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To find out whether particular symptoms tend to appear together and how this related to the progression of the disease, the research team used a machine learning algorithm to analyse data from a subset of around 1,600 users in the UK and US with confirmed COVID-19 who had regularly logged their symptoms using the app in March and April.

The analysis revealed six specific groupings of symptoms emerging at characteristic timepoints in the progression of the illness, representing six distinct ‘types’ of COVID-19. The algorithm was then tested by running it on a second independent dataset of 1,000 users in the UK, US and Sweden, who had logged their symptoms during May.

All people reporting symptoms experienced headache and loss of smell, with varying combinations of additional symptoms at various times. Some of these, such as confusion, abdominal pain and shortness of breath, are not widely known as COVID-19 symptoms, yet are hallmarks of the most severe forms of the disease.

The six clusters are as follows:

 

1- (‘flu-like’ with no fever): Headache, loss of smell, muscle pains, cough, sore throat, chest pain, no fever.

2- (‘flu-like’ with fever): Headache, loss of smell, cough, sore throat, hoarseness, fever, loss of appetite.

3- (gastrointestinal): Headache, loss of smell, loss of appetite, diarrhea, sore throat, chest pain, no cough.

4- (severe level one, fatigue): Headache, loss of smell, cough, fever, hoarseness, chest pain, fatigue.

5- (severe level two, confusion): Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain.

6- (severe level three, abdominal and respiratory): Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhea, abdominal pain.

Next, the team investigated whether people experiencing particular symptom clusters were more likely to require breathing support in the form of ventilation or additional oxygen.

They discovered that only 1.5% of people with cluster 1, 4.4% of people with cluster 2 and 3.3% of people with cluster 3 COVID-19 required breathing support. These figures were 8.6%, 9.9% and 19.8% for clusters 4,5 and 6 respectively. Furthermore, nearly half of the patients in cluster 6 ended up in hospital, compared with just 16% of those in cluster 1.

Broadly, people with cluster 4,5 or 6 COVID-19 symptoms tended to be older and frailer, and were more likely to be overweight and have pre-existing conditions such as diabetes or lung disease than those with type 1,2 or 3.

The researchers then developed a model combining information about age, sex, BMI and pre-existing conditions together with symptoms gathered over just five days from the onset of the illness.

This was able to predict which cluster a patient falls into and their risk of requiring hospitalisation and breathing support with a higher likelihood of being correct than an existing risk model based purely on age, sex, BMI and pre-existing conditions alone.

Given that most people who require breathing support come to hospital around 13 days after their first symptoms, this extra eight days represents a significant ‘early warning’ as to who is most likely to need more intensive care.

“These findings have important implications for care and monitoring of people who are most vulnerable to severe COVID-19,” said Dr Claire Steves from King’s College London. “If you can predict who these people are at day five, you have time to give them support and early interventions such as monitoring blood oxygen and sugar levels, and ensuring they are properly hydrated - simple care that could be given at home, preventing hospitalisations and saving lives.”
https://www.technologynetworks.com/diagnostics/news/researchers-identify-six-distinct-types-of-covid-19-337592
 

https://www.medrxiv.org/content/10.1101/2020.06.12.20129056v1

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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.

That's not a blanket right.  If my religion required human sacrifice, I can't practice it.  If my religion required sexual assault, I can't practice it. Freedom of religion isn't a blanket right

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1 hour ago, Plum said:

To find out whether particular symptoms tend to appear together and how this related to the progression of the disease, the research team used a machine learning algorithm to analyse data from a subset of around 1,600 users in the UK and US with confirmed COVID-19 who had regularly logged their symptoms using the app in March and April.

The analysis revealed six specific groupings of symptoms emerging at characteristic timepoints in the progression of the illness, representing six distinct ‘types’ of COVID-19. The algorithm was then tested by running it on a second independent dataset of 1,000 users in the UK, US and Sweden, who had logged their symptoms during May.

All people reporting symptoms experienced headache and loss of smell, with varying combinations of additional symptoms at various times. Some of these, such as confusion, abdominal pain and shortness of breath, are not widely known as COVID-19 symptoms, yet are hallmarks of the most severe forms of the disease.

The six clusters are as follows:

 

1- (‘flu-like’ with no fever): Headache, loss of smell, muscle pains, cough, sore throat, chest pain, no fever.

2- (‘flu-like’ with fever): Headache, loss of smell, cough, sore throat, hoarseness, fever, loss of appetite.

3- (gastrointestinal): Headache, loss of smell, loss of appetite, diarrhea, sore throat, chest pain, no cough.

4- (severe level one, fatigue): Headache, loss of smell, cough, fever, hoarseness, chest pain, fatigue.

