Coronavirus/COVID-19, Thread 2

[ConstableGeneva]

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[exculpatory]

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Preliminary.

I read a combination of my endocrinology literature AND, since 3/2020, COVID publications almost every day of the week.

One recent study suggested the sensitivity of saliva tests is not as good as the sensitivity of tests using nasopharyngeal swab gunk & sputum.

Ultimately, if they can document at least equivalent sensitivity in a large sample size, it will indeed be a game changer b/o much greater convenience, decreased cost, & much faster turnaround!

[Curmudgeon]

According to the folks at Yale, who developed it, the saliva test produces results that are 98% the same as the swab-up-the-nose test. Is this hyperbole?

[exculpatory]

According to the folks at Yale, who developed it, the saliva test produces results that are 98% the same as the swab-up-the-nose test. Is this hyperbole?

Counselor,

It was a very small study.

"It's really with a small, fairly controlled sample," said Dr. Andrew Morris, a professor of medicine at the University of Toronto and Sinai Health System, who wasn't involved in the research. "We don't know how the test will perform in the real world." However, based on that preliminary data, he called the performance "pretty good."

“So far, the test has only undergone limited testing in the lab and results have only been published online, prior to peer review, on a few dozen known positive and negative samples.“

Also, there are other preliminary studies where saliva did not perform nearly as well as NP swab material (trying to find where I read that very recently).

Results of large randomized trial using this particular methodology have not been reported as yet.

I am HUGELY rooting for it!

[Curmudgeon]

Yes, it's cheap and quick. If it works, it could be almost as game changing as a vaccine.

[canman1971]

Has anyone heard of a finger prick test for Covid-19? My friend's boss for a huge company said, give me your finger, so she held it out and he stuck her and it was a test. And how effective is it? Maybe it was for the antibodies?

Edit: Google is my friend. I believe it was for antibodies. But I haven't spoken with her since.

[sam_I_am]

Until we as a society do what the NBA has done ( like Australia, NZ, Korea, Japan, Taiwan, Norway etc.), testing only documents how bad it is. Once we get things under control, then mass testing like NBA does in bubble can be done at schools, colleges, work places to contact and isolate and keep the virus at bay. Since the country is unwilling to do this - perhaps because a horrific outbreak combined with post office shenanigans and armed police at polling sites could stifle the vote in blue cities in swing states - all this testing doesn’t change a thing.

[jmr07019]

The **** was Trump talking about last night with plasma? Sounded like BS but maybe it was a legitimate breakthrough and a reason for optimism.... thoughts from people who have been following this thing closely? I get the basic concept of the treatment but 35% does not seem like a number to be excited about.

[exculpatory]

How many mother freaking posts (including links to HIGH QUALITY, PROSPECTIVE, RANDOMIZED, PLACEBO CONTROLLED STUDIES peer reviewed/published by the most esteemed journals on the planet & NOT some of the earlier irredeemably & fatally flawed studies hyped by a few idiot ‘physicians’ & **** morons in the media & the WH) do I have to post for you to understand that there is a 99% likelihood that HCQ has NO efficacy in early, middle or late COVID, and that if you happen to have a prolonged QTc interval on your EKG for any one of a number of reasons (not very common - but not uncommon), exposure to HCQ (especially together w azithromycin) may result in lethal ventricular tachycardia/torsades de pointes.

I mean, I've seen you post a bunch of studies indicating "no clinical benefit" to HCQ (in at least one or two cases no anecdotal benefit), as well as studies documenting the risk of lethal (and I presume non-lethal) ventricular tachycardias. I don't doubt the legitimacy of any of that. And maybe I have missed something in between where there is clinical proof or even good anecdotal evidence that HCQ leads to more deaths/symptoms/hospitalizations/etc than no HCQ. I'll just take my L.

IIRC, there are at least 2 studies (in inpatients I believe) where HCQ resulted in more mortality & morbidity. When I have the time, I will search the Covid publication folder I created (which I added to my massive endocrinology & critical care folders back in 3/2020).

