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18 minutes ago, Ausmumof3 said:

Tricor/fenofibrate could reduce severity of Covid to more like the common cold

https://m.jpost.com/health-science/hebrew-u-scientist-drug-could-eradicate-covid-19-from-lungs-in-days-635028/amp?__twitter_impression=true

I can’t find anything more about this bit will be looking out for the study later in the week when it’s supposed to be released.  

Y'know my pessimist side thinks of the saying, if it seems too good to be true it probably is... My optimistic side, however, thinks that looks very promising. 🤞 If it is already FDA approved hopefully they can move quickly to human trials.

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DS got home 3 hours ago!  ❤️❤️

Update-  my youngest is not only short of breath, coughing, dizzy, nausaues, and with headache-  she is also confused.  I called our doctor and talked with him and she is going to be going to the ER.

Thought I'd post a pic of my dd, getting ready to spend another day in a coronavirus triage tent!  

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@Pen Possible good news? Somewhat like a measles response to antibodies tests?

A recent preprint study published in bioRxiv, suggests that many people who contract SARS-CoV-2 but have mild or no clinical signs still develop so-called T-cell-mediated immunity to the virus, even in the absence of a positive antibody test.
 

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In a University press release, Marcus Buggert, Assistant Professor at the Center for Infectious Medicine, Karolinska Institutet, and one of the paper’s main authors commented, “Advanced analyses have now enabled us to map in detail the T-cell response during and after a COVID-19 infection. Our results indicate that roughly twice as many people have developed T-cell immunity compared with those who we can detect antibodies in.”

The team showed that even in the absence of a detectable antibody response, a robust memory T cell response could be measured in many individuals, akin to the response seen following vaccination against other viral infections.

Professor Danny Altmann, British Society for Immunology spokesperson and Professor of Immunology at Imperial College London, said, “Among the many studies of cellular (T cell) immunity to SARS-CoV-2 that have appeared in the past few months, this is one of the most robust, impressive and thorough in the approaches used. It adds to the growing body of evidence that many people who were antibody-negative actually have a specific immune response as measured in T-cell assays, confirming that antibody testing alone under-estimates immunity.”


Whilst this could be good news for public health, T-cell testing is less straight-forward than antibody detection, and so may be less accessible for mass testing endeavors.


Altmann continued, “The big unknown for the moment is which parameters of immunity offer the most faithful indicator of true, protective immunity from future infection. So far, there is a sense from some studies that functional, virus-neutralizing antibody is one such correlate of protection. We urgently need experimental studies to help confirm whether T-cell immunity alone can give protection.” This sentiment was echoed by Buggert. “Larger and more longitudinal studies must now be done on both T cells and antibodies to understand how long-lasting the immunity is and how these different components of COVID-19 immunity are related”.

 

https://www.technologynetworks.com/immunology/news/sars-cov-2-immunity-likely-to-be-higher-than-antibody-testing-has-shown-336861?fbclid=IwAR2EYDys-aXhe7tLqkc47jLmk_OEyWGrWjI6b1htOH5XSihBVW4awHQuuPA

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6 minutes ago, Plum said:

@Pen Possible good news? Somewhat like a measles response to antibodies tests?

A recent preprint study published in bioRxiv, suggests that many people who contract SARS-CoV-2 but have mild or no clinical signs still develop so-called T-cell-mediated immunity to the virus, even in the absence of a positive antibody test.
 

https://www.technologynetworks.com/immunology/news/sars-cov-2-immunity-likely-to-be-higher-than-antibody-testing-has-shown-336861?fbclid=IwAR2EYDys-aXhe7tLqkc47jLmk_OEyWGrWjI6b1htOH5XSihBVW4awHQuuPA

 

Yes.  Probably very good news!

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40 minutes ago, Ausmumof3 said:

Tricor/fenofibrate could reduce severity of Covid to more like the common cold

https://m.jpost.com/health-science/hebrew-u-scientist-drug-could-eradicate-covid-19-from-lungs-in-days-635028/amp?__twitter_impression=true

I can’t find anything more about this bit will be looking out for the study later in the week when it’s supposed to be released.  

 

Very interesting. 

 

There have been some word of mouth indications that possibly Ketogenic diet is helpful. If this article’s suggestion about the reason that Tricor is helpful is that it helps carbohydrate/ fat metabolism as part of mechanism that might be a positive sign for Ketogenic diet as well. 

