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Covid-19 - Facts and Information Only thread

Hapless Bills Fan

[This is a general message.  If you see it, please don't take it personally]
To avoid creating another mega-thread, I am returning to edit previous posts:

-update them with current information as it emerges or to add better information, so check back to the same post.

-paste in comments from knowledgable people that were originally separate posts

-delete discussion

 

If you want to discuss, please use the other thread. On a computer, click on the post date-time in the upper left corner to obtain a direct link to the post in question, then copy a link to include in your post so people know what you're referencing.  On a mobile device, this can be done but instructions vary.

 

If you find updated info, feel free to post it - but your post may disappear as I merge your info into the relevant original post.  I try to quote and give credit.

 

Thanks, and again - please don't take it personally if your post is deleted, I'm trying to maintain a succinct thread for information and resources. The other thread is there for your Covid-19 discussions and ruminations.

Message added by Hapless Bills Fan

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Homemade masks.  These ladies are legit.  They actually bought a particulate-testing machine from Grainger and went at it:
https://www.businessinsider.com.au/homemade-mask-using-hydro-knit-shop-towel-filters-better-2020-4?fbclid=IwAR35xOtPEvmleo5i7kFlGkIOrWmK_Y78e_ggPtZijkxCxuFwnmRAn8eZ0HU

 

"They bought a $US1,400 particulate-counter device from Grainger that measures filtration ability down to 0.3 microns and spent another 10 sleepless days testing all the fabrics they could find. ...They wanted a material they could buy as easily as cotton but that balanced filtration with breathability – they discovered that HEPA vacuum-cleaner bags, for instance, had great filtration but were too suffocating to wear."
 

"The ideal material turned out to be stretchy blue shop towels made from a polyester hydro knit.

Inserting two of these towels into an ordinary cotton mask brought filtration up to 93% of particles as small as 0.3 microns, the smallest their machine could test. Meanwhile, the cotton masks filtered 60% of particles at best in their tests, Schempf said."

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I saw this posted in a couple places. I found it here: https://www.worldometers.info/coronavirus/country/italy/

 

I somewhat feel like this might be the case when things start to settle down. Not to minimize it, but I know people in my office that were showing symptoms similar to Coronavirus back in December. So more people might have been infected than reported, especially with the lack of testing early on:

 

"Italy: the real number of COVID-19 cases in the country could be 5,000,0000 (compared to the 119,827 confirmed ones) according to a study which polled people with symptoms who have not been tested, and up to 10,000,000 or even 20,0000,000 after taking into account asymptomatic cases, according to Carlo La Vecchia, a Professor of Medical Statistics and Epidemiology at the Statale di Milano University.

 

This number would still be insufficient to reach herd immunity, which would require 2/3 of the population (about 40,000,000 people in Italy) having contracted the virus [source].

 

The number of deaths could also be underestimated by 3/4 (in Italy as well as in other countries) [source], meaning that the real number of deaths in Italy could be around 60,000.

 

If these estimates were true, the mortality rate from COVID-19  would be much lower (around 25 times less) than the case fatality rate based solely on laboratory-confirmed cases and deaths, since it would be underestimating cases (the denominator) by a factor of about 1/100 and deaths by a factor of 1/4."

[Edit: please see cross post in Covid Discussion thread to discuss/debate]

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1 minute ago, Justin C said:

I saw this posted in a couple places. I found it here: https://www.worldometers.info/coronavirus/country/italy/

 

"I somewhat feel like this might be the case when things start to settle down. Not to minimize it, but I know people in my office that were showing symptoms similar to Coronavirus back in December. So more people might have been infected than reported, especially with the lack of testing early on:

 

Italy: the real number of COVID-19 cases in the country could be 5,000,0000 (compared to the 119,827 confirmed ones) according to a study which polled people with symptoms who have not been tested, and up to 10,000,000 or even 20,0000,000 after taking into account asymptomatic cases, according to Carlo La Vecchia, a Professor of Medical Statistics and Epidemiology at the Statale di Milano University.

 

This number would still be insufficient to reach herd immunity, which would require 2/3 of the population (about 40,000,000 people in Italy) having contracted the virus [source].

