacrifice of a legion of healthcare workers. I saw people from every medical profession working longer hours, for more consecutive days, than should ever be considered safe; and though most carried the burden of this difficult work with grace, all will feel the emotional aftershocks for months or years to come. 6. Simple preventive public health measures like wearing a mask and limiting gatherings make a much bigger difference than the elaborate and expensive things I can do in an ICU. The exponential growth of cases in this community did not stop when we added more ICU beds; it stopped when the local population started wearing masks and reduced the size and frequency of gatherings. 7. “Getting to herd immunity” is a ridiculous and frankly criminal policy proposal. This community was so devastated, and the local healthcare system so overwhelmed, that they needed extensive federal support for two months to get back on track; even after 30,000 cases and 1,400 deaths, they are far below the threshold for achieving meaningful herd immunity. None of this is breaking news. You have heard it all before. But clearly, for reasons beyond my comprehension, many people still do not seem to get it. We need to come together as a community at every level - from neighborhood to nation - and do the uncomfortable, unpopular, but undeniably necessary things to safeguard ourselves and our neighbors. We can start by wearing masks, and once the short term problem is under control we can work on fixing our fundamentally flawed institutions. This is not someone else’s problem. It is my problem, and your problem. It’s time to stop pointing fingers and waiting around for a magical solution. It’s time to link arms (but not literally) and be the solution.

What kind of mask are you wearing? A plastic bag over your head? Normal masks that are widespread do not affect oxygen levels and do not cause CO2 retention. Do you know how tiny these molecules are? They can freely move between the fibers of a normal mask. Here's an ICU doc that ran 35k with a mask on, no effect whatsoever to oxygenation. https://www.menshealth.com/fitness/a33521706/face-mask-oxygen-levels-running-myth-coronavirus-doctor-fact-check/

Seems like that Sturgis motorcycle rally has kicked off South Dakota's biggest outbreak of the pandemic. The 7 day moving average at the start of the rally was 84 and has more than tripled in the last three+ weeks to just shy of 300.

We were there two months ago, hopefully you're right and things go well. Cases here exploded after about a month of being fully open. Had to take multiple steps backwards because the hospitals got under stress from the surge in sick people. Just opening everything doesn't mean it's "wrapping up".

Interesting article, thanks for sharing it. I think both of your take aways miss the point though. Those positive tests are still positive cases and we cannot infer one way or another whether or not they were infectious at some point in their infection. The authors imply from study of other viruses that they probably aren't infectious at highly amplified/very sensitive(40 cycle) thresholds for test positivity rates. This is probably true and they are probably right that these people aren't the best targets for testing in terms of isolation and contact tracing efforts. Keep in mind, these are not false positives but if the test threshold were lowered then they would be false negatives. So the total number of true cases are still out there but just not recognized. The authors of the article make the more important point that non PCR based testing and fast preferable home based results that identify all the people with high levels of virus is the best way to utilize testing to accomplish the goal of isolating highly infectious individuals. We've been waiting on the testing technology to give us this tool. Hopefully it's used wisely. A competent federally coordinated response with transparency and end points communicated openly would be preferred.

I can speak from first hand experience, the confusion is a pain in the ass. As many know, I'm a physician. My daughter is 18 months old and in daycare, she caught some sort of a URI virus and brought it home and gave it to me. I had the typical viral sore throat and developed some body aches and chills. Under any other circumstances I would easily work through something like this and just take a Tylenol and she throat lozenges. With covid circulating that's a no go. It would be the wrong answer to go in mildly sick and be wrong that is just a regular cold and accidentally spread covid to the staff and patients. So I got tested and it was negative thankfully but I couldn't just go back to work because our policy is 7 days from symptom onset even if the covid test is negative. Not the end of the world but it wasn't an easy call to go get tested knowing that is have to take off for 7 days. Really disruptive to my patients and colleagues. Worse if I had a job that is hourly and would lose income from going to get tested. If we have a meaningful flu and other respiratory virus season, it's going to be a mess.