5- (severe level two, confusion): Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain.

6- (severe level three, abdominal and respiratory): Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhea, abdominal pain.

Next, the team investigated whether people experiencing particular symptom clusters were more likely to require breathing support in the form of ventilation or additional oxygen.

They discovered that only 1.5% of people with cluster 1, 4.4% of people with cluster 2 and 3.3% of people with cluster 3 COVID-19 required breathing support. These figures were 8.6%, 9.9% and 19.8% for clusters 4,5 and 6 respectively. Furthermore, nearly half of the patients in cluster 6 ended up in hospital, compared with just 16% of those in cluster 1.

Broadly, people with cluster 4,5 or 6 COVID-19 symptoms tended to be older and frailer, and were more likely to be overweight and have pre-existing conditions such as diabetes or lung disease than those with type 1,2 or 3.

The researchers then developed a model combining information about age, sex, BMI and pre-existing conditions together with symptoms gathered over just five days from the onset of the illness.

This was able to predict which cluster a patient falls into and their risk of requiring hospitalisation and breathing support with a higher likelihood of being correct than an existing risk model based purely on age, sex, BMI and pre-existing conditions alone.

Given that most people who require breathing support come to hospital around 13 days after their first symptoms, this extra eight days represents a significant ‘early warning’ as to who is most likely to need more intensive care.

“These findings have important implications for care and monitoring of people who are most vulnerable to severe COVID-19,” said Dr Claire Steves from King’s College London. “If you can predict who these people are at day five, you have time to give them support and early interventions such as monitoring blood oxygen and sugar levels, and ensuring they are properly hydrated - simple care that could be given at home, preventing hospitalisations and saving lives.”
https://www.technologynetworks.com/diagnostics/news/researchers-identify-six-distinct-types-of-covid-19-337592
 

https://www.medrxiv.org/content/10.1101/2020.06.12.20129056v1

That sounds like a really good tool!

I hope your dh is feeling better. I was wondering if you knew how hospitals are faring in your state? I heard someone at work saying the report of bed availability in Houston wasn’t as bad as portrayed- although the person she heard it from was not a HCW but lived in the city and knew 3 nurses, not sure what kind of nurses they were. I wish there was an easier way of getting just the facts but it seems very difficult to do that right now.

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22 hours ago, TCB said:

That sounds like a really good tool!

I hope your dh is feeling better. I was wondering if you knew how hospitals are faring in your state? I heard someone at work saying the report of bed availability in Houston wasn’t as bad as portrayed- although the person she heard it from was not a HCW but lived in the city and knew 3 nurses, not sure what kind of nurses they were. I wish there was an easier way of getting just the facts but it seems very difficult to do that right now.

Thanks! He’s currently “cluster 2” but his fever hasn’t really come back yet. We’re only on day 2 of symptoms. 

Capacity depends on location. The denser area hospitals are at 90%+ capacity. His hospital was behind the others but has recently had record high hospitalizations  

Some of his sister hospitals sent vents to another sister hospital in TX. I don’t know which one or where. (not that I could say anyway) 

Edited by Plum
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4 hours ago, Ktgrok said:

There were almost 500 participants. And 2 of the 10 hopitalized in the placebo arm were hospitalized for something not related to Covid. So it was 8 vs 4, and when you are looking at 500 people that isn't enough to be statistically significant vs just random fluctuation. 

I wondered about including those 2. Whether 10 or 8 vs. 4 it seemed significant to me, but I guess I don't know how that works when it comes to these studies. 

3 hours ago, square_25 said:

Yeah, that’s the problem with following people who aren’t sick yet — you might have few enough people get sick that you have no statistical power.

If I remember correctly, the 500 isn’t relevant here, only the small numbers hospitalized. 

By the way, “statistically significant” generally means “has a chance of less than 5 percent of happening randomly.” If you randomly distributed 12 hospitalized patients between two groups, the chance of having 4 or fewer in one group is around 20 percent, which is far too high.

That makes sense, though I guess this study is still going to leave me with unanswered questions about hcq which is annoying. 😋 Do either of you (or anyone) have thoughts on remdisivir? That drug seems to be quite popular even though the study results seemed fairly insignificant to me. 

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275 new cases in Victoria today. 1 death. 

Reusable Face masks are going to be issued to all staff and students in schools. Teachers can chose not to wear the mask in the classroom at their own discretion but need to wear the mask when not actively teaching. Students need to wear a mask or scarf at all times unless eating. Only year 11 and 12 and special school students are back to school in Melbourne greater area. The rest are to be taught at home 

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This sounds promising. 

