>I am worried there is a fine line between 'realism' and a backlash against care for the elderly and chronically ill.
I guarantee you that if we don't target our lockdowns on the at-risk population (elderly being the most numerous in that group), whatever backlash there is will be worse when the general population realizes they aren't at any significant personal risk.
>Hydroxycholorquine is interesting [1] both as an anti-inflammatory and immune modulator. The Azithromycin probably does nothing against nCoV-2 but may well help control secondary infection.
I had no clarity as to why azithromycin had improved the outcomes in that study to 100% of those treated with it, when HCQ didn't. That's very interesting.
Maybe you could clarify something else for me. Is there any information about whether these two drugs together could function as a prophylactic, or is this something patients have to be administered at the beginning of symptoms, or is this something that can be done late in the course of the disease?
You're putting words into my mouth. And I really don't appreciate it. In fact, I think that our focus should be directly on the at risk population. I think we should do more to protect them and provide a whole host of interventions and services. I think we can do that without causing a depression; Remember, the effects of economic downturns affect every single aspect of peoples lives including their health. If we do this wrong even more people may die or have significant, long lasting, hardship because of an ill-considered and potentially unnecessary intervention.
Read through my profile to find what I've said to this end, I don't feel like giving you any more of my time after you've not given me the benefit of the doubt and basically called me inhumane.
>We don't usually call a disease that can easily evolve to pneumonie "a cold".
That's not true. Just not true. Colds and influenza regularly proceed to pnemonia or long lasting secondary lower respiratory infections, especially in the elderly but also in the young and healthy.
>Way more people need a stay in an hospital (sometimes short).
No that isn't clear at all. The current understanding is that because the infectivity is so high the proportion of cases that are serious come in many times faster than other respiratory viruses, and on TOP of other respiratory illnesses.
>This disease as the power to double (or even worse) the mortality rate of industrialized country during months or even years.
That's potentially true, but it isn't necessarily true. The excess mortality of this disease -- it is plausible and it can be sensibly argued, may not be that high. That is because it is killing, in general, those who are already ill. In Italy 88% of those who have died had one or more serious commodities such as heart disease, and that is on top of the fact that the median age of death is currently 81 (median case age 63.) An unknown but potentially high proportion of these deaths may have happened in the next two years anyway. So at the end of this the excess mortality rates may not be anywhere close to double amortized over two years, and consequently in two years we might see a drop in general mortality rates as a result (if this illness does end up infecting >50% of the population as some leaders have seen fit to say.
>That some people are even asymptomatic is not even a particularly good news IMO. It will just spread more because of that...
It is good news, definitely. Because it means that we don't need to worry about most people. We need to worry about those at high risk. We may be able to get through this by focusing on isolating, social distancing, and providing at home resource for those at significant risk. Such a strategy, if properly done, could even be used to allow the illness to travel through the otherwise not vulnerable population creating herd immunity which will allow those at risk to come out of quarantine earlier.
No we typically don't. But in this case we may have. The science is beginning to point to the fact that this virus is not particularly lethal, but it is extremely contagious with an R0 of at least 2. That's where the danger lies -- if this was the plague and more than half of people who got it died our response should be what China did or perhaps significantly stronger than that. But there may be better options that don't doom an entire generation to an economic depression and its manifold consequences (which in and of themselves, in the long run, could kill more people than this disease ever will.)
in the case where the disease itself is not particularly lethal.
The lockdown stuff that has economic consequences is speculated to need to last as long as 18 months! Even two months will cause untold damage that will have knock on effects for years, perhaps decades. We didn't even recover from 2007 before this latest downturn and the effects have rippled through our society touching everything, including suicides.
That's too bad. We really need to ramp up PCR tests as well as begin serological studies (there is one I am ware of, and a product on the way.) Immediately. We will not get this under control if we don't. We need to know how fast it's spreading, where, and so on.
It is clear that in some ways our hands are tied on testing, but a case like yours at this time knowing if you have it or not could affect your course of treatment.
To be clear, the evidence seems to be that your outcome is still in the minority of cases. Some unknown but double digit percentage experience no symptoms at all despite testing positive, another large proportion only experience upper respiratory symptoms and never get a lower respiratory infection or pneumonia, finally there are so called "mild" cases which I believe are "a bad flu." What these proportions are exactly is unclear, but it is clear that the vast vast majority people are not at risk of death. The data is unreliable and all over the place, but it's trending in this direction: in otherwise healthy people, this isn't particularly lethal.
I am not a doctor but you should probably get tested.
I had read that rebuttal. The odd thing about it is as the author himself wrote, I'm not sure that Ioannidis is advocating inaction. Neither would I. Things must be done. It's that it's completely unclear that the "lockdown" stuff that is going to cause a new depression is actually worth it, or effective. And because lockdown is so vague, I mean not allowing people to go outside under threat of imprisonment and fines, or needing papers to travel somewhere. It may be an extreme overreaction, and I personally believe the cure would be worse than the disease. There are other things we can do.
