wuhan - coronavirus

[ElizabethB]

We have a friend who is a nurse in a hospital that sees a lot of Covid-19 patients. He says that they can see a difference with HCQ early and plasma late, and is mad that the news media is not reporting about either. They're not doing studies, they're just using what they see works with all patients that come in. (He's mad at all news, it's not political! He also says he doesn't know why plasma would be political because no one has said anything about it.)

Edited July 25, 2020 by ElizabethB

[Ausmumof3]

I think one part of the reason we don’t have good HCQ studies is because after the lancet study that has been called into question claiming it was a safety risk lots and lots of studies were stopped or put on hold.  Some have recommenced but I suspect that delay is why we haven’t had much recent info.

[Ausmumof3]

284,196 cases worldwide yesterday 

[Ausmumof3]

https://www.nytimes.com/interactive/2020/05/05/us/coronavirus-death-toll-us.html

excess death graph 

I do wish they showed the baseline number they are working off though.

[Ausmumof3]

357 for Vic today close to 4000 active cases now

[Ausmumof3]

                

[Ausmumof3]

Israeli data showing breakdown of where of infections were acquired in the past week 

https://www.haaretz.com/amp/israel-news/.premium-data-shows-where-israelis-contract-the-coronavirus-1.9005504?__twitter_impression=true
 

education institutions, events and places of  Worship came in top.  Beaches and Pools, salons and social gatherings at the bottom.

[Corraleno]

1 hour ago, ElizabethB said:

We have a friend who is a nurse in a hospital that sees a lot of Covid-19 patients. He says that they can see a difference with HCQ early and plasma late, and is mad that the news media is not reporting about either. They're not doing studies, they're just using what they see works with all patients that come in. (He's mad at all news, it's not political! He also says he doesn't know why plasma would be political because no one has said anything about it.)

But how can they "see a difference" if there's no control group — a "difference" ... compared to what? If everyone gets the drug, there is no control group. If they are selecting the healthiest patients to get it, they have no way of knowing whether all those people would have done just as well without it. If they're giving it in conjunction with other treatments, they have no way of knowing which component is significant, and by how much. This is why pharmaceutical trials must be randomized, blind, and placebo-controlled.

The University of Minnesota's large, randomized, double-blind, placebo-controlled study showed no benefit from HCQ. The large, randomized RECOVERY study in UK showed no benefit. Anecdotal accounts from random healthcare workers who want to believe that it helps their patients do not outweigh the evidence of "gold standard" clinical trials.

[Ausmumof3]

https://advances.sciencemag.org/content/early/2020/07/24/sciadv.abc5801.1
 

study showing the mechanism that probably causes loss of smell in COVID.

Must admit I’m too tired to wade through the science language today to make sense of it but thought I’d put it here and hopefully read it later.

[Ausmumof3]

We are going to have a pretty hard border closure with VIC.  South Australians have until Tuesday to get home then they’ll be banned for returning.  I haven’t seen the finer details yet as there always seem to be some exceptions.  We’re also back to limits of 50 in homes and 100 for funerals and weddings.  (25,000 is apparently fine for the football though)

[ElizabethB]

9 minutes ago, Corraleno said:

But how can they "see a difference" if there's no control group — a "difference" ... compared to what? If everyone gets the drug, there is no control group. If they are selecting the healthiest patients to get it, they have no way of knowing whether all those people would have done just as well without it. If they're giving it in conjunction with other treatments, they have no way of knowing which component is significant, and by how much. This is why pharmaceutical trials must be randomized, blind, and placebo-controlled.

The University of Minnesota's large, randomized, double-blind, placebo-controlled study showed no benefit from HCQ. The large, randomized RECOVERY study in UK showed no benefit. Anecdotal accounts from random healthcare workers who want to believe that it helps their patients do not outweigh the evidence of "gold standard" clinical trials.

Difference because they saw a lot of patients when the whole Covid thing started, before there were any treatments, a certain percentage of them died.

Now, he said they only patients they have die are those the are 80+ or a few who are over 60 and have multiple conditions.  So, seeing a lot of patients still but a lot fewer deaths. 

Yes, there should be randomized trials, but if the effect is big enough, doctors and nurses notice.

I haven't seen an early randomized trial of HCQ with zinc.  He says HCQ only helps early, and plasma may help early but it helps late, so they save it for late, they have limited amounts, they try HCQ first.

