Coronavirus/COVID-19, Thread 2

[exculpatory]

HCQ is most likely a bust.

Pea brained politicians & media need to STFU when it comes to medicine.

7/16/2020 Annals of Internal Medicine


Finally a randomized trial:

https://www.acpjournals.org/doi/10.7326/M20-4207


Editorial providing context:

https://www.acpjournals.org/doi/10.7326/M20-5041

[threrf23]

HCQ is most likely a bust.

Pea brained politicians & media need to STFU when it comes to medicine.

7/16/2020 Annals of Internal Medicine


Finally a randomized trial:

https://www.acpjournals.org/doi/10.7326/M20-4207


Editorial providing context:

https://www.acpjournals.org/doi/10.7326/M20-5041

If I am reading this correctly, 201 patients received HCQ, and 194 patients received a placebo (edit - 212 received HCQ and 211 a placebo). Of patients receiving a placebo, 10 of them - just over 5% of them - ended up hospitalized (edit, two were supposedly non-Covid related). Of patients receiving HCQ, 4 of them - just under 2% of them - ended up hospitalized. That is a 60% decrease (edit 50% decrease) in hospitalizations, coupled with no increase in deaths. Those receiving HCQ also were 20% less likely to still show symptoms after 14 days.

Am I missing something? It seems more impressive than the Remesdevir results.

btw I'm not saying it's a miracle cure, a highly effective treatment, or a vaccine, nor am I saying the politicians and media being referred to aren't peabrained. I'm just saying.

[exculpatory]

HCQ is most likely a bust.

Pea brained politicians & media need to STFU when it comes to medicine.

7/16/2020 Annals of Internal Medicine


Finally a randomized trial:

https://www.acpjournals.org/doi/10.7326/M20-4207


Editorial providing context:

https://www.acpjournals.org/doi/10.7326/M20-5041

If I am reading this correctly, 201 patients received HCQ, and 194 patients received a placebo (edit - 212 received HCQ and 211 a placebo). Of patients receiving a placebo, 10 of them - just over 5% of them - ended up hospitalized (edit, two were supposedly non-Covid related). Of patients receiving HCQ, 4 of them - just under 2% of them - ended up hospitalized. That is a 60% decrease (edit 50% decrease) in hospitalizations, coupled with no increase in deaths. Those receiving HCQ also were 20% less likely to still show symptoms after 14 days.

Am I missing something? It seems more impressive than the Remesdevir results.

btw I'm not saying it's a miracle cure, a highly effective treatment, or a vaccine, nor am I saying the politicians and media being referred to aren't peabrained. I'm just saying.

Yup, you missed the only thing that matters. You somehow completely ignored the most important findings in this or any worthwhile publication (STATISTICAL ANALYSIS) - which demonstrated NON-significant differences or P values - except for a highly statistically significant increase in adverse effects with HCQ. (FYI - depending on the pre-specified statistical analysis for any given study, P values at least <0.05 [& ideally <0.01 or <0001] are required to demonstrate statistical significance.)

“Of 491 patients randomly assigned to a group, 423 contributed primary end point data. Of these, 341 (81%) had laboratory-confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or epidemiologically linked exposure to a person with laboratory-confirmed infection; 56% (236 of 423) were enrolled within 1 day of symptoms starting. Change in symptom severity over 14 days did not differ between the hydroxychloroquine and placebo groups (difference in symptom severity: relative, 12%; absolute, −0.27 points [95% CI, −0.61 to 0.07 points]; P = 0.117). At 14 days, 24% (49 of 201) of participants receiving hydroxychloroquine had ongoing symptoms compared with 30% (59 of 194) receiving placebo (P = 0.21). Medication adverse effects occurred in 43% (92 of 212) of participants receiving hydroxychloroquine versus 22% (46 of 211) receiving placebo (P < 0.001). With placebo, 10 hospitalizations occurred (2 non–COVID-19–related), including 1 hospitalized death. With hydroxychloroquine, 4 hospitalizations occurred plus 1 nonhospitalized death (P = 0.29).“

[threrf23]

Yup, you missed the only thing that matters. You somehow completely ignored the most important findings in this or any worthwhile publication (STATISTICAL ANALYSIS) - which demonstrated NON-significant differences or P values - except for a highly statistically significant increase in adverse effects with HCQ. (FYI - depending on the pre-specified statistical analysis for any given study, P values at least <0.05 [& ideally <0.01 or <0001] are required to demonstrate statistical significance.)