Here's speculation based on data:
I can't help but see the demographics of those who are dying and come to the conclusion that this is not a threat to the general population in the direct sense. No one aged 0-9 has died worldwide to date. No one in Italy under 30 has died. Of those that have died in Italy, 88% had one or more serious comorbidities; only 12% can be directly attributed to COVID-19. It seems that this is killing people who are already sick or in fragile health; it just so happens that the elderly of course dominate those categories. Consider this: nearly 3,000,000 people die every year in the USA. How many of those who will die this year from COVID-19 will overlap with that 3,000,000? In other words, could it be that the excess mortality rate of COVID-19 when amortized over the next two years isn't actually that high? Does it make any sense to throw ourselves into a depression because of this? Remember, the effects of eceonomic downturns affect every single aspect of peoples lives including their health. If we do this wrong even more people may die or have significant, long lasting, hardship because of an ill-considered and potentially unnecessary intervention.
I read a paper this morning that suggested some things that I believe need more attention:
> For example, we are learning that hospitals might be the main Covid-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients. Patients are transported by our regional system,1 which also contributes to spreading the disease as its ambulances and personnel rapidly become vectors. Health workers are asymptomatic carriers or sick without surveillance; some might die, including young people, which increases the stress of those on the front line.
>This disaster could be averted only by massive deployment of outreach services. Pandemic solutionsare required for the entire population, not only for hospitals. Home care and mobile clinics avoid unnecessary movements and release pressure from hospitals.2 Early oxygen therapy, pulse oximeters, and nutrition can be delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments. This approach would limit hospitalization to a focused target of disease severity, thereby decreasing contagion, protecting patients and health care workers, and minimizing consumption of protective equipment. In hospitals, protection of medical personnel should be prioritized. No compromise should be made on protocols; equipment must be available. Measures to prevent infection must be implemented massively, in all locations and including vehicles. We need dedicated Covid-19 hospital pavilions and operators, separated from virus-free areas.[0]
Absolutely. One of the worst consequences that we may have to deal with at the end of this is that public trust will go down. In the beginning our leaders failed to act on the guidance of the scientific and medical communities -- almost two months wasted. And now, our leaders are flailing around implementing policy that is not based on reliable data or scientific evidence. They've both failed to react and then when they did react they are in many ways failing to act prudently.
Take a look at this editorial written by John Ioannidis. Excerpt that is relevant, though the whole thing is a worthwhile read:
>If COVID-19 is not as grave as it is depicted, high evidence standards are equally relevant. Exaggeration and over-reaction may seriously damage the reputation of science, public health, media, and policy makers. It may foster disbelief that will jeopardize the prospects of an appropriately strong response if and when a more major pandemic strikes in the future. [0]
Quick BIO rip from wikipedia:
>Ioannidis studies scientific research itself, especially in clinical medicine and the social sciences. He is one of the most-cited scientists in literature. His 2005 paper "Why Most Published Research Findings Are False" is the most downloaded paper in the Public Library of Science, and has the highest number of Mendeley readers across all science."
>Ioannidis is a Professor of Medicine, of Health Research and Policy and of Biomedical Data Science, at Stanford University School of Medicine and a Professor of Statistics at Stanford University School of Humanities and Sciences. He is director of the Stanford Prevention Research Center, and co-director, along with Steven N. Goodman, of the Meta-Research Innovation Center at Stanford (METRICS). He is also the editor-in-chief of the European Journal of Clinical Investigation. He was chairman at the Department of Hygiene and Epidemiology, University of Ioannina School of Medicine as well as adjunct professor at Tufts University School of Medicine.
It's not all that confusing. The science is pretty clear. The best use of masks on people in public is on the sick themselves. You can't use the standards and practices in something like a TB hospital for medical personnel in public spaces. Not only is it an inefficient use of resources, but the efficacy is in question.
You cannot expect the general population to adhere to the standards of a TB hospital. It cannot be done, even if it was a good idea. For example, standard practice is that a mask is meant to be worn for only 8 hours and that is under the assumption that you have no reason to believe you were exposed. If the mask becomes wet, damp, or if you have any reason to believe you've been exposed you're supposed to immediately doff it carefully and dispose of it. Typically PPE is used only once per exposure, or is reused for exposure to one patient at a time.
There are so many variables at play here. From the efficacy of the masks themselves, the best allocation of resources, the different varieties of masks, the techniques for proper fitting, the decontamination processes, other PPE. Does this mean masks are not useful? No. And you won't find many experts making this claim. It's clear that masks help.
Think critically about this. It is not as simple as "masks good" or "surgeon general lied." There are manifold hysterics going around -- please don't contribute to it.
Is this a serum or antibody test? If so, this is very good news.
If mass testing occurs we will know very soon the true nature of the disease. For example, after serum testing for H1N1 we learned -- to our horror -- that 1.4 billion people had it. However, it also meant that H1N1 wasn't as dangerous as we thought it was.
I hope this will give the medical community and our governments the clear data we desperately need. The decisions our governments are making are based on unsound data -- we are flying blind.
Is it? It's a letter intended to persuade President Donald Trump to act in relief of California. I think the statistic is not out of context. There's nothing in that letter that changes the meaning.
We have outside knowledge with respect to the letter that changes how we understand that number, but it has been rhetorically used in the letter just as it is quoted in the title.
Often times things are sensationalist, or out of context, this is not one of those situations.