Beyond that, I will say this (Fauci BTW said the same thing to Congress on Fri 7/31): IF any peer reviewed, properly designed & powered, randomized trial EVER demonstrated statistically significant efficacy in ANY Covid sub-population (post-exposure, asymptomatic outpatient, symptomatic outpatient, non-ICU inpatient, ICU inpatient usually on a vent - which at this point would shock me), & the study was replicated by another A+ group, & baseline EKG & medication history (to R/O other drugs known to prolong the QTc interval) were obtained, I would have NO hesitation whatsoever supporting the use of HCQ (with periodic F/U EKGs at appropriate intervals TBD by how sick the patient is).

Let me conclude with a comment that REALLY matters (and remember, with the HUGE exception of the historically incompetent Covid management cluster ****, I mostly viscerally abhor the policies of the left). As per Dr. Fauci last Friday, & Dr. Birx today, if the WH AND all of our Governors/Mayors AND our millennial protestors AND our Red State citizens who somehow think wearing a mask infringes on their **** civil liberties do not once & for all wake the **** up & put on a **** full court press of masking (including INDOORS in multi-generational households) & social distancing (while we simultaneously continue to mega-maximize quick turnaround & accurate testing & tracing when feasible) during the next few weeks in August (while we hope & pray for a vaccine or vaccines in Q1/Q2 of CY 2021), our already indescribably disastrous death count of 155K will **** double or triple during the next few months. Count on it.

PS I must say that, even though you were wrong on the science, you write very well. :0)

For threrf23:

More goodies for you - in patients w RA (not COVID), but still quite relevant.
(This is separate & distinct from the risk of torsade de pointes/V tach in susceptible patients w prolonged QTc intervals at baseline.)

“Hydroxychloroquine and azithromycin together had a cardiovascular mortality risk that was more than twice (2.19) as high as the comparative treatment even in the short term based on findings from more than 320,000 users of that combination therapy. This treatment also produced a 15-20% increased rate of angina and heart failure.”

https://www.mdlinx.com/news/using-hydroxychloroquine-and-azithromycin-together-increases-cardiovascular-risk/4bHjgLPefSlhgIKQCAibOy?show_order=3&iqs=9z2z68r423knqg1em492qtg4ig1sare1i5srdg5i2g0&utm_medium=email&ipost_environment=m3usainc&utm_source=iPost&utm_campaign=All+Specialties+8%2F24%2F2020+Evening+Snippet

[exculpatory]

And some hopeful news from an ID doc at UVA (Sam’s alma mater & my youngest daughter’s alma mater)

https://www.mdlinx.com/news/9-reasons-why-you-should-be-optimistic-a-covid-19-vaccine-will-be-available-in-2021/RfZNk1INTxcJ41ESpQRk8?iqs=9z2z2giir0ikid7sjg7m2a2rqm2sqcs51ctsv5tq398&ipost_environment=m3usainc&utm_medium=email&show_order=2&utm_source=iPost&utm_campaign=All+Specialties+8%2F24%2F2020+Evening+Snippet

[theman]

The **** was Trump talking about last night with plasma? Sounded like BS but maybe it was a legitimate breakthrough and a reason for optimism.... thoughts from people who have been following this thing closely? I get the basic concept of the treatment but 35% does not seem like a number to be excited about.

At least four NBA players who have recovered from COVID-19 plan to donate blood for an experimental treatment that could help high-risk patients overcome the virus, according to Dr. Michael Joyner, a member of the leadership team of the National COVID-19 Convalescent Plasma Project.

https://abcnews.go.com/Health/nba-players-whove-beaten-covid-19-donate-blood/story?id=69909547#:~:text=At%20least%20four%20NBA%20players,COVID%2D19%20Convalescent%20Plasma%20Project.

[theman]

Not sure if this has been reported but at the risk of being repetitive.

Immune cells for common cold may recognize SARS-CoV-2
At a Glance
A study of blood samples taken before the COVID-19 pandemic showed that some people already had certain immune cells that recognize SARS-CoV-2.
These immune cells also reacted with coronaviruses that cause common colds.
The findings suggest that existing immune cells may help account for the wide range of symptoms experienced by people with COVID-19.

https://www.nih.gov/news-events/nih-research-matters/immune-cells-common-cold-may-recognize-sars-cov-2

[exculpatory]

Get your flu shot ASAP. I got mine 3 days ago.

