OtherGround Forums OG doc. AMA on COVID-19

7/3/20 9:41 AM
5/13/02
Posts: 32902

Question: are recommendations about hydroxychloroquine changing?

https://justthenews.com/politics-policy/coronavirus/trump-touted-covid-19-drug-hydroxychloroquine-works-according-new-study

7/3/20 10:00 AM
3/23/12
Posts: 25520
mataleo1 -
youarewhatiswrong - 
mataleo1 -
Billco - 
mataleo1 - 
Matrix - 

“Honestly, and i've mentioned this before, the total number of COVID cases is an important albeit minor metric, as testing is ramping up everywhere.”

Its not minor. I hope that’s just the doctor speaking. MANY MORE people have had COVID-19 than were ever being reported. It skews the death rate drastically and would calm the fears of many Americans. I get the hospital being overrun thing but to say it’s minor is not correct. We need accurate numbers.

Not trying to be an asshole as I’ve thanked you several times. Just my .02.


I think we're saying the same thing.

It's minor only in the sense that it doesn't necessarily have an impact on hard clinical outcomes. It's obviously important for many other reasons, including how to prepare for it in a second wave.

To clarify, it's all good if the mortality rate goes from 2% to 0.2%. But I'm more interested in how many (absolute number) get sick from it, how many need to be admitted, how many need to be tubed, and how many die from it. Absolute numbers vs relative numbers.

To give another example. Ebola has a 25% mortality rate, but no one in the US dies from it.


Thank you for all the information you provided. I try and use this thread as a context point for information, given your expertise (and those of others, of course) are adding contributions and information that cut through the rhetoric you hear elsewhere.

Given that we are seeing (at least I think we are) rises in positive cases (both testing and increase transmission) are effecting more young people lately, do you anticipate that mortality will be positively affected by this?

Again, thank you for providing this information.....

It's a really good question, and not easy to answer.

Obviously, the explosion of cases (50k every day) should translate into a lot more deaths. Since this spike is already several weeks old, you'd expect to these deaths now (deaths occur on average 10-14 days after infection). So far, this does not appear to materialize. Here are possible hypotheses that you mention:

-The new cases are young patients mostly (this is true) who have very low mortality
-Where simply testing more, so we're not really having more new cases
-The virus has less virulence in the summer (there's data for this)
-Treatments are showing more effect (plasma, remdesivir, steroids)
-There's a longer lag in deaths

Personally, I think we will see a small spike in deaths but it's really impossible to make reliable predictions. It will be a different story in the fall.

If the virus is less virulent in the summer, shouldn’t we be doing everything we can to spread it as much as possible right now in the summer months?

 

I’ve been on the streets every day for my job since this began.  Here in my home state of the People’s Republic of Maryland, I havent seen a single person in a public place without a mask on, but Maryland seems to be doing quite poorly in infection rate.  Got any guesses on why this might be?


Good question.

However, if you noticed, I can only start with the observation "Cases are going up, Mortality isn't". From that fact, I develop hypotheses. Then we have to test these hypotheses. That's the scientific method.

I'm not completely convinced the virus is milder in the summer although it's been looked at. Mortality in Iran (where a second spike is occurring) is increasing (obviously these may be other factors in play here). Before suggesting we contaminate ourselves to reach herd immunity (which is still far off, even in Sweden), we better have some degree of certainty. If hospitalizations / ICU/ mortality remains low in the US, then yes, what you suggest may be very useful.

As for Maryland, are people wearing masks inside?

I’ve never seen someone inside a public place without a mask on.

7/3/20 10:06 AM
10/23/05
Posts: 4124
theseanster - 

Question: are recommendations about hydroxychloroquine changing?

https://justthenews.com/politics-policy/coronavirus/trump-touted-covid-19-drug-hydroxychloroquine-works-according-new-study


Not yet.

Other studies have not shown what this study has shown, so take that into account.

Also, considering all the fuck-ups pro and against HCQ, most docs at this point await trials (prospective = looking forward, with comparable groups at baseline). My wife is on the the COVID treatment guidelines panel, so I'll know when that happens :)

7/3/20 10:08 AM
10/23/05
Posts: 4125
youarewhatiswrong - 
mataleo1 -
youarewhatiswrong - 
mataleo1 -
Billco - 
mataleo1 - 
Matrix - 

“Honestly, and i've mentioned this before, the total number of COVID cases is an important albeit minor metric, as testing is ramping up everywhere.”