He feels that it is wrong to withhold treatment with minimal risk waiting for a trial that may never happen. They are not a research hospital, they only see patients.

Edited July 25, 2020 by ElizabethB

[Corraleno]

Apparently the U of MN study also looked at HCQ + zinc and found no additional benefit. This comment was in an article reporting the results of the U of MN study:

"Boulware said there was hope that zinc would boost the effectiveness of the drug, but neither of the U’s first two studies showed any improved benefit for patients who took that supplement."

[Jean in Newcastle]

9 minutes ago, ElizabethB said:

Difference because they saw a lot of patients when the whole Covid thing started, before there were any treatments, a certain percentage of them died.

Now, he said they only patients they have die are those the are 80+ or a few who are over 60 and have multiple conditions.  So, seeing a lot of patients still but a lot fewer deaths. 

Yes, there should be randomized trials, but if the effect is big enough, doctors and nurses notice.

I haven't seen an early randomized trial of HCQ with zinc.  He says HCQ only helps early, and plasma may help early but it helps late, so they save it for late, they have limited amounts, they try HCQ first.

He feels that it is wrong to withhold treatment with minimal risk waiting for a trial that may never happen. They are not a research hospital, they only see patients.

Dh (RN who does deal with COVID19 patients but not in the ICU) says that a big reason why there are fewer deaths is the move away from putting patients on ventilators.  So it's not necessarily simply what meds are being used. 

[ElizabethB]

1 minute ago, Jean in Newcastle said:

Dh (RN who does deal with COVID19 patients but not in the ICU) says that a big reason why there are fewer deaths is the move away from putting patients on ventilators.  So it's not necessarily simply what meds are being used. 

That's possible, too, I'm not sure when they stopped using vents vs. when they started with HCQ, but they only started plasma recently and he said he's seen an additional drop in deaths from late patients with the addition of plasma.

[Corraleno]

5 minutes ago, ElizabethB said:

Difference because they saw a lot of patients when the whole Covid thing started, before there were any treatments, a certain percentage of them died.

Now, he said they only patients they have die are those the are 80+ or a few who are over 60 and have multiple conditions.  So, seeing a lot of patients still but a lot fewer deaths. 

But that is generally true everywhere, whether patients are treated with HCQ or not. Doctors have a much better understanding now of how to manage ARDS (e.g. proning and high-flo nasal cannula instead of ventilators), we now understand that Covid can present in many ways, not just fever and cough, and testing is far more widely available, which means people are getting tested, diagnosed, and treated sooner. It's not valid to compare the survival rates of patients in July to survival rates in March and conclude that HCQ is the one thing that is making the difference when so many other things have changed. 

[ktgrok]

2 hours ago, ElizabethB said:

We have a friend who is a nurse in a hospital that sees a lot of Covid-19 patients. He says that they can see a difference with HCQ early and plasma late, and is mad that the news media is not reporting about either. They're not doing studies, they're just using what they see works with all patients that come in. (He's mad at all news, it's not political! He also says he doesn't know why plasma would be political because no one has said anything about it.)

I've seen tons in the media about plasma treatments. 

 

[Ausmumof3]

https://amp.star-telegram.com/news/coronavirus/article244443257.html?__twitter_impression=true
 

😞 

[ElizabethB]

5 minutes ago, Ktgrok said:

I've seen tons in the media about plasma treatments. 

 

Maybe he quit too soon, I'll let him know! 

It might be more restful for him to not watch, though, he does have a lot going on at work, news is not really restful viewing right now.

[Ausmumof3]

https://www.adelaidenow.com.au/subscribe/news/1/?sourceCode=AAWEB_MRE170_a&dest=https%3A%2F%2Fwww.adelaidenow.com.au%2Flifestyle%2Fsa-weekend%2Fsa-weekend-australian-soldiers-call-for-royal-commission-into-malaria-drugs-scandal%2Fnews-story%2F2806e894e466ee6850ed5e104b5e26b8&memtype=anonymous&mode=premium
 

does anyone know more about this?  I don’t have a tonne of trust in the reliability of this news source so I’m wondering if this is a credible link.  Australia East Timor veterans who were given antimalarial drugs including HCQ claim it causes depression and anxiety etc.  That was only one of the named drugs so I think it’s just being raised due to the Covid thing.  But are there any concerns over psychiatric effects with it?

