triplehorn

Felt good to get some real fresh air today.

NY Congressman Chris Collins was sentenced to 2 years in prison in January for the same thing Burr and miss Loeffler did.

Also everyone is wearing masks no matter what.

coralavirus reefs

'A generation has died': Italian province struggles to bury its coronavirus dead Coffins pile up and corpses are sealed off in homes as Bergamo’s funeral firms are overwhelmed "Coffins awaiting burial are lining up in churches and the corpses of those who died at home are being kept in sealed-off rooms for days as funeral services struggle to cope in Bergamo, the Italian province hardest hit by the coronavirus pandemic. As of Wednesday, Covid-19 had killed 2,978 across Italy, all buried or cremated without ceremony. Those who die in hospital do so alone, with their belongings left in bags beside coffins before being collected by funeral workers. cont."

Redneck in the rural Southwest handling stuff w deer mouse urine on it, imo. Remember Hantavirus ? deadly shit. That virus just lacked other features that prevented it from being the pandemic that this novel coronavirus is. Nature will always be generating new variations of bugs and the virulence and infectivity will ebb and flow with chance and evolution. But we definitely need to curtail things we can control, like wet markets, that are known accelerants to the number of "trials" new bug combinations get. There's a difference in chance outcomes over time when you roll the dice 10,000 times compared to 10 in the same time period.

Estimate of global numbers if rate curve doesn't flatten: Those numbers reflect that a lot horses are already out of the barn, but hopefully we do better than that.

curious what that means. In all seriousness, a lot of people will end up in physical trouble if access to etoh is abruptly curtailed. I don't see that exactly happening, but something locales should keep in mind to avoid adding insult to injury. #flattenthewithdrawalcurve.

Exactly. All of those longer term phased-in steps are important, not to mention how we adapt globally going forward to anticipate and respond to the next one as it's always lurking just below the surface. But as of today, full bore chloroquine/hydroxychloroquine with mass testing appears to be THE emerging path to rein this pandemic in within 30-60 days while maintaining strict standards for social distancing. The rate limiting step is production/availability of meds and tests. Chloroquine may be a godsend in that it's such a known quantity. It's been around for 50 something years, has well understood tolerance and safety parameters, has been taken by tens of millions of people, and is inexpensive. win win win.

I saw where Taiwan has implemented a 14 day quarantine for all people arriving from abroad. China is doing a lot of 14 day quarantines but I guess not everywhere for everyone. what I see (and hope) happens is that meds like chloroquine/hydroxychloroquine prove effective as prophylaxis or with early intervention after early detection. The key will be immediate mass availability of covid testing and production of effective meds. Positive tests should warrant immediately starting the med and contacts should be considered for prophylaxis. long term quarantine ultimately won’t work. Nature always finds a way.

Apart from the tragedy that it is, it raises questions about genetic predisposition to complications, something like a well above average expression of ACE2 receptors or something else we have yet to even recognize.

That's a 500mg tab of chloroquine, also comes in 250mg. Hydroxychloroquine comes in 200mg tabs, so x3 for 600mg/d is what was used in the French study that came out today. They appear to both work by the same mechanism of increasing intracellular zinc to thwart viral replication. This really could be it. Or at least could knock this bug down to a point where morbidity and mortality levels become comparable to flu. If that's the case we probably will rapidly establish stability in our health care system and form an acceptable compromise that lets us get back to normal routines. Full court press to manufacture enough of this, even if it's only a part of the picture of full success.

24/7

We’re going to take a beating over the next month, but I genuinely think we’re going to turn this around faster than than expected without long term shelter in place measures.