Whatever. Just because the positive findings were not statistically significant, doesn't mean they should be considered evidence of HCQ's uselessness. And "adverse effects," unless they are causing hospitalization or death, are largely besides the point to me if HCQ is effective IMO; wouldn't you happily deal with some pesky side effects if it increased your chance of surviving, and/or if it prevented you and others from requiring hospitalization?

The study examined 423 subjects with mild symptoms (or in some cases no symptoms nor diagnosis but suspected exposure) - edit - "Symptomatic, nonhospitalized adults with laboratory-confirmed COVID-19 or probable COVID-19 and high-risk exposure within 4 days of symptom onset" - many subjects were on the younger side, of course only a small number of subjects were likely to end up hospitalized or dead. Perhaps the idea was that any meaningful findings could be written off as statistically insignificant?

To me, this bit is as important as anything else:

Primary Funding Source:

Private donors.

[claycarver]

Yup, you missed the only thing that matters. You somehow completely ignored the most important findings in this or any worthwhile publication (STATISTICAL ANALYSIS) - which demonstrated NON-significant differences or P values - except for a highly statistically significant increase in adverse effects with HCQ. (FYI - depending on the pre-specified statistical analysis for any given study, P values at least <0.05 [& ideally <0.01 or <0001] are required to demonstrate statistical significance.)

Whatever. Just because the positive findings were not statistically significant, doesn't mean they should be considered evidence of HCQ's uselessness. And "adverse effects," unless they are causing hospitalization or death, are largely besides the point to me if HCQ is effective IMO; wouldn't you happily deal with some pesky side effects if it increased your chance of surviving, and/or if it prevented you and others from requiring hospitalization?

The study examined 423 subjects with mild symptoms (or in some cases no symptoms nor diagnosis but suspected exposure), many subjects were on the younger side, of course only a small number of subjects were likely to end up hospitalized or dead. Perhaps the idea was that any meaningful findings could be written off as statistically insignificant?

To me, this bit is as important as anything else:

Primary Funding Source:

Private donors.

Yeah, as far as I can see, this study only demonstrates the study was useless.

[exculpatory]

Both of you guys are obviously free to conclude whatever you wish.

The non-significant efficacy findings in this particular prospective, randomized study taken together with the excellent editorial provided suggests to this particular Professor of Medicine (who I guarantee you has written & reviewed countless more medical publications than either of you gentlemen) that HCQ more than likely & unfortunately will not be an important therapeutic for COVID-19 patients (whether it is administered to modestly ill patients or very ill patients). A few more peer reviewed, randomized studies in prestigious journals will soon be published. We will see what we will see.

PS The significant increase in relatively non-consequential adverse events would mean nothing to me if HCQ was truly efficacious.

[Captain_Caveman]

Both of you guys are obviously free to conclude whatever you wish.

The non-significant efficacy findings in this particular prospective, randomized study taken together with the excellent editorial provided suggests to this particular Professor of Medicine (who I guarantee you has written & reviewed countless more medical publications than either of you gentlemen) that HCQ more than likely & unfortunately will not be an important therapeutic for COVID-19 patients (whether it is administered to modestly ill patients or very ill patients). A few more peer reviewed, randomized studies in prestigious journals will soon be published. We will see what we will see.

PS The significant increase in relatively non-consequential adverse events would mean nothing to me if HCQ was truly efficacious.