 

The number of deaths could also be underestimated by 3/4 (in Italy as well as in other countries) [source], meaning that the real number of deaths in Italy could be around 60,000.

 

If these estimates were true, the mortality rate from COVID-19  would be much lower (around 25 times less) than the case fatality rate based solely on laboratory-confirmed cases and deaths, since it would be underestimating cases (the denominator) by a factor of about 1/100 and deaths by a factor of 1/4."

I check that site also. Today they posted some possible good news...

 

  • 4805 new cases and 681 new deaths in Italy. The number of patients hospitalized in intensive care has declined for the first time since the beginning of the epidemic in Italy

    The target of bringing down the reproductive number (R0) to 1 has been reached. Now the goal is to bring it below 1. Earlier in the epidemic, it was as high as 3. This value represents the average number of people to which a single infected person will transmit the virus. An epidemic with a reproductive number below 1 will gradually disappear

    An estimated 30,000 lives have been saved as an effect of the lockdown measures, according to Istituto Superiore di Sanità (ISS) [source] [source]
 

 

 

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Some promising small results with monoclonal antibody treatment

 

https://www.wsbtv.com/news/trending/hiv-drug-showing-signs-successfully-treating-coronavirus-patients/4ONG76NRAREW7C2LAWBVTHK7EI/

 

https://markets.businessinsider.com/news/stocks/treatment-with-cytodyn-s-leronlimab-indicates-significant-trend-toward-immunological-restoration-in-severely-ill-covid-19-patients-1029057991

 

The drug, leronlimab, doesn't treat the covid-19 virus directly.  One complication of covid-19 is cytokine storm, where the patient's own immune system goes into berserker mode and starts attacking the lungs (this happens as a complication of some influenza cases as well).   Leronlimab "calms the storm"

 

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1 hour ago, OldTimeAFLGuy said:

..in deference to Hap and other TRD'ers with medical expertise and to help my shortsightedness, can I assume that the medical community faces two mutually exclusive conundrums as follows....

 

1. Treatment(s) to Eventuate or Promulgate Recovery-much has been made about various malaria related drugs that may assist in a COVID-19 infected person surviving.

2. A Vaccine Cure-as with the flu, I doubt there can ever be a 100% preventive cure; perhaps best case as with flu vaccines is 50%.

 

...are these the focus today in concurrence?.....

 

I'm having a bit of trouble parsing this.  I don't think vaccines and treatments are "mutually exclusive conundrums"?

 

I think the #1 priority for the medical community is assuring disease protection for health care workers and other first responders - not just medical, but police officers, social workers, personal care aides.  We don't want to render our HCW and 1st responders extinct.  There are three parts to this:

1) adequate supplies of good PPE.  We got people wearing N95 masks who should be wearing PAPRs or N95 masks + face shields, and people wearing surgical masks who should be wearing N95s.  We got people wearing gowns who should be wearing coveralls and hoods, and people wearing trash bags or rain ponchos over scrubs who should be wearing gowns.

2) serology (blood) testing and quick turn around PCR testing - if we can identify who is immune, but not contagious, then we know who can safely work most closely with infected people, assure public safety, care for elders without risking them

3) effective prophylactic treatment for people who are exposed/to clear virus from asymptomatic or presymptomatic people - if hydroxychloroquine/azythromycin work for this alone, that would be HUGE - clinical trials underway.

 

#2 priority is tools to control the epidemic and let people out of lockdown once the disease passes. 

1) Serology testing to know who in the general public is immune

2) Mask-wearing in public to cut off asymptomatic and presymptomatic transmission chains. 

3) a contact tracing system based on "big data" from cell phones etc - so that when someone tests positive, you can find out if you were close enough that you should be tested

 

#3 specific treatment for those unlucky enough to become critically or seriously ill.  Discussion of various options up thread

1) identifying/treating cytokine storm (autoimmune response) when it occurs

2) use of convalescent plasma donated by all those lucky souls who have had the disease (identified by serology testing) to help heal

are the two surest bets near term

 

There may be a "magic bullet" found in the 110+ clinical trials underway, and that will be great, but we need to figure out how to manage this with the tools we have to hand now

 

Vaccination  - it's not clear yet how long immunity from people who have been ill will last, or how long immunity from a vaccine will last.   People studying the genomics of this virus are saying they think it will probably take several years to mutate away from a vaccine developed against the current virus, which would be good - but the real question is for people who get the disease, how long does their immunity last?

