Coronavirus

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Mormad
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Lots of things are approved by the FDA for use, and yet still require monitoring and regulation. The government regulating the use of approved medical care is nothing new.

The rapid test may be less accurate. In fact, Spain found it to be about 30 percent accurate. Just like the flu rapid antigen test, it may or may not be reliable. I don't think any doctor or politician is ready to count on that yet. Maybe one day, we'll see. Several antibody tests are becoming available. We'll see how they're used.

The drug is very old, but it doesn't mean all docs understand it because most don't prescribe it regularly. This one has some potential harmful SEs, especially along with a zpak which also can prolong QT intervals. Also, just because the FDA allowed compassionate use doesn't mean docs will play nicely. See the opioid crisis. As a doctor I hate to say it, but they still have to regulate my peers until there's a huge supply of drug to manage those who actually NEED it. Just the way it is. The regulations should only hold as long as it takes to produce more drug.

I don't believe the government knows the next steps. Maybe you understand the disease and all its implications better than those about whom you speak. Most of the infectious disease docs and pulmonologists I discuss this with have no real feeling for what's coming, they just know it's coming and hope for the best and prepare for the worst. Because when they don't people die. If I knew what the next steps should be (other than hoard PPE, ventilators, and drugs) based on what I'm seeing, hearing, and reading everyday I'd tell you guys. I suspect our leaders are feeling the same way.

There is no politician or doctor benefiting from this crap. The docs are nervous. Italian docs are dying. There is not one person aside from the media and bachelor contestants who want life shut down one day longer than necessary because we're ALL LOSING.
Daviewolf83
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If people are interested, here is a link describing the test approved by the FDA yesterday:

https://www.abbott.com/corpnewsroom/product-and-innovation/detect-covid-19-in-as-little-as-5-minutes.html#sf232041268

Also, with regards to testing, the US has now passed South Korea in the number of daily tests (per capita):

On March 26th, Korea performed 12,019 tests. That's 235 tests per million population.
In the US, on March 26th, 107,172 tests were performed. That's 325 tests per million population.
Mormad
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Great for Abbott. Now let's just hope it works. As I said, lots of tests coming. But they gotta be accurate and highly available to make a difference. Here's to hoping.
Packchem91
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RunsWithWolves26 said:

Ground_Chuck said:

952 confirmed cases in N.C., 115k nationwide.

We added 35k cases in the last two days.


53,000 cases in NY alone
And another 8k in NJ.
I assume 90% of those are in NYC / Metro?

Why is NYC so much worse off than the other big cities in US? Places like Chicago, SF, LA are crowded too. but the scale is several orders of magnitude worse.
lumberpack5
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The density of NYC is orders of magnitude greater than LA, SF, or Chicago.

NYC has 8 million people and a density of 27K per square mile
SF has 800K people and a density of 17K per square mile
Boston has 600K people and a density of 13K per square mile
Chicago has 2.6 million people and a density of 12K per square mile
Philly has 1.5 million people and a density of 11K per square mile
LA has 4 million people and a density 8K per square mile

Manhattan has a density of 67K per square mile and a population in excess of a 1.7 million

There is not another city in North America that is comparable to NYC in terms of total population and population density. While Mexico City is close terms of population and is a dense as SF, it's not NYC from an infrastructure standpoint meaning the speed at which the the transportation system allows them to move.

If you rank ordered NA on population and density as combined separate factors you get something like:

1. NYC
Gap
2. Mexico City
Big Gap
3. Chicago/Toronto/Philly
4. SF/Vancouver/Montreal
5. Houston, LA, Dallas, Denver

Another way to think about it is to think about the transit systems in the cities. If they have a real subway they have readily communicable density because without the density you would have no need for a subway. Some cities have a subway because they need it, some have a subway for specific transportation issues - Atlanta and MARTA for example.
I like the athletic type
DirtPitPacker
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Mormad said:

There's no strong evidence it "work's." There is however some encouraging news. The "study" has big holes in it.

NC has also restricted use on an outpatient setting. Cannot be prescribed to those not infected. Until more is produced, have to preserve supply for the sick or those with conditions more commonly prescribed like RA, AS. No evidence that I know of that suggests it should be used prophylacticly...yet. should be an easy drug to produce for sure. Have to be careful about potential harms of the drug (QT prolongation, hypoglycemia, electrolyte disturbance, irreversible retinopathy, potentiation of certain meds).
There is a not insignificant indication that Plaquenil works. But just as important, Plaquenil has a well established safety profile. So this direction is not a reckless direction to take as implied by some. And until a better pathway is established, convince me we should deny Plaquenil to symptomatic patients. A fundamental tenant of the Hippocratic Oath is, "first do no harm". Plaquenil seems to fit well into this criteria.
packgrad
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PackBacker07 said:

They are saving these drugs for folks who actually need them to survive. For folks who have diseases where these drugs have actually been approved. If governors, etc didn't invoke these orders then you'd have idiots hoarding this stuff, prescribing to family/friends, etc like mormad mentioned. To pull out "Democrat Governor Blah Blah is banning" is an asinine talking point drummed up by people with political motives.


