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Thread: Coronavirus thread

  1. #2821
    Gray Hobbyist Wondering Beard's Avatar
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    Quote Originally Posted by Aisin Gioro View Post
    I really want to share his optimism too, and he does make some good points about the social/psychological reactions many people are having, but even with my basic foundation in epidemiology, there is so much wrong with his information and and data selection that it reads more like hope than analysis. A lot of his snapshots were accurate information weeks ago, but have been greatly superseded, he compares incomparable data, and he generally operates under the presumption that a lack of data on risk implies lower risk, which is fundamentally the opposite of what most epidemiological risk assessment guidelines indicate, especially when additional data establishes a pattern of higher risk or at least doesn't reinforce a lack of risk. This is especially highlighted in his views on infection rates among children, where he uses information from February 5 (!) to suggest that children not only suffer less clinical illness, but also have significantly lower infection rates (and are thus less a source of infection and spread). While he acknowledges some risk, his data is way behind what we know now.

    A good example of a bad example is his treatment of the bell curve on Italian cases. He cites this:

    Attachment 50358

    To use some meme lingo, "This comment has not aged well", because moving ahead to today, we have:

    Attachment 50359

    His data sets are constructed according to different criteria, the time scales are different, and (crucially) the data on his bell curve example is about 2 weeks old. Subsequent events did not bear out the bell curve status at all, even allowing for indirect comparables.

    I think the author was sincere, and from a behavioural standpoint he makes some good points about how people need to consider all angles and not panic, but his epidemiological presentation and conclusions are founded on some highly erroneous methods and information.
    Thank you.
    " La rose est sans pourquoi, elle fleurit parce qu’elle fleurit ; Elle n’a souci d’elle-même, ne demande pas si on la voit. » Angelus Silesius
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  2. #2822
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    Quote Originally Posted by Nephrology View Post
    The model I used to estimate 35k infected by April 1 had baked in to its assumptions a "moderate" degree of public health intervention (social distancing etc). We're at 25k today with over a week to go. "No intervention" projected 65k cases by April 1, and it looks to me like we're going to end up closer to 65k than 35k.
    I’d be pleasantly surprised if it’s that low.

    From this table:

    Attachment 50389

    It’s taken 8 days for the total US cases to grow by a factor of 10 (100 on 2 March, 1000 on 10 March), the last two times (almost 10,000 on 18 March). If that rate continues (and we have the testing capacity), it would be reasonable to expect over 250,000 by the end of the month (10 x the current ~25k). But I can’t imagine even testing that many people (and getting results back) in the next 8 days.

    Data point: my sister (a doctor) had a test last Monday, and today is the 7th day awaiting results. My conclusion: the all the reported numbers lag reality by the better part of a week.

  3. #2823
    THE THIRST MUTILATOR Nephrology's Avatar
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    Quote Originally Posted by GyroF-16 View Post
    Data point: my sister (a doctor) had a test last Monday, and today is the 7th day awaiting results. My conclusion: the all the reported numbers lag reality by the better part of a week.
    My thesis advisor, an ICU attending at the big name county hospital, says COVID tests are taking 5 days to process for his patients, so 7 isn't a surprising number at all. We're definitely way behind the 8 ball.

  4. #2824
    THE THIRST MUTILATOR Nephrology's Avatar
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    Quote Originally Posted by the Schwartz View Post
    Any of the doctors here care to weigh in?
    There are lots and lots of drugs currently being evaluated, and lots of theories about what makes patients more vulnerable (hypertension, ACE inhibitor/NSAID use) but this is all very speculative. Here is a quote from a PM I sent to a member here who was asking me about this:

    Re: chloroquine.... the evidence simply isn't there yet. It is regrettable that this drug in particular is being touted by Trump specifically as the data is very poor and currently confined to cells in a dish. There is another drug, Remdesivir, that is currently being evaluated by both Gilead (the manf.) and the NIH for its efficacy against coronavirus. Those trials are moving expeditiously but by definition it takes time to get results. Cells in a dish are nice, but the rubber meets the road so to speak when this is used in real people.

