samwise Posted April 17, 2020 Posted April 17, 2020 @cigar a lot of control groups are given placebos...meaning they are given something which purports to be a therapeutic but really isn't...hence the ethical issue for severely ill cohorts where you are in effect practicing deception...arguably good for science but not for the control group cohort so I just think the lack of a control group in this GILD anti-viral example is a feature and not a bug Cherzeca, its an important question, but this already happens with other life threatening illnesses. I don't think its unethical to give a placebo if you *don't know* that the drug works. If it doesn't work then both people getting the drug and getting the placebo are going to have statistically similar outcomes. Thats the point of the trial: to see *if it works*. It would be unethical to charge for a drug which doesn't work, or has bad side-effects/interactions. Thats what doctors did for centuries, and it has only recently improved. Lets keep the improvement. Empirical evidence is very important, probably more than theory, as proved by the story of the doctor who advocated hand washing and ended up in a mental asylum since no one would believe him. https://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives Other have considered the ethics, and the current scenario is the first place where they say a placebo trial is justified. From: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3844122/ Ethical analysis and international ethical guidance permit the use of placebo controls in randomized trials when scientifically indicated in four cases: (1) when there is no proven effective treatment for the condition under study;
patience_and_focus Posted April 17, 2020 Posted April 17, 2020 @cigar a lot of control groups are given placebos...meaning they are given something which purports to be a therapeutic but really isn't...hence the ethical issue for severely ill cohorts where you are in effect practicing deception...arguably good for science but not for the control group cohort so I just think the lack of a control group in this GILD anti-viral example is a feature and not a bug Cherzeca, its an important question, but this already happens with other life threatening illnesses. I don't think its unethical to give a placebo if you *don't know* that the drug works. If it doesn't work then both people getting the drug and getting the placebo are going to have statistically similar outcomes. Thats the point of the trial: to see *if it works*. It would be unethical to charge for a drug which doesn't work, or has bad side-effects/interactions. Thats what doctors did for centuries, and it has only recently improved. Lets keep the improvement. Empirical evidence is very important, probably more than theory, as proved by the story of the doctor who advocated hand washing and ended up in a mental asylum since no one would believe him. https://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives Other have considered the ethics, and the current scenario is the first place where they say a placebo trial is justified. From: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3844122/ Ethical analysis and international ethical guidance permit the use of placebo controls in randomized trials when scientifically indicated in four cases: (1) when there is no proven effective treatment for the condition under study; This is why not having expertise is so not helpful. Control group is not necessarily placebos. People have figured out trial designs in difficult diseases (e.g. cancer) decades ago. In broad strokes, the control is frequently standard of care, which is not placebo in these cases but whatever is the standard of care in that field at that point in time. For covid, they will not stop current treatment (using whatever they are trying to currently use). They will keep all the underlying prescribed treatments exactly the same between treated vs control group *except* one variable, the new drug that is being tested being the only treatment factor that is different. Also has to be randomized (for subjects) and double blinded because, you know, doctors and drug companies also have biases. And surprise, there are cowboy doctors who do not know much about trial design (it is a specialty field which also needs expertise) but nevertheless make big claims with flawed trial design data (the french doctor who published paper on hydroxychloroquine). P.S: Standard of care doesn't mean some drug, it can be devices (e.g. ventilator) or palliative care in the absence of no proven treatment options.
Spekulatius Posted April 17, 2020 Posted April 17, 2020 @cigar a lot of control groups are given placebos...meaning they are given something which purports to be a therapeutic but really isn't...hence the ethical issue for severely ill cohorts where you are in effect practicing deception...arguably good for science but not for the control group cohort so I just think the lack of a control group in this GILD anti-viral example is a feature and not a bug When does speculation become investment? When do you decide that conviction is sufficient to put 10% of your net worth in a specific investment? ---)You need to define a threshold. I fully realize that comparing an investment decision to a life or death situation is different but you (we) need a framework. It has been suggested (from various observational and rational reasons) that remdesivir could result in better outcomes than doing nothing for CV. We don't know the answer to this question. In order to answer that question, trials that involve randomized blind trials with control groups will be essential unless several trials done in different centers with different patients clearly show an advantage (pre-defined targets). When patients are recruited for the studies now, they have a choice to accept (and potentially get drugs that are potentially useful {or not and with negative side effects}) or not. Given the difficult situation, patients may get access to remdesivir through a company-sponsored expanded access program or through a compassionate program. The results do look promising and that should speed up the process. The approach is obviously not perfect but has provided the shoulders on which future generations could see. How could you know if you don't know? The pharma cemetery is full of ideas that looked good at some point. We need a controlled study - Remdesivir for Democrats, hcq for Trump supporters.
