Coronavirus

[SnarkyPuppy]

@orthopa

"how can the hospitalization rate/positive rate be so high..."

 

I have heard from several NYC doctors I know that when admits are presumed covid based upon symptoms, and then there is a "confirmatory" test which is negative, hospital just treats it as a false negative and doesnt change record, and proceeds with oxygen, IV and monitoring

 

Accepts anecdotal data in direction that confirms preconceived bias.  Ignores anecdotal data in opposite direction

 

https://www.sfgate.com/bayarea/article/Santa-Clara-county-coronavirus-February-deaths-15217371.php

[Guest cherzeca]

hume interview of Berenson:  https://www.foxnews.com/politics/brit-humes-interview-with-ex-nyt-reporter-alex-berenson-read-the-transcript

[RichardGibbons]

this is BS Hj.  the early data from china was definitive on excessive impact on elderly.  and we knew the genomics of this virus very early on.  we were not operating in the dark, we were just operating stupidly.

 

This is BS, CZ. People have tried closing down nursing homes.  It doesn't work, particularly when the President prevents testing.  Your repeated assertions that it would work are silly.

[RichardGibbons]

The only thing that is delusional is to believe that people who have spent all their lives in this area (doctors in the area of infectious diseases, diagnostic, vaccine and drug development experts, and yes, epidemiologist) make decisions solely based on models and not update their hypothesis based on hard data on the ground.

 

+1.  Note that "making decisions based on the most pertinent observations" basically means "enhancing models based on new information".

[RichardGibbons]

Accepts anecdotal data in direction that confirms preconceived bias.  Ignores anecdotal data in opposite direction

 

I find it remarkable that people have lived through two months of this, but, as new information has come in, have not updated their theories at all.

 

Terrifying.

 

But it does show nicely how someone like Trump can maintain popularity. Basically, a large segment of the population--including some doctors!--doesn't care at all about evidence except insofar as it supports what they want to believe.

[clutch]

FYI, guys, I was talking about the situation in Ontario, Canada... not US or Trump...

 

I guess nobody cares about Canada and I should just leave this thread alone.  ;D

[Guest cherzeca]

this is BS Hj.  the early data from china was definitive on excessive impact on elderly.  and we knew the genomics of this virus very early on.  we were not operating in the dark, we were just operating stupidly.

 

This is BS, CZ. People have tried closing down nursing homes.  It doesn't work, particularly when the President prevents testing.  Your repeated assertions that it would work are silly.

 

More BS from you RG.  No visitors to nursing homes instituted by the industry late march.  should have been late January.

[rb]

It is really amazing to me. When all this anti-intellectualism, anti-expertise started with Trump there were questions posed like if you have the guy who operates on you to be a doctor? That was purely theoretical back then and didn't need to be addressed. Now fast forward to 2020 when you have a situation where it's not theoretical anymore. You actually need the doctors. Turns out that no, they still don't want the doctors.

 

This is how you end up with a situation where they put a dog breeder in charge of the COVID task force. Unbelievable! But it's ok... because he's a small business guy.

 

https://www.reuters.com/article/us-health-coronavirus-usa-hhschief-speci/special-report-hhs-chief-azar-had-aide-former-dog-breeder-steer-pandemic-task-force-idUSKCN2243CE

 

As an aside, what's up with the Republicans putting animal people in charge of disaster? Wasn't the guy who fucked up Katrina a horse guy or something like that?

[Spekulatius]

While we are talking about how this virus is a curveball and we keep learning new things, here is another one -

 

Alarmed as COVID patients' blood thickened, New York doctors try new treatments

https://www.reuters.com/article/us-health-coronavirus-usa-blood/alarmed-as-covid-patients-blood-thickened-new-york-doctors-try-new-treatments-idUSKCN22421Z

 

In many subjects showing up in hospitals, no typical symptoms of covid-19 but stroke or kidney complications.

 

"At Mount Sinai, nephrologists noticed kidney dialysis catheters getting plugged with clots. Pulmonologists monitoring COVID-19 patients on mechanical ventilators could see portions of lungs were oddly bloodless. Neurosurgeons confronted a surge in their usual caseload of strokes due to blood clots, the age of victims skewing younger, with at least half testing positive for the virus."

