At what point did you / will you take the coronavirus epidemic seriously?

[Jeff Lebowski]

I legit guffawed at a some of the paragraphs in that article. A couple faves:

That article is incredible. How did that get published?

[SteelBlue]

That article is incredible. How did that get published?

"...Dylan attended classes on Zoom from the butler pantry."

[SeattleUte]

That article is incredible. How did that get published?

The New York Times is the media outlet for self-satisfied white elites. A lot of the coverage is practical advise, like this, but also a lot of pious woke stuff that makes them feel better about themselves because they're reading it. A lot of these same kinds of people as are featured in that article are rioting in Portland, Seattle and elsewhere.

Here is what Black leaders actually think of this phenomenon. This sentiment was expressed in more than one place this week.

https://www.nbcnews.com/news/us-news/black-lives-white-spectacle-portland-protests-have-lost-focus-civil-n1234886

[UVACoug]

UEA is making some noise about delaying in-person openings and the president didn't rule out a strike. I try not to get too extreme in my views, but this really irritates me. Pretty much every other industry/business/profession has restarted and adapted. Time to get on with it and smarten up those kids.

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Completely honest question (and maybe a stupid one), can UEA credibly threaten a strike in Utah? Both of my parents have worked in public schools, and the impression I get (which is completely anecdotal) is that most teacher's in Utah don't pay one bit of attention to UEA. Would they actually participate in a strike if UEA called for one? Maybe they would over this issue. Have there been any teacher's strikes in Utah in the past?

[beefytee]

Completely honest question (and maybe a stupid one), can UEA credibly threaten a strike in Utah? Both of my parents have worked in public schools, and the impression I get (which is completely anecdotal) is that most teacher's in Utah don't pay one bit of attention to UEA. Would they actually participate in a strike if UEA called for one? Maybe they would over this issue. Have there been any teacher's strikes in Utah in the past?

The last one I remember was about 20 years ago and they did shut things down for one day IIRC. They didn't call it a strike. I don't remember what it was called, something like A Day of Action. It would be hard to organize a serious strike here in Utah with the low participation rate in the Union.

[Jeff Lebowski]

There are some great public schools, such as in affluent, mostly white areas like Alpine. I am a big advocate of public schools and I think public education should be a constitutional right. One of my daughters is a public school teacher. You probably think your Alpine schools are what all public schools are like, you in your bubble with your progressive pretense. Well, it's not. If you don't realize that there is a crisis of bad public education in this country, and that is a source of inequality, you're clueless.

But you're clueless about a lot.

FTR, I have never lived in Alpine you knucklehead.

[SeattleUte]

FTR, I have never lived in Alpine you knucklehead.

Did I say you live in Alpine? I was just using that as an example. Read closely. I could have said Bainbridge Island or Medina.

[Mormon Red Death]

I've decided to trepidatiously dip a toe into the raging cesspool of debate surrounding the use of hydroxychloroquine (HCQ) to treat COVID-19 patients. I'm a scientist; by both career and interest in this topic. I could not be less interested in the dizzying and mind-numbing opinions about conspiracy theories, cover-ups, underlying political motives, etc. If these past 5 months have taught me anything from social media, it's that I love a seriously diverse group of people. It turns out that I love people who think Donald Trump is our nation's political and social savior who does no wrong, while also loving people who think he is the devil incarnate. I have decided not to stop loving people based on whether I actually agree or disagree on this or any other issue. Life's too short and the world needs so much less hate and so much more love, kindness, rationality, and tolerance.

With that out of the way, here are a few of my thoughts and honest questions as a scientist, connected to actual scientific publications, being as objective about the use of hydroxylchloroquine as possible:

1) Good science often requires modification of the hypothesis (i.e., in science, things can change). This may seem like a contradiction, but when you are dealing with a massively multivariable problem, such as effective therapeutic strategies for COVID-19, scientists are going to have to manage fast-moving and occasionally misleading results. So, rather than get caught up on how scientists "flip flopped" on a topic or "changed their minds", it'd be more effective to ask what changed in their hypothesis and what new findings drove that change (e.g., masks were initially hypothesized to do more harm than good when wore by the masses, but this hypothesis changed as more scientific and situational evidence emerged).