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24 minutes ago, TracyP said:

Y'know my pessimist side thinks of the saying, if it seems too good to be true it probably is... My optimistic side, however, thinks that looks very promising. 🤞 If it is already FDA approved hopefully they can move quickly to human trials.

So from skimming through the paper it’s only being done at cellular level yet so might be a way off but agreed hopefully they can get on with human trials given the safety side is taken care of.  

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3 minutes ago, Pen said:

 

Very interesting. 

 

There have been some word of mouth indications that possibly Ketogenic diet is helpful. If this article’s suggestion about the reason that Tricor is helpful is that it helps carbohydrate/ fat metabolism as part of mechanism that might be a positive sign for Ketogenic diet as well. 

I must admit the last couple of weeks this virus has been motivating me to up the exercise levels to an hour a day.  

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6 minutes ago, Ausmumof3 said:

I must admit the last couple of weeks this virus has been motivating me to up the exercise levels to an hour a day.  

 

I wish I could say the same. This virus has been motivating me to do nothing but drink more chardonnay. 😪

Can you tell I am nearing my end of term (in nursing school) and am a wee bit stressed? (Term 3 ends July 31st and I am trying to get all my papers and clinical hours in on time.)

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3 minutes ago, SeaConquest said:

 

I wish I could say the same. This virus has been motivating me to do nothing but drink more chardonnay. 😪

Can you tell I am nearing my end of term (in nursing school) and am a wee bit stressed? (Term 3 ends July 31st and I am trying to get all my papers and clinical hours in on time.)

Well we are all in the lucky position here of opening up almost back to normal.  Closely watching the situation over the border and prepared to change but seeing people has done wonders for my motivation levels even as a crazy level introvert.  I really feel for those who are still in lockdown or going back into lockdown for the second time.  I suspect still that at some point our time is coming but having a breather has been nice.

good luck with your papers and hours and good on you for doing what you’re doing!

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6 hours ago, square_25 said:

Right, the lack of rapid testing means people can't make good decisions :-/;. 

I haven’t heard that any are really sick, but haven’t heard any details other than they are positive and it seemed that bars were implicated in the spread.

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https://wwwnc.cdc.gov/eid/article/26/9/20-1806_article
 

Collectively, these preliminary data suggest that SARS-CoV-2 is resilient in aerosol form and agree with conclusions reached in earlier studies of aerosol fitness (6). A clear limitation of the aerosol stability data is that we report only 1 measurement of the 16-h time point; future studies need to repeat these findings before any definitive conclusions are reached. Aerosol transmission of SARS-CoV-2 may be a more important exposure transmission pathway than previously considered (7). Our approach of quantitative measurement of infectivity of viral airborne efficiency augmented by assessment of virion morphology suggests that SARS-CoV-2 may be viable as an airborne pathogen. Humans produce aerosols continuously through normal respiration (8). Aerosol production increases during respiratory illnesses (9,10) and during louder-than-normal oration (11). A fraction of naturally generated aerosols falls within the size distribution used in our experimental studies (<5 μm), which leads us to conclude that SARS-CoV-2–infected persons may produce viral bioaerosols that remain infectious for long periods after production through human shedding and airborne transport. Accordingly, our study results provide a preliminary basis for broader recognition of the unique aerobiology of SARS-CoV-2, which might lead to tractable solutions and prevention interventions. 

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23 minutes ago, Ausmumof3 said:

https://wwwnc.cdc.gov/eid/article/26/9/20-1806_article
 

Collectively, these preliminary data suggest that SARS-CoV-2 is resilient in aerosol form and agree with conclusions reached in earlier studies of aerosol fitness (6). A clear limitation of the aerosol stability data is that we report only 1 measurement of the 16-h time point; future studies need to repeat these findings before any definitive conclusions are reached. Aerosol transmission of SARS-CoV-2 may be a more important exposure transmission pathway than previously considered (7). Our approach of quantitative measurement of infectivity of viral airborne efficiency augmented by assessment of virion morphology suggests that SARS-CoV-2 may be viable as an airborne pathogen. Humans produce aerosols continuously through normal respiration (8). Aerosol production increases during respiratory illnesses (9,10) and during louder-than-normal oration (11). A fraction of naturally generated aerosols falls within the size distribution used in our experimental studies (<5 μm), which leads us to conclude that SARS-CoV-2–infected persons may produce viral bioaerosols that remain infectious for long periods after production through human shedding and airborne transport. Accordingly, our study results provide a preliminary basis for broader recognition of the unique aerobiology of SARS-CoV-2, which might lead to tractable solutions and prevention interventions. 