 

“I’ve never seen any other viruses causing that,” Jabbour said.

 

Yes, that’s a real problem . My wife runs the dialysis machines in ICU‘s and they’re super busy , because many patient need dialysis (often the result of organ failures from oxygen deficiencies most likely) and the machines clogging up from blood clots. Nobody expected anyone this going into this. Now we are short dialysis equipment, staff to operate them and consumables. Doctors trying treat this with blood thinners and clot busters.

 

On a related note, an investigation offend in Switzerland and Germany found blood knots  in lung and heart of the deceased, likely contributing or even causing the death. This may have implications for treating severe cases going forward.

[RichardGibbons]

More BS from you RG.  No visitors to nursing homes instituted by the industry late march.  should have been late January.

 

Agreed it should've been January. It doesn't matter though--you can't stop COVID-19 from getting into care homes if a large segment of the population is infected. Your "best practices" would roughly be the same outcome as a bunch of COVID-19 patients running around care homes, coughing on people.

 

(Yeah, I know you don't care....)

[pocoapoco]

Let me repost my 5 things that people don't understand.

[*]Exponential growth

[*]It takes weeks between infection and hospitalization and death

[*]Hospitals are not infinitely expandable--if enough people come in, hospitals run out of resources

[*]If you're in the ICU with this, you are likely in there for weeks

[*]That without ventilators, the death rate increases dramatically

 

Maybe #5 not true

 

 

Some 88% of Covid-19 patients in the New York City area who had to be placed on ventilators subsequently died.

https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study?cmpid=BBD042220_BIZ&utm_medium=email&utm_source=newsletter&utm_term=200422&utm_campaign=bloombergdaily

 

[orthopa]

Let me repost my 5 things that people don't understand.

[*]Exponential growth

[*]It takes weeks between infection and hospitalization and death

[*]Hospitals are not infinitely expandable--if enough people come in, hospitals run out of resources

[*]If you're in the ICU with this, you are likely in there for weeks

[*]That without ventilators, the death rate increases dramatically

 

Maybe #5 not true

 

 

Some 88% of Covid-19 patients in the New York City area who had to be placed on ventilators subsequently died.

https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study?cmpid=BBD042220_BIZ&utm_medium=email&utm_source=newsletter&utm_term=200422&utm_campaign=bloombergdaily

 

Overall, the researchers reported that 553 patients died, or 21%. But among the 12% of very sick patients that needed ventilators to breathe, the death rate rose to 88%. The rate was particularly awful for patients over 65 who were placed on a machine, with just 3% of those patients surviving, according to the results. Men had a higher mortality rate than women.

 

What a crazy stat. As unpleasant as it sounds the best way to not overload the healthcare system is to not put these pts on a ventilator, try everything else possible and let them expire if unsuccessful. All you end up with is an ICU full of pts destined to die with a 3% survival rate.

 

[LC]

It is really amazing to me. When all this anti-intellectualism, anti-expertise started with Trump there were questions posed like if you have the guy who operates on you to be a doctor? That was purely theoretical back then and didn't need to be addressed. Now fast forward to 2020 when you have a situation where it's not theoretical anymore. You actually need the doctors. Turns out that no, they still don't want the doctors.

 

The best part is watching them squirm when their lack of knowledge is exposed. It's pretty hilarious, in a "laugh so you don't cry" sort of way.

[KCLarkin]

this is BS Hj.  the early data from china was definitive on excessive impact on elderly.  and we knew the genomics of this virus very early on.  we were not operating in the dark, we were just operating stupidly.

 

This is BS, CZ. People have tried closing down nursing homes.  It doesn't work, particularly when the President prevents testing.  Your repeated assertions that it would work are silly.

 

More BS from you RG.  No visitors to nursing homes instituted by the industry late march.  should have been late January.

 

This whole theory is absolutely nuts! People are in nursing homes because they are no longer independent. You can lock all the olds up in a home and they won’t get the virus. But as soon as you have a worker come into the home, they are exposed to the virus.

 

You have aircraft carriers in the middle of the ocean with massive outbreaks and you think you can somehow only isolate the vulnerable when they are 100% dependent on the outside world. Certifiably nuts.

