Coronavirus

[Castanza]

I think some (not all) but some of the slow response and lack of leadership in the US is a result of the degradation of the state’s responsibilities. When all is said and done, I hope state examine themselves and how they responded.

This is utter bullshit. This situation is why you have federal/national governments. In order to have a large coordinated response to large scale problems that don't care about borders or your political views. It doesn't get more textbook than a pandemic.

 

Did I say all responsibility? No....the states should have acted quickly to lockdown their own communities. Also is it the federal govts job to stockpile goods for local hospitals across the country or should that be up the the state?

 

It’s not bullshit at all. The federal level is for directing at a high level. Federal is there to backup what States need assistance with.  The State is responsible for localities and their response. They have much better visibility into supplies and needs than the federal government.

[Castanza]

I think some (not all) but some of the slow response and lack of leadership in the US is a result of the degradation of the state’s responsibilities. When all is said and done, I hope state examine themselves and how they responded.

This is utter bullshit. This situation is why you have federal/national governments. In order to have a large coordinated response to large scale problems that don't care about borders or your political views. It doesn't get more textbook than a pandemic.

 

I agree with rb.

Cuomo just said today NYS is paying 7$/mask because they are competing with other states. This is where federal government is supposed to step in.

 

And I don’t disagree with that....but states were slow to communicate to federal government what was needed. Who has better visibility into local hospitals and what supplies they do and don’t have? States do. That is all I’m saying.

[rb]

I no nothing about Europe so I can't begin to guess. There are a lot of things that all of Europe does but the US doesn't. The general setup of your logic is easily countered. I'm open to more nuanced counter-arguments.

The reason why Europe is such a mess is because the idiots wouldn't listen. The days before national emergency/lockdown orders came through the restaurants/cafes/ etc were full.

 

The virus probably had an orgy with the culture of kissing too.

[Castanza]

https://training.fema.gov/emiweb/downloads/is208sdmunit3.pdf

 

Details local and State governments job in a crisis. Communication was poor all around (fed, state, local).

 

Edit: It was only 5 days ago 48 states declared an emergency.

[rb]

I think some (not all) but some of the slow response and lack of leadership in the US is a result of the degradation of the state’s responsibilities. When all is said and done, I hope state examine themselves and how they responded.

This is utter bullshit. This situation is why you have federal/national governments. In order to have a large coordinated response to large scale problems that don't care about borders or your political views. It doesn't get more textbook than a pandemic.

 

I agree with rb.

Cuomo just said today NYS is paying 7$/mask because they are competing with other states. This is where federal government is supposed to step in.

 

And I don’t disagree with that....but states were slow to communicate to federal government what was needed. Who has better visibility into local hospitals and what supplies they do and don’t have? States do. That is all I’m saying.

And when you communicate you get called a snake during a presidential press conference. For what it's worth I think that the CDC "there's a beautiful COVID test in every pot" press conference will probably be recorded as a historic moment.

 

The feds' job is not just to coordinate purchase of masks. Besides the coordination of response to the outbreak you also need to coordinate the economic response. If i shut down Washington state, then you don't have aircraft parts for your factory in South Carolina causing economic harm. Furthermore a lot of states have balanced budget legislation. So without the feds stepping in then they cannot offer any economic response.

[cubsfan]

An excellent document (2 days old) provided by a good friend of the board:

 

https://www.mitre.org/sites/default/files/publications/COVID-19_MITRE_Action_Paper_March-2020.pdf

 

I suggest going right to the specific recomendations (page 7), as you all get the problem is out of control.

 

Here's a glimpse:

 

• We believe that we need to reduce the human-to-human contact rate of Americans by 90 percent to stop this epidemic.

 

There are 14 Specific Recommendations, here's the first 3:

 

Specific recommendations:

 

1. Immediately close all schools and institutions of learning in the United States regardless of location (move to remote learning where possible).

 

2. Incentivize private enterprises to implement remote work policies and ensure social distancing is maximized in operating facilities.

 

3. Support and encourage commercial food, medical, and basic supply distribution businesses to remain in operation as well as related transport and logistics operations.

Have the government ensure a sanitary environment for the production and delivery of materials and protect employees of these entities with testing and protective gear.