 

 

CDC seems to be slow on figuring this out. 

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3 hours ago, Ausmumof3 said:

Tricor/fenofibrate could reduce severity of Covid to more like the common cold

https://m.jpost.com/health-science/hebrew-u-scientist-drug-could-eradicate-covid-19-from-lungs-in-days-635028/amp?__twitter_impression=true

I can’t find anything more about this bit will be looking out for the study later in the week when it’s supposed to be released.  

I'm wondering how this impacts the clotting issues and the organ damage?  Does it help with that?

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Just now, Terabith said:

I'm wondering how this impacts the clotting issues and the organ damage?  Does it help with that?

I believe yes but obviously will be hard to know without trials in people.

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7 minutes ago, Terabith said:

I'm wondering how this impacts the clotting issues and the organ damage?  Does it help with that?

Requoting to add - I think it relates to the problems the virus causes for the epithelial cells and they are linked to the clotting issues.   However I am way out of my depth here.

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14 minutes ago, Pen said:

 

I haven’t listened to it yet, but DrBeen has a YouTube video addressing statins and Covid. Since Tricor is a statin, maybe it will apply .  He usually explains likely mechanisms of action. 

Thanks!  I am still sucking at making time to watch the videos because I can read so much faster.  But will look for it tonight 

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https://9now.nine.com.au/a-current-affair/coronavirus-sydney-lockdown-nsw-premier-gladys-berejiklian-says-state-will-not-shut-down-despite-covid19-spike/3a529577-a8c6-4c60-a200-cfbfb4fdaa2c
 

nsw won’t go into lockdown again 😬

premier is citing the lack of slowdown in Melbourne’s numbers as justification!!! They locked down five days ago.  Not long enough to see full impact anyway and they appear to have stopped increasing.  

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The Age - Melbourne ☹️ Five healthcare workers at Royal Children's Hospital test positive to COVID-19 in outbreak that may be linked to sushi outlet at the hospital's food court
 

 

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4 hours ago, Ausmumof3 said:

https://www.nytimes.com/2020/07/14/us/politics/trump-cdc-coronavirus.html
 

I know ny times can be a bit political but anyone got a different perspective on this. Looks like Covid Data won’t be going to the CDC?  Happy to delete if it’s too political for this thread.

I can't read the article, but this was written by someone at the NY Times. https://www.bariweiss.com/resignation-letter?fbclid=IwAR1frDrnCieISDLiQGbmJrs2H33wEtk-M6EHn0QRVV3CCXb4dalIgq1sxOs

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10 minutes ago, Meriwether said:

I can't read the article, but this was written by someone at the NY Times. https://www.bariweiss.com/resignation-letter?fbclid=IwAR1frDrnCieISDLiQGbmJrs2H33wEtk-M6EHn0QRVV3CCXb4dalIgq1sxOs

I’m aware of the issues people here have with the times as a source I just wondered if anyone knew anything about the specific issue in the article.

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18 minutes ago, Meriwether said:

I can't read the article, but this was written by someone at the NY Times. https://www.bariweiss.com/resignation-letter?fbclid=IwAR1frDrnCieISDLiQGbmJrs2H33wEtk-M6EHn0QRVV3CCXb4dalIgq1sxOs

Gently, and trying to not get too political -- What does the resignation of one opinion editor have to do with factual reporting? Too many people nowadays can't (or choose not to) distinguish between an outlet's editorial pages and their news reporting.

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1 minute ago, Ausmumof3 said:

I’m aware of the issues people here have with the times as a source I just wondered if anyone knew anything about the specific issue in the article.

I haven't heard anything outside this article which clearly paints this new data collection attempt as a bad thing. My thoughts... The U.S. needs a better data collection system. This seems to fill this need. The article talks about politicization and transparency being issues. Pffft, as if those aren't already issues within the CDC. So for now, I think this is a positive step.

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8 minutes ago, square_25 said:

The article is about the CDC not getting COVID data, and what you linked has nothing to do with that.

I don’t think the NYT is particularly political. Too elitist and uniform, yes. 

If you don't believe it is too political, it is probably because you agree with the politics. What I linked (how nicely euphemistic) spoke only to the lead in of the post. I had just read the resignation letter and found it interesting. To be clear, I don't care if people love and read the Times. It isn't the farthest left news source, but it does have a definite bias.

