COVID-19

[Irish YJ]

I think most fair-minded folks can agree that democratically governed nations do their best to report accurate data in times like a pandemic whereas authoritarian dictatorships like China & Russia can not be taken at face value.

Oh I agree, but I'm just a little surprised how blatant they have been, and how bad the lie is.

 

[greyhammer90]

Oh I agree, but I'm just a little surprised how blatant they have been, and how bad the lie is.

The lie being bad is only an issue if your intent is to deceive. The lie being obviously untrue just reinforces their power.

 

[Irishize]

Here's a daily updated look at NYC with great data including demographics and charts. Deaths decreased yesterday, cases did not.
https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-daily-data-summary.pdf

Here's one with a good global view with trending
https://www.worldometers.info/coronavirus/
https://www.worldometers.info/coronavirus/country/us/

Here's a map view that can drill down to county level
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

IIRC, this week will see a huge uptick in reported cases b/c of the ramp up in testing.

 

[Irishize]

The recovery rate shown on that graph was pretty incredible if true. Sure hope it's the real deal. Many places are now trying it. Glad the FDA didn't hold up things due to the off-label use. Read that some were putting up a huge fight.

I understand Dr. Fauci’s take. He’s in a leadership position that requires the he stick to the science before making grand pronouncements. He’s as hopeful as everything else but he risks more than his reputation if he rushes to judgement before a statistically significant phase 3 trial is successfully completed.

In the “real world” however, MDs work off-label ALL the time. At least the good docs do. IMO, being a physician requires some art along w/ the necessary science. I want my HCP to “think outside the box” when treating an illness where approved therapies have failed. Don’t give me “well despite your symptoms, your test results report that you fall w/in normal range”.

I saw where the actor from “Lost” who acquired COVID-19 has added his anecdotal evidence to Plaquenil as he agreed it’s what led to his recovery as well.

 

[Irish YJ]

I understand Dr. Fauci’s take. He’s in a leadership position that requires the he stick to the science before making grand pronouncements. He’s as hopeful as everything else but he risks more than his reputation if he rushes to judgement before a statistically significant phase 3 trial is successfully completed.

In the “real world” however, MDs work off-label ALL the time. At least the good docs do. IMO, being a physician requires some art along w/ the necessary science. I want my HCP to “think outside the box” when treating an illness where approved therapies have failed. Don’t give me “well despite your symptoms, your test results report that you fall w/in normal range”.

I saw where the actor from “Lost” who acquired COVID-19 has added his anecdotal evidence to Plaquenil as he agreed it’s what led to his recovery as well.

Purely my opinion, but we're in drastic times, and I don't see this as a drastic measure. Seems pretty simple and obvious. Existing approved drug that has shown positive outcomes vs doing nothing and waiting. I'm sure 99% of patients are willing to sign a waiver. Not a time for being overly cautious and embracing red tape. If this were an experimental drug, I'd understand. Off label is very different.

IIRC, this week will see a huge uptick in reported cases b/c of the ramp up in testing.

Yup. We've already seen a huge spike with the new testing, and should see a lot more.

The lie being bad is only an issue if your intent is to deceive. The lie being obviously untrue just reinforces their power.

IDK. I personally think it makes them look desperate and stupid. Not sure how it reinforces anything. They've always done what they've wanted, but they've been better spinners and liars in the past.

 

[Legacy]

It most likely has to do with California's regulations pertaining to their Certificate of Need (CON) program. Long story short, the states that require CONs have utilization rules attached to their facilities. In Hawaii, the governing body is called SHPDA (State Health Planning and Development Agency). To attain an acute-care facility CON in Hawaii and build a new hospital, the hospitals in your desired service area (let's say Oahu county) have to show an average utilization rate of about 75%. If the hospitals aren't that full, then there is no justification for building a new facility.

Why do they do that? So that you don't waste resources and build/buy stuff that won't be utilized. A state like Texas doesn't require CONs and it's the literal Wild Wild West at times. Things get built and burnt down with frequency.

The result is a much more economical and efficient system regarding costs, resources, and waste. The downside is you don't have the slack to pick up a huge and sudden influx of patients. That's why our system cannot absorb a pandemic. It was never meant to.

