triplehorn

damn. Until there's a safe and effective vaccine, China's total population and population density will continue to hold it hostage indefinitely. The sheer quantity of resources needed to stabilize rolling outbreaks in that country is beyond calculation.

There are already various cocktail combinations being used in other countries with a head start on us. That should allow for individual tailoring going forward.

Arky repurposing stills to make hand-shine

Azithromycin appears to promote some immune functions that have anti-viral effects

We're hearing some (premature) hints about the combination of chloroquine and the antibiotic azithromycin. Interesting info on the antibiotic: Azithromycin induces anti-viral effects in cultured bronchial epithelial cells from COPD patients The part at the end of the abstract about Azithromycin increasing expression of interferons in affected tissue is interesting. There's been anecdotal accounts from other parts of the world about interferon inducing meds having an effect fighting this coronavirus, Russia touting it in particular with its own "Cycloferon".

I do believe we are about to find out in short order that these meds make a real difference. Just my opinion, would hate to be wrong. Fauci was doing the responsible thing by not putting the cart before the horse and creating a partially informed public stampede that further places a counterproductive burden on the healthcare system. Of course, Trump is constantly looking for any way to claim credit, so he doesn't even pause to think about the problems his need for self validation causes. Shit, I even regret talking up CHQ on this site starting 2 weeks ago. Transparency helps, but making promises before any semblance of a coordinated national response has even materialized is asking for it. We still lack basic supplies.

It's people who have underlying cardiac conditions like a history arrhythmia or are already on other medications that affect cardiac conduction (like prolonging QT interval). A lot of medications unrelated to heart issues can prolong QT interval. So it's something for a provider to assess before going forward.

Striking real time evidence of flattening the curve --> KY vs. TN To be clear, the KY Governor is the opposite of a Trumper or Mitch acolyte.

Toilet paper brick Inside a bubble watching Shitty pandemic

Mass testing will be most useful if and when there's a consensus on medication applications, especially for early detection and intervention before pneumonia sets in. Otherwise, you're right. If you're not in acute respiratory distress, you stay home whether you have it or not.

SoKo already has an antibody test packaged and ready to go. The US having a version of this right now is essential. Recovery starts even before the peak hits.

The losses are real. People will come together. What is most important will become more clear.

(tl;dr) About 3 weeks ago I registered with the Oregon Health Authority for email updates after the first covid case was diagnosed here. A few days later when we were still at about 4-6 cases after the Vets in that nursing home got diagnosed down in the valley, I got an OHA email about a conference call with the press you could dial into to listen. I joined the conference which had a panel of several state level medical officials and other govt policy types. The 15-20min briefing was calm and reassuring and went on about the great length efforts that would be made to ensure the greatest protection and care would be provided to our cherished elderly Vets. Then on the call they said you could enter a code on your phone to ask a question. I got patched in after hitting the buttons as the first question for the panel. I identified myself and after acknowledging the effort to care for our nursing home elderly, I asked "considering this has a case doubling rate of 4 days with exponential spread, and that two weeks ago Italy was tranquil, and that right now our neighbors in Washington are under fire as I speak, what aggressive steps are are you considering to prevent spread such as social distancing or school closures when every day matters?" The moderator then asks, "what news outlet are you with? Oh, this is only for press reporters *click*." I stayed on to listen and there was a looong pause. The reporters were freaked and the whole discourse in the room shifted. The next day Gov. Kate Brown and some same panelists did a live webstream from PSU with a very different message speaking to urgency and laying out anticipated soon to be defined measures, making particular note of the predicament facing "our neighbors in Washington."

Cross posting from CFH on another thread - good overview of timelines and other considerations related to the immune response (doesn't speak to any medication effects). I think generally if you have enough virus for an infection that triggers the onset of symptoms, you have enough to trigger an immune response even if you knock it out with some medication in short order, though strength and types of response vary. thread VVV As the thread notes, other countries have already produced post-infection antibody detection tests. Having those available here as soon as possible is very important and will help our country get past this and back to normal work and routines.

I think what’s meant is that deaths today reflect relative case incidence for 15-20 days ago, ie about 5 to 6 case doubling intervals. So with no real flattening over the last 15 days we could see increases in absolute deaths that reflect two weeks of exponential spread.

yeah, that’s my quad of town. Very close to where I live. Learned about it yesterday from my neighbor. Not surprised in the least. It’s been in the community here at least 3 weeks. Not that I think I may have been exposed or anything.

Italy alone has had 627 more covid deaths in the last 24 hrs. It’s hard to imagine. Germany, who initially showed low death rate as a function of total positive cases, is also now showing 3% CFR by one analysis I saw, though likely lower due to undertesting. The death numbers appear to have been lagging and are starting to mount after it hit so fast with positive cases with lack of progression to deaths.

