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Thread: Disease and pandemics thread (because it's science)

  1. #1441
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    Quote Originally Posted by Ken G View Post
    The question there is, again, what do they do in South Korea? Do they constantly reuse masks, or discard them, or clean them? It shouldn't be that hard to just figure out what they're doing, and do it. That is very sobering indeed. In the US, there is great stress on getting more ventilators, but if even a ventilator is not going to save most cases, it sounds like the stress is on the wrong things. I get that hospitals don't want to have to decide who gets a ventilator and who just dies, but that shouldn't be the main focus of how our society is coping. Everything we do must be to reduce R0 with minimal cost to everything else. I hear maybe 5% of the reports focused on just being smart about how to do that, and 95% on short-term issues like who needs a ventilator tomorrow and who should stay in their homes for a month. It's time to think more strategically, we know a lot about this disease, or should by now. Time for real solutions. The stopgaps are needed at the moment, like more ventilators and stay-at-home orders, but those stopgaps are not long-term solutions and I think we can start asking what those solutions are going to be. If facial covering is going to be part of the solution, and are not actually part of the problem, then our focus needs to be on how to make lots and lots of masks-- of good kinds that help prevent people from spreading the disease, including asymptomatic people who think they are trying to keep from getting it but are actually needing to not spread it. Do we even know what fraction of new cases are coming from asymptomatic spread, like someone has COVID-19 and also a seasonal allergy? Do we know what fraction is airborne or surface borne? These questions are not even being asked in any of the media I'm seeing.
    I have just listened to a ministerial explanation that we did not enter this period with a scaled up lab service but it is about now coming on stream. Testing by swab for patients, triage, then antibody testing to find those asymptomatic people. Tests that have high false negatives are worse than no test, so I find the argument is fair. Testing will, I think, arrive before a vaccine and will scale up faster. A reliable antibody finger prick test will make a huge policy difference. They are going to start sample testing the only approved antibody test at small scale now.
    Unless it is all lies, the reliability of these tests has not reached an acceptable level, some already proved inaccurate.

    Personally I prefer distancing over mask wearing and self isolation for those with a cough and fever, which seems to be policy here.
    Masks are for trained front line people. I would want one if treating a coughing patient.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

  2. #1442
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    Quote Originally Posted by George View Post
    I'm convinced this is right and it's why I have ordered a couple gross of bandannas.
    I suggest infected people should stay at home, where they do not need a mask.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

  3. #1443
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    We went to the grocery store this morning during the senior citizen’s hour. This week, there were quite a few people wearing masks, from surgical to simple bandannas. Last week, there were none.

    Of course, this means nothing more than people are becoming increasingly worried.


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  4. #1444
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    The First Minister of Scotland (a lawyer by training) has just, on our regional TV news, demonstrated a sound grasp of how the Positive Predictive Value of a diagnostic test varies with prevalence of disease, and has explained the concept clearly to a journalist.
    I'm astonished and gratified--it's a concept I've often had difficulty getting across to medical trainees, and it would appear that the political mantra of "we're following the science" is actually more than just an empty buzz-phrase on this occasion.

    Also, the UK government's public COVID-19 briefing tonight contained a surprising nugget, the significance of which seems to have been missed by journalists in the discussion that followed. We were told that early data and modelling suggests that the current control measures have pushed R0<1 in the UK. Obviously early days, need for caution and more data, and I'm very much not holding my breath, but it's interesting that this has even been ventured into the public domain.

    Grant Hutchison
    Last edited by grant hutchison; Yesterday at 06:27 PM.

  5. #1445
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    Quote Originally Posted by Swift View Post
    Call this prejudice if you wish, but I automatically ignore anything that Dr. Oz says; I think he is basically a snake oil salesman.
    But are his objective claims erroneous or untestable or what? In my experience, sometimes great ideas come from strange people. He at least is both lucid and articulate in his short interviews, and he warns that using HCQ may prove to be not that beneficial, something you don't hear from most any salesman. Perhaps I'll have time later to chase down the Wuhan story from those doctors as I found his account interesting from a scientific point of view, perhaps just because I like the history involved.

    I have also heard from multiple news sources that all these reports about HCQ and related drugs have created shortages for patients with diseases, like lupus, that are being treated with them.

