OtherGround Forums OG doc. AMA on COVID-19

12 days ago
1/1/01
Posts: 11894

Doctors:

Trump is purportedly being tested for COVID daily.

Around here (Ontario) the only tests I'm aware of is the nasal
swab. (My wife, a doctor, just had one because she had pink eye - got results today: negative).

That would be a nasty test to endure every day so I'm sure it must be some other test for Trump. Any idea what it would be?
12 days ago
1/1/01
Posts: 18413

Thanks, mata

trying to flow with the go on treatments should I find myself getting it and hospitalized and being armed with something to ask for treatment wise

12 days ago
2/28/12
Posts: 4670
prof - 
Doctors:

Trump is purportedly being tested for COVID daily.

Around here (Ontario) the only tests I'm aware of is the nasal
swab. (My wife, a doctor, just had one because she had pink eye - got results today: negative).

That would be a nasty test to endure every day so I'm sure it must be some other test for Trump. Any idea what it would be?

Trump already mentioned there was a simpler test several weeks ago, dunno any further details.
12 days ago
2/28/12
Posts: 4674

I dont think this addresses the "easier test" question, but it is relevant to "faster test" and includes Trump unboxing and modeling the device which is somewhat entertaining.

 

11 days ago
10/23/05
Posts: 3757
prof - 
Doctors:

Trump is purportedly being tested for COVID daily.

Around here (Ontario) the only tests I'm aware of is the nasal
swab. (My wife, a doctor, just had one because she had pink eye - got results today: negative).

That would be a nasty test to endure every day so I'm sure it must be some other test for Trump. Any idea what it would be?

We use nasal here too.

I'm wondering if he's getting serology instead? We currently use this for antibody testing only.

Edited: 11 days ago
2/4/09
Posts: 11863
mataleo1 -
prof - 
Doctors:

Trump is purportedly being tested for COVID daily.

Around here (Ontario) the only tests I'm aware of is the nasal
swab. (My wife, a doctor, just had one because she had pink eye - got results today: negative).

That would be a nasty test to endure every day so I'm sure it must be some other test for Trump. Any idea what it would be?

We use nasal here too.

I'm wondering if he's getting serology instead? We currently use this for antibody testing only.

I hate to say it but there some throat swabs being done where I am. 

 

My fiance also works in health care. She had to get tested and they only swabbed her throat. 

 

I was very surprised.

10 days ago
3/22/16
Posts: 1309
Green Vermonster - 
prof - 
Doctors:

Trump is purportedly being tested for COVID daily.

Around here (Ontario) the only tests I'm aware of is the nasal
swab. (My wife, a doctor, just had one because she had pink eye - got results today: negative).

That would be a nasty test to endure every day so I'm sure it must be some other test for Trump. Any idea what it would be?

Trump already mentioned there was a simpler test several weeks ago, dunno any further details.

I think Trump might be getting the Abbott rapid test, which I'm not sure uses the swab, and gives results in 20 mins or something. Great for speed testing daily, however I read some that they are only 85% accurate, whereas the swabs are over 99
10 days ago
3/7/07
Posts: 11725
the_shrike -

Thanks, mata

trying to flow with the go on treatments should I find myself getting it and hospitalized and being armed with something to ask for treatment wise

I feel you.

10 days ago
11/23/10
Posts: 265

Mata, how are you guys looking with regards to starting supplying/prescribing Remdesivir? What’s the outlook?

It hasn’t been approved just yet over here, but that’ll come soon - just a matter of going formally through the process. I imagine the price and availability of it will be the next iteration of toilet paper/PPE/test kits, though.

And what’s your take on the real-world power of it, based on the NEJM study? (I suppose you don’t have any open-label experience with it yet?). Even with the small numbers in each of the different disease severity strata, it looks more convincing than tamiflu back in the day, wouldn’t you say? Of course it depends on how age may possibly modify its effect, given how the study population was 10 years younger on average than those who are at the biggest risk in the real world (70+ years). But that is always the case with these types of studies, unfortunately.

