shoshin

Is there some reason to root against Bill Gates helping to develop a vaccine?

My wife works with an at-risk population daily. Your second sentence is EXACTLY what is happening. It is a nightmare and what's worse is that many of the support services outside of the medical care but related are also shut down or running barebones. Meals. Transport. Medical supply delivery. An entire chain of homecare support is nearly shut down. Thank a doctor and thank a nurse. But really, thank anyone in healthcare right now. What there are doing not only treating covid patients, but trying to keep the remaining healthcare system from collapsing, is heroic. It's that dire.

No good study yet really. The handful of ones so far show the same result, which is good, but all were small and had significant faults. None quite as bad as, "We may have mixed in blood donated because it was known to have covid antipbodies" but other problems nonetheless. We know there are more cases than have been tested, both that are/were symptomatic and those that are/were asymptomatic. What that number is we don't know. I hope it's high as f###.

That would be amazing both in rapid spread of the virus and amazing results. The Germany and WA studies will be more definitive. I'm sure there are a million other studies happening on bigger scales as this is a critical number to estimate.

That study was withdrawn for a pretty catastrophic reason. Now it has emerged that the researchers cannot rule out that a smaller proportion of blood samples were made on people who had covid-19, who donated blood to produce plasma for the treatment of covid patients. Talk about a pretty serious "oh *****" moment for a researcher on a critical study. Hopefully they can replicate it once it's cleaned up. Wash State has, I believe, the definitively biggest test ongoing on this topic. Germany has a big one happening too. Those will be the bigger data sets to look for. (Sorry that you have to use the translate function)

Of course this is what is going to happen barring treatment breakthroughs. It's not even that controversial. We will start in the fall with thousands of cases still floating around spread across lots of geographies, instead of just a few located in few places.

No h in Fauci FYI. It's newsworthy because there is so little talk about it. It's been clear that this first 70-100,000 deaths and hospital overrun is just an initial small wave (small because it started at zero cases, small because we shut down, and small probably because the south already had some warm weather coming to the rescue), so it's worth understanding what is coming in the fall lineup. Barring treatment leaps and big changes to the way we act, it ain't gonna be pretty.

I’ve only seen the clinical trials showing one result sadly. Bigger trials are needed with double blinding but the initial results are not positive. There have been lots of stories about HCQ but no trials showing it’s effective. The initial results on Remsidivir, however, are very promising.

Yesterday was another new high that got in the ballpark of 3000 deaths. That’s with distancing measures in place and a healthcare system shut down so it can focus on this. And in spite of NY/NJ taking up less of the total than they have in many weeks. There appears to be a weather component but barring a serious treatment breakthrough, the fall will be worse than now. And that is a near certainty unless we have accurate serological testing, track contacts with precision, and are ready to shut down regions when they outbreak. We won’t get to will this away because we want to work, and I sure do. This is real but the cases don’t drop off a lot. We are in the midst of a leveling out at 2000-2500 per day. No sign of decline on deaths yet.

Temperature screening is going to accomplish about zilch. Unless some idiot is out there trying to spread the disease, it just blocks that guy. With so many asymptomatic people out there, temp screening is a waste of time. I can't wait to go back to my gym and I'll be one of the first people back when it opens, but I'll only be safe by looking out for myself and even then I might not be safe from Covid-19.

Most people recover, which is why the double blind test is so critical. Giving people HCQ and seeing them do better is what would happen whether most of them had HCQ or not. Hopefully the double blind study will show that HCQ makes a difference.

We should open but man should we be careful about it. 3000 deaths/day in an open economy even with precautions seems like it would be almost a certainty, especially come the colder weather. I hope that we have some treatments by then.

Don't do Internet nonsense. You know that's not what I said. And, that PCPs are telling people not to get tested to protect the patients and HCWs, which happens every day because the health care system is bogged down. You keep not responding to this point that I keep making. The biggest reason not every symptomatic person is getting tested now is because people are not going to get it done for the many reasons I've mentioned at least 4 times. This I agree with. But given the number of cases out there, we will probably never be swabbing every sick person. Once we have the serological tests, PCPs will tell every symptomatic person to get tested.

Yes, it is. They are saying they have the capacity to run more tests, but Quest does not administer the tests. You keep making this same mistake. Quest is a lab. They ship a test. ANOTHER PERSON ADMINISTERS IT. Then that administering person ships it to Quest to run the test. Not every place has the human resource to administer the test or wants to waste that person's time when their time is more valuable running a test on everyone who walks through the door. And most PCPs are trying to keep that person from harm so they tell people to stay home unless it's serious.

But that's also different from having enough human capacity to administer the tests, and doctors encouraging people to come take the tests when that just puts others at risk. Capacity in numbers of tests available is not the issue. These swab tests are not fast enough for what we truly need to get ahead of this in a big way. When there's true availability of an accurate serological test, that will give us a big leg up.

I've read lots of anecdotes but the only two studies I've seen, the one mentioned (paper here) and this one, show no benefit unfortunately. Novartis has a bigger study in progress with proper controls so that will be a better measure. I hope it works somehow. We need all the help we can get and a cheap and well-known drug like Hydrochloroquine would be a godsend.