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16 minutes ago, TracyP said:

I haven't heard anything outside this article which clearly paints this new data collection attempt as a bad thing. My thoughts... The U.S. needs a better data collection system. This seems to fill this need. The article talks about politicization and transparency being issues. Pffft, as if those aren't already issues within the CDC. So for now, I think this is a positive step.

I think a central data source that’s reliable is a positive step.  I am seeing a number of doctors/epidemiology peeps sharing the story now so I think they are seeing some cause for concern.  I think the issue is the New database won’t be available to the public like CDC data. There are allegations about figures being fudged (from both sides of the political spectrum) so transparency seems kind of critical at this point.  However I don’t really know the difference between the functions of say the CDC versus whatever the other group was.  So I’m wondering if concerns are valid . I still don’t know what to make of the Florida lady.

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I'm hoping the switch to providing the data to the White House and prividing it to the CDC doesn't mean it won't still be published on states' dashboards. A lot of independent tracking rely on the state dashboards for information. (I didn't read the article.)

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https://www.nature.com/articles/s41467-020-17436-6
 

“We report a proven case of transplacental transmission of SARS-CoV-2 from a pregnant woman affected by COVID-19 during late pregnancy to her offspring. Other cases of potential perinatal transmission have recently been described, but presented several unaddressed issues. For instance, some failed to detect SARS-CoV-2 in neonates or only reported the presence of specific antibodies1,2,4; others found the virus in the newborn samples but the transmission route was not clear as placenta, amniotic fluid and maternal or newborn blood were not systematically tested in every mother-infant pair3,5,6,11,12.”

well crap

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46 minutes ago, Meriwether said:

If you don't believe it is too political, it is probably because you agree with the politics. What I linked (how nicely euphemistic) spoke only to the lead in of the post. I had just read the resignation letter and found it interesting. To be clear, I don't care if people love and read the Times. It isn't the farthest left news source, but it does have a definite bias.

All good ... I like to know the bias of my sources but I still read them all.  That’s why I was wondering if anyone had more perspective.  I usually check the media fact bias page if I don’t know the source.  However I was really hoping we could talk about the contents.

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36 minutes ago, Ausmumof3 said:

I think a central data source that’s reliable is a positive step.  I am seeing a number of doctors/epidemiology peeps sharing the story now so I think they are seeing some cause for concern.  I think the issue is the New database won’t be available to the public like CDC data. There are allegations about figures being fudged (from both sides of the political spectrum) so transparency seems kind of critical at this point.  However I don’t really know the difference between the functions of say the CDC versus whatever the other group was.  So I’m wondering if concerns are valid . I still don’t know what to make of the Florida lady.

I don't think anybody knows yet whether they will be transparent with the numbers. If they are not, that will be very concerning. (Although, since states are still putting out their own data, I don't know how much they could hide.) As usual in the partisan world we live in, a large segment of people will say this is a negative with no other information than it is coming from the Trump administration. And believe me plenty did the same to Obama so this is not a political statement. I find it all sickening. I will reserve judgment for now. We need a better data collection system. I'm hoping this is it. 

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Does anybody want to talk about declining mortality rates around covid? I brought this up a couple weeks ago because it appears from my state's data that outcomes are improving. Since then I have heard a NYC doctor (on TWiV) say that outcomes are vastly improved. He said that 65% of people on vents would end in death in March. Now most people never get put on vents and when they do 29% die. This seems like such positive news, I'm wondering why nobody is talking about it. Here is an article I found detailing the difference Oregon hospitals are seeing.

https://www.oregonlive.com/health/2020/07/covid-19-survival-rate-improves-significantly-at-local-hospitals.html

Of the 900 patients hospitalized in all Providence facilities in March, 20% died. Of the 1,200 hospitalized in May, 14% died, Robicsek said.

Oregon Health & Science University showed even steeper declines. The mortality rate fell from 23% in March when six of the hospital’s 26 COVID-19 patients died to 3% in May (one of 37) and 4% in June (two of 52).

At Legacy Health, the mortality rate was 40% in March, when 12 of the hospital’s 30 patients died. By May, the rate had declined to 13% when five of 37 patients died.

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1 hour ago, square_25 said:

The article is about the CDC not getting COVID data, and what you linked has nothing to do with that.

I don’t think the NYT is particularly political. Too elitist and uniform, yes. 