10 days ago
10/23/05
Posts: 3768
Job Security - 

Mata, how are you guys looking with regards to starting supplying/prescribing Remdesivir? What’s the outlook?

It hasn’t been approved just yet over here, but that’ll come soon - just a matter of going formally through the process. I imagine the price and availability of it will be the next iteration of toilet paper/PPE/test kits, though.

And what’s your take on the real-world power of it, based on the NEJM study? (I suppose you don’t have any open-label experience with it yet?). Even with the small numbers in each of the different disease severity strata, it looks more convincing than tamiflu back in the day, wouldn’t you say? Of course it depends on how age may possibly modify its effect, given how the study population was 10 years younger on average than those who are at the biggest risk in the real world (70+ years). But that is always the case with these types of studies, unfortunately.


I'm still stuck in Montreal for the time being and we haven't started to use remdesivir. But my colleagues in NYC have, again with mixed results.

I'm assuming you're quoting the RCT rather than the compassionate use study. My wife has been extremely critical of the RCT, as you and I have been. Yes it's an RCT, but to change the goalposts during a trial is really unheard of. I was not impressed with their excuse for doing so. And to terminate the study early, based on that new primary outcome, reeks of shit.

I guess I'm waiting for a second RCT to really start considering it. And don't get me started with tamiflu!! I was practicing during those crap study years :)

10 days ago
2/4/09
Posts: 11875

Maybe one of these bad boys?

 

10 days ago
1/1/01
Posts: 20606

From a buddy of mine at Mt Sinai:

“Just to clarify, as various places in the US open up: we aren't opening because the virus is gone, we're opening because we've made room for you in the hospital” - David Sachs

Edited: 9 days ago
7/4/11
Posts: 13896
mataleo1 -
Job Security - 

Mata, how are you guys looking with regards to starting supplying/prescribing Remdesivir? What’s the outlook?

It hasn’t been approved just yet over here, but that’ll come soon - just a matter of going formally through the process. I imagine the price and availability of it will be the next iteration of toilet paper/PPE/test kits, though.

And what’s your take on the real-world power of it, based on the NEJM study? (I suppose you don’t have any open-label experience with it yet?). Even with the small numbers in each of the different disease severity strata, it looks more convincing than tamiflu back in the day, wouldn’t you say? Of course it depends on how age may possibly modify its effect, given how the study population was 10 years younger on average than those who are at the biggest risk in the real world (70+ years). But that is always the case with these types of studies, unfortunately.


I'm still stuck in Montreal for the time being and we haven't started to use remdesivir. But my colleagues in NYC have, again with mixed results.

I'm assuming you're quoting the RCT rather than the compassionate use study. My wife has been extremely critical of the RCT, as you and I have been. Yes it's an RCT, but to change the goalposts during a trial is really unheard of. I was not impressed with their excuse for doing so. And to terminate the study early, based on that new primary outcome, reeks of shit.

I guess I'm waiting for a second RCT to really start considering it. And don't get me started with tamiflu!! I was practicing during those crap study years :)

That RCT publication really bummed me out. The fucking compassionate use study already had false information about the measured cumulative incidence and the authors completely sidestepped any responsability for their errors or poor methodology by playing the altruist angle of "urgency." Even their of disease severity was somewhat suspect, so it's less than heartening to see this garbage with the NEJM publication.

Hard to see a group switch primary and secondary outcomese for no explicit reason -- COVID lasts longer than we thought oopsy poopsy, but don't worry we PROMISE we had no idea what the data was when making that decision -- while practically quadrupling their target enrollments for moderate and severe patient groups and not think it's fucking widespread p-hacking. I know there's a lancet publication from a Chinese remdesivir trial, but I haven't had a chance to read it myself yet.

This garbage is major reason why pre-clinical research, especially academic pre-clincical research, struggles with replicability and we can't afford that type of culture in clinical trials. Even on the academic side, I've been noticing a pretty significant dip in quality of publications. Everyone's so eager to pump anything out related to COVID.