    Clinical trials require a lot of people to be treated both with the drug/some form of placebo and then time to watch, wait and crunch the numbers. Even if you cut all the red tape, there's a required amount of time that has to elapse before you can meaningfully compare both groups. It's made even harder by the fact that finding a statistical difference between treatment and control groups is made even more complicated when the people in each group are very different. For example, if a young person gets Drug X and survives and old person gets Placebo Y and dies, it's hard to say if the drug or young age made the the difference in the surviving patient. It's also important to make sure the treatment is safe and dosed appropriate.

    So, for these reasons, current targeted therapies are entirely experimental and I would recommend against getting your hopes up for anything specific right now. Right now standard of care is basically supportive - use drugs and other interventions (ie proned ventilation, ECMO, CRRT, etc) to support failing organ function as needed until the patient recovers. I will certainly be sure to update the thread as things progress, but biomedical research moves slowly and we are only a few months into this (believe it or not), so there is still a long road ahead.

  5. #2825
    Member JHC's Avatar
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    https://www.cnn.com/2020/03/22/us/ge...zed/index.html

    12 year old on a ventilator in Atlanta
    “Remember, being healthy is basically just dying as slowly as possible,” Ricky Gervais

  6. #2826
    Quote Originally Posted by GyroF-16 View Post
    While I agree with the premise, and the advocacy for taking action, I find the data a bit fishy, because it seems so generic.
    When I look at the graphs for CO, WY, and MI, for example, the curves look identical, and peak on the same dates. The only things that change are the numbers on the Y-axis, due to (I presume) differences in state populations. Since the known infection numbers in those states are different today, I have difficulty believing that they’d all peak at the same time. CA is a little different, but not enough to impress me with the “granularity” of the data.

    To be clear - I am far from a “COVID-19 denier” - I just think that playing too fast and loose with the data to make a point doesn’t help the credibility of the scientific case.

    Thoughts from others? (Especially those with medical backgrounds)
    And, lumping stats by state can be sketchy. For Rhode Island-sized states, or states with fairly even population distribution (aka "back East) it might work. For Nevada, you have most of the population in Las Vegas which doesn't really have any relevance to medical system utilization in the rest of the state, but Vegas will drive the numbers. We have a few population islands surrounded by very low population density.

  7. #2827
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    Quote Originally Posted by Nephrology View Post
    lots of theories about what makes patients more vulnerable (hypertension, ACE inhibitor/NSAID use) but this is all very speculative.
    Any scuttlebutt on Beta-Blockers?
    "No free man shall ever be debarred the use of arms." - Thomas Jefferson, Virginia Constitution, Draft 1, 1776

  8. #2828
    Quote Originally Posted by JHC View Post
    https://www.cnn.com/2020/03/22/us/ge...zed/index.html

    12 year old on a ventilator in Atlanta
    I hate this kind of info (nothing against JHC) but this headline will be milked for a week or until something else that can be made more scary comes along. I wish we had a real news agency.

    Real stats and useful info will not get viewers or market share. So lets scare people even more.

  9. #2829
    Quote Originally Posted by Navin Johnson View Post
    I hate this kind of info (nothing against JHC) but this headline will be milked for a week or until something else that can be made more scary comes along. I wish we had a real news agency.

    Real stats and useful info will not get viewers or market share. So lets scare people even more.
    Please take that shit to the other politics thread.

  10. #2830
    I'm seeing about 12-14 hour turn around for swab results, and they are getting driven 45 min away to the lab. Seeing lots of pts on hydroxychloroquine & azithroymycin. Had 2 pts that had to be intubated last night, one of them could have possible been avoided, both had serious comorbs. Seeing more loose stools than originally expected, and also seeing some up and down temps, and then stabilizing around 100-101.

    I need to try and find answers about IV steroid use, if any of you know have anything? Seen some toradol usage, not alot of ibuf orders. All in all, the numbers are increasing and the hospitals will run out of airborne rooms soon id imagine. We get changes to policy daily, hard to keep up- at once point my place was only rec airborne ROOMs for those getting breathing tx. Idk.. we'll see what tom holds.

    FRom what ive seen so far, we could benefit from having a stricter threshold for admission, send the true med surg / floor levels home to monitor with strict instructions on when to come back, give them an pulse ox even- cheaper than an admit.. so that we have more rooms for the IMC/PCU level pts, those are the ones that need to be watched like hawks.

    -Charge Nurse on a 22 bed Covid+ or rule out unit (once they result neg we boot em immediately)
    Last edited by Isaac; 03-22-2020 at 01:40 PM.

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