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cwbullet

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Dexamethasone demand higher than supply:


This is interesting because there is limited support to treating steroids as an outpatient and that is what most hospitals are doing ti treating patients on request with pills. On a positive note, prior research on other diseases shows that IV is rarely superior or oral steroids. They tend to be equivalent.
 

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Given propensity for clotting, is anyone recommending aspirin or antiplatelet agents at time of diagnosis?
 

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Given propensity for clotting, is anyone recommending aspirin or antiplatelet agents at the time of diagnosis?
Yes and no. It is controversial. The Cleaveland Clinic has said takin git is dangerous.


I would agree that children should not take it. I am undecided on adults. That being said, there is a large clinical trial to look at it.

 

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Update for today: Yesterday, GA hit 2000. An interesting study released this week that should Colchicine mine protects the heart and reduce inflammation in COVID infections.
That piece about Colchicine is interesting to me because I take it occasionally for gout. Hopefully there is not a big run on it!

One thing about that drug is it can definitely give you diarrhea and nausea depending on dose. Obviously that is a small concern for someone who needs it to survive. But let this be a warning to the Chloroquine hoarders and bleach garglers — start popping colchicine, you might crap your pants!

Another factoid about Colchicine is that it has been around so long that when the FDA approval process was first created, certain drugs with a long history were grandfathered in, so things like aspirin and colchicine did not go through the FDA approval process that a new drug would go through now. And those kinds of drugs have always been very cheap. Maybe 10 years ago or so, the FDA decided they wanted to have colchicine go through FDA approval, and one pharmaceutical company took the drug through the approval process. That gave that company exclusive rights to sell colchicine in the US. So in one day, the price of colchicine went from around 10 cent per pill up to 4 or 5 bucks each. The price increased by a factor of 40 or 50. The refill that cost me $6 or less suddenly cost $240 or more. Since then, I’ve always purchased partial refills of maybe 15 pills instead of the 60 that the prescription is always written for. It’s something I need to keep on hand and use immediately when I sense a gout attack coming on. But it doesn’t happen very often, so I sometimes end up having to just trash some of it due to expiration. It‘s kind of irritating to have to toss out $100 worth of medicine knowing it really only cost $2 to manufacture it.
 

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Given propensity for clotting, is anyone recommending aspirin or antiplatelet agents at time of diagnosis?
Ask your doctor. Every person in these scenarios are type A blood. My mother's doctor did NOT recommend aspirin regimen therapy. But a friend who "poorly timed" his heart attack (his wording, ROFL!) is already on a blood thinning regimen and had an appointment with his cardiologist. During the Zoom appointment, the cardiologist spoke to my friend's wife who is not yet able to see her doctor. The cardiologist gave her a questionnaire, then advised my friend's wife to consider taking a daily 81 mg aspirin for the duration of this plague. Not a prescription, but certainly a recommendation. There are so many things to consider.
 

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That piece about Colchicine is interesting to me because I take it occasionally for gout. Hopefully there is not a big run on it!

One thing about that drug is it can definitely give you diarrhea and nausea depending on dose. Obviously that is a small concern for someone who needs it to survive. But let this be a warning to the Chloroquine hoarders and bleach garglers — start popping colchicine, you might crap your pants!