[Viking]

It is really amazing to me. When all this anti-intellectualism, anti-expertise started with Trump there were questions posed like if you have the guy who operates on you to be a doctor? That was purely theoretical back then and didn't need to be addressed. Now fast forward to 2020 when you have a situation where it's not theoretical anymore. You actually need the doctors. Turns out that no, they still don't want the doctors.

 

The best part is watching them squirm when their lack of knowledge is exposed. It's pretty hilarious, in a "laugh so you don't cry" sort of way.

 

Crazy how those in charge get a free pass. “But their intentions were good.” So it really doesn’t matter if they burn down the house with their stupidity.

 

Actually, the stupidity is to be celebrated; and the more stupid the better.

 

And then we are told that all this stupidity is just ‘common sense.’

 

It is explained and twisted in ways that reek of Animal Farm. George Orwell is smiling from the grave right now at all the irony.

[ERICOPOLY]

It is really amazing to me. When all this anti-intellectualism, anti-expertise started with Trump there were questions posed like if you have the guy who operates on you to be a doctor? That was purely theoretical back then and didn't need to be addressed. Now fast forward to 2020 when you have a situation where it's not theoretical anymore. You actually need the doctors. Turns out that no, they still don't want the doctors.

 

The best part is watching them squirm when their lack of knowledge is exposed. It's pretty hilarious, in a "laugh so you don't cry" sort of way.

 

It doesn't help when Kushner is advising Trump and daughters tend to marry their fathers.

[Spekulatius]

Let me repost my 5 things that people don't understand.

[*]Exponential growth

[*]It takes weeks between infection and hospitalization and death

[*]Hospitals are not infinitely expandable--if enough people come in, hospitals run out of resources

[*]If you're in the ICU with this, you are likely in there for weeks

[*]That without ventilators, the death rate increases dramatically

 

Maybe #5 not true

 

 

Some 88% of Covid-19 patients in the New York City area who had to be placed on ventilators subsequently died.

https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study?cmpid=BBD042220_BIZ&utm_medium=email&utm_source=newsletter&utm_term=200422&utm_campaign=bloombergdaily

 

Overall, the researchers reported that 553 patients died, or 21%. But among the 12% of very sick patients that needed ventilators to breathe, the death rate rose to 88%. The rate was particularly awful for patients over 65 who were placed on a machine, with just 3% of those patients surviving, according to the results. Men had a higher mortality rate than women.

 

What a crazy stat. As unpleasant as it sounds the best way to not overload the healthcare system is to not put these pts on a ventilator, try everything else possible and let them expire if unsuccessful. All you end up with is an ICU full of pts destined to die with a 3% survival rate.

 

Actually, this mortality rate is an indication that the health care system in NYC was overloaded. A lot of patients admitted to hospitals went straight on the respirator. They probably had already organ damage from oxygen deficiency at that point. Earlier admission with oxygen supplementation (which is what Boris Johnson got) might saved many. The high mortality rate in NYC also indicates such.

[RichardGibbons]

Let me repost my 5 things that people don't understand.

[*]Exponential growth

[*]It takes weeks between infection and hospitalization and death

[*]Hospitals are not infinitely expandable--if enough people come in, hospitals run out of resources

[*]If you're in the ICU with this, you are likely in there for weeks

[*]That without ventilators, the death rate increases dramatically

 

Maybe #5 not true

 

 

Some 88% of Covid-19 patients in the New York City area who had to be placed on ventilators subsequently died.

https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study?cmpid=BBD042220_BIZ&utm_medium=email&utm_source=newsletter&utm_term=200422&utm_campaign=bloombergdaily

 

Overall, the researchers reported that 553 patients died, or 21%. But among the 12% of very sick patients that needed ventilators to breathe, the death rate rose to 88%. The rate was particularly awful for patients over 65 who were placed on a machine, with just 3% of those patients surviving, according to the results. Men had a higher mortality rate than women.

 

What a crazy stat. As unpleasant as it sounds the best way to not overload the healthcare system is to not put these pts on a ventilator, try everything else possible and let them expire if unsuccessful. All you end up with is an ICU full of pts destined to die with a 3% survival rate.

