Coronavirus (No politics)

#1,951
#1,951
vollygirl said:
My mom was on 11 different kinds of chemo in the six years she fought ovarian cancer, and everytime she got a new prescription for something, we joked about which side effects she would have. Cause she was like a walking ad for side effects. I don't say this to be funny. It was horrible. It is absolutely something you have to be ready for.
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I agree but if you're laying there struggling to breath I believe I would take it like the guy in the link above you did.
 
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#1,952
#1,952
xavierbballfan said:
So that would be what is called anecdotal evidence. Which means it hasn't caused a problem in a limited number of people without comparing it to anyone else. It is great that Hydroxychloroquine may be effective in treating Covid. It's great that the drug has been around previously so we know that patients can tolerate it.

However, just because "they said no side effects listed bother them at all" as if it is a justification that it is safe for everyone is rubbish. Plaquenil would not be what I would call a "safe" medication. It has very real risks albeit in the setting of long term use of macular degradation (see blindness, rarely) for which many patients are routinely monitored by an ophthalmologist with routine special testing. I think the bigger concern acutely would be in patients having the cardiac arrhythmia I previously mentioned and it would probably be prudent to monitor most patients with serial EKGs to watch their QT interval and thereby try to identify higher risk patients and discontinue their therapy if necessary. I fully admit that this is all uncharted territory in many ways but scientific evidence is the foundation of medicine and the only reason we aren't constantly plagued by the legions of infectious disease that our ancestors were forced to accept. If we abandon it now to appease fear, it will not lead to better outcomes.

All that is to say that the practical considerations involved in implementing new treatments are much less straightforward than "Trump says it works and the bureaucrats are in the way." In a case by case basis we are certainly at the point where individual providers and patients can enter into shared decision making regarding whether to utilize the treatment or not. In patients with more severe disease and lower chances of survival it's also likely a reasonable option. I fully support a provider using the medication on that basis and there is no impediment to that at this time that I am aware of. The FDA is not simply signing off on the medication because that adds no value in this situation. The medication can already be used by providers "off label"! But, there is not good evidence behind it and a rubber stamp from the FDA will not change that.

In "normal life" different providers have different requirements for evidence (studies) and guidelines before directing new care for their patients. The FDA is very often far behind on these issues because their job is to primarily assess safety. That does not stop people from utilizing treatments when there is good data (insurance coverage often does, as an aside). Physicians will use their "common sense" as everyone is fond of saying which they will balance between the data available and each individual patient they see. The only reason it's being pushed as "an issue" so heavily in press conferences, in my opinion, is because the administration can set up a scenario where it is ostensibly fighting to get people treatment that science and medicine is "afraid" to provide. Somehow clearing the way for the magic bullet treatment. Meanwhile, they neither discovered the medication nor made it more accessible. All the practical public health benefits that should have been provided (masks, testing) were not done and it's an attempt to rewrite history to put them in a positive light that they frankly do not deserve. Providers can use this already when they deem it appropriate. It is inappropriate to endorse it on a national level tantamount to "a cure" because the data doesn't support it and the risks are unknown. Just like we all want Tennessee to win the NC for the next 10 years, unfortunately, we can't just proclaim it preseason and hoist the trophy. You have to prove it on the field.

To be clear, I believe the medication has promise. However as a cure all that everyone should stockpile, take daily, or utilize for mild cases likely to recover on their own, the benefits begin to be more questionable with the risks. If your 18 year old daughter without co-morbidities is diagnosed with Covid 19 but feeling well and asymptomatic should she get the drug? I would argue that given the extremely limited evidence, no she is not a good candidate.

More specific to Covid, if the very small trial is wrong and it actually does more harm than good then we could potentially be hurting patients by giving them the drug. There has been some postulation that many of the severe cases are related to acute respiratory distress in the setting of a "cytokine storm" which is an autoimmune reaction. If this is the case, will utilizing an antibiotic like Azithromycin (in the same French study with increased efficacy in combination with Hydroxychloroquine) expose the body to more "foreign stuff" when it breaks down bacteria and increase the immune response that is already in overdrive? That's just a hypothesis that could sound good but may be complete garbage. The point is we don't know until we look at studies. I believe and am hopeful that the studies will pan out. Don't put the cart before the horse, though. And please don't disparage the people who are out there in the field trying to make these difficult decisions with real people, not statistics who know the potential burden of a misstep. The people working now are doing it because they care and because they believe in their responsibility. No provider is trying to deny treatments that can be beneficial, there is a burden to temper hope with reason.
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Long term effects would not apply in this case. And I don't think anyone is saying give it to some 19 year old with zero symptoms.
 
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#1,953
#1,953
Orange_Vol1321 said:
Long term effects would not apply in this case. And I don't think anyone is saying give it to some 19 year old with zero symptoms.
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Agreed long term effects don't apply which I tried to allude to and should have been more clear about. I'm just pointing out that it isn't risk free and that there is a spectrum of disease severity for which it would likely be tried first due to real concerns around side effects.

When there is initial hope it is easy to extrapolate. What if there is a different drug that really works and you are using this instead but you never find that treatment or find it later because you focused on Hydroxychloroquine?