[chiguirre]

7 hours ago, Pen said:

I certainly don’t think it should be mandatory — so that anyone who feels uncomfortable with it would not take it.

If supplies are limited maybe it should first be offered to HCW, LEO, teachers etc.    especially people who would be at risk from CV19, but not particularly at risk from HCQ.  But I think if it can be an over the counter medicine in Venezuela, it can be in USA too.  I don’t think Americans are hugely more stupid than Venezuelans.   Idk.  Maybe Americans are.

 

 

 

Almost all meds are OTC in Venezuela. The only things that need a prescription are controlled substances (opioids, stimulants, etc.)

Also, malaria has made quite the comeback, so HCQ is needed for its original purpose.

[Ausmumof3]

US - 78,009 cases for the day on worldometer 

[Melissa in Australia]

5 hours ago, Ausmumof3 said:

We are going to have a pretty hard border closure with VIC.  South Australians have until Tuesday to get home then they’ll be banned for returning.  I haven’t seen the finer details yet as there always seem to be some exceptions.  We’re also back to limits of 50 in homes and 100 for funerals and weddings.  (25,000 is apparently fine for the football though)

I really feel for all those tiny border towns that are now struggling. right along the Vic /NSW border and now the Vic /SA border

[cintinative]

https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm?s_cid=mm6930e1_w

In a multistate telephone survey of symptomatic adults who had a positive outpatient test result for SARS-CoV-2 infection, 35% had not returned to their usual state of health when interviewed 2–3 weeks after testing. Among persons aged 18–34 years with no chronic medical conditions, one in five had not returned to their usual state of health.

 

[cintinative]

21 minutes ago, square_25 said:

That actually fewer than I would have thought, given our personal sample, but maybe that sample leans older.

2-3 weeks is also not super long. I’ve had colds last that long. I’d be much more curious about what happens after a few months.

 

I probably should have linked this, but it doesn't share a lot more, other than a reference to a woman who has had symptoms since March, and a "long timers club." My friend's mom is in this "club"--she has been sick since February.  https://www.nbcnews.com/health/health-news/monumental-acknowledgment-cdc-reports-long-term-covid-19-patients-n1234814?fbclid=IwAR0y-iAliTdLS-gYe-b5WIf4kMwtv-8kYNfMoO5qjkqIILeclvEbU2aV_Gs

[TracyP]

36 minutes ago, cintinative said:

https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm?s_cid=mm6930e1_w

In a multistate telephone survey of symptomatic adults who had a positive outpatient test result for SARS-CoV-2 infection, 35% had not returned to their usual state of health when interviewed 2–3 weeks after testing. Among persons aged 18–34 years with no chronic medical conditions, one in five had not returned to their usual state of health.

 

These are far better numbers than I have seen elsewhere. Usually they are following up on hospitalized cases, so I knew the number of long timers was skewed high. I just haven't known how high. So 65% of symptomatic cases had fully recovered in 2-3 weeks, that's so much better than I have been thinking. It does happen to fit my personal sample, but I haven't wanted to give that too much weight.

[TracyP]

Just now, square_25 said:

Yeah, it's still higher than I would like it, but it's actually kind of encouraging. Not that I want to test those percentages in my family... 

Totally agree. I don't ever want to make light of covid, but I have had some pretty bad worst case scenarios in my head over the last 6 mos. I do find this encouraging.

[TracyP]

3 minutes ago, square_25 said:

My personal guess is that there are fewer deaths only because the hospitalized population is very different from the early days of the pandemic -- more spread out, so they take less sick cases. 

Possibly, but I've actually heard the opposite. I heard a NYC doc saying that at the beginning they hospitalized many people who didn't need hospitalization. Basically they didn't know what to do, so if someone had tested positive and felt sick enough to be seen, they were automatically hospitalized. He said they are much better now at targeting the sickest patients. 

[TracyP]

Just now, square_25 said:

I mean, maybe at the very beginning? There were SO MANY cases in NY, I doubt they managed to hospitalize a significant fraction. I know that mid-pandemic, people were reporting being told not to come in unless they were sure they weren't OK. 

