YVK is not a lay person, and his post was not about the validity of CDC guidelines for prevention, but about the state of clinical exploration of therapeutics.Originally Posted by NoTacTravis
YVK is not a lay person, and his post was not about the validity of CDC guidelines for prevention, but about the state of clinical exploration of therapeutics.
Ignore Alien Orders
This is true but I would say in this case the effect has been more pronounced partly because of two factors:
A) obvious missteps and deceit early on by the WHO et al - remember early on they were saying there wasn't an advantage to the general population wearing masks, and had this cockamamie story about how people would wear them wrong and increase their risks and lots of people (amazingly) bought into that when it was very clear they were just trying to prevent a run on masks so medical staff could be equipped correctly. The goal of getting PPE to frontline medical staff is, obviously, a reasonable one...but the medical advice was "wearing masks isn't necessary and people will do it wrong and be touching their faces and get sicker" when that was obviously incorrect. So we've all seen the institutions flat out lie to our faces, specifically on matters of medical advice, because that was how they thought they could best get us to do what they wanted.
B) there's also a genuine tendency in the mainstream media, not to mention anyone remotely involved in global governance issues, to take absolutely anything Trump says, does, wants, or tweets, and oppose it no matter what. This has deepened the erosion of trust in institutions because while you and I might perceive a difference between "CNN" and "world leading experts on infectious diseases quoted by CNN" that's a bigger cognitive lift for some people and as such I think a lot of people have taken the lessons they've learned about other civilizational institutions, and are applying it to scientists as a whole. I think that's a mistake, but then I also believe in the basic mechanisms of climate change as presented by the IPCC.
So basically I think there were two valid lessons learned:
1: you can't actually trust medical institutions, they'll lie to you and tell you stuff that is directly harmful to your health in service of their own goals (which may be noble goals, but they will still tell you to do stuff that will harm you)
2: you can't actually trust other institutions, because they will oppose anyone you support and anyone who thinks like you.
BUT: the problem here is that while you can't trust institutions at all, what you can be pretty confident in is the scientific process. Ultimately, all the big pharma companies are competing with each other; they need to make vaccines that work and they need to provide treatments that work and they're paying researchers to figure it out because they need it to work because they want to get paid and they want their stock price to go up. And individual researchers themselves could be wrong, but when all the research starts to point in the same direction and some stuff keeps working and other stuff keeps not working, that I think you can be pretty confident about.
But you have to be able to distinguish between organizations, which are totally untrustworthy, and this amorphous process which includes a lot of those same organizations, which is fairly trustworthy. But trusting the outcome of a process that involves a bunch of organizations you can't trust generates a lot of cognitive dissonance for people and I don't blame them for struggling with that.
I think there's also overt misinformation, or the deliberate casting of information in a deceptive manner, that happens on all sides and certainly Trump has played the "we can't trust the elites" card extremely hard so a lot of people are primed for this kind of skepticism on every front. Which maybe they should be, I don't know.
But the bottom line for me is that what we're seeing here is the misapplication of otherwise valid lessons.
This is a thread where I built a boat I designed and which I very occasionally update with accounts of using it, which is really fun as long as I'm not driving over logs and blowing up the outboard.
https://pistol-forum.com/showthread....ilding-a-skiff
You realize you quoted a cardiologist, right?
If anyone has the appetite for some long reads, here are the UpToDate's management guidelines for adults with COVID-19
Coronavirus disease 2019 (COVID-19): Outpatient evaluation and management in adults
Coronavirus disease 2019 (COVID-19): Management in hospitalized adults
Last edited by Nephrology; 12-05-2020 at 12:29 PM.
This really kills me. I wonder how much goodwill and trust got destroyed when they recommended no masks. There was a definite strain of "masks wearer = paranoid" the first few weeks, before recommendations changed. It may have helped short term to supply masks to front line medical personnel, but I wonder what the long term effect was.
Watching this thread reminds me of people who make arguments for crap pistols (Taurus etc) because all their friends had them run 100% while ignoring SME's who've been there and done that and have 100's of thousands of round down the pipe.
I'd just laugh if it wasn't so sad.
That was my thought while that was happening...I immediately understood why they were doing it but it was obviously short term gain for long term pain and I thought "boy, that'll sure kill a bunch of people... I wonder if the number of people saved by the possibly-faster acquisition of PPE for hospitals will exceed the number of people killed by the combination of erosion of trust when people figure it out, and people killed directly by following that medical advice?"
And sadly there's no way to compare the third option, which wasn't attempted, of saying "Look, masks are definitely critical, and we desperately need to get hospitals stocked up. Please, help if you can; we are begging you not to hoard them, we are asking you to make do with scarves and doubled-over t-shirts or whatever is already in your home so that we can ensure there are enough for the medical staff who are at much greater risk."