Its not minor. I hope that’s just the doctor speaking. MANY MORE people have had COVID-19 than were ever being reported. It skews the death rate drastically and would calm the fears of many Americans. I get the hospital being overrun thing but to say it’s minor is not correct. We need accurate numbers.

Not trying to be an asshole as I’ve thanked you several times. Just my .02.


I think we're saying the same thing.

It's minor only in the sense that it doesn't necessarily have an impact on hard clinical outcomes. It's obviously important for many other reasons, including how to prepare for it in a second wave.

To clarify, it's all good if the mortality rate goes from 2% to 0.2%. But I'm more interested in how many (absolute number) get sick from it, how many need to be admitted, how many need to be tubed, and how many die from it. Absolute numbers vs relative numbers.

To give another example. Ebola has a 25% mortality rate, but no one in the US dies from it.


Thank you for all the information you provided. I try and use this thread as a context point for information, given your expertise (and those of others, of course) are adding contributions and information that cut through the rhetoric you hear elsewhere.

Given that we are seeing (at least I think we are) rises in positive cases (both testing and increase transmission) are effecting more young people lately, do you anticipate that mortality will be positively affected by this?

Again, thank you for providing this information.....

It's a really good question, and not easy to answer.

Obviously, the explosion of cases (50k every day) should translate into a lot more deaths. Since this spike is already several weeks old, you'd expect to these deaths now (deaths occur on average 10-14 days after infection). So far, this does not appear to materialize. Here are possible hypotheses that you mention:

-The new cases are young patients mostly (this is true) who have very low mortality
-Where simply testing more, so we're not really having more new cases
-The virus has less virulence in the summer (there's data for this)
-Treatments are showing more effect (plasma, remdesivir, steroids)
-There's a longer lag in deaths

Personally, I think we will see a small spike in deaths but it's really impossible to make reliable predictions. It will be a different story in the fall.

If the virus is less virulent in the summer, shouldn’t we be doing everything we can to spread it as much as possible right now in the summer months?

 

I’ve been on the streets every day for my job since this began.  Here in my home state of the People’s Republic of Maryland, I havent seen a single person in a public place without a mask on, but Maryland seems to be doing quite poorly in infection rate.  Got any guesses on why this might be?


Good question.

However, if you noticed, I can only start with the observation "Cases are going up, Mortality isn't". From that fact, I develop hypotheses. Then we have to test these hypotheses. That's the scientific method.

I'm not completely convinced the virus is milder in the summer although it's been looked at. Mortality in Iran (where a second spike is occurring) is increasing (obviously these may be other factors in play here). Before suggesting we contaminate ourselves to reach herd immunity (which is still far off, even in Sweden), we better have some degree of certainty. If hospitalizations / ICU/ mortality remains low in the US, then yes, what you suggest may be very useful.

As for Maryland, are people wearing masks inside?

I’ve never seen someone inside a public place without a mask on.


That's weird then. Not sure why this is. Is there more extensive testing than elsewhere? So maybe they are capturing more asymptomatic cases? Is the ICU and hospitalization rates worse than elsewhere?

Edited: 7/3/20 11:04 AM
5/5/09
Posts: 11070

Question- is there a liberal communist agenda in this country using Covid as a means of destroying Donald Trumps flagship; his economy in order to overthrow Capitalism and insert Socialism/Communism into America?  

 

Answer- Yes, why yes thats true. These commies are trying to divide and conquer and bring America’s small businesses to their knees and destroy the poor and middle while inciting race warfare.  

7/3/20 1:12 PM
3/28/02
Posts: 8530
DKielbasa -

Question- is there a liberal communist agenda in this country using Covid as a means of destroying Donald Trumps flagship; his economy in order to overthrow Capitalism and insert Socialism/Communism into America?  

 

Answer- Yes, why yes thats true. These commies are trying to divide and conquer and bring America’s small businesses to their knees and destroy the poor and middle while inciting race warfare.  

Wow

just wow

7/3/20 1:18 PM
6/22/03
Posts: 7387
DKielbasa - 

Question- is there a liberal communist agenda in this country using Covid as a means of destroying Donald Trumps flagship; his economy in order to overthrow Capitalism and insert Socialism/Communism into America?  

 

Answer- Yes, why yes thats true. These commies are trying to divide and conquer and bring America’s small businesses to their knees and destroy the poor and middle while inciting race warfare.  