 

Flu vaccine has a huge effect being 50-60% effective.  The cases of flu that develop are generally milder, due to partial immunity.  Flu has an effective transmission number of 1.3, due to partial immunity and vaccination.  This beast transmission number currently 2.2.  If you lower the transmission number to where it's like flu, covid-19 will still be a serious disease for some people, but it will no longer overwhelm hospitals with desperately sick people.  That, plus specific treatment to lessen the severity will make it manageable.

 

 

 

 

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Anybody post the technical guide:

 

https://arstechnica.com/science/2020/04/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/

 

[Edit: This is quite good!  There are places where the information is a bit dated, as in the early belief that asymptomatic carriers were few, and that transmission from asymptomatic carriers and aerosol transmission were not occurring....it is now acknowledged at best, we don't know the extent]

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Posted (edited)
On 4/4/2020 at 10:36 PM, Hapless Bills Fan said:

Some promising small results with monoclonal antibody treatment

 

https://www.wsbtv.com/news/trending/hiv-drug-showing-signs-successfully-treating-coronavirus-patients/4ONG76NRAREW7C2LAWBVTHK7EI/

 

https://markets.businessinsider.com/news/stocks/treatment-with-cytodyn-s-leronlimab-indicates-significant-trend-toward-immunological-restoration-in-severely-ill-covid-19-patients-1029057991

 

The drug, leronlimab, doesn't treat the covid-19 virus directly.  One complication of covid-19 is cytokine storm, where the patient's own immune system goes into berserker mode and starts attacking the lungs (this happens as a complication of some influenza cases as well).   Leronlimab "calms the storm"

 

 

Hap, feel free to move/delete this if you feel it does not belong here.  It was posted in the PPP thread 'Know Anyone with a Disease'.  That is a medical cannabis thread here. There I have posted more of my personal experience with recent respiratory problems and cannabis concentrates.

 

https://www.twobillsdrive.com/community/topic/169052-know-anyone-with-a-disease-read-this/?do=findComment&comment=6463090

 

 

I have been reading a bit more about the 'cytokine storm' that seems to overwhelm the lungs in covid-19 patients.  This is essentially an overreaction by our immune system to the virus.  It seems that this overreaction is at the heart of the fluid build up in the lungs and so to the shortness of breath issue.  With THC being a bronchodilator, there may be a treatment hidden in here somewhere I think.

 

I am no expert in this field, unfortunately.  From what I have read, many of the potential pharma treatments try to also quiet this cytokine storm.  I am curious if there is any actual current research on using cannabinoids to try to treat covid-19 patients.

 

https://www.projectcbd.org/medicine/cannabis-cbd-covid-19

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828614/

 

from the study

 

Executive summary

Cannabinoids, the active components of Cannabis sativa, and endogenous cannabinoids mediate their effects through activation of specific cannabinoid receptors known as cannabinoid receptor 1 and 2 (CB1 and CB2).

The cannabinoid system has been shown both in vivo and in vitro to be involved in regulating the immune system through its immunomodulatory properties.

Cannabinoids suppress inflammatory response and subsequently attenuate disease symptoms. This property of cannabinoids is mediated through multiple pathways such as induction of apoptosis in activated immune cells, suppression of cytokines and chemokines at inflammatory sites and upregulation of FoxP3+ regulatory T cells.

Cannabinoids have been tested in several experimental models of autoimmune disorders such as multiple sclerosis, rheumatoid arthritis, colitis and hepatitis and have been shown to protect the host from the pathogenesis through induction of multiple anti-inflammatory pathways.

Cannabinoids may also be beneficial in certain types of cancers that are triggered by chronic inflammation. In such instances, cannabinoids can either directly inhibit tumor growth or suppress inflammation and tumor angiogenesis.

Edited by Bob in Mich
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Really good explanation from virologist Peter Kolchinsky of why covid-19 is a harder beast to fight than SARS was.