[Guest cherzeca]

https://www.en24.news/a/2020/03/hydroxychloroquine-would-be-effective-according-to-professor-raoult-of-the-ihu-in-marseille-after-a-first-limited-test.html

 

Bayer and Sanofi seem to have huge supplies of this stuff and seem to have offered donations to whatever country wants it.

 

Too early to tell obviously, but if approved, existing and widely available (combo of) medicines turn out to decrease the severity of the virus (at least for a large number of patients) obviously that would be a quick and complete game-changer.

 

some random dude on twitter wrote some interesting (and very bullish) comments on the French study I linked here yesterday: https://twitter.com/boriquagato/status/1240630279301033986 and posts below that. It's just one person's thoughts so who cares, but I found them interesting, and I'd like to be an optimist these days and tweets like these help.

 

what I and others had missed yesterday in this study was that it might have been remarkably succesful because of the combo of two seperate drugs working together, not just the hydroxychlorquine.

 

SMH at people who think azithromycin, an antibiotic that works against bacteria and hydroxychlorquine, an agent that works against a parasite, is likely to fight a virus. Same as anti-HIV drugs for this which are anti-retrovirals (hint: COVID-19 is not a retrovirus).

 

Hydroxychloroquine also fights lupus and rheumatoid arthritis.

 

Are you saying lupus and rheumatoid arthritis are caused by viruses? Because if you're not, than the comment you made is stupid.

 

actually there is a theory that RA is "triggered" by an infection in people who are susceptible genetically.  so yes.

 

and of course lyme's is caused by a bacteria, with attendant inflammation results.  while most of research money goes to cancer research, given that so many important diseases are inflammation based (arteriosclerosis, arthritis etc), one might hope that covid19 (causing pneumonia, inflammation of lungs) might have a salutary effect to focus more attention on inflammation

[Guest Schwab711]

I think some (not all) but some of the slow response and lack of leadership in the US is a result of the degradation of the state’s responsibilities. When all is said and done, I hope state examine themselves and how they responded.

This is utter bullshit. This situation is why you have federal/national governments. In order to have a large coordinated response to large scale problems that don't care about borders or your political views. It doesn't get more textbook than a pandemic.

 

I agree with rb.

Cuomo just said today NYS is paying 7$/mask because they are competing with other states. This is where federal government is supposed to step in.

 

And I don’t disagree with that....but states were slow to communicate to federal government what was needed. Who has better visibility into local hospitals and what supplies they do and don’t have? States do. That is all I’m saying.

 

People were praising the lack of testing on this thread.

 

NY has been asking for HC equipment and testing for over a month. They eventually made their own test and now have the highest testing per capita of any country in the world.

 

https://www.nbcnewyork.com/news/local/mayor-de-blasio-to-talk-nyc-coronavirus-preps-trump-set-to-address-nation-wednesday/2303179/

 

https://www.pix11.com/news/local-news/trump-administration-cancels-8b-health-care-grant-for-new-york-cuomo

 

The latter cost NY $600m in healthcare funding in 2020, during the period you are talking about. Not only did local governments complain, but Congress was asking Trump about how it planned to deal with the outbreak as early as 1/28.

 

https://www.hsgac.senate.gov/media/minority-media/peters-johnson-seek-information-on-federal-response-to-the-coronavirus-outbreak

[EliG]

https://www.en24.news/a/2020/03/hydroxychloroquine-would-be-effective-according-to-professor-raoult-of-the-ihu-in-marseille-after-a-first-limited-test.html

 

Bayer and Sanofi seem to have huge supplies of this stuff and seem to have offered donations to whatever country wants it.

 

Too early to tell obviously, but if approved, existing and widely available (combo of) medicines turn out to decrease the severity of the virus (at least for a large number of patients) obviously that would be a quick and complete game-changer.

 

some random dude on twitter wrote some interesting (and very bullish) comments on the French study I linked here yesterday: https://twitter.com/boriquagato/status/1240630279301033986 and posts below that. It's just one person's thoughts so who cares, but I found them interesting, and I'd like to be an optimist these days and tweets like these help.

 

what I and others had missed yesterday in this study was that it might have been remarkably succesful because of the combo of two seperate drugs working together, not just the hydroxychlorquine.

 

SMH at people who think azithromycin, an antibiotic that works against bacteria and hydroxychlorquine, an agent that works against a parasite, is likely to fight a virus. Same as anti-HIV drugs for this which are anti-retrovirals (hint: COVID-19 is not a retrovirus).

