Coronavirus

[Castanza]

I would assume masks are certainly beneficial during surgeries. But I cannot speak to that.

 

My wife has worked in a few different hospitals now, all top of their field level 4 NICUs. Some hospitals required gloves and masks for specific procedures and others did nor require anything except washed hands for the same procedures. It seems there is not a lot of uniformity in some healthcare best practices (which is shocking). She looked into this as it worried her at first, but both hospitals took stances with peer reviewed research to back their "best practice" choices.

[rb]

For those who think wearing a mask is ineffective, next time you go in for a surgery tell the doctors & nurses not to bother wearing masks as they slice you open.

 

Covid is like any other serious risk. You take common sense steps to avoid becoming a victim. But if your number comes up, your number comes up.

 

I think my comment is being taken out of context and this issue is becoming unnecessarily emotional as opposed to invoking rational thought. So let me clarify. My comment of masks not being shown to be effective so far was in the context of multiple previous posts specifically on covid studies that are being cited to argue in favor of or against effectiveness of masks to prevent infection for the wearer (not source control). I am not making any general claims about masks, especially for source control.

 

Also I was clear that so far there is absence of evidence that is coming from gold standard randomized controlled trials that unequivocally show effectiveness in that context. I am fully aware that absence of evidence is not evidence of absence. However, given what we know so far, wearing masks just by themselves is unlikely to show very high effectiveness to prevent getting infected in such studies. This may be partly due to difficulty in getting a large enough study going for something that is behavioral or masks may be more effective when combined with other non pharmaceutical interventions. But such trials have not been conducted.

 

By the way, I do wear mask in public. It has more to do with lack of harm doing it and potential for source control (in the unlikely situation of source being myself) than proof of preventative intervention.

I think that there's pretty well understood that mask work much better as source control than infection control. That's why it's important that you have a mask mandate. That's also why it works really well in disciplined populations. Even if masks are not very good at infection control, they become very good at controlling the infection if they're good at source control and have a high % of mask wearing.

 

As for a randomized trial for mask infection control I'm not sure how you do that. You get people to cough in other people's faces with covid, some with masks some without? I don't think there's any setup that goes past an ethics panel.

[Cigarbutt]

Added for analytical purposes and sterilized of political content, to the extent possible.

 

In terms of evidence for surgical masks, Investor20 is mostly right and to be mostly right means potential dramatic and detrimental outcomes, especially at the margin. So what to do?

Much of what is done in the medical field is related to ‘common sense’, tradition and even dogma. At least, there is a certain amount of internal will to re-evaluate various aspects. This discussion about surgical masks and their efficacy is relevant to the whole coronavirus episode. There are built-in expectations now and in most places that people going about operating rooms should always wear a mask but little evidence supports that. Outside of people closely involved with the ‘case’, there is actually reasonable evidence that wearing a mask does not reduce the rate of surgical site infections. Even for people closely involved, in minimally invasive and short procedures like cataracts or vasectomy, it very likely does not make a material difference for all relevant outcomes (the patient and the healthcare people). However, at least because of common sense and some evidence and because of the precautionary principle, masks of various sorts are used for more extensive procedures, especially when critical body cavities are opened (brain, chest, abdomen etc) and especially if implants are left inside. In these cases, the burden of proof is lowered as wearing a mask is a relatively simple measure, cost is reasonable, masks also protect healthcare personnel (infections can go both ways) and complications from a deep-seated infection in those cases can have catastrophic consequences. Investor20 will be happy to learn that it’s standard procedure to have sophisticated ventilation systems even with laminar air flow, filters and differential pressures in operating rooms but the evidence remains uncertain as to whether these specifications make a difference for infections.

