Miscellaneous And Off Topic Subjects

[Jeff Buchanan]

In the category of unintended consequences, this story is interesting. Skip the fluff and get to the point. This coffee shop's owner had to close her shop when her baristas made more money receiving the total UIB that they would have made coming to work. They stayed home......her pay was $10-12/h. UIBs fully collected are around $15/h.

Apparently Munchin expressed this concern to Congress but, of course, hey, free money! Lets give it away to get elected.

https://www.npr.org/2020/04/21/838879361/bitter-taste-for-coffee-shop-owner-as-new-600-jobless-benefit-closed-her-busines?utm_medium=RSS&utm_campaign=news

[Hannibal]

Scott Gottlieb was on CNBC again this morning and he questioned why gyms, barber shops, and beauty salons were among the first tier of businesses being reopened. As he argued those are businesses that both A) Involve people being in close contact with each other and in the case of gyms, have lots of heavy breathing and moisture in the air B) Do not make major contributions to the national economy. He felt opening up commercial offices and certain retail would make a bigger difference to the economy.

Gyms I can see but barber and beauty shops aren't as packed and you don't have people doing stuff like sweating all over equipment.

[Jeff Buchanan]

DSL, I don't think one can argue that opening gyms, barbershops, nail and hair salons doesn't have the potential for untoward PH consequences. As Kemp described it, he said that these businesses in GA employ or provide wages to a large number of GA citizens who don't have access to small business loans, credit or cash to sustain them through COVID. His intent is a bottom up rescue plan for the most vulnerable businesses and employees.

From that perspective it makes sense. It does not make sense from a health risk avoidance standpoint. I think he and his people think the economic benefits outweigh the health risks. Guess we'll see whether choices like this will withstand the certain scrutiny they will receive.

[Ghengis Jon]

If I'm any indication, the barbershops and hair salons will be packed. I'm starting to look like Grizzly Adams.

[Hannibal]

At the barber, you have one person circulating through the chair every half hour or so, but at the gym you might have 15 dudes sweating on a bench press over that same half hour and maybe nobody wiping it down in between. You're in close proximity to your barber for a half hour but that's it. IMHO reopening those kinds of shops is a low risk no-brainer.

[iam416]

It'd be pretty easy to wipe down the chair after every haircut and require each new customer to sanitize hands. I agree. Fairly low risk. Gyms don't make a great of sense.

[Dr. Strangelove]

Not an exhaustive study (368 patients) but the VA was keeping track of people it was giving hydroxychloroquine and determined there were no benefits for covid patients.

The chances for remdesivir look a lot more promising

https://apnews.com/a5077c7227b8eb8b0dc23423c0bbe2b2

[Da Geezer]

Ohio school is officially out for the year (physically, at least). No surprise there.

Edit: I mean school year, not calendar year. No answer on this fall yet.

Is there any reason school cannot commence on July 1 (for example) and try to make up for time lost?

[Ghengis Jon]

Its not the haircut, its the standing room only wait with "eased restrictions". Not comparing it to a gym, worse by far.

[Jeff Buchanan]

Just eyeballed the VA study at the link DSL provided and I haven't written enough today.

It has a control arm (no HydroxyQ) and two test groups (HydroxyQ w/wo Azithromyciin). The study was controlled for a bunch of other factors with none of them biasing the results. For a couple of years while I was practicing, I reviewed these kinds of studies for practice application with an eye toward recognizing flaws that might compromise application of the recommendations. This is a good study.

I've said all along that at one point very early in COVID, I took the position, hey, go for it if you have a drug that looks like it works. Subsequently and not much later I changed that position and said, wait, there's a process, use it. This is a perfect example of why the later position is the soundest.

The VA study cast reasonable doubt as to the use of this drug to treat COVID-19. In fact, although it does not stand out because the authors considered the differences insignificant between groups that the drug may contribute to organ damage. HydroxyQ and especially it's cousin Quinalone - the drug that was used in a test in Brazil that got stopped because patients being administered Quinalone were dying from heart failure secondary to arrhythmia - have a side effects profile worse than most drugs. And that's when HCPs are administering them for their intended use (Malaria and Lupus). I had already thought that if I get this thing, I'm not taking HydroxyQ or Quinalone. I would take Remdisivir in a heart beat.

The cat's pretty much out of the bag now. Don't rely on this shit to pull your seriously ill COVID infected patient's out of a death spiral. I'm seeing the best practices emerge that call for:

• Early supportive intervention with 02 at 4L by nasal canula alone or in combo with respiratory services.
• That includes Bi-pap (02 in your standard CPAP device) and maneuvers designed to facilitate removal of secretions from the lungs and improve lung capacity. Simple bed-side stuff.
• Basically rolling the patient on his side, pounding his lungs, coughing up sputum then using a bed-side device to blow into to fully expand and contract your lungs.
• If you can't maintain 02 saturation, use ECMO (extracorporeal membrane oxygenation by bedside machines designed to do that) before turning to intubation and mechanical ventilation.
• Be aware that mechanical ventilation has significant unwanted side effects that are hard for most to recover from.

Simple stuff works. You want to keep the patient from intubation and ventilation if at all possible. Ventilate if you can't sustain O2 saturation levels by the above steps. As these best practices emerged, it became pretty clear why ventilator availability became a non-issue. Still, GM was directed (encouraged because Trump didn't use his war powers) to make vents that probably won't be need.

It also should make most ardent supporters of Trump, well those with an IQ above 100 or so, that nothing he says about this pandemic, including his very wrong statements about HydroxyQ as a "miracle drug" or what's going on in the US on most any public health subjects should be trusted at all ..... and that is a very sad state of affairs.

[lineygoblue]

If I'm any indication, the barbershops and hair salons will be packed. I'm starting to look like Grizzly Adams.

Buy a pair of scissors and a razor, ya cheapskate ...

[Ghengis Jon]

I think I need a weed whip.

[THE_WIZARD_]

I think you need to STFU

[Hannibal]

Find a friend with barber shop clippers. Apply desired guard. Shave head. Profit.

[THE_WIZARD_]

Buy the "Suck Cut"