Yeah, I don't know how that all balances out. I assumed that was part of his point tho. That if they thought they were sick enough to come in, that was enough to get them hospitalized. They now would be better able to determine who actually needs to be hospitalized.

[TracyP]

1 minute ago, square_25 said:

I would guess this is all really hard to disentangle. That's why I'm sticking to my simple model and watching it, lol. It's so surprisingly predictive that if it keeps working, it really cuts through the noise. 

Heading out for now, but can you explain why the possibility of better outcomes would make a difference to your model? I hope it's not a totally dense question, but I don't see how they're connected.

[Pen]

11 minutes ago, square_25 said:

I would guess this is all really hard to disentangle. That's why I'm sticking to my simple model and watching it, lol. It's so surprisingly predictive that if it keeps working, it really cuts through the noise. 

 

Did you run calculations for earlier (a few months ago) in NY ? 

 

As I have been following since February or whenever (but not specifically NY) case fatality rate has seemed to be decreasing. 

 

[Pen]

1 minute ago, Plum said:

Zoe only asked us about treatment only after a hospital visit. I entered what the hospital prescribed which we haven’t used either the Tylenol or the cough medicine and that’s it. It didn’t ask about supplements. 
 

 

Having prescribed medication versus actually taken seems like a problem for meaningful statistics if that’s common. 

 

1 minute ago, Plum said:

Day 8 and dh’s only symptom is anosmia. The hospital won’t clear him to go back to work until his senses return. 
 

“Our findings indicate that the novel coronavirus changes the sense of smell in patients not by directly infecting neurons but by affecting the function of supporting cells,” said senior study author Sandeep Robert Datta, associate professor of neurobiology in the Blavatnik Institute at HMS.

This implies that in most cases, SARS-CoV-2 infection is unlikely to permanently damage olfactory neural circuits and lead to persistent anosmia, Datta added, a condition that is associated with a variety of mental and social health issues, particularly depression and anxiety.

“I think it’s good news, because once the infection clears, olfactory neurons don’t appear to need to be replaced or rebuilt from scratch,” he said. “But we need more data and a better understanding of the underlying mechanisms to confirm this conclusion.”

A majority of COVID-19 patients experience some level of anosmia, most often temporary. Analyses of electronic health records indicate that COVID-19 patients are 27 times more likely to have smell loss but are only around 2.2 to 2.6 times more likely to have fever, cough or respiratory difficulty, compared to patients without COVID-19.

Some studies have hinted that anosmia in COVID-19 differs from anosmia caused by other viral infections, including by other coronaviruses.

https://www.technologynetworks.com/neuroscience/news/how-covid-19-might-be-causing-smell-loss-337872

 

Perhaps also some role for 

Zinc?

too much, or nasal spray, can cause anosmia, but so can zinc deficiency 

if zinc gets depleted fighting the virus I wonder if that could be an added factor

[Joker]

I’m interested to see what comes of all the studies into loss of taste and smell. I lost mine years ago with the flu and ENT’s were all basically saying it’s more common than people realize and there’s nothing I can do. Maybe something will come from it that will help.

[Pen]

34 minutes ago, square_25 said:

Err, let me check, one sec. 

So, I'd estimate that at the peak, we had 

50*1/10000*20,000,000  = 100,000 

daily cases or so, and at the peak 2 weeks later we had about 1000 deaths a day

 Right now, we have about 

1.1*1/10000*20,000,000  = 2200 

cases per day or so, and about 20 deaths a day. 

I'm seeing about the same IFR around a percent, frankly, if I assume my calculations are right. 

Also, note how GOOD these estimates are. There's a linear relationship. 

 

Shouldn’t it (IFR) change if any treatment at all is any better now than earlier? 

So...   if that’s actually true ...  could we conclude  then  from your statistics that nothing , not dexamethasone or anything else done in NY actually is helping survival? 

 

That does not seem to fit with what people I know in medicine are saying.

 

Word albeit anecdotal is that at certain points for some patients giving HCQ cocktail or at other points steroid cocktail (anticoagulants etc) is making s difference.  (Difference in terms of someone seeming deathly ill feeling and doing much better).

 

I know you tend to go with statistics as most significant and important.

I tend to rate observations in field from people I trust more highly than you do.  