Are all those other countries in the world who are locking part of the conspiracy?
7/3/20 10:13 PM
3/23/06
Posts: 8506

Ok I’ve reached out to 3 friends at 3 different hospitals.  None of them are above 50% capacity.  There are some major lies going around about overcapacity.

7/3/20 10:15 PM
3/23/06
Posts: 8507
Matrix -

“Honestly, and i've mentioned this before, the total number of COVID cases is an important albeit minor metric, as testing is ramping up everywhere.”

Its not minor. I hope that’s just the doctor speaking. MANY MORE people have had COVID-19 than were ever being reported. It skews the death rate drastically and would calm the fears of many Americans. I get the hospital being overrun thing but to say it’s minor is not correct. We need accurate numbers.

Not trying to be an asshole as I’ve thanked you several times. Just my .02.

You are just guessing.  You can’t claims a ton of people had it and never got tested.  It doesn’t work that way.

7/3/20 10:17 PM
3/23/06
Posts: 8508
mataleo1 -
knockoutfighter - 

OG docs... I made a thread on this but as always it’s crickets.

do you agree with the NEW qualifications to be labeled a Covid case number? 

You can be counted as a positive Covid case with no test and no symptoms!!

 


I just saw the first 5 min. Will finish later. I also can't properly read their slides.

From what I've seen so far, they do ask for some tests (antibody testing) or symptoms? You would need 2 of the 3 colors to be considered probable. Of course if you have a positive IgG or IgM for COVID, then yes you've been exposed.

In my opinion, from a public health perspective, what is important, is to have a consistent definition throughout. Confirmed cases should require a nasal swab or antibody. Probable cases are different (they may have a looser definition) and they should never be lumped with the confirmed numbers. Antibody test should NOT count as NEW cases (unless it's IgG).

Honestly, and i've mentioned this before, the total number of COVID cases is an important albeit minor metric, as testing is ramping up everywhere. It's an issue if the number of hospitalized cases and deaths are spiking, which, at least where I work, are decreasing. I've read different in places like Texas and Arizona.



Thanks.  I think we will never see accurate numbers the way it’s going.  To say someone has Covid based on plausible definition seems like another way to inflate the numbers.  

7/3/20 10:19 PM
3/23/06
Posts: 8509
EazyG -
DKielbasa -

Question- is there a liberal communist agenda in this country using Covid as a means of destroying Donald Trumps flagship; his economy in order to overthrow Capitalism and insert Socialism/Communism into America?  

 

Answer- Yes, why yes thats true. These commies are trying to divide and conquer and bring America’s small businesses to their knees and destroy the poor and middle while inciting race warfare.  

Wow

just wow

Wow what?  He’s right.   If you can’t see this is being politicized to the maximum you are lying. 

7/3/20 10:20 PM
3/23/06
Posts: 8510


totally not political
7/3/20 10:20 PM
3/23/06
Posts: 8511


agendas everywhere
7/4/20 4:09 AM
2/27/11
Posts: 11380

Why its still not clear that you must wear a mask mainly to protect others rather than yourself?

 

think about a poor cashier in a grocery store being breathed on by thousand of people every day.

If all the customers wear a mask she’ going to receive nearly zero viral load.

if not, shes guaranteed to get infected within days and then infecting all her family at home.

7/4/20 4:46 AM
1/16/04
Posts: 136

thanks for sharing everything you have Doc! ive gained a lot of weight the last three years and was surpised kind of that im at 285lbs im 37 but train bjj daily and have no diabetes or high blood pressure yet from what ive read if i get the virus im in a lot of shit so im going to drop weight as quickly as possible how much will it improve my odds?

7/4/20 10:21 AM
10/23/05
Posts: 4136
knockoutfighter - 
mataleo1 -
knockoutfighter - 

OG docs... I made a thread on this but as always it’s crickets.

do you agree with the NEW qualifications to be labeled a Covid case number? 

You can be counted as a positive Covid case with no test and no symptoms!!

 


I just saw the first 5 min. Will finish later. I also can't properly read their slides.

From what I've seen so far, they do ask for some tests (antibody testing) or symptoms? You would need 2 of the 3 colors to be considered probable. Of course if you have a positive IgG or IgM for COVID, then yes you've been exposed.