 

About 20 years ago, I was asked to participate in a group whose responsibility was to produce an updated guideline for the use of antibiotics at the onset of various procedures in order to reduce infections. The use of antibiotics has clearly been shown to reduce infection risks in key categories. There were (and still are) many contentious and controversial issues. Although this was only a guide and individual decisions had to be tailored to specific conditions, this was a clear case where recommendations from ‘experts’ was potentially constructive as inappropriate use of antibiotics could contribute to unwanted side effects, allergic reactions, selection of resistant bugs and systemic build-up of resistance globally (and unnecessary costs). When deciding where to draw the line, the idea is to constructively argue based on facts and to adjust to cover grey areas because of the precautionary principle in selected cases. When such systematic approach is consistently applied, outcomes tend to improve in a cost effective way and people wearing masks don't typically feel that their personal freedom is threatened.

 

Tonight, the household is going to skate (indoor rink). The reservation procedure is an extra step, the procedure to get on and leave the ice is slightly more complicated and it’s prescribed to wear masks during the activity. I guess that some of that is excessive but I can easily live with that.

 

[Investor20]

https://www.c-span.org/video/?478159-1/senate-hearing-covid-19-outpatient-treatment&live

Senate Hearing on COVID-19 Outpatient Treatment

 

The problem described Dr. Peter Mcculough I think is real.  There is no early treatment protocol in US.

 

Unfortunately virus is not waiting and unless the person has good immune response, the virus is replicating.  To try to treat after the virus has replicated is not done for any infection says Dr. Peter Mcculough. And even if the doctors are succesfful in treating them in hospital, there is damage done by virus and we end up with long term symptoms.

 

Medicines like Remdesivir even if they work, they can be given only in hospital and there are only so many hospital beds.

 

And so much is about masks, with no clear study showing they work, while completely disregarding medicines for early treatment.

 

I think this is something to listen to.

[cwericb]

" And even if the doctors are sucessful in treating them in hospital, there is damage done by virus and we end up with long term symptoms."

 

And that certainly is a major concern many people seem to ignore. Too many seem to be under the impression that Covid really only effects seniors and people with pre-existing problems. There is another concern with the creation of future ongoing health problems and that is the health and social costs should millions of people have recurring issues. 

[Cardboard]

Height of stupidity:

 

WHO tells doctors not to use Gilead's remdesivir as a coronavirus treatment, splitting with FDA

https://www.cnbc.com/2020/11/19/coronavirus-who-tells-doctors-dont-use-gileads-remdesivir-splitting-with-fda.html

 

If people are looking for a criminal organization in this world this is it.

 

Cardboard

[Spekulatius]

Height of stupidity:

 

WHO tells doctors not to use Gilead's remdesivir as a coronavirus treatment, splitting with FDA

https://www.cnbc.com/2020/11/19/coronavirus-who-tells-doctors-dont-use-gileads-remdesivir-splitting-with-fda.html

 

If people are looking for a criminal organization in this world this is it.

 

Cardboard

 

Why is this stupid? The drug apparently has not produced any tangible benefit in their large study and it is expensive and complex to administer. They are not the first ones to bring this up either. The WHO supports more trials but so far, it does not seem very effective, if at all.

[Cigarbutt]

https://www.c-span.org/video/?478159-1/senate-hearing-covid-19-outpatient-treatment&live

Senate Hearing on COVID-19 Outpatient Treatment

The problem described Dr. Peter Mcculough I think is real.  There is no early treatment protocol in US.

Unfortunately virus is not waiting and unless the person has good immune response, the virus is replicating.  To try to treat after the virus has replicated is not done for any infection says Dr. Peter Mcculough. And even if the doctors are succesfful in treating them in hospital, there is damage done by virus and we end up with long term symptoms.

Medicines like Remdesivir even if they work, they can be given only in hospital and there are only so many hospital beds.

And so much is about masks, with no clear study showing they work, while completely disregarding medicines for early treatment.

I think this is something to listen to.

:)

[Spekulatius]

The story of how BioNtech developed the COVId-19 vaccine:

https://www.ft.com/content/c4ca8496-a215-44b1-a7eb-f88568fc9de9

 

I didn’t know this, but Pfizer was not involved in the early stages, but assisted with manufacturing and running the trials. The research was funded by the German government (375M Euro) and of course a large order (if the vaccine would be approved ) by the US government played a role too.