Cigarbutt Posted April 17, 2020 Posted April 17, 2020 @cigar a lot of control groups are given placebos...meaning they are given something which purports to be a therapeutic but really isn't...hence the ethical issue for severely ill cohorts where you are in effect practicing deception...arguably good for science but not for the control group cohort so I just think the lack of a control group in this GILD anti-viral example is a feature and not a bug When does speculation become investment? When do you decide that conviction is sufficient to put 10% of your net worth in a specific investment? ---)You need to define a threshold. I fully realize that comparing an investment decision to a life or death situation is different but you (we) need a framework. It has been suggested (from various observational and rational reasons) that remdesivir could result in better outcomes than doing nothing for CV. We don't know the answer to this question. In order to answer that question, trials that involve randomized blind trials with control groups will be essential unless several trials done in different centers with different patients clearly show an advantage (pre-defined targets). When patients are recruited for the studies now, they have a choice to accept (and potentially get drugs that are potentially useful {or not and with negative side effects}) or not. Given the difficult situation, patients may get access to remdesivir through a company-sponsored expanded access program or through a compassionate program. The results do look promising and that should speed up the process. The approach is obviously not perfect but has provided the shoulders on which future generations could see. How could you know if you don't know? The pharma cemetery is full of ideas that looked good at some point. We need a controlled study - Remdesivir for Democrats, hcq for Trump supporters. Somebody has volunteered to head the ethics and advanced statistical analysis team: "It could have a very positive effect, or a positive effect, maybe not very, but maybe positive, it’s very, very exciting."
vikx01 Posted April 17, 2020 Posted April 17, 2020 Not sure if this has already been posted: https://www.nejm.org/doi/full/10.1056/NEJMoa2007016 From NEJM posted about a week ago.
Mephistopheles Posted April 17, 2020 Posted April 17, 2020 Not sure if this has already been posted: https://www.nejm.org/doi/full/10.1056/NEJMoa2007016 From NEJM posted about a week ago. In this trial, Remdesevir was started a median # of 12 days after symptom onset. I think like 53% were already on a ventilator when the medication was started. Not sure what # of days of symptoms the patients in the U Chicago Gilead had, but one of the inclusion criteria for the study was a positive viral PCR within <4 days (going on memory). Usually symptom onset is when people get tested. So in other words, for the NEJM trial the median patient went almost a full two weeks of symptoms without starting the medication and I think that's a key difference. By that point if you're really sick, the virus has likely taken over lungs, you develop ARDS and the drug won't touch you. U Chicago data implies if you start patients early enough then it can make a big difference. Still need controlled data but it's a good start.
samwise Posted April 17, 2020 Posted April 17, 2020 This is why not having expertise is so not helpful. Control group is not necessarily placebos. People have figured out trial designs in difficult diseases (e.g. cancer) decades ago. In broad strokes, the control is frequently standard of care, which is not placebo in these cases but whatever is the standard of care in that field at that point in time. For covid, they will not stop current treatment (using whatever they are trying to currently use). They will keep all the underlying prescribed treatments exactly the same between treated vs control group *except* one variable, the new drug that is being tested being the only treatment factor that is different. Also has to be randomized (for subjects) and double blinded because, you know, doctors and drug companies also have biases. And surprise, there are cowboy doctors who do not know much about trial design (it is a specialty field which also needs expertise) but nevertheless make big claims with flawed trial design data (the french doctor who published paper on hydroxychloroquine). P.S: Standard of care doesn't mean some drug, it can be devices (e.g. ventilator) or palliative care in the absence of no proven treatment options. Thanks for clarifying. Since you mention expertise on an internet forum, I assume you are a bio-statistician and run/consult for these kinds of trials?