HCQ is obviously not going to be useful, but a smart friend of mine said it was a pretty good week for vaccine research. He's bullish on effective vaccine treatments being available by the first quarter of next year, and thinks that antibody therapies will get increasingly effective by the fall. Still looking at 250-300k dead by the end of this, but there's light at the end of the tunnel, I guess.

[exculpatory]

Both of you guys are obviously free to conclude whatever you wish.

The non-significant efficacy findings in this particular prospective, randomized study taken together with the excellent editorial provided suggests to this particular Professor of Medicine (who I guarantee you has written & reviewed countless more medical publications than either of you gentlemen) that HCQ more than likely & unfortunately will not be an important therapeutic for COVID-19 patients (whether it is administered to modestly ill patients or very ill patients). A few more peer reviewed, randomized studies in prestigious journals will soon be published. We will see what we will see.

PS The significant increase in relatively non-consequential adverse events would mean nothing to me if HCQ was truly efficacious.

HCQ is obviously not going to be useful, but a smart friend of mine said it was a pretty good week for vaccine research. He's bullish on effective vaccine treatments being available by the first quarter of next year, and thinks that antibody therapies will get increasingly effective by the fall. Still looking at 250-300k dead by the end of this, but there's light at the end of the tunnel, I guess.

Hi Cave,
Hope you & your family remain well & as content as possible in the midst of this insanity.
I very sadly agree that we are looking at ~250K dead by the end of 2020. A combination of incomprehensibly incompetent leadership by too many of our ‘leaders’ & selfish/ignorant behavior by Gen Z & many millennials (fortunately not including the 2 millennials I love dearly) has resulted in the freaking United States of America (for all its many flaws the best country in the history of planet Earth) currently leading the way in worldwide COVID-19 morbidity & mortality.
I also agree that monoclonal antibodies as a therapeutic is looking better & better (together with REMDESIVIR & high dose dexamethasone [albeit the latter is very much a two-edged sword given its voluminous potential adverse effects - I have lots & lots of experience with high dose glucocorticoids as an endocrinologist]).
I am certainly not a ‘vaccinologist’, but if Tony Fauci (truly a ‘national treasure’ who I have had the privilege to meet a couple of times years ago when he first took over NIAID at NIH) is impressed with the preliminary results from Moderna, Pfizer/BioNtech & Oxford/AstraZeneca in particular (all about to launch Phase III trials) & is optimistic about the availability of these vaccines during Q1 2021, then I sure as **** am as well.
The other good news is that a home-performed, 15 minute turnaround, ‘hopefully accurate’ saliva test (using LAMP technology rather than PCR) for the virus will become available in the not too distant future.
In the meantime, be very cautious & stay safe.
Ex/Rob

[Slax]

Yup, you missed the only thing that matters. You somehow completely ignored the most important findings in this or any worthwhile publication (STATISTICAL ANALYSIS) - which demonstrated NON-significant differences or P values - except for a highly statistically significant increase in adverse effects with HCQ. (FYI - depending on the pre-specified statistical analysis for any given study, P values at least <0.05 [& ideally <0.01 or <0001] are required to demonstrate statistical significance.)

Whatever. Just because the positive findings were not statistically significant, doesn't mean they should be considered evidence of HCQ's uselessness. And "adverse effects," unless they are causing hospitalization or death, are largely besides the point to me if HCQ is effective IMO; wouldn't you happily deal with some pesky side effects if it increased your chance of surviving, and/or if it prevented you and others from requiring hospitalization?

The study examined 423 subjects with mild symptoms (or in some cases no symptoms nor diagnosis but suspected exposure), many subjects were on the younger side, of course only a small number of subjects were likely to end up hospitalized or dead. Perhaps the idea was that any meaningful findings could be written off as statistically insignificant?

To me, this bit is as important as anything else:

Primary Funding Source:

Private donors.

