Coronavirus

[renim]

https://www.health.gov.au/sites/def...cases-in-australia-by-notification-date_5.png

Australia, is flattening the curve, (ignore the last bar, it tends to lag update)
2nd last bar ~210 new case, total case count is ~4200, so a neat 5% daily increment. (compared to 25%-30% 10 days ago)

fatality lag, blue squiggle is about 10 days, so large surge is still to come, currently it was 19. it should get to 100, but its open question past that.

this is results from 244,000 tests, so obviously not comparable to other western governments

masks are generally NOT worn, they are too precious, for instance health professionals are asking nail saloons for their masks.
(so this was primarily achieved by border controls/tracing and hand washing, 1.5 meter social distancing, social cancellations)

challenging source was cruise ships ships, next up back packers.

ohh and currently ICUs are almost empty, state policy was to send people home for 'self-isolatation'

big problem is lack of PPE for medical, basically private hospitals are stopping work (premature) due to need to preserve PPE for government upcoming COVID 19. its not tests, beds or ventilators, its PPE that is the constraint here.

 

[Norbert]

As 2 or 3 of us predicted, Germany's (unadjusted) CFR just crossed 1%, going upwards.

I still believe that underestimating the problem is the larger danger.

 

[TheTalkingMule]

To assume that we could get as low as 100K just by avoiding an overload of hospitals, but still reach herd immunity, for which an infection rate of 50% estimate is on the low side AFAIK, that implies an IFR below 0.1%. I'm not aware of anyone thinking it is that low, at this point. You are usually one of my favorite posters, so I'd like to urge you to reconsider this point.

Those levels are now a near certainty, so long as we don't screw up worse than we already have.

 

[mikevbf]

Here is a summary of NewYork-Presbyterian Hospital's update from yesterday:

Javits center is open for caring for med surge patients

Comfort Navy Boat is landing in NYC this week

We have about 350 ventilators, the kinds that we most needed that came in.

The region now has a travel advisory (no non-essential travel)

Our very first inpatient that was admitted here at NYP with covid went home this weekend

1559 inpatients (and more in ED waiting for their tests) 23% of them are in ICU most of which require vents

Our major focus over the next few days will be on dramatically increasing our ICU capacity at our four major NYC campuses

Remote patient monitoring: patients that are sick but not too sick and can safely be sent home with close monitoring (telehealth visits, oxygen monitoring)

Healthcare Heroes: working with local businesses to distribute food to healthcare workers


Clinical update:

On Wednesday of this week at 5:30pm we will have our two chiefs of ED, and they will be taking your questions in live format[email protected]

We are looking at a variety of other ways to expand testing capabilities, even with shortage of swabs.

Self-swab testing is in conversation

Blood test, more coming as early as this Wednesday

Trial: Also looking for antibodies testing (1) to look for evidence of prior infection which may or may not provide immunity (2) and to identify potential donors who could donate plasma to treat patients with severe COVID 19

Today a patient who recovered from the disease is being tested to see if they are a good donor for plasma


PPE:

We are going to shut down the site [email protected] too many unhelpful leads. We feel good about the suppliers we are moving forward with. But please conserve your masks.

Universal Masks On (anyone walking in should have a mask on). Surgical masks only. If people are starting to get sick at work, the mask helps to reduce risk of exposure for our coworkers.

Wash your hands before you put on your mask and before you take it off. How you wear it is important.

N95 Masks: for high risk procedures and direct patient care.

Surgical masks are in wide circulation.

Scrubs: we are trying to provide more

We do not have a shortage of gowns and gloves.


Policy:

We changed our labor and delivery policy. One support person may be with the mother.

 

[jhm]

Giuliani wasn't a very effective person in the interview. It took him too long to get some of the concepts. Nonetheless, there's substance to what has been shown in results so far by the doctor. Don't let choice of messenger blind you to the contents of the message.

I will absolutely let the messenger blind me to the message. This is called having a health BS filter in an age of disinformation. Some people just leave you less informed after you listen to them. Propagandists often use valid information to establish some credibility with their targets.