 

Hydroxychloroquine also fights lupus and rheumatoid arthritis.

 

Are you saying lupus and rheumatoid arthritis are caused by viruses? Because if you're not, than the comment you made is stupid.

 

actually there is a theory that RA is "triggered" by an infection in people who are susceptible genetically.  so yes.

 

and of course lyme's is caused by a bacteria, with attendant inflammation results.  while most of research money goes to cancer research, given that so many important diseases are inflammation based (arteriosclerosis, arthritis etc), one might hope that covid19 (causing pneumonia, inflammation of lungs) might have a salutary effect to focus more attention on inflammation

 

My mom was on Plaquenil (Hydroxychloroquine) for 25 years to keep her lupus in check. Lupus is an autoimmune disease. Hydroxychloroquine helps to control lupus symptoms by modulating the immune system.

 

If hydroxychloroquine works agains covid-19 (a big if at this point) -- it will like be via immune system modulation, rather than a direct action against the virus.

 

[Paarslaars]

It's a shame countries aren't learning from each other... the U.S. was well behind the EU with the infection but since it does not take the same precautions earlier, it is now rapidly catching up...

[ERICOPOLY]

I no nothing about Europe so I can't begin to guess. There are a lot of things that all of Europe does but the US doesn't. The general setup of your logic is easily countered. I'm open to more nuanced counter-arguments.

The reason why Europe is such a mess is because the idiots wouldn't listen. The days before national emergency/lockdown orders came through the restaurants/cafes/ etc were full.

 

The virus probably had an orgy with the culture of kissing too.

 

Now the Pence appointment is making sense to me.

[Jurgis]

The virus probably had an orgy with the culture of kissing too.

 

Would you really give up kissing just because of some virus?

[rb]

Then there's this.

 

https://www.reuters.com/article/us-health-coronavirus-china-cdc-exclusiv/exclusive-u-s-axed-cdc-expert-job-in-china-months-before-virus-outbreak-idUSKBN21910S

 

You couldn't script this stuff.

[rb]

And... Limit dowm

[Mephistopheles]

 

SMH at people who think azithromycin, an antibiotic that works against bacteria and hydroxychlorquine, an agent that works against a parasite, is likely to fight a virus. Same as anti-HIV drugs for this which are anti-retrovirals (hint: COVID-19 is not a retrovirus).

 

Hydroxychloroquine also fights lupus and rheumatoid arthritis.

 

Are you saying lupus and rheumatoid arthritis are caused by viruses? Because if you're not, than the comment you made is stupid.

 

actually there is a theory that RA is "triggered" by an infection in people who are susceptible genetically.  so yes.

 

and of course lyme's is caused by a bacteria, with attendant inflammation results.  while most of research money goes to cancer research, given that so many important diseases are inflammation based (arteriosclerosis, arthritis etc), one might hope that covid19 (causing pneumonia, inflammation of lungs) might have a salutary effect to focus more attention on inflammation

 

I meant to say "are you suggesting lupus/RA are caused by parasites"?

 

Regardless, the point I was making is that the drug has other benefits unrelated to parasitic infections, thus it being a malaria drug is not a reason to ignore it.

[minten]

Not sure if anybody noticed but new daily cases from most European countries were quite encouraging today (finally).  Italy 6500 -> 5500, Lombardy 3250->1700, Spain 3925 -> 1750, Germany 2500 -> 2500 (down from 4500 Friday), France 1800 -> 1500, Switzerland 1250 -> 650, UK 1000 -> 650, etc. 

 

Perhaps people just don't tend to come in in weekends (altough seems weird to me, considering you need pretty serious complaints to get a test at all in most European countries), no clue. Hopefully lockdowns and semi-lockdowns are trickling down into the numbers at last, we'll see tomorrow.

[RichardGibbons]

Then there's this.

 

https://www.reuters.com/article/us-health-coronavirus-china-cdc-exclusiv/exclusive-u-s-axed-cdc-expert-job-in-china-months-before-virus-outbreak-idUSKBN21910S

 

You couldn't script this stuff.

 

The irony is that axing the CDC expert probably wouldn't have made a difference, as Trump ignored everything until March anyway.  There's no reason to believe that an additional CDC expert would have resulted in Trump being less stupid or pigheaded.