 

https://threadreaderapp.com/thread/1246975275021348865.html?fbclid=IwAR0fbXN74tI4gmZETIgRhNSuuk5KCEh3X0lG90w0Rnf9bjNx0IdoFvqOclE

 

"Well, the ACE2 doorknob that SARS-1 & SARS-2 use is present on a variety of cells, including those in our lungs & throat. SARS-1 would enter a person via a droplet in the air (from cough) & quickly start infecting lung cells, causing severe damage person could really feel (i.e. become symptomatic). In other words, SARS-1 quickly made its presence known. In some patients, SARS-1 would go into the upper airways to replicate from where it could spread to others with a cough (or just breathing). But b/c SARS-1 patients got very sick from all the virus replicating in their lungs, they were quarantined before others got close enough to get sneezed or coughed on.

 
SARS-2, on the other hand, takes up residence in the throat cells first, which doesn’t cause significant symptoms. The person can remain asymptomatic or might not think they have anything worse than a cold. And from that person’s throat it can readily spread to others. Over the course of a week, in some patients, it will move into the lung neighborhood and replicate just as SARS-1 would, causing severe symptoms, by which point the person is quarantined, but no matter since it had successfully spread."

"So SARS-1 was a comparatively dumb virus. It went straight for the lungs, announced itself before it could spread to others, and so got social distanced into extinction. "
 
"But SAR-2, the one plaguing us now, is stealthier, spreading first before revealing itself (and causing harm).  What’s the take-away for all of us? It’s that beating this virus means social distancing & wearing masks even if we think we aren’t infected. Because we might be. The virus might be replicating in our throats without us knowing (that’s its evil plan!), so put up a roadblock. "
 

Nature publication about study this info is based upon: https://www.nature.com/articles/s41586-020-2196-x

 

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3 hours ago, OldTimeAFLGuy said:

...Hap...any validity to this?....

Indoor humidity may slow coronavirus spread, Yale scientists say

By James Rogers | Fox News

 

Researchers at Yale say that we may get some respite from the coronavirus pandemic as we move into spring, although this depends on how indoor environments adapt.

While the effectiveness of social distancing measures obviously plays a crucial role in battling the spread of COVID-19, the scientists are also eyeing changes in relative humidity indoors from winter to spring to summer.

 

Relative humidity measures water vapor relative to the temperature of the air.

 

“In other words, it is a measure of the actual amount of water vapor in the air compared to the total amount of vapor that can exist in the air at its current temperature,” explains the National Weather Service on its website. This differs from absolute humidity, which is a measure of the actual amount of water vapor in the air, regardless of its temperature.

 

https://www.foxnews.com/science/indoor-humidity-may-slow-coronavirus-spread-yale-scientists-say

 

Eh, here's the paper:

https://www.annualreviews.org/doi/pdf/10.1146/annurev-virology-012420-022445

 

Basically the operative word is "MAY".  Their argument seems to be that other human coronaviruses that cause common cold are seasonal and tail off at the end of April, so this one will too.  But there is no new evidence offered on that point.

 

They make a case for relative humidity - the amount of water vapor in the air, vs the amount the air can hold at that temperature - which is low in heated environments in winter - as a factor impacting virus viability and ability to spread - and they review a bunch of research on that point, but none of that research is on covid-19

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University of Texas group takes a look at the chances that even 1 positive case in a county indicates community spread is underway:

 

https://cid.utexas.edu/sites/default/files/cid/files/covid-risk-maps_counties_4.3.2020.pdf?m=1585958755&fbclid=IwAR3xoK7HG6WvIrdYMfC0zwswIf7ePb-qGo9FXR8JbXDWdOfaPSlZi-rAwlQ

 

Without a coordinated state or federal response to COVID-19 across the United States,counties are left to weigh the potentially large yet unseen threat of COVID-19 with theeconomic and societal costs of enacting strict social distancing measures. Theimmediate and long-term risk of the virus can be difficult to grasp, given the lack ofhistorical precedent and that many cases go undetected. We calculated the risk thatthere already is sustained community transmission that has not yet been detected.Given the low testing rates throughout the country, we assume that one in ten cases aretested and reported. If a county has detected only one case of COVID-19, there is a 51%chance that there is already a growing outbreak underway. COVID-19 is likely spreadingin 72% of all counties in the US, containing 94% of the national population. Proactivesocial distancing, even before two cases are confirmed, is prudent

