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  1. #121
    team ketchup AdamWW's Avatar
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    Originally Posted by MrCarrot View Post
    On a more important note, is anyone still ordering takeout? Someone in the misc commented that people ordering takeout are "brave", suggesting it's a bad idea. Personally I don't see how it can be any worse than having your groceries delivered (or going to collect them).

    I've been having takeout every weekend mainly due to boredom and because it's about the only thing to look forward to. I collect it myself, but I phone in advance so I only spend a few seconds in the shop, anti-bac my hands when I get back in the car, wash my hands when I get home, empty the food out on to plates and then wash my hands again.
    I’ve been doing delivery on food and groceries and leaving BIG tips to thank the shoppers and drivers. Given most containers are paper or cardboard, that limits transmission compared to hard surfaces. Most experts simply recommend handling the containers with gloves, and/or washing after touching them and plating food vs eating from their containers... and always washing hands/disinfecting prior to consumption.
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  2. #122
    I love my power hour MrCarrot's Avatar
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    Originally Posted by hardyboysare View Post

    I must admit I have been following WolfRose view and assumed I would be pulled over by the police as an non-essential travel. I personally haven't had a takeaway in 2 weeks since the lockdown due to the advice not to travel.

    I guess the interpretation of the law is down to the police. Even though you can collect according to the government, is going to collect a takeaway classed as 'essential'. I am not saying I am against anyway getting a takeaway as I damn would like to, but I can never find any assurance that I won't be fined for 'non-essential' travel by going to get one as the cops seem to be very keen in my area to pull people over (live near the seaside so no wonder).
    I've never really been one to play by the rules when they defy common sense. I mean, I'm not going to go and hang out down the local park for hours or take my kids to a play area when you're not supposed to. But I don't perceive going to collect takeaway as being any worse than going to collect groceries. In fact I get more twitchy going into the supermarket with 3 dozen other people than I do going into an empty takeaway for a few seconds. With that said, the only time you see police around here are when they are getting their dinner in McDonalds, and since McDonalds is now closed...

    Originally Posted by AdamWW View Post
    I’ve been doing delivery on food and groceries and leaving BIG tips to thank the shoppers and drivers. Given most containers are paper or cardboard, that limits transmission compared to hard surfaces. Most experts simply recommend handling the containers with gloves, and/or washing after touching them and plating food vs eating from their containers... and always washing hands/disinfecting prior to consumption.
    Unfortunately there are no delivery slots available for groceries around here. I don't particularly like spending half an hour in the store with 3 dozen other people, but I am trying to do it as little as possible now (ordinarily we would go to the store every other day for one thing or another). Also, I'm the only one in my family to go, and I'm also getting my parents shopping at the same time and dropping it off outside their door. I kind of feel sorry for the delivery drivers though, because it seems as though the risk is being passed on to them.
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  3. #123
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    Originally Posted by MrCarrot View Post
    I've never really been one to play by the rules when they defy common sense.
    Amen. The fact that I can be fined $500 by my local police for driving through the countryside - never stopping or talking to ANYONE - while it's perfectly allowed to go to Walmart to purchase a magazine is beyond the realm of reason or logic.
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  4. #124
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    Called my favourite Chinese tonight. CLOSED UNTIL FURTHER NOTICE. I half expected it, but thought they might switch to delivery only.

    Fish and chip shop closed too. Had to resort to kebab shop, but who knows how much longer until they close?
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  5. #125
    team ketchup AdamWW's Avatar
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    Originally Posted by MrCarrot View Post
    Called my favourite Chinese tonight. CLOSED UNTIL FURTHER NOTICE. I half expected it, but thought they might switch to delivery only.

    Fish and chip shop closed too. Had to resort to kebab shop, but who knows how much longer until they close?
    It's really sad how many small businesses are going to go under...
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  6. #126
    I love my power hour MrCarrot's Avatar
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    Originally Posted by AdamWW View Post
    It's really sad how many small businesses are going to go under...
    I'm just hoping they have savings, or get government assistance (or both), get a rent or mortgage holiday for a few months, then get back on their feet in 2-3 months. Assuming this is all under control by then, but who knows.
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  7. #127
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    Originally Posted by hardyboysare View Post
    For example I could state that the deaths with the Human papillomavirus is nearly 500000 people in the UK yearly and has an infection rate of 90% in adults which would make scary headlines but once you understand its basically warts or even no symptoms its not scary at all seeing as nearly all sexually active individuals will have it.
    I completely understand the full point you are making and agree with the sentiment. Just an FYI though regarding HPV is that it is super common and does cause warts but it also causes cancer and the vaccine saves many thousands of lives every year. So for a lot of people it is much more than warts and is scary. Again, that doesn't take away from your point, just a bit of clinical education.


