Miscellaneous And Off Topic Subjects

[iam416]

Can you imagine being that unlucky son of a bitch that's given the all clear and then later dies when it re-emerges? Woof.

[Dr. Strangelove]

Can you imagine being that unlucky son of a bitch that's given the all clear and then later dies when it re-emerges? Woof.

Yeah, and they don't mention if these people had been released from the hospital or left quarantine. Imagine getting an all clear and returning to your family only to start hacking three days later and head back to the ER to find out you never should have been let out.

I don't want to dwell on the media stuff so I won't. But J. D. Vance (Hillbilly Elegy guy) posted a very lengthy thread last night pushing back on what he called four growing contrarian arguments, mostly pushed by other conservatives. He's no more a medical expert than Brit Hume but at least he presented facts and evidence to counter Hume's claims. So much so that I'd have to write a Jeff-length post to even summarize what he said. But the four contrarian claims he was criticizing are:

1) COVID-19 is no more lethal than the ordinary flu and may actually be less lethal
2) COVID has been circulating through the population much earlier than we realize. We already have a herd mentality built up so the shutdowns are largely pointless.
3) The COVID death count is way overstated because anyone who catches it and dies gets counted. Most of those people should be listed as having died of asthma, heart attacks, diabetes, old age, whatever their pre-existing condition was.
4) The cure is worse than the disease. The economic pain we're self-inflicting will, in the end, be worse than just letting the disease run its course.

Quick mention of #2 and #4 because I think those two are at least arguable and legitimate.

#2: Vance provided evidence of limited antibody tests done in other countries (Denmark, Italy) and particularly in Demark there is no evidence of a pre-existing her immunity. They tested 244 random people in central Denmark and none had the antibodies. They tested people in Copenhagen too and found antibodies -- but I believe only in people known to have had the disease. So much as I'd kind of like to believe this one, there seems to be waning hope it's true.

#4: Definitely debatable and not going to say a lot but as Vance points out, Sweden is going with the most laissez-faire response on the planet and the economic forecasts there are still extremely grim. -4% GDP growth. Now that's certainly better than -30% but the idea that the economy can just hum along while a pandemic kills off the elderly and some others is ludicrous. At some point people will choose to self-isolate voluntarily with or without govt instructions.

#1 and #3 are the ones I find irresponsible and borderline offensive for reasons already mentioned. Those two are closely linked. One thing I'd mention that I didn't before is that even if you think the logic of #3 is correct and COVID shouldn't be the listed cause of death for many if not most of the patients, you could say the exact same thing about the ordinary flu or H1N1. I'm willing to bet most of the people who die from the flu any given year are elderly or have an underlying long-term health problem and weren't fit as a fiddle to begin with. Haven't seen any comparable arguments from these people that the flu death numbers are highly overstated.

[iam416]

Well, look, if you get to count #1 and #3 as issues of concern then I get to cite Vox and whatever other 2nd tier news organizations I want to. I've watched and read conservative outlets and the vast majority of them are not pimping "it's just the flu" or, for that matter, the deaths are overstated (I haven't a clue why Hume is pimping that). A few weeks ago the Guardian (I believe) ran a piece on why Italy is so different from Germany. One point in that article was that Germany counts deaths differently (i.e., in the Hume-fashion). Italy counts them like rational people. I don't know if that's the case today or if it ever was the case, but it was out there. It's certainly a point to keep in the back of one's head if one reads GERMANY GREAT! US SUCKS!

I can also post links to NBC trumpeting Chinese stats or CBS laughably tweeting out a video of a nurse how allegedly had to quit because she couldn't take it no more (and Bernie picking it up) -- obviously a fake video, but when you're dead set on the narrative you don't much give a fuck, right?

4) The cure is worse than the disease. The economic pain we're self-inflicting will, in the end, be worse than just letting the disease run its course.

This one is obviously a legimate policy discussion.

And frankly, I think the left narratives about the total unpreparedness and abject failure of US institutions does massive damage to any sort of fair discussion on this absolutely essential point. You rail against Hume (and whoever else with a marginal platform says the same) because it unbalances this discussion. Well, what do you think the other side is doing?

Again, I'm not sitting here whistling past the Britt Hume is nutso or FOX has a narrative graveyard.

[THE_WIZARD_]

Who the fuck is "they"? Damn "they" sure get quoted a lot.

[Ghengis Jon]

Sinai-Grace in Detroit has nurses at the breaking point. The end of the article reports that the hospital has told dayshift nurses to work a 24 hour shift. That seems like the hospital doesn't care about liability. You want an ER nurse tending your life threatening issue when she's had no sleep and been on her feet for 22 hours already? Nurses quite often are super human in their performance, but 24 hour shifts?

https://www.cnn.com/2020/04/07/us/detroit-nurses-sinai-grace-coronavirus/index.html

[Jeff Buchanan]

On COVID-19 and racial disparity. It doesn't take a rocket scientist to figure this out.