Another factoid about Colchicine is that it has been around so long that when the FDA approval process was first created, certain drugs with a long history were grandfathered in, so things like aspirin and colchicine did not go through the FDA approval process that a new drug would go through now. And those kinds of drugs have always been very cheap. Maybe 10 years ago or so, the FDA decided they wanted to have colchicine go through FDA approval, and one pharmaceutical company took the drug through the approval process. That gave that company exclusive rights to sell colchicine in the US. So in one day, the price of colchicine went from around 10 cent per pill up to 4 or 5 bucks each. The price increased by a factor of 40 or 50. The refill that cost me $6 or less suddenly cost $240 or more. Since then, I’ve always purchased partial refills of maybe 15 pills instead of the 60 that the prescription is always written for. It’s something I need to keep on hand and use immediately when I sense a gout attack coming on. But it doesn’t happen very often, so I sometimes end up having to just trash some of it due to expiration. It‘s kind of irritating to have to toss out $100 worth of medicine knowing it really only cost $2 to manufacture it.
I had a friend who worked on a weight loss drug for Roche many years ago, and during a meeting at Roche HQ in Basal he informed the management that Americans will not take this drug. They asked why as it worked well, so he explained that a know side effect is that when you are taking this and eat a high fat meal, you basically WILL crap your pants. The management thought that this would be extra encouragement to stick to the diet part of the plan, so my friend explained that Americans will not completely give up cheeseburgers, and the only two side effects they absolutely will not tolerate is crapping themselves, or having their "appendage" fall off. The drug sold great in the first quarter of release, and barely ever again.

The FDA program that granted that exclusivity sounded like a great idea at the time as strictly run clinical trials are a great way to figure out the low occurrence side effects, and also firmly establish the degree of the drug's effect. Unfortunately, it has been the source of some of the most heinous pricing events in recent times. Drugs are expensive for a lot of reasons (some good, some not...I am no pharma apologist), but one of the main good reasons is that a lot of drugs don't work when you try them in large, massively expensive clinical trials (despite looking really good to that point), so you price those failures and the risk of future failures into the things that do work. When doing a trial on a know effective drug that risk of a failed trial is pretty much reduced to your team's ability to execute the trial, and I'm not aware of a trial of this nature that has failed. Therefore, applying the same "pricing in the risk" to this type of drug is complete BS as the risk of failure is so low, and pretty much only based on your own competence.
 

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Ask your doctor. Every person in these scenarios are type A blood. My mother's doctor did NOT recommend aspirin regimen therapy. But a friend who "poorly timed" his heart attack (his wording, ROFL!) is already on a blood thinning regimen and had an appointment with his cardiologist. During the Zoom appointment, the cardiologist spoke to my friend's wife who is not yet able to see her doctor. The cardiologist gave her a questionnaire, then advised my friend's wife to consider taking a daily 81 mg aspirin for the duration of this plague. Not a prescription, but certainly a recommendation. There are so many things to consider.
Absolutely. Not many studies out there, but I am sure they are starting them.
 

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What kind of time are you seeing for turnaround on a test, Chuck? I ask because I know of 2 people who were symptomatic when tested on Monday, and their tests are still not back. The people they were in contact with can’t get tested because they are requiring that people be first responders/health care workers, symptomatic or the potential exposure have a confirmed positive test.

The numbers for Dallas county had me worried, and now with the realization that they are probably a week behind has me real worried. The other DFW counties are getting out of hand too, including Tarrant which is catching up in cases despite being 500k less people...this Is not going well. From what I can tell Houston is even further along than we are, but in true Dallas fashion, we can’t be outdone by Houston, so we are digging hard to catch up.

On a related note, I check clinicaltrials.gov everyday to see if Moderna is enrolling their P3 vaccine trial yet, because I am volunteering for that thing Day 1. I like their data, and see their attempt as a home run swing instead of a bunt single like the Oxford/AZ vaccine. Everyone who steps up to be in a clinical trial gets this thing over that much faster.
 

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What kind of time are you seeing for turnaround on a test, Chuck?
2-4 hours for our facility and less than 24 for any that are sent to us by FEDEX.


On a related note, I check clinicaltrials.gov everyday to see if Moderna is enrolling their P3 vaccine trial yet, because I am volunteering for that thing Day 1. I like their data, and see their attempt as a home run swing instead of a bunt single like the Oxford/AZ vaccine. Everyone who steps up to be in a clinical trial gets this thing over that much faster.
I hope we have vaccine soon.
 

