Coronavirus: What questions do you have?

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cwbullet

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Doctors have political beliefs the same as everyone else, and some allow those beliefs to color how they interpret science.
True, but good ones avoid allowing it to flex their practive of medicine. I used to get drug reps who would try to sell me on the new drugs. I rarely used new medication on patients. Too expensive and they are rarely better than the old ones. That being said, you buy most f the medication for my patients. I am especially frugal with our dollars so there much be a true benefit to the patient for me to use these million dollar pills and not just the million dollar bill to the GOVN.
 

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I want to make something clear. I am pro for the research HCQ. I am just not sold yet on all of the claims and would not take it myself.

There too many anecdotal claims that are conflicted in the research. I recommend that you discuss these meds with a medical provider you trust.

There are a number of promising studies on HCQ by itself being reviewed. If they make it through the scrutiny, we might be using it more.
 

Joe Bruce

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There is some intersect. I have now reviewed over 50 studies. I would not fault doctors for using it. For the prevention of infections, it is unclear whether HCQ could flip the bill. Although an option piece, this editorial sums up the findings:
.

I think there might be some benefits to use in an ICU setting.
Thanks for the editorial link! I would note, however, that it only refers to HCQ by itself rather than the cocktail of HCQ + zinc + zithromax. Also, Dr. Risch (and AFD, if people can ignore politics and consider the information itself) only recommend this cocktail as early treatment. As a layperson, it sounds kind of like the role Tamiflu has in influenza, in which case the ICU would be too late to help?

Our findings were plus-minus on this drug. We stopped using it not because of political pressure or FDA warnings. Rather we moved on to medications that were clearly working. Our death rate was just under 70% range with HCQ and is now under 40% with newer cocktails.
Excellent insight -- thanks for sharing. I realize it is "only" anecdotal, but evidence is still part of the scientific process. But, wow! 70% or 40% mortality rates?! My apologies for not understanding the context of your medical practice (I'm sure it is covered elsewhere in this huge thread), but those numbers are post-ICU admission or something, right? Overall mortality rate is nowhere near that for the general population.

The problem with this article is that it is an opinion piece presented with are argument that the definitive treatment for COVID already exists. That is not quite as clear as the good doctor presents.
That certainly seems to be true.

I want to make something clear. I am pro for the research HCQ. I am just not sold yet on all of the claims and would not take it myself.
Again, thanks for the insight! And for an open mind -- I would want my doctor to make decisions based on facts and reason, not politics or emotion.
 

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Thanks for the editorial link! I would note, however, that it only refers to HCQ by itself rather than the cocktail of HCQ + zinc + zithromax. Also, Dr. Risch (and AFD, if people can ignore politics and consider the information itself) only recommend this cocktail as early treatment. As a layperson, it sounds kind of like the role Tamiflu has in influenza, in which case the ICU would be too late to help?
There is next to zero peer reviewed evidence that this cocktail helps prevent infection or the severity of infections. It is based on Chlorquine and nto HCQ and a study from 2003 that wa snot based on Coronavirus but viruses in general.


We really need to no act bu wait till there is more evidence. There is no hurry. The risk is real and significant when combining Azithro and HCQ. Simple enough, it results in an increase in sudden cardiac death. Sure, it is small, but nearly all clinicians live by the Oath: “first do no harm”. A harm by action is clearly worse than a harm by inaction. We have time to gather evidence and peer review it.
 

Joe Bruce

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Thanks for the information. It is also heartening to see that the medical community in general is pursuing research on all of these different treatment options. It is what one would expect, but certainly not the view presented by the media (mainstream or otherwise).
 

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Question: If the # of cases are exploding in a particular state, how can contact tracing keep up? Doesn't it take time to hire and train personnel to do contact tracing? And even if using an app, don't you need people to follow up on the "hits" and get in touch with the contacts?
 

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Question: If the # of cases are exploding in a particular state, how can contact tracing keep up? Doesn't it take time to hire and train personnel to do contact tracing? And even if using an app, don't you need people to follow up on the "hits" and get in touch with the contacts?
Good question. I can only tell you what we do, but it has been touted as a best practice. We do most of our tracing by phone and we have taken volunteers to assist with tracing. We train them. Most of our volunteers are family members of our staff or Red Cross volunteers. We have 6-8 teams on any given day that can do 20-40 tracings per team per day.
 

