OT: What changes are you and family making to your lifestyle due to coranavirus?

[Doctor Hoop]

Yep, interesting and encouraging. Some important basic medical research study critique notes:

1. Very small sample size, not a true randomized trial. Control group was selected from a couple different sites other than the one where they gave the treatments
2. Vast majority of patients had only mild disease or were asymptomatic. At this point. can't extrapolate the encouraging results to the sickest patients who could benefit most from active antiviral therapy with much level of confidence
3. Main endpoint of interest was seeming to reduce the nasopharngeal viral load to undetectable levels in a decent % of hydroxychloroquine patients and all of the hydroxychloroquine+azithromycin patients. This finding *IF REAL & REPRODUCIBLE*, coupled with widespread screening of patients, could be a PROFOUND intervention to curtail rampant spread of the disease by mildly symptomatic/asymptomatic people.

BAD NEWS:
-In true panic fashion, since this has circulated like wildfire on social media, people are jumping all over this and hounding MDs for prescriptions whether they need them or not. Similar to what we saw with Tyler Phommachanh, most pharmacies & healthcare facilities already are in "backorder" status with usual suppliers trying to order these meds for patients.

Exactly what I was going to write. Nice work.

The results are very interesting, and if there's a dramatic reduction in the viral load it could definitely reduce the spread of the disease. I'd definitely like to see a larger controlled trial, however that also takes time.

 

[JustbrewitMan]

I forgot to past in the figure from the research manuscript in my first post:

 

[pj]

Remdesivir and Favipiravir also seem to be working.

 

[JustbrewitMan]

I posted about this but disappeared.

They have run and some human trials in China, South Korea, France, Australia and Oklahoma and all have met with some success. I have been following the press on this for about a week. Very encouraging.

While we are all aware that China is unreliable, the others were all done by competent professionals.

I am going to remain encouraged and hopeful but have a high level of skepticism until I see all the real data published from these researchers (its my job as a healthcare researcher/professional to always be skeptical).

The history of medicine is littered with countless small, non-peer-reviewed and peer-reviewed uncontrolled observational "research" that ultimately turns out to be rubbish once subjected to a proper prospective, randomized, controlled medical trial. This unfortunately seems to be the case with the possible use of lopinavir/ritonavir for COVID-19:

https://www.nejm.org/doi/full/10.1056/NEJMoa2001282

For obvious reasons, though, I'm rooting like hell for the hydroxychloroquine+azithromycin findings to pan out "for real"

 

[JustbrewitMan]

Remdesivir and Favipiravir also seem to be working.

Yep, encouraging anecdotal/small sample evidence emerging for those, too.

Biggest problem with remdesivir is that its experimental and compassionate use currently. Process to get it into the patient takes a minimum of 48 hours, based on real front-line experience from a number of colleagues I've communicated with. A critically-ill patient is likely to be dead by the time the drug arrives.

Also, data on Tocilizumab (Actemra®), an Interleukin-6 inhibitor (monoclonal antibody) also looked really encouraging in a 21-patient series described in non-peer-reviewed manuscript:
http://www.chinaxiv.org/user/download.htm?id=30387&filetype=pdf

 

[NJHusky]

Amesh Adalja from John's Hopkins thinks the upper end of mortality is about 0.6% and the lower bound is about 0.1% (seasonal flu)....very good news

Also said doesn't think its much more contagious than flu

This Amesh Adalji-Sam Harris podcast is a fascinating listen

 

[cohenzone]

Apparently medical pros are not all that optimistic. Be nice if it works.

 

[Dream Jobbed 2.0]

I have no clue how long it would take to start widely using these treatments. Anyone who knows more?

 

[JustbrewitMan]

I have no clue how long it would take to start widely using these treatments. Anyone who knows more?

Hydroxychloroquine, Chloroquine, and Azithromycin are already prescribeable and "available" (will be in short supply in short order, no doubt). All 3 are relatively cheap as far as Rx meds go.

Tocilizumab (Actemra®) is IV only and is about $2000+ per dose because its a biologic (monoclonal antibody) product.

 

[pj]

In English??

It's a good drug but in women who are pregnant or trying to conceive, might hurt the baby.

 

[RichZ]

The history of medicine is littered with countless small, non-peer-reviewed and peer-reviewed uncontrolled observational "research" that ultimately turns out to be rubbish...

Obviously has little bearing here, but as a lay person with next to zero actual knowledge pertinent to the topic, my immediate thought upon reading that was, "Tell that to Pasteur."
On a serious note, I really, really hope the fast track it's supposedly on is very, very fast.
As a 74 year old poster boy for the high risk population, I'm doing all I can to avoid exposure, but it seems impossible to avoid ALL contact with the outside world. I'm scheduled for major surgery, and the number of pre surgical tests I have to go through and doctors who have to sign off on it in the next few weeks, kind of preclude isolating myself.

 

[navery12]

 

[CL82]

I’m watching De Blasio‘s speech. I’m about 90% sure that the guy doing sign next to him is faking it.

 

[kingdobbs]

In English??

(1) Hydroxychloroquine has been used prophylactic for malaria for 40 years.

(2) It has some side effects including teratogenicity.

(3) While its mechanism of action as an anti-malarial is unknown it does have some topisomerase inhibiting activity.

(1) We have used the drug as a preventative measure for a common tropical disease for a long time.

(2) It can cause birth defects if it is used while pregnant.

(3) We don’t know precisely WHY it works against malaria, but we have a theory.

 

[Dream Jobbed 2.0]

So I suppose it’s a thing people have been out walking their dogs and such I take my dog for two walks a day and have been seeing a lot of dogs and owners out for the first times this week. A lot of them have no idea how to walk on a leash and it’s kinda scary. A massive greyhound got off its leash and went at my dog the other day.

