Thought this was an interesting recap of the recent Delta variant in one country.
https://talkingpointsmemo.com/edblog...-delta-variant
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Thought this was an interesting recap of the recent Delta variant in one country.
https://talkingpointsmemo.com/edblog...-delta-variant
Thanks Paul, balanced article from TPM. Not sure however if a 100-200 cases equates to a super spreader. We like to throw around terms these days. Unfortunately they carry more weight than they used to. Hope we don't panic over the Delta variant and remain somewhat rational this time.Quote:
Originally Posted by paulxu
Thanks. Seems like there is still a lot we don't know about the Delta variant. My perception is that we have been down this road before with "XYZ variant is much worse and will become the dominant strain in the U.S." and it hasn't really materialized in a doom and gloom manner. I hope this is consistent with that.Quote:
Originally Posted by paulxu
So far I have heard that the Delta variant is more contagious and also (possibly significantly) more dangerous than the other circulating varieties, which is obviously not good. It also seems pretty safe to say that the vaccines are still highly effective against it though, which is very good news.
Hopefully we can start getting the rest of the world vaccinated so that we can reduce the opportunities for these variants to incubate and spread.
now the WHO is recommending that even vaccinated people should be wearing masks and essentially going back to the behavior of being unvaccinated. I'm sorry but no, been pretty understanding at this point for about 18 months, but this is enough.
LOL. Go fuck yourselves WHO! I didn't realize how awesome living in Kansas was until Covid hit (mostly because this is the first time it's been awesome relative other places!).Quote:
Originally Posted by Xville
Just a few hours ago I was having lunch at a little sidewalk place and started paying attention to how many people were walking around wearing masks. LOTS of people! I wonder if they think they are protecting themselves or are trying to be a good citizen. I thought of asking some, but thought it might have been taken as insulting. I never understood the people driving around alone wearing a mask. I’m honestly curious what they are thinking!Quote:
Originally Posted by Xville
I’m done with masks based upon the current situation unless I go somewhere that specifically requires it, like taking the dog to the vet. They still insist, so I still wear it. Other than that, I’m done for now and praying that doesn’t change.
To play devil's advocate, I thought the WHO was recommending masks indoors in crowded situations, or indoors with poor ventilation.
I thought this was based on data showing vaccinated people were picking up the variants and were asymptomatic.
So, they could potentially spread it to un-vaccinated people, and by wearing a mask you were helping them if you were vaccinated already.
Probably all wrong about that. Did have to wear a mask in doctor's office this morning.
Call me a cold hearted bastard or selfish or whatever, but at this point, I don’t give a f about unvaccinated people. Sorry but they have had their chance, and if they can’t get vaccinated then I’m sorry but then they are the ones who should be taking the proper precautions. The Who can go f themselvesQuote:
Originally Posted by paulxu
Also at this point, I’ll take the extremely slight risk of getting some variant and dying over having to live the way we have over the past 18 months, that’s not living.
I wish them well, but yes, they had an opportunity to get vaccinated. I’ll take my chances and they can take theirs. I’m just moving forward. Life goes on, until it doesn’t. I’m rolling with it.Quote:
Originally Posted by Xville
Completely agree, live away at this point!Quote:
Originally Posted by Xville
You cold hearted bastard (pun of course).
I agree with this, with the exception that a lot of kids still aren't eligible for the vaccine. If a variant were to circulate that was more harmful to young children than the current crop of COVID varieties that would probably change my calculus. With the current forms' impact on young children it isn't really an issue.Quote:
Originally Posted by xu82
I also feel bad for the immunocompromised and people who can't get the vaccine for medical reasons. That's part of why I want as many healthy people vaccinated as possible so that we can (1) reduce variants and (2) protect vulnerable populations through herd immunity.