Yeah, as far as I can see, this study only demonstrates the study was useless.

My main takeaway from the study is that regardless of whether the statistically insignificant difference in hospitalization between the two groups is a consequence of random fluctuation or a genuine difference between the two samples that just didn't have the sample size to result in a low enough p score, apparently such a small % of people presenting with *mild* cases of COVID-19 are hospitalized or die that treating them with a drug that has adverse side effects to prevent hospitalizations probably makes very little sense even if it is modestly efficacious (which we don't have the statistical power to show on hospitalization, and on all other metrics appears not to be the case), and as far as I'm aware there is even less evidence that HCQ is efficacious for treating *serious* cases where hospitalization and death are likely and therefore where treatment could have a dramatic impact on population health.

[Slax]

More broadly, my wife is running into this problem now in her own research. She's trying to work on studies relating to the inflammatory syndrome in pediatric COVID cases, but because it's kids, it's hard to get enough patients who don't recover fully and quickly to actually demonstrate statistical significance in diagnostic criteria and treatment efficacy. As she put it, "It's a problem for research caused by a good thing for patients."

[threrf23]

My main takeaway from the study is that regardless of whether the statistically insignificant difference in hospitalization between the two groups is a consequence of random fluctuation or a genuine difference between the two samples that just didn't have the sample size to result in a low enough p score, apparently such a small % of people presenting with *mild* cases of COVID-19 are hospitalized or die that treating them with a drug that has adverse side effects to prevent hospitalizations probably makes very little sense even if it is modestly efficacious (which we don't have the statistical power to show on hospitalization, and on all other metrics appears not to be the case), and as far as I'm aware there is even less evidence that HCQ is efficacious for treating *serious* cases where hospitalization and death are likely and therefore where treatment could have a dramatic impact on population health.

I mean, if we took the results of this study at face value, and I am not saying we can or should, early HCQ would be likely to cut hospitalizations in half. It would also be likely to shorten the length of symptoms, and hence shorten the length of hospitalization required. The study also found an albeit small (12%) decrease in symptom severity (or severe symptoms?) with HCQ. And we could conclude that a decrease in 911 calls might be proportionate to a decrease in hospitalizations.

To be clear, the 'adverse effects' we are talking about - well, I'm entirely sure without pulling up the data sets - but it says that the most common adverse effects reported by those who took HCQ, were nausea, and related gastrointestinal symptoms, and that there was no correlation with Covid symptom severity. So it sounds like we're talking pesky side effects, and nothing adverse as far as treatment progress itself is concerned.

There seems to be evidence that HCQ is dangerous, or potentially dangerous in more severe contexts where patients are already hospitalized, coupled with evidence that it is also not very, if at all efficacious in such contexts. Even as far as early/mild administration is concerned, I am not really here to argue in favor of HCQ. I'm just taken aback that this study - which IMO is very clearly favorable to HCQ if anecdotally - is being widely twisted as indicating that HCQ confers zero benefit to Covid outpatients with mild symptoms. It reeks of agenda.

[SuperDeluxe]

Some more good news: https://www.bbc.com/news/health-53467022?fbclid=IwAR2SDuBmIs7QbZ1VAJ8SRRjbKqPS1CVdAsh6sJELOjUYIuH8xwDiaMS6S80

[Slax]

There was also a recent study suggesting dexamethasone is an effective treatment for some severe cases: https://www.nejm.org/doi/full/10.1056/NEJMoa2021436

[exculpatory]

There was also a recent study suggesting dexamethasone is an effective treatment for some severe cases: https://www.nejm.org/doi/full/10.1056/NEJMoa2021436

If you want to be completely current regarding + news - read my post the other day directed to Cave regarding monoclonal antibodies as therapeutics & multiple emerging/very promising vaccines imminently entering Phase III AND the following from the ACP (American College of Physicians) Internist Weekly regarding dexamethasone, REMDESIVIR & tocilizumab as therapeutics - as well as 2 more negative HCQ studies (one of which I explained the other day).

