Preparing for COVID-19

[ian]

In the WSJ yesterday it was explained how HC became used as a treatment, first in Wuhan (of course). Basically in Wuhan the Drs noticed that none of the patients in their hospitals who has lupus and were being treated for it with HC (or C I can't remember) came down with Covid. Realizing they were all being treated for their lupus with HC or C they started using that to treat Covid patients.

Indeed, that's interesting, and perhaps it was a good wartime decision then to start using it! But while talking about this, let's keep in mind that this is like the complete opposite of a clinical trial...

What is "HC" and "C"?

HC = hydroxychloroquine
C = chloroquine

 

[CiderBear]

Homeless people in Las Vegas bed down for the night, in marked areas that maintain minimum distance in a parking lot that opens at 6:00 pm and closes at 8:00 am.
View attachment 75515
The homeless are given a mat and blanket that get disinfected every day, while 150,000 hotel beds are empty in Las Vegas.

Honestly though, a lot of homeless people are homeless because of mental illness and they cannot (read: refuse to) stay inside. They will destroy that hotel room if you put them in it, and possibly endanger staff.

I'm all for converting hotel rooms into *something* (makeshift hospitals, quarantine zones for cruise ships, domestic violence shelters, temporary residence for doctors and nurses and other frontline workers so they don't put their families at risk, housing for traveling nurses, etc), just don't think homeless camps are a good use for them.

 

[Michi]

Right, thanks.

Yes, no doubt, vitamin C and Coke may well be the answer. Someone please call the governor of New York. And the Italian and Spanish prime minister. And Angela Merkel. Because they need all the help they can get right now.

 

[Michi]

Honestly though, a lot of homeless people are homeless because of mental illness and they cannot (read: refuse to) stay inside. They will destroy that hotel room if you put them in it, and possibly endanger staff.

I acknowledge the point.

The US is one of the richest countries (if not the richest country) on earth. I honestly cannot think of any other first-world country that treats its poor and under-privileged with as little compassion.

Some cooperation between the public and the private sector could go a long way.

 

[ian]

Honestly though, a lot of homeless people are homeless because of mental illness and they cannot (read: refuse to) stay inside. They will destroy that hotel room if you put them in it, and possibly endanger staff.

I'm all for converting hotel rooms into *something* (makeshift hospitals, quarantine zones for cruise ships, domestic violence shelters, temporary residence for doctors and nurses and other frontline workers so they don't put their families at risk, housing for traveling nurses, etc), just don't think homeless camps are a good use for them.

Hmm, not sure I'm comfortable speaking for the homeless in full generality here. Maybe some of them have a fear of confinement, but I've known a couple people that were homeless when they were kids, and I don't think they would say that they wanted to live on the streets.

 

[Michi]

HC = hydroxychloroquine
C = chloroquine

Ah, of course.

I agree, we have way too little data at this point.

If this turns out to be the miracle cure, that would be awesome. I won’t be holding my breath though. We’d have to be insanely lucky for things to be as simple as that.

 

[CiderBear]

Hmm, not sure I'm comfortable speaking for the homeless in full generality here. Maybe some of them have a fear of confinement, but I've known a couple people that were homeless when they were kids, and I don't think they would say that they wanted to live on the streets.

That's why I said domestic violence shelters. A lot of people can't safely stay home with their kids during shelter-in-place orders, unfortunately.

 

[Bert2368]

Back in the 1980s, the several Republican administrations took steps which resulted in our chronically mentally ill population being de institutionalized (they put them out on the streets and quit offering inpatient care to) just about all the non violent CMI people in USA to save money they thought would be better spent on the military and tax cuts to big investors and wealthy campaign donors. "Read my taxes, no more lips".

The Democrats went along with it because they conned themselves into thinking such people needed "freedom" from being involuntarily or voluntarily institutionalized more than a place to live and effective care.

I watched it happen. The people who formerly lived in an institution just North of where I went to college were suddenly wandering the streets and Capitol square talking to themselves and swapping their meds with eachother, they re-named one of the local drug stores where they hung out at the soda fountain after their old common room at the institution.

From there, the rest of the measures taken to bring the USA's work force to heel (globalization, outsourcing, NAFTA, maquiladora factories) added to the homeless population.

There are a fair number of CMI people on the streets. If you weren't when you got put on the street, it's not uncommon to end up that way after a while.

 

[WildBoar]

The US is one of the richest countries (if not the richest country) on earth. I honestly cannot think of any other first-world country that treats its poor and under-privileged with as little compassion.

Some cooperation between the public and the private sector could go a long way.

As usual, it is a lot more complicated than that. I wrote more, but deleted it.