"Now we are well advanced during the flu season in the Southern Hemisphere, and we have not seen any spike, any upsurge of flu," Aldighieri says.
Flu hasn't totally disappeared, but it's way down. For example, he says, consider 3,391 clinical samples that were taken from patients with an acute respiratory illness during a three-week period in the middle of winter in Chile. "Zero were positive for influenza," Aldighieri says, explaining that he'd normally expect to see hundreds test positive for flu.
Chile isn't alone. Other countries are having a similar experience. "Based on what we've seen in the Southern Hemisphere, and I would say this is true of all through the Southern Hemisphere — South America, Africa, Australia, New Zealand, all across this region — there's been very little influenza activity," Subbarao says.
No one can say for sure what's responsible for this unusual flu season, but it seems likely that all the changes in people's movements and behaviors, because of COVID-19, must have played a major role.
"The restriction on travel is a big, big element," says Subbarao, who notes that the mask-wearing, hand-washing and social distancing would also be expected to prevent flu transmission.
Flu researchers say that watching this all play out on the global scale is absolutely fascinating from a scientific point of view, but that no one can rest easy when it comes to influenza, especially in these days of the COVID-19 pandemic.
"We don't know why this is happening. It's a good thing; we're going to assume it's all of the control measures, but we don't need a major flu epidemic on top of this," says Stacey Schultz-Cherry, a flu researcher at St. Jude Children's Research Hospital in Memphis, Tenn.
"This is one of those years that it is more important than ever to get your flu vaccine."
Aldighieri adds, "If the Northern Hemisphere doesn't implement measures comparable to the south, the Northern Hemisphere will be at risk to have a combined epidemic, COVID-19 and influenza."
Already in the U. S., more than 175,000 people have died of COVID-19. The Centers for Disease Control and Prevention says that in a typical flu season, tens of thousands of people in this country die of influenza.


Get your flu shot ASAP.

Do what our Aussie mates have been doing (right, Reload?)
Too many of our protesting blue state millennials AND red state deniers of all ages have NOT been behaving wisely & unselfishly. The Covid DNGAF who you are voting for - it is an equal opportunity killer & maimer of all human beings! The onerous & dangerous potential pulmonary & cardiac chronic sequelae afflicting Covid survivors (not just ICU survivors - but even those who were relatively asymptomatic) are just becoming apparent.

As many of you know, I am a very compulsive, precise & informed/well read/experienced as **** physician & I **** know from whence I speak. NO excuses.

Read this. Well worth your time.

https://www.sjchs.org/living-smart-blog/blog-details/blog/2017/11/02/there-s-no-excuse.-now-is-the-time-to-get-the-flu-vaccine

That excellent expose was written in lay language & is easy to understand.
Let me add 2 more medically sophisticated truisms.
1. The debilitating & morbid Gullain Barre syndrome (which occurred more frequently after the flu shot in the 1970s has been a very rare adverse consequence during the last 4 decades.
2. Multiple high quality studies have NOT established an association with autism.

I am not going to debate this with any VAX Deniers on the Forum.
Do the right thing for yourself & your family OR further validate Darwin. :0)

Celtics. Oorah! Beat these mother **** hard & fast. I respect Lowry’s fierce gamesmanship - but he is so so so annoying, Do what our beloved Truth did to them almost singlehandedly when he crushed the Craps in the spring of 2014 & the spring of 2015 POs playing for the Nets & the Wizards, respectively (after a historic & legendary 15 year career with the Boston **** Celtics)!

[jirrit]

Thanks for that information ex. Ima get my shot asap and share this info with close ones.

[Green89]

It's pretty silly to post in giant bold type to get a flu shot but then say you're not going to debate it. The flu shot is extremely ineffective and has one of the highest adverse reactions of any vaccine. It is NOTHING like other vaccines. One doesn't have to be an anti-vaxxer to not like this one. The rewards are not worth the risks.

Last year's shot was a failure, as it was virtually ineffective on one targeted flu strain, and less than 50% effective on the other main targeted strain. It goes by previous year's data and picks the highest occurrences to target, but if three new flu strains are out this winter, the shot does nothing at all for you. Other vaccines have a single targeted virus, and they are highly successful and effective at the targeted virus, and allowing your body to build resistance to it. The fu shot is nowhere near as effective as other vaccines.