    LINK
    Yes, and to keep my prior post less long, I omitted the part where Oz mentioned Israel was shipping 100 million units, but he didn't happen to mention when they would arrive. Dr. Oz also addressed this shortage concern and stated that NY has recently banned HCQ likely to protect the normal users of the drug.

    This apparent shortage, hopefully short-term, however, isn't due to toilet-paper hoarders but by doctors, which is an indication that there may be something to HCQ in treating Covid-19. Your link noted, "Organizations representing doctors and pharmacists criticized physicians who, they say, have prophylactically prescribed chloroquine, hydroxychloroquine and the antibiotic azithromycin “for themselves, their families, or their colleagues.” It's a good sign when the cook eats its own cooking.

    [Added: Why can't prescriptions for HCQ and perhaps z-pack be limited to those Covid-19 patients who are severely ill, thus allowing enough to assist NY patients, no doubt.?]
    Last edited by George; Yesterday at 09:04 PM.
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  6. #1446
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    Quote Originally Posted by profloater View Post
    I suggest infected people should stay at home, where they do not need a mask.
    Agreed but who are they if they are untested? We don't even know how many are aymptomatic, some say 25% as a guess. Serological tests, however, are coming soon, I think. [Now that I know what that means.]

    I may have even had the virus because I've been fighting what I have assumed to be allergies and, most years, I struggle with it this time of year as spring arrives with lots of pollen. But this year I had a fever, yet for only one day, and my upper lungs were congested more than I can remember, and not long after attending a 75,000 person expo in Vegas (cough). I called the doctor and did get my normal prescription including a z-pack (uh oh) but it didn't do the trick so he gave me another prescription that finally, with the last pill, cleared it up by perhaps >90%, and I'm improving each day with just an off-the-shelf allergy pill. Until I'm tested to see if I'm contagious I would think that a bandanna vs. no bandanna -- along with distancing, washing, etc. -- will be the better course.
    Last edited by George; Yesterday at 07:13 PM.
    We know time flies, we just can't see its wings.

  7. #1447
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    Quote Originally Posted by grant hutchison View Post
    The First Minister of Scotland (a lawyer by training) has just, on our regional TV news, demonstrated a sound grasp of how the Positive Predictive Value of a diagnostic test varies with prevalence of disease, and has explained the concept clearly to a journalist.
    I'm astonished and gratified--it's a concept I've often had difficulty getting across to medical trainees, and it would appear that the political mantra of "we're following the science" is actually more than just an empty buzz-phrase on this occasion.
    The director of our National Institute for Public Health and the Environment (RIVM) is doing a great job in presenting to our parliament on live TV. Taking the time to calmly explain why FAQs aren't always so easily answered.

    As to how the disease develops, the usually careful news site shows that the number of people admitted into hospitals in our country is slowly dropping. Of course that might be driven by dropping demand or decreasing capacity. Or both. Still, the explanation we got on the lag between being exposed to the virus, admitted in hospital typically 2 weeks later, and ICU stay of 2 to 3 weeks is sobering. A few days ago, only 40 patients had left the ICU, I presume they meant alive. The company I work for is still expanding the emergency capacity to care for COVID infected elderly and special needs that don't require hospital care (yet), and we're carefully being warned the big hit still has to come. Even those trying to keep the IT and other infrastructure working for the care givers and the work-at-home folks are slowly starting to get very, very tired.
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  8. #1448
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    In 1918 there was no internet, so people could not telecommute. This time around many people can and yet many companies are still reluctant to let their employees do so even though studies indicate productivity goes up. "Working" 9 to 5 is such an idiotic concept. Time spent in the office is not a measure of the work done.[̲̅$̲̅(̲̅ ͡° ͜ʖ ͡°̲̅)̲̅$̲̅] earned by the companies is. I hope more executives will eventually figure this out and we can save some lives. As-is, there does not seem to be a clear path out of this Covid-19 affair.

