Coronavirus

[AlanSubie4Life]

I suspect western and southwestern Florida May fare better than Miami and Atlantic side of state
1,682 with 23 deaths so far
From about 5 days ago
City officials have voted to shut down Clearwater Beach for two weeks

• Sarasota and Manatee counties will close all public beaches
  
• Miami-Dade County Mayor Carlos Gimenez says all public beaches will close
  
• The City of Naples has closed all public beaches
  
• The City of Tampa has voted to shut down its beaches
  
• Lee County in Southwest Florida will close county-owned beaches
  
• The Town of Fort Myers Beach is closing all public parking, public beach access points, and commercial activity
  
• Also Sanibel and Captiva in Lee county

Are all the restaurants in the state closed, takeout only? All non-essential businesses closed across the entire state, too, right? I haven't been tracking closely.

 

[AlanSubie4Life]

"If I hadn't done that early, thousands and thousands of people would have died." FML.

You can't make this stuff up.

 

[SageBrush]

My math skills have rusted away, so I need some help here:

if Y = a^t is the curve of interest, then 'a - 1' is the growth rate, correct (where a > 1) ?

Looked at a bit differently, dy/dt = ky,
and after integration y = e^kt

I presume k = a -1
Yet a^t != e^kt

Please point out my dumb error

 

[lascavarian]

Just listening to some statements made by the administration regarding difficulty selling medical equipment into Europe.

My experience is that for US companies making medical equipment and complying with CE mark, Europe is quite welcoming and it is faster to introduce medical device products into Europe than the US. CE certification allows for self certification of devices. As long as our quality system was top notch, shipping into Europe consisted of a 30 day notice of intent and then shipping.

The US took months longer (FDA device approval) and there is a patchwork of local requirements (UL) that can be burdensome for device makers. We always shipped first into Europe once the CE mark was established.

Years earlier, I would have to go to various regulatory agencies in Europe to get individual approvals. Not a problem anymore. Clean and quick. YMMV

 

[CanadaEV]

Definitely not new. Viruses with pandemic potential are quite common.

Viruses are not stopped by borders or travel restrictions. They must be addressed aggressively from within - before there is any evidence there is a problem. You have to assume they are there and seek and destroy.

Since about the beginning of February, I also assumed this virus would spread everywhere.

If you follow Westerners in China on their YouTube channels, you'll see that they believe borders do matter. The Chinese want every visitor in isolation for 14 days, and they now charge the cost of medical care, which they didn't before. Both those measures are barriers to protect their accomplishment so far.

But I agree that it guarantees nothing. They can find themselves in the same boat again.

 

[Causalien]

It's also very likely that it is not contained in Canada as the number of cases appears to be growing exponentially. Has Canada taken any measures to slow the spread?

Not in the west. We are like Florida. However Quebec somehow blew up. No idea why. We are also not testing the general population or anyone who doesn't have confirmed contact with an infected. There is evidence that 50% of the cases are from community spread, but there are no effort to contact trace.

Last week saw every vagabound, hippie and snowbird return to Canada, there is a large amount of asians and Iranians in the west as well as a large asian and Italian population in the east coast, so it's going to be very painful for the next 21 days.

Our health system has been through SARS before, so they will not be caught off guard. What will be hard is herding the rebels and the hippies to remain into remaining in lock down.

The radio was doing an interview of some famous musician/hippie and the host asked his opinion on the virus. He said, and I quote "It's just a flu bro, the media is blowing this all out of proportion and the authorities are trying to control you and stop you from getting your heroines. So I say, **** em, **** the rules."

I believe that is the general attitude here.

 

[SageBrush]

If only the _govenor_ of the state DeSantis would .....

Beaches are a magnet for criticism because it is easy to see that social distancing is not observed, but it does no good to close beaches if the people just congregate elsewhere.

 

[AlanSubie4Life]

@TheTalkingMule has at least two people who agree with him. These two doctors say the IFR might be as low as 0.06%. For some reason they don't explain how South Korea only caught 9,137 of their 210,000 cases... In fact they don't mention South Korea at all. Strange. I guess it's worth it to get published in the WSJ. We should know if their prediction of only 20,000-40,000 deaths in the US is true in the next few weeks, just in time for Easter.
Opinion | Is the Coronavirus as Deadly as They Say?

