***NON-POLITICAL COVID-19 Discussion Thread***

[JakeF]

A couple of reminders...

Originally Posted by Bwana

Once again, don't come in this thread with some kind of political agenda, or you will be shown the door. If you want to go that route, there is a thread about this in DC.

Originally Posted by Dartgod

People, there is a lot of good information in this thread, let's try to keep the petty bickering to a minimum.

We all have varying opinions about the impact of this, the numbers, etc. We will all never agree with each other. But we can all keep it civil.

Thanks!

Click here for the original OP:

Spoiler!

Apparently the CoronaVirus can survive on a inanimate objects, such as door knobs, for 9 days.

California coronavirus case could be first spread within U.S. community, CDC says
By SOUMYA KARLAMANGLA, JACLYN COSGROVE
FEB. 26, 2020 8:04 PM

The Centers for Disease Control and Prevention is investigating what could be the first case of novel coronavirus in the United States involving a patient in California who neither recently traveled out of the country nor was in contact with someone who did.

“At this time, the patient’s exposure is unknown. It’s possible this could be an instance of community spread of COVID-19, which would be the first time this has happened in the United States,” the CDC said in a statement. “Community spread means spread of an illness for which the source of infection is unknown. It’s also possible, however, that the patient may have been exposed to a returned traveler who was infected.”

The individual is a resident of Solano County and is receiving medical care in Sacramento County, according to the state Department of Public Health.

The CDC said the “case was detected through the U.S. public health system — picked up by astute clinicians.”

Officials at UC Davis Medical Center expanded on what the federal agency might have meant by that in an email sent Wednesday, as reported by the Davis Enterprise newspaper.

The patient arrived at UC Davis Medical Center from another hospital Feb. 19 and “had already been intubated, was on a ventilator, and given droplet protection orders because of an undiagnosed and suspected viral condition,” according to an email sent by UC Davis officials that was obtained by the Davis Enterprise.

The staff at UC Davis requested COVID-19 testing by the CDC, but because the patient didn’t fit the CDC’s existing criteria for the virus, a test wasn’t immediately administered, according to the email. The CDC then ordered the test Sunday, and results were announced Wednesday. Hospital administrators reportedly said in the email that despite these issues, there has been minimal exposure at the hospital because of safety protocols they have in place.

A UC Davis Health spokesperson declined Wednesday evening to share the email with The Times.

Since Feb. 2, more than 8,400 returning travelers from China have entered California, according to the state health department. They have been advised to self-quarantine for 14 days and limit interactions with others as much as possible, officials said.

“This is a new virus, and while we are still learning about it, there is a lot we already know,” Dr. Sonia Angell, director of the California Department of Public Health, said in a statement. “We have been anticipating the potential for such a case in the U.S., and given our close familial, social and business relationships with China, it is not unexpected that the first case in the U.S. would be in California.”

It is not clear how the person became infected, but public health workers could not identify any contacts with people who had traveled to China or other areas where the virus is widespread. That raises concern that the virus is spreading in the United States, creating a challenge for public health officials, experts say.

“It’s the first signal that we could be having silent transmission in the community,” said Lawrence Gostin, director of the World Health Organization Collaborating Center on National and Global Health Law. “It probably means there are many more cases out there, and it probably means this individual has infected others, and now it’s a race to try to find out who that person has infected.”

On Tuesday, the CDC offered its most serious warning to date that the United States should expect and prepare for the coronavirus to become a more widespread health issue.

“Ultimately, we expect we will see coronavirus spread in this country,” said Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases. “It’s not so much a question of if, but a question of when.”

According to the CDC’s latest count Wednesday morning, 59 U.S. residents have tested positive for the new strain of coronavirus — 42 of whom are repatriated citizens from a Diamond Princess cruise. That number has grown by two since Messonnier’s last count Tuesday, although the CDC was not immediately available to offer details on the additional cases.

More than 82,000 cases of coronavirus have been reported globally, and more than 2,700 people have died, with the majority in mainland China, the epicenter of the outbreak.

But public health leaders have repeatedly reminded residents that the health risk from the novel coronavirus to the general public remains low.