 

 

Edited July 25, 2020 by Pen

[Pen]

3 minutes ago, square_25 said:

I mean, my estimates are obviously not perfect, and the data is noisy. I would guess the IFR is changing from 1 percent to, like, 0.8 percent. But no, I don't think there's been something revolutionary that decreases deaths by a big factor. And to be fair, none of these studies are showing this large an effect. 

The data is all very noisy, but as long as I'm getting a linear relationship with some minor variation, I'm assuming that a lot of the anecdotal reports are confirmation bias. 

 

I will think about that. 

 

[ElizabethB]

There was a country, I'm not sure which, I can look around for the graph if people are interested, that started and stopped HCQ and had a lag of 13 days to more deaths after stopping and then less deaths after starting.

Panama stopped HCQ and death rate went up.  They started HCQ again a few days ago. I think it's worth watching and could tell us something if their deaths go down in about 10 days.

One country could be a coincidence. Two countries and a future prediction is another story, IMO, we'll see what happens.

 

[ElizabethB]

23 minutes ago, ElizabethB said:

There was a country, I'm not sure which, I can look around for the graph if people are interested, that started and stopped HCQ and had a lag of 13 days to more deaths after stopping and then less deaths after starting.

Panama stopped HCQ and death rate went up.  They started HCQ again a few days ago. I think it's worth watching and could tell us something if their deaths go down in about 10 days.

One country could be a coincidence. Two countries and a future prediction is another story, IMO, we'll see what happens.

 

The other country was Switzerland. Here is the graph, and an article about it in Francesoir.

http://www.francesoir.fr/societe-sante/covid-19-hydroxychloroquine-works-irrefutable-proof

[Pen]

 

 

 

PrEP
100%

 

PEP
100%

 

Early
100%

 

Late
60%

 

All
74%

 

  62 studies

Global HCQ studies. PrEP, PEP, and early treatment studies show high effectiveness, while late treatment shows mixed results.

 

 

 

https://c19study.com/

 

 

 

 

https://www.palmerfoundation.com.au/61-studies-37-peer-reviewed-early-treatment-studies-are-very-positive-covid-deaths-621-206/

[Pen]

 

The real reason why not HCQ is  dry likely that needed ingredients apparently come from places like India that have banned exports . 

Though if these types of pandemics are here to stay we should probably start growing chinchona trees - or whatever is needed now — maybe it will help in a few decades. 

Edited July 25, 2020 by Pen

[BeachGal]

A preprint saying that asymptomatic people might not be able to feel the symptoms caused by Covid because the virus is capable of blocking pain signals.

https://www.biorxiv.org/content/10.1101/2020.07.17.209288v1.abstract

Quote

One Sentence Summary SARS-CoV-2’s Spike protein promotes analgesia by interfering with VEGF-A/NRP1 pathway, which may affect disease transmission dynamics.

 

Asymptomatic carriers can still end up with health problems but they're usually mild.

[BeachGal]

Loss of smell (anosmia) can sometimes be reversed by doing daily smelling exercises for a few months of specific aromas. It's called olfactory retraining.

https://www.drgreene.com/qa-articles/smell-training

 

[Pen]

15 minutes ago, BeachGal said:

A preprint saying that asymptomatic people might not be able to feel the symptoms caused by Covid because the virus is capable of blocking pain signals.

https://www.biorxiv.org/content/10.1101/2020.07.17.209288v1.abstract

 

Asymptomatic carriers can still end up with health problems but they're usually mild.

 

Wow. Fascinating! 

[Pen]

1 hour ago, square_25 said:

I looked at his own article that he mentions, and it's unreadably dense. I need charts that show comorbidities in the groups, at the very least. He also mentions "natural experiments" that seem pretty odd to me -- again, I'd just need to know more about this. 

It's entirely possible that HQC works! I would just like to judge the evidence myself. 

 

 

https://c19study.com/

 

 

 

 

https://www.palmerfoundation.com.au/61-studies-37-peer-reviewed-early-treatment-studies-are-very-positive-covid-deaths-621-206/

 

Maybe if you read these you will find what you are looking for.  Or not. 

 

As I read things neither masks nor HCQ are perfect, but both help—help very significantly.  It is a  crying shame that both became political. 

 

[Pen]

34 minutes ago, square_25 said:

No, that doesn't help much, because it's just a list of studies. I'd have to dig into the specifics. Here's a randomly controlled study: 

https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

No positive effect. It's probably been posted already, it's just what I found using Google. 