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I had a friend who worked on a weight loss drug for Roche many years ago, and during a meeting at Roche HQ in Basal he informed the management that Americans will not take this drug. They asked why as it worked well, so he explained that a know side effect is that when you are taking this and eat a high fat meal, you basically WILL crap your pants. The management thought that this would be extra encouragement to stick to the diet part of the plan, so my friend explained that Americans will not completely give up cheeseburgers, and the only two side effects they absolutely will not tolerate is crapping themselves, or having their "appendage" fall off. The drug sold great in the first quarter of release, and barely ever again.

The FDA program that granted that exclusivity sounded like a great idea at the time as strictly run clinical trials are a great way to figure out the low occurrence side effects, and also firmly establish the degree of the drug's effect. Unfortunately, it has been the source of some of the most heinous pricing events in recent times. Drugs are expensive for a lot of reasons (some good, some not...I am no pharma apologist), but one of the main good reasons is that a lot of drugs don't work when you try them in large, massively expensive clinical trials (despite looking really good to that point), so you price those failures and the risk of future failures into the things that do work. When doing a trial on a know effective drug that risk of a failed trial is pretty much reduced to your team's ability to execute the trial, and I'm not aware of a trial of this nature that has failed. Therefore, applying the same "pricing in the risk" to this type of drug is complete BS as the risk of failure is so low, and pretty much only based on your own competence.
Xenical? My NP tried it and decided to eat a chili cheese dog. Got through the day until she left for home from work. When she hit the door, the diarrhea hit and she just made it up the steps to the WC. The stool was foul smelling, frothy with fat globules in it. It stained their pricey expensive toilet bowl too.
Husband came home and muttered some expletive about the smell and she had already put an exhaust fan in the upstairs bathroom window to try to get the stink out. Last time she tried falling off the recommended low fat diet while taking Xenical.

Yeah, I remember when colchicine went "off generic". Ticked me off royally as patients were getting gouged royally. I think its been around since the 50's.
Kurt
 

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Who needs a COVID test?

When we first started hearing about COVID-19 in the U.S., the symptoms of the virus were released and they have shifted and so should testing. My hospitals has started testing just about everyone that wants a test and is willing to live with the expectations. Not everyone is testing so wide a group. Many are using the CDC criteria for testing. The testing is pretty straightforward. Basically, if you have a fever and a cough, get tested. It is nto quite that simple, but you get the idea. Below is a graphic with a full list of symptoms:

maxresdefault.jpg


If I have the symptoms, do I have to be tested? No. I recommend it. Testing the high-risk patient or to confirm tracing is essential, but if you are low risk, you and your medical provider can decide to perform the test. Test or no test, you should be prepared to stay home and quarantine. Currently, anyone who receives a test positive should prepare to stay home fro 14 days. We quarantine all those tested for 14 days and we are beginning to do the same for those that are not tested. It is done to prevent infections. If you work in a high-risk environment like a hospital or a prison you might qualify for testing even without symptoms. This testing is to reduce risk

Each state sets its own standards for who can obtain a COVID-19 test. This situation partly stems from the early shortage of tests, which required authorities to prioritize who could and could not receive testing. In some places, these shortages have eased, but that doesn’t mean everybody now can go out and get tested.

Florida guidelines state that doctors and county health department officials will determine, on a person-by-person basis, who can get tested for COVID-19.
In all states, people with symptoms of the coronavirus receive priority for testing. If you’re symptomatic, call your primary care provider for instructions on how and where to get tested. If you’re not symptomatic, then your local guidelines will determine whether or not you can get tested. To find out if you’re eligible for a test, look on your state’s website.
 

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Chuck, Florida is now testing just about anyone, at least in my county. Some test centers have certain requirements but our county health department will test anyone with no prerequisites, just need an appointment, no ID required. I have had 2 in last 2 weeks as I’m trying to travel to Bahamas and they require one before entry and you have a 10 day window to enter otherwise need to retest. Trying to travel by boat and boat has not been cooperative.
 

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Chuck, Florida is now testing just about anyone, at least in my county. Some test centers have certain requirements but our county health department will test anyone with no prerequisites, just need an appointment, no ID required. I have had 2 in last 2 weeks as I’m trying to travel to Bahamas and they require one before entry and you have a 10 day window to enter otherwise need to retest. Trying to travel by boat and boat has not been cooperative.
That is pretty much what I understand. Sorry if I confused it.