Right. Because ordinary people can "hoard" these drugs. The governors are being political assbags and the left is defending them because "Trump ".

Mormad
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There is no good class A evidence that it works for covid-19. There are 6 little papers with weak evidence from a medical study point of view. This is why it's given authorization for compassionate use while studies are designed and implemented. That's why it's being used in sick patients, but there are warnings against using it in asymptomatic patients or minor illness. Again, I listed some common concerns with its use (sudden death from prolonged QT which is exacerbated by other drugs like a zpak, antidepressants, etc, hemolytic anemia in those with G6PD which is common in AA males, problems with K or Mg, hypoglycemia, irreversible retinopathy). There will be a price to pay for some individuals, and that price may be high if they're treated for minor disease. That's not do no harm. Look, I hope it works. I hope it's a wonder drug until a vaccine is established. But it has limited evidence for now, and certainly not enough to start widespread use for those that aren't really sick and hospitalized.
Packchem91
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lumberpack5 said:

The density of NYC is orders of magnitude greater than LA, SF, or Chicago.

NYC has 8 million people and a density of 27K per square mile
SF has 800K people and a density of 17K per square mile
Boston has 600K people and a density of 13K per square mile
Chicago has 2.6 million people and a density of 12K per square mile
Philly has 1.5 million people and a density of 11K per square mile
LA has 4 million people and a density 8K per square mile

Manhattan has a density of 67K per square mile and a population in excess of a 1.7 million

There is not another city in North America that is comparable to NYC in terms of total population and population density. While Mexico City is close terms of population and is a dense as SF, it's not NYC from an infrastructure standpoint meaning the speed at which the the transportation system allows them to move.

If you rank ordered NA on population and density as combined separate factors you get something like:

1. NYC
Gap
2. Mexico City
Big Gap
3. Chicago/Toronto/Philly
4. SF/Vancouver/Montreal
5. Houston, LA, Dallas, Denver

Another way to think about it is to think about the transit systems in the cities. If they have a real subway they have readily communicable density because without the density you would have no need for a subway. Some cities have a subway because they need it, some have a subway for specific transportation issues - Atlanta and MARTA for example.
Thanks...didn't realize the gap was so big.
PackBacker07
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packgrad said:

PackBacker07 said:

They are saving these drugs for folks who actually need them to survive. For folks who have diseases where these drugs have actually been approved. If governors, etc didn't invoke these orders then you'd have idiots hoarding this stuff, prescribing to family/friends, etc like mormad mentioned. To pull out "Democrat Governor Blah Blah is banning" is an asinine talking point drummed up by people with political motives.


Right. Because ordinary people can "hoard" these drugs. The governors are being political assbags and the left is defending them because "Trump ".




This has nothing to do with Trump! Give it a rest.
PackBacker07
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packgrad
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Fauci should read "The Boy Who Cried Wolf".
GoPack71
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That's better than the millions he predicted would die a few weeks ago
Glasswolf
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PackBacker07 said:


If people would just keep themselves home this would be over by now. I went by Umstead Park yesterday. Gates are barricaded but Glennwood Ave had cars lines up parked on the side. Just stay home. Some people I guess are smarter than the medical experts
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wilmwolf
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My neighborhood looks like the Boston Marathon today. And I don't know what good it does for parents to stay away from each other when the neighborhood kids are roaming in packs.
Just a guy on the sunshine squad.
Mormad
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wilmwolf80 said:

My neighborhood looks like the Boston Marathon today. And I don't know what good it does for parents to stay away from each other when the neighborhood kids are roaming in packs.


Ha! So true! Better to stay in and try new Bourbons I think...well, maybe not the kids.
DirtPitPacker
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Mormad said:

Lots of things are approved by the FDA for use, and yet still require monitoring and regulation. The government regulating the use of approved medical care is nothing new.

The rapid test may be less accurate. In fact, Spain found it to be about 30 percent accurate. Just like the flu rapid antigen test, it may or may not be reliable. I don't think any doctor or politician is ready to count on that yet. Maybe one day, we'll see. Several antibody tests are becoming available. We'll see how they're used.