samwise Posted April 17, 2020 Posted April 17, 2020 @cigar a lot of control groups are given placebos...meaning they are given something which purports to be a therapeutic but really isn't...hence the ethical issue for severely ill cohorts where you are in effect practicing deception...arguably good for science but not for the control group cohort so I just think the lack of a control group in this GILD anti-viral example is a feature and not a bug When does speculation become investment? When do you decide that conviction is sufficient to put 10% of your net worth in a specific investment? ---)You need to define a threshold. I fully realize that comparing an investment decision to a life or death situation is different but you (we) need a framework. It has been suggested (from various observational and rational reasons) that remdesivir could result in better outcomes than doing nothing for CV. We don't know the answer to this question. In order to answer that question, trials that involve randomized blind trials with control groups will be essential unless several trials done in different centers with different patients clearly show an advantage (pre-defined targets). When patients are recruited for the studies now, they have a choice to accept (and potentially get drugs that are potentially useful {or not and with negative side effects}) or not. Given the difficult situation, patients may get access to remdesivir through a company-sponsored expanded access program or through a compassionate program. The results do look promising and that should speed up the process. The approach is obviously not perfect but has provided the shoulders on which future generations could see. How could you know if you don't know? The pharma cemetery is full of ideas that looked good at some point. +1 As usual you said it better than I did CB.
patience_and_focus Posted April 17, 2020 Posted April 17, 2020 This is why not having expertise is so not helpful. Control group is not necessarily placebos. People have figured out trial designs in difficult diseases (e.g. cancer) decades ago. In broad strokes, the control is frequently standard of care, which is not placebo in these cases but whatever is the standard of care in that field at that point in time. For covid, they will not stop current treatment (using whatever they are trying to currently use). They will keep all the underlying prescribed treatments exactly the same between treated vs control group *except* one variable, the new drug that is being tested being the only treatment factor that is different. Also has to be randomized (for subjects) and double blinded because, you know, doctors and drug companies also have biases. And surprise, there are cowboy doctors who do not know much about trial design (it is a specialty field which also needs expertise) but nevertheless make big claims with flawed trial design data (the french doctor who published paper on hydroxychloroquine). P.S: Standard of care doesn't mean some drug, it can be devices (e.g. ventilator) or palliative care in the absence of no proven treatment options. Thanks for clarifying. Since you mention expertise on an internet forum, I assume you are a bio-statistician and run/consult for these kinds of trials? First, my apologies, I was not trying to be confrontational, in-fact was trying supportive of what you were trying to explain and add to it. But it came out very different. Full disclosure, we consult on clinical trials and other aspects of pharma/biotech business but not in the capacity of card carrying clinical design statistician. But sitting in some of the meetings where they discuss the trial design really helps me understand the complexity, limited information and very aggressive deadlines people in this field have to work with. Hence my deference to them. They surely get it wrong sometimes but their batting average will put anyone else to shame if they tried to do it a few times without the expertise.
samwise Posted April 17, 2020 Posted April 17, 2020 This is why not having expertise is so not helpful. Control group is not necessarily placebos. People have figured out trial designs in difficult diseases (e.g. cancer) decades ago. In broad strokes, the control is frequently standard of care, which is not placebo in these cases but whatever is the standard of care in that field at that point in time. For covid, they will not stop current treatment (using whatever they are trying to currently use). They will keep all the underlying prescribed treatments exactly the same between treated vs control group *except* one variable, the new drug that is being tested being the only treatment factor that is different. Also has to be randomized (for subjects) and double blinded because, you know, doctors and drug companies also have biases. And surprise, there are cowboy doctors who do not know much about trial design (it is a specialty field which also needs expertise) but nevertheless make big claims with flawed trial design data (the french doctor who published paper on hydroxychloroquine). P.S: Standard of care doesn't mean some drug, it can be devices (e.g. ventilator) or palliative care in the absence of no proven treatment options. Thanks for clarifying. Since you mention expertise on an internet forum, I assume you are a bio-statistician and run/consult for these kinds of trials? First, my apologies, I was not trying to be confrontational, in-fact was trying supportive of what you were trying to explain and add to it. But it came out very different. Full disclosure, we consult on clinical trials and other aspects of pharma/biotech business but not in the capacity of card carrying clinical design statistician. But sitting in some of the meetings where they discuss the trial design really helps me understand the complexity, limited information and very aggressive deadlines people in this field have to work with. Hence my deference to them. They surely get it wrong sometimes but their batting average will put anyone else to shame if they tried to do it a few times without the expertise. Thanks. Yes those people are good, and they charge big bucks. Glad to have someone here with the relevant experience to talk about trials. I think it will be a recurring topic.