Quote

The preliminary results of a clinical trial suggest a new treatment for Covid-19 dramatically reduces the number of patients needing intensive care, according to the UK company that developed it.

The treatment from Southampton-based biotech Synairgen uses a protein called interferon beta which the body produces when it gets a viral infection.

The protein is inhaled directly into the lungs of patients with coronavirus, using a nebuliser, in the hope that it will stimulate an immune response.

The initial findings suggest the treatment cut the odds of a Covid-19 patient in hospital developing severe disease - such as requiring ventilation - by 79%.

...

If it does get approval, the drug and the nebulisers used to deliver it would then need to be manufactured in large quantities.

Mr Marsden says he instructed companies to start producing supplies back in April to ensure they would be available should the results be positive.

He says he expects Synairgen to be able to deliver "a few 100,000" doses a month by the winter.

https://www.bbc.com/news/health-53467022

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7 minutes ago, Ausmumof3 said:

Does sound good.  I wonder how it interacts with the whole cytokine storm over active immune system thing.  

Good question. I hope we find out more soon.

 

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13 hours ago, Ausmumof3 said:

https://www.thelocal.ch/20200715/only-those-with-plastic-visors-were-infected-swiss-government-warns-against-face-shields/amp
 

just a single anecdote but this feels worth knowing about.  Particularly as some airlines are moving toward complementary face shields instead of masks.

 

Thanks so much for posting. Our pediatrician & practice are advocating for face shields as an alternative to masks, so I'm forwarding this to their office. I think we'll use a face shield only as added protection if we need to go anywhere that seems particularly risky.

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If you have some tome on your hands, UCSF gathered some of the top scientists to talk about studies regarding masks, face shields, airborne particles/aerosols, and planes (that part cuts out but they come back to him later in the podcast).  

 

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I am planning to use a face shield over a mask for me. I’ve ordered some and plan to add vinyl to decorate them with things like princess crowns, so they look less clinical and hopefully less intimidating for kids. 

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MedCram just posted this at the top of his FB link to his latest video about at-home tests. Anyone know where he gets that number? I’ve been hearing for months that case counts are greatly undercounted and the current case count can be multiplied by 10-100x  to get an accurate number. 

The current COVID-19 testing strategy in the United States is estimated by the CDC to pick up less than 10% of infections...  

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7 hours ago, Acadie said:

 

Thanks so much for posting. Our pediatrician & practice are advocating for face shields as an alternative to masks, so I'm forwarding this to their office. I think we'll use a face shield only as added protection if we need to go anywhere that seems particularly risky.

I sent the link to my oldest ds. He said from an aerodynamic perspective it is pretty obvious that a mask would be better. 

He is in Melbourne. He is using a industrial face mask with replaceable filters 

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54 minutes ago, Plum said:

MedCram just posted this at the top of his FB link to his latest video about at-home tests. Anyone know where he gets that number? I’ve been hearing for months that case counts are greatly undercounted and the current case count can be multiplied by 10-100x  to get an accurate number. 

The current COVID-19 testing strategy in the United States is estimated by the CDC to pick up less than 10% of infections...  

This NYT article talks about where these numbers come from. The article says that this is the study that the CDC used to get those estimates. I think 10 times (or more)  is a good estimate for early on. I'm gonna second @square_25 At this point I've been assuming we are catching 20-25% of the cases.

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2 minutes ago, matrips said:

Saw this picture today.  It looks different as a picture than as just numbers.

 

 

I like the graphic, but given that lots of people get tested more than once, it would be interested to see the number of people tested, not the number of tests.

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10 minutes ago, square_25 said:

Hmmmmm. I'm not entirely sure what that's trying to communicate, to be honest. That there are many more tests than cases? That there are many more cases than deaths? That there are many more US citizens than tests? 

Am I missing a key that tells what the colors mean? 

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17 minutes ago, square_25 said:

Hmmmmm. I'm not entirely sure what that's trying to communicate, to be honest. That there are many more tests than cases? That there are many more cases than deaths? That there are many more US citizens than tests? 

Given that the source appears to something called "Ohio Liberation," I'm guessing that's supposed to show that 140,000 dead Americans is no big deal and that hardly anyone is really sick. 

ETA: Apparently "Ohio Liberation" = some guy on Facebook who makes similar graphs proving that CV19 is no worse than the flu, and is involved in organizing anti-mask rallies against the "tyranny" of Gov. DeWine.

I wonder where they got the 4.3 million cases — that's about 400K more than Worldometer lists.

Edited by Corraleno
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1 minute ago, square_25 said:

It took me some time to figure out that there was no point to the map, other than to create a visual for the total population. 