The drug is very old, but it doesn't mean all docs understand it because most don't prescribe it regularly. This one has some potential harmful SEs, especially along with a zpak which also can prolong QT intervals. Also, just because the FDA allowed compassionate use doesn't mean docs will play nicely. See the opioid crisis. As a doctor I hate to say it, but they still have to regulate my peers until there's a huge supply of drug to manage those who actually NEED it. Just the way it is. The regulations should only hold as long as it takes to produce more drug.

I don't believe the government knows the next steps. Maybe you understand the disease and all its implications better than those about whom you speak. Most of the infectious disease docs and pulmonologists I discuss this with have no real feeling for what's coming, they just know it's coming and hope for the best and prepare for the worst. Because when they don't people die. If I knew what the next steps should be (other than hoard PPE, ventilators, and drugs) based on what I'm seeing, hearing, and reading everyday I'd tell you guys. I suspect our leaders are feeling the same way.

There is no politician or doctor benefiting from this crap. The docs are nervous. Italian docs are dying. There is not one person aside from the media and bachelor contestants who want life shut down one day longer than necessary because we're ALL LOSING.
Good post. I would add that the ventilator options to manufacture are out of control. It would make much more sense to tap a company like Philips Respironics who is already a major brand in CPAPs. CPAP is a "first cousin" to a ventilator. So you've got a company who already has expertise in that arena. Craziest thing I've heard is Ford using a heater blower from their F-150 truck. Nowhere near enough pressure. Plus, the fan is not rated for continuous duty 24/7, just for starters. Crazy.
Ground_Chuck
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RunsWithWolves26 said:

Ground_Chuck said:

RunsWithWolves26 said:

Ground_Chuck said:

410 cases in NC, 46,000 cases nationwide.

We will probably 80k cases by end of week.


Right on track then. Dr. Berx said last week they expected cases to be between 50,000-150,000


By the end of the month or total?


I believe she was speaking of total but not 100% on that. She talked about it in terms of taking steps now to prevent what has happened in China and Italy. She may have been using it as a reference and not a definate. That I do not know.
Looks like we are going to hit 150k by end of month.

1,124 cases in NC, 133,146 cases nationwide.

19.5k new cases yesterday
packgrad
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wilmwolf80 said:

My neighborhood looks like the Boston Marathon today. And I don't know what good it does for parents to stay away from each other when the neighborhood kids are roaming in packs.


Lowe's garden center is packed today.
Glasswolf
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packgrad said:

wilmwolf80 said:

My neighborhood looks like the Boston Marathon today. And I don't know what good it does for parents to stay away from each other when the neighborhood kids are roaming in packs.


Lowe's garden center is packed today.
Home Depot Garden Center on Capital was packed yesterday. Everyone was keeping their distance but still. Rest of the store was almost empty
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RunsWithWolves26
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Ground_Chuck said:

RunsWithWolves26 said:

Ground_Chuck said:

RunsWithWolves26 said:

Ground_Chuck said:

410 cases in NC, 46,000 cases nationwide.

We will probably 80k cases by end of week.


Right on track then. Dr. Berx said last week they expected cases to be between 50,000-150,000


By the end of the month or total?


I believe she was speaking of total but not 100% on that. She talked about it in terms of taking steps now to prevent what has happened in China and Italy. She may have been using it as a reference and not a definate. That I do not know.
Looks like we are going to hit 150k by end of month.

1,124 cases in NC, 133,146 cases nationwide.

19.5k new cases yesterday


Probably so. Let me know when it kills 2.2 Americans.
Wayland
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Ground_Chuck said:

RunsWithWolves26 said:

Ground_Chuck said:

RunsWithWolves26 said:

Ground_Chuck said:

410 cases in NC, 46,000 cases nationwide.

We will probably 80k cases by end of week.


Right on track then. Dr. Berx said last week they expected cases to be between 50,000-150,000


By the end of the month or total?


I believe she was speaking of total but not 100% on that. She talked about it in terms of taking steps now to prevent what has happened in China and Italy. She may have been using it as a reference and not a definate. That I do not know.
Looks like we are going to hit 150k by end of month.

1,124 cases in NC, 133,146 cases nationwide.

19.5k new cases yesterday

Positive test cases are a useless stat unless you have done true population sampling, it likely already IS 150k. I am ok for now looking at hospital admissions and ICU numbers. Death numbers are an ok tracking metric too. Might be able to extrapolate some numbers using Iceland's numbers. Norway is going to do true sampling soon too, looking forward to seeing more meaningful data.
Daviewolf83
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More on the combination of hydroxychloroquine and azithromycin to treat Coronavirus. The drug combination was just approved by the French government as a treatment for Coronavirus. I have linked to the PDF to the entire study below:

https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-IHU-2-1.pdf

I found this statement in the Abstract to be interesting:

"In 80 in-patients receiving a combination of hydroxychloroquine and azithromycin we noted a clinical improvement in all but one 86 year-old patient who died, and one 74 yearold patient still in intensive care unit. A rapid fall of nasopharyngeal viral load tested by qPCR was noted, with 83% negative at Day7, and 93% at Day8. Virus cultures from patient respiratory samples were negative in 97.5% patients at Day5. This allowed patients to rapidly de discharge from highly contagious wards with a mean length of stay of five days."