9 days ago
10/23/05
Posts: 3776
MattyECB - 
mataleo1 -
Job Security - 

Mata, how are you guys looking with regards to starting supplying/prescribing Remdesivir? What’s the outlook?

It hasn’t been approved just yet over here, but that’ll come soon - just a matter of going formally through the process. I imagine the price and availability of it will be the next iteration of toilet paper/PPE/test kits, though.

And what’s your take on the real-world power of it, based on the NEJM study? (I suppose you don’t have any open-label experience with it yet?). Even with the small numbers in each of the different disease severity strata, it looks more convincing than tamiflu back in the day, wouldn’t you say? Of course it depends on how age may possibly modify its effect, given how the study population was 10 years younger on average than those who are at the biggest risk in the real world (70+ years). But that is always the case with these types of studies, unfortunately.


I'm still stuck in Montreal for the time being and we haven't started to use remdesivir. But my colleagues in NYC have, again with mixed results.

I'm assuming you're quoting the RCT rather than the compassionate use study. My wife has been extremely critical of the RCT, as you and I have been. Yes it's an RCT, but to change the goalposts during a trial is really unheard of. I was not impressed with their excuse for doing so. And to terminate the study early, based on that new primary outcome, reeks of shit.

I guess I'm waiting for a second RCT to really start considering it. And don't get me started with tamiflu!! I was practicing during those crap study years :)

That RCT publication really bummed me out. The fucking compassionate use study already had false information about the measured cumulative incidence and the authors completely sidestepped any responsability for their errors or poor methodology by playing the altruist angle of "urgency." Even their of disease severity was somewhat suspect, so it's less than heartening to see this garbage with the NEJM publication.

Hard to see a group switch primary and secondary outcomese for no explicit reason -- COVID lasts longer than we thought oopsy poopsy, but don't worry we PROMISE we had no idea what the data was when making that decision -- while practically quadrupling their target enrollments for moderate and severe patient groups and not think it's fucking widespread p-hacking. I know there's a lancet publication from a Chinese remdesivir trial, but I haven't had a chance to read it myself yet.

This garbage is major reason why pre-clinical research, especially academic pre-clincical research, struggles with replicability and we can't afford that type of culture in clinical trials. Even on the academic side, I've been noticing a pretty significant dip in quality of publications. Everyone's so eager to pump anything out related to COVID.


Agreed on all counts.

The urgency of getting some data out for COVID (a sensible objective) has devalued proper standards for clinical research.

Researchers and journals are to blame for this. It's been a golden goose for everyone, except clinicians and patients who rely on science to get better care. Shameful really.

9 days ago
1/1/01
Posts: 99154

This seems like possible good news. 

https://www.sciencemag.org/news/2020/05/t-cells-found-covid-19-patients-bode-well-long-term-immunity

"The teams also asked whether people who haven’t been infected with SARS-CoV-2 also produce cells that combat it. Thiel and colleagues analyzed blood from 68 uninfected people and found that 34% hosted helper T cells that recognized SARS-CoV-2. The La Jolla team detected this crossreactivity in about half of stored blood samples collected between 2015 and 2018, well before the current pandemic began. The researchers think these cells were likely triggered by past infection with one of the four human coronaviruses that cause colds; proteins in these viruses resemble those of SARS-CoV-2."

9 days ago
1/1/01
Posts: 11902

Another question for the Docs:

I'm having a "first world" problem/debate with my wife.
Our local government is now allowing cleaning staff to go back in to homes and my wife wants to get our cleaning lady back in cleaning our place again.

Our conflict comes from her being a clean-freak, but a total non-germophobe, I'm less a clean freak, more bordering on germophobe (as in, I understand how disease spreads, and I actually take it seriously).

Anyway, I've read that it can be ok to have a cleaning person come in "as long as physical distancing is maintained" between her and the house occupants.