[Dalal.Holdings]

 

SMH at people who think azithromycin, an antibiotic that works against bacteria and hydroxychlorquine, an agent that works against a parasite, is likely to fight a virus. Same as anti-HIV drugs for this which are anti-retrovirals (hint: COVID-19 is not a retrovirus).

 

Hydroxychloroquine also fights lupus and rheumatoid arthritis.

 

Are you saying lupus and rheumatoid arthritis are caused by viruses? Because if you're not, than the comment you made is stupid.

 

actually there is a theory that RA is "triggered" by an infection in people who are susceptible genetically.  so yes.

 

and of course lyme's is caused by a bacteria, with attendant inflammation results.  while most of research money goes to cancer research, given that so many important diseases are inflammation based (arteriosclerosis, arthritis etc), one might hope that covid19 (causing pneumonia, inflammation of lungs) might have a salutary effect to focus more attention on inflammation

 

I meant to say "are you suggesting lupus/RA are caused by parasites"?

 

Regardless, the point I was making is that the drug has other benefits unrelated to parasitic infections, thus it being a malaria drug is not a reason to ignore it.

 

Yawn. Discussing drug candidates on forums, Twitter, or even by this President is not going to help anything. A lot of pharma investors have gone broke betting on trials using similar rationale. There's been a lot of misinformation about COVID and drugs that CANNOT be verified unless a randomized clinical trial is completed. Anti-HIV agents. IV Vitamin C. Ibuprofen making COVID worse. A lot of noise out there that cannot be trusted.

 

Hydroxychloroqine/Chloroquine is primarily anti parasite and immunosuppressant (why it works for RA which is an autoimmune disease). Taking an immunosuppressant when you have an infection could make things worse (compromising your defenses) or it could make them better (may reduce inflammatory damage to lungs in this case). It may also have antiviral effects but it is never used clinically for that and you have the immunosuppressive action which can make a viral infection much worse. But I'm not relying on Trump or random Tweets to draw conclusions. Good luck waiting for that trial result.

 

Azithromycin for this is just plain stupid. See image.

[minten]

Azithromycin for this is just plain stupid. See image.

 

yeah, apparently you do know better than everybody else, including people working in the field.

 

anyway, here's a Forbes article on both drugs:  http://www.forbes.com/sites/marybethpfeiffer/2020/03/22/one-patient-dodges-a-covid-bullet-is-she-a-harbinger-or-outlier/#583db5b85b84

[minten]

Azithromycin for this is just plain stupid. See image.

 

yeah, apparently you do know better than everybody else, including people working in the field.

 

anyway, here's an fair Forbes article on both drugs:  forbes.com/sites/marybethpfeiffer/2020/03/22/one-patient-dodges-a-covid-bullet-is-she-a-harbinger-or-outlier/#583db5b85b84

 

I work in the field. I am a practicing MD in NYC. Good luck.

 

well, a lot of your colleagues disagree with you then. anyway this is pointless as nobody knows at this stage, we'll see pretty soon i guess.

[Dalal.Holdings]

Azithromycin for this is just plain stupid. See image.

 

yeah, apparently you do know better than everybody else, including people working in the field.

 

anyway, here's an fair Forbes article on both drugs:  forbes.com/sites/marybethpfeiffer/2020/03/22/one-patient-dodges-a-covid-bullet-is-she-a-harbinger-or-outlier/#583db5b85b84

 

I work in the field. I am a practicing MD in NYC. Good luck.

 

well, a lot of your collegues disagree with you then. anyway this is pointless as nobody knows at this stage, we'll see pretty soon i guess.

 

Yeah, it's not like I have an uncle who went to MIT, so wut do I know.  :-X

[EliG]

Apropos of nothing...

 

2007 paper about SARS virus by Hong Kong researchers

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2176051/

 

Quote from the last paragraph in the paper:

 

The presence of a large reservoir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb.

 

 

[LongHaul]

At times the Coronavirus may travel further.  Uncertainty suggests staying much farther than 6 ft from people, 20 ft seems safer.

 

"Whereas previous modeling might have suggested that 5-micron droplets can travel only a meter or two—as we’ve heard about the new coronavirus—her work suggests these same droplets can travel up to 8 meters when taking into account the gaseous form of a cough."