 

[ian]

That's why I said domestic violence shelters. A lot of people can't safely stay home with their kids during shelter-in-place orders, unfortunately.

Sure, but not everyone who doesn't have a home (and doesn't have a fear of confinement or something) is a victim of domestic violence either. It's all good, though. I agree this is a hard problem. I just didn't want to have it out there that noone who's sleeping in the parking lot would benefit from an actual room.

Back in the 1980s, the several Republican administrations took steps which resulted in our chronically mentally ill population being de institutionalized (they put them out on the streets and quit offering inpatient care to) just about all the non violent CMI people in USA to save money they thought would be better spent on the military and tax cuts to big investors and wealthy campaign donors. "Read my taxes, no more lips".

The Democrats went along with it because they conned themselves into thinking such people needed "freedom" from being involuntarily or voluntarily institutionalized more than a place to live and effective care.

I watched it happen. The people who formerly lived in an institution just North of where I went to college were suddenly wandering the streets and Capitol square talking to themselves and swapping their meds with eachother, they re-named one of the local drug stores where they hung out at the soda fountain after their old common room at the institution.

From there, the rest of the measures taken to bring the USA's work force to heel (globalization, outsourcing, NAFTA, maquiladora factories) added to the homeless population.

There are a fair number of CMI people on the streets. If you weren't when you got put on the street, it's not uncommon to end up that way after a while.

Yea, it's pretty heartbreaking.

 

[Matus]

... guys, keep the politics out please ...

 

[M1k3]

Honestly though, a lot of homeless people are homeless because of mental illness and they cannot (read: refuse to) stay inside. They will destroy that hotel room if you put them in it, and possibly endanger staff.

I'm all for converting hotel rooms into *something* (makeshift hospitals, quarantine zones for cruise ships, domestic violence shelters, temporary residence for doctors and nurses and other frontline workers so they don't put their families at risk, housing for traveling nurses, etc), just don't think homeless camps are a good use for them.

Can confirm some don't want to be inside/confined. My mom was mentally ill and couldn't handle living in a place with other mentally ill people. She decided to live in a motorhome. Then she could move away from bad "neighbors". I also understand that this isn't the case for everyone. Everything from drugs, to losing everything because the economy and banks. And everything in between.

 

[Luftmensch]

Homeless people in Las Vegas bed down for the night, in marked areas that maintain minimum distance in a parking lot

Wow... very sad. On the one hand, homeless shelters are underfunded and have been stripped to the bone - they aren't resourced well enough to handle an (epi/pan)demic. It probably is better to shutdown the facility rather than let it operate as a petri dish. On the other... a parking lot with painted squares is far from adequate.

You would think a humane program for the homeless wouldnt even be 'rounding error' when $2.2T is being bandied about.

Yikes. Poor people...

 

[M1k3]

It's dehumanizing also.

 

[Bert2368]

Here and there, heartwarming stories which restore your hope for the human race:

In Brazil, President Jair Bolsonaro flouted the government’s recommendation to stay indoors, and gangs in Rio de Janeiro enforced their own lockdown. “If the government won’t do the right thing, organized crime will,” their official statement read.

https://harpers.org/2020/03/rikers-island-covid-cases-orban-pollution/

Who knew Brazilian organized crime in Rio had an official spokesperson?

Caution is temporary
Viral Infection lingers
Stay indoor folks
Or we break your fingers

 

[VICTOR J CREAZZI]

Is it my imagination, or is traffic way down on the forums?

 

[ian]

New membership seems way up. Or at least, that's my completely uninformed impression from seeing lots of new member posts yesterday/today.

 

[McMan]

Is it my imagination, or is traffic way down on the forums?

No phone app anymore... unless something else is going on?

 

[ian]

I do alternately find it hard to think about knives (what with all the childcare and the lack of time to do my real work and the obsessing over the news) and then hard to think about anything but knives.

Now I'm convinced I need to spend >$400 on a ~250mm suji, even though I'm sure I'd hardly ever use it. Not many big cuts of protein to portion in this house, unfortunately. I bet the knife would average out to like $1 per cut over the first year or two.

 

[thermophile]

Seriously tho, I've been taking calls for myself doh since this nonsense started. And not a single day goes by that some one doesn't call demanding to speak with the governor with some homeopathic cure. It's really agrevating because I'm on a virus information hotline and I'm trying to help sick people get tested not field cures from the mentally deficient. ( This was supposed to be a reply. Lol)

 

[Matus]

@thermophile be strong, it must be tough on the hotline. There are always people who will call in just to share their nonsense theory or want to preach about the bleach, or some other cure. You are doing a very important job.

 

[thermophile]

@thermophile be strong, it must be tough on the hotline. There are always people who will call in just to share their nonsense theory or want to preach about the bleach, or some other cure. You are doing a very important job.