I do think the lower occurrences of flu are due to hygiene and covid measures people are doing, that will also help stop the flu spread. All masking, hand washing, and germ awareness should help lower the flu numbers this year.

[exculpatory]

It's pretty silly to post in giant bold type to get a flu shot but then say you're not going to debate it. The flu shot is extremely ineffective and has one of the highest adverse reactions of any vaccine. It is NOTHING like other vaccines. One doesn't have to be an anti-vaxxer to not like this one. The rewards are not worth the risks.

Last year's shot was a failure, as it was virtually ineffective on one targeted flu strain, and less than 50% effective on the other main targeted strain. It goes by previous year's data and picks the highest occurrences to target, but if three new flu strains are out this winter, the shot does nothing at all for you. Other vaccines have a single targeted virus, and they are highly successful and effective at the targeted virus, and allowing your body to build resistance to it. The fu shot is nowhere near as effective as other vaccines.

I do think the lower occurrences of flu are due to hygiene and covid measures people are doing, that will also help stop the flu spread. All masking, hand washing, and germ awareness should help lower the flu numbers this year.

Regardless of the partial truth of what u posted, what I wrote & the recommendation I made is 1000% valid.

Given who I am & what I do for a living, I say again that “I know whence I speak.”

All that said, I respect the fact that you absolutely have the right to make your own choices.

And I wish you well. :0)

[Green89]

It's pretty silly to post in giant bold type to get a flu shot but then say you're not going to debate it. The flu shot is extremely ineffective and has one of the highest adverse reactions of any vaccine. It is NOTHING like other vaccines. One doesn't have to be an anti-vaxxer to not like this one. The rewards are not worth the risks.

Last year's shot was a failure, as it was virtually ineffective on one targeted flu strain, and less than 50% effective on the other main targeted strain. It goes by previous year's data and picks the highest occurrences to target, but if three new flu strains are out this winter, the shot does nothing at all for you. Other vaccines have a single targeted virus, and they are highly successful and effective at the targeted virus, and allowing your body to build resistance to it. The fu shot is nowhere near as effective as other vaccines.

I do think the lower occurrences of flu are due to hygiene and covid measures people are doing, that will also help stop the flu spread. All masking, hand washing, and germ awareness should help lower the flu numbers this year.

Regardless of the partial truth of what u posted, what I wrote & the recommendation I made is 1000% valid.

Given who I am & what I do for a living, I say again that “I know whence I speak.”

All that said, I respect the fact that you absolutely have the right to make your own choices.

And I wish you well. :0)

No problem, doc. I agree. Anyone who wants it can certainly get it. Between my own personal experiences, and the experiences of others I know, I won't ever get one. I've had the confirmed flu once in my life that I can recall, so that would have been a lot of unnecessary vaccines in my body year after year when I didn't need them.

The elderly and/or those who could be seriously ill from the seasonal flu should strongly consider getting it, as their risks of getting seriously ill would then outweigh the shot's low effectiveness and chance of side effects. Health care workers who are regularly exposed to the flu should also get it. But Baker should have never made it mandatory for all students in the state. Let's just send a million kids and close to a million more parents who have to drive them to the doctors this fall and winter, to stand in lines at clinics, or wait in waiting rooms with covid going around. Great idea.

[exculpatory]

It's pretty silly to post in giant bold type to get a flu shot but then say you're not going to debate it. The flu shot is extremely ineffective and has one of the highest adverse reactions of any vaccine. It is NOTHING like other vaccines. One doesn't have to be an anti-vaxxer to not like this one. The rewards are not worth the risks.

Last year's shot was a failure, as it was virtually ineffective on one targeted flu strain, and less than 50% effective on the other main targeted strain. It goes by previous year's data and picks the highest occurrences to target, but if three new flu strains are out this winter, the shot does nothing at all for you. Other vaccines have a single targeted virus, and they are highly successful and effective at the targeted virus, and allowing your body to build resistance to it. The fu shot is nowhere near as effective as other vaccines.

I do think the lower occurrences of flu are due to hygiene and covid measures people are doing, that will also help stop the flu spread. All masking, hand washing, and germ awareness should help lower the flu numbers this year.