    I alluded to COVID-19 not presenting fully like ARDS above, for the chemists/pathologists/etc who want to read more here's an interesting theory: http://farid.jalali.one/covid19email...R8HPmsll7ceVbQ and here's one of the novel papers going around generating other theories of pathogenesis: https://chemrxiv.org/articles/COVID-...Ey4wdJlMWmMt38

    Another finding of how COVID-19 enters cells, yielding potentially other treatment targets: https://www.sciencedirect.com/scienc...5qG8n9LLASJvpc

    May seem ironic while healthcare workers are on the front lines but with so many elective things cancelled and people not wanting to go to the doctor a lot of medical practices are struggling and people are being furloughed or laid off. My job at this point in time seems stable. There are a lot of pros/cons of working for a large hospital system vs private practice; right now I am quite thankful I am in a large hospital system. https://www.nytimes.com/2020/04/03/u...IPEsb5YV3Pq54k

    Here is a link where all of the clinical trials related to COVID-19 are attempting to be compiled: https://www.transparimed.org/single-...kUsW6JWvv0kKyg
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  8. #128
    Han shot first! TolerantLactose's Avatar
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    Originally Posted by Heisman2 View Post
    May seem ironic while healthcare workers are on the front lines but with so many elective things cancelled and people not wanting to go to the doctor a lot of medical practices are struggling and people are being furloughed or laid off. My job at this point in time seems stable. There are a lot of pros/cons of working for a large hospital system vs private practice; right now I am quite thankful I am in a large hospital system. https://www.nytimes.com/2020/04/03/u...IPEsb5YV3Pq54k
    It's true where I am. It may seem even more ironic, but the number of requests for COVID testing across my region has decreased dramatically. If I had to guesstimate, I'd say it's about 30-35% of what it was at its peak.
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  9. #129
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    I am seeing more and more people congregating here in LA, relaxing the Social Distancing rule, with their silly homemade masks on than before the CDC recommended to do this.

    Based on what I am seeing, I think it was a very poor decision on the part of the CDC (yes I read all the studies) to do so being that Social Distancing is best way to go. I dont think they thought, however, this would lead to more congregating, but it has.

    But of course the best course would be just stay home.

    I for one am not wearing any mask unless its N95 but at this time HCWs need them way more than I do.
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  10. #130
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    Originally Posted by boo99 View Post
    I am seeing more and more people congregating here in LA, relaxing the Social Distancing rule, with their silly homemade masks on than before the CDC recommended to do this.
    Communal social distancing. I'm seeing this as well.
    I can tell time. Time cannot tell me.

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  11. #131
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    Originally Posted by TolerantLactose View Post
    Communal social distancing. I'm seeing this as well.

    Though the CDC kinda meant well, they were better to stick with their original advice, not to wear masks

    Just now at CVS I saw a pack of people talking very close to each other with their stupid looking masks on

    Smh
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  12. #132
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    For the NHS/UK people: icnarc.org - a report on critically ill patients can be found here for anyone curious

    Another link with some clinical protocols: https://www.evms.edu/covid-19/medica...-o#d.en.140202

    Easy to read article on the potential impact of COVID-19 on the nervous system: https://www.suzannegazdamd.com/scien...xv3UhVDlV8SZBg

    I'm told this was a good watch for people curious in more details on mechanical ventilation for COVID-19 (I have not watched this): https://esicm-tv.org/webinar1_live_2...M15qMXD9qanbf4

    Brief Q&A on ARDS (caution: he says that the ARDS here is typical ARDS but many physicians are saying they are seeing things that are definitely not typical of ARDS and rather similar to altitude sickness/microangiopathy): https://advances.massgeneral.org/res...5OKARsvwr0YlyM