I think it is relevant when reading an article in the NYT to have that information. The NYT is considered political by many people. I myself am sick and tired of the left and the right spinning absolutely everything to meet their agenda. Now, I’m not sure about the article about the data linked above. It seemed fairly balanced as it seemed to include both sides of the argument about the reason for the change in reporting, but I definitely take just about every news source these days with a huge pinch of salt.

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12 minutes ago, TracyP said:

Does anybody want to talk about declining mortality rates around covid? I brought this up a couple weeks ago because it appears from my state's data that outcomes are improving. Since then I have heard a NYC doctor (on TWiV) say that outcomes are vastly improved. He said that 65% of people on vents would end in death in March. Now most people never get put on vents and when they do 29% die. This seems like such positive news, I'm wondering why nobody is talking about it. Here is an article I found detailing the difference Oregon hospitals are seeing.

https://www.oregonlive.com/health/2020/07/covid-19-survival-rate-improves-significantly-at-local-hospitals.html

Of the 900 patients hospitalized in all Providence facilities in March, 20% died. Of the 1,200 hospitalized in May, 14% died, Robicsek said.

Oregon Health & Science University showed even steeper declines. The mortality rate fell from 23% in March when six of the hospital’s 26 COVID-19 patients died to 3% in May (one of 37) and 4% in June (two of 52).

At Legacy Health, the mortality rate was 40% in March, when 12 of the hospital’s 30 patients died. By May, the rate had declined to 13% when five of 37 patients died.

That does seem like good news.  The cmo here said they expect around 15pc of those in ICU to die which seemed much more positive than the earlier statistics.  It’s also why it makes sense to me to slow this down as much as possible so we can develop better treatments even if a vaccine is a long way away.

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10 minutes ago, TracyP said:

Does anybody want to talk about declining mortality rates around covid? I brought this up a couple weeks ago because it appears from my state's data that outcomes are improving. Since then I have heard a NYC doctor (on TWiV) say that outcomes are vastly improved. He said that 65% of people on vents would end in death in March. Now most people never get put on vents and when they do 29% die. This seems like such positive news, I'm wondering why nobody is talking about it. Here is an article I found detailing the difference Oregon hospitals are seeing.

https://www.oregonlive.com/health/2020/07/covid-19-survival-rate-improves-significantly-at-local-hospitals.html

Of the 900 patients hospitalized in all Providence facilities in March, 20% died. Of the 1,200 hospitalized in May, 14% died, Robicsek said.

Oregon Health & Science University showed even steeper declines. The mortality rate fell from 23% in March when six of the hospital’s 26 COVID-19 patients died to 3% in May (one of 37) and 4% in June (two of 52).

At Legacy Health, the mortality rate was 40% in March, when 12 of the hospital’s 30 patients died. By May, the rate had declined to 13% when five of 37 patients died.

I'm hoping that this means they've started to have better treatments and area starting to have a better grip on the disease and how it progresses and which treatments have better results.

It could also be that the first outbreaks were more in nursing homes and the average ages of the patients were higher - mortality is so much higher in older people.

But I think all bets are off if we get hospital overwhelm again.  If ICUs are full and they have to start triaging people as to who even gets treated at all, or there are shortages of not just beds but equipment, drugs, and staff, like is starting to happen in the states that are spiking again, then mortality rates are going to climb much higher again.  

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1 minute ago, Ausmumof3 said:

That does seem like good news.  The cmo here said they expect around 15pc of those in ICU to die which seemed much more positive than the earlier statistics.  It’s also why it makes sense to me to slow this down as much as possible so we can develop better treatments even if a vaccine is a long way away.

That sounds very close to Oregon's numbers, and definitely much lower than earlier. I agree - very good argument for keeping this slow and hopefully continuing to see better outcomes!

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3 minutes ago, square_25 said:

What I would really like to know is whether it’s the same population being hospitalized or not. If this is simply a result of less sick patients having access to hospitals, then it’s not news. If it’s the result of actually improving treatments, then that’s a good thing.

The NYC doctor said it is directly related to better treatments. He went very specifically into what they are doing now and how it is changing outcomes. Let me know if you are interested and I'll try to summarize what I remember.

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2 minutes ago, square_25 said:

I’m definitely interested :-). But how would he know if it’s the same population, though?

Ok, it'll take me a little time. I'm typing on phone...

The population could be making a difference. That is what I wondered with the MN numbers. But I don't think Oregon ever had a significant nursing home problem. The NYC doc deals solely with covid patients, you think he'd know if there was a huge difference in the population.

