Coronavirus: What questions do you have?

[Marc_G]

We anticipate all schools in our area will go a virtual by mid fall if not sooner. It's a hybrid situation for most kids in our area now, but our kids chose virtual schooling for the semester. They will do fine and we are fortunate for having options.

 

[manixFan]

And that's going to be a freaking problem. One kid exposes the entire class (12 in the case of my son's classroom size), all 12 kids and their entire immediate families have to quarantine for 2-3 weeks. My wife is an essential worker (pharmacist), and she is particularly vulnerable, as am I. But we basically have to send my son back to school, as a) he is developing psychological issues being home all the time and not seeing any of his friends much, and b) he doesn't do well with the distance "learning" no matter how much we ride his butt to study. The materials just don't "click" with him as well as with in-person instruction.

I'm missing your point, what are you suggesting as an alternative? Not having students and teachers isolate after potential exposure? If your son is exposed, and then exposes your wife, are you saying she should not have to quarantine until she is sure she is not sick?

If we had enough capacity to routinely test everyone at risk, we could avoid these issues. Without that, what option is there to quarantining?


Tony

 

[NOLA_BAR]

The back to school thing is very stressful. My wife lost her job back in the spring which was fortuitous timing as everything locked down and schools went online. I was fully expecting to have him start homeschool this fall, except my wife has a job offer. Talk about a twisted up world when you dread a job offer. All my common sense was against sending him back to the classroom. Out of his class only 2 went virtual or homeschool. His school is small, so mitigating is easier, but sooner or later it’s gonna happen.

And that's going to be a freaking problem. One kid exposes the entire class (12 in the case of my son's classroom size), all 12 kids and their entire immediate families have to quarantine for 2-3 weeks. My wife is an essential worker (pharmacist), and she is particularly vulnerable, as am I. But we basically have to send my son back to school, as a) he is developing psychological issues being home all the time and not seeing any of his friends much, and b) he doesn't do well with the distance "learning" no matter how much we ride his butt to study. The materials just don't "click" with him as well as with in-person instruction.

Same here with my son. Homeschool/Distance learning too many distractions at home. We said no play dates and stayed away from family and friends all summer. You could tell the changes in personality in the whole family. My wife lost her consulting work last spring, which was fortuitous with the lockdown and schools closed. Now she has a job offer so it was a tough decision either way. What a goofball world where people are out of work and a job offer gives you this much stress.

 

[cbrarick]

The plan is many locations is to do pooled testing. You test an entire class with a single salivary test. It saves a lot of money and it the vial is negative, all of the class is negative. You sequester or cohort the group until the test comes back. It is highly useful after a break.

If they come up positive, you test the whole group as singles to find the affected persons.

sounds perfectly insane. How do you test everyone with a single test? How can you be certain that there's a contribution from everyone in the class and that there is enough of a contribution to identify a single positive person. Show me the data that this will work.

Also, anyone who's positive would be quarantined, and by extension their families, siblings, the classmates of the siblings. Not at all realistic way to reduce the spread of disease

Problem is that we need to GIVE UP on ways to justify the risk of starting "in person" schools and spend our energy and talent developing remote classes. Why are YOU so afraid to look at ALL the science and admit that there's just no safe way to put kids together for 6-8 hours in a classroom?

 

[ThirstyBarbarian]

sounds perfectly insane. How do you test everyone with a single test? How can you be certain that there's a contribution from everyone in the class and that there is enough of a contribution to identify a single positive person. Show me the data that this will work.

Also, anyone who's positive would be quarantined, and by extension their families, siblings, the classmates of the siblings. Not at all realistic way to reduce the spread of disease

Problem is that we need to GIVE UP on ways to justify the risk of starting "in person" schools and spend our energy and talent developing remote classes. Why are YOU so afraid to look at ALL the science and admit that there's just no safe way to put kids together for 6-8 hours in a classroom?

On the pooled testing, I think the idea is if any single student came back positive, the entire class would be required to isolate, not just the one student, because the entire class would be exposed. By pool testing the entire class, you can determine if anyone in the class is positive with a single test, instead of however many tests would be required to test each student individually. A positive pool test would mean everyone in the class must isolate. Presumably there would be further testing to determine the status of individuals in the group.