2) There are compelling studies showing that certain treatment regiments with hydroxychloroquine can be HARMFUL, actually increasing mortality rate in COVID-19 patients. Perhaps the most discussed example of this is in the Recovery Trial found here: https://www.recoverytrial.net/result...oquine-results (for scientific write-up not yet peer reviewed, see here: https://www.medrxiv.org/content/10.1....15.20151852v1). What stood out to me in this study is that the dosage for HCQ was quite high, with a loading dose (i.e., first day) at 1600mg followed by a daily regiment of 800mg for 9 days, with no additional therapeutic medications.

3) There are compelling studies showing that certain treatment regiments with hydroxychloroquine can be HELPFUL, actually decreasing mortality rate in COVID-19 patients. I think the most legitimate example is from the Henry Ford COVID-19 Task Force in the following report: https://www.ijidonline.com/article/S...534-8/fulltext. Of note is that the dosage for HCQ was 800mg loading dose followed by a daily regiment of 400mg for 4 days (treatment of a total of 5 days). They studied patients on just HCQ and patients on a combination of HCQ and azithromycin. Their results show ~50% drop in mortality rate for patients treated on HCQ alone and ~24% drop for patients on HCQ + azithromycin.

4) A professor of epidemiology from Yale has published an article reviewing other supportive studies (most of them from outside the US) on the benefits of the combined HCQ + azithromycin treatment strategy for COVID-19. The article can be found here: https://academic.oup.com/aje/article...waa093/5847586 .

5) Much of the critique of the evidence for efficacy in using HCQ is related to the lack of a more complete or extensive trial/study. These criticisms are valid if you compare to historical processes for developing therapeutic regiments; however, as the saying goes, "desperate times call for desperate measures" and this perhaps should translate to our willingness to embrace a less-vetted treatment for this runaway virus. This point is subjective and open to discussion. See response from the author connected to point 4 above on this topic here: https://academic.oup.com/aje/article...waa152/5873640

6) There is also some evidence that adding zinc sulfate to an HCQ + azithromycin treatment regiment reduces the need for ventilation and further reduces the mortality rate. There is less extensive evidence for this addition to the suggested therapeutics, but this particular study can be found here: https://www.medrxiv.org/content/10.1....02.20080036v1

7) No study is perfect. All of the examples I cited above have limitations, some of which are openly acknowledged in the scientific articles. Even still, analysis of the key takeaways between just these few studies suggests the appropriate use of HCQ can improve mortality in COVID-19 patients while misuse can have an exacerbating effect on the course of the disease.

8) Where does this leave me? Well, from my few hours of digging into the scientific literature on this, it seems there is evidence that proper use of HCQ (combined with other therapeutics) has the potential to improve mortality of patients with COVID-19. What I did not find is evidence of this being a flawless, universal cure. To me, that seems like dangerous and troubling rhetoric. HCQ is part of what appears to be a potentially effective therapy, but it does not appear to be a cure.

9) Based on point 8, I see no scientifically supported basis for using the growing evidence of HCQ's therapeutic efficacy as a reason to stop taking precautions that help limit the rampant spread of the coronavirus. I'm not interested in turning this post into a debate about wearing masks or opening schools (perhaps a different day); my point is simply that I do not see the scientific support for a therapy that is complete enough to warrant the dismissal of all caution.

Based on these points, what happens now? My hope is for continued studies around the use of HCQ that builds on the myriad positive results cited above. Meanwhile, I hope this good news does not get overblown -- many solid scientific findings have died a hype-caused death, being suffocated by media-driven rhetoric overstating certain claims and ignoring remaining challenges and pitfalls. For science generally, hype-caused death keeps many promising findings from receiving sufficient