Good points. Additionally, the HC system is a combination of public and private entities. Reimbursement from federal sources is sixty cents on the dollar. So a for-profit nursing home or Skilled Nursing Facility that would take a patient after hospitalization would either limit the number of federal patients they take or cut costs. Finding placement for a post-Covid 19 could potentially be problematic not only due to capacity but due to insurance. Add that to a state's uninsured like Kansas who did not expand Medicaid (18-64) and one that has more citizens in poverty, the backup in the system when there may be more demand for hospital beds as well as factoring in a state's bed capacity is a factor that a state's HC system's administrators must contend with. Also, since 2014, CMS has ratcheted up its oversight of such facilities, with corresponding penalties, which may include decreased reimbursements. Certainly, there are subpopulations in other parts of the country at risk - homeless, prison/detention including asylum-seeking children, oncology, dialysis and other immunocompromised, etc, which may be urban problems. The solution? Government hc institutions like the VA or military bases/ships....
That still may be constrained by the availability of appropriately skilled providers including nurses and respiratory therapists. Each state mentioned - Wyoming, Iowa, Kansas and Missouri - have their unique factors -- as does Hawaii.

 

[Irish#1]

Score one for the good guys. I had a meeting with my staff this morning recapping the management meeting from yesterday concerning the Gov's EO and us being an essential business. The silence when I was done was deafening so I decided to talk to the owner and his son. It took a little convincing, but I'm having a meeting with my staff to let them know most of them can work from home during the "stay at home" directive.

 

[Legacy]

Since the uninsured non-elderly in a pandemic and their subsequent placement on recovery will be a drain on hospitals, here's a general illustration of each state's categories.

45% are uninsured due to cost with the second highest reason being lost job or employer does not provide it. Layoffs will contribute to this. Many of these states have higher rural populations.

From: Key Facts about the Uninsured Population

 

[Irish YJ]

Just heard from the briefing that they are waiting on FDA's approval to re-purpose a machine that is more or less a ventilator used during surgery by anesthesiologists. Sounded like there are a ton out there, and just needs the FDA's OK.

Also, Ford is using F150 parts to make ventilators. Honestly, I'd much rather a Ford model than a GM...

 

[Irish2155]

Score one for the good guys. I had a meeting with my staff this morning recapping the management meeting from yesterday concerning the Gov's EO and us being an essential business. The silence when I was done was deafening so I decided to talk to the owner and his son. It took a little convincing, but I'm having a meeting with my staff to let them know most of them can work from home during the "stay at home" directive.

"most" meaning everyone but the one guy who keeps asking about it?

 

[Legacy]

Just heard from a co-worker who's family member was in the hospital with the virus. Family member was given the anti-malaria drug last night and he claims he feels 100% better. FM being sent home from hospital tonight/tomorrow morning.

Believe FM is in his 40s - unknown if he has preexisting conditions.

Good to hear about those who recover. Age is clearly one of the risk factors. 8 of 10 deaths in the U.S. from COVID-19 are in those 65 and over. (Link)

Immunotherapy has changed a lot of treatment protocols. I'm reading that, in those patients who develop severe symptoms, their Natural Killer cells, which are part of a person's immunological defenses, are low. Clinical trials have proven benefit for some oncology patients and are being started for COVID-19 patients. A year from now treatment options will be much different.

One solution to lack of bed capacity is what is happening in the UK. The private sector of their healthcare is donating all their beds, extra staff and ventilators to their NHS at cost.

FIGHT FOR LIFE NHS given 20,000 extra staff and thousands of beds & ventilators from private hospitals to fight coronavirus

 

[Irish YJ]

FDA has approved off-label use of the Chloroquine drug.

 

[InKellyWeTrust]

Azithromycin + hydroxychloriquine may be a huge windfall. Hospitals will use it in their ICUs. It may same many lives. We will see.

 

[Irish YJ]

States reject Trump talk of restarting U.S. economy early
https://www.reuters.com/article/us-...of-restarting-u-s-economy-early-idUSKBN21B1EC

Yet Cuomo said almost the exact same things.

 

[Irish YJ]

Azithromycin + hydroxychloriquine may be a huge windfall. Hospitals will use it in their ICUs. It may same many lives. We will see.

Pence said we have large availability. Bayer is one of the makers. Also said they expect more drugs in the late spring. Sounded like he was talking about "new" drugs.

 

[koonja]

FDA has approved off-label use of the Chloroquine drug.

This seems like a big deal, no? I don't have the context.

 

[Irishize]

Just heard from the briefing that they are waiting on FDA's approval to re-purpose a machine that is more or less a ventilator used during surgery by anesthesiologists. Sounded like there are a ton out there, and just needs the FDA's OK.

Also, Ford is using F150 parts to make ventilators. Honestly, I'd much rather a Ford model than a GM...