At least two vaccines are well on their way.
 

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Update; With over a week of GA hovering around and above 2K, it finally hit. GA overrun with patients. Huge numbers with large waits. Not overrun with admissions yet. Our local facility is deciding whether to move the tent operations indoors. The staff is tired of the heat. I had an AC tent but it failed to work for the last week.
 

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Can’t say there are not a lot of ideas.

I can’t say I know a lot nor could I have an educated answer. This sounds good, but I need to defer this question. You stumped the chump.
 

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One thing that would worry me is do those nanosponges accumulate in your body (ie, can the body get rid of them), and would they cause even more harm to the waterways and oceans when they get into the wild. Yeah, I get that they are "biodegradeable", but still...
 

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One thing that would worry me is do those nanosponges accumulate in your body (ie, can the body get rid of them), and would they cause even more harm to the waterways and oceans when they get into the wild. Yeah, I get that they are "biodegradeable", but still...
I would agree with your first concern. Anything “nano” in the body gives pause. As for getting into the environment I would think it would be minuscule compared to the millions of tons of plastic that is already out there, however that “nano” property again? Getting anything like that into the food chain.
 

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I can’t say I know a lot nor could I have an educated answer. This sounds good, but I need to defer this question. You stumped the chump.
Oops! It seems like a lot of technologies are being moved along more quickly than normal. It will interesting what medical innovations mature more quickly from this pandemic.
 

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Update: GA had 1800 new infections. Admissions remain low. My facilities doubled the positive tests in 2 weeks. The numbers are down in the past 24 hours but still 13 times higher than our average the prior 3 months. I hope we see a milder July.

I want to encourage people to remain physically active. 2-6 months of sedentary lifestyle can be devastating.

 

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Tidbit from WHO: A couple of new medical sources are identifying a new H1N1 that may hit us with Coronavirus. The new Influenza called G4 is hitting workers at pig slaughterhouses in China. It appears that WHO is finally cooperating with the release of information in a more timely manner. This might be the sequel China Flu 2.

Good news from research, UVA had identified a new test that can accurately predict the severity of the infection using a marker for cytokines. Hopefully, it will be available on a EUA by fall.
 

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I want to encourage people to remain physically active. 2-6 months of sedentary lifestyle can be devastating.

I can say from personal experience this is true. We went to great lengths to get out and walk 45-60 mins a day, just to get the heck out of the house so we wouldn't go totally house-crazy, but we weren't able to do our normal gym routines. Our aerobic condition went to crap, and we're struggling to catch up, now that the gym is open. Same with strength - we didn't have any significant weights here we could use to keep our strength up. I think that the physical strength is going to take longer to catch up on; the aerobic capacity is coming back faster than I expected.

It is also very difficult to wear a mask in the gym while working out, even just using the weight machines, so its a roll of the dice every time we go in, but we really need to.
 

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I can say from personal experience this is true. We went to great lengths to get out and walk 45-60 mins a day, just to get the heck out of the house so we wouldn't go totally house-crazy, but we weren't able to do our normal gym routines. Our aerobic condition went to crap, and we're struggling to catch up, now that the gym is open. Same with strength - we didn't have any significant weights here we could use to keep our strength up. I think that the physical strength is going to take longer to catch up on; the aerobic capacity is coming back faster than I expected.

It is also very difficult to wear a mask in the gym while working out, even just using the weight machines, so its a roll of the dice every time we go in, but we really need to.
Get out and walk and get that heart pumping but do so with some guidance from a clinician if you have not done it in 60-90 days. Start slow and work up to more minutes.
 

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Get out and walk and get that heart pumping but do so with some guidance from a clinician if you have not done it in 60-90 days. Start slow and work up to more minutes.
We usually walk our dogs daily. In the winter it was typically at least two miles. Lately, it's at least three. This morning was four.
 
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