[orthopa]

For those who think wearing a mask is ineffective, next time you go in for a surgery tell the doctors & nurses not to bother wearing masks as they slice you open.

 

Covid is like any other serious risk. You take common sense steps to avoid becoming a victim. But if your number comes up, your number comes up.

 

For those that think that cloths masks may be or may not be effective think about whether or not you can smell your own fart or someone else fart when they pass gas.

[DooDiligence]

For those who think wearing a mask is ineffective, next time you go in for a surgery tell the doctors & nurses not to bother wearing masks as they slice you open.

 

Covid is like any other serious risk. You take common sense steps to avoid becoming a victim. But if your number comes up, your number comes up.

 

For those that think that cloths masks may be or may not be effective think about whether or not you can smell your own fart or someone else fart when they pass gas.

 

I know it stinks but here you go.

 

https://medium.com/geek-physics/if-masks-work-why-can-i-smell-farts-c0b8e10323c6

[ERICOPOLY]

We will have potentially 20m vaccine doses available by the end of December.  Assuming there is a means of distributing and administering the doses...

 

We have 28m Americans over the age of 70.

 

Most of the dying are age 70+.

 

If we first vaccinating the age 70+ the death tool should drop by over 90%.  Right?

[KCLarkin]

For those that think that cloths masks may be or may not be effective think about whether or not you can smell your own fart or someone else fart when they pass gas.

 

And then think about whether fecal diseases (typhoid, cholera, etc) are spread by farts.

 

[KCLarkin]

We will have potentially 20m vaccine doses available by the end of December.  Assuming there is a means of distributing and administering the doses...

 

We have 28m Americans over the age of 70.

 

Most of the dying are age 70+.

 

If we first vaccinating the age 70+ the death tool should drop by over 90%.  Right?

 

Vaccines will go to med staff first, but regardless remember two doses per person.

 

[Spekulatius]

For those that think that cloths masks may be or may not be effective think about whether or not you can smell your own fart or someone else fart when they pass gas.

 

And then think about whether fecal diseases (typhoid, cholera, etc) are spread by farts.

 

Farts work well to enforce social distancing though.

[ERICOPOLY]

We will have potentially 20m vaccine doses available by the end of December.  Assuming there is a means of distributing and administering the doses...

 

We have 28m Americans over the age of 70.

 

Most of the dying are age 70+.

 

If we first vaccinating the age 70+ the death tool should drop by over 90%.  Right?

 

Vaccines will go to med staff first, but regardless remember two doses per person.

 

I know that's the plan to prioritize the med staff, but I'm not in agreement that it's the right approach.  If one were to take the 70+ age group out of the equation, what would be the load on the hospitals today?  That's how the pressure comes off the hospitals, and the rational for the curfews and shutdowns is that the spread of the virus is risking our hospitals being overrun. 

 

Anyways...

[Peregrine]

We will have potentially 20m vaccine doses available by the end of December.  Assuming there is a means of distributing and administering the doses...

 

We have 28m Americans over the age of 70.

 

Most of the dying are age 70+.

 

If we first vaccinating the age 70+ the death tool should drop by over 90%.  Right?

 

Vaccines will go to med staff first, but regardless remember two doses per person.

 

I know that's the plan to prioritize the med staff, but I'm not in agreement that it's the right approach.  If one were to take the 70+ age group out of the equation, what would be the load on the hospitals today?  That's how the pressure comes off the hospitals, and the rational for the curfews and shutdowns is that the spread of the virus is risking our hospitals being overrun. 

 

Anyways...

 

The thinking I think is that front-line workers are vectors of spread to the elderly. Though I agree with you that the elderly should be vaccinated first.

[rb]

Well it's a safety thing. Med staff is at risk cause they are exposed to it every day.

 

What Eric says has some logic from an efficiency perspective. But to use an imperfect analogy it would be like sending soldiers into battle without body armour because you'll bomb the enemy's bullet factories.