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7 minutes ago, TracyP said:

The NYC doctor said it is directly related to better treatments. He went very specifically into what they are doing now and how it is changing outcomes. Let me know if you are interested and I'll try to summarize what I remember.

It makes perfect sense I think, that once we got our feet under us and learned more that mortality would go down. I think the big problem to continuing to do well now is testing. If we can’t test people and know who to quarantine etc. we’ll continue to lose control. At first the testing was appalling, but then we all stayed home so it didn’t matter quite so much that we didn’t know who was sick. Now we’re all trying to go about our lives not knowing who should stay home.

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7 minutes ago, square_25 said:

It does make sense, but on the other hand, I don't see why we then don't have positive studies of any of the treatments except remdesivir, which didn't have a huge effect. It's possible it's just lag, but it does make me wonder if catching more cases is making us more complacent. 

There is a study showing good outcomes for the dexamethazone (?sp) from Uk unless it’s been retracted.

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8 hours ago, square_25 said:

I’m definitely interested :-). But how would he know if it’s the same population, though?

OMG I was almost done and lost my post!! !#*%&@*

First off this is NY specific. He is hoping other hospitals hear this, but he says hospitals can be slow to change.

Understanding the disease progression is key. WEEK 1: typically mild symptoms; WEEK 2: most recover but this is where severe respiratory symptoms show up in some; WEEK 3: risk of blood clots becomes significant in those who haven't recovered

This is important because the treatment you get is dependent on where you are in the progression. WEEK 1: self care at home, a certain number of people should be on an anticoagulant at this stage but they haven't pinpointed who (personally I wonder if adults would benefit from a low dose aspirin at this point?); WEEK 2: most recover but those that don't should have a pulse ox to watch for numbers under 90, those that are hospitalized should start a blood thinner and dexamethasone (or an equivalent steroid); WEEK 3: patients at home should continue as before, those that are still hospitalized should be startes on tossilites (ok, I'm sure I have that wrong and will try to edit. I'm not risking leaving this page...) 

This is combined with what we know about proning and using low flow oxygen which has also improved outcomes. They also said that antibiotics were being used inappropriately at first. They were actually causing more problems so they should be an absolute last resort even if blood work indicates a bacterial infection. Whew, I think I covered most of it...

ETA: to the "tossilites" I can't find anything that fits the word I recall. I got the impression that it was a family of drugs, not a specific drug. He said there was "low quality evidence" that they improved the most severe cases. He defined low quality evidence as anecdotal evidence that he and his colleagues were seeing, he emphasized that studies would need to be run to verify their effectiveness. Dang, I wish I could remember the name.

ETA 2: I believe the drug is tocilizumab. Thanks @Pen

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twitter thread on Sweden.  I wouldn’t say it’s unbiased but interesting to read the different stages and explanation for the increasing case/declining death scenario.  Comments are interesting for balance as well.

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9 minutes ago, square_25 said:

It does make sense, but on the other hand, I don't see why we then don't have positive studies of any of the treatments except remdesivir, which didn't have a huge effect. It's possible it's just lag, but it does make me wonder if catching more cases is making us more complacent. 

It may be that some of the early mortality was because of things we did badly that we then stopped, rather than the fact that we have found things that really work and that’s why mortality may be lower now. I think it’s too early to make any real judgment because of the lag. In the early days there was so much anecdotal stuff coming from the hard hit areas that policies changed daily or even more often, and people were nervous about applying previous knowledge of other disease processes in case it was the wrong thing to do.

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3 minutes ago, Ausmumof3 said:

There is a study showing good outcomes for the dexamethazone (?sp) from Uk unless it’s been retracted.

He said this had made huge improvements. It should be given for anybody severe enough to be hospitalized. If dexamethasone is unavailable, he listed 2 other steroids and the dosage that should be given. 

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52 minutes ago, TracyP said:

He said this had made huge improvements. It should be given for anybody severe enough to be hospitalized. If dexamethasone is unavailable, he listed 2 other steroids and the dosage that should be given. 

We are using dexamethasone on hospitalized patients and Remdesivir on some.

 

ETA - only a very few patients here though so far

Edited by TCB
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10 hours ago, Pen said:

 

I haven’t listened to it yet, but DrBeen has a YouTube video addressing statins and Covid. Since Tricor is a statin, maybe it will apply .  He usually explains likely mechanisms of action. 