 

[Joe Bruce]

What about those $1-2 paper spit tests? Not as sensitive as swab tests, but are supposedly a good indicator of "infectious" and you have results in 10 minutes. Test daily. Negative, go to school / work. Positive, stay home.

 

[Marc_G]

What about those $1-2 paper spit tests? Not as sensitive as swab tests, but are supposedly a good indicator of "infectious" and you have results in 10 minutes. Test daily. Negative, go to school / work. Positive, stay home.

Once these make it to market, will be very good. Let's see how quickly final approval and ramped up manufacture/distribution will be.

 

[cbrarick]

On the pooled testing, I think the idea is if any single student came back positive, the entire class would be required to isolate, not just the one student, because the entire class would be exposed. By pool testing the entire class, you can determine if anyone in the class is positive with a single test, instead of however many tests would be required to test each student individually. A positive pool test would mean everyone in the class must isolate. Presumably there would be further testing to determine the status of individuals in the group.

you just don't get it. this is nothing more then a "feel good" smoke screen. STOP DRINKING THE COOL-AID AND READ THE SCIENCE


On average a family has 1.93 children. You just don't isolate the child, you need to do ALL of the families of the potentially exposed children, and if it takes >24 hours, ALL of the families of the classes those siblings are.

One other issue, PCR is only correct 60% of the time. You'd almost be as correct by just flipping a coin.

the saliva test reports stability over temperature (and to some extent, time) as well as cost. My quick scan didn't find false positive or false negative rates (or sensitivity, specificity and accuracy) https://www.medrxiv.org/content/10.1101/2020.08.03.20165233v1.full.pdf+html
The other problem is pooled testing has NEVER BEEN TESTED so we should put our kid's health (and yours, if you have kids) on some witch magic testing that has never been validated. It's not enough to say you have a good test, you also have to prove that pooled testing will give you good results. AND I have to wonder how you actually pool saliva testing in a safe manner.

 

[rharshberger]

you just don't get it. this is nothing more then a "feel good" smoke screen. STOP DRINKING THE COOL-AID AND READ THE SCIENCE


On average a family has 1.93 children. You just don't isolate the child, you need to do ALL of the families of the potentially exposed children, and if it takes >24 hours, ALL of the families of the classes those siblings are.

One other issue, PCR is only correct 60% of the time. You'd almost be as correct by just flipping a coin.

the saliva test reports stability over temperature (and to some extent, time) as well as cost. My quick scan didn't find false positive or false negative rates (or sensitivity, specificity and accuracy) https://www.medrxiv.org/content/10.1101/2020.08.03.20165233v1.full.pdf+html
The other problem is pooled testing has NEVER BEEN TESTED so we should put our kid's health (and yours, if you have kids) on some witch magic testing that has never been validated. It's not enough to say you have a good test, you also have to prove that pooled testing will give you good results. AND I have to wonder how you actually pool saliva testing in a safe manner.

only way I can see to do pooled testing safely is multiple swabs (one per individual) going into a single vial of indicator fluid(?), not sure I fully understand the testing side of this whole thing.

 

[OverTheTop]

I had heard from an Iranian friend that in that country, in the early days of testing, they used one swab for five or so people in this sort of testing. That method contributed to the rapid spread of the disease there.

 

[cbrarick]

only way I can see to do pooled testing safely is multiple swabs (one per individual) going into a single vial of indicator fluid(?), not sure I fully understand the testing side of this whole thing.

that's just crazy. once a swab has been used, it is, but definition BIOHAZARD.

I will NEVER allow my son to be exposed in such a direct manner. In fact, I WILL NOT GIVE MY PERMISSION for him to be tested anywhere outside of my sight. The best way to prevent exposure is to be your own exposure control cop. I tell all my patients who have not gotten sick to just stay the course and stay healthy. Double down on your efforts because we should have a vaccine in 6 months or so. The only way to get one is to not do silly **** and stay well.