Hydroxychloroquine failed to improve outcomes in early or mild COVID-19, according to two recent studies.

One trial, published by Clinical Infectious Diseases on July 16, randomized 293 outpatients with recently confirmed SARS-CoV-2 infection and less than five days of symptoms to either hydroxychloroquine or no antiviral treatment. No significant differences were found in the mean reduction of viral load at day 3 or at day 7, risk of hospitalization, or time to complete resolution of symptoms. “Our findings provide the scientific community and policymakers with essential insights on the inefficacy of [hydroxychloroquine] as a therapeutic candidate for SARS-CoV-2, at least in similar settings and conditions to ours,” the authors wrote.

The other trial, published by Annals of Internal Medicine on July 16, included 423 outpatients with laboratory-confirmed or probable COVID-19 randomized to either hydroxychloroquine or placebo. There were no significant differences in changes in symptom severity over 14 days, or in rates of hospitalization or mortality, both of which were rare. An accompanying editorial highlighted failures on the part of the producers, publishers, and consumers of scientific research during the “saga” of hydroxychloroquine. “The scientific community needs to do a good bit of stock-taking and soul-searching about its performance in meeting the challenges of the pandemic and how it will meet these challenges in future pandemics that are certain to emerge,” the editorialist wrote.


My comment on the second study (in response to some stuff you guys wrote after my last detailed post regarding this paper): Comparison of the values on their face is MEANINGLESS. Why? The p values were not just insignificant. They were freaking light years insignificant. They would have to enroll a ridiculously MASSIVE number of patients in a very likely UNSUCCESSFUL attempt to confirm that the trends in favor of HCQ were actually statistically significant.

These authors, the Annals of Internal Medicine & the ACP are all top of the line. The editorial I originally posted provides critical context. NOTHING WHATSOEVER ‘reeks of agenda.’ The original HCQ studies from France & wherever were disgracefully poor publications & then moronic & ignorant politicians & media took over & reprehensibly publicized the drug.


https://acpinternist.org/weekly/archives/2020/07/21/1.htm

[Pacino62]

Both of you guys are obviously free to conclude whatever you wish.

The non-significant efficacy findings in this particular prospective, randomized study taken together with the excellent editorial provided suggests to this particular Professor of Medicine (who I guarantee you has written & reviewed countless more medical publications than either of you gentlemen) that HCQ more than likely & unfortunately will not be an important therapeutic for COVID-19 patients (whether it is administered to modestly ill patients or very ill patients). A few more peer reviewed, randomized studies in prestigious journals will soon be published. We will see what we will see.

PS The significant increase in relatively non-consequential adverse events would mean nothing to me if HCQ was truly efficacious.

HCQ is obviously not going to be useful, but a smart friend of mine said it was a pretty good week for vaccine research. He's bullish on effective vaccine treatments being available by the first quarter of next year, and thinks that antibody therapies will get increasingly effective by the fall. Still looking at 250-300k dead by the end of this, but there's light at the end of the tunnel, I guess.

Hi Cave,
Hope you & your family remain well & as content as possible in the midst of this insanity.
I very sadly agree that we are looking at ~250K dead by the end of 2020. A combination of incomprehensibly incompetent leadership by too many of our ‘leaders’ & selfish/ignorant behavior by Gen Z & many millennials (fortunately not including the 2 millennials I love dearly) has resulted in the freaking United States of America (for all its many flaws the best country in the history of planet Earth) currently leading the way in worldwide COVID-19 morbidity & mortality.
I also agree that monoclonal antibodies as a therapeutic is looking better & better (together with REMDESIVIR & high dose dexamethasone [albeit the latter is very much a two-edged sword given its voluminous potential adverse effects - I have lots & lots of experience with high dose glucocorticoids as an endocrinologist]).
I am certainly not a ‘vaccinologist’, but if Tony Fauci (truly a ‘national treasure’ who I have had the privilege to meet a couple of times years ago when he first took over NIAID at NIH) is impressed with the preliminary results from Moderna, Pfizer/BioNtech & Oxford/AstraZeneca in particular (all about to launch Phase III trials) & is optimistic about the availability of these vaccines during Q1 2021, then I sure as **** am as well.
The other good news is that a home-performed, 15 minute turnaround, ‘hopefully accurate’ saliva test (using LAMP technology rather than PCR) for the virus will become available in the not too distant future.
In the meantime, be very cautious & stay safe.
Ex/Rob