[Spekulatius]

Well it's a safety thing. Med staff is at risk cause they are exposed to it every day.

 

What Eric says has some logic from an efficiency perspective. But to use an imperfect analogy it would be like sending soldiers into battle without body armour because you'll bomb the enemy's bullet factories.

 

Medical staff infection are becoming more and more an issue. We will run out of medical workers before we run out of hospital capacity, hence the need to vaccinate medical workers as well as nursing home staff first.

[Investor20]

https://www.c-span.org/video/?478159-1/senate-hearing-covid-19-outpatient-treatment&live

Senate Hearing on COVID-19 Outpatient Treatment

The problem described Dr. Peter Mcculough I think is real.  There is no early treatment protocol in US.

Unfortunately virus is not waiting and unless the person has good immune response, the virus is replicating.  To try to treat after the virus has replicated is not done for any infection says Dr. Peter Mcculough. And even if the doctors are succesfful in treating them in hospital, there is damage done by virus and we end up with long term symptoms.

Medicines like Remdesivir even if they work, they can be given only in hospital and there are only so many hospital beds.

And so much is about masks, with no clear study showing they work, while completely disregarding medicines for early treatment.

I think this is something to listen to.

:)

 

https://www.covid19treatmentguidelines.nih.gov/therapeutic-management/

 

The problem described by Dr. Mcculough is correct:

 

For Patients with COVID-19 Who Are Not Hospitalized or Who Are Hospitalized With Moderate Disease but Do Not Require Supplemental Oxygen

The Panel does not recommend any specific antiviral or immunomodulatory therapy for the treatment of COVID-19 in these patients. Patients are considered to have moderate disease if they have clinical or radiographic evidence of lower respiratory tract infection and a saturation of oxygen (SpO2) ≥94% on room air at sea level.

[Gregmal]

https://www.instagram.com/tv/CH1c_h8A7AI/?utm_source=ig_embed

 

"covid stricken" Don Jr.....

[ERICOPOLY]

Well it's a safety thing. Med staff is at risk cause they are exposed to it every day.

 

What Eric says has some logic from an efficiency perspective. But to use an imperfect analogy it would be like sending soldiers into battle without body armour because you'll bomb the enemy's bullet factories.

 

I think a better analogy is giving soldiers R&R without a condom.

 

Frontline workers have proper PPE that protects them, and training.  They are catching it from each other when their guard is down (in the breakroom, for example).  This information is from my wife who is an HR manager at a large healthcare company (several hospitals and clinics with tens of thousands of employees).  They are doing stupid things like having potlucks in the breakroom.

[Cardboard]

Wait... your wife?

 

You married a 2nd time?

 

You should know by now that divorce lawyers are worst than Covid....

 

Cardboard

[ERICOPOLY]

Yes, I remarried January 3rd, 2020.  Less than 3 months after my divorce was final.

[Cigarbutt]

Well it's a safety thing. Med staff is at risk cause they are exposed to it every day.

Frontline workers have proper PPE that protects them, and training.  They are catching it from each other when their guard is down (in the breakroom, for example).  This information is from my wife who is an HR manager at a large healthcare company (several hospitals and clinics with tens of thousands of employees).  They are doing stupid things like having potlucks in the breakroom.

This is interesting.

Vaccine capacity vs demand mismatch will eventually be resolved but there will be a period over a few months that will require some kind of stratification introduced in the distribution logistics.

Even if the protection aspect applies mostly, i would include, in the first line of distribution, frontline healthcare workers exposed in the following areas: emergency rooms, intensive care units, Covid-dedicated wards, nursing and chronic care homes, given that the virus spread is still rampant in many areas. Personnel retention in those areas has been a chronic problem and Covid-19 hasn't helped.

This AM, i read (and find ironic) that the HHS is aiming for a top-down and uniform strategy for distribution, implying that states and individuals should have limited input in the process. In periods of vaccine scarcity, the idea is to optimize overall societal functioning. Given how things have evolved so far and given the polarization, this will be interesting to watch and this does not even include the aspect of vaccine nationalism.