Originally Posted by Bwana:
Once again, don't come in this thread with some kind of political agenda, or you will be shown the door. If you want to go that route, there is a thread about this in DC.
Originally Posted by Dartgod:
People, there is a lot of good information in this thread, let's try to keep the petty bickering to a minimum.
We all have varying opinions about the impact of this, the numbers, etc. We will all never agree with each other. But we can all keep it civil.
Thanks!
Click here for the original OP:
Spoiler!
Apparently the CoronaVirus can survive on a inanimate objects, such as door knobs, for 9 days.
California coronavirus case could be first spread within U.S. community, CDC says
By SOUMYA KARLAMANGLA, JACLYN COSGROVE
FEB. 26, 2020 8:04 PM
The Centers for Disease Control and Prevention is investigating what could be the first case of novel coronavirus in the United States involving a patient in California who neither recently traveled out of the country nor was in contact with someone who did.
“At this time, the patient’s exposure is unknown. It’s possible this could be an instance of community spread of COVID-19, which would be the first time this has happened in the United States,” the CDC said in a statement. “Community spread means spread of an illness for which the source of infection is unknown. It’s also possible, however, that the patient may have been exposed to a returned traveler who was infected.”
The individual is a resident of Solano County and is receiving medical care in Sacramento County, according to the state Department of Public Health.
The CDC said the “case was detected through the U.S. public health system — picked up by astute clinicians.”
Officials at UC Davis Medical Center expanded on what the federal agency might have meant by that in an email sent Wednesday, as reported by the Davis Enterprise newspaper.
The patient arrived at UC Davis Medical Center from another hospital Feb. 19 and “had already been intubated, was on a ventilator, and given droplet protection orders because of an undiagnosed and suspected viral condition,” according to an email sent by UC Davis officials that was obtained by the Davis Enterprise.
The staff at UC Davis requested COVID-19 testing by the CDC, but because the patient didn’t fit the CDC’s existing criteria for the virus, a test wasn’t immediately administered, according to the email. The CDC then ordered the test Sunday, and results were announced Wednesday. Hospital administrators reportedly said in the email that despite these issues, there has been minimal exposure at the hospital because of safety protocols they have in place.
A UC Davis Health spokesperson declined Wednesday evening to share the email with The Times.
Since Feb. 2, more than 8,400 returning travelers from China have entered California, according to the state health department. They have been advised to self-quarantine for 14 days and limit interactions with others as much as possible, officials said.
“This is a new virus, and while we are still learning about it, there is a lot we already know,” Dr. Sonia Angell, director of the California Department of Public Health, said in a statement. “We have been anticipating the potential for such a case in the U.S., and given our close familial, social and business relationships with China, it is not unexpected that the first case in the U.S. would be in California.”
It is not clear how the person became infected, but public health workers could not identify any contacts with people who had traveled to China or other areas where the virus is widespread. That raises concern that the virus is spreading in the United States, creating a challenge for public health officials, experts say.
“It’s the first signal that we could be having silent transmission in the community,” said Lawrence Gostin, director of the World Health Organization Collaborating Center on National and Global Health Law. “It probably means there are many more cases out there, and it probably means this individual has infected others, and now it’s a race to try to find out who that person has infected.”
On Tuesday, the CDC offered its most serious warning to date that the United States should expect and prepare for the coronavirus to become a more widespread health issue.
“Ultimately, we expect we will see coronavirus spread in this country,” said Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases. “It’s not so much a question of if, but a question of when.”
According to the CDC’s latest count Wednesday morning, 59 U.S. residents have tested positive for the new strain of coronavirus — 42 of whom are repatriated citizens from a Diamond Princess cruise. That number has grown by two since Messonnier’s last count Tuesday, although the CDC was not immediately available to offer details on the additional cases.
More than 82,000 cases of coronavirus have been reported globally, and more than 2,700 people have died, with the majority in mainland China, the epicenter of the outbreak.
But public health leaders have repeatedly reminded residents that the health risk from the novel coronavirus to the general public remains low.
“While COVID-19 has a high transmission rate, it has a low mortality rate,” the state Department of Public Health said in a statement Wednesday. “From the international data we have, of those who have tested positive for COVID-19, approximately 80% do not exhibit symptoms that would require hospitalization. There have been no confirmed deaths related to COVID-19 in the United States to date.”
CDC officials have also warned that although the virus is likely to spread in U.S. communities, the flu still poses a greater risk.
Gostin said the news of potential silent transmission does not eliminate the possibility of containing the virus in the U.S. and preventing an outbreak.
“There are few enough cases that we should at least try,” he said. “Most of us are not optimistic that that will be successful, but we’re still in the position to try.”