But what worries me isn't so much the physical distancing - that would be easy enough. It's the "contamination" effect.
If the cleaning person is infected with COVID, as I understand it, the virus is being expelled even just by breathing, then it's possible those tinier droplets can remain in the air for a while. And even if it's not being aerosolled the larger droplets containing the virus are just dropping to the ground.

So even if we maintain physical distancing, I'm imagining a sick person coming in to every single room in the house, and breathing the virus in to every room which, even if it doesn't hang around in the air, is left in droplets all over the room - living room, bedrooms, everywhere. I don't know how viable the virus remains when dropped on to all these surfaces, but...still...it's a real heebie jeebies scenario to me.

Wife thinks I'm overreacting and worrying too much.

Any thoughts on this? Is my analysis/worry off-track somehow?

(BTW, another reason for having the cleaning lady in is to keep her paid. Yes I know there's the option of not bringing her in yet still paying her, which is what we've been doing so she doesn't go broke. But this is a discussion about actually bringing her in).


9 days ago
11/23/10
Posts: 266
MattyECB -
mataleo1 -
Job Security - 

Mata, how are you guys looking with regards to starting supplying/prescribing Remdesivir? What’s the outlook?

It hasn’t been approved just yet over here, but that’ll come soon - just a matter of going formally through the process. I imagine the price and availability of it will be the next iteration of toilet paper/PPE/test kits, though.

And what’s your take on the real-world power of it, based on the NEJM study? (I suppose you don’t have any open-label experience with it yet?). Even with the small numbers in each of the different disease severity strata, it looks more convincing than tamiflu back in the day, wouldn’t you say? Of course it depends on how age may possibly modify its effect, given how the study population was 10 years younger on average than those who are at the biggest risk in the real world (70+ years). But that is always the case with these types of studies, unfortunately.


I'm still stuck in Montreal for the time being and we haven't started to use remdesivir. But my colleagues in NYC have, again with mixed results.

I'm assuming you're quoting the RCT rather than the compassionate use study. My wife has been extremely critical of the RCT, as you and I have been. Yes it's an RCT, but to change the goalposts during a trial is really unheard of. I was not impressed with their excuse for doing so. And to terminate the study early, based on that new primary outcome, reeks of shit.

I guess I'm waiting for a second RCT to really start considering it. And don't get me started with tamiflu!! I was practicing during those crap study years :)

That RCT publication really bummed me out. The fucking compassionate use study already had false information about the measured cumulative incidence and the authors completely sidestepped any responsability for their errors or poor methodology by playing the altruist angle of "urgency." Even their of disease severity was somewhat suspect, so it's less than heartening to see this garbage with the NEJM publication.

Hard to see a group switch primary and secondary outcomese for no explicit reason -- COVID lasts longer than we thought oopsy poopsy, but don't worry we PROMISE we had no idea what the data was when making that decision -- while practically quadrupling their target enrollments for moderate and severe patient groups and not think it's fucking widespread p-hacking. I know there's a lancet publication from a Chinese remdesivir trial, but I haven't had a chance to read it myself yet.

This garbage is major reason why pre-clinical research, especially academic pre-clincical research, struggles with replicability and we can't afford that type of culture in clinical trials. Even on the academic side, I've been noticing a pretty significant dip in quality of publications. Everyone's so eager to pump anything out related to COVID.

Ding ding ding! Completely agree!

It’s ironic to find myself using tamiflu as a reference that makes it look good by comparison - that’s like trying to wash yourself clean in other people’s filth.

Are there any interesting studies in the pipeline in the near future?

I wonder what the HCQ trials will show with their partial data, now that some of them are getting cancelled after the WHO statement advising to stop using it for COVID-19.

9 days ago
11/23/10
Posts: 267
prof -
Another question for the Docs:

I'm having a "first world" problem/debate with my wife.
Our local government is now allowing cleaning staff to go back in to homes and my wife wants to get our cleaning lady back in cleaning our place again.

Our conflict comes from her being a clean-freak, but a total non-germophobe, I'm less a clean freak, more bordering on germophobe (as in, I understand how disease spreads, and I actually take it seriously).

