triplehorn

Thanks. Fauci speaks to the principle of avoiding “enhancement” of an infection after receiving a vaccine against said infection. no bueno. Fauci is a no bullshittin truth teller. Glad we have him.

I looked for it earlier today and haven’t found it yet. His podium time yesterday was brief but very information dense. It’s worth keeping an eye out for it. Maybe a transcript pops up.

So far, what I’ve learned second hand is little to no clinical improvement or benefit noted once you’re in an ICU setting on O2/vent and have pneumonia. Early intervention/prophylaxis is where I’d be focused looking at right now. But then assuming clear benefit, applying that is dependent on access to mass testing and rapid results turnaround. Absent that, treatment would be rendered relatively useless due to rapid progression to bilateral pneumonia on average 5 days after symptom onset.

re bolded: there's an exponential growth "phase" of the sigmoidal curve, which we're in right now. Since testing is so variable and unknown, one estimate of where we are on the curve is looking at death rates in Italy/Spain/France when they went lockdown compared to today, then apply our "delayed" start of social distancing date relative to Europe's. Italy shut down March 9 and had 366 deaths. They're at about 8,100 deaths today. France and Spain shut down about March 14 and had 79 and 121 deaths, today at 1700 and 4000 respectively. On March 20 (rough avg natl shut down date ?), US was at 150 deaths, 3 days later was at 340. Given the sheer size of our population, the fact that we have the most cases of any nation in the world and have started social distancing the latest relative to all other major nations with believable data, and similar association of curve to relative shut down dates, we're probably going to end up with the most absolute deaths for any country in the immediate future, and it probably won't be close. I'm using these tables as a reference. Also not so concerned about those table wrt accuracy to the case, just looking at gross relative numbers and associated points on curve.

things are about to get really shitty there

One thing Dr. Fauci spoke about at yesterday's presser is that with this coronavirus, there is concern over a possible observed phenomenon where re-exposure to the bug after you form immunity can result in a fatal immune response when the lungs are involved. In other words you drown from your own immune response targeting the lungs. So that is something that is being carefully looked at and understood before rushing out with a vaccine.

Normal quantities for restocking medical supplies got disrupted (I think cut in half in some cases) back in January due to the internal demand in China and other areas that got hit first by the pandemic. So even without our surge in need for mass PPE supplies, there was an acute shortage by any standard. Add that our demand has risen by some order of magnitude in a span of weeks and It's a deadly double hit.

I haven't tried to do absolute numbers. I'm watching for the change in the slope of the curve. On the whole. we are massively spiking right now. The good news is that epidemiologic math shows that even small changes to alter the rate of spread have huge effects resulting in lower total numbers visible after 3 weeks. Acting even one day sooner to implement strict social distancing can result in 40% fewer infections after 21 days. That is and has been happening to varying degrees regionally but big chunks of our country only really started a week ago.

It's just math. You can look at the numbers 2-3 weeks ago vs where we are today. If there were a significant percent of the population already exposed and asymptomatic offering herd immunity (a brake) we wouldn't be seeing the upslope we're seeing over the last 2-3 weeks. The curve will flatten and start to slow down, but that will be observed more regionally in a rolling fashion. It follows the hot spots today will be the first to show improvements in the curve. To the extent some areas have better numbers over the long term, it will be those places where the population acted favorably early on re distancing and measures like school closures happened fairly early before communities had a true sense of urgency.

Right - given that percentages remain fairly constant for a country re observable hospitalizations/complications and deaths, you can extrapolate to those curves that would otherwise be verified by mass testing. We're on the steep exponential upslope of the curve right now. No brakes, no seatbelts.

In that first clip, note that the French are making chloroquine available to "certain" patients buy they don't specify which ones. If I had to guess, they're using it on early uncomplicated cases. It's looking more and more like once the hypoxia and pneumonia set in, it's a downward spiral. This is an excerpt of a post by an ER doc in MS or LA forwarded to me by an ER doc friend:

The bad news is that Italy is a couple weeks ahead of us yet we have more cases than them today - most in the world despite the lag in onset. Factor in exponential growth and it doesn't look good.

It's an NSAID, like ibuprofen or naproxen. Not much out there, but the association probably has more to do with the NSAIDS as a class, and not ibuprofen alone. If you're ok with not taking ibuprofen, might as well avoid the class. Some people take aspirin for heart purposes by doc's order, so better for everyone to first ask their doc before stopping that. May not be worth the risk of stopping it. stay at home.