DocSnowball Posted April 17, 2020 Posted April 17, 2020 I agree I think alot of people think we need to get cases to zero before we open the economy again. That wasn't the point of this lockdown. It was to limit the deaths (but not prevent it entirely) by not overwhelming hospitals. In terms of mask, Dr Fauci originally stated masks weren't required but I believe he came around to suggesting it as an effective way of preventing transmission. Originally I think the shortage of supplies for front line workers was the agenda behind the message of the masks effectiveness. That may still be the case which is why they suggest most to wear scarfs, or some form of clothing around your mouth area instead of directly suggesting masks for the general public. Flatening the curve was goal to not overwhelm our health system and as long as country can operate without causing health crisis, opening should proceed with tons of centralized testing. Without centralized testing , we may be flying blind when some region gets a spike. I think that this is an extremely good point that has gotten lost over the past month or two. The goal is to avoid overwhelming the healthcare system, not to eliminate every potential death from the virus by remaining shut for a year. (Based on Canadian polling, it's pretty clear that Canadians in aggregate don't get it.) On the "how to reopen" list, it shocks me that they aren't bothering to require masks, since it seems to be a cheap and easy solution to reduce transmission (and deaths and medical costs). I wonder if there was some reasoning behind that, or if they were just writing down stuff on autopilot, and not really thinking. If they decided not to include it for cultural reasons, that puts the US at a competitive disadvantage relative to other countries that are more open-minded about such things. When you ‘mismanage’ the virus outbreak you have to resort to lock down. (And by mismanage i mean not being able to control the virus.) We all know that lock down exacts an enormous toll on the economy. While in lock downs governments have a small window of time to pull together experts and implement a very detailed national strategic plan to combat the virus. This involves switching from playing defense to playing offense. The playbook is pretty straight forward: massive focussed and prioritized testing, quick results (within 24 hours), massive group of people to contact trace. How effective governments are with this stage will determine how quickly they can unlock the economy. And also, more importantly, how long the economy will remain unlocked. If you have no detailed national plan for phase 2 (reopening of the economy) you are likely screwed. As you try an reopen the economy all that will happen is the virus will win again. It will start to silently spread. Clusters will form and governments will need to resort to lock down again. We will find in the coming months which governments are up to the challenge. This is NOT a debate about ‘health’ OR ‘economy’. This is a debate about leaders who are effective and leaders who are ineffective. I fear the healthcare workforce is going to be the biggest loser in this mismanagement. Still trying to figure out what this will mean to healthcare workers long term. Many who are high risk (or their family members are) may choose to walk away after a few rounds of mismanagement...
vinod1 Posted April 17, 2020 Posted April 17, 2020 Peggy Noonan in a WSJ post https://www.wsj.com/articles/needed-a-little-give-and-a-lot-of-integrity-11587079973?mod=hp_opin_pos_3 Here’s the part about integrity. Our federal government has to stop making empty and misleading claims about testing. Leave to history how much the Centers for Disease Control and Prevention and the Food and Drug Administration were allowed to screw up. Since then, White House announcements on testing have been all showbiz. Tests are always coming in 10 days, they’re in the pipeline and being shipped next week, we’re scaling up. Wednesday Mike Pence crowed at the daily White House briefing: “We have conducted and completed 3,324,000 tests across the nation.” That’s barely 1% of the population three months into a crisis. That’s not an achievement, it’s a scandal. President Trump said, “We have the best tests in the world.” If so, poor world. There’s a complete disconnect between the numbers with which Washington mesmerizes itself and facts on the ground. Operatives give credulous cable hosts excited reports of new tests: You spit in a vial and results are immediate—it’s like a gender reveal, they shoot cannons with colors! We’re developing a home test that’s a pinprick. Elizabeth Holmes comes to your house; Theranos is on the case! Ha ha, kidding, not true I think. Testing is a national responsibility because a pandemic is a national problem. From the beginning it needed to be priority No. 1. It was never priority No. 1. If it had been, we’d have tests. The federal government’s lack of integrity has been destructive. No opening of America will be sustained until it’s got right.
