Miscellaneous And Off Topic Subjects

[AlabamAlum]

Yeah, I get it. I am more disappointed in the CDC, though, because Trump gonna Trump. The CDC didn’t even recommended masks until the beginning of April and at the end of March the Surgeon General was saying masks weren’t effective and to not buy them.

[lineygoblue]

I was surprised to see the number of blatant violations by proprietors of businesses, some of whom received citations with big fines for failing to comply after warnings issued. I can see why case numbers are increasing in an environment where lots of young folks are partying and don't give a shit. Does not change how I'm behaving but it's disappointing. There are places I simply won't go and all of them are in the restaurant scene in the Los Olas and Fort Lauderdale beach area. Outside that, there are plenty of places I will go and tend to go there during business hours where things are slow.

And this is the locale where Carnival Cruises expects me to fly into from Michigan, stay overnight in one of their hotels, and buy a couple meals from their local restaurants, before I sail on Carnival Cruise Lines from Port Everglades in February. I had been thinking about 2 months ago that February would be PLENTY of time for any outbreak in Florida to be controlled and contained. Now, I'm not so sure. They may still be in the midst of the battle by then.

So far, our county here in mid-Michigan has only had 3-4 new cases since the end of June. A couple of those were by a couple of knotheads who attended the bar in East Lansing where 157 new cases popped up. We have nobody hospitalized in our local hospital with Covid.

I'm thinking home in February isn't such a bad idea ... even if it will be sub-zero outside....

[Jeff Buchanan]

Liney ..... you can be safe in Fort Lauderdale by taking appropriate precautions. My analysis indicates business non-compliance is waning. The youngsters are getting better but not yet good enough in masking and distancing and today's numbers demonstrate that. But, you have to llok at new case #s in context. "Detection, not infection" is something I'm hearing from some knowledgeable folks on this. We'll see about that.

I had a discussion with the manager of an outdoor restaurant we frequent last week. I asked him about the general mood of other restaurant managers he knows. His response was, a month ago, enforcement was lax and managers, on the brink, were rolling the dice. Lately, the message is getting out and I can see it. Places that are open and barely staying afloat, want to continue doing that. Places who can't make a go at it for any number of reasons, have already closed up shop and plans for reopening at some point are slim.

The problem with cruising is that I don't think the industry is going to be operating until the beginning of the 2nd quarter 2021. PM me if you want to discuss this. I watch it closely.

[Dr. Strangelove]

Florida shatters the old record for a single day’s cases (also held by Florida) by reporting 15,000+ new cases. I believe the national number of Covid hospitalizations is now very close to the March-April peak and almost certain to go well above it.

[*JD*]

May need to keep an eye on Texas. They've reported 20,000 cases in the past two days and today reported 98 deaths, their alltime high by a longshot. But it's also possible some of that is still delayed reporting from the long holiday weekend. Have heard anecdotal stories about testing results starting to take a long time again.

15,300 for Florida today. This is getting crazy.

[*JD*]

Florida shatters the old record for a single day’s cases (also held by Florida) by reporting 15,000+ new cases. I believe the national number of Covid hospitalizations is now very close to the March-April peak and almost certain to go well above it.

I hope this is the "Second wave" that's been talked about for months. If it isn't, that's seriously scary.

Meanwhile, all of Canada had 221 new cases yesterday.

[Dr. Strangelove]

15,300 for Florida today. This is getting crazy.

There were more known cases reported in Florida in one day than South Korea has reported total. And South Korea’s population is way more densely packed and has 30 million more people than the state of Florida. I know we shouldn’t compare across countries but it’s just kind of crazy to think about that.

[*JD*]

Mexico was worse, with 6,891. So, what the fuck is wrong with us?

[CGVT]

Mexico was worse, with 6,891. So, what the fuck is wrong with us?

Shitty national leadership.