I understand that, and you find ways to work around it as the situation currently stands. Maybe the vet’s office has an immunocompromised employee? I don’t know, but they say wear a mask and I put it on without hesitation or complaint. There are no perfect solutions here, we just do the best we can.Quote:
Originally Posted by boozehound
I'll be the first to admit, and put my hand up that I was wrong, I actually had big faith in HCQ when it was being theorized, the mechanism which was proposed (I won't bore you with details) made a lot of sense when speaking with other professionals who took an interest to reading up on the stuff and bouncing ideas off each other. Obviously, I would not have coined it a "miracle drug," nor prescribe it to a bunch of patients with COVID, but I thought if a condition was deteriorated and nothing seemed to be working it was worth a helluva shot. Subsequent studies showed that was very wrong, and Remdesivir and Dexamethasone were the ones that won out.Quote:
Originally Posted by boozehound
I agree with your main point, that there has been some great rallying done by people a shit ton smarter than I will ever, though we had been working on mRNA technology for years, to get those vaccines with the efficacy out in such a rapid time was incredible, and though the long-term effects are unknown currently, I still find it a brilliant feat. There have been people who have worked countless hours, and though the sheer level of people getting sick and dying is never something to celebrate, I do think the people that held their shit together, fought for advocating for patient care, and navigated tough waters through a full blown pandemic is amazing. Pandemics are going to be a part of life, we know from history that one's going to spring up every so often, but being able to follow the advances through modern medicine in a first-person view rather than reading up on history has been a heck of an experience.
Nope, not speaking for me at all there bud, honestly you echo my sentiments. Not to get political, but the handling of the situation was a shit show for a lack of better terms. Obviously in science, our whole thing is "test a hypothesis, analyze results," and we're not going to be right every time, no matter how good the theory sounds *cough* HCQ *cough*, and in a situation where people are getting ill, intubated, dying, etc. that brings on a certain baseline level of fear. When people are scared, they tend to lash out, we got a few things wrong, and that was amplified by different viewpoints, which you could attribute not only politically (and I'm not saying either side was right, might I add) but also from media reports, the internet as mentioned, etc. It seems everyone turned into an epidemiologist, couple that with some mistakes while testing theories and we have a perfect storm causing a rift between opposing viewpoints. It was a chance for healthcare to get a win in showing, "hey look, we're not just pill pushers, we're not insurance companies, we aren't making toxic vaccines on purpose, we're here to help," which ended up turning into what we have today.Quote:
Originally Posted by noteggs
In the end, I hate it wasn't a clean win for healthcare, but I also think on reflection that it couldn't have been avoided. People are entitled to opinions, in an ideal world, we'd sit and listen to people with the knowledge of what's going on, see where their heads at, and form a decision based on that. However, for that to occur, we also as scientists, providers, etc. have to explain what's going on in relatable terms, and be sure to foster an appropriate level of understanding (which I think was also lacking) and it would have to remove the fear equation completely, which is impossible. It's the same as seeing that jaded, burnt out doctor going into a room, spitting a diagnosis and saying "here take this, we're gonna schedule you for a follow up in x amount of days." That patient is frightened, has no idea what the hell happening, and to build a better rapport you sit there and you explain things to their understanding and address concerns. No rapport here was established, different viewpoints pushed different narratives through accessibility of technology these days (I mean come on, all the hot takes on Twitter were nauseating), and what happened is we had a firestorm of people dealing with the psychological pressure of basically being locked-up and having limited information on what was going on. The information that did come out turned into conflicting arguments, and here we are. As healthcare providers, we should 100% be proud of the work that was done to get through these times, but we have to understand the limitations as well.
"So the researchers divided the patients into four age ranges: 20-39, 40-59, 60-79, and over 80. They found that in the two younger groups - including adults up to age 60 - being obese was associated with nearly ALL the risk that Covid would lead to intensive care or death. The findings held even after they adjusted for many different potential confounding factors, like smoking, non-weight-related illnesses, and wealth.
The excess risk was extremely high even for people who weren’t morbidly obese - defined as a body-mass index of 40 or more. A person between 40 and 60 with a BMI of 35 - someone who is 230 pounds and 5’8” - had about five times the risk of dying of Covid of a person of normal weight. For younger adults, the excess risk was even higher, and for morbidly obese people even higher still.