Regardless of the partial truth of what u posted, what I wrote & the recommendation I made is 1000% valid.

Given who I am & what I do for a living, I say again that “I know whence I speak.”

All that said, I respect the fact that you absolutely have the right to make your own choices.

And I wish you well. :0)

No problem, doc. I agree. Anyone who wants it can certainly get it. Between my own personal experiences, and the experiences of others I know, I won't ever get one. I've had the confirmed flu once in my life that I can recall, so that would have been a lot of unnecessary vaccines in my body year after year when I didn't need them.

The elderly and/or those who could be seriously ill from the seasonal flu should strongly consider getting it, as their risks of getting seriously ill would then outweigh the shot's low effectiveness and chance of side effects. Health care workers who are regularly exposed to the flu should also get it. But Baker should have never made it mandatory for all students in the state. Let's just send a million kids and close to a million more parents who have to drive them to the doctors this fall and winter, to stand in lines at clinics, or wait in waiting rooms with covid going around. Great idea.

No problem on my end either, Celtic colleague!
I could refute much of what you said, in particular your pure “luck” & good fortune that you have only contracted the flu once in spite of no flu shots, but let’s stop now.
Those who wish to follow my recommendation (which, BTW, is also the recommendation of every single Infectious Disease subspecialist I have known at multiple primo medical centers) will get the flu shot, & others like yourself will not. That’s the way the cookie crumbles.


GO CELTICS
Slam these baby dinousars into oblivion.
And then we are to going to blast the Greek Deers (while the Fakers & the Clips devour each other).

[soxfan2003]

https://www.worldometers.info/coronavirus/

Worth looking at so one can see the stark differences between Asia vs Europe/US/Mexico/even Canada. US has 11th highest death rate in the world.

Not enough people are asking why this virus is spreading so much faster in the United States/Europe/Mexico/even Canada and Germany than it has in Asia, especially East Asia. Even in the countries of Asia that barely test, it hasn't spread nearly as much.

While I don't doubt masks at the outset part of the answer, I do not think it explains much of what we have seen so far. Part of the answer appears to be thanks to poor diet, the United States in these other countries are so much more vulnerable to this virus that it isn't even funny.

The politicians/CDC/media/Fauci/Birx/medical experts often talk about the risk factors such as age/obesity/comorbidities increasing your chances of dying if you get the virus. That explains much of the difference in death rates.

But not enough people are talking about how the high presence of comorbidites including obesity in the population appears to be the key difference why this virus spreads so easily in many countries but not so easy in other countries.

The obesity -- not just overweight -- rate in the United States is astronomically higher than in Singapore, South Korea, Hong Kong, China and Japan. This difference isn't small/moderate. It is flat out enormous.

On average, someone with a comorbdity usually has a weaker immune system in the first place. Studies and year of scientific report back this up.

Where is Fauci/Birx/Trump/Pelosi/Biden/Bush/Obama/Bill Gates/anyone else, saying the importance for people that are obese or with other comborbidities to do their best to improve their health situation to help take care of others.

The reason I point all of this out if this coronavirus like all of the other coronaviruses so for is with the world for a very long time and their is never a vaccine that totally wipes it out in our lifetimes, we may have to live with it. Much easier for healthy population to live with it.

Compare the coronavirus death rates of even Germany with Japan, South Korea, Singapore, China. It is still dramatically higher despite Germany supposedly excelling in testing and Japan not really caring about testing.

Germany appears to have a lot less trade with China than the US and a modestly healthier population. May have a little less social interactions as well.

But in the medium to relatively long term(25 years), the US has to be prepared for the possibility that the only really answer may be encouraging everyone to get in shape and eat healthy. Even if your skinny, your immune system may be weaker than it could be if you do not eat healthy.

https://www.health.harvard.edu/staying-healthy/how-to-boost-your-immune-system

[Curmudgeon]

Well sure. Obesity is a killer, not just from Covid-19 but from other diseases, e.g. diabetes.

I'm more concerned about the short-term answer, since I probably won't be alive 25 years from now. Absent a vaccine, the short term answer is testing, contact tracing and masks. It has worked wonders in Massachusetts and Rhode Island, where the rate of infection, and the deaths, have reached manageable levels.

In states like Florida it hasn't. I wonder why.