    An article on why the death rate in Germany is so low (if you read it, please note how early they were ready for mass testing): https://www.nytimes.com/2020/04/04/w...ugO3d47u9o9zG4

    I can't recall if I posted this previously but there are seemingly weekly updates being done here that I'm told are very good (if they are weekly another one should be coming out soon). Of note I haven't watched this myself:

    Apparently skin manifestations can be seen as well: https://www.mdedge.com/internalmedic...hnjid_Zcqdfnmo

    This has now been updated for where we currently are in the US: https://covid19.healthdata.org/
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  13. #133
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    Thought I would add this piece up for people looking to 'hear' the protein structure of COVID-19 actually sounds quite pleasant:-



    An explanation why it helps science, and I find it may help relax you during your homeworking:-

    https://www.sciencemag.org/news/2020...navirus-music#

    Also thanks Heisman for all the links really helpful reads getting through quite a few of them in my spare time.
    Last edited by hardyboysare; 04-06-2020 at 06:34 AM.
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  14. #134
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    Well, hardyboysare if you want more links...

    For people interested in combing through the latest literature regarding COVID-19, two links:

    1. This is updated daily with all (well, it probably misses some things, but at least most) of the new published research: https://www.ncbi.nlm.nih.gov/research/coronavirus/

    2. This is compiling new research but also various popular news articles: https://covid19primer.com/

    No other updates from me today other than the following; 3 days ago I posted this link saying the model should update that day: https://covid19.healthdata.org/united-states-of-america. Well, it updated the next day and a lot of the updates seem really questionable. It's not clear to me how they arrived at their numbers but they have taken down the number of expected deaths and expected peaks in a lot of states even when the state health departments clearly expect the peaks to come later. If you're looking at that model, be skeptical (granted, you should be skeptical at all models for this as things are changing rapidly).
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    I didn't really post any new things today (other then sources for studies). Here are a couple of things:

    - an indication that air pollution quality correlates with fatality rate: https://www.theguardian.com/environm...gq4KoA_t83d6MM

    - a couple more links regarding the ARB/ACE-I questions: https://jamanetwork.com/journals/jam...358o0DmeRTsttw and https://blogs.sciencemag.org/pipelin...NBInn8ABnx6s4s

    - a small study but hopeful regarding convalescent plasma: https://www.pnas.org/content/early/2...QnhBx5a2KvszMo
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    Not sure if this has already been posted, but some very good news

    Germany's number of coronavirus recoveries exceeds new cases

    https://www.bloomberg.com/news/artic...eeds-new-cases
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    A lot of hospitals are still struggling to obtain adequate PPE: https://www.yahoo.com/news/hospitals...210748808.html

    This is a preprint and much more work needs to be done but this in isolation is concerning that some patients will not generate an antibody response and thus may be susceptible to reinfection: https://www.medrxiv.org/content/10.1...6p3S2TsqE6qVHc

    Another link with a different set of graphics for the US going down to county-level data: http://covid19dataproject.org/?fbcli...VEE7BjYoggqSx0

    A book chapter being updated weekly on COVID-19 and SARS: http://www.essentialevidenceplus.com...sgboy-Y#accept

    An ICU physician's experience caring for these patients: https://www.theguardian.com/commenti...Zs7xxn5HoGvSXk

    A Medium article on what South Korea has done: https://medium.com/@indica/the-korea...d-c726aa21c0a3

    An overview of some of the various treatment possibilities: https://www.forbes.com/sites/kurtbad.../#158233c14100
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    I keep wondering if covid-19 will go away for the summer and then come back next cold and flu season. Is there any evidence to suggest this will happen?
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    Originally Posted by BromanianDL View Post
    I keep wondering if covid-19 will go away for the summer and then come back next cold and flu season. Is there any evidence to suggest this will happen?
    Good question. Short answer is we don't know. Depends on if long lasting immunity develops, how the virus infection rate changes in different weather, and how long we employ social distancing measures. For a longer answer looking at the various answers (but still concluding we do not know), see here: https://www.nap.edu/read/25771/chapter/1

    Here's another visualization of the cases in the US for anyone curious: https://www.nytimes.com/interactive/...4TCnzsuVy6wrlI
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    New Zealand has only had 1 fatality: https://edition.cnn.com/2020/04/09/a...o5NC-tnaOI3jDY