Anyway, I've read that it can be ok to have a cleaning person come in "as long as physical distancing is maintained" between her and the house occupants.

But what worries me isn't so much the physical distancing - that would be easy enough. It's the "contamination" effect.
If the cleaning person is infected with COVID, as I understand it, the virus is being expelled even just by breathing, then it's possible those tinier droplets can remain in the air for a while. And even if it's not being aerosolled the larger droplets containing the virus are just dropping to the ground.

So even if we maintain physical distancing, I'm imagining a sick person coming in to every single room in the house, and breathing the virus in to every room which, even if it doesn't hang around in the air, is left in droplets all over the room - living room, bedrooms, everywhere. I don't know how viable the virus remains when dropped on to all these surfaces, but...still...it's a real heebie jeebies scenario to me.

Wife thinks I'm overreacting and worrying too much.

Any thoughts on this? Is my analysis/worry off-track somehow?

(BTW, another reason for having the cleaning lady in is to keep her paid. Yes I know there's the option of not bringing her in yet still paying her, which is what we've been doing so she doesn't go broke. But this is a discussion about actually bringing her in).


The risk should be minimal, as long as she isn’t coughing and spluttering all over the place. And the risk of her being infected is very low in the first place if she only comes over when she’s not feeling sick, especially if the load of infections in your area isn’t very high (which I assume, since restrictiona are getting lifted).

Another solution might be to provide her PPE or at least a mask and gloves to use while cleaning your house. That is probably the most you can do.

Edited: 9 days ago
12/7/06
Posts: 23321

Docs—

If you have a chance, I have a couple of questions.  

 

Background:

Two of my coworkers, each of whom I worked within six feet of for much longer than 10 minutes,tested positive on May 22nd and 23rd respectively. They last worked on May 18th and became symptomatic ~May 19th. I worked with them on numerous occasions for the 14 days prior to May 18th.

 

Question:

My employer facilitated testing for me and everyone I work with today. I have zero symptoms.  I completed an antibody and nasal swab test-negative for antibodies and obviously waiting on the swab results.

Was it too early to test us based on the potential dates of exposure? I’ve read mixed opinions. 
 

Thank you!

9 days ago
11/23/10
Posts: 268
LakerUp -

Docs—

If you have a chance, I have a couple of questions.  

 

Background:

Two of my coworkers, each of whom I worked within six feet of for much longer than 10 minutes,tested positive on May 22nd and 23rd respectively. They last worked on May 18th and became symptomatic ~May 19th. I worked with them on numerous occasions for the 14 days prior to May 18th.

 

Question:

My employer facilitated testing for me and everyone I work with today. I have zero symptoms.  I completed an antibody and nasal swab test-negative for antibodies and obviously waiting on the swab results.

Was it too early to test us based on the potential dates of exposure? I’ve read mixed opinions. 
 

Thank you!

Timing of testing is a rock and a hard place: you want to catch infections before people get sick or infect others, and at the same time you risk false-negatives if you’re too early. One solution is to retest e.g. every second day, if it is possible (it’s probably not in most places). And neither swabs nor antibody testing detects 100% of cases, so that’s another argument for repeated testing. Also, a lot of antibody test kits are dog-shit inaccurate, especially for use in non-severe cases in a non-Chinese population (where most have been validated/quality assured from the manufacturer).

In your case, it sounds like the highest risk of you getting infected was 8-15 days before your tests. In that incubation time-frame there’s a good risk of false-negative results from the antibody test (esp. if you got infected closer to 8 days ago, most mild cases will not have developed antibodies yet). So that coming up negative was probably to be expected. It’s a good timing for swabs though, so the combination of the two makes sense, and if that one comes back negative you’re good (but look out for symptoms and get retested if you start to feel sick).

9 days ago
12/7/06
Posts: 23322
Job Security -
LakerUp -

Docs—

If you have a chance, I have a couple of questions.  