 

[NateB]

that's just crazy. once a swab has been used, it is, but definition BIOHAZARD.

I can't imagine that swabs would be reused. I understand the pooled testing for samples to be taken in the normal manner, but before they are processed in the lab, the samples are pooled and run. If the lab's machine allows for 12 tests at a time, this would allow for 12 groups to be tested at a time rather than 12 individuals. If the group returns negative, than everyone within the group is presumed to be negative. If the group returns positive, than samples are run individually to determine which one is positive. If multiple samples were taken at the time of collection, the person receiving a positive result would not even need to know their tests were pooled for the first run.

 

[Mushtang]

Early on, back in the spring when there was a cruise ship in the news that had nearly everyone infected, one of the passengers was being interviewed on the phone and I listened to that on the radio one morning. He said everyone on the ship was quarantined to their rooms early to try and stop the spread. The ship's doctor came to his room each day to check on them, first him and then his wife, and then moving to the next room. When the guy noticed the doctor using the same plastic tip to look in his wife's nose that was used in his, with just a casual wipe in between, he asked the doctor why he wasn't discarding these after each use. The doctor said they didn't have nearly enough tips to be able to do that and had to make do with the supply they had and just wipe off each one.

He realized that he'd just been checked with the same tip as the rest of the people on his hall did that day. He knew there was no hope in anyone not getting infected if the doctor was delivering the virus to everyone's nose on a daily basis.

Disclaimer - I heard this on the radio months ago, but that is what I remember was said.

 

[cwbullet]

On the pooled testing, I think the idea is if any single student came back positive, the entire class would be required to isolate, not just the one student, because the entire class would be exposed. By pool testing the entire class, you can determine if anyone in the class is positive with a single test, instead of however many tests would be required to test each student individually. A positive pool test would mean everyone in the class must isolate. Presumably there would be further testing to determine the status of individuals in the group.

The term is cohort or quarantine. You only isolate if you are symptomatic or positive.

 

[cwbullet]

Ok, guys think. Each test is $150-300 a person. Testing a whole class of 20 to screen would be $6000. That is cost-prohibitive. If you do pool testing, it saves a lot of money. It is proven to work by several studies.

Yes, you use one swab per person and they are all put in one vial. Why would you think we would ever use the same swab on multiple patients. Now that is idiotic.

 

[BABAR]

I had heard from an Iranian friend that in that country, in the early days of testing, they used one swab for five or so people in this sort of testing. That method contributed to the rapid spread of the disease there.

Ick!

I can see the kid with the pocket protector and glasses yelling, “Me first!”

Thinking outside the box, what if you segregated all the asymptomatic or minimally symptomatic PROVEN Covid positive teachers and students to one wing of one school? Not a perfect solution, but keeps ‘em in school and out of trouble.

 

[cwbullet]

Ick!

I can see the kid with the pocket protector and glasses yelling, “Me first!”

Thinking outside the box, what if you segregated all the asymptomatic or minimally symptomatic PROVEN Covid positive teachers and students to one wing of one school? Not a perfect solution, but keeps ‘em in school and out of trouble.

No one is using a single swab on multiple people.

 

[cwbullet]

Does anyone have any questions?

 

[Marc_G]

You've talked at length about HQ and your thoughts on it. Do you have an understanding of the docs behind the "open letter" about it? Is this some fringe group or do they have some sort of point?

 

[cwbullet]

You've talked at length about HQ and your thoughts on it. Do you have an understanding of the docs behind the "open letter" about it? Is this some fringe group or do they have some sort of point?

It is mostly based on anecdotal findings and poor research. I continue to review studies. There is better stuff out there to treat with now, but I do think it is worth research further.

They have a long way to go to prove it works for COVID

 

[Exactimator]

I've heard a few things about vitamin D helping the immune system fight Covid. All anecdotal, no firm studies. Do you have any thoughts on Vitamin D?

 

[cwbullet]

I've heard a few things about vitamin D helping the immune system fight Covid. All anecdotal, no firm studies. Do you have any thoughts on Vitamin D?