I understood this to already have been approved as of yesterday? This took way too long to approve & is another reason why gov’t shouldn’t be able to nationalize private business...it’s a lose/lose except for those who are using this tragedy as an excuse to seize more power long term. Go back to WWII when corps like Ford Motor Company pivoted to help w/ building airplane parts as a great example.

 

[Irishize]

This seems like a big deal, no? I don't have the context.

Typically insurance companies will have a standing order to deny off-label usage of medicines. That’s typically b/c the medicines are novel biotech therapies that cost thousands per month (i.e., oncology) and insurance obviously wants to avoid costs where they can get away with.

The thing w/ Plaquenil is that it’s been generic forever so I wouldn’t expect it to cost much even for cash paying patients. Bayer & Novartis have stepped up to donate production of this molecule so hopefully there’s not a scarcity attached to this.

You will hear horror stories about it possible leading to loss of vision. Context is important. Patients taking it for lupus are required to get their vision tested regularly b/c prolonged use may lead to loss of color in one’s vision. If a vision test shows a trend that way, the therapy is halted immediately and the patient monitored going forward.

 

[Irishize]

Purely my opinion, but we're in drastic times, and I don't see this as a drastic measure. Seems pretty simple and obvious. Existing approved drug that has shown positive outcomes vs doing nothing and waiting. I'm sure 99% of patients are willing to sign a waiver. Not a time for being overly cautious and embracing red tape. If this were an experimental drug, I'd understand. Off label is very different.

Oh I agree with you. My point is that Fauci and other clinicians in gov’t or academic institutions are trained to follow the science and not to swerve outside of the “data driven” lane. I guarantee Fauci would tell you in confidence that he would suggest it in the proper case but he can’t say that in his role for obvious reason. I’ve heard leading HCPs from academic institutions say the same thing on podcasts or at conferences. They will acknowledge the promise of a drug in a new indication but are careful to say that it needs to be fully tested through Phase III data.

As you know the FDA is a shitshow and has had egg on its face in the past for approving drugs for additional indications w/o proper merit. That leads to docs getting deposed and pharma companies getting sued.

Again I agree with you but Fauci is saying what his role requires him too which I don’t fault him for.

 

[notredomer23]

Trump just said he hopes to have the country opened up by Easter.

 

[ACamp1900]

El Paso going full lockdown so I’m finally fully work from home,... which is good because I’m feeling pretty shitty.

 

[Irish#1]

"most" meaning everyone but the one guy who keeps asking about it?

Fortunately he is one that can work from home as he doesn't have much face to face interaction with users. Two of the ladies I expected to work from home said they want to come into the office. One has her mother living with them. Her husband is working from home and her DIL and three grandkids are there for a couple of months. Coming to work is something of a relief for her. The second one also wants a break from her two kids. lol

 

[GATTACA!]

Since the uninsured non-elderly in a pandemic and their subsequent placement on recovery will be a drain on hospitals, here's a general illustration of each state's categories.

45% are uninsured due to cost with the second highest reason being lost job or employer does not provide it. Layoffs will contribute to this. Many of these states have higher rural populations.

From: Key Facts about the Uninsured Population

I wonder if this accounts for homeless people. No way Cali isn't in the highest category if so.

 

[loomis41973]

Summer Olympics have been postponed til 2021

Veteran International Olympic Committee member Dick Pound told USA TODAY Sports on Monday afternoon that the 2020 Tokyo Olympic Games are going to be postponed amid the coronavirus pandemic

What a name.

 

[Irish YJ]

Oh I agree with you. My point is that Fauci and other clinicians in gov’t or academic institutions are trained to follow the science and not to swerve outside of the “data driven” lane. I guarantee Fauci would tell you in confidence that he would suggest it in the proper case but he can’t say that in his role for obvious reason. I’ve heard leading HCPs from academic institutions say the same thing on podcasts or at conferences. They will acknowledge the promise of a drug in a new indication but are careful to say that it needs to be fully tested through Phase III data.

As you know the FDA is a shitshow and has had egg on its face in the past for approving drugs for additional indications w/o proper merit. That leads to docs getting deposed and pharma companies getting sued.

Again I agree with you but Fauci is saying what his role requires him too which I don’t fault him for.

I don't blame the docs to an extent as they're used to hedging every single thing in fear of getting sued. And yes, the FDA is a huge shit show, and has been for decades. Both slow moving, and also in the pockets of drug companies. I read somewhere it cost like 4 billion just to get a drug to trial because of all of the BS.