Trump hasn’t been pounding this drum lately. Still need more robust tests but this is the second Good size study to conclude this. I hope it’s wrong or there is some flaw in it.

If anything, Trump is never ever consistent.

If your definition of "overwhelmed" is that they are caring for patients like they were before and also have capacity for Covid patients, that is a very long ways off.

https://www.nytimes.com/interactive/2020/04/16/opinion/coronavirus-mutations-vaccine-covid.html

It hasn't significantly mutated yet to say there's a new strain. And that's a good thing.

Still in a state of mostly lockdown, Milan/Lombardy is no longer seeing deaths and cases slowing, they are just remaining level, right at the time when it wants to reopen. This should be the thing to worry about in bigger US cities, maybe especially those US cities that only had fewer cases so far compared to NYC. Lombardy got things under some degree of control through the lockdown, but it doesn't seem likely to last when they raise the restrictions given the high case counts.

A couple of things. On the 70,000 for this wave, that’s just numbers. We are at 43,000 dead. The current deaths/day is about 2000. In Italy and Spain, they held their peak deaths per day for what, 20 or so days and then didn’t steeply decline but went down gradually with a long pause at 50-70% of their peak where they currently are. It’s only going to take 2 weeks at 1500/day to get to 70,000. So that’s not pessimism or gloom and doom, it’s just numbers. The 70,000 would have been right if we locked down through May. With reopening, I don't know. What we are seeing is a definite drop in NY Metro deaths finally but a rise elsewhere. And even with the drop, it's still a staggering 500/day. As to your second point about flattening the curve enough so hospitals can manage this, I agree. But I think you may miss how hospitals in most places handled this in the last month since the shutdown started. From my friend who is a surgeon in rural WV to here in a big city, our medical system went dark for almost every non-Covid patient to handle this. And it mostly worked except NYC and a few other spots. But shutting everything in a medical system down is not handling this. It’s a ultra-crisis mode. The people not getting treatment need treatment for a variety of issues. Think of it like the economy: We can only put things off for so long. I am for reopening but let’s not kid ourselves that it’s going to be something other than extremely messy. Distancing worked to stem the flood of cases and deaths. Reopening will not continue a downward trend of cases and deaths. And maybe you’re right that it's better for warm places, so the summer will help but that’s a brief respite. On Sweden. Stockholm is by far the largest city in Sweden. It has 1.7M people. The entire country doesn’t have 11M. It doesn’t have one city with the socio economic makeup of a Cincinnati let alone 30, with some of our metro areas having more people than their entire country. It’s a neat place but it is not similar to here in important ways. Sweden can show what is possible when people act intelligently but as you can see from our protestors crowding around each other, Sweden does not show what is probable. And Remember: Sweden and the US have very similar numbers NOW. That’s a country that didn’t shut down (Sweden) vs a country that did (us). Our numbers wouldn’t be the same if we had stayed open.

I’m eager to be wrong. I need to be back to friggin work!

You have me wrong here but that's not a big deal. I want to reopen and would love us to have Sewden's outcome. It's just that with our cities, we resemble Sweden very little. The rest of the US resembles Sweden in population density more, but not in many other ways. I say this based on data and having had to travel there for work a lot. There is a lot of inaccurate stuff in your bullet points, the most glaring of which is "At least 50% of the population of both the UK and Sweden will be shown to have already had the disease when mass antibody testing becomes available." There is not a single study to support this but I'd love this fantasy to be true. But another doozy is "Covid-19 is a “mild disease” and similar to the flu, and it was the novelty of the disease that scared people." That's absurd. The flu doesn't kill 70K people in 5 months from 0 the months proceeding --with distancing in place--, and the flu doesn't swamp morgues and hospitals and overwhelm healthcare systems that are turning away all unnecessary surgeries. I want to reopen according to the Trump guidelines, but even the states that are opening now appear to not care about those. That's fine, but let's do it eyes wide open. Things will get a lot worse in deaths and health care before they get better by rushing into reopening. Since I think reopening is the priority, I lean towards taking that risk but it's real and let's not think some miracle is going to happen where we find ourselves with less than several hundred thousand more dead by April 2021. The bodies from Covid and an overwhelmed healthcare system will pile up. I keep anecdotally saying it but my wife works in a huge health system and her team is literally swamped with people getting sicker by the day, not just from Covid though that too, but from all the other ***** that's not getting adequate treatment (drains, assisted nursing procedures, home care issues, a myriad of other health services). When Covid cases rise beyond where they are now, those people will get even sicker. As will all the other "elective" doctor appointment people. Let's reopen but let's not be stupid enough to think the price for doing it will be anything other than high. No, it's just that the NY Times bestowed a gold star to Sweden but guess what, Sweden despite it's many many advantages in dealing with something like this (including that such a high number of its people live alone, its high degree of compliance with social distancing guidelines, that its workers are working from home as a result of corporate decisions, and its dispersed population), is doing no better than us. We have a way more susceptible population than Sweden. Have no fear: When we lift restrictions, our numbers won't stay where they are level with Sweden.