Recall on the 7th Trump said he wanted to keep Grand Princess cruise passengers on the ship so that US coronavirus numbers don't 'double.' fuckin a. less than 3 weeks ago.

German and French ICU docs made the same association about 3 weeks ago. Seems like an easy choice. Fauci at the podium said that even though causality has not been demonstrated, NSAIDS generally aren't vital by any stretch so might as well avoid them in the short term, then rec'd tylenol as a primary for fever.

Fauci laid a lot out in that brief appearance. Mainly focused on active research into treatments, and accurately explained the vaccine timeline justified by some pretty technical safety and efficacy considerations. He also previewed that we're going to be hearing about results soon, which sounded like within 2 weeks. I get the feeling he's on top of a lot of important work being done behind the scenes, which is good.

There was a brief follow-up question about the Defense Production Act asking him to give an example to back up his claim that he's invoked it Trump paraphrased: "we'll get back to you on that". This is outrageous. He is siding with boosting profits of members of the US Chamber of Commerce over expediting access life saving materials in a national emergency.

That was his verbatim response to the press question about his thoughts on the US surpassing China and Italy today for most coronavirus cases.

Press needs to call out his dissembling on the Defense Production Act. He just completely bamboozled with that response. #conman

US surpassing China to lead the world in virus cases? "It's a testament to our testing." "Tremendous testing"

There's not a consensus yet. Different studies have applied different non-overlapping parameters A French study used a 50% higher dose of the med than the Chinese study. That could mean the difference between therapeutic response and sub-therapeutic dosing. That's a thing. The French study also had another group which combined a second drug .The French study was not fraudulent. There are more robust experimental designs that will tell a lot more time, but time is of the essence right now. If anything, the first thing you look at from these basic studies is basic safety. We will be learning in the next 2-3 weeks about duplicate and variant studies, and other studies we haven't heard about. Obviously it's moving fast. Despite numerous positive case reports and reports of active protocols being actively used in multiple countries, it is premature to call anything a wonder treatment. stay at home.

eh, I don't agree with all that. The minimum requirement was that participants complete 6 days of testing. Any subject that couldn't do that didn't have data included piecemeal. Treating dropouts as "failures" (how you're defining that I have no idea) is not sound. Despite the dropouts, which happen in most every clinical trial, there were enough subjects in both the treatment group and the unmedicated control group who completed a sufficient duration of participation for valid statistical analysis. Again there was a control group - albeit the design wasn't randomized or blinded. There are more robust models with larger sample sizes forthcoming, but this study is pretty standard given the circumstances. It provides a clear reason to proceed further, not to abandon and look elsewhere. It's pretty basic stuff. I'm not saying "Eureka!", but given a quick risk/benefit analysis for a positive symptomatic covid case, I wouldn't defer having a conversation. The printed study: Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an openlabel non-randomized clinical trial The graphs on pages 24-25 are helpful visuals.

The outcome measure was viral load, not improvement or worsening of clinical symptoms. In other words, a subject could demonstrate a reduced or increased viral load in response to treatment but still die from complications unrelated to the viral load (poor outcome unrelated to dependent variable). The French study incorporated people across the full spectrum of illness with their only similarity being they had a confirmed positive covid result for at least 6 days prior. Intuitively early intervention will yield better results. So those people standing in line for HCHQ at the pharmacy likely will fare better than those starting treatment in a hospital on O2, all things being equal. I don't fault anyone for trying it with physician supervision. Med supply bottlenecks should also be getting resolved more quickly than PPE shortages.

Subjects typically do drop out of studies and that was accounted for in the write-up. Those drop-outs were not used for statistical analysis. It was a small sample size overall and not controlled. But to get a statistically significant result with a small sample size, you need a fairly robust treatment effect. Small differences in outcomes that are statistically significant require comparatively larger N subjects. A Type I error is more likely in the former, but this is more acceptable when the risk of treating is relatively low while the risk of doing nothing is high.

The Chinese study you reference with no statistical difference between groups used 400mg/d HCHQ dosing. The French study that showed statistically significant results used 600mg/d. That 50% higher dose could be the difference between therapeutic and sub-therapeutic dosing. just sayin.