 

[87Xfer]

My bosses' husband just tested positive. Luckily my company was pretty early and we've been working from home since last Thursday so I'm not too worried, but it's getting closer.

Not exactly surprising info but the doctor said they won't test the rest of the family. Said numbers are at least 10x higher than reported/tested and at this point they're not even testing most who show symptoms

So if they don't test, how are they treating those who show symptoms?

 

[87Xfer]

At this point. can't extrapolate the encouraging results to the sickest patients who could benefit most from active antiviral therapy with much level of confidence.

As someone not in the medical field, what is "active antiviral therapy"? If someone gets diagnosed with Covid-19, what is the treatment? If someone can't get tested but shows symptoms, what is the treatment?

I'm only in my 50s, but I got diagnosed with pneumonia last year, and my lungs haven't been fully right since. So i'm a little nervous about this thing.

 

[Hey Adrien!]

So if they don't test, how are they treating those who show symptoms?

How they normally treat flu: rest, hydration, OTC stuff.

Over the last 13 days, I've gone to a benefit (Stamford), visited a school for an observation (Stamford) and worked five days with kids at my own school (Greenwich), had a full day of PD and I live in Norwalk. This area has been a hotbed.

After about 7 days of cough/tight chest/no fever and stomach issues on Saturday, I woke up Tuesday in nightsweats. Since then, my cough has gone away completely and chest tightness has decreased a lot, but I still get short of breath if I exercise or walk uphill. My wife has been totally fine.

On Wednesday, I called the Stamford CoVid-19 hotline, and they basically told me I'm not a candidate to get tested, but just keep isolating, hydrating, resting, etc.

No way to be sure, but I'd bet $$$ I came down with a mild case.

 

[NJHusky]

Vaccines take at least a year... better chance is that they discover a medicine or cocktail of medicines that reduce symptoms and shorten incubation. I have modest hope that’s coming within a few weeks.

The only real hope we have right now is people staying home. South Korea got hit on a similar timeline as us and is already looking up while we haven’t come close to seeing the worst because they took social isolation seriously. If people would really take staying seriously we’d have a chance against this but THIS IS MURICA AND ITS MY RIGHT TO SPREAD INFECTIOUS DISEASE DERPY DURRRR

do you think kids went to the beach in Korea on spring break??

 

[NJHusky]

My 88 year old father lives alone in his house. I'm itching to do a wellness check (lay eyes on him), even though I'm speaking to him daily. I want to do a fridge check (and store run if necessary) and my wife to cook a lot of meals and freeze. Perhaps do a thorough cleaning (he gets no visitors) of his 9 room house, just for comfort. Come up late afternoon, leave the next morning, after an early morning grocery run.

My wife and I are staying indoors with no exposure other than our mail delivery. I am positive we wouldn't be bringing anything to his house. Its just his age, and the uncertainty if we would be putting him at risk. He's all alone outside of neighbors who do look out for him to a certain extent, but I'm sure not lately.

Not sure if that's wise, advisable or even worth it. Or should we treat him like a one man nursing home.

Being the closest family member 90 miles away, this sucks.

My mom is 91 and lives alone..I live 1200 miles away but luckily my sis is only 5 miles away...daily calls and a weekly food drop off has been the plan. She tried to take the senior bus but we vetoed that...told her to walk in the park which is down the block if she wants to get out.

 

[Dream Jobbed 2.0]

do you think kids went to the beach in Korea on spring break??

Probs not.

 

[Kitaman]

teratogenicity. topisomerase

Thank goodness for google. Now on to dictionary.com for pronunciation.

 

[uconnfan68]

How they normally treat flu: rest, hydration, OTC stuff.

Over the last 13 days, I've gone to a benefit (Stamford), visited a school for an observation (Stamford) and worked five days with kids at my own school (Greenwich), had a full day of PD and I live in Norwalk. This area has been a hotbed.

After about 7 days of cough/tight chest/no fever and stomach issues on Saturday, I woke up Tuesday in nightsweats. Since then, my cough has gone away completely and chest tightness has decreased a lot, but I still get short of breath if I exercise or walk uphill. My wife has been totally fine.

On Wednesday, I called the Stamford CoVid-19 hotline, and they basically told me I'm not a candidate to get tested, but just keep isolating, hydrating, resting, etc.

No way to be sure, but I'd bet $$$ I came down with a mild case.

Good luck.

 

[Waquoit]

Just came across this:

Nighthawks 2020

 

[JustbrewitMan]

As someone not in the medical field, what is "active antiviral therapy"? If someone gets diagnosed with Covid-19, what is the treatment? If someone can't get tested but shows symptoms, what is the treatment?

I'm only in my 50s, but I got diagnosed with pneumonia last year, and my lungs haven't been fully right since. So i'm a little nervous about this thing.

"Active antiviral therapy" just means a medication that is actually "killing" or "inactivating" the virus. Like an antibiotic. We don't have definitive drugs that do this for SARS-CoV-2 yet, but some of the potentially active ones have been mentioned in this thread.

Right now, COVID-19 treatment is largely supportive care. For severe cases, it's ICU care, IV fluids, blood pressure support (if needed), oxygen, +/- ventilator support.

If someone has symptoms but can't be tested, manage it like the flu (mentioned in a number of posts already).

If your symptoms start to get worse (really short of breath, unstoppable coughing, really high fevers, substantial mental status changes, etc.), you (or a friend, family member, etc) needs to call your doctor or call a healthcare facility, where they can give you further instructions about going to an Emergency Room, etc.)