It doesn't show the effects of the virus on previously healthy young(er) people who still can't work months after getting it.  It doesn't show the effects of the high costs of hospitalization for those who got it but still survived.  It doesn't show the devastation those deaths cause to families - especially in some families where entire generations are now wiped out.  And putting it in dots like that (do the total number of dots actually add up to the population of the US or is that meaningless too?), it makes 100,000 deaths for one dot seem so little.  I mean, it's just one dot, right?  But (as of today) 143,723 people have died in the US alone. 

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2 minutes ago, square_25 said:

By the way, someone should pat me on the back. DH has now discovered TONS of people at his work who had gotten COVID. I'm extremely glad that we started home when we did, because that could have absolutely been us. 

Most of them have lingering symptoms months later, by the way. 

I was just telling ds last night that I understand what it's like to have lingering symptoms from a virus.  I got a virus at the end of college over 30 years ago.  I am still chronically ill and in pain.  I hope hope hope that the lingering effects of this virus is not like what I have experienced. 

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On 7/19/2020 at 7:48 PM, Ausmumof3 said:

https://www.thelocal.ch/20200715/only-those-with-plastic-visors-were-infected-swiss-government-warns-against-face-shields/amp
 

just a single anecdote but this feels worth knowing about.  Particularly as some airlines are moving toward complementary face shields instead of masks.

I wonder if someone could attach a fabric neckpiece/sidepiece to a face shield to make it effective--something that ties behind the neck and head like a mask would. I know the masks with the plastic mouth area fog up, so maybe a shield with attached fabric, if it works, could be used for those that need to lip read or see full faces for some other reason. 

Updated: looky here...https://www.designboom.com/design/x-hood-face-shield-stuck-design-05-15-2020/  I bet someone could make a homemade version too.

Edited by kbutton
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2 hours ago, matrips said:

Saw this picture today.  It looks different as a picture than as just numbers.

C9EF8D7E-E206-4FD0-8EB5-61A3D0724B6B.png

I look at this map and see a disaster in the making. All those gray dots are tinder for Covid to burn through. I'm sure that's not what Ohio Liberation intended but sitting in a hot spot, things feel very dire.

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18 minutes ago, kbutton said:

I wonder if someone could attach a fabric neckpiece/sidepiece to a face shield to make it effective--something that ties behind the neck and head like a mask would. I know the masks with the plastic mouth area fog up, so maybe a shield with attached fabric, if it works, could be used for those that need to lip read or see full faces for some other reason. 

Updated: looky here...https://www.designboom.com/design/x-hood-face-shield-stuck-design-05-15-2020/  I bet someone could make a homemade version too.

This is what I'm doing for the teachers at my business.   I have one shield that's on a visor hat and one that's the typical band with the foam.    My mother is a quilter and she's making drapes that attach to the visor on the top and then drape around the shield on three sides.   I think they will work like a combination of a visor and mask because air will have to go through the drape to get in/out.  

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11 minutes ago, chiguirre said:

I look at this map and see a disaster in the making. All those gray dots are tinder for Covid to burn through. I'm sure that's not what Ohio Liberation intended but sitting in a hot spot, things feel very dire.

 

And every 1-2 days another green dot gets filled. 

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2 hours ago, square_25 said:

To me, those two messages seem to be opposites, lol. If hardly anyone is sick, it's going to be a lot worse when many people are ;-). 

That’s what I thought when I looked at it - Oh no we’ve got so many more to go!

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1 hour ago, Ausmumof3 said:

Apparently trump tweeted a picture of himself in a mask and called wearing masks patriotic.  Really hoping that generates a shift in the discussion around masks now.

I really hope so! I’m glad that he did.

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374 new cases in Victoria, 3 more deaths 

Some stupid idiot had symptoms, got tested in Melbourne on Friday then drove somehow past the Roadblocks and travelled to my rural town, over 400 km.they stayed with relatives. they then went to just about every single shop and pub in the town and coastal village before they got their results last night. Positive. It has caused mad panic in the town. It is mostly elderly. Half the town wants to get tested and just about all the shops are closed. 

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I have to share these two screenshots. These were projections from May 2 for the U.S. and California. We are getting close to August 4 now and these projections are surprisingly close.