On principle, I agree with a lot of the sentiment in your post and see a lot of people saying the same thing. In practice, when this sentiment is put into practice, this darn virus spreads like crazy because people cut enough corners to spread it around too quickly and there are not enough precautions available to protect the vulnerable so many end up in the hospital needing inpatient care and stressing hospital capacity and causing massive death toll. In addition the hospitalization rate is much higher than the fatality rate so though most survive, not all survive without incurring some degree of morbidity. This is not a fear thing, at this point IMO, I think while there are some still afraid of the virus, most are just tired, frustrated or angry with how much it has screwed up our normal way of life. The extra frustrating part to me is that it appears we are likely very close to an effective vaccine - all data points are coming back positive so avoiding the policies necessary for containment in the early and second wave stages of the pandemic as executed in other developed countries mean we end up with a massive amount of excess morbidity and mortality that could have been delayed and saved.

Oahu has just moved back to stay-at-home orders closing down most non-essential businesses again. We were nearly the lightest hit on the first wave but have had a surge in cases over the last month. They have made some pretty questionable moves leading up to this step back - they started by closing beaches and hiking trails ... as has been well covered, the great outdoors is not exactly the place this thing likes to spread widely. They did close down bars at the same time. Next move they made was to say no gatherings over 5 people but without any real way to enforce so it wasn't really a practical change in any meaningful way. With the new stay at home, personal services are closed, restaurants are take out only, gyms closed again. Has any other area moved backward this far in terms of their reopening? They did it not just because of cases going up but also because the pace was straining the local healthcare resources so they needed to do something. It's frustrating to see them take away good outlets like the beach and hiking rather than tackle high risk indoor settings under their initial set of new restrictions. Their rationale was that they didn't want to impact the already struggling businesses. Unfortunately delaying important restrictions just allowed the case number to keep rising which will also mean it's longer and more difficult to bring back down to a reasonable level. The covid fatigue is real. At least it seems like things are mostly heading in a better direction in the US as a whole for the most part.

This is literally the most predictable thing one could imagine. Obviously if you bring students back to campus they are going to act like college students and party and get drunk and try to have the college experience. You only get to be an undergrad once after all. I don't care how many precautions you try to scheme up in your mind, the college setting is just not built to contain the virus. Is the risk worth it? Seems like many are saying no and deferring from starting college or taking a year off. If I were in the student's shoes I would take a year off rather than doing virtual.

What he describes is what happened in NYC and to be somewhat fair, their situation is much more under control than most other areas. But the scale of the carnage and cost of letting it run out of control were so extreme in NYC that I don't see how anyone can come in and say that we should have all let it rip until hospitals were overwhelmed. Sure, people would not be debating how serious it is like they currently do but the cost in human life and suffering would be unconscionable to choose that path.

This is a pretty long read but I think it provides a more nuanced explanation for how the epidemic evolves in a newly hard hit area as shown in NY initially and more recently in Florida, Arizona, etc. In particular the discussion around "herd immunity threshold" which is another way of saying what is the natural amount of infection before the epidemic starts burning itself out. This is a variable number and is entirely dependent on what mitigation measures are in place to reduce R(t). In other words if we go back to no restrictions then the R(t) increases and the epidemic takes off again after getting contained. https://covid19-projections.com/estimating-true-infections/ From the article: "Looking at the data, we see that transmissions in many severely-impacted states began to slow down in July, despite no clear policy interventions. This is especially notable in states like Arizona, Florida, and Texas. While we believe that changes in human behavior and changes in policy (such as mask mandates and closing of bars/nightclubs) certainly contributed to the decrease in transmission, it seems unlikely that these were the primary drivers behind the decrease. We believe that many regions obtained a certain degree of temporary herd immunity after reaching 10-35% prevalence under the current conditions. We call this 10-35% threshold the effective herd immunity threshold, eHIT." "One thing to note is that original definition of the herd immunity threshold is derived from the basic reproduction number, R0, and assumes no intervention and no social distancing. Hence, by definition, the HIT of the SARS-CoV-2 virus remains unchanged over time, between 50-80%. But the effective herd immunity threshold (eHIT) in the context of COVID-19 is changing over time because the effective reproduction number, Rt, decreases as a result of society adjusting to the virus. That’s why we are seeing infections and cases plateau and decline after prevalence reaches 10-35% as people gain temporary immunity. A removal of current restrictions and interventions, as well as a loss of immunity over time, may cause this threshold to return to its original levels of 50-80%."