    I was just made aware of it and have not gone through it; at first glance it looks like too much information but this may be an easy way to stay on top of various sources of literature: https://www.protopage.com/protodoc#P...ona_Virus_News

    Different ways the pandemic may play out: https://www.theguardian.com/commenti...KIDPB-S5wjkreM

    Lastly, I am going to try to go through LitCovid daily and highlight the new papers/editorials/etc that I find potentially interesting. This is totally me being subjective so keep that in mind. Also, this does not capture all of the new things being put on the internet so this is not exhaustive. I am using the spoiler tag so it doesn't take up so much space on the main page:
    Spoiler!
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  21. #141
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    Originally Posted by Heisman2 View Post
    Two patients with sickle cell disease got COVID-19 and had smooth recoveries; one did not even have respiratory symptoms.
    This may be serendipity but there is evidence that sickle cell disease is protective against malaria. And given the hubbub regarding chloroquine, that jumped out at me.
    I can tell time. Time cannot tell me.

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    Originally Posted by TolerantLactose View Post
    This may be serendipity but there is evidence that sickle cell disease is protective against malaria. And given the hubbub regarding chloroquine, that jumped out at me.
    My guess is that it is unrelated as the notion of COVID-19 interacting with hemoglobin is based on one theoretical paper that has holes in it: https://medium.com/@amdahl/covid-19-...y-ce27773d1096

    Unfortunately the forum will not let me post my summary of the studies today so I'm giving up on that.
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    The forum won’t let me post links here, but I just read a Business Insider article that claims 80% of NYC patients put on ventilators die. Some doctors weighed in and said the ventilators might due more harm than good. I’d love to hear your thoughts, Dr. H.
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    Guess I'm not the only one having trouble with links. It sucks this forum is so glitchy at times.

    Anyways, some people are following classic ARDS where you get ill in some way, get an inflammatory response in the lung, and the lungs kind of turn to jello (functionally) where you need high pressure to force oxygen through. These people absolutely need ventilators.

    Some of these patients though are not having this happen. Many patients are becoming hypoxic (low on oxygen) without having significant trouble breathing. It's unclear why. There is some thought lots of small blood clots could be playing a role; for example if you get blood clots in the lungs (pulmonary emboli) such that blood doesn't flow to part of the lungs it does not matter how good the oxygen delivery to that lung segment is as the blood cannot flow to it to pick up the oxygen.

    There was this other hemoglobin hypothesis but that has been debunked by the post I put above (other people have reasons to not think it is accurate as well).

    Bottom line we don't really know why some of these patients are presenting the way they are. Some of them (not all) are responding really well to proning (having them lie down on their stomach instead of their back). It's unclear why they are responding so well to this.

    To back up a bit, patients are put on ventilators either because they need more help getting oxygen into the body, more help getting carbon dioxide out of the body, or are working really hard to breathe and need support for their respiratory muscles before they tire out. If patients can be proned and given really high flow nasal cannula (think of thick tubes going into the nostrils delivering a lot of oxygen) and this can keep them well oxygenated they may not need to be intubated and put on a vent. On the other hands at times it can be better to put people on a vent a bit earlier than waiting until the last minute as the longer you wait the more they can tire out and the more oxygen deprivation they may experience. On the 3rd hand, another thing we are seeing is that some of these patients are clinically improving and then all of a sudden they tank really quickly; it's unclear why.

    Thus, we don't really understand the pathophysiology of this illness, at least not in all people, and we can't accurately predict which clinical pathway any one patient will go on, so it's a bit of a guessing game regarding how to treat them. Many who are put on ventilators do die but I'm skeptical of the notion that the ventilator is actually causing a lot of harm and contributing to death; I think it's more likely they are just in the unlucky group who get progressively sicker and eventually die in spite of what we do. There are tons of studies and research protocols out there now; we'll have a lot more data in the coming weeks.
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    Let's try one link: the Infectious Disease Society of America has just put out some treatment guidelines that will be updated as new data emerges. They recommend HCQ + AZI only be used inpatient as part of a controlled trial. https://www.idsociety.org/practice-g...ZNK4XhPkBup1VE
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    I was just made aware of this resource that appears excellent, I encourage everyone to glance through this: https://www.covidclinical.org
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    Here's a link compiling data on different tests: http://www.centerforhealthsecurity.o...GjWT95vpQ#sec5