“While COVID-19 has a high transmission rate, it has a low mortality rate,” the state Department of Public Health said in a statement Wednesday. “From the international data we have, of those who have tested positive for COVID-19, approximately 80% do not exhibit symptoms that would require hospitalization. There have been no confirmed deaths related to COVID-19 in the United States to date.”

CDC officials have also warned that although the virus is likely to spread in U.S. communities, the flu still poses a greater risk.

Gostin said the news of potential silent transmission does not eliminate the possibility of containing the virus in the U.S. and preventing an outbreak.

“There are few enough cases that we should at least try,” he said. “Most of us are not optimistic that that will be successful, but we’re still in the position to try.”

[Monticore]

Originally Posted by TLO

500mg bid I believe. Then they taper it down to 500mg one daily. (I think I'm remembering that right)

I do know there is a very fine line between what is considered a theraputic dose, and a dose that causes a greater deal of side effects and even overdose.

My wife said it’s 500mg per week as far a malaria prophylaxis. Malaria treatment is 1000mg for initial and 500mg 6-8 hrs later then 500mg per day for 2 days. Parasitic infection is 1000mg then 500mg daily for 2 weeks.

My wife says it’s not something she would take unless she really had too , I understand for some it is s last ditch effort.

[Monticore]

Their dosage doesn’t seem that extreme.

[petegz28]

Originally Posted by TLO

She showed a couple of them.

One that showed NJ/NY going off like a rocket compared to the rest of the country. We all know it's happening, but it's crazy to see it in graph form like that.

Another that showed other metropolitan "outbreaks". St. Louis was on that chart, though I couldn't tell where because all the colors are far too similar.

I believe Mo was supposed to be peeking here in the next week or two so I think it logical to see things get worse before they get better. But I also think it is more on the east side of the state as well.

[TLO]

Originally Posted by Monticore

My wife said it’s 500mg per week as far a malaria prophylaxis. Malaria treatment is 1000mg for initial and 500mg 6-8 hrs later then 500mg per day for 2 days. Parasitic infection is 1000mg then 509mg daily for 2 weeks.

My wife says it’s not something she would take unless she really had too , I understand for some it is s last ditch effort.

My Mom has said the same thing. I absolutely would not take it on an outpatient basis.

[petegz28]

Barring some sort of surprise today looks to be a mirror image of yesterday on the totals.

[PAChiefsGuy]

Originally Posted by petegz28

Barring some sort of surprise today looks to be a mirror image of yesterday on the totals.

Its peaked which is great news.

['Hamas' Jenkins]

Okay, here's the deal with the Brazilian study:

1) They used chloroquine phosphate, not hydroxychloroquine (Plaquenil). Hydroxychloroquine dosages are normally smaller, but the chloroquine doses themselves are quite a bit above what a patient would normally receive for malaria. However, mechanistically, the drugs are the same. Hydroxychloroquine is given at a lower dose and is generally considered a safer drug, but if chloroquine is not efficacious, hydroxychloroquine is unlikely to demonstrate efficacy either.

2) The reason why the study was stopped was that 25% of the participants in the high dose arm (the low dose arm is still a high dose) developed a QTc interval of >500. This is not surprising given that the patients were also receiving azithromycin which also prolongs the QT interval. Clinicians get very nervous with a QTc above 500 because it greatly increases your risk of Torsades de Pointes, which is a fatal heart arrhythmia (imagine an inversion of your normal heart rhythm).

3) All patients in the trial were also being given ceftriaxone, which is a broad spectrum cephalosporin. It's a great drug and is often used for empiric therapy of a variety of infections patients may present with in the hospital; however, the results of that study would be muddied by its addition.

There are other issues with trial design that I could point out, but it's not really necessary for the purpose of this discussion.

More importantly, this is a teachable moment about anchoring. This is a common occurrence in medicine: someone will see a patient, begin reading their chart and latch on to a diagnosis or therapy without considering changes to the clinical picture as more information is unveiled.

[mr. tegu]

According to the article they were giving 600 mg and it was those high dose patients that had the heart problems and it was that part of the study that was stopped. The lower 450 mg dosage patients apparently did not have those issues.

['Hamas' Jenkins]

Originally Posted by mr. tegu

According to the article they were giving 600 mg and it was those high dose patients that had the heart problems and it was that part of the study that was stopped. The lower 450 mg dosage patients apparently did not have those issues.