Obviously...vaccine is priority number one, but holy hell that last bit about the home test would be huge if we could get it soon enough to mitigate spread this winter

[Slax]

HCQ is obviously not going to be useful, but a smart friend of mine said it was a pretty good week for vaccine research. He's bullish on effective vaccine treatments being available by the first quarter of next year, and thinks that antibody therapies will get increasingly effective by the fall. Still looking at 250-300k dead by the end of this, but there's light at the end of the tunnel, I guess.

Hi Cave,
Hope you & your family remain well & as content as possible in the midst of this insanity.
I very sadly agree that we are looking at ~250K dead by the end of 2020. A combination of incomprehensibly incompetent leadership by too many of our ‘leaders’ & selfish/ignorant behavior by Gen Z & many millennials (fortunately not including the 2 millennials I love dearly) has resulted in the freaking United States of America (for all its many flaws the best country in the history of planet Earth) currently leading the way in worldwide COVID-19 morbidity & mortality.
I also agree that monoclonal antibodies as a therapeutic is looking better & better (together with REMDESIVIR & high dose dexamethasone [albeit the latter is very much a two-edged sword given its voluminous potential adverse effects - I have lots & lots of experience with high dose glucocorticoids as an endocrinologist]).
I am certainly not a ‘vaccinologist’, but if Tony Fauci (truly a ‘national treasure’ who I have had the privilege to meet a couple of times years ago when he first took over NIAID at NIH) is impressed with the preliminary results from Moderna, Pfizer/BioNtech & Oxford/AstraZeneca in particular (all about to launch Phase III trials) & is optimistic about the availability of these vaccines during Q1 2021, then I sure as **** am as well.
The other good news is that a home-performed, 15 minute turnaround, ‘hopefully accurate’ saliva test (using LAMP technology rather than PCR) for the virus will become available in the not too distant future.
In the meantime, be very cautious & stay safe.
Ex/Rob

Obviously...vaccine is priority number one, but holy hell that last bit about the home test would be huge if we could get it soon enough to mitigate spread this winter

In fact, widespread home testing combined with a national quarantine strategy would be almost as good as a vaccine for controlling coronavirus. Paul Romer did some simulations with a modified SIR model to demonstrate that even a test with very poor sensitivity could suppress spread of a disease so long as people are tested frequently enough. In Romer's model, a test with 80% sensitivity (20% false negatives) administered to every American every two weeks followed by quarantine for positive results results in the virus being quickly contained, without social distancing or lockdowns. In addition, even lower sensitivity tests would still work well at containing the virus. Obviously you should take the actual numbers with a huge grain of salt considering Romer isn't a public health expert, the model is really basic, and the parameters are from a few months ago when we had less knowledge, but the basic idea that if you can test asymptomatic people frequently enough and quarantine those who tests positive then you can contain an epidemic with very few other measures is solid. In practice, I don't expect us to develop enough testing capacity for this before a vaccine comes out, but we could plausibly build up testing capacity for targeted testing of essential and at-risk workers, contact tracing, etc., which would all reduce the need for painful shutdowns and allow us to resume some of the activities we are missing out on. I don't think we're really on a path to get there, but it would be nice to at least try.