The good news is Teva (as mentioned again just above) apparently has 6 million doses ready to drop. So this could be a godsend. Obviously we still need guidance on how to best apply it. I'd go straight to the medical communities in China, SoKo, HK, Japan, Taiwan, Singapore (and even emerging observations in Italy and France) to find out their best consensus recommendations in light of the absence of controlled studies. Politicians need to get the hell out of the way as much as possible, here and abroad, and let the medical communities be the messengers and spokespeople on ow to best proceed. The bad news is that the supply of CHQ may be the least of our supply and rationing problems 10 days from now. It's going to be gut wrenching. fwiw, I've received notice from my state medical board to be prepared to be called into disaster relief efforts. So might about to be asked to step directly into the fray.

^^^ Graph omits Taiwan which is on same trajectory as its neighbors through use of same aggressive interventions. The ambivalent contradictory messaging and lack of definitive intervention from the top down will be crushing. Every single day we wait has a profound effect on numbers 3 weeks from now, because math.

cross posted: wasting little time with this is good news, especially when every single day delayed has a major impact on final numbers affected.

Yes. Exactly what we need to be doing right now. I expect there will be a sense of which way this is going to break within a couple weeks.

I appreciate you not calling me out by name but do recognize you're addressing me. I earned a medical degree over 20 years ago. I am licensed and have active board cert. To be clear, I am not giving medical advice to anyone here. I'm making observations when controlled data is lacking and wondering about unproven options that have a relatively low risk while offering potential significant upside when a global emergency is spreading like an ether fire. You may be able to think of examples in your experience when a new med came to market and lo and behold your experience and observations differ from what the drug companies advertised at the start in terms of uses, dosing, and efficacy. Physicians' observations and experience play an important role in clinical application. I'm sure you have some of your own tricks. Regarding "And please don’t tell us you’re convinced you have Covid if you haven’t been formally diagnosed. I have been involved in personally testing dozens of people and the vast majority with URI symptoms are still testing negative for now. So chances are your headache and sore throat isn’t Covid." First, I'm not convinced, I have no way to confirm it due to test rationing. Fwiw, I had fever and chills and trach and lung and involvement, not even a sore throat. Is that different than a headache and sore throat? It was to me. When you mention the majority with URI symptoms are still testing negative for now, that's an important qualifier. That could mean two different things off the top of my head. What do you mean?

Seems like the key chunk is the percentage of affected people who progress to needing ICU and/or vents, which is about 5% of all cases, definitely less than 10%, I believe. If early intervention with meds can cut the need for that level of care by a half or 2/3's, maybe we get just below the threshold that crashes the system. Maybe health care still gets swamped, but finding a way to curtail progression to pneumonia would go a long way to making a sustainable effort. Temporary hospitals in tents, hotels, boats etc can be set up in a reasonably quick manner and handle a lot of sick people. Even though it's that critical need for ICU's/vents that really grabs headlines, the shortage of PPE and Covid tests is almost equally as big an obstacle to getting a handle on this with no time to prepare. I'm hopeful that with millions of doses chloroquine now being essentially immediately available, there's a chance for an unforeseen turnaround. But our national total lack of preparation means we still stand to get t-boned over the next 4-8 weeks regardless. I think the linchpin will be early detection and treatment. The meds will almost assuredly be more effective at preventing/managing pneumonia if taken early as you mention, but that hinges on testing ---> so you just start giving out chloroquine for presumptive positives and tweener cases, which given the alternatives may be the best option under the circumstances.

Correct. As you are likely aware, there are many examples of medications that are commonly prescribed for off-label purposes, several of which do have legitimate potential side effects down the line but are used for things like insomnia or anxiety - second generation antipsychotics in particular. Documenting informed consent involving risks and benefits while not going Daktari on your patient is sufficient. The chloroquines are appropriate for off-label use because they are well established with a long track record. The theoretical mechanism has been demonstrated in vitro and there are early emerging accounts out of China, SoKo, and France with basic protocols that appear to offer benefit, if not dramatic benefit. That said, I'd pull stock and funnel it immediately to health care providers in the high exposure acute care settings to have if desired. The potential prophylactic benefits of chloroquine for exposed contacts needs to be considered. edit: holy crap just saw the Teva news. could be a real game changer. couldn't be more timely

For Burr, apart from whatever tea leaves you read about China, it's the contradictory signaling to the private group versus around a week later in a public op-ed that stands out. If he told the public in his op-ed as he told the private gathering recorded on tape - that we were facing something severely dangerous and more akin to 1918, one of the deadliest pandemics on record, seems like it would be harder to fault him. He'd be acting on information he also publicly disclosed. But that's not what happened. He used non-public information to inform a stock sale while shortly thereafter messaging to the public the opposite meaning. fuck that guy.