 

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Posted (edited)

hospitalizations drop for second day in a row in NYC - local DC TV news  no link sorry 

[Edit: graphic on positive cases and deaths.  positive cases closely linked to hospitalizations since they are only testing people sick enough for admission and HCW/1st responders]

image.thumb.png.b4d72575e2bbc7fa8cbca847fc7d799e.png

 

Edited by Hapless Bills Fan
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18 hours ago, Hapless Bills Fan said:

 

Eh, here's the paper:

https://www.annualreviews.org/doi/pdf/10.1146/annurev-virology-012420-022445

 

Basically the operative word is "MAY".  Their argument seems to be that other human coronaviruses that cause common cold are seasonal and tail off at the end of April, so this one will too.  But there is no new evidence offered on that point.

 

They make a case for relative humidity - the amount of water vapor in the air, vs the amount the air can hold at that temperature - which is low in heated environments in winter - as a factor impacting virus viability and ability to spread - and they review a bunch of research on that point, but none of that research is on covid-19

 

...if I understand correctly, it should NOT be flourishing in Brazil which is in their summer season..........

 

from The Guardian:

Brazil is bracing for a surge in coronavirus cases as doctors and researchers warn that underreporting and a lack of testing mean nobody knows the real scale of Covid-19’s spread.

 

“What’s happening is enormous underreporting,” said Isabella Rêllo, a doctor working in emergency and intensive care in Rio de Janeiro hospitals, in a widely shared Facebook post challenging official numbers. “There are MANY more,” she wrote.

 

As Latin America’s worst hit country, Brazil officially has 9,056 coronavirus cases – including actors, singers, government ministers and Fabio Wajngarten, press secretary of the president, Jair Bolsonaro.

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3 hours ago, SlimShady'sSpaceForce said:

Also NYC related: https://gothamist.com/news/surge-number-new-yorkers-dying-home-officials-suspect-undercount-covid-19-related-deaths

 

[Thanks for posting - seemed inappropriate for me to "like" tho. 😥 This is pretty common in an epidemic situation.  Very likely happened in China and is happening in Italy/Spain and elsewhere too.  When the dust settles, statisticians look at seasonal deaths from previous years and calculate an "excess death rate" which may be attributed to the disease]

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Posted (edited)

 

This is a good visualization with lasers as to how microdroplet transmission occurs, and a model of how it would linger and move about a closed room with relatively poor air circulation.  My bottom line: Indoors, Mask up!

 

 

 

Edit: and here is a Belgian study about the effects of exercising close to others:

https://medium.com/@jurgenthoelen/belgian-dutch-study-why-in-times-of-covid-19-you-can-not-walk-run-bike-close-to-each-other-a5df19c77d08

 

 

Edited by Hapless Bills Fan
add second visualization video
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https://www.npr.org/sections/health-shots/2020/04/02/826105278/ventilators-are-no-panacea-for-critically-ill-covid-19-patients

 

Hapless what are your thoughts on this? 

What are my thoughts on this?  I saw this a couple days ago and it took me a bit to unsnarl my thoughts to give a more-or-less reasoned response. 

 

Ventilators for patients in the throes of viral infection have always been a bit of a hail-Mary pass.  In an acute injury or post-surgery, they provide time for healing; with a bacterial infection they provide time for antibiotics to take hold.  For a viral infection, if there's an effective antiviral, Same, but otherwise it's a race against time.  Does the patient recover faster than they develop complications from the effects of the ventilation or secondary infections?

As I understand it, overall in China their experience was people who wound up in ICU on ventilators were 50-50 if they recovered or not.  If they did recover, it took a long time - 2 to 4 weeks.  I think the referenced initial study from Wuhan was early on, and they improved outcomes as the outbreak went on.  So I'm not sure about the statistics there.

