re: Coronavirus Disease 2019 (COVID-19) ***W.H.O. DECLARES A GLOBAL PANDEMIC***

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I have to imagine they are constantly receiving chatter on different viruses and the potential for serious issues. I cannot imagine how difficult the decision would be to shutdown the country in January when this thing was at the earliest stage vs letting it play out.

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For sure. I'm not blaming them. I'm just saying that they knew something was going on a lot earlier than we did. You're probably right that their skimmers pick up quite a few hot spots a year that fizzle out.

NSA has some seriously smart people that can design really sophisticated machine-learning bots that can pick up on this stuff from a mile away. I don't buy them knowing how bad it was in November. I can however buy them know about it, but not the severity. I could see them figuring out the severity by mid-December.

Any docs dealing with covid on here? Got a question for you about treatment.

Just got the call from my boss, I'm to stay home all next week because I was exposed to someone at work who had it. I'll be remoting in everyday for the week. I was exposed on Monday but have no symptoms and I feel fine.

I'm part of IT and we had a large project on Sunday where we moved a ton of people from a public area on one floor to a locked down area away from the public so they could work on SBA loans. Well one of the employees has it and our entire department now has to be quarantined along with 20 other people.

Looks like I'll be sipping on Whisky and working via VPN for the next week.

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And Disney had announced its closure before that.

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Because they knew the shelter in place was coming. Not to mention the PR nightmare of Disney not closing if they had the option. The parks were still crowded until they closed. I have no doubt the park would still have a ton of people if it were open.

I read the guidelines and your wording is different from their actual recommendations. You said .

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HCQ, HCQ/azithro, toci or Kaletra...should be utilized only in hospitalized patients ideally in the context of a clinical trial

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Their #1 recommendation said

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Among patients who have been admitted to the hospital with Covid-19, the IDSA guideline recommends hydroxychloroquine/chloroquine in the context of a clinical trial.

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Their #2 recommendation said:

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Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommends hydroxychloroquine/chloroquine plus azithromycin only in the context of a clinical trial.

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So their recommendations (all seven of them, including other drugs) are only adressing the management of Covid-19 in hospitalized patients, and they do not adress any recommendation to management of non-hospitalized patients. However, the recommendations specifically do not say that HCQ should be "should be utilized only in hospitalized patients", or even "only in a clincal trial", although in a trial would be their preferred setting. They also differentiate monotherapy HCQ from HCQ/Azithromycin by adding the word "only" in a clincial trial, probably due to preliminary observations of increased incidence of QT prolongation in the latter.

Interesting to me that they say nothing about early pharmacologic treatment (i.e., at diagnosis and not waiting for hospital admission), which may be a potentially more effective indication for HCQ (or other drugs) and which is how it's been widely used in Italy for the last two weeks. Other antivirals, for instance Tamiflu, have been found to show efficacy only if given earlier in the course of infection. It could be that HCQ is more effective if given before pulmonary pathology is advanced to the point of dyspnea and hypoxemia (commonly used criteria for hospital admission), and particularly before progression toward ARDS.

If some of these obviously preliminary indications of quicker viral eradication or decreased sheddding could be proven with early administration of an antiviral, then that might help limit/slow spread of the disease. Since HCQ has a very long history of use in hundreds of millions of non-hospitalized patients, I don't see why it's not reasonable to proceed randomizing some of the tens of thousands of newly diagnosed cases per day to HCQ vs control arms, with endpoints to assess viral load, symptom progression, rate of hospitalization, intubation, etc. We could have preliminary results in a very short time to answer some of these questions with robust data.

Exactly what I am thinking myself

To be fair this is from an infectious disease (ID) group rather than critical care. While there can be crossover it is a bit outside their wheelhouse. This is why that early study said all of the patients responded well to treatment with the footnote that the really sick ones were transferred out so they didn't count their numbers. It was an ID doc and those patients left his care.

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You obviously have a very low opinion of the IDSA and of the global medical community in general.

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Please.

HCQ might have a small benefit, and it's definitely worth doing clinical trials to see if there is a small benefit to some patients, but there's a reason that lots of hospitals were using it and have now quit -- they don't think that it's doing anything to improve outcomes.

HCQ has been used a tremendous amount in the last few weeks.
It there were a significant benefit to the drug, we'd have seen it by now. You'll be hard-pressed to find many doctors who are working in ICUs right now who believe in HCQ at this point.

I have considerably more hope for remdesivir, convalescent plasma, and especially, for the nitric oxide trials that LSU-Shreveport is doing.

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HCQ might have a small benefit

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Thanks for giving us that tidbit of your wisdom.

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there's a reason that lots of hospitals were using it and have now quit

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Which hospitals? What's the reason, have you seen any clinical data? Did the "hospitals" run trials in patients started on early therapy who weren't in the hospital? What were the endpoints, numbers, etc., or are we disproving the drug based on anecdotal evidence?

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It there were a significant benefit to the drug, we'd have seen it by now.

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You continue to insist that anecdotal outcomes can be used to prove your point of view, while disregarding whatever preliminary evidence you don't like. Wait, this is your omniscience again, right?

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You'll be hard-pressed to find many doctors who are working in ICUs right now who believe in HCQ at this point.

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How many have you polled? I guess they told you personally that the drug doesn't work in patients with impending respiratory failure or ARDS? Yeah, I think lots of folks suspected that would be the case, especially since ARDS-like lung disease has been around for a long time and we've never found a good way to treat it, but thanks again for your proof. I'm assuming you have "substantive evidence" to back up all these talking points so how about a link to your paper in a peer reviewed journal?

What about your data re early onset therapy with HCQ, how's that looking? Bad too, I guess. I was hoping for something, but this data dump of "substantive evidence" you've piled out here is quite disappointing.

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I have considerably more hope for remdesivir, convalescent plasma, and especially, for the nitric oxide trials that LSU-Shreveport is doing.

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Any link to the safety and efficacy trial data? Are we talking preclinical, phase 1, 2, 3, or what? How soon can we expect these drugs/treatments to be available in quantity? Any chance they'll be available before next Sunday, to help any of the tens of thousands of people who will otherwise die this week? Are your hospital ICU sources excited about this?

BTW, nitric oxide is a pulmonary vasodilator that has been previously used in ARDS in an attempt to improve oxygen transfer, helped temporarily improve Pa02, but not much impact on outcomes. Hopefully they'll find some role in which it helps improve mortality in Covid-19 severe/ventilated patients, but what we badly need is early antiviral treatments to reduce the number of patients getting to that point.

Sorry, I'm just being sarcastic. I thought when you raised the bar to the level of substantial evidence that there might be something really meaningful forthcoming. None of these drugs is either proven or disproven. When there's something with proven safety and efficacy data that's available now, I'll be very happy. Until then I still think HCQ is our best prospect until proven otherwise and there are still thousands of good doctors around the world using it for that reason.