Looks like this would not be the first time one of the authors would have had to had his statistics checked.

Authors retract PLoS Medicine foreign health aid paper that had criticized earlier Lancet study

 

[PeterJA]

Not double-blinded. That's why it got a "D" grade on the actual study.

Link please.

I.e. the enrollees were told what they were getting, and in studies like this there is an incredible "placebo effect".

An "incredible" placebo effect is unlikely here, since both groups received pills: either decongestants and pain-relievers or vitamin C, as stated in the abstract.

Also, the "end point" was basically "do you feel better". That's a really poor scientific metric.

It's the metric often used for discharge from a hospital.

I would had more faith in the study if it measured inflammatory factors or something. But as-is, there is a reason this study didn't get much press.

I agree that double-blind trials are stronger evidence than this one. But to ignore this one as worthless when the treatment is totally nontoxic (and cheap and unpatentable) suggests there are other reasons for not following it up with double-blind trials.

 

[Oil4AsphaultOnly]

Warning OT post:

You Won't Believe My Morning — Wait But Why

I wanted to share, because it made me chuckle. And anything light is needed now. But I wonder if our leaders are truly not missing the opportunity here?

Thinking about it a little further, most of the n95 masks are actually made in China, so why do we have so little, and Elon was able to get 250k? Is China hoarding them? Should we not be coordinating and cooperating with China and SKorea?

 

[Thekiwi]

When you look back at your life, it's not the failures you will regret the most. It will be the risks you didn't take.

A popular saying, but if all those extra risks you could have taken end up in an alternative universe as miserable life destroying failures it’s not really that instructive.

I’m half joking, but many people just aren’t suited to starting their own business. Yes there are many out there who would be great at it who don’t know it yet, but there are many many more who would be utter crap at it and should most definitely not give up their day jobs.

 

[bkp_duke]

Link please.

Grading quality of evidence and strength of recommendations

Reference Box 2 for grading criteria.

Not being a randomized double-blinded trial immediately takes the quality of the evidence to "low". Low means that the absolutely highest evidence grade it could get would be a "C" on the Grade Practice Recommendation system (i.e. how we practice medicine) - see link below (I like this system simply because people understand A through D). When you go into the "Decrease grade if" section and point out more problems like "serious limitation of study qualify" and "high probability of reporting bias" it drags the study down further.

Another review paper for those that care how studies are graded and clinical recommendations made:
The Levels of Evidence and their role in Evidence-Based Medicine

 

[vwman111]

Not in the west. We are like Florida. However Quebec somehow blew up. No idea why. We are also not testing the general population or anyone who doesn't have confirmed contact with an infected. There is evidence that 50% of the cases are from community spread, but there are no effort to contact trace.

Last week saw every vagabound, hippie and snowbird return to Canada, there is a large amount of asians and Iranians in the west as well as a large asian and Italian population in the east coast, so it's going to be very painful for the next 21 days.

Our health system has been through SARS before, so they will not be caught off guard. What will be hard is herding the rebels and the hippies to remain into remaining in lock down.
The radio was doing an interview of some famous musician/hippie and the host asked his opinion on the virus. He said, and I quote "It's just a flu bro, the media is blowing this all out of proportion and the authorities are trying to control you and stop you from getting your heroines. So I say, **** em, **** the rules."

I believe that is the general attitude here.

Quebec is reporting probable cases...doesn't look like any other provinces are reporting that way... Not sure about the other countries

 

[kyzhk]

Not double-blinded. That's why it got a "D" grade on the actual study.

I.e. the enrollees were told what they were getting, and in studies like this there is an incredible "placebo effect".

Basically, to take anything away from this, someone would need to redo the study and double blind it.

Also, the "end point" was basically "do you feel better". That's a really poor scientific metric. I would had more faith in the study if it measured inflammatory factors or something. But as-is, there is a reason this study didn't get much press.

Since at this stage, we are primarily still relying on the immune system to fight off the virus, shouldn't we take full advantage of the placebo effect? Does it violate ethics code to lying about using a "cure" on a patient?

