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CR: COVID-19 --Political Talk

Mrs Whiggins

By Mrs Whiggins
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I'd just like to point out that neither myself nor any of my fellow nurses, fellow advanced nurse practitioners, and other healthcare providers ever swore an oath that we would lay down our lives for

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Welp, it finally happened. I snapped in public today. I went into work for a bit this morning because I’m trying to figure out the safest way to host physicians we are recruiting given our CV-19 sit

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I don't really know what to say anymore tbh. What happened last night is hard to put into words for anyone who hasn't worked in a hospital healthcare setting. Just unreal. Everyone is getting fucked.

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Macanudo

Macanudo 12937

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1 minute ago, David Dennison said:

Every time he speaks, you get a real picture of how far the United State of America has fallen.

Why is it that we see that but so many dont?  Is it because when he talks they can understand his mouth breathing knuckle dragging words?

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David Dennison

David Dennison 18731

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2 minutes ago, Macanudo said:

Why is it that we see that but so many dont?  Is it because when he talks they can understand his mouth breathing knuckle dragging words?

Racist white people support Donald Trump and the Republican Party because they represent white grievance. They feel put upon. They feel like they are the victims.

It really is that simple.

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Mikey4

Mikey4 2476

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So China, with 1.4 BILLION people, and no time to prepare, limited cases to 80K, but the U.S., with 325 million people, and several weeks' advance notice, it going to be ravaged by this virus. What an epic failure.

And yes, I know that China's numbers are way understated, but so are ours, and there's no denying that China handled this virus exceptionally well compared with the blundering idiocy that we employed.
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InkaUtexas

InkaUtexas 25567

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2 minutes ago, Mikey4 said:

So China, with 1.4 BILLION people, and no time to prepare, limited cases to 80K, but the U.S., with 325 million people, and several weeks' advance notice, it going to be ravaged by this virus. What an epic failure.

And yes, I know that China's numbers are way understated, but so are ours, and there's no denying that China handled this virus exceptionally well compared with the blundering idiocy that we employed.

Agree, but we cannot shut down Barton Springs let alone a city. 

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InkaUtexas

InkaUtexas 25567

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Coronavirus: Man planning to bomb Missouri hospital killed, FBI says

A man suspected of planning to attack a hospital treating coronavirus cases in the US state of Missouri died after a shootout with the FBI, officials say.

The confrontation happened as agents tried to arrest the 36-year-old in the city of Belton as part of a domestic terrorism investigation, the FBI said.

Officials said the man was motivated by racist and anti-government beliefs.

He had allegedly considered a range of targets before settling on the hospital because of the current outbreak.

The suspect, identified by authorities as Timothy R Wilson, had been under surveillance for months, which revealed him to be a "potentially violent extremist" who had expressed racial and religious hatred, the FBI said in a statement.

Wilson had previously considered attacking a school with a large number of black students, a mosque and a synagogue, according to the FBI.

https://www.bbc.com/news/world-us-canada-52045958

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BrickHorn

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54 minutes ago, triplehorn said:

Treating dropouts as "failures" (how you're defining that I have no idea) is not sound.

Those dropouts dropped out because, after receiving “treatment,” they were on ventilators in the ICU. At least one of those dropouts dropped dead. That this study omitted a sizable chunk of treated patients from its statistics because those patients were too busy struggling to survive or actually being dead to take a nasal swab shows how worthless the results are for determining the one thing that matters: will this medicine cure me or am I still going to choke to death in a hospital bed?

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Anastasis

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43 minutes ago, triplehorn said:

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.  

 

I completely agree that we should proceed with better designed studies with larger sample size. I would enroll myself without hesitation in such a trial.  I have hopes that HCQ will shake out. It seems like our best out given the circumstances, and the small study definitely establishes a signal.

But let's keep a clear head and not get ahead of the data. Differential drop out is absolutely a problem, and should be accounted for in the analysis imo. Especially when all but 1 of the drop-outs are treatment failures (defined as PCR positive or dead at last observation). At a minimum carry the last observation forward and report the LOCF data as a secondary analysis. The baseline differences in viral load could very well explain the results; however, teh sample size is too small for any sort of statistical adjustment. I don't know enough about the range of the viral load to suggest cut points, but maybe a stratified analysis would be insightful. I don't see anything in the +Azithromycin data that is compelling, it's literally an N of 6 and much younger pts (range 20-60 vs, 25-87 for HCQ only group).

I'm good with chasing the lead based on a signal. Maybe the data gets there and we can speak definitely.  I fucking hope it does.  And maybe in the mean time the president can stfu and stop tweeting about it and creating supply chain problems. Let the ID docs do their thing.  We all want something to be optimistic about with this shit.   

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