In my opinion, from a public health perspective, what is important, is to have a consistent definition throughout. Confirmed cases should require a nasal swab or antibody. Probable cases are different (they may have a looser definition) and they should never be lumped with the confirmed numbers. Antibody test should NOT count as NEW cases (unless it's IgG).

Honestly, and i've mentioned this before, the total number of COVID cases is an important albeit minor metric, as testing is ramping up everywhere. It's an issue if the number of hospitalized cases and deaths are spiking, which, at least where I work, are decreasing. I've read different in places like Texas and Arizona.



Thanks.  I think we will never see accurate numbers the way it’s going.  To say someone has Covid based on plausible definition seems like another way to inflate the numbers.  


Yeah, I do agree. But there are many States doing it the right way. For now. Not everyone is Texas

7/4/20 10:27 AM
10/23/05
Posts: 4137
sourflesh - 

thanks for sharing everything you have Doc! ive gained a lot of weight the last three years and was surpised kind of that im at 285lbs im 37 but train bjj daily and have no diabetes or high blood pressure yet from what ive read if i get the virus im in a lot of shit so im going to drop weight as quickly as possible how much will it improve my odds?


You're better off being 37 and overweight than 75 and thin.

The risk for you is still very low but higher than for someone your age weighing 170lbs.

If that doesn't seem to make sense, consider this:
37 yo 170 lbs, risk of dying of COVID: 0.05%
37 yo, 285 lbs, risk of dying: 0.1%

So you have double the risk but still very unlikely.

I would lose weight on general grounds though, even if you're fit.

7/5/20 7:20 AM
1/1/01
Posts: 38965

I might have a loved one with covid. They have the dry cough and just started getting a mild fever. Getting tested ASAP.

They are 70 but get a lot of execise and sun. Take no vitamins but eat healthy. Would any supplements like vit C help them fight it while they are waiting for and doing testing?

7/5/20 7:51 AM
10/23/05
Posts: 4138
BJ Penn Forever - 

I might have a loved one with covid. They have the dry cough and just started getting a mild fever. Getting tested ASAP.

They are 70 but get a lot of execise and sun. Take no vitamins but eat healthy. Would any supplements like vit C help them fight it while they are waiting for and doing testing?


Fluids (think broth), vitamin C, zinc. They certainly won't make things worse and may help. Consult if they develop any breathing problems.

7/5/20 10:14 AM
7/28/08
Posts: 1892
Lazarus -
DKielbasa - 

Question- is there a liberal communist agenda in this country using Covid as a means of destroying Donald Trumps flagship; his economy in order to overthrow Capitalism and insert Socialism/Communism into America?  

 

Answer- Yes, why yes thats true. These commies are trying to divide and conquer and bring America’s small businesses to their knees and destroy the poor and middle while inciting race warfare.  


Are all those other countries in the world who are locking part of the conspiracy?

No, every country has rolled over and done as the WHO has told them to. US and UK policy was based on the same model, there’s no conspiracy from other countries, we’re all under the same control 
 

7/5/20 4:49 PM
1/1/01
Posts: 38968
mataleo1 -
BJ Penn Forever - 

I might have a loved one with covid. They have the dry cough and just started getting a mild fever. Getting tested ASAP.

They are 70 but get a lot of execise and sun. Take no vitamins but eat healthy. Would any supplements like vit C help them fight it while they are waiting for and doing testing?


Fluids (think broth), vitamin C, zinc. They certainly won't make things worse and may help. Consult if they develop any breathing problems.

Got it, thanks.

7/5/20 6:11 PM
12/24/16
Posts: 1165
A goat and a piece of fruit tested positive for Corona. Time to end this Charade !
7/5/20 7:26 PM
4/27/02
Posts: 15136
How are they getting these numbers when my nephew who is sick, AND an RN at St. Bernardine's in San Bernardino cannot get tested?
7/6/20 8:30 AM
1/1/01
Posts: 38974

I'm about to look up some suggested zinc, c and d amounts for men with possible covid but anyone have good links to ranges or doses?

7/6/20 9:09 AM
10/23/05
Posts: 4139
BJ Penn Forever - 

I'm about to look up some suggested zinc, c and d amounts for men with possible covid but anyone have good links to ranges or doses?


They are no guidelines, especially for COVID.

And consider that Vitamin D can be toxic at high doses. And probably doesn't do much once you have symptoms.

Vitamin C: 500-1000mg 3x/day for 3 days
Vit D: 10,000u per week
Zinc (zinc gluconate): 50mg at night