Miscellaneous And Off Topic Subjects

[Dr. Strangelove]

Buchanan:terse, The_Wizard: ?

hygienic?

[iam416]

Your use of a question mark puzzles me.

[THE_WIZARD_]

Et tu Talent?

[iam416]

English, motherfucker.

[AlabamAlum]

[Ghengis Jon]

Two paths are what destiny hath
One wide and very well known
One thin and very over grown
With only two I need no math
I choose to take the psycho path

[Dr. Strangelove]

There is unrest in the forest

There is trouble with the trees

For the maples want more sunlight

And the oaks ignore their pleas

[lineygoblue]

Well then, I'm going to start advocating for separate restaurant seating and bar space for over 65s - keep the younger crowd somewhere else.

Wiz, get on it.

I like that idea.

Put the debauchery in another part of the building

[Jeff Buchanan]

If you haven't heard it already today, you will in the next news cycle ......miracle drugs and vaccines are in the works. The battle v. Sars-COV-2 is won. Well, markets think that's the case. Spoiler, it isn't.

There are literally dozens of drugs, therapeutic approaches and vaccines in the pipeline. None of them are going to be scaleable and ready for prime time before, oh, probably 6 months for drug therapies at the earliest and 18-24 for vaccines. Sure, a useable vaccine may emerge sooner that that way out there date but there is so little known about how effective one will be in preventing COVID-19 all-together or even mitigating fatal cases, that hoping for such a thing to protect the work force and get the economy back to pre-COVID activity is a waste of time.

I do think Remdisivir - an antiviral that is being re-purposed from Ebola to Sars-COV-2 - it worked but not well for Ebola - and Convalescent Serum - a therapeutic approach around for centuries - have the most promise, but it is, long term, not right now. Hydroxychloroquin we know about. It's actual effectiveness is truly unknown at this point but it's available, relatively safe at known doses for other diseases (e.g., malaria and lupus) and cheap so, there is that.

Here's my report on the two in the news today:

Remdesivir is an antiviral, IV drug, presently being administered once per day for 10d, that prevents replication of the RNA within Sars-COV-2. It has shown some effectiveness in very limited trials in China and, most recently (the one you are hearing about today), in a trial run by Gilead, the drug's maker, under the compassionate care provisions of the FDA. The problem is that the drug has gotten undeserved hype given that the sample size is small (53 patients) there was no control arm in the designed study and there are a million caveats presented by the authors that conclusions about it's effectiveness simply cannot be drawn. Sure, it looks like it might have promise clinically but scientifically and by established drug trial standards one can't say that it is going to consistently work v. Sars-COV-2.

Convalescent Serum transfuses serum (the yellow stuff left over after all the Red Cells are spun out of it) that contains immunoglobins that supposedly mediate an antibody response. This is tricky stuff. Researchers still don't know exactly how the body's antibodies interact with the virus. There are examples of transfused antibodies making symptoms worse in animal studies suggesting that as the antibody response arises in infected individuals in an attempt to defeat the virus, they actually make the patient sicker. Lots of work to be done on this before we can conclude that this approach will work consistently v. Sars-COV-2.

I want people in this forum to know how to respond to friends that say, these drugs and therapeutic approaches are going to get us out of this and back to normal. That is a false belief at this point. We'll know more in 6 months and better drugs and therapeutic approaches may be available for future spikes in cases. That is good news ...... long term.

But right now, we really have very little to combat or mitigate serious symptoms in the critically ill. MDs are getting better at managing them (e.g. low-flow/low pressure O2 works well and vents are not always needed). It is helpful that only a small, non-negligible portion, of persons infected with Sars-COV-2 will require critical care (looking like overall less than 10% - higher as age over 65 or comorbidities start to play) but when you're talking about 2m - plus cases world wide, that's a lot of folks who sure as hell would like to have a drug or therapeutic approach that might save their lives. On a scalable level, given the scope of this pandemic, we're not even close to that level of reassurance.

[iam416]

While Buchanan is raining down pessimism in torrents of garbled English, some interesting news out of California: https://www.cnbc.com/2020/04/17/sant...ic-spread.html

A Stanford study suggests that the virus may, indeed, be way more prevalent than we thought.

[AlabamAlum]

About a month ago I had a high fever and a dry cough.

[iam416]

Did you just return from New Orleans? Or Wuhan?

[CGVT]

Screenshot 2020-04-17 at 6.13.54 PM.png

[Jeff Buchanan]

While Buchanan is raining down pessimism in torrents of garbled English, some interesting news out of California: https://www.cnbc.com/2020/04/17/sant...ic-spread.html

A Stanford study suggests that the virus may, indeed, be way more prevalent than we thought.

This article deals deal well with questions about the usefulness of the study. To add to that, something I read today addresses these critical question: do infected persons who have recovered have immunity? Can infected persons who have recovered be universal donors of convalescent serum.

The answer to the first question is scientists don't know yet. The second, it depends.

Infected individuals mount different immune responses and this seems to be dependent on the viral load that the infected person receives. There is huge variation in inoculation among those infected - some mount robust immune responses that defeat the virus and probably confer immunity, others mount very little and still recover. Immunity? Maybe but probably not. It's age and health state dependent as well - older or immune-compromised individuals don't mount much of a humoral immune response at all, the virus flourishes and death rates can be high.

That's why not all recovered individuals can provide convalescent serum that will work in the treatment of others. It's believed that the pool of good donors is quite small and can not be expected to treat the large number of critically ill patients today or in the near term. These facts also confer doubt on the likelihood that if you have been exposed you'll now have immunity. Clearly it depends. Another question raised in all of this, how strong, for lack of a better word, does a vaccine need to be to confer immunity without making the person receiving the vaccine sick as hell.

Lot of uncertainty remains; as time goes on things will become clearer and hopefully in a good way.

[iam416]