Glasswolf
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90's Country Music star Joe Diffie has died from the virus
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CLTWolf
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Glasswolf said:

PackBacker07 said:


If people would just keep themselves home this would be over by now. I went by Umstead Park yesterday. Gates are barricaded but Glennwood Ave had cars lines up parked on the side. Just stay home. Some people I guess are smarter than the medical experts
Finger wagging everyone that's out and about while you were out and about as well? lol, nice.
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packgrad
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https://www.foxnews.com/politics/trump-coronavirus-briefing-death-rate-social-distancing

" Furious nurses staged protests outside of Jacobi Hospital's emergency room in the Bronx over the weekend, claiming there was a dangerous shortage of masks and gloves there. Sean Petty, a pediatric nurse at the hospital, told the New York Post: 'We need billions of N95 masks. This policy that was put out by the [Centers for Disease Control and Prevention] is killing nurses. We already lost our first nurse in New York City. We're gonna lose more."

Starting to think we need to stop giving random medical professionals a microphone. The hyperbole and fear mongering is getting out of control.

Billions. They need billions of masks.
Daviewolf83
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I have included a link to one of the primary models cited today for the extension of the social distancing lock-down until the end of April. I think most metro areas will not open up until June (assuming the model holds), but some areas that get to the downhill portion of the curve sooner could start opening up in mid-May. Of course, as mentioned in today's press conference, testing must continue to increase. While focus remains in the short-term on people in hospitals exhibiting symptoms, they said testing will have to extend to the broader population. The new test developed by Abbott Labs recently was mentioned.

The link to the model mentioned above is found here: https://covid19.healthdata.org/projections
Mormad
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packgrad said:

https://www.foxnews.com/politics/trump-coronavirus-briefing-death-rate-social-distancing

" Furious nurses staged protests outside of Jacobi Hospital's emergency room in the Bronx over the weekend, claiming there was a dangerous shortage of masks and gloves there. Sean Petty, a pediatric nurse at the hospital, told the New York Post: 'We need billions of N95 masks. This policy that was put out by the [Centers for Disease Control and Prevention] is killing nurses. We already lost our first nurse in New York City. We're gonna lose more."

Starting to think we need to stop giving random medical professionals a microphone. The hyperbole and fear mongering is getting out of control.

Billions. They need billions of masks.


You can always do some scrubs and come on out on the front lines if you want.
WarrenPeace
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CLTWolf said:

Glasswolf said:

PackBacker07 said:


If people would just keep themselves home this would be over by now. I went by Umstead Park yesterday. Gates are barricaded but Glennwood Ave had cars lines up parked on the side. Just stay home. Some people I guess are smarter than the medical experts
Finger wagging everyone that's out and about while you were out and about as well? lol, nice.


Thought you were under quarantine Glass?
packgrad
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I'm busy keeping the economy moving.
Mormad
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Daviewolf83 said:

I have included a link to one of the primary models cited today for the extension of the social distancing lock-down until the end of April. I think most metro areas will not open up until June (assuming the model holds), but some areas that get to the downhill portion of the curve sooner could start opening up in mid-May. Of course, as mentioned in today's press conference, testing must continue to increase. While focus remains in the short-term on people in hospitals exhibiting symptoms, they said testing will have to extend to the broader population. The new test developed by Abbott Labs recently was mentioned.

The link to the model mentioned above is found here: https://covid19.healthdata.org/projections


Interesting study. I received that today via email. It emphasizes the lack of resources, specifically the lack of ICU beds and ventilators and providers needed to care for the sick at the peak. We're substantially short on all. And look at those confidence intervals on projected death rates... Between 38k and 162k.
Mormad
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packgrad said:

I'm busy keeping the economy moving.


Haha, cool. But once that has crashed, grab a mask. Looks like the help will be needed based on Davie's link.
packgrad
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New cases per day and new deaths both dropped yesterday. Hopefully the start of a trend.

https://www.worldometers.info/coronavirus/country/us/
Ground_Chuck
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https://www.today.com/video/dr-deborah-birx-predicts-up-to-200-000-deaths-if-we-do-things-almost-perfectly-81368133527

Big change in messaging.
PackBacker07
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