Thanks, I appreciate it. It's not too difficult tbh, mostly tedious. It's all such a mess.

 

[HRC_64]

Quick update re:HydroxyChloroquine

MDs either are clearly idiots and don't know anything about medical trials work, or on the contrary, they understandind RCT data is simply unavailable for large swathes of medical conditions and they are trained to use clinical judgement in the context of imperfect information.

>NYT - Published March 24, 2020
>States Say Some Doctors Stockpile Trial Coronavirus Drugs, for Themselves
https://www.nytimes.com/2020/03/24/business/doctors-buying-coronavirus-drugs.html


Translation:

"there is no [evidence] this works"
"there is no [scientific] evidence this works
"there is no [RCT ] evidence this works
<you are now here>
"OK there is no [GOOD quality] evidence this works
[still waiting for this]

 

[HRC_64]

One week later...31 March, 2020

First decent RCTs are out today...
https://blogs.sciencemag.org/pipeline/archives/2020/03/31/comparing-chloroquine-trials

As for adverse events, neither trial reported anything serious...for now hydroxychloroquine is in the “...might do some good” category, which under the current conditions seems sufficient for treating patients.... You will notice that we are not exactly in the “total cure” category that the Marseilles group has been putting itself in, but....

 

[HRC_64]

Curioulsy, revisions/stealth edits that now appear to Washington post's version of the NY Times article from last week...
WAPO-March 23, 2020 at 2:02 PM EDT
>https://www.washingtonpost.com/busi...t-supplies-an-unproven-coronavirus-treatment/

1) As [POTUS] touts an unproven coronavirus treatment, supplies evaporate for patients who need those drugs
2) Lack of definitive evidence has not stopped exploding demand for chloroquine and hydroxychloroquine
3) A run on [...?...] anti-malaria drugs chloroquine and hydroxychloroquine has wiped out supply of potential coronavirus treatment

 

[Dave Martell]

 

[Nemo]

One week later...31 March, 2020

First decent RCTs are out today...
https://blogs.sciencemag.org/pipeline/archives/2020/03/31/comparing-chloroquine-trials

Note while that these 2 trials did not have any serous side effects, they are small trials. There are a total of 231 in the treatment arms (the patients actually receiving the drug) across the 2 trials. This may be enough patients to detect a thrapeutic efffect if the effect is large, but probably not if the effect is small. It certainly is not enough to detect uncommon but catastrophic side effects. The statistcians would say that the trials are not powered do detect those side effects.

 

[pistachio]

One week later...31 March, 2020
First decent RCTs are out today...
https://blogs.sciencemag.org/pipeline/archives/2020/03/31/comparing-chloroquine-
trials

for now hydroxychloroquine is in the “...might do some good” category, which under the current conditions seems sufficient for treating patients

The Zhejiang study was out a week ago, and found no difference between the groups. Quite small numbers and a strong response in the control group make it difficult to conclude much one way or the other. The new data is the Wuhan study, which managed to enroll more people, and they seem to be showing at least some benefit to treatment. It's still a very small study and the effect looks to be a long way from a cure, but hopefully it holds up. The only way we're going to find out is with larger controlled studies.

Also, I think you left out a very important part of a sentence you quoted from the Pipeline post, which changes the meaning. The actual quote is (emphasis added in bold):

So as long as such patients [with cardiac arrhythmias] are excluded, for now hydroxychloroquine is in the “might do nothing, might do some good” category, which under the current conditions seems sufficient for treating patients, pending further data.

 

[HRC_64]

Here's another one...Wed 25 Mar 2020 00.26 EDT

Australian doctors warned off after prescribing potentially deadly Covid-19 trial drug to themselves

Drugs regulator cracks down on ability to prescribe anti-malarial hydroxychloroquine

Hydroxychloroquine and chloroquine have potentially severe and even deadly side effects if used inappropriately, including heart failure and toxicity. Some Australian media outlets have wrongly reported the drug as a “cure” for the virus even though trials have been either inconclusive or too small to be useful, have only been conducted in test tubes, are not yet complete, or have not even received ethics approval.

Genuinely puzzled if they think reporters know this and doctors are too dumb to figure it out?

 

[Luftmensch]

Yeah... I am not sure if I can even ask, because I think the answer is political... but: why is hydroxychloroquine being spruiked as the 'duck's nuts'?

One of Australia's politicians* is being investigated by the TGA for this...


* Australia has a fairly egalitarian election system. Historically, the number of cases where a person has 'bought' their way into parliament is extremely low. The politician being investigated is one of those rare cases: A mining magnate who has the resources to throw large some of money at marketing.