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Screened a bunch of patients today. Lots of clusters revealed and very poor mask compliance.
I will say that it is slowing. The number screened today was half what we did int he past on a Saturday.
 

cwbullet

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Thank you to everyone: Every post that I answer or read helps me understand how to better answer my customers. This infection has been a grand struggle from all. I hope the maker has mercy on us and lifts this plague, but doubt that will come soon. Keep the questions coming!

I had a guy argue with me today that you can't get this form surfaces. He said CNN reported that you could only get this from aerosols. Just wow, how the public oversimplifies the news message!
 

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I had a guy argue with me today that you can't get this form surfaces. He said CNN reported that you could only get this from aerosols. Just wow, how the public oversimplifies the news message!
There's a big difference between "can't" and "aren't likely."
 

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There's a big difference between "can't" and "aren't likely."
Great question! Lets first look at the exact verbiage from the CDC:

CDC said:
The primary and most important mode of transmission for COVID-19 is through close contact from person-to-person. Based on data from lab studies on COVID-19 and what we know about similar respiratory diseases, it may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this isn’t thought to be the main way the virus spreads.
The key is that close contact physically or without masks is the primary means of passage and not the only means. Our tracing reaveals that poor mask compliance and physical contact can be found in near every case. That does not mean that hand hygiene is not important.

Now to your questions:
  • "Can't" means it will not happen. For example, you can't catch Coronavirus from the burner of a stove that had been heated to 300 degrees or a 70 alcohol solution. Both would destroy the virus.
  • "Less likely" means that is it is not the primary mechanism of infection. It still may only be a small percentage difference but it is less likely. It is the oppositive or "more likely". The "more likely" means of passage is the primary means of catching the infection.
  • "Not or aren't likely" is nto used a lot in medicine or research, but to me, it means that a less than 10-20% chance. If I used this team it was in error.
COVID is less likely to pass by any means other than close contant that involves either Aerosol or physical contact. That does not mean it is not passed at all through surfaces.
 

Bill S

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Safer to assume it can be spread by surfaces and take precautions, I say. :)
 

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We stopped trying to "decontaminate" our groceries, but we're still washing our hands a lot and using hand sanitizer before we touch anything in the car.
 

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We stopped trying to "decontaminate" our groceries, but we're still washing our hands a lot and using hand sanitizer before we touch anything in the car.
We still do the decontamination thing. It’s getting old though. Right now we are most stressed about school starting. It just seems like there is no way it can be done safely with the numbers so high. But we also can’t keep our son home any longer. We are going bonkers!
 

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quote: "We stopped trying to "decontaminate" our groceries, but we're still washing our hands a lot and using hand sanitizer before we touch anything in the car. "

If you want to be thorough, you could clean the bottom of your shoes before you get in the car, using a disinfecting wipe, and hit the top of the shoes as well. I used to do that, but due to my running low on wipes, I've stopped that. Disinfecting wipes are extinct around here; I haven't seen any in a store in about 2 months (and it was single rolls only).
 

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We still do the decontamination thing. It’s getting old though. Right now we are most stressed about school starting. It just seems like there is no way it can be done safely with the numbers so high. But we also can’t keep our son home any longer. We are going bonkers!
The start of school is scaring me. I am very worried.
 

BABAR

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We still do the decontamination thing. It’s getting old though. Right now we are most stressed about school starting. It just seems like there is no way it can be done safely with the numbers so high. But we also can’t keep our son home any longer. We are going bonkers!

Scroll down to #7

The suggestion on groceries made sense, for things that don’t require immediate refrigeration or freezer placement.

Bring the bags that don’t need to go immediately into refrigerator or freezer into the pantry or other out of the way area, and leave them for at least 24 hours (if you have cats, or dogs, or if you have rodents or pests, this may not work.)

Go wash your hands.

Virus lifespan on cardboard is supposed to be less than 24 h, so after 24 h you should be good.

The article also has some other good ideas.
 

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quote: "We stopped trying to "decontaminate" our groceries, but we're still washing our hands a lot and using hand sanitizer before we touch anything in the car. "

If you want to be thorough, you could clean the bottom of your shoes before you get in the car, using a disinfecting wipe, and hit the top of the shoes as well. I used to do that, but due to my running low on wipes, I've stopped that. Disinfecting wipes are extinct around here; I haven't seen any in a store in about 2 months (and it was single rolls only).
Look into a product called KennelSol. We made our own wipes by drying out the baby wipes, then saturate in KennelSol mixed according to directions for anti-viral. It is on the approved list with all the disclaimers:


Problem is it stinks and takes a long time for surface to dry. Use your best judgment.
 