[exculpatory]

Hi Cave,
Hope you & your family remain well & as content as possible in the midst of this insanity.
I very sadly agree that we are looking at ~250K dead by the end of 2020. A combination of incomprehensibly incompetent leadership by too many of our ‘leaders’ & selfish/ignorant behavior by Gen Z & many millennials (fortunately not including the 2 millennials I love dearly) has resulted in the freaking United States of America (for all its many flaws the best country in the history of planet Earth) currently leading the way in worldwide COVID-19 morbidity & mortality.
I also agree that monoclonal antibodies as a therapeutic is looking better & better (together with REMDESIVIR & high dose dexamethasone [albeit the latter is very much a two-edged sword given its voluminous potential adverse effects - I have lots & lots of experience with high dose glucocorticoids as an endocrinologist]).
I am certainly not a ‘vaccinologist’, but if Tony Fauci (truly a ‘national treasure’ who I have had the privilege to meet a couple of times years ago when he first took over NIAID at NIH) is impressed with the preliminary results from Moderna, Pfizer/BioNtech & Oxford/AstraZeneca in particular (all about to launch Phase III trials) & is optimistic about the availability of these vaccines during Q1 2021, then I sure as **** am as well.
The other good news is that a home-performed, 15 minute turnaround, ‘hopefully accurate’ saliva test (using LAMP technology rather than PCR) for the virus will become available in the not too distant future.
In the meantime, be very cautious & stay safe.
Ex/Rob

Obviously...vaccine is priority number one, but holy hell that last bit about the home test would be huge if we could get it soon enough to mitigate spread this winter

In fact, widespread home testing combined with a national quarantine strategy would be almost as good as a vaccine for controlling coronavirus. Paul Romer did some simulations with a modified SIR model to demonstrate that even a test with very poor sensitivity could suppress spread of a disease so long as people are tested frequently enough. In Romer's model, a test with 80% sensitivity (20% false negatives) administered to every American every two weeks followed by quarantine for positive results results in the virus being quickly contained, without social distancing or lockdowns. In addition, even lower sensitivity tests would still work well at containing the virus. Obviously you should take the actual numbers with a huge grain of salt considering Romer isn't a public health expert, the model is really basic, and the parameters are from a few months ago when we had less knowledge, but the basic idea that if you can test asymptomatic people frequently enough and quarantine those who tests positive then you can contain an epidemic with very few other measures is solid. In practice, I don't expect us to develop enough testing capacity for this before a vaccine comes out, but we could plausibly build up testing capacity for targeted testing of essential and at-risk workers, contact tracing, etc., which would all reduce the need for painful shutdowns and allow us to resume some of the activities we are missing out on. I don't think we're really on a path to get there, but it would be nice to at least try.

While awaiting vaccines, what should have happened months ago & still should happen & could happen is a “Manhattan project-like” full court press to maximize the quantity & quality of testing & tracing NATION-WIDE together with maximal non-stop NATION-WIDE emphasis on social distancing/masking. The WH & many other of our “leaders’ have failed us miserably & continue to fail us. There are many other countries who have done these things 1000 fold better than us & have therefore contained the virus dramatically better than we have. Regarding the pandemic, there are no words to describe the indescribable incompetence & ignorance Trump has displayed & continues to display. I am compelled to write these incontrovertible truths as a physician who has dedicated his career to excellence in medicine - irrespective of my very significant problems with the other side on many non-COVID issues.

[djFan71]

Obviously...vaccine is priority number one, but holy hell that last bit about the home test would be huge if we could get it soon enough to mitigate spread this winter