 

Actually, this mortality rate is an indication that the health care system in NYC was overloaded. A lot of patients admitted to hospitals went straight on the respirator. They probably had already organ damage from oxygen deficiency at that point. Earlier admission with oxygen supplementation (which is what Boris Johnson got) might saved many. The high mortality rate in NYC also indicates such.

 

Yeah, so maybe #5 isn't true--I was incorrect in attributing the skyrocketing death rate to ventilators when hospitals become overloaded. Maybe it should be changed to "when hospitals run out of resources, the death rate skyrockets".

 

Does that make sense? We've certainly observed that effect in multiple places.

[Dalal.Holdings]

It is really amazing to me. When all this anti-intellectualism, anti-expertise started with Trump there were questions posed like if you have the guy who operates on you to be a doctor? That was purely theoretical back then and didn't need to be addressed. Now fast forward to 2020 when you have a situation where it's not theoretical anymore. You actually need the doctors. Turns out that no, they still don't want the doctors.

 

The best part is watching them squirm when their lack of knowledge is exposed. It's pretty hilarious, in a "laugh so you don't cry" sort of way.

 

Crazy how those in charge get a free pass. “But their intentions were good.” So it really doesn’t matter if they burn down the house with their stupidity.

 

Actually, the stupidity is to be celebrated; and the more stupid the better.

 

And then we are told that all this stupidity is just ‘common sense.’

 

It is explained and twisted in ways that reek of Animal Farm. George Orwell is smiling from the grave right now at all the irony.

 

The problem is when we all share "the house" with them...

 

Similar problem with the environment. Oh well.

[Cigarbutt]

...

this is BS Hj.  the early data from china was definitive on excessive impact on elderly.  and we knew the genomics of this virus very early on.  we were not operating in the dark, we were just operating stupidly.

cherzeca, you've been a regular contributor to this thread and the diversity of opinions is welcome.

 

Some comments:

 

-You now imply that the obvious strategy would have been to "protect" the 'vulnerables' from the onset (isolate, masks and gloves). However, your initial contributions at the onset suggested that the virus should have been allowed to run its course. It's OK to change opinion but trying to retroactively instate a new opinion is a kind of misrepresentation. It's still unclear, in practice, how isolation of older (at some point you mention age 80 or above and then modify gradually to include immunosuppressed and eventually delegate to the government for the definition and handling of the at-risk groups, about a third of the population in the US)) could be accomplished while allowing (even encouraging) community spread. Some above mentioned the common sense statement that the institutionalized elderly population needs a high workforce ratio from outside who could be at-risk themselves or who could have at-risk individuals in their own household. Presently, i'm involved (in various degrees) in strategy modification efforts in chronic care institutions and common sense experience shows how difficult it is to "isolate" nursing homes when the virus has already spread widely in the community.

 

-You also tend to recommend various treatments based on anecdotal observations which is weak evidence, especially if such recommendations are tied to controversial theories or to theories that are not globally supported by relevant peers, when the threshold for proof then should be extremely elevated.

 

-You still also recurrently equate CV with the flu, "this is the flu". While there are many common themes, there are also fundamental differences, the major ones being that natural immunity for CV is much lower than the flu and the most frequent cause of death is not bacterial secondary infection but a viral-induced inflammatory reaction in the lung tissue.

 

-Mortality rate in the US now is above 47K. In a few months, the total mortality from CV and flu will result in a very high and unusual number of virus-related deaths. You often underestimated the number of deaths and the duration of the CV episode, at times suggesting that the containment efforts actually contributed to an increase in number of deaths which is contrary to most evidence and most common sense. In all likelihood, the containment efforts contributed in a reduction of mortality. And while there are costs, a more relevant discussion may concern ways to maximize the cost-benefit equation.

 

Tough questions need to be asked especially, at this point, about the exit strategies and i will look forward to your inputs.

[Dalal.Holdings]

https://www.bloomberg.com/news/articles/2020-04-22/top-health-official-says-he-was-ousted-over-trump-touted-drug

 

A top U.S. health official who was helping lead efforts to find a coronavirus vaccine said he was removed from his post because he insisted on limiting the use of a drug President Donald Trump has pushed as a Covid-19 treatment despite little clinical evidence it works.