That stupid pivot, on a really obvious aspect of this, played a big role in making the whole thing a mess. The messaging wasn't consistent across different layers of public health, and it wasn't even consistent from one week to the next. I haven't gone back and looked but I wouldn't be a tiny bit surprised if we could see, in this thread, people who should have known better, parroting the absurd "masks won't help normal people" line from the WHO et al from back then. But that was so transparently wrong - it's a freaking coronavirus, it's not like we don't know what PPE works and if we for some reason develop amnesia on that, why the hell are we trying to get this stuff for medical professionals? - that it just sowed this seed of "the experts either don't have a clue, or they're lying to us and they'll get us killed."
Massive misstep IMO and a big part of why we have not been able to build a unified front against this thing. There would always have been dissent, but there's a big difference in your ability to muster force against (original German, not this Namibian imposter) Adolf Hitler and the Axis powers if from day one he's been an evil tyrant doing evil things and we need to find a way to stop him, vs if you went around telling everyone his "liberation" of Poland and France were great for the world, but whoops, he's lost his way and is now attacking England and THAT'S evil. People will, consciously or unconsciously, detect the inconsistency and suspect that your change is self-serving or manipulative or something, and now you've shot yourself in the foot.
And the people who don't detect that inconsistency are just going to be the true believers in your "side" who would have accepted whatever position you took, and while they may ultimately end up on the good, supported-by-science, stopping Hitler side...it's not because they're the good guys, it's because they accepted what they were told.
Anyway, nobody in this whole thing came off looking very good to me...not Trump, not the WHO, not the CDC, nobody. They all just worked together to deepen my mistrust of organizations.
Thankfully they haven't shaken my faith (word used intentionally) in science itself, in the same way that cronyism is widespread and trashes economies but hasn't shaken my faith in the market itself as a mechanism of human achievement and civilizational progress. But I have learned not to trust the official line, and that you have to wait to see large-scale consensus of research by various competing bodies, and aggregate the information yourself if you want to have much insight into anything.
This is a thread where I built a boat I designed and which I very occasionally update with accounts of using it, which is really fun as long as I'm not driving over logs and blowing up the outboard.
https://pistol-forum.com/showthread....ilding-a-skiff
I think for anyone paying attention to COVID, there were other related issues that I observed as the crisis was unfolding.
First, I remember early on if anyone just looked at the numbers, it clearly had the potential to be worse than the flu, and which was consistent with the fairly drastic actions taken by the Chinese government to stop the spread. However, tons of scientists, doctors, epidemiologists and public health experts kept chiming in with "just the flu" and engaging in credentialing against anyone that went against that narrative.
Second, I think there was a long time where experts refused to come out with saying that COVID was airborne since definitive proof was not available. I think this was more of a messaging error, as I understand there is a technical definition for what diseases qualify as airborne. However, normal people will understand the term in the colloquial sense and by extension think masks are dumb.
Third, I think there were repeated instances where experts and agencies were taking blatantly partisan stances.
ETA - continued hypocrisy from scientists and leaders surely doesn't help. Just saw something about the Austin mayor telling people to stay home while on vacation in Mexico.
The point of my post was that, while low quality data always exists in the field, covid seems to have exacerbated that. Normally when I read studies, I gave them a benefit of a doubt. With covid studies I don't.
In regards to expert opinion and guidelines, I am aware what they are. I am also aware how many times practice approach and opinion has been changed on every level of expertise from organizational to national, starting from Fauci's no reason to wear masks all the way down to other things. So, while I am not a Mayo cardiologist, some 20 years of practice and an additional epidemiology training has led to a habit of a personal review of reference materials and formulation of my position based off of that. Whenever I am really interested, that is.
Doesn't read posts longer than two paragraphs.
There's definitely been a research dogpile that has happened since March, but the quality of a lot of the larger studies are fairly robust. It does sort of feel like there is a lot of "enthusiasm"
I think one area of controversy that is worth highlighting have been various trials of the efficacy of remdesivir. IMO a lot of that is evident in the selection of study endpoints (e.g. baricitinib). Decadron seems to have more robust data behind it but I'll admit I haven't dug into it deeply.
In general my sense is that, just like with all other causes ARDS, the mainstay of care is and will remain supportive in nature. I think it was a little silly to expect we would find a magic bullet for the critical illness caused by COVID-19 when we have failed to do so for sepsis/ARDS/etc despite 30 years of focused effort.
I am curious however to see if there are any advances in the management of COVID associated coagulopathy as it appears to be in many distinct from, for example, sepsis associated DIC, or other coagulopathy associated with severe illness. It may easily prove to be just as complex and elusive to treat however.
Reply With Quote