In fact, widespread home testing combined with a national quarantine strategy would be almost as good as a vaccine for controlling coronavirus. Paul Romer did some simulations with a modified SIR model to demonstrate that even a test with very poor sensitivity could suppress spread of a disease so long as people are tested frequently enough. In Romer's model, a test with 80% sensitivity (20% false negatives) administered to every American every two weeks followed by quarantine for positive results results in the virus being quickly contained, without social distancing or lockdowns. In addition, even lower sensitivity tests would still work well at containing the virus. Obviously you should take the actual numbers with a huge grain of salt considering Romer isn't a public health expert, the model is really basic, and the parameters are from a few months ago when we had less knowledge, but the basic idea that if you can test asymptomatic people frequently enough and quarantine those who tests positive then you can contain an epidemic with very few other measures is solid. In practice, I don't expect us to develop enough testing capacity for this before a vaccine comes out, but we could plausibly build up testing capacity for targeted testing of essential and at-risk workers, contact tracing, etc., which would all reduce the need for painful shutdowns and allow us to resume some of the activities we are missing out on. I don't think we're really on a path to get there, but it would be nice to at least try.

While awaiting vaccines, what should have happened months ago & still should happen & could happen is a “Manhattan project-like” full court press to maximize the quantity & quality of testing & tracing NATION-WIDE together with maximal non-stop NATION-WIDE emphasis on social distancing/masking. The WH & many other of our “leaders’ have failed us miserably & continue to fail us. There are many other countries who have done these things 1000 fold better than us & have therefore contained the virus dramatically better than we have. Regarding the pandemic, there are no words to describe the indescribable incompetence & ignorance Trump has displayed & continues to display. I am compelled to write these incontrovertible truths as a physician who has dedicated his career to excellence in medicine - irrespective of my very significant problems with the other side on many non-COVID issues.

Ex, I both and-1ed this post and removed your last paragraph. I love your contributions to the thread, but we gotta have a line on the political stuff somewhere. I feel like it was between the rest of your post and that closing.

[Captain_Caveman]

Obviously...vaccine is priority number one, but holy hell that last bit about the home test would be huge if we could get it soon enough to mitigate spread this winter

In fact, widespread home testing combined with a national quarantine strategy would be almost as good as a vaccine for controlling coronavirus. Paul Romer did some simulations with a modified SIR model to demonstrate that even a test with very poor sensitivity could suppress spread of a disease so long as people are tested frequently enough. In Romer's model, a test with 80% sensitivity (20% false negatives) administered to every American every two weeks followed by quarantine for positive results results in the virus being quickly contained, without social distancing or lockdowns. In addition, even lower sensitivity tests would still work well at containing the virus. Obviously you should take the actual numbers with a huge grain of salt considering Romer isn't a public health expert, the model is really basic, and the parameters are from a few months ago when we had less knowledge, but the basic idea that if you can test asymptomatic people frequently enough and quarantine those who tests positive then you can contain an epidemic with very few other measures is solid. In practice, I don't expect us to develop enough testing capacity for this before a vaccine comes out, but we could plausibly build up testing capacity for targeted testing of essential and at-risk workers, contact tracing, etc., which would all reduce the need for painful shutdowns and allow us to resume some of the activities we are missing out on. I don't think we're really on a path to get there, but it would be nice to at least try.

While awaiting vaccines, what should have happened months ago & still should happen & could happen is a “Manhattan project-like” full court press to maximize the quantity & quality of testing & tracing NATION-WIDE together with maximal non-stop NATION-WIDE emphasis on social distancing/masking. The WH & many other of our “leaders’ have failed us miserably & continue to fail us. There are many other countries who have done these things 1000 fold better than us & have therefore contained the virus dramatically better than we have. Regarding the pandemic, there are no words to describe the indescribable incompetence & ignorance Trump has displayed & continues to display. I am compelled to write these incontrovertible truths as a physician who has dedicated his career to excellence in medicine - irrespective of my very significant problems with the other side on many non-COVID issues.

[exculpatory]

https://www.mdlinx.com/news/-breakthrough-treatment-slashes-virus-death-risk-study/3z3hKQozSbh9dnfcvYIbWi?publish_dt=07-20-2020&utm_source=alert&utm_medium=email&utm_campaign=ajm_50143

Potentially a very big deal - await peer review & formal publication!