In contrast, people of normal weight under 40 are at essentially no risk of death from Covid. The researchers found their rate to be under 1 in 10,000 per year. Even in the 40 to 59 age range, normal-weight adults had an annual risk well under 1 in 1,000."
https://alexberenson.substack.com/p/...d-is-like-aids
Other studies have also come to the exact same conclusion. Covid is a risk for the old and the obese..... and yet, world leaders and the media wanted you all to think that everyone was at risk. And now they are trying to force young children to take a vaccine they have no use for.
So what you're saying Lou is when Trump got sick and he checked a couple of those boxes it was a helluva lot more serious than he or anyone else let on!!
Who knows??? Does it matter???Quote:
Originally Posted by cutterX
The War on Reality - this article does a great job of summing up the lies, fear mongering and the refusal of authorities and health officials to learn from new data and information as the pandemic progressed. I encourage all of you to read this:
https://www.tabletmag.com/sections/n...ality-gutentag
Not really. He received HCQ and was touting it because it worked for him.Quote:
Originally Posted by cutterX
Maybe he can buy back the 63 million unused doses we pissed away money on.
Or the FDA shouldn’t have wasted them since we know they may have saved lives…Quote:
Originally Posted by bobbiemcgee
CDC, Fauci and Democrats definitely have blood on their hands. No doubt HCQ would've saved lives - especially in the beginning - but they politicized, demonized and opposed it simply b/c Trump mentioned it.Quote:
Originally Posted by Strange Brew
But….you can’t MAKE people get the shots.Quote:
Originally Posted by Strange Brew
There are no real winners here.
And you can’t MAKE them take an “expiremental” drug however giving people the option would’ve saved lives. I’m sure the loved ones of the deceased would feel like winners.Quote:
Originally Posted by xu82
Were people denied those shots? Serious question.Quote:
Originally Posted by Strange Brew
Otherwise, what is your point?
Yes, the FDA revoked its use for COVID in June of last year. What’s your point?Quote:
Originally Posted by xu82
Please don’t make me go back and try to figure this out. Which shots? Of what? Why? I’m pointing at me and thinking I missed something, not being accusatory. When I said “serious question”, I meant it as a serious question.Quote:
Originally Posted by Strange Brew
Are we talking HCQ?
.
Lots of misinformation here, maybe I can try to put a few flames out-
-From my understanding the vast majority of the 63 million doses were donated, so it was not a waste of taxpayer money to pitch them.
-I don’t think they were all wasted as some were allocated for other use (autoimmune conditions etc). They could have expired by now either way…
-HCQ was still used for covid after June 2020, and at a high rate in many areas by various physicians. The FDA revoked EUA but that doesn’t mean it wasn’t used. It just means they didn’t support the use. I saw many people still prescribed this for covid treatment regimens. Medications are written off label every single day. Were people denied HCQ for covid? In Ohio they were for a couple days before the board of pharmacy determined against restricting use to the label. Since then it has been available for use of covid at the discretion of the prescriber, just like pretty much every other non-scheduled medication.
Nothing has had full FDA approval for the treatment or prevention of covid outside of remdesivir. That doesn’t mean that remdesivir is the only medication prescribed for covid.
The regimens for treatment now are fairly effective when implemented in a timely fashion. Monoclonal antibodies on the outpatient side, remdesivir/decadron/supportive treatments on the inpatient side. Over time as immunity continues to increase it will become more difficult to spot cases that should be treated. People that are vaccinated are more hesitant to be tested early, feeling invincible from the vaccine which I totally get. I’ve seen some breakthrough cases in those fully vaccinated but not many, and those cases are about as common as getting covid a 2nd time in the relatively small sample size I have (less than 10 in each population).