Here is a study from UK where so far they are running 1/3 wean and leave, 2/3 fatalities for ventilated patients (but many not yet resolved, still in ICU):

https://ricochet.com/742120/covid-19-data-survival-rates-for-patients-on-ventilators/

 

Factors:

1) The saturated health care system in NYC currently.  They are only hospitalizing the most severely ill patients and sending the others home with instructions to return if they meet certain critera.  By the time those sent home meet the criteria and return, they may already be in such respiratory distress as to require immediate ventilator treatment. 


Several therapeutic windows that might keep them from needing ventilation are already lost - windows to try a clinical trial for an antiviral medication, or immune plasma, windows to see if improved oxygenation and hydration will improve outcome, and a window to test for and treat/manage cytokine storm (There is a simple, inexpensive blood test for this, ferritin, and if any of you have a seriously ill family member be sure to ask the results of this test.  But do not ask for the test before they are showing respiratory symptoms, false negative may occur). 

 

If the patient comes in with lungs already severely damaged from covid-19 or already in the throes of cytokine storm, there is little to do but support them and wait.  Either they will heal or they won't.  They can be treated to contain cytokine storm or treat sepsis, but if damage exists, it won't be reversed, it must wait to heal itself or not.

 

2) How is the ventilator being used?  The current standard of care is to treat as acute respiratory distress syndrome.   There is some evidence suggesting that covid-19 damaged lungs are sensitive and require lower pressure settings than are standard.  I do not know how clear this evidence is or how widespread use of lower pressure settings are becoming, but obviously if the ventilator is being split between patients, controlling pressure carefully (and controlling secondary infections) becomes more of an issue.

 

3) Is the patient being monitored and treated for complicating conditions such as cytokine storm or sepsis?   Are there clear clinical guidelines for these treatments?  Do the staff have time to order  the appropriate laboratory tests and keep up with the findings?  Are the medications in good supply?

 

Bottom line is this: as long as there is no cure, prevention is essential - both to avoid overstressing the health care system and to give the patients who do require it their best chance.  A metric like "I haven't heard of ventilators being unavailable" simply doesn't begin to capture the effects of health care system overload.

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1 hour ago, SlimShady'sSpaceForce said:

The United States on Tuesday reported more than 1,800 coronavirus-related fatalities, a new one-day high.

 

https://www.washingtonpost.com/world/2020/04/07/coronavirus-latest-news/

 

a Guardian report has a higher number


Some good news (model accuracy or lack thereof notwithstanding):

 

https://covid19.healthdata.org/united-states-of-america

 

Estimates of death toll and max resource consumption are down significantly.

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35 minutes ago, Pilsner said:

America’s major medical society specializing in the treatment of respiratory diseases has endorsed using hydroxychloroquine for seriously ill hospitalized coronavirus patients.

The American Thoracic Society issued guidelines Monday that suggest COVID-19 patients with pneumonia get doses of the anti-malaria drug.

 

 

https://nypost.com/2020/04/06/medical-group-backs-giving-hydroxychloroquine-to-coronavirus-patients/

For context:

 

guidelines on who who qualifies for this treatment and their thinking behind issuing this advise:

Quote

“To prescribe hydroxychloroquine (or chloroquine) to hospitalized patients with COVID-19 pneumonia if all of the following apply: a) shared decision-making is possible, b) data can be collected for interim comparisons of patients who received hydroxychloroquine (or chloroquine) versus those who did not, c) the illness is sufficiently severe to warrant investigational therapy, and d) the drug is not in short supply,” the Thoracic Society said.

Quote

The medical group said evidence about the impact of hydroxychloroquine is “contradictory” but it is worth experimenting with during a public health crisis to treat very sick patients.

 

“We believe that in urgent situations like a pandemic, we can learn while treating by collecting real-world data,” said Dr. Kevin Wilson, chief of guidelines and documents at the American Thoracic Society.

 

“There are in vitro studies that suggest that hydroxychloroquine and chloroquine have activity against SARS-CoV-2019, the virus that causes COVID-19,” Wilson said.

 

But he also said several controlled trials from China and France “all have serious flaws and inconsistent findings. … Thus, the bottom line is, whether hydroxychloroquine and chloroquine confer benefits to patients with COVID-19 are unanswered questions.”

 

Like Trump, Cuomo said Monday giving sick COVID patients doses of hydroxychloroquine is a worthy experiment to try to save lives.

 

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