 

Background:

Two of my coworkers, each of whom I worked within six feet of for much longer than 10 minutes,tested positive on May 22nd and 23rd respectively. They last worked on May 18th and became symptomatic ~May 19th. I worked with them on numerous occasions for the 14 days prior to May 18th.

 

Question:

My employer facilitated testing for me and everyone I work with today. I have zero symptoms.  I completed an antibody and nasal swab test-negative for antibodies and obviously waiting on the swab results.

Was it too early to test us based on the potential dates of exposure? I’ve read mixed opinions. 
 

Thank you!

Timing of testing is a rock and a hard place: you want to catch infections before people get sick or infect others, and at the same time you risk false-negatives if you’re too early. One solution is to retest e.g. every second day, if it is possible (it’s probably not in most places). And neither swabs nor antibody testing detects 100% of cases, so that’s another argument for repeated testing. Also, a lot of antibody test kits are dog-shit inaccurate, especially for use in non-severe cases in a non-Chinese population (where most have been validated/quality assured from the manufacturer).

In your case, it sounds like the highest risk of you getting infected was 8-15 days before your tests. In that incubation time-frame there’s a good risk of false-negative results from the antibody test (esp. if you got infected closer to 8 days ago, most mild cases will not have developed antibodies yet). So that coming up negative was probably to be expected. It’s a good timing for swabs though, so the combination of the two makes sense, and if that one comes back negative you’re good (but look out for symptoms and get retested if you start to feel sick).

Thank you for the thorough explanation and all of the other insight you’ve provided in this thread. 

9 days ago
11/24/09
Posts: 2412

what do you think about these military reports of long term care home in ontario ? 

im not saying this virus is not bad but i really wonder how many died in those places from just stupidity 

some parts of the reports say they used the same needles on multiple ppl in the home , they let ppl with covid just roam around free , they put covid ppl in the same room as ppl who didnt have it 

 

9 days ago
12/13/15
Posts: 3476

Hey docs

I had asthma as a kid but grew out of it somewhat. I've always kept an inhaler around. I'll use it maybe five times a year. Sometimes never for the last 20 years. I'm 50 and this year I use it just about every day. I was in Vegas a week before they shut it down. Is there anyway I contracted it and got over it without knowing but it damaged my lungs. Or is this just coincidence?

One night in Vegas my girlfriend and I felt like we had a fever but it was gone the next day.

9 days ago
8/19/13
Posts: 800
mataleo1 -
Matrix - 
MyTJsuX -

Tried to stay out of these threads... Woke up this morning feeling a little congested. Had a wet cough several times today. :( Wife is due in 40 days so I went and got a test done. We are keeping our distance till Saturday when we find out the results.

How old are you? I’m assuming somewhat young? No conditions? You’ll most likely be okay brotha.

Btw, you more than likely don’t have it. I did and the people that have said the same around me is unbelievable. Got tested and I was positive. Not shocking bc I had no smell for a month but the others all negative. Don’t let the BS fool you. You could absolutely be like my wife though that had at worst the muscle aches which SUCK but still it’s better than a few flu’s I’ve had as well as a couple of stomach bugs. Hope all is well!


MyTJsuX, no need to panic. As Matrix mentioned, you both are likely to be just fine.

However, take this seriously for your wife. A pregnant woman is considered someone who is immunosuppressed.

Good luck.

Thanks for the responses. Tests came back negative. Personally I was fine, but like we said, for my wife's sake I had to be cautious. 

8 days ago
2/4/09
Posts: 11918
akbar87 -

what do you think about these military reports of long term care home in ontario ? 

im not saying this virus is not bad but i really wonder how many died in those places from just stupidity 

some parts of the reports say they used the same needles on multiple ppl in the home , they let ppl with covid just roam around free , they put covid ppl in the same room as ppl who didnt have it 

 

Sounds like there are some serious issues with LTC homes. 

 

In a ford presser he addressed it. I think it hit close to home. Wasnt his wife's mother in one of those homes.