ETA: the projections are now 213,000 deaths in the US by Nov 1 and 16,000 for CA. 😞

F1C852B1-8051-4AD2-AF85-F13885777237.thumb.jpeg.a5ea0b64262ef3d97e95320928c8365b.jpeg

 

824927F0-0FA6-4335-A3B3-DCA7FF5A34A5.thumb.jpeg.c2f96de6e447e478139f954f9d5315b6.jpeg

Edited by lovelearnandlive
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9 minutes ago, Melissa in Australia said:

374 new cases in Victoria, 3 more deaths 

Some stupid idiot had symptoms, got tested in Melbourne on Friday then drove somehow past the Roadblocks and travelled to my rural town, over 400 km.they stayed with relatives. they then went to just about every single shop and pub in the town and coastal village before they got their results last night. Positive. It has caused mad panic in the town. It is mostly elderly. Half the town wants to get tested and just about all the shops are closed. 

I'm going to set someone off by saying this, but this kind of behavior deserves being arrested and charged with reckless endangerment.  With damages going to all the people who have been negatively impacted by their reckless behavior. 

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12 minutes ago, Jean in Newcastle said:

I'm going to set someone off by saying this, but this kind of behavior deserves being arrested and charged with reckless endangerment.  With damages going to all the people who have been negatively impacted by their reckless behavior. 

I agree, plus I  think of someone dies in the area they should be charged with manslaughter 

Edited by Melissa in Australia
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17 minutes ago, Jean in Newcastle said:

I'm going to set someone off by saying this, but this kind of behavior deserves being arrested and charged with reckless endangerment.  With damages going to all the people who have been negatively impacted by their reckless behavior. 

They are looking at jail time for illegal border crosses In SA.  I’m not sure how realistic it is given we don’t want Covid in prisons 

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8 hours ago, Jean in Newcastle said:

I'm going to set someone off by saying this, but this kind of behavior deserves being arrested and charged with reckless endangerment.  With damages going to all the people who have been negatively impacted by their reckless behavior. 

the person was fined $1600 for leaving a lockdown area

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12 hours ago, Jean in Newcastle said:

Am I missing a key that tells what the colors mean? 

Yes, I see now what it is supposed to show. It’s showing how tiny the amount of people who have died compared to the whole vast USA.

I think it is a terrible, misleading graphic. The space of US geography has no role in describing deaths, cases, or number of tests given. IMO, this graphic is simply meant to minimize the tragedy of 130,000 deaths by saying, “See this giant country? Only this tiny dot of people have died.” It is the opposite of humanizing the deaths. 

Just a few months ago, I sat in the dining room with my husband as he speculated that surely no more than 40,000 US people would die; 60,000 at the very most. I told him I thought it would surely be many more than that, given how it grew so exponentially in Europe. So now, here we are. More than three times the estimate the “minimizers” were postulating just a few months ago. So I guess now the tactic is to illustrate that 130,000 deaths is just a little dot on the whole vast US. 

I can’t stand it. It makes me furious. 

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3 hours ago, Melissa in Australia said:

the person was fined $1600 for leaving a lockdown area

I would be in support of a separate charge for each indoor stop (whether a home or a shop) in the clean area. Each one was a distinct threat to someone's safety.

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A local mother was arrested yesterday for lying to the police about her 14yods covid status.  He was awaiting test results but she told them he had a negative result.  Three policemen had to self-quarrantine for 14 days.

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5 minutes ago, JanOH said:

A local mother was arrested yesterday for lying to the police about her 14yods covid status.  He was awaiting test results but she told them he had a negative result.  Three policemen had to self-quarrantine for 14 days.

I think that at this point those of us having to get up close to others for our job should treat everyone as if they’re positive. Universal Covid precautions, just like we use universal precautions.

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HCQ and Zinc - Zelenko interview—

 

i keep hoping drbeen woll get to interview him, but I found this which at least gives more than s soundbite  (Some gets political, but my reason for posting is the Medical aspect—including exact suggestions for dosages and types of zinc prophylactic, Quercitin, D, and more) 

https://youtu.be/uEntfcBiW4k

 

 

 

Meanwhile this DrBeen interview of Dr Patterson is interesting in the long term viral effects etc

 

 

Edited by Pen
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8 hours ago, TCB said:

I think that at this point those of us having to get up close to others for our job should treat everyone as if they’re positive. Universal Covid precautions, just like we use universal precautions.

Pssst...everyone is presumed Covid positive in my little corner of the medical world. Only way to protect me and mine given that, well, people lie distressingly frequently. 

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4 hours ago, brehon said:

Pssst...everyone is presumed Covid positive in my little corner of the medical world. Only way to protect me and mine given that, well, people lie distressingly frequently. 

Mine too.

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Abc:  Victorian Premier Daniel Andrews said from the 3,810 cases between July 7 to July 21, 3,400 cases did not isolate when they first felt sick and when they went to get a test.
 
"Now, that's an interesting measure in that people have felt sick, they've got symptoms, and they've kept going shopping. They've kept going to work," Mr Andrews said.
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