Gads of studies .......demonstrate that the prevalence of multiple chronic conditions varies by race/ethnicity. After adjustment for age, sex, and other factors, non-Hispanic blacks have a higher prevalence of multimorbidity than non-Hispanic whites.

In fact, it is double the prevalence (the link makes this conclusion hard to flesh out for blacks because the CDC study differentiates groups by both age and ethnicity). But, duhhhh.

Basically brown people of all ages are way less healthy than white people and that is why they are dying at a higher rate. They utilize health care less due to multiple factors beyond just no having health insurance, are more likely to be obese, have diabetes and cardiopulmonary conditions (astham, COPD)

But Noooooo. This obvious factoid can't be brought up as it destroys the narrative.

https://www.cdc.gov/pcd/issues/2017/16_0241.htm

[THE_WIZARD_]

You...JB...are a racist...

[Jeff Buchanan]

I sent a Chinese research paper done by biomedical engineers in China (and Dr. Oz says "Chinese research is very good" so, I guess it is!) to the group of HCPs talking about COVID-19, minus the political BS. It's clinical; it's about data.

The paper presents a study in which the SARS COV-2 viruis (COVID_19) unwraps the virus in ways that only PhD biochemists and engineers will understand. Still, the conclusions are solid based on the evidence they present. The bottom line being pushed by the authors is that the way COVID-19 kills patients is by attacking the porphyrin ring of Hemoglobin (what makes your blood cells red) and removing it's O2 carrying capacity. It's like, but not the same process, as CO poisoning. Victims of CO poisoning have good cardiopulmonary function; they aren't getting 02 to the tissues of your organs ..... they quit ..... you die.

What's important about this is that the process of dying from COVID-19 has been described in the medical literature as pneumonia progressing to ARDS - intervention with mechanical ventilation to safe the patient - with a > 50% mortality rate (in certain groups) in 2-3w or less. That might turn out to not be treating the underlying cause - hypoxia.

Cholorquin phopshate (Hydroxyhlorquine) is thought to prevent the virus from attacking the prophyrin ring of red blood cells (RBCs) and disabling the O2 carrying capacity of them. How this is done is exquisitely explained in the paper ..... and way above my head but I can follow it. It is thought that the introduction of hydroxychloriqine, however, may not be 100% effective and might vary by patient (explains why there has inconsistent response to the drug).

What the researchers suggest is that it may be effective enough to keep the patient from dying long enough for the humoral immune system to mount a defense and eradicate the virus. It is thought that rather than mechanical ventilation as an intervention, IV packed RBCs (contain a lot of fully functional RBCs) and oral Hydroxychloroquine in combo with IV antivirals (e.g. Remdesivir - there are others) may be a better approach.

The consensus of our group is that it's takes a long time from bringing what happens in research labs to efficacious clinical practice. It's worth noting the Chinese try a lot more shit in clinical practice without good evidence to support such practice than we do in the West. There's very good reasons for this and has marked the differences in the practice of medicine in the West from that of Asia for centuries They are also not good, getting better though, in documenting what happens to the patient when they try something new. So ...... TIFWIW.

[Jeff Buchanan]

HydoxyQ (manufactured by Sanofi pharma among others and also known as Plaquenil) is NOT poison ...... but, the dosing schedule for it carries some significant risks. It is possible that the drug might confer prophylactic benefits. It's all speculative at this point because, even in China, to my knowledge, it was never used for that purpose, i.e., there is not even sound anecdotal evidence to support it's use in that mode. I have heard stories of people I know working in what might be considered high risk for exposure occupations trying to get it from their doctors, who prescribed it, and being denied at pharmacies by state protocols for it's distribution - and probably rightfully so.

Currently, the dosing schedule is for Malaria treatment. Because this has been tested and is generally regarded as safe, this dosing schedule is what I believe is being used. You take a loading dose of 800mg (4, 200mg tabs) and then take a weight based amount of it at 6, 24 and 48h after initial dose. I'm not sure but I think for COVID -19, you continue with the drug using a weight based dose until, I assume, clinical improvement is assured.

Now for the bad news ..... don't read the RX hand-out if you are given this drug. Like the RX hand-out for acetasalacylic acid (aka Aspirin), you gonna DIE.