Originally Posted by Donger:
Question: don't most of us have antibodies for seasonal flu?
We do, but the mutation rate of the flu is high enough that those antibodies don't confer much protection as the virus mutates. That's why it's generally best to wait until October to get the flu shot, as if you get it when it first comes out in August, you'll have declining protection towards the end of the flu season.
By the time of the next flu season, strains (of which there are four we are vaccinated for) have changed enough to render previous vaccines mostly ineffective.
That's also why vaccination for MMR was so important. If you maintain high vaccination levels and prevent a reservoir of infection, you don't give the viruses a chance to mutate, which reduces the efficacy of the vaccine for everyone. Similarly, the incredibly high mutation rate of HIV has been one of the largest stumbling blocks for the development of a vaccine (although there are others that make it incredibly difficult). [Reply]
Originally Posted by 'Hamas' Jenkins:
We do, but the mutation rate of the flu is high enough that those antibodies don't confer much protection as the virus mutates. That's why it's generally best to wait until October to get the flu shot, as if you get it when it first comes out in August, you'll have declining protection towards the end of the flu season.
By the time of the next flu season, strains (of which there are four we are vaccinated for) have changed enough to render previous vaccines mostly ineffective.
That's also why vaccination for MMR was so important. If you maintain high vaccination levels and prevent a reservoir of infection, you don't give the viruses a chance to mutate, which reduces the efficacy of the vaccine for everyone. Similarly, the incredibly high mutation rate of HIV has been one of the largest stumbling blocks for the development of a vaccine (although there are others that make it incredibly difficult).
Do not use chloroquine or hydroxychloroquine alone or in combination with azithromycin as a treatment of patients with COVID-19 due to known harms and no available evidence of benefits in patients with COVID-19.
In light of known harms and very uncertain evidence of benefit in patients with COVID-19, using shared and informed decision making with patients (and their families), clinicians may treat hospitalized COVID-19–positive patients with chloroquine or hydroxychloroquine alone or in combination with azithromycin in the context of a clinical trial.
This is all I ask. If I'm hospitalized with it I'd prefer to try this combination. I understand if physicians aren't allowed to recommend it but I'd sign a waiver or informed consent form to be allowed to.
The idea that there is no evidence is false. It may not be enough evidence to advise an entire country to make it the default treatment but there is some evidence. Small numbers and small trial sizes.
Two news stories that cite the same study with completely different conclusions. It would appear that these trials seem to prove what those conducting them wanted to prove (positive or negative.) What those who are optimistic about it state is the importance of giving the combo early - those that state little to no positive results gave the combo between 7 to 12 days after symptoms began. That's a big difference.
And doctors regularly prescribe drugs for off label use. The last 4 drugs I tried for insomnia were not developed to specifically treat that.
Also the biggest negatives seem to be heart complications due to the QT interval. People with a longer interval can have negative or fatal effects and should be tested for this before being considered. I guess there's a range that's dangerous and people close to that shouldn't take either drug.
Any drug can cause a negative reaction in small percentages of people. Do what you can to educate yourself and make informed decisions. I am not a doctor and don't know more about medicine than my doctor.
Nothing is "safe." Dozens of vaccines have been hurried into production and discontinued due to negative side effects and infections. Probably hundreds of medications as well. Hell, I just found out the damned antacid I'd been taking for 10 years causes cancer... [Reply]
I'd also like to state how nearly impossible it is to find any "non-political" C19 information. This virus IS highly political. In nearly all articles the study is used to slam/support the president.
Journalism is less reliable than at any point in my lifetime. All media has an agenda and the facts get pushed through that agenda. I've probably watched 20 or 30 videos with physicians on the topic and I knew exactly how they would vote in the first 5 minutes of the interview... [Reply]
Guidelines from the American College of Physicians
Should Clinicians Use Chloroquine or Hydroxychloroquine Alone or in Combination With Azithromycin for the Prophylaxis or Treatment of COVID-19?
The efficacy of chloroquine or hydroxychloroquine alone or in combination with azithromycin to prevent COVID-19 after infection with SARS-CoV-2 or to treat patients with COVID-19 is not established and future clinical trials are needed to answer these questions. There are known harms of these medications when used to treat other diseases (5, 6). Current evidence about efficacy and harms for use in the context of COVID-19 is sparse, conflicting, and from low quality studies, increasing the uncertainty and lowering our confidence in the conclusions of these studies when assessing the benefits or understanding the balance when compared with harms. These interim practice points are based on best available evidence. We will maintain these practice points as a living guidance document, updated as new evidence becomes available.
Do not use chloroquine or hydroxychloroquine alone or in combination with azithromycin as prophylaxis against COVID-19 due to known harms and no available evidence of benefits in the general population.