Liberty Posted April 17, 2020 Posted April 17, 2020 Two new Attia interviews on this topic: https://peterattiamd.com/ameshadalja/ https://peterattiamd.com/johnbarry/ (on the 1918 flu pandemic)
arcube Posted April 17, 2020 Posted April 17, 2020 As Muscleman said earlier, lot of false reporting by China. I believe the total China numbers are off too. China Raises Coronavirus Death Toll by 50% in Wuhan. https://www.nytimes.com/2020/04/17/world/asia/china-wuhan-coronavirus-death-toll.html?action=click&module=Top%20Stories&pgtype=Homepage
Guest cherzeca Posted April 17, 2020 Posted April 17, 2020 thanks for the control group info. clearly if a patient can select between the GILD anti-viral and plaq/z-pack, then I wouldn't see any ethical issue.
KCLarkin Posted April 17, 2020 Posted April 17, 2020 thanks for the control group info. clearly if a patient can select between the GILD anti-viral and plaq/z-pack, then I wouldn't see any ethical issue. I'm assuming this is a typo. But obviously if a patient can select between two experimental drugs, it isn't a blind or random study! Plaq/z-pack isn't standard of care, so it wouldn't be the control. The patient enrols in trial knowing they get 50/50 chance at Remdisivir. This is informed consent. Any clinical trial needs to be approved by multiple ethics boards, so don't waste too much time thinking about the ethics.
minten Posted April 17, 2020 Posted April 17, 2020 https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1 another antibody test study: " Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%). "
Liberty Posted April 17, 2020 Posted April 17, 2020 Trump: Nobody told me about the pandemic I warned you about. If the economy is bad, it's the governors' fault, but if you don't get sick, credit me. I have all the authority and none of the responsibility. When Trump is wrong, he simply spins 180 and lies about what he said yesterday. This is what his years of constant lying have set the stage for. "The truth is what I say today." But you cannot bluff a virus.
Cigarbutt Posted April 17, 2020 Posted April 17, 2020 thanks for the control group info. clearly if a patient can select between the GILD anti-viral and plaq/z-pack, then I wouldn't see any ethical issue. Obviously, you're entitled to your own ethical opinions. A problem that is often seen is that drug companies find placebo control (no real treatment, sugar pill etc) to be a pain when trying to establish superior performance (to nothing) because, very often, a significant number of patients report better outcomes (!) and also higher incidence of side effects (!) in the placebo arm of the investigation. Sometimes, it's not what's real that counts, it's what you believe in. :) Speaking of placebo effects in the investing world, they happen all the time. The most impressive manifestation (from my humble perspective) was when accounting rules were relaxed for financial institutions' mark-to-market accounting in March 2009. The symbolic move really 'helped' from the proprietary data perspective i was looking at. The most impressive part is that the financial institutions (most of them anyway) most exposed to MBS and NPLs showed the most spectacular improvement in the market perception of risk for these entities. Eventually, it was discovered that most would have been fine anyhow but their stay in the ICU was shortened considerably. I've always had mixed feelings about placebo effects. https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1 another antibody test study: " Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%). " Interesting but (the contrarian side keeps manifesting) they explain well how their results should be interpreted with caution for example when discussing their (major) assumption about specificity: "We consider our estimate to represent the best available current evidence, but recognize that new information, especially about the test kit performance, could result in updated estimates. For example, if new estimates indicate test specificity to be less than 97.9%, our SARS-CoV-2 prevalence estimate would change from 2.8% to less than 1%, and the lower uncertainty bound of our estimate would include zero." (my bold) The wording about caution reminds me of the present discussion about AMC. Some see it (the equity) coming through unscathed and some see the fulcrum security way down. One of the big problems with the false positive results is that a low but still significant positive antibody response may be related to other kinds (the old and common kinds) of CV. Those antibodies may or may not provide protection against the new CV and, obviously, would terribly reduce the value of the published 'random' prevalence data about the recent outbreak.