[lineygoblue]

Here in Michigan, our numbers went so low, that the state was recognized by the CDC as a state that would likely be among the first to control the Covid outbreak. But then, Gretch allowed the bars to reopen. Now our numbers are sneaking back up.

I know its not a popular thought, but the bar scene seems to be an ideal source of transmission.

And just an update on our local barber who made national news. Karl Manke has still not tested positive for Covid, nor has anyone been infected that can trace their infection back to Karl's shop. I drove by his shop yesterday, and there was only one car in his parking lot. Back to normal ...

[Whitley]

Mexico was worse, with 6,891. So, what the fuck is wrong with us?

1) Unprepared for this despite having warnings that something like this was going to happen

2) Administration that, outside of a few weeks, has consistently downplayed the severity and has politicized even the most basic steps to flatten the curve (ie masks)

3) An awful federal response that lead to a binary choice (money vs. health) for many lower socio-economic classes.

[foxhopper]

I know a bunch of different people who winter in Florida. They all swear they had it back in Jan/Feb before they came back up to Michigan. All stay in retirement type parks. They tell me almost everyone in the parks were sick with the same flu type illness. Just talked to 4 who think they are safe now (even though they haven't been tested) but there are couple that aren't so sure and are thinking of spending the winter here this year.

Just wondering if it could be reinfections happening down there? Or did everyone just have regular flu back then? Probably never know without antibody tests, right?

[Jeff Buchanan]

I know a bunch of different people who winter in Florida. They all swear they had it back in Jan/Feb before they came back up to Michigan. All stay in retirement type parks. They tell me almost everyone in the parks were sick with the same flu type illness. Just talked to 4 who think they are safe now (even though they haven't been tested) but there are couple that aren't so sure and are thinking of spending the winter here this year.

Just wondering if it could be reinfections happening down there? Or did everyone just have regular flu back then? Probably never know without antibody tests, right?

No, it's not "reinfections." It is new infections being discovered by increased testing into a pool of a largely younger (mean age around 35), asymptomatic cohort. We're pushing 6 months time since the virus was first reported in a US citizen. Most experts think the virus was circulating in the US way before that. The thing has had plenty of time to spread and with increased testing, well, no shit, we're finding it! What's the disease burden individually and on the US health care system and down to the local level? It varies but is substantailly less than it was in March/April for a lot of reasons.

Look, here's the problem. Back 2-3 months ago, I thought the data was reliable enough to draw conclusions from it and develop PH policy. It's not. Another issue: It has been widely understood that looking at case numbers in isolation and drawing conclusions about containment v. community spread from that is a useless endeavor. So, PH officials started adding other metrics, e.g., ED visits for ILI or COVID SX, admissions, etc. That helped for a while until it became clear that data being collected in one area couldn't be paralleled with other data to draw conclusions because of reporting processes for all of them vary. e.g., hospital admissions are reported but they are done so in clumps not on a 24h basis. COVID + test data gets reported in clumps that may not reflect the last 24h but may reflect the last 72h of testing, or more or less. Deaths aren't reported as they occur but when the data is released by the local coroner's office, causes of death can be misreported and frequently are with respect to a COVID diagnosis ...... it's crazy.

We have a data reporting crisis and a failure to adequately understand the pandemic in the US. My view is that crisis is causing huge problems in correctly reacting to it. I said last week that I was done trying to take a stance on a position and to justify it with facts. IMO, I can no longer draw reasonable conclusions from the data that is available to me. That I know and understand most of the science wrt SARS-CoV'2 and then see MDs and researchers flail around with markedly different takes, makes me angry. That there is concomitant mixed messaging from our leaders based on who they are listening to or who is talking the loudest is unnerving. We are flying blind for the most part.

[Jeff Buchanan]

This guy is probably on to something here. Whether it changes the paradigm of how we are facing SARS-CoV-2 I don't know. Caveat, his work is based on anecdotal evidence, not peer reviewed and no controlled studies have proven the effectiveness of his recommended drug therapy. Still, it deserves attention in the mire of confusion over the virus and it's impact.

