Coronavirus thread

[Nephrology]

Says a history of diabetes too. Not as healthy as she seemed.

Sort of unclear - reads sort of like a bad medical history. If T2DM, why hospitalized for hypoglycemia? If T1DM, why is she not on insulin? Kinda feels like it ended up erroneously in the ED chart via paramedic report. Easy to imagine that happening with a resuscitation that ends in pronouncement.

[Wondering Beard]

Why do some COVID-19 patients infect many others, whereas most don’t spread the virus at all?

[0ddl0t]

The CDC recently downgraded its "best estimate" of COVID19's infection fatality rate to 0.4% for those with symptoms - roughly 4x higher than the seasonal flu. They also estimated 35% of those infected have no symptoms at all, implying an overall infection fatality rate of 0.26%. For those under 50, the estimated CFR is 0.05%.

R0 is now estimated at 2.5 - approximately equal to the 1917-1919 H1N1 "Spanish" flu pandemic. R0 for the 2009 H1N1 flu was estimated at 1.5.

With Covid19 infections causing 4x as many fatalities and spreading 67% easier than the flu, COVID19 should be less than 7 times as deadly as the flu.

[BehindBlueI's]

A friend of mine works in a plant that's now making parts for ventilators. The plant has roughly 200 workers. Everybody had to be tested for COVID. Right at 1/4 of the workers tested positive and were completely asymptomatic.

However they were told the testing was only about 60% accurate. He didn't know if accurate as false positives, false negatives, or a mixture.

So WTF really knows what any of that actually indicates.

Another friend works at an auto parts plant and he said they'd fired two workers for refusing to wear masks on the floor. They both thought it was no big deal and they'd get that sweet sweet unemployment, but were apparently shocked to find out getting fired for refusing to wear required PPE doesn't qualify you for unemployment and want to come back. In a plant that's running well under capacity, those jobs have already gone to others called back. Their probably SOL, and that factory is about the best paying one in their area.

[Maple Syrup Actual]

It must officially be a non-event at this point: I saw my dad yesterday and he was just shaking his head and saying "what a bust" over and over. Very briefly he perked up when talking about reopening everything but at this point I think he's given up hope.

My island of ~980,000 is down to one case in one hospital. Looks like we peaked about eight weeks ago. Still no great explanation as to why the place with the worst and earliest outbreaks, almost certainly the greatest exposure, the greatest population density, and only moderate social distancing had basically no impact from it at all.

Our average all-cause mortality for the last three months is below normal as well, so it's not like there's a pile of misdiagnosed bodies. It's just that nothing happened.

[Cookie Monster]

You can read her autopsy report here -

http://www.autopsyfiles.org/reports/...any_report.pdf

Per the report, she did have several Rx psych meds and narcotics on board - fluoxetine, klonopin, hydrocodone - but it seems like she died of respiratory arrest 2/2 the pneumonia.

Wait, there is a website that just posts autopsy file? Learn something new everyday. Wacky world out there.

[Nephrology]

A friend of mine works in a plant that's now making parts for ventilators. The plant has roughly 200 workers. Everybody had to be tested for COVID. Right at 1/4 of the workers tested positive and were completely asymptomatic.

However they were told the testing was only about 60% accurate. He didn't know if accurate as false positives, false negatives, or a mixture.

So WTF really knows what any of that actually indicates.

Another friend works at an auto parts plant and he said they'd fired two workers for refusing to wear masks on the floor. They both thought it was no big deal and they'd get that sweet sweet unemployment, but were apparently shocked to find out getting fired for refusing to wear required PPE doesn't qualify you for unemployment and want to come back. In a plant that's running well under capacity, those jobs have already gone to others called back. Their probably SOL, and that factory is about the best paying one in their area.

I assume they did PCR based testing (e.g. looks for active virus). As far as I know that should be pretty specific (i.e. few false positives) but thats only based on my knowledge of the LabCorp PCR test. If they used another vendor or a non-PCR based testing method it may be much less specific, I couldn't tell you for sure.

Unrelated to your post, but I finally read the Lancet article on HCQ for COVID-19. I haven't dug into it deeply but, uh, it's pretty bad. The danger of HCQ, if accurately described by this article, is pretty significant. Emphasis mine:

After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity), when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531), chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each independently associated with an increased risk of in-hospital mortality. Compared with the control group (0·3%), hydroxychloroquine (6·1%; 2·369, 1·935–2·900), hydroxychloroquine with a macrolide (8·1%; 5·106, 4·106–5·983), chloroquine (4·3%; 3·561, 2·760–4·596), and chloroquine with a macrolide (6·5%; 4·011, 3·344–4·812) were independently associated with an increased risk of de-novo ventricular arrhythmia during hospitalisation.

It's not as strong of a study as a prospective clinical trial, but the evidence does not look good. e.g. :

[MickAK]

Unrelated to your post, but I finally read the Lancet article on HCQ for COVID-19. I haven't dug into it deeply but, uh, it's pretty bad. The danger of HCQ, if accurately described by this article, is pretty significant. Emphasis mine:



It's not as strong of a study as a prospective clinical trial, but the evidence does not look good. e.g. :

The 'Vaccines cause autism' people have a credibility problem with me.
https://en.m.wikipedia.org/wiki/The_...#Controversies

At any rate I don't understand the study or why it was conducted the way it was. I guess it has something to do with the in vitro stuff but I don't see anything legitimate that suggests HcQ+Zinc as anything but a prophylactic. That's obviously going to be difficult to conduct a proper trial on.
I'm really, really not understanding the sudden push to suggest that HcQ kills people. I don't understand why it would be prescribed the way it was before the pandemic for the things it was prescribed for before the pandemic if it was that dangerous. I smell horseshit.