Dalal.Holdings Posted April 17, 2020 Posted April 17, 2020 https://www.bloomberg.com/news/articles/2020-04-17/trump-tells-three-democratic-states-to-liberate-themselves Trump tweet: LIBERATE VIRGINIA, and save your great 2nd Amendment. It is under siege! A sorry excuse for a leader.
matts Posted April 17, 2020 Posted April 17, 2020 https://seekingalpha.com/news/3561767-stanford-study-points-to-far-higher-rate-of-covidminus-19-infection\ EDIT: looks like this was already posted above, but maybe you are all interested in the seeking alpha comments section :)
Dalal.Holdings Posted April 17, 2020 Posted April 17, 2020 https://seekingalpha.com/news/3561767-stanford-study-points-to-far-higher-rate-of-covidminus-19-infection\ EDIT: looks like this was already posted above, but maybe you are all interested in the seeking alpha comments section :) This is my quick take from the full text: https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1.full.pdf The unadjusted prevalence of antibodies to SARS-CoV-2 in Santa Clara County was 1.5% 1) Completely disproves the "this infection has been widespread for months thesis". It wasn't even widespread by April 3 in this CA county. 2) Pretty much makes herd immunity unfeasible due to #1 3) Their estimated mortality rate is very low--like close to Flu level low. Note how they recruited volunteers: they used facebook ads. From the Dutch bloodbank study, we say that younger folk have this in much higher numbers asymptomatically. So their estimate of asymptomatic infections may skew higher due to Facebook ads as the method of recruiting. There are some other caveats to their estimates that cigarbutt pointed out. And note: We did not account for age imbalance in our sample But anyway, let's say this is the case and it is just as deadly as the Flu. How does one explain Italy, parts of WA, and NYC getting a surge of ICU/vented patients? Is it just as deadly as the Flu, but much more contagious so we see a sudden surge of critically ill patients? If that is the case, then why should we declare "this is nothing to worry about"? You have two choices here: 1) Occam's razor: every country that saw this didn't overreact for a reason--this is something to take seriously and Wuhan, Italy, NYC show that clearly. 2) Everyone is wrong and this is no different than the Flu. Choose wisely. Or unwisely. The choice is yours.
Guest cherzeca Posted April 17, 2020 Posted April 17, 2020 thanks for the control group info. clearly if a patient can select between the GILD anti-viral and plaq/z-pack, then I wouldn't see any ethical issue. I'm assuming this is a typo. But obviously if a patient can select between two experimental drugs, it isn't a blind or random study! Plaq/z-pack isn't standard of care, so it wouldn't be the control. The patient enrols in trial knowing they get 50/50 chance at Remdisivir. This is informed consent. Any clinical trial needs to be approved by multiple ethics boards, so don't waste too much time thinking about the ethics. why cant the data collector/analyzer not be told which group is which? again, if you are denying patient care/choice when the patient is critically ill (as I understand these studies are focusing on...some or all on respirators) then you have an ethical issue. since reasonable people can disagree with respect to ethics, no problem if you disagree, as we will agree to disagree
DocSnowball Posted April 17, 2020 Posted April 17, 2020 Just finished doing a session of healthcare workers in the NYC/CT relating their own and their family's experiences with COVID (entirely anecdotal stuff coming up)... A lot of the time the entire household was infected, except for kids under 10 It was very hard to get testing unless you were very sick or fought tooth and nail (remember these are healthcare workers, still could not get tested easily in the beginning - later guidance started to include them in testing prioritization) Hospital staff capacity was at breaking points consistently, with it being difficult for those admitted to even get food to eat within a couple of hours of schedule - due to staff out sick, expanded capacity, and proning of ICU patients taking a lot of time It is a nightmare to communicate with someone admitted to the hospital - very limited, it is extremely lonely and isolating for both those in the hospital and their families outside the hospital I'm trying to make meaning out of these anecdotes - likely there are a lot more infected than testing indicates (we all know that by now). This excess number includes those who are mildly ill but never got tested, and then double that total to include those who were infected could have been asymptomatic. So multiply case counts by 2-5x. This is how we are getting to 0.6-15% total infected population in different geographies that have released data so far. While CFR may be lower, the people who did get to the front of the queue and got tested is testimony to the fact how many moderate to seriously ill patients are out there. This is not a virus to mess with. The hospitalization rate and critical illness rates are quite staggering as well. This explains why hospitals are so overwhelmed. Nothing much except COVID care is going on in most hospitals in our region for the last month.
Castanza Posted April 17, 2020 Posted April 17, 2020 https://www.bloomberg.com/news/articles/2020-04-17/trump-tells-three-democratic-states-to-liberate-themselves Trump tweet: LIBERATE VIRGINIA, and save your great 2nd Amendment. It is under siege! A sorry excuse for a leader. So is the Governor of Virginia. You know, the guy who can't follow the Constitution, likes to dress up in blackface, and would kill babies after birth. Is he a great leader in your opinion?
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