For reference "An analysis by the Biotechnology Industry Organization says they (phase II trials with initially positive phase I results, all trials in infectious disease) worked out only 27.5% of the time between 2009 and 2015."

It isn't that it's not worth a shot and it should be used in the setting of shared decision making on an individualized basis. But there is more than a 75% chance (given phase III trials succeed just over 60% of the time) that a successful phase I trial means nothing at all.

I think the point I'm trying to get across is that I hope that it works but it shouldn't make us all feel like the end is in sight.

Why Trump is at odds with his medical experts over Covid-19 drugs - STAT
 
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#1,957
#1,957
kiddiedoc said:
Well, finally got our first test result and it was negative :)

I really hope the turn-around time becomes shorter in the coming days/weeks. Still waiting on one from last Monday...
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It will.

Do you know if your tests went to CDC or private lab like Vandy?

The testing kit failures early and our demonstrated problems with getting testing scaled up has definitely been the most disappointing part of our response to this (I’m ignoring disappointment in people making runs on toilet paper).

South Korea had their first confirmed CV case within a day of the US and their CDC approved their first test within a day of our FDA approval. So same timeline. Yet the stories from there were fundamentally different in ramping up testing.
 
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#1,958
#1,958
kiddiedoc said:
Well, finally got our first test result and it was negative :)

I really hope the turn-around time becomes shorter in the coming days/weeks. Still waiting on one from last Monday...
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Is it lab backup instead of actual processing delays?
 
#1,959
#1,959
TennTradition said:
It will.

Do you know if your tests went to CDC or private lab like Vandy?

The testing kit failures early and our demonstrated problems with getting testing scaled up has definitely been the most disappointing part of our response to this (I’m ignoring disappointment in people making runs on toilet paper).

South Korea had their first confirmed CV case within a day of the US and their CDC approved their first test within a day of our FDA approval. So same timeline. Yet the stories from there were fundamentally different in ramping up testing.
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Those went to Quest. We haven't had any that meet the strict guidelines for the state lab.

Agree completely on the blatant ineptitude of our testing development and application. It's a national embarrassment. I don't even know who to point my finger at...comedy of errors.
 
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#1,965
#1,965
One of things that makes it somewhat hard on people is the amount of chatter about it. Everything from vinegar does/doesn't disinfect this virus, to keep a distance of 3ft (WHO) vs 6ft (CDC).

Got an email from TN Wildlife telling me to go fishing, get some fresh air, take a walk in the state parks that open, get vitamin D.

Then you have nurses posting on Facebook saying stay in your home, take your shoes off before you come in, send one person to the grocery store, wash your clothes as soon as you come inside the house.

It's like one entity is talking about the flu, and the other is talking about The Happening.

Everybody just has to be smart and encourage others to be smart as well. I would like to designate a state for the stupid though, maybe Florida since so many of them wanted to be there last week. And the gators are there.
 
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#1,966
#1,966
Regulator said:
I’m not seeing or hearing anything that can be substantiated, and it’s certainly not the case at my hospital. Our ER visit numbers are actually down over the last week or so, especially amongst our regulars/frequent flyers. It’s almost as if they’re afraid of getting the virus and not coming in for their usual bullish!t.
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I’ve been off for 6 days, but the last day I worked was actually a pretty... dare I say the word.. Ok here goes...slow day. Who knows what It will be like when I walk in tomorrow tho.
 
#1,969
#1,969
kiddiedoc said:
Well, finally got our first test result and it was negative :)

I really hope the turn-around time becomes shorter in the coming days/weeks. Still waiting on one from last Monday...
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My girlfriend had to get tested after a coworker tested positive and she got her results in less than 24 hours. They seem to be making progress.
 
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#1,971
#1,971
My uncle was tested over the weekend after developing symptoms on Friday night. He is in a few high risk categories or otherwise he wouldn’t have been given a test. He was told 5 days.
 
#1,972
#1,972
TennesseeFan07 said:
I thought that's what yesterday was about? And, yes, what is nonessential?
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The governor’s order addressed restaurants, bars, and I think movie theaters.

Non-essential businesses will include much more. But they need to provide guidance - just use NY’s essential list if they need to.
 
#1,973
#1,973
From one of my nephews in Louisiana:

"The governor of Louisiana is implementing a statewide lockdown of all nonessential personnel starting at 5pm today.
Groceries stores, gas stations, and hospitals are the exception.
Restaurants are allowed to do take out only.
Louisiana seems to be a hotspot for covid-19 due to the number of positive tests.
I have a friend that works in the ICU where I live and they are at max capacity right now. They are trying to find more ICU nurses to work. They started implementing 7 on 7 off shifts with $1000 bonuses every week. "
 
#1,974
#1,974
TennesseeFan07 said:
I thought that's what yesterday was about? And, yes, what is nonessential?
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When it begins to list what is actually closed It says the order includes, but is not limited to: "on site activities at hospitality, educational, and entertainment venues, businesses, and facilities are directed to close to the public" which reads pretty vague to me.

Really the only businesses spelled out are, public and private social clubs and "personal appearance" businesses (salons, nail bars, tattoo parlors, etc). I guess the rest are covered by that gray-ish first line.

There's like 3 sections of exceptions, so it will be interesting to see them sort this out.
 
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