There's been talk of emerging therapeutics such as Remdesivir that lowers the likelihood of death and oral and parenteral (IV) Dexamethasone, an inexpensive steroid used to reduce inflammation. All good.

This Texas MD is using Budesonide a standard of care for asthmatics. It is in the same class as Dexamethasone (a steroid). Nothing to see here, right? Well, there is. First, he treats early at the first positive RT/PCR test, accompanied by symptoms (cough, fever, diarrhea, etc.) or if that patient develops any of them, even mildly, within the days immediately following the positive test.

This is a huge departure from the current standard of care that waits for symptoms to worsen or, in the case of Remdesivir, only used in critically ill patients (some of that as a result of drug availability). Second, he delivers it to his patients via a nebulizer. You may know about these because of a child you are familiar with that has Asthma. Basically, you put a packet of the drug in a table top machine, it puts out a stream of mist and you either use a mask of just hold the stream up to your nose and mouth and breath it in. You administer Budesonide at home. It's not complicated.

He reports that he hasn't had a single patient on his service die. He puts this in the context of Iceland, Taiwan, Japan and Singapore, all these countries with very low death rates, who have treated patients much earlier than we do in the US and EU, obtaining very low death rates with that approach.

OK, who gets this if it were to be done this way on a national scale? Not the "50%" of people who test + and don't develop symptoms. It's the "20%" who do test + and have symptoms of any kind (I have some issues with those quoted figures but they don't detract from his hypothesis). He also stresses, if a patient presents with a + test and symptoms (cough, fever, diarrhea, etc), start them on at-home, nebulized Budesonide right away. He contrasts this approach to the rest of the world who send patient's home to recover then re-appear if symptoms worsen. This delays treatment and assures the symptoms may kill them or at the least make them very ill requiring hospitalization to stabilize vitals. He asserts this asinine approach is exactly what the WHO is recommending and, oh, BTW, it is exactly what the majority of papers coming out of China recommended as a means of keeping hospitals from getting over whelmed. Scary that this recommendation came from China and the WHO has been patting them on the back for it. Keep in mind that I believe while the PRC didn't intentionally release the virus, once it was clear it had been released and was spreading, they optimized their position at the expense of the rest of the democratic world.

Now, there's a bit of politicking going on here. He's clearly an R, thinks pretty highly of himself but still, his approach makes complete sense to me. He has authored a paper and it's going through the review process. He's hawking it because he thinks it has potential to be widely implemented as US standard of care and get the care paradigm in the US off the schnied. To wit, worry less about new case numbers "exploding," keep aggressively testing then treating those that develop symptoms early and stop the hand-wringing over the 10s of thousands who are asymptomatic after testing and remain so. I'm going to be looking for reliable organizations taking hits on this guy. If I find them, I'll post them.

https://www.youtube.com/watch?v=eDSDdwN2Xcg

[Jeff Buchanan]

I'm going to be looking for reliable organizations taking hits on this guy. If I find them, I'll post them.

I found some criticism of Budesonide use. It came from a Medical Director of a large Texas Hospital System. He stated that the video contains only anecdotal, small sample size evidence and that there are no controlled studies of nebulized Budesonide as a treatment for C-19. Medical practice doesn't work that way, he said. Studies on effectiveness and safety are essential before adapting a drug for off-label use. He also points out that the use of steroids in the treatment of C-19 is a serious medical decision that must way risk and benefits and be made in a hospital setting. He stated this is becasue steroids can suppress the immune system when you need a strong immune response to fight C-19.

Of course, he's right about the need for evidence to support a particular therapy but the practice of medicine in the US has frequently been criticized by MDs who practice within it that some very good treatment approaches succumb to this logic. Moreover, inhaled steroids, as opposed to oral and IV steroids (Dexa), are completely safe and impart no short or long term damaging effects to one's immune system. So, black mark right there on this guy practice knowledge.