It wasn’t for you 😷

No. I received a legitimate prescription from a physician where I live for off label use of chloroquine. The doc takes this bug and what's happening very seriously and understood the rationale we discussed and supported my request. I got my scrip filled where I live. I gave my elderly folks information and they approached their PCP who also understood the rationale and gave them a prescription to hold and to use ONLY in event they get sick with presumed coronavirus. Yes there are potential side effects of and drug interactions with chloroquine and you should only take it with oversight from a physician. I took 500mg/d for 5 days in a row last week starting on the first day I noticed my airways were getting constricted. It seemed to halt the progression and 72 hours later I felt better. So far my lungs haven't turned to glass and I seem ok. I can't confirm yet whether I even had coronavirus. But I'm in a regional hot spot, I had 3 nights of sweats and chills, restricted breathing, and had rapid onset heaviness down in the middle of my lungs/chest. I had a single episode of diarrhea 2-3 days before the respiratory symptoms started, which one study out of China reports happened in 50% of cases of covid-19 in their study. A thin watery nasal drip started about a day before the airways got involved. I think I got it from my kid week before last who has also had upper airway and chest involvement that's just now clearing up . The classroom teacher fell out with sickness Tuesday last week, same time my symptoms ramped up. Malaria prophylaxis is one tab (500mg) once per week. So the dose being used in other countries for covid is notably higher. It's also why the pharmacist was asking a lot of questions. I had to visit and contact about 4 different pharmacies to find a small quantity. When I got to final pharmacy they said they couldn't find it. Supposedly finally found it in the "expired meds" bin. Then couldn't fulfill it because I wasn't registered in their system. It was like they were trying to find any reason to not fill it. I was feeling the symptoms coming on and didn't have much patience for having to explain at that point.

good interview w Dr. Fauci. responds to questions about NSAIDS and ACE inhibitors, for one.

Schools will remain open for the children of the most vulnerable? Unless those are boarding schools, might as well take a bullet.

I took Chloroquine for 5 days last week when I was pretty certain I had been sick w Covid for about 5-6 days. Felt notably better 3 days later. My elderly folks in Dallas got an Rx from their PCP in Dallas after communicating info about it with them. Step-dad takes anti-arrhythmia meds so pharmacist wouldn't fill over weekend until could talk w doc (fuuuuuuuuuk). So mom ordered from online pharmacy in MX. But now pharmacist finally releasing it. Also, not every pharmacy exactly has this in stock. I had to hunt for it where I am then had to spin a story to convince them I was going scuba diving in Honduras to prevent malaria instead of off label use to get the pharmacist to let me have it. jfc.

not great. Common knowledge is that a typical sign of alcohol withdrawal is acute transient hypertension, even of a withdrawal severity not requiring formal medical detox. Safe to say that anyone going to the ER with possible covid acute respiratory distress should be sure to notify triage about alcohol use. If by chance you're admitted and get intubated, that's important history you may not be able to communicate after you're tubed. Just glancing at mechanical ventilation sedation protocols on the web, looks like propofol is most used, or midazolam if propofol is poorly tolerated. Midazolam (Versed) is a relatively short acting benzodiazepine. Benzodiazepines are indicated for acute alcohol withdrawal and will help bring down hypertension from acute alcohol withdrawal. But due to short half life of midazolam, using a longer acting benzodiazepine like Ativan or Librium might be better for acute hypertension associated with alcohol withdrawal. I think it's very likely alcohol withdrawal, even mild to moderate in people who don't self identify as being at risk, is likely a significant contributor to bad outcomes during the acute management of covid ARDS. To the extent this is being considered by the front line docs, and can be co-managed, more lives may be saved. ---> I could be wrong. just my opinion. Still tell any docs or triage about regular alcohol use to be safe.

China started the Wuhan lockdown on Jan 23rd. Feb 3rd was about the last day they showed the cases double 4 days later (~max observed unconstrained doubling rate). Starting about Feb 4th the doubling rate shifts to about 6-7 days and the curve really got flat by Feb 11th. So 12 days to appx double the doubling time and 19 days to flatten the rate of new cases. So yes hopefully we see the case double rate double (ie spread half as fast) in Italy 3 days from now and in 10 days flatten out all together. That will still leave many thousands on life support going forward.

We might get to threshold herd numbers faster than imagined. Really underscores the emerging need for mass antibody testing, ideally an at home test.

Whoever comes up with a mass produced home administered covid antibody test is going to make a haul.