re: Facts about Ivermectin from an ICU Nurse

This should be all over the news. Why is this not stickied?

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Public health officials don't deal in nuance as a general rule.

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Do you think natural immunity is nuance? Seems like a big deal to me.

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Their job is to make policy for large populations

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CDC estimates as many as 120 million Americans have had the virus.

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and to be frank they regard the average American as a moron who can't understand nuanced instruction. They think "everyone should be vaccinated" is a better message.

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Well, they’re not very good at what they do then. And it’s not just public health. It’s medicine broadly - hospitals are some of the first with vaccine mandates, and doctors don’t seem interested in being a rational voice.

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Now that being said, there are groups who clearly benefit from vaccination even after primary infection. Very elederly patients, the severely immunocompromised (chronic high dose steroid use, chemotherapy, etc.) and probably advanced kidey/liver disease patients on average mount much lesser responses to natural infection.

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There are very few Americans, including the unvaccinated, that don’t think the elderly, obese and unwell should be vaccinated.

I can imagine. COVID has been a hellscape for pharmacy admin trying to keep cost per patient day down.

Actemra, remdesivir, and pirate bugs abound

So you think they’ve read the room well? Are steering the country through Covid effectively and efficiently?

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pirate bugs

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I’ve never heard this before now, but damn it, I’m going to start using it. Let me know where I need to send the nickel each time I use it.

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remdesivir

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This one bugs me the most. The very first patient we had that got it made a miraculous turnaround. Their story:
50s. Obese. Hypertensive. Tested for COVID by the ED. Did not need o2. I still don’t understand why they admitted them. When I went to see the patient , they were in the shower and looked, well, fine. Patient understands that a pending test means they spend the night in the hospital. CXR had some moderate infiltrates. I figure they may have looked bad earlier. I decide to hold them and watch them overnight. Continue to look fine. It’s my off day. Partner sees them (and the patient actually belongs to my partner, but he was off. Agrees they look fine. D/c home. Something like 48h later, they were intubated. LFTs in the 1000s. They improve. Something like 3-4d into being ventilated they are down low enough that we can give remdesivir, and 24h later we extubate. Everyone was beyond excited about remdesivir and the promise it held.
I hope people don’t tend to view me as overly positive or negative when they read my writings, but holy shite were we excited, and I am not exaggerating the patient’s turnaround. I’m always very skeptical of the “and the next day they were better” stories, but this one was pretty much that.



…since then a retrospective review has been done by one of our pharmacists. No matching/cohorting, but they find no difference in LOS or mortality with the med. and since the very first time we gave it, we haven’t witnessed the “miracle.” Evidence is mounding that it’s ineffective. But we are such a small center that we aren’t going to ever get trial drugs and lag a month or more behind on access to whatever the “new” stuff is for COVID. So what do we do? We give it. Because why not?
I hate the “why not?” approach.

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Majority of HCP fricking hate the CDC response to this

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Wait, you don’t live, breathe, and love Fauci’s every word? I’m not certain we can be friends…

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So you think they’ve read the room well?

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No, I’m agreeing with you

Public health officials are often pie in the sky career academics who rarely if ever see patients.

Yeah, remdesivir just doesn’t move the needle for me. I’ve seen little anecdotally that excites me and the overal data for efficacy is meh.

Most patients, even most hypoxic patients, will get better no matter what we do. The greatest good we can do is to try and preventing severely ill patients from getting tubed at all cost. To this end I feel like steroids, IL6 inhibitors and stretching high flow to its limits does save some people. In my experience, once you’re tubed and a second organ system begins failing (usually kidneys) inpatient mortality approaches 100%. Ive yet to see an intubated covid patient with new dialysis requirements leave the hospital, even trached to an LTACH. They ALL die.

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Can you doctors explain how Dehli's seven day moving avg remains at 50, with a population of 17 million after their population was given Ivermectin as a prophylaxis?

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The delta variant has an R0 of 7-9 and Indians spend their lives stacked on top of each other

There’s just not that many people left to infect anymore