Here's a research paper that just came out today actually speaking of what you guys are arguing about: Outcomes of COVID-19 Patients Hospitalized at Acute Care Services
Real-World Experience in the New York Metropolitan Area During the Early Pandemic Before Initiation of Clinical Trials
The mortality was 8.7% higher in the treatment group (15.6% [61/392] versus 6.9% [17/247] of patients in the supportive care group, P < 0.001) (Table (Table2).2). In patients who received HCQ only, L/R only, and both agents, the 28-day mortality rate was 16.4% (54/329), 8.3% (3/36), and 14.8% (4/27), respectively. Hospital length of stay was 7 days (IQR, 4–11 days) among all the patients admitted to acute care services and was significantly longer for patients in the treatment group (4 days [IQR, 3–7 days] vs 8 days [IQR, 6–13 days] in the supportive care group, P < 0.001). Treatment was not protective against progression to severe disease (18.4% vs 3.6% with supportive care, P < 0.001). Delayed time to defervescence, prolonged duration of oxygen requirements, and prolonged hospital and ICU lengths of stay were also more frequent in the treatment group
Obviously some limitations like every study, but the results are interesting.
The key to the success of using HCQ is starting it's use during the early onset of the infection. My understanding is that many of the studies that concluded that HCQ didn't work were mostly given to people late in the game when the drug proved to be ineffective. Given early is when the drug saw success.Quote:
Originally Posted by GIMMFD
NEW - recently published in JAMA:
Study shows mask-wearing children at risk for ‘unacceptable’ CO2 levels, cautions against the practice:
"We measured means (SDs) between 13 120 (384) and 13 910 (374) ppm of carbon dioxide in inhaled air under surgical and filtering facepiece 2 (FFP2) masks, which is higher than what is already deemed unacceptable by the German Federal Environmental Office by a factor of 6. This was a value reached after 3 minutes of measurement. Children under normal conditions in schools wear such masks for a mean of 270 (interquartile range, 120-390) minutes. The Figure shows that the value of the child with the lowest carbon dioxide level was 3-fold greater than the limit of 0.2 % by volume. The youngest children had the highest values, with one 7-year-old child's carbon dioxide level measured at 25 000 ppm. (Emphasis added.)"
https://jamanetwork.com/journals/jam...rticle/2781743
The obvious question is why would there be any difference for adults if the implication of this study is that masks increase carbon dioxide levels across the board?
Who ordered them? FDA under who? They are all garbage now, long since expired.Quote:
Originally Posted by Strange Brew
Per the study: Patients were excluded if they required an intensive care unit (ICU) level of care on admission or at the start of HCQ or L/R therapy (whichever came first), had received HCQ or L/R as home medications for other indications or for COVID-19 within the last 30 days, were enrolled in clinical trials for sarilumab versus placebo or clazakizumab versus placebo, had taken any drug not Food and Drug Administration (FDA) approved for the treatment of COVID-19 (except azithromycin) with the intent to treat COVID-19 within 30 days before admission, received less than 48 hours of HCQ or L/R during admission, or were pregnant.Quote:
Originally Posted by XU_Lou
Our primary endpoint was 28-day mortality from the date of admission and time to death. Our secondary endpoints included progression to severe disease, treatment response, and treatment-related ADE. Progression to severe disease was assessed by the need for ICU admission, development of hypotension requiring vasopressor support, or need for escalation of oxygen supplementation to endotracheal tube or extracorporeal membrane oxygenation. Treatment response was assessed by time to defervescence, time of supplemental oxygen requirement, and length of stay in the ICU and/or hospital. We report the outcomes for the full study cohort, patients receiving HCQ or L/R or both (treatment group), and patients who received supportive care only (supportive care group). We also compared patients who died with survivors to identify potential risk factors for mortality.
Of 935 patients with COVID-19 who were admitted to the hospital during March 2020, a total of 296 were excluded (Fig. (Fig.1).1). Requirement of ICU level of care on admission or at the start of treatment with L/R or HCQ or both was the most common reason for exclusion (153/296; 51.7%). A total of 639 consecutive patients with a confirmed COVID-19 test who were initially admitted to acute care services in March 2020, and either died or were discharged before the cut off day of May 8, 2020, were included in the analysis. The median time to first dose of HCQ from the time of admission was 1 day (IQR, 1–2 days), with a median total inpatient duration of therapy of 5 days (IQR, 4–6 days).