    I don't know where this comes from but I saw a link on facebook and it's apparently a chain of emails between different public health experts and officials of some sort: https://int.nyt.com/data/documenthel...t5VH-pA#page=1

    Here is some data from surveillance in Germany showing only 15% of the population in an area with decent spread had antibodies, but the case fatality rate was low at 0.36%. I really don't know what to make of this as these numbers depend on the notion that everyone who was sampled was exposed and it's not clear to me that is the case, but hopefully nonetheless regarding the case fatality rate... less hopeful about developing lasting immunity. https://www.land.nrw/sites/default/f...a3lX5EiaLLWp5s

    A nice link that is attempting to compile dermatologic manifestations of COVID-19: https://www.dermsolutionstx.com/covi...DPTjAwLOHyL6ak
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  28. #148
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    Nice overview of general immunity concepts/questions regarding COVID-19: https://www.nytimes.com/2020/04/13/o...pmT_qtEyCpbaCM

    This study of pregnant women in New York found ~15% were asymptomatically positive. I have questions about this (ie, were they symptomatic at all in the prior month, would they have become symptomatic over the next 1-2 weeks if followed for more than 2 days), but nonetheless this indicates in a hard hit area it should be assumed anyone can be positive and healthcare workers need to act safely accordingly. https://www.nejm.org/doi/full/10.105...FIguaOm3hhwk_4

    There's been talk in many circles online that COVID-19 may be presenting like altitude sickness; here's a nice commentary regarding this: https://www.liebertpub.com/doi/10.10...YCZSDQIhf5hq5w


    In happier news, the last 2 days has seen a decrease in the deaths/day in the US. Hopefully this keeps up.



    Also, online there are lots of conspiracies flowing around COVID-19 and lots of inaccurate things are being written/stated. If anyone here has questions about anything or comes across an article/video and wants my opinion on it, please post it and I'll address it when I'm able to do so.
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    Two more amazing links I was just made aware of:

    For finding all of the latest literature, both peer-reviewed and preprints (you can simply search with no terms entered to see a list of all of the new literature): https://icite.od.nih.gov/covid19/search/

    Compilation of clinical trials & treatment aspects: https://covid.idea.medicine.uw.edu/?...x9hDFxZJfcips8
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  30. #150
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    New study on HCQ; I posted a blurb about it in the R&P so decided I will include it here to:


    Here is a new study in pre-print (not yet peer-reviewed) that is a randomized controlled trial with 150 patients, almost all mild/moderate illness, who were randomized to a high dose of hydroxychloroquine (HCQ) + standard of care (SOC) or to just simply SOC. Most patients began treatment >1 week after symptom onset, many >2 weeks after symptom onset. Overall there was no difference in the decrease in viral RNA shedding over time. There was no difference in symptoms overall, however if they just look at the patients who were not given any other antiviral agents there was a statistically significant improvement in the symptoms of the patients given HCQ, as well as a decrease in the CRP, neither of which are very surprising as HCQ has an antiinflammatory effect. There were more side effects in the HCQ group but these side effects were mild and mainly consisted of diarrhea and vomiting. So, overall, this doesn't indicate that HCQ will help get rid of the virus. There were not enough really sick patients to be able to see if HCQ may help prevent disease progression, so that needs to be evaluated elsewhere. Some people propose using HCQ early in treatment is needed to see a real benefit; that wasn't strongly evaluated here as usually patients were not hospitalized until they have already been sick for ~1 week or so (<15 patients in each arm in this trial began treatment <7 days after symptom onset).

    I just want to point out that if they only published the people who got the HCQ and not the control group that it would be possible to look at it and say: "Wow, they gave ~75 people HCQ, a relatively small percentage had mild side-effects, essentially none had severe side-effects, and almost all of them got better without severe complications! This is an amazing medication!!!". With the control group though it's more clear that the HCQ did not make a significant difference clinically here and failed with respect to the primary endpoint of decreasing viral particle detection. This is why it's so critically important to do controlled trials prior to drawing any type of firm conclusion.

    https://www.medrxiv.org/content/10.1...qnkL18Vk-bMYHE
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