Probably safe as long as you don't take too much or get too much in your diet. Vitamin D requires activation. You have to get some sunlight - not sunbathing. Just a 20-30 minute stroll outside. I suggest it to all of my chronic pain patients. They swear it helps. My question is it the exercise or the Vit D? Research would suggest it is exercise or outdoor exposure.

 

[cwbullet]

I have complete all research released through 8/15. I have excluded all research prior to Late 2019. If it predates COVID, how can it show it works for COVID? I am also excluding non-human trials. I am also excluding reviews and theoretical articles.

My review of the research in HCQ:

ICU / Severely Ill: 19:10:7 (Positive: Negative: Inconclusive)
Prophylaxis: 7:3:2
Post Exposure: 3:2:1
Early in COVID: 11:4:6

I have also reviewed:

https://c19study.com/#early
It selectively leaves out negative studies to meet its needs.

My personal belief is that when the smoke clears, HCQ will prove to have some modest effect on COVID. Some post-exposure and prophylaxis studies look promising but these folks were expected to recover and more research is needed. Most of them were done one hospital employee and quite a few of the studies had patients with low or no risk factors for a bad outcome.

What is needed? A large research study that is blinded and randomized. One that is reduced in bias and pressure to acquire a result in one direction or the other.

Would I take it? Probably not. I would have to have no other options. Stronger results support the use of atleast a half dozen other medications. Some are still in researech phases but they will be released soon.

 

[cwbullet]

Update - 7-8 day general downtrend in GA. The spike in deaths may be lowering. The next 3 days will be telling.

 

[NateB]

Does anyone have any questions?

What are your thoughts on flu season and how it will impact or be impacted by Covid spikes?

We have some doctors who are concerned about the influenza B infections in Australia making for a bad flu season here. We have other doctors who feel the flu season won't be as bad due to social distancing, masks, etc...

 

[cwbullet]

What are your thoughts on flu season and how it will impact or be impacted by Covid spikes?

We have some doctors who are concerned about the influenza B infections in Australia making for a bad flu season here. We have other doctors who feel the flu season won't be as bad due to social distancing, masks, etc...

I think the largest impacts of flu combined with COVID are going to be on supplies and diagnostic confusion. I am not currently ordering influenza testing but I have had a number of folks that I maybe should have on relook. The COVID was negative and I currently re-evaluating that decision. No a huge impact. I have called them each and told them to follow up if they get worse Or do not improve.

I sure hope masks and social distancing reduce the spread and blunt the peak of influenza Cases. My research shows that 1 meter will lower the risk by at least 50%. Each additional meter will lower that risk by 1/2. The mask is expected to the the same lowering effect Or better. I would recommend and not or. Mask + Meter of social distancing + lathering up with Purrell regularly.

 

[Joe Bruce]

Can you explain the changes in opinion -- speaking only of CDC and WHO, not media / public opinions -- on the effectiveness of masks? Earlier in the spring, mask wearing was deemed by CDC/WHO to be more dangerous than doing nothing. Now they are deemed critical for everyone, and some states even mandate them inside cars, inside your own home, and outside even when social distance can be maintained.

 

[cwbullet]

Can you explain the changes in opinion -- speaking only of CDC and WHO, not media / public opinions -- on the effectiveness of masks? Earlier in the spring, mask wearing was deemed by CDC/WHO to be more dangerous than doing nothing. Now they are deemed critical for everyone, and some states even mandate them inside cars, inside your own home, and outside even when social distance can be maintained.

There was limited research on masks outside hospitals prior to COVID. Now, we have evidence to back their use and I would recommend a mask now and during influenza season.

 

[Joe Bruce]

There was limited research on masks outside hospitals prior to COVID. Now, we have evidence to back their use and I would recommend them during influenza season.

Eek! I assumed the masks would be temporary. Much like Storm Trooper uniforms, they are dehumanizing (outside of medical settings).

 

[cwbullet]

Eek! I assumed the masks would be temporary. Much like Storm Trooper uniforms, they are dehumanizing (outside of medical settings).

I don’t thinks so. May be wrong, but I think out culture is changed.,