We excluded patients who required ICU level of care on admission or at the start of COVID-19 treatment, making our cohort unique compared with other recently published retrospective studies from the early pandemic in New York Hospitals.
Comparatively, time to initiation of COVID-19 off-label antivirals from symptom onset was shorter in our study, reflecting real word practice before randomized trials, where the need to consent, randomize, and wait for other study logistics before initiation of therapy was not a factor in patient care.
In a randomized, double-blind, placebo-controlled trial of 423 patients with COVID-19, medication ADE occurred in 43% (92/212) of participants receiving HCQ versus 22% (46/211) receiving placebo (P < 0.001).18 Of the HCQ-related ADE, gastrointestinal symptoms were the most commonly reported, with 31% (66/212) reporting upset stomach or nausea, 24% (50/212) reporting abdominal pain, diarrhea, or vomiting, and no patients experiencing cardiotoxicity.
My thoughts: I will say they did admit that treatment groups would be those that are more likely to progress to severe disease, since that is the whole purpose of off-label use and theorized treatments, and there's obviously limitations since nothing is perfect, but if we're going by theory and what was being done in the early stages of the pandemic, I think this study did do well in trying to control as many variables as possible.
[QUOTE=xu82;705841]Please don’t make me go back and try to figure this out. Which shots? Of what? Why? I’m pointing at me and thinking I missed something, not being accusatory. When I said “serious question”, I meant it as a serious question.
Are we talking HCQ?
.[/QUOTE
Yes.
Like Lloyd said, companies like Sanofi, Novartis, Bayer and Mylan (and others) donated 100 millions of doses of HCQ for treating covid across the globe including here in the US. Those companies can manufacture the drug for pennies on the dollar. Also, shelf life for HCQ is 3 years, so not sure how they can be expired already?Quote:
Originally Posted by bobbiemcgee
Also Lloyd is correct in that we reallocated it for other uses. Could be wrong, but I assume many doses went to undeveloped countries who rely on it for treating diseases like malaria. Kinda like what the Biden administration is doing with the unused vaccines. What if HCQ was more effective and we didn’t react to market demand? We would still be hearing how Trump killed thousands.
Listen I hate wasteful spending, but definitely can make exceptions if others countries can save lives. Honestly, this is a strange thing to be concerned about considering we are accumulating 4 billion dollars in interest debt daily.
Shelf life vs. expiry date on the bottle. Isn't efficacy reduced monthly? Some say 7% a month.
I’m sorry Bobbie, but you have lost me. Are you suggesting the drug companies gave us short dated supplies of HCQ? To your last point - totally depends on the drug. Some lose efficacy more quickly and some can maintain integrity for 15 years later than the expiration date. Please update me on what you know about HCQ in this regard.Quote:
Originally Posted by bobbiemcgee
On a barely related note, my wife will go thru our spices (and everything else) and throw out what is “expired”. I was SURE we had crushed red pepper flakes! They won’t kill you, they just won’t be as spicy. AND, if you DO throw it out, put it on the damn list!Quote:
Originally Posted by noteggs
Rant over, thank you for listening. :-)
And happy holiday weekend to everyone!
Meh, not the best study, but was curious about this: Drug expiry debate: the myth and the reality, I'll further dig to find out more.Quote:
Originally Posted by bobbiemcgee
Which brand did you use, if you don’t mind me asking.Quote:
Originally Posted by GIMMFD
I never prescribed it actually, since that was end of medical school, and the hospitals I worked in, or my sister's hospital, I couldn't tell you since it was just given as whatever was in the hospital pharmacy, so most likely the cheapest one. Haha I know that's not very helpful, so I do apologize.Quote:
Originally Posted by xudash