Do not use chloroquine or hydroxychloroquine alone or in combination with azithromycin as a treatment of patients with COVID-19 due to known harms and no available evidence of benefits in patients with COVID-19.
In light of known harms and very uncertain evidence of benefit in patients with COVID-19, using shared and informed decision making with patients (and their families), clinicians may treat hospitalized COVID-19–positive patients with chloroquine or hydroxychloroquine alone or in combination with azithromycin in the context of a clinical trial.
Should chloroquine or hydroxychloroquine in combination with azithromycin be used for treatment of patients with COVID-19?
Interventions Use? Rationale
Chloroquine NO* No available evidence in COVID-19–positive patients
Chloroquine + Azithr NO* No available evidence in COVID-19–positive patients
Hydroxychloroquine NO* Insufficient evidence about benefits and harms
Hydroxychloroquine + NO* Insufficient evidence about benefits and harms
Azithromycin
Originally Posted by Rausch:
I'd also like to state how nearly impossible it is to find any "non-political" C19 information. This virus IS highly political. In nearly all articles the study is used to slam/support the president.
Journalism is less reliable than at any point in my lifetime. All media has an agenda and the facts get pushed through that agenda. I've probably watched 20 or 30 videos with physicians on the topic and I knew exactly how they would vote in the first 5 minutes of the interview...
Originally Posted by petegz28:
If the flu puts you down for weeks it is not mild. Enough with the drama.
For some ppl. I got the flu in Feb. First time in about 15 years. I was fine after 2 days just a residual cough. Illnesses affect ppl differently. [Reply]
Originally Posted by Rausch:
I'd also like to state how nearly impossible it is to find any "non-political" C19 information. This virus IS highly political. In nearly all articles the study is used to slam/support the president.
Journalism is less reliable than at any point in my lifetime. All media has an agenda and the facts get pushed through that agenda. I've probably watched 20 or 30 videos with physicians on the topic and I knew exactly how they would vote in the first 5 minutes of the interview...
Originally Posted by Rausch:
I'd also like to state how nearly impossible it is to find any "non-political" C19 information. This virus IS highly political. In nearly all articles the study is used to slam/support the president.
Journalism is less reliable than at any point in my lifetime. All media has an agenda and the facts get pushed through that agenda. I've probably watched 20 or 30 videos with physicians on the topic and I knew exactly how they would vote in the first 5 minutes of the interview...
My issue is this:
There are currently hundreds (thousands?) of studies going on for treatments for COVID-19. Some of them have shown promise. Others less so.
Can you name even 2-3 of them aside from HCQ? If not, why is that one in particular the one you are willing to receive? What is it about the others that makes them less promising?
I mostly just don't understand why we're even talking about it.
EDIT: There are currently 1,114 studies going on according to the WHO.
Where are all the “we will never have a vaccine” chicken littles these days? Love to hear their opinions now that the facts continue to bear fruit and give way for immense optimism. Science is awesome. Politicians all suck. [Reply]
Originally Posted by Rausch:
This is all I ask. If I'm hospitalized with it I'd prefer to try this combination. I understand if physicians aren't allowed to recommend it but I'd sign a waiver or informed consent form to be allowed to.
The idea that there is no evidence is false. It may not be enough evidence to advise an entire country to make it the default treatment but there is some evidence. Small numbers and small trial sizes.
Two news stories that cite the same study with completely different conclusions. It would appear that these trials seem to prove what those conducting them wanted to prove (positive or negative.) What those who are optimistic about it state is the importance of giving the combo early - those that state little to no positive results gave the combo between 7 to 12 days after symptoms began. That's a big difference.
And doctors regularly prescribe drugs for off label use. The last 4 drugs I tried for insomnia were not developed to specifically treat that.
Also the biggest negatives seem to be heart complications due to the QT interval. People with a longer interval can have negative or fatal effects and should be tested for this before being considered. I guess there's a range that's dangerous and people close to that shouldn't take either drug.
Any drug can cause a negative reaction in small percentages of people. Do what you can to educate yourself and make informed decisions. I am not a doctor and don't know more about medicine than my doctor.
Nothing is "safe." Dozens of vaccines have been hurried into production and discontinued due to negative side effects and infections. Probably hundreds of medications as well. Hell, I just found out the damned antacid I'd been taking for 10 years causes cancer...
You have absolutely no idea what you are talking about. [Reply]
Originally Posted by Rausch:
I'd also like to state how nearly impossible it is to find any "non-political" C19 information. This virus IS highly political. In nearly all articles the study is used to slam/support the president.