600mg BID, not just 600mg.

[Monticore]

Originally Posted by 'Hamas' Jenkins

Okay, here's the deal with the Brazilian study:

1) They used chloroquine phosphate, not hydroxychloroquine (Plaquenil). Hydroxychloroquine dosages are normally smaller, but the chloroquine doses themselves are quite a bit above what a patient would normally receive for malaria. However, mechanistically, the drugs are the same. Hydroxychloroquine is given at a lower dose and is generally considered a safer drug, but if chloroquine is not efficacious, hydroxychloroquine is unlikely to demonstrate efficacy either.

2) The reason why the study was stopped was that 25% of the participants in the high dose arm (the low dose arm is still a high dose) developed a QTc interval of >500. This is not surprising given that the patients were also receiving azithromycin which also prolongs the QT interval. Clinicians get very nervous with a QTc above 500 because it greatly increases your risk of Torsades de Pointes, which is a fatal heart arrhythmia (imagine an inversion of your normal heart rhythm).

3) All patients in the trial were also being given ceftriaxone, which is a broad spectrum cephalosporin. It's a great drug and is often used for empiric therapy of a variety of infections patients may present with in the hospital; however, the results of that study would be muddied by its addition.

There are other issues with trial design that I could point out, but it's not really necessary for the purpose of this discussion.

More importantly, this is a teachable moment about anchoring. This is a common occurrence in medicine: someone will see a patient, begin reading their chart and latch on to a diagnosis or therapy without considering changes to the clinical picture as more information is unveiled.

Thanks for making me feel stupid dick , lol

[Bearcat]

Originally Posted by Monticore

Thanks for making me feel stupid dick , lol

via GIPHY

[TLO]

Originally Posted by 'Hamas' Jenkins

Okay, here's the deal with the Brazilian study:

1) They used chloroquine phosphate, not hydroxychloroquine (Plaquenil). Hydroxychloroquine dosages are normally smaller, but the chloroquine doses themselves are quite a bit above what a patient would normally receive for malaria. However, mechanistically, the drugs are the same. Hydroxychloroquine is given at a lower dose and is generally considered a safer drug, but if chloroquine is not efficacious, hydroxychloroquine is unlikely to demonstrate efficacy either.

2) The reason why the study was stopped was that 25% of the participants in the high dose arm (the low dose arm is still a high dose) developed a QTc interval of >500. This is not surprising given that the patients were also receiving azithromycin which also prolongs the QT interval. Clinicians get very nervous with a QTc above 500 because it greatly increases your risk of Torsades de Pointes, which is a fatal heart arrhythmia (imagine an inversion of your normal heart rhythm).

3) All patients in the trial were also being given ceftriaxone, which is a broad spectrum cephalosporin. It's a great drug and is often used for empiric therapy of a variety of infections patients may present with in the hospital; however, the results of that study would be muddied by its addition.

There are other issues with trial design that I could point out, but it's not really necessary for the purpose of this discussion.

More importantly, this is a teachable moment about anchoring. This is a common occurrence in medicine: someone will see a patient, begin reading their chart and latch on to a diagnosis or therapy without considering changes to the clinical picture as more information is unveiled.

Very informative. Thank you.

And a question..

Why are they set on using azithromycin? Couldn't you substitute another antibiotic that doesn't have the potential cardiac side effects? Why not just use doxycycline or something?

[petegz28]

final numbers a smidge better than Sunday but the same for the most part

+7 new deaths

but

-780 new cases

['Hamas' Jenkins]

Originally Posted by TLO

Very informative. Thank you.

And a question..

Why are they set on using azithromycin? Couldn't you substitute another antibiotic that doesn't have the potential cardiac side effects? Why not just use doxycycline or something?

Macrolides have immunomodulatory effects which may be helpful in mitigating a hyperactive immune response (like the frequently referenced cytokine storm). Azithromycin has fewer drug interactions and a longer half life than other macrolides, so it's used much more often.

If you were concerned about the antibiogram and proper coverage, doxycycline would actually be a good choice as it is a broad spectrum antibiotic, like azithromycin, that also covers atypical pathogens.

[Titty Meat]

Ain't that something

http://nypost.com/2020/04/13/virgini...f-coronavirus/