 

https://www.wired.com/story/they-say-coronavirus-isnt-airborne-but-its-definitely-borne-by-air/

[Mephistopheles]

 

Yawn. Discussing drug candidates on forums, Twitter, or even by this President is not going to help anything. A lot of pharma investors have gone broke betting on trials using similar rationale. There's been a lot of misinformation about COVID and drugs that CANNOT be verified unless a randomized clinical trial is completed. Anti-HIV agents. IV Vitamin C. Ibuprofen making COVID worse. A lot of noise out there that cannot be trusted.

 

Hydroxychloroqine/Chloroquine is primarily anti parasite and immunosuppressant (why it works for RA which is an autoimmune disease). Taking an immunosuppressant when you have an infection could make things worse (compromising your defenses) or it could make them better (may reduce inflammatory damage to lungs in this case). It may also have antiviral effects but it is never used clinically for that and you have the immunosuppressive action which can make a viral infection much worse. But I'm not relying on Trump or random Tweets to draw conclusions. Good luck waiting for that trial result.

 

Azithromycin for this is just plain stupid. See image.

 

You realize Malaria is also an infection right?

 

Obviously a clinical trial would take a long time. But time is not what we have on our side in a pandemic, and we have to rely on the best data we have. Take a look at this report by French providers:

 

https://www.sciencedirect.com/science/article/pii/S0924857920300996

 

Lol at "Azithromycin is an antibiotic". So dismissive. I highly suggest you read the evidence on synergistic effects of Azithromycin+Plaquanil in malaria:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170143/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944689/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC127390/

 

I'm not relying on Trump or Twitter either

[Dalal.Holdings]

 

Yawn. Discussing drug candidates on forums, Twitter, or even by this President is not going to help anything. A lot of pharma investors have gone broke betting on trials using similar rationale. There's been a lot of misinformation about COVID and drugs that CANNOT be verified unless a randomized clinical trial is completed. Anti-HIV agents. IV Vitamin C. Ibuprofen making COVID worse. A lot of noise out there that cannot be trusted.

 

Hydroxychloroqine/Chloroquine is primarily anti parasite and immunosuppressant (why it works for RA which is an autoimmune disease). Taking an immunosuppressant when you have an infection could make things worse (compromising your defenses) or it could make them better (may reduce inflammatory damage to lungs in this case). It may also have antiviral effects but it is never used clinically for that and you have the immunosuppressive action which can make a viral infection much worse. But I'm not relying on Trump or random Tweets to draw conclusions. Good luck waiting for that trial result.

 

Azithromycin for this is just plain stupid. See image.

 

You realize Malaria is also an infection right?

 

Obviously a clinical trial would take a long time. But time is not what we have on our side in a pandemic, and we have to rely on the best data we have. Take a look at this report by French providers:

 

https://www.sciencedirect.com/science/article/pii/S0924857920300996

 

Lol at "Azithromycin is an antibiotic". So dismissive. I highly suggest you read the evidence on synergistic effects of Azithromycin+Plaquanil in malaria:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170143/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944689/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC127390/

 

I'm not relying on Trump or Twitter either

 

The mechanism of action of Chloroquine and related compound on heme in RBCs and therefore malaria is known. COVID has nothing to do with RBCs.

 

Azithromycin is a very commonly used antibiotic with some antimalarial properties. Malaria is not a virus. The evidence that Azithro could work against viruses is not really out there. Coronaviruses are not new either.

 

There is very little real evidence out there that these drugs would work against COVID. Obviously if there is a patient who is very ill and nothing else is working, it may be worth a shot, but the French study showing a combination of Azithro + Hydroxychloro is very very flawed and you can read what's out there from physicians & scientists on how poorly constructed that study was.

 

I am not here to discuss pharmacology anyway.

 

I think probabilistically and I my estimates for Azithro working is not zero, but close. Hydroxychloro is higher, but it's not significant and nowhere close to 50%. Remdesivir sounds more promising (and unlike any other drug that's being discussed something that targets single stranded RNA viruses), but we'll have to wait.

 

This thread has taken up much of my time the past month or so I've been sounding the alarms on this whole COVID thing. Glad to see some people out in the real world finally taking this seriously. Hope many patients can be spared from the worst of this, and glad to have a real leader in Gov Cuomo.

 

I'm out.