 

Just to clarify, Tricor/Fenofibrate is a fibric acid, which is not a statin. They are both used to lower cholesterol and triglycerides, but they have a different mechanism of action in the body. 

ETA: Here is a good cheatsheet:

https://step1.medbullets.com/cardiovascular/108073/lipid-lowering-drugs

Edited by SeaConquest
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25 minutes ago, square_25 said:

How big is the effect size, do you know? Is it randomized? 

It was randomized. 

Now, preliminary results from the RECOVERY trial conducted in the United Kingdom are showing that the agent reduced mortality by approximately one-third in patients with COVID-19 who were on ventilators (rate ratio [RR] 0.65; 95% CI, 0.48-0.88; P = .0003).2 Moreover, for other patients who received oxygen only, dexamethasone reduced deaths by one-fifth (RR 0.80; 95% CI, 0.67-0.96; P = .0021).

Link to the preprint

https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1

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4 hours ago, TracyP said:

OMG I was almost done and lost my post!! !#*%&@*

First off this is NY specific. He is hoping other hospitals hear this, but he says hospitals can be slow to change.

Understanding the disease progression is key. WEEK 1: typically mild symptoms; WEEK 2: most recover but this is where severe respiratory symptoms show up in some; WEEK 3: risk of blood clots becomes significant in those who haven't recovered

This is important because the treatment you get is dependent on where you are in the progression. WEEK 1: self care at home, a certain number of people should be on an anticoagulant at this stage but they haven't pinpointed who (personally I wonder if adults would benefit from a low dose aspirin at this point?); WEEK 2: most recover but those that don't should have a pulse ox to watch for numbers under 90, those that are hospitalized should start a blood thinner and dexamethasone (or an equivalent steroid); WEEK 3: patients at home should continue as before, those that are still hospitalized should be startes on tossilites (ok, I'm sure I have that wrong and will try to edit. I'm not risking leaving this page...) 

This is combined with what we know about proning and using low flow oxygen which has also improved outcomes. They also said that antibiotics were being used inappropriately at first. They were actually causing more problems so they should be an absolute last resort even if blood work indicates a bacterial infection. Whew, I think I covered most of it...

ETA: to the "tossilites" I can't find anything that fits the word I recall. I got the impression that it was a family of drugs, not a specific drug. He said there was "low quality evidence" that they improved the most severe cases. He defined low quality evidence as anecdotal evidence that he and his colleagues were seeing, he emphasized that studies would need to be run to verify their effectiveness. Dang, I wish I could remember the name.

 

Is the MD Daniel Griffin? Do you recall which episode of TWiV where he was discussing treatments? He’s recently mentioned the convalescents being somewhat helpful (convalescent plasma used to passively transfer antibodies).

ETA TriCor (fenofibrate) falls under the fibrates group of drugs but I don’t think they are being used to treat Covid patients. The Hebrew University of Jerusalem and Mt. Sinai Medical Center study involved in vitro testing, not in vivo, iirc, but it looks promising.

Edited by BeachGal
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5 hours ago, TracyP said:

Does anybody want to talk about declining mortality rates around covid? I brought this up a couple weeks ago because it appears from my state's data that outcomes are improving. Since then I have heard a NYC doctor (on TWiV) say that outcomes are vastly improved. He said that 65% of people on vents would end in death in March. Now most people never get put on vents and when they do 29% die. This seems like such positive news, I'm wondering why nobody is talking about it. Here is an article I found detailing the difference Oregon hospitals are seeing.

https://www.oregonlive.com/health/2020/07/covid-19-survival-rate-improves-significantly-at-local-hospitals.html

Of the 900 patients hospitalized in all Providence facilities in March, 20% died. Of the 1,200 hospitalized in May, 14% died, Robicsek said.

Oregon Health & Science University showed even steeper declines. The mortality rate fell from 23% in March when six of the hospital’s 26 COVID-19 patients died to 3% in May (one of 37) and 4% in June (two of 52).

At Legacy Health, the mortality rate was 40% in March, when 12 of the hospital’s 30 patients died. By May, the rate had declined to 13% when five of 37 patients died.

 

Yes.

I think that is real and significant.

 

Whatever all it represents, fewer Nursing Home uncontrolled outbreaks, better understanding of how to manage hospital patients, etc, I think it is a good sign . 

 

were you able to get past paywall without subscribing or did you subscribe? 

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