Journalism is less reliable than at any point in my lifetime. All media has an agenda and the facts get pushed through that agenda. I've probably watched 20 or 30 videos with physicians on the topic and I knew exactly how they would vote in the first 5 minutes of the interview...
HCQ seems to have been politicized more than all the other treatments being trialed but I don’t think it has politicized to the same degree in other countries.
Hard to explain any potential cause with getting into politics so I will stop there.
As for HCQ , my wife has a few patients currently on it for lupus or RA and she has to routinely monitor them with lab tests etc .. not just QT interval , I understand other meds need that as well , It it is something she would not want to take as a prophylaxis and we avoid traveling to countries where it is recommended. I also understand it has been around and considered safe etc
There are probably safer options being trialed I would look into first. [Reply]
Originally Posted by stumppy:
The posters who continually bring up HCQ as a treatment for CV19 all have one thing in common. They have taken the advice of one person.
Unfortunately the US is very divided right now and I don’t see it getting better. The world in general seems to going in that direction as well. [Reply]
Originally Posted by Rausch:
This is all I ask. If I'm hospitalized with it I'd prefer to try this combination. I understand if physicians aren't allowed to recommend it but I'd sign a waiver or informed consent form to be allowed to.
It's not that they aren't allowed to recommend it, but that the overwhelming majority of evidence suggests that they shouldn't. If I was an MD I wouldn't write for it, and as a PharmD I wouldn't authorize the order. This isn't Burger King. You don't get to decide what antiviral medication to take.
Originally Posted by Rausch:
The idea that there is no evidence is false. It may not be enough evidence to advise an entire country to make it the default treatment but there is some evidence. Small numbers and small trial sizes.
Have you been trained on how to read a clinical trial? I have. I can show you numerous trials with supposed benefits that are terribly designed, and it just so happens that all of the trials that espouse the benefits of hydroxychloroquine have major, major flaws (absence of control groups, attrition biases, lack of randomization, flaws in statistical analysis), which is why treatment guidelines don't recommend them.
Originally Posted by Rausch:
Two news stories that cite the same study with completely different conclusions. It would appear that these trials seem to prove what those conducting them wanted to prove (positive or negative.) What those who are optimistic about it state is the importance of giving the combo early - those that state little to no positive results gave the combo between 7 to 12 days after symptoms began. That's a big difference.
Link, please.
Originally Posted by Rausch:
And doctors regularly prescribe drugs for off label use. The last 4 drugs I tried for insomnia were not developed to specifically treat that.
Yes, you can prescribe drugs for off-label use. It doesn't mean that you should prescribe whatever drug the patient wants. We're not here to cater to your wants--we're here to provide evidence-based therapies to best treat your needs.
Originally Posted by Rausch:
Also the biggest negatives seem to be heart complications due to the QT interval. People with a longer interval can have negative or fatal effects and should be tested for this before being considered. I guess there's a range that's dangerous and people close to that shouldn't take either drug.
Getting an EKG as an outpatient would be extremely difficult right now. If you want monitoring, you're likely going to have to be hospitalized already. What have the trials shown about hydroxychloroquine in patients severe enough to be hospitalized? No efficacy.
Originally Posted by Rausch:
Any drug can cause a negative reaction in small percentages of people. Do what you can to educate yourself and make informed decisions. I am not a doctor and don't know more about medicine than my doctor.
And yet you claim that you would still try the drug despite multiple evidence-based guidelines, compiled by PHd's, MD's, and PharmD's showing that there is no benefit to taking hydroxychloroquine. So which is it?
Originally Posted by Rausch:
Nothing is "safe." Dozens of vaccines have been hurried into production and discontinued due to negative side effects and infections. Probably hundreds of medications as well. Hell, I just found out the damned antacid I'd been taking for 10 years causes cancer...
No, it doesn't. You're talking about ranitidine. Ranitidine was recalled because it had an excess amount of N-nitrosodimethylamine.
From the FDA:
A. FDA does not expect nitrosamines to cause harm when ingested at low levels. Nitrosamine impurities may increase the risk of cancer if people are exposed to them at above acceptable levels and over long periods of time, but a person taking a drug that contains nitrosamines at, or below, the acceptable daily intake limits every day for 70 years is not expected to have an increased risk of cancer.
There has been no documented increased risk of cancer in patients taking ranitidine. May does not mean has. Moreover, you shouldn't have been taking ranitidine for 10 years anyway, because people that take H2RA's experience tachyphylaxis that reduces their efficacy over time.
This is the problem with a layperson having so much access to information they don't understand--they may read it but they don't know how to interpret it. Consequently, they end up making decisions that are worse than had they done nothing at all.
You need to be able to ask questions of your providers and advocate for yourself. It is imperative. But you also need to recognize the limits of your expertise. [Reply]