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Right now we are most stressed about school starting. It just seems like there is no way it can be done safely with the numbers so high. But we also can’t keep our son home any longer. We are going bonkers!
Same here.
I am struggling to visualize the virus staying contained in a school setting, but our school district has been very transparent with their plans and efforts (emails, community Zoom sessions, etc). Keeping kids inside the house for another semester is really not desirable either, and would be the last resort.

Our school district is pursuing a "hybrid" half-day schooling strategy (I posted about it somewhere), and is taking all reasonable precautions. I don't really expect them to keep the virus contained indefinitely, but am optimistic they can provide some f2f instruction with responsible precautions (1/2 capacity, everyone is masked, etc), for a while.

I feel our governor and local school board are acting responsibly, with minimal (if any) political considerations.
If I still lived in FL, TX or AZ (BTDT), I would definitely feel very differently.
For more at to why, read here: https://www.washingtonpost.com/nati...ronavirus-arizona-superintendent/?arc404=true

School aside, the ongoing restrictions on indoor sports will be another major challenge this winter. For now, we are keeping them busy with outdoor sports, but most of those will become not viable once the cold weather sets in. As of right now, only swimming has been cleared to move indoors, and even that is conditional on things not getting any worse.
Last winter, all winter sports got cancelled, and slopes closed. I expect more of the same this winter.
 
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We're seeing news about the sleep away camp in GA that ended up with about 50% infection rate, or about 250 children and teenagers infected in one week. That doesn't bode well for schools opening.

Chuck, I was wondering about the counts in California, Florida and TX Versus New York and New Jersey. CA, FL and TX all have higher case counts but significantly lower deaths. The chart below is from NPR.org.

Is it that testing was scarce early on and the actual case counts in NY (and NJ) are higher than what's shown?
Have treatments improved?
Is it that younger people are being infected?
Is it because when NY and NJ were having their outbreaks the seasonal flu was still in full swing and the combo is more deadly?

1596395491806.png
 

afadeev

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We're seeing news about the sleep away camp in GA that ended up with about 50% infection rate, or about 250 children and teenagers infected in one week. That doesn't bode well for schools opening.
We talked about that with our Scouts council this spring.
By and large, all summer / Scout camps are the antithesis of social distancing - the camps are built around encouraging teamwork, group learning, and socialization. I'm both sad, but also glad that we've cancelled all Scout summer camps for this season.

Alternatively, my kids had attended a few indoor camps this summer (robotics, clay something or another). With everyone masked and social distancing enforced, there were no issues, and those camps are still operating without any CV19 interruptions. With proper precautions, indoor instruction can be conducted safely.

10:1, there were near-zero masks and social distancing accommodations at those camps where CV19 had spread exponentially.

Chuck, I was wondering about the counts in California, Florida and TX Versus New York and New Jersey. CA, FL and TX all have higher case counts but significantly lower deaths. The chart below is from NPR.org.

Is it that testing was scarce early on and the actual case counts in NY (and NJ) are higher than what's shown?
Have treatments improved?
Is it that younger people are being infected?
Is it because when NY and NJ were having their outbreaks the seasonal flu was still in full swing and the combo is more deadly?
Likely yes on all of the above, but also consider factor #5:
- There is a significant time lag between infection detection and resolution (positive or negative). In some cases, NE had folks in ICUs and/or on respiratory support for 20-50 days, before resolution.
The mortality curve lags the case detection curve by 2+ weeks. Then add the determination and reporting lags.

More details here:

a
 
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rocketsaway

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The start of school is scaring me. I am very worried.
Hey Chuck, been a long while since I last spoke w/ you. Been trolling this thread for months. Thanks !
But now, I need some insight.
I drive a school bus. And do have a comorbidity. Its about halfway down the list.
Ive always been conscious about washing hands and sanitize for years.
The school district has been leaving VMs about driving in a few weeks. I havnt answered.
The bus company hasnt told me about their protocols, however I found a guideline on the district's website.
All that is mentioned is for parents to ck kids for symptoms , only 2 to a seat (90% of the time that is the normal), the 2 front seats shall remain empty, loading from back to front (thats not going to happen), wear masks and to open bus windows if weather permits.
Being on the Mid Atlantic coast, it rains alot and gets cold. You can't drive buses in the rain w/ the windows open, everyone will get wet.
Also, buses will be sanitized after every run. That usually means the drivers will do it.
In other words, the only difference is the wearing of masks. But, they are splitting class in half, during the week, until Nov.
That may or may not cut bus loads down.