 

Rick Bright was abruptly pushed out of his position as the director of the Biomedical Advanced Research and Development Authority on Tuesday and given a smaller role at the National Institutes of Health. BARDA is helping pharmaceutical companies develop a vaccine for the novel coronavirus.

 

The drugs Trump has touted, hydroxychloroquine and chloroquine, “clearly lack scientific merit,” Bright said in a statement through his lawyers on Wednesday.

 

There seems to be a disease that is endemic. No, I am not talking about Covid. I am talking about the epidemic of pride in ignorance that afflicts this administration and its supporters. There is unfortunately wide collateral damage beyond the administration & its supporters.

 

And people ask how dare we criticize this administration w moves like this? Please.

[Guest cherzeca]

@cigarbutt

 

1.  I believe I have been consistent in stating that given limited resources, we should have focused our mitigation efforts on the elderly and the immune-compromised, which turned into the elderly and those with underlying conditions.  we knew early on that the average mortality age was around 80, and a little later on that only 2% of those who died with covid did not have advanced age or other conditions (obesity/hypertension).  this would have required a focused effort to close nursing homes to visitors, outreach to all other elderly with masks etc., and yes testing/masking of care workers.  all of this is not easy, but much easier and smarter than shutting down almost the entire economy.  mass hysteria favors only those like the michigan governor who want to control your life, and is good for no one's health.

 

2.  I have an 85 year old friend who contracted covid, was hospitalized, prescribed plaq/z-pack and immediately recovered...released in two days (he had no underlying conditions other than advanced age).  I also have 4 MD friends (one a pulmonologist critical care MD) who report that hospitals at where they practice have had good results with this regimen...not 100% recovery, but good enough to become the default regimen until something else that is better comes along. it would be criminal not to use it until something else more effective comes along.  so yes anecdotal, but more relevant to me than a bureaucrat telling us what we all know, which is that it hasn't been "proven".  by the way, the pneumonia you mention as a distinguishing cause of death is exactly why plaq-z-pack makes sense.  most people dont realize that z-pack is a senolytic, which is important.

 

3.  I expect when we have a better grasp on the scope of covid infection without symptoms, we will find that the mortality rate compared to the flu is in the same ballpark.  many more people have been infected without symptoms than the epidemiologists are using in their models...and of course breathlessly reported by the media.  mass hysteria is also good for the media, not just for people like the governor of michigan.

 

4. exit strategy can't be imposed by government bureaucrats, with or without MDs.  this is a local decision to be made based upon local facts, and I am referring to each business making its own determination based of course with input from federal and state level advisors.  but this stalinesque attitude of governors like in michigan is bad public policy and a bad precedent for the future of freedom in my beloved country.  this whole shutdown was intended to avoid a hospital crowding crisis, and the only place where that was close to happening is NYC (and maybe Detroit and New Orleans).  and the navy hospital ship in NYC sits mostly empty.  exit strategy cannot be an ego trip of governors but a careful reliance upon the good common sense of the businesses and private actors who were forced to shut down.  this is still America. 

 

edit:  I do believe "the containment efforts actually contributed to an increase in number of deaths ".  closing schools did not serve the public interest, but only sent many covid carring kids not at risk and without symptoms to spend much more time in confined households with elderly in residence (see queens, Brooklyn and bronx).  again, a focused effort protecting teachers would have been smarter than increasing covid exposure to elderly family members.  this is common sense.

[LC]

Some factual context, here is the most recent European mortality numbers

 

 

Note on interpretation of data: The number of deaths shown for the three most recent weeks (shaded area) should be interpreted with caution as adjustments for delayed registrations may be imprecise.

[perulv]

Some factual context, here is the most recent European mortality numbers

 

 

Note on interpretation of data: The number of deaths shown for the three most recent weeks (shaded area) should be interpreted with caution as adjustments for delayed registrations may be imprecise.

 

I know this is pointing out the obvious, but it would be interesting to see the same graph for a parallel-universe Europe where we did not put in place the most severe restrictions on movement etc since WW2.

Attached is a graph of hospitalizations due to covid-19 in Norway. The shut-down went into effect 13th march. (edit: smaller picture-size)

[clutch]

'Up to half' of Europe deaths in care homes, WHO warns

 

https://www.bbc.com/news/live/world-52391597