 

[Daniel in SD]

Thinking about it a little further, most of the n95 masks are actually made in China, so why do we have so little, and Elon was able to get 250k? Is China hoarding them? Should we not be coordinating and cooperating with China and SKorea?

I'm pretty sure the masks were industrial N95 masks that they had at the factory (I've actually found a few of my own in my tool chest!). Yes, it does seem like getting enough masks would be good.

 

[bkp_duke]

Since at this stage, we are primarily still relying on the immune system to fight off the virus, shouldn't we take full advantage of the placebo effect? Does it violate ethics code to lying about using a "cure" on a patient?

Hey, I'm not saying don't try to use it. If it does no harm, we will give it a shot.

Where the argument comes in, and is a VERY important consideration, is to call it a bon-a-fied treatment. THAT is what I strongly argue against. When we do that without proper evidence it gets an incorrect layman's label as a "cure" or "treatment" and you have people incorrectly propagating false or at best dubious information.

As physicians we cautiously call these "off label" or "compassionate care" usages. This is so that they are properly labeled as non-conforming to evidence-based standards.

Everything we do right now for COVID-19 except standard respiratory care falls under the above two usages. The closest thing in the pipeline to being evidicence-based and therefore getting an "indicated" label by the FDA is Remdesivir. It's now in two Phase III trials, and that is very promising (and also why Gilead is making it as fast as they possibly can):
Gilead Sciences Initiates Two Phase 3 Studies of Investigational Antiviral Remdesivir for the Treatment of COVID-19

 

[kyzhk]

Hey, I'm not saying don't try to use it. If it does no harm, we will give it a shot.

Where the argument comes in, and is a VERY important consideration, is to call it a bon-a-fied treatment. THAT is what I strongly argue against. When we do that without proper evidence it gets an incorrect layman's label as a "cure" or "treatment" and you have people incorrectly propagating false or at best dubious information.

As physicians we cautiously call these "off label" or "compassionate care" usages. This is so that they are properly labeled as non-conforming to evidence-based standards.

Everything we do right now for COVID-19 except standard respiratory care falls under the above two usages. The closest thing in the pipeline is Remdesivir. It's now in two Phase III trials, and that is very promising (and also why Gilead is making it as fast as they possibly can):
Gilead Sciences Initiates Two Phase 3 Studies of Investigational Antiviral Remdesivir for the Treatment of COVID-19

Wasn't arguing against your point. Just interested if and how we are using placebo effect to our advantage. Thanks for the information. I guess "off-label" and "compassionate care" are the standard procedure for taking advantage of the placebo effect.

 

[bkp_duke]

Thinking about it a little further, most of the n95 masks are actually made in China, so why do we have so little, and Elon was able to get 250k? Is China hoarding them? Should we not be coordinating and cooperating with China and SKorea?

Pure supposition here, but if I were a betting man, I would guess he had Gigafactory 3 personnel round up all the masks in that facility and ship them over. Then they could replenish the stock locally from China.

And last I heard, he only was able to bring over 50k masks, not the 250k he originally said.

 

[shinytop]

Just a layman here, but my feeling is that any report of a working treatment will lead to many growing less worried and quit practicing social distancing.

 

[Lessmog]

Hey, I'm not saying don't try to use it. If it does no harm, we will give it a shot.

Where the argument comes in, and is a VERY important consideration, is to call it a bon-a-fied treatment. THAT is what I strongly argue against. When we do that without proper evidence it gets an incorrect layman's label as a "cure" or "treatment" and you have people incorrectly propagating false or at best dubious information.

As physicians we cautiously call these "off label" or "compassionate care" usages. This is so that they are properly labeled as non-conforming to evidence-based standards.

Everything we do right now for COVID-19 except standard respiratory care falls under the above two usages. The closest thing in the pipeline to being evidicence-based and therefore getting an "indicated" label by the FDA is Remdesivir. It's now in two Phase III trials, and that is very promising (and also why Gilead is making it as fast as they possibly can):
Gilead Sciences Initiates Two Phase 3 Studies of Investigational Antiviral Remdesivir for the Treatment of COVID-19

But has there ever been any sign of that here?