Ive read alot on airborne transmission studies. IE.. South Korean call center, Guangzhou restaurant, etc..
And recently started to wear a 3M 07048 N95 particulate mask, instead of cloth. Leftovers from the days of painting rockets.

Is wearing that 3M particulate N95 mask and nitrile gloves, in a enclosed area along with possible mask wearing, noisy, asymptomatic kids, enough for my protection ?
Or should I call it quits for a year or two and move to the Alaskan wilderness ?
 

cwbullet

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Is wearing that 3M particulate N95 mask and nitrile gloves, in a enclosed area along with possible mask wearing, noisy, asymptomatic kids, enough for my protection ?
Or should I call it quits for a year or two and move to the Alaskan wilderness ?
Yes and possibly. The protection is good as long as you maintain it. The problem is scratching and doning and doffing.
 

rocketsaway

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Yes and possibly. The protection is good as long as you maintain it. The problem is scratching and doning and doffing.
What's bothering me the most is when the windows will need to be closed due to inclement weather. Ventilation.

The scratching part, yes I have a tendency to rub my eyes. I wear glasses. Maybe adding a plastic shield to prevent that.
Doning and doffing, maybe some coveralls or jumpsuits.
 

NOLA_BAR

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Hey Chuck, been a long while since I last spoke w/ you. Been trolling this thread for months. Thanks !
But now, I need some insight.
I drive a school bus. And do have a comorbidity. Its about halfway down the list.
Ive always been conscious about washing hands and sanitize for years.
The school district has been leaving VMs about driving in a few weeks. I havnt answered.
The bus company hasnt told me about their protocols, however I found a guideline on the district's website.
All that is mentioned is for parents to ck kids for symptoms , only 2 to a seat (90% of the time that is the normal), the 2 front seats shall remain empty, loading from back to front (thats not going to happen), wear masks and to open bus windows if weather permits.
Being on the Mid Atlantic coast, it rains alot and gets cold. You can't drive buses in the rain w/ the windows open, everyone will get wet.
Also, buses will be sanitized after every run. That usually means the drivers will do it.
In other words, the only difference is the wearing of masks. But, they are splitting class in half, during the week, until Nov.
That may or may not cut bus loads down.

Ive read alot on airborne transmission studies. IE.. South Korean call center, Guangzhou restaurant, etc..
And recently started to wear a 3M 07048 N95 particulate mask, instead of cloth. Leftovers from the days of painting rockets.

Is wearing that 3M particulate N95 mask and nitrile gloves, in a enclosed area along with possible mask wearing, noisy, asymptomatic kids, enough for my protection ?
Or should I call it quits for a year or two and move to the Alaskan wilderness ?
I have been wearing an N95 mask covered with a simple cloth mask or folded bandanna. In case I accidentally touch the mask I’m touching the cloth cover which can be washed. Keep outside air flowing in your driver area. Open the vents to the outside instead of recirculated. Look to see if there are small fans that you can place to pull in the outside air. The school bus that I remember riding the driver had a sliding window, keep that thing open or cracked. If there is a seat behind you keep it unoccupied.

If you can afford it take a sabbatical. Not worth the risk. We have teachers and professional football players sitting this one out.
 

cwbullet

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Is it that testing was scarce early on and the actual case counts in NY (and NJ) are higher than what's shown?
Have treatments improved?
Is it that younger people are being infected?
Is it because when NY and NJ were having their outbreaks the seasonal flu was still in full swing and the combo is more deadly?
Is it that testing was scarce early on and the actual case counts in NY (and NJ) are higher than what's shown?
Good question. Here, we are testing more than we should. I do not think there is a shortage of testing in all areas.

Have treatments improved?
Yes. Especially for ventilated and ICU patients. No much change for the rest. Symptom control and wait and see for the most part. A lot of folks are anecdotally suggesting treatments to reduce progression but not much research to back it.

Is it that younger people are being infected?
Yes. Mild infection but they are catching it. Our tracing reveals they are bringing it home to partents and grandparents.

Is it because when NY and NJ were having their outbreaks the seasonal flu was still in full swing and the combo is more deadly?
That is what we fear, but we still do not know.
 

OverTheTop

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We stopped trying to "decontaminate" our groceries, but we're still washing our hands a lot and using hand sanitizer before we touch anything in the car.
I was at the supermarket yesterday and observed a customer touching her mask quite solidly, then going back to another aisle and putting a can of tomatos back and picking up other tins before finally deciding on a particular can. You may want to reconsider your decon.

We have just gone into lockdown here, including an overnight curfew. We are spiking badly, with around 600 extra cases per day in our city (5.5 million people).
 
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