 

I meant to read all or many of the actual studies- not just the list.  That is what I did!

[Pen]

@square_25 many if not all of the studies in the 

https://c19study.com/  

Are clickable.  

When I click They first bring up an abstract, and often in the abstract I can then link to the original publication to read the full study!!!

[Corraleno]

43 minutes ago, square_25 said:

No, that doesn't help much, because it's just a list of studies. I'd have to dig into the specifics. Here's a randomly controlled study: 

https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

No positive effect. It's probably been posted already, it's just what I found using Google. 

Thank you for linking that, I hadn't seen that one. I find it really curious that not a single randomized, controlled study has been able to show any benefit in either HCQ alone or HCQ+AZ (and the U of MN study also included zinc). If it's so clearly beneficial, why do the benefits disappear as soon as the subjects are randomized? Why have four large, randomized, controlled studies, from three different countries, all returned identical results showing no benefit?

Edited July 25, 2020 by Corraleno

[Pen]

5 minutes ago, square_25 said:

Oh, great!! I'll take a look. 

 

I suggest starting with older ones and working to newer

[Pen]

 

 

https://youtu.be/7GRDVBiSE9U

https://youtu.be/7GRDVBiSE9U

 

drBeen going through a recent publication in Nature.  I highly recommend it!

 

[Melissa in Australia]

459 new cases 10 deaths, ranging from 40s to 80s

Because there are quite a few medical workers either with coronavirus or in quarantine the defence force are going to pair up with paramadics

Also student paramadics are going to be deployed

Also 14000 retired or non active medical workers mostly nurses have put up their hand to take some shifts  particularly in nursing homes as it turns out that many casual workers worked in multiple nursing homes, and that is how it spread between the nursing homes so quickly. 

 

 

Edited July 26, 2020 by Melissa in Australia

[ktgrok]

5 hours ago, Pen said:

 

https://c19study.com/

 

 

 

 

https://www.palmerfoundation.com.au/61-studies-37-peer-reviewed-early-treatment-studies-are-very-positive-covid-deaths-621-206/

 

Maybe if you read these you will find what you are looking for.  Or not. 

 

As I read things neither masks nor HCQ are perfect, but both help—help very significantly.  It is a  crying shame that both became political. 

 

ok, looking at the studies, this doesn't seem that impressive, given that I can't see where they controlled for how sick thy were to start with, etc. 

Results: Out of 26,815 SARS-CoV-2 positive patients, 77 (0.29%) were chronically treated with HCQ, while 1,215 (0.36%) out of 333,489 negative patients were receiving it chronically (P=0.04). After adjustment for age, sex, and chronic treatment with corticosteroids and/or immunosuppressants, the odds ratio of SARS-CoV-2 infection for chronic treatment with HCQ has been 0.51 (0.37-0.70).https://www.palmerfoundation.com.au/chronic-treatment-with-hydroxychloroquine-and-sars-cov-2-infection/

And

The majority of hospitalized patients received hydroxychloroquine (74.6% of survivors and 71.3% of non-survivors) and azithromycin (67.4% of survivors and 71.3% of non-survivors). Fewer hospitalized patients received other medications such as remdesivir, anakinra, tocilizumab, or sarilumab (Table 2). 

https://www.palmerfoundation.com.au/risk-factors-for-mortality-in-patients-with-covid-19-in-new-york-city/

[TravelingChris]

On 7/12/2020 at 3:02 AM, Ausmumof3 said:

https://www.medrxiv.org/content/10.1101/2020.07.02.20145003v1
 

Pre print study claiming that the patterns of tissues infected with Covid versus the tissues suffering most damage in cases where people have died indicates that the biggest killer is immune system overreaction rather than the virus itself.  I’m probably paraphrasing that horribly but that’s what I think it’s saying.  This also explains why steroids that help moderate immune response are helping survival rates.

I think this is why when seeing my rheumatologist this week and she gave me instructions about which medications this week to stop if I have presumed Covid or actually Covid for 2 weeks, she did mention that patients on immunosuppressants like me seem to be doing much better with Covid.  Interestingly, the only medicine I stop for the two weeks are Arava and Cimzia, which is the biologic.  I continue with Hydroxychloriquine and my steroid as usual