  9. #1449
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    Quote Originally Posted by George View Post
    But are his objective claims erroneous or untestable or what? In my experience, sometimes great ideas come from strange people. He at least is both lucid and articulate in his short interviews, and he warns that using HCQ may prove to be not that beneficial, something you don't hear from most any salesman.
    I watched one interview with Oz some days ago about this. My impression was that he was cheerleading for the drug, but after talking it up he put in some qualifiers. I don’t care for that behavior. Like I mentioned in my last post, other doctors consider existing “studies” to be junk (or worse), but he didn’t say anything like that.

    Of course it can be tested, and should be, but in my opinion at this point the position should be that this is one of a number of drugs that is to be tested in proper studies, and until that’s done we can’t say much about it. Also the problems with current “studies” should be pointed out. And that’s it. It shouldn’t be promoted or put ahead of other investigational drugs.

    Again, here is an article I linked to in my earlier post on this, discussing hydroxychloroquine and azithromycin and some of the bad science surrounding it:

    https://sciencebasedmedicine.org/are...-for-covid-19/

    There is a follow-up:

    https://sciencebasedmedicine.org/hyd...rsus-covid-19/

    It discusses another “study” that Raoult has put forward, how poor it is, yet Oz is apparently promoting it. Quoting from the article:

    One version of the treatment uses chloroquine (which is sold under the trade name Aralen and others), an anti-malaria drug that’s also used to treat autoimmune diseases. Another version, the one that at the time was getting the most press, claimed that the combination of hydroxychloroquine (trade name Plaquenil, and it’s a drug which is very similar to chloroquine) and the antibiotic azithromycin (often prescribed in the famous “Z-Pak”) could completely render SARS-CoV-2, the virus that causes COVID-19, undetectable in patients. As I described, it was a horrible, horrible study about which I later found out things that make me suspect that its awfulness could have been due to more than mere incompetence and instead might have been scientific fraud. Meanwhile, the only existing randomized trial of chloroquine in COVID-19 was negative. As I said at the time, that doesn’t mean that the drug doesn’t work, but it does strongly suggest that its effects are probably not dramatic, although it is also possible that the dose used was too low.
    This was written by David Gorski. I trust him a lot more than Oz. He often covers questionable medical claims with a skeptical focus.


    Quote Originally Posted by George View Post
    This apparent shortage, hopefully short-term, however, isn't due to toilet-paper hoarders but by doctors, which is an indication that there may be something to HCQ in treating Covid-19. Your link noted, "Organizations representing doctors and pharmacists criticized physicians who, they say, have prophylactically prescribed chloroquine, hydroxychloroquine and the antibiotic azithromycin “for themselves, their families, or their colleagues.” It's a good sign when the cook eats its own cooking.
    Not everyone that can write prescriptions has the expertise to properly evaluate this and has done so. Hopefully the majority are skeptical and considering risks, but there are credulous doctors too that can be taken in by hype. There are doctors that are just plain bad. As I mentioned before, there are dentists that have tried to write prescriptions for this. It doesn’t take a huge number of doctors to cause shortages for a drug like this that is being produced for established uses with an expected level of demand.

    Quote Originally Posted by George View Post
    [Added: Why can't prescriptions for HCQ and perhaps z-pack be limited to those Covid-19 patients who are severely ill, thus allowing enough to assist NY patients, no doubt.?]
    It has other legitimate uses, so it is hard to police. Apparently there is some attempt, though.

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  10. #1450
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    Quote Originally Posted by George View Post
    That's surprising to learn especially for women who wear them, who I assume even in Asia like to wear makeup and look nice. If it's now in their culture to wear them, then why are they, apparently, all white and not more colorful? I associated a lot of their use of masks with their terrible air pollution.
    I'm not sure where the idea came up that it has something to do with fashion. At least in Japan and South Korea, it is definitely not about fashion in the sense that makeup is. It really doesn't have much to do with pollution (though it does in China). In Japan it has to do with two things. One is hay fever. Because there was a bad policy after the war to plant massive numbers of cedar trees throughout Japan (for rebuilding), there is a huge problem with hay fever, and people wear masks to (whether it works or not is a different question) help with that. And then secondly, it is considered impolite to cough on other people, so when people are coughing they tend to wear masks. I got reprimanded once by a colleague because I was coughing at work (a long time ago) and wasn't wearing a mask. So as Grant says, an expression of respect for others. I think that is what he meant by "fashion."
    As above, so below

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