If there is any truth here, let it come through other messengers. Yes there are real medical researcher doing real work to sort this out. Let's focus on the true scientists. We should not give an inch of credit to trickster disinformationists like Giuliani. That only taints the science stealing credibility away from true scientists.

Please exercise some good judgment before posting stuff from BS artists like Giuliani, if you want to maintain your own credibility here.

 

[EinSV]

Keep in mind that this is now an FDA approved treament, so clinical studies won't accelerate the use much more. If it makes as dramatic a difference as some people claim it does, doctors who have been treating patients before approval, and now after approval will start shouting it from the rooftop if they also personally observe that much of a difference. It would be like when antibiotics or steroids first started out.

If on the other hand, it makes only a marginal difference, then a longer term study that weighs positives vs. negatives is actually warranted.

That's a good point and will help. On the other hand, the studies on CQ/HCQ to date have many limitations and while promising it's not clear whether these drugs will work, if so which drug and/or combination is best, or whether there is something that works better.

Given that 100-200K people may die just in the US, we have shut down huge chunks of the economy and are likely to have 25% unemployment, have a multi-trillion dollar bailout plan AND are planning to conduct clinical trials anyway, it seems to me that every effort should be made to accelerate clinical trials so our doctors have the best possible information as early as possible to improve their patients' prospects and minimize hospital stays.

 

[Norbert]

Those levels are now a near certainty, so long as we don't screw up worse than we already have.

I didn't hear anything about certainty. It sounded more aspirational to me, in the first place.

 

[Norbert]

Given that 100-200K people may die just in the US, [...]

What I heard is: Because we'd rather have 100K-200K die than 1.6M to 2.2M.

Which is a bit different.

 

[jhm]

Let me offer a quote from this article about using hydroxychloroquine; and aithromycin together to treat COVID-19:

"This appears to be the best widely available option for treating Covid-19 and not merely easing the suffering from the disease. It would be irresponsible not to pursue this option aggressively.

Dr. Colyer is a practicing physician. He served as governor of Kansas, 2018-19.

Further, here's another article from Forward that addresses the controversy Dr. Vladimir Zalenko has stirred up. In the "use it right now" camp is the FDA and the POTUS, who have given their blessings to physicians prescribing the HCQ and AZ combination for treatment with COVID-19. In the "we need a careful trial before this goes any further" camp are those such as NY Governor Cuomo. I think part of the controversy is political and part is "save lives now" vs. "be careful". In the article linked in this paragraph, Zalenko's patients are now having to drive to other states to get their prescriptions.

Here you present even more evidence that this whole thing is politically motivated quackery. Gov Colyer recently lost to a democrat. Now he's trading on his credentials as a "Dr" to spread counternarratives for the pandemic.

The conflict of interest between politics and medicine is enormous here. Please stop promoting this misinformation campaign.

 

[jhm]

You are absolutely correct. That is why Dr. Zelenko is NOT prescribing the drugs to young (under 60) people who have no underlying issues and who are free from shortness of breath. As Zelenko put it, "this is not candy, these medicines have side-effects."

Part of the problems with Governor Cuomo preventing the use of the drugs outside of formal clinical tests and outside of the hospital are:
1) Zelenko's procedure includes the use of zinc, which might produce substantially better results than a clinical trial without zinc included
2) People are dying. Dr. Zelenko's point is that treatment needs to begin as soon as possible when a person comes down with the virus to get the viral count down before ARDS sets in. Waiting until someone is hospitalized before offering the treatment is often self-defeating.

Desperate times call for quackery. Trying to justify treatments that run well ahead of clinical trials grounds of desperation is a huge red flag that absolute BS quackery is running the show. "Use of zink...substantianly better results that a clinical trial..." This is utter nonsense.

 

[renim]

RACGP - Healthcare workers trial TB vaccine for coronavirus protection

Australian Healthcare workers trial TB vaccine for coronavirus protection Around 4000 doctors, nurses and other medical staff will test the efficacy of a century-old tuberculosis vaccine.


https://www.health.qld.gov.au/__data/assets/pdf_file/0027/637614/bcg-English.pdf
don't ask why, ask why not.