Seriously though, it has major liver and cardiac side effects that require strict EKG and lab monitoring if you take it. That's why the current approach is to administer this drug only to patient's who have been admitted. If you are prescribed this drug for Malaria prophy, Lupus or Rheumatoid Arthritis as an outpatient, the standard of care requires close follow-up for labs. Your primary care doc is unlikely to give it to you for these conditions preferring referral toan Infectious Disease (D) specialist or a Rheumatologist. A good PCP isn't going to write for this for you if you are complaining of COVID_19 signs and symptoms. I will guarantee you there will be quacks out there who will ...... don't go that route.

For me, I wouldn't take it because I have a long standing, mostly benign, cardiac rhythm disturbance that would be exacerbated by the loading dose of this drug. What is a benign condition now could kill me if I took this drug and I have no intention of doing that, ending up in the ER and having anyone in that place go through the Advanced Cardiac Life Support protocols on me. Most of you here, I assume, have no medical training and you may not know if you have some kind of disease where the drug is contraindicated. Don't go drinking Fish Tank Cleaner that actually does contain this drug ..... among other poisonous ingredients!

[Dr. Strangelove]

Bernie dropping out

[iam416]

Best news in weeks.

[Jeff Buchanan]

Re China is great (or any other country for that matter - fuck them) and the US sucks ....... read this. It is a report by a reporter surreptitiously in contact with friends who are in the heath care field and were on the front lines in China in the early days and continue to work on there. No surprise ..... but still shocking.

Side note: even though I flew aircraft in Vietnam, I never personally witnessed the horrors of combat. I did have a handful of post Desert Storm Desert Shield or Afgan operations folks who would see me for unrelated health care but would wonder if they were suffering from PTSD. I listened but diagnosis and management for that condition isn't in my wheelhouse. They got referred to a psychiatrist. But, the stories were pretty awful. Heart wrenching. This pandemic is, on a vastly larger and world wide scale, going to produce a huge wave of PTSD and depression among HCPs who were on the front lines of this thing. This is just one story:

https://www.marketwatch.com/story/wh...wsviewer_click

[Jeff Buchanan]

I went to Costco in Davie, FL today. It opens at 8am for seniors over 60. Regular customers go in at 9am. It was very well organized with staff outside directing traffic to clean carts and a line to go in. I walked in at right after 8am. There were maybe 25 other shoppers inside as the numbers grew after that. Lots of staff constantly wiping down surfaces. Everyone I saw, patrons and staff, were masked up. Shelves were well stocked. Meat was particularly plentiful as was TP. No sanitizers but I can't recall Costco selling singles of that, maybe multiple cans, huge bottles or packages of that stuff. By the time I left at around 8:45am, the line outside was long. Benefits of being old!

Gas was $166/gallon. I'm seeing it just under 2 bucks locally in FTL. Fuck the gas retailers.

Something I've been watching is the battle going on within OPEC + over P/B. It flirted with $18 but has jumped back up to around $23. Last Sunday, the news was that oil and the markets were going to crash as the price of oil plummeted. Well, it didn't and in fact that was the day the DJI went up something like 1600 points. Things are just weird right now.

The interesting news is that oil prices are stabilizing because there will be production cuts as there ain't no more storage space for what's being pumped or distilled. Funny how somehow, things take care of themselves ..... and fuck the Russians and Saudis since I'm saying that for a lot of countries, among others, today.

[froot loops]

On COVID-19 and racial disparity. It doesn't take a rocket scientist to figure this out.

Gads of studies .......demonstrate that the prevalence of multiple chronic conditions varies by race/ethnicity. After adjustment for age, sex, and other factors, non-Hispanic blacks have a higher prevalence of multimorbidity than non-Hispanic whites.

In fact, it is double the prevalence (the link makes this conclusion hard to flesh out for blacks because the CDC study differentiates groups by both age and ethnicity). But, duhhhh.

Basically brown people of all ages are way less healthy than white people and that is why they are dying at a higher rate. They utilize health care less due to multiple factors beyond just no having health insurance, are more likely to be obese, have diabetes and cardiopulmonary conditions (astham, COPD)

But Noooooo. This obvious factoid can't be brought up as it destroys the narrative.

https://www.cdc.gov/pcd/issues/2017/16_0241.htm

I don't know there might be something to it, but I just know what what my wife has said she had to work on. A lot of fit middle age black men have had a problem with this. Some that wouldn't be identified as someone with underlying conditions. I've not really wanted to bring this up because of stuff like this, "But Noooooo. This obvious factoid can't be brought up as it destroys the narrative."

[iam416]

Men are supposedly more likely to die by a noticeable amount. I'm not sure anyone really cares about that, though. It's more along the lines of, yeah, sure -- they're more likely to smoke -- or eat like shit. Something like that.