This seems like a big deal, no? I don't have the context.

Huge considering the FDA's history. Trump was blasted for talking it up, and I felt like things would come to a crawl. Then we quickly saw/heard that China and SKO were already using it, we saw the limited test results which were fantastic, and then France came out and said it immoral to withhold the treatment. IMO, the French report likely pushed them over the edge. Hard to poo poo another Western country and risk the optics after the strength of their recommendation.

 

[Irish YJ]

El Paso going full lockdown so I’m finally fully work from home,... which is good because I’m feeling pretty shitty.

Tests should be available now. I read that the damn has broke on tests, and we've tested more in the last 8 days than SKO's total. Something like 250k in the last week. FDA just approved a very simple/quick test too.

 

[Irish#1]

Looks like the stimulus package is close to being approved by both parties. Don't have details but it looks like some of the "extras" unrelated to COVID-19 relief have been stripped.

 

[Irish YJ]

<blockquote class="twitter-tweet"><p lang="en" dir="ltr">The US govt has declared a few times that they are ready to help <a href="https://twitter.com/hashtag/Iran?src=hash&ref_src=twsrc%5Etfw">#Iran</a> with medicines to fight the <a href="https://twitter.com/hashtag/CoronaOutbreak?src=hash&ref_src=twsrc%5Etfw">#CoronaOutbreak</a>. That's strange. Firstly, based on the words of your own officials, you face shortages in the US. So use what you have for your own patients./1</p>— Khamenei.ir (@khamenei_ir) <a href="https://twitter.com/khamenei_ir/status/1241640461602881536?ref_src=twsrc%5Etfw">March 22, 2020</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>

<blockquote class="twitter-tweet"><p lang="en" dir="ltr">2nd, you're accused of having created <a href="https://twitter.com/hashtag/Coronavirus?src=hash&ref_src=twsrc%5Etfw">#Coronavirus</a>. I don't know how true it is. But when there's such an allegation, can a wise man trust you? You could be giving medicines that spread the virus or cause it to remain. Experience shows you can’t be trusted & you do such things./2</p>— Khamenei.ir (@khamenei_ir) <a href="https://twitter.com/khamenei_ir/status/1241642515943620610?ref_src=twsrc%5Etfw">March 22, 2020</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>

 

[greyhammer90]

<blockquote class="twitter-tweet"><p lang="en" dir="ltr">The US govt has declared a few times that they are ready to help <a href="https://twitter.com/hashtag/Iran?src=hash&ref_src=twsrc%5Etfw">#Iran</a> with medicines to fight the <a href="https://twitter.com/hashtag/CoronaOutbreak?src=hash&ref_src=twsrc%5Etfw">#CoronaOutbreak</a>. That's strange. Firstly, based on the words of your own officials, you face shortages in the US. So use what you have for your own patients./1</p>— Khamenei.ir (@khamenei_ir) <a href="https://twitter.com/khamenei_ir/status/1241640461602881536?ref_src=twsrc%5Etfw">March 22, 2020</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>

<blockquote class="twitter-tweet"><p lang="en" dir="ltr">2nd, you're accused of having created <a href="https://twitter.com/hashtag/Coronavirus?src=hash&ref_src=twsrc%5Etfw">#Coronavirus</a>. I don't know how true it is. But when there's such an allegation, can a wise man trust you? You could be giving medicines that spread the virus or cause it to remain. Experience shows you can’t be trusted & you do such things./2</p>— Khamenei.ir (@khamenei_ir) <a href="https://twitter.com/khamenei_ir/status/1241642515943620610?ref_src=twsrc%5Etfw">March 22, 2020</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>

Bye Felicia.

 

[MJ12666]

FDA has approved off-label use of the Chloroquine drug.

Sorry to get a little technical, but I worked in the pharmaceutical industry for most of my carrier and the process basically is that the FDA approves a drug for a specific purpose generally after data from phase III trials are completed, submitted to the FDA and reviewed. Once approval is granted the drug can only be marketed for use to treat the condition for which it was initially intended. However since the drug was approved as safe to prescribe, the FDA has no restrictions on prescribing the drug for any purpose, even if that purpose is to treat a condition that it was not specifically approved to treat Using the drug to treat a condition for which it was not initially approved is called “off‐​label” because the label is only allowed to state the condition for which its use was FDA‐​approved and the manufacturer cannot market the drug for any other purpose without facing severe civil penalties. So technically the FDA would not approve the off-label use of Chloroquine as they cannot prevent it.