 

[SageBrush]

Yeah there is something wrong with that model. The 718 beds available never change on the time line.

Says on the website that they calculate available as total capacity less usage pre covid

 

[Dr. J]

I read that trump said today that he is 'open' to the idea of widespread face mask use.

Does that mean something coherent and consistent (hah!) in dog whistle ?
Or is he just fertilizing the soil for his apologists to explain away his failure in this regard until now ?

Trump has artfully avoided accepting any responsibility for any failure by trusting in federalism to put the onus on the territories' and states' governors to act. I can't remember any US president in modern times taking such a passive role during a time of disaster. So far, it seems to be working for him. Not so much for us.

 

[Dr. J]

The University of Washington has done projections for the peak in each state and how many beds and ICU beds will be needed. Some states are going to be disasters.

IHME | COVID-19 Projections

I think they're underestimating what's going to happen in some states that are just getting started. But it's probably pretty accurate for states well into their outbreaks.

As of today, they are only projecting ~84,000 US deaths through August, which apparently is below the federal government's guidance of 100,000 to 200,000 (although no time frame given for the latter). So, yeah, seems optimistic overall.

 

[SageBrush]

World data through Mar 30

Least effective
US
Turkey
UK

Best Benders
Switzerland
Italy

The remainder are showing some bending lately but no where near enough

 

[Dr. J]

That's call exploring all options and also how AI works.

It's generally called "trial and error," or in this case, no preparation and failure. If AI implements disastrous failures before arriving at the successful step, then Elon is right: we are doomed.

 

[jhm]

You're describing the usual platinum-plated clinical trials process, but that's almost completely useless here given the timelines involved.

And there are quite a few clinical trials in the pipeline that are not structured like that.

For example, the HYDRA trial only has 500 participants and treatment lasts only 10 days.

Hydroxychloroquine Treatment for Severe COVID-19 Pulmonary Infection (HYDRA Trial) - Full Text View - ClinicalTrials.gov

View attachment 527687

There is no reason this trial couldn't be done in a matter of a few weeks and preliminary results released a couple days later, with complete results and analysis coming later.

If the results aren't clear enough after smaller trials, then so be it. Or spend some more money and expand the trials -- there are no shortage of patients as others have mentioned.

Either way, nothing ventured, nothing gained.

You could duplicate this approach for other approved anti-virals that show promise for covid-19 (or other approved, well-characterized drugs). It would also make sense to add higher doses of HCQ, plus HCQ+azithromycin. Trials like this are in the works, but they all seem to be on comfortable but nearly useless timelines (fall 2020-summer 2021).

There is nothing to lose and everything to gain by accelerating these trials.

The point of a well designed study is to put an end to quackery. In the short run, desperate people will try out all sorts of desperate long shots, but come next fall we really need to put an end to foolishness.

 

[jdw]

Trump has artfully avoided accepting any responsibility for any failure by trusting in federalism to put the onus on the territories' and states' governors to act. I can't remember any US president in modern times taking such a passive role during a time of disaster. So far, it seems to be working for him. Not so much for us.

In fairness, I can't remember any US President in modern times dealing with a simultaneous disaster in all 50 states either. Not a lot of precedent for this situation.

 

[jhm]

Why did the doctor use Giuliani to get word out that his experience with HCQ, AZ, and Zinc was so positive? I think it's because he's a doctor and HE WANTS TO SAVE LIVES. That's what doctors do. He simply wanted max exposure of his experience and bringing in a well-known politician is a way to do it. Guess what? It worked. Unfortunately, we are a politically-divided country and there are of course negatives associated with using someone too closely linked to either party.

This is incredibly naïve. This has as much to do with saving lives as Giuliani going to Ukraine to fight corruption.

 

[TheTalkingMule]

What I heard is: Because we'd rather have 100K-200K die than 1.6M to 2.2M.

Which is a bit different.

I would rely on direct observation rather than what's heard in the news these days.