[Paul Blackburn]

I suspect covid 19 will be over after the election.

[Nephrology]

The 'Vaccines cause autism' people have a credibility problem with me.
https://en.m.wikipedia.org/wiki/The_...#Controversies

I'm of course familiar with the Wakefield scandal, but a retraction doesn't really reflect at all on the quality of the journal - more the character of the author. There is a degree of good faith that has to be assumed by the editors of any academic journal, because often there is no way to detect academic dishonesty on their behalf. Literally every well respected academic journal has retracted at least dozens, if not closer to hundreds, of articles over the course of their history (in the case of the Lancet, almost 200 years).

While not perfect, the Lancet remains a premier medical journal, and the authors of the study are medical faculty at premier medical schools. Their findings should be taken seriously.

At any rate I don't understand the study or why it was conducted the way it was.

As to how the study was conducted, it's pretty easy to understand. They describe their methods fairly succinctly. Per below:

We did a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19. The registry comprised data from 671 hospitals in six continents. We included patients hospitalised between Dec 20, 2019, and April 14, 2020, with a positive laboratory finding for SARS-CoV-2. Patients who received one of the treatments of interest within 48 h of diagnosis were included in one of four treatment groups (chloroquine alone, chloroquine with a macrolide, hydroxychloroquine alone, or hydroxychloroquine with a macrolide), and patients who received none of these treatments formed the control group. Patients for whom one of the treatments of interest was initiated more than 48 h after diagnosis or while they were on mechanical ventilation, as well as patients who received remdesivir, were excluded. The main outcomes of interest were in-hospital mortality and the occurrence of de-novo ventricular arrhythmias (non-sustained or sustained ventricular tachycardia or ventricular fibrillation).

They used a multinational, 3rd party database - the Surgical Outcomes Collaborative - to find inpatients around the world with COVID-19 and to examine their hospital stay to see what factors about the patient or the care they received predisposed them to morbidity or mortality.

They specifically had an eye for HCQ/azithromycin use and cardiac arrhythmias. They found that these drugs increased patient mortality and were associated with an increased rate of ventricular arrhythmia, a predictable consequence of inappropriately prescribing a drug that prolongs your QT interval.

I guess it has something to do with the in vitro stuff

It didn't

but I don't see anything legitimate that suggests HcQ+Zinc as anything but a prophylactic. That's obviously going to be difficult to conduct a proper trial on.

I don't know what you mean by this

I'm really, really not understanding the sudden push to suggest that HcQ kills people.

Then you're not reading carefully enough.

when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531), chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each independently associated with an increased risk of in-hospital mortality. Compared with the control group (0·3%), hydroxychloroquine (6·1%; 2·369, 1·935–2·900), hydroxychloroquine with a macrolide (8·1%; 5·106, 4·106–5·983), chloroquine (4·3%; 3·561, 2·760–4·596), and chloroquine with a macrolide (6·5%; 4·011, 3·344–4·812) were independently associated with an increased risk of de-novo ventricular arrhythmia during hospitalisation.

Patients taking HCQ had a 18% chance of dying and a 6.1% chance of developing a ventricular arrhythmia while in hospital. For patients not taking HCQ, those numbers were 9.3% and 0.3%, respectively. These numbers were worse when azithryomycin ("z-pack") was added on top of HCQ.

I don't understand why it would be prescribed the way it was before the pandemic for the things it was prescribed for before the pandemic if it was that dangerous. .

Because it's being prescribed in different doses, to a very different patient population, with very different medical problems, by providers who do not have experience using this drug. It is very, very well known to predispose to cardiac dysrhythmia, which is consistent with the paper's findings.

I smell horseshit

Your reply makes it clear you didn't really read or understand the article I linked.

I don't know why you have such a strong belief that HCQ is an appropriate treatment for COVID-19, or what you do for a day job. However, it does seem quite clear that this belief is based in emotion and/or social/political identity and not in a nuanced understanding of the medical literature.

There is lots of room in medicine for debate, uncertainty, and disagreement. However, this conversation is underpinned by rational and lucid examination of the evidence in published literature. In the last two months, we have rapidly advanced our understanding of this disease and produced an astonishingly large body of knowledge in a short period of time. The lion's share of that evidence suggests that HCQ +/- azithromycin does not provide any benefit to patients with COVID-19, and more than likely predisposes them to worse outcomes.

If you'd like to explain your position more carefully, using the findings presented in medical literature, I'm more than willing to listen. However, given that this doesn't seem to be within your wheelhouse, I'd instead suggest you keep a much more open mind on the subject and perhaps re-examine the reasons you believe so strongly in this drug.

Is this the kind of material or debate you would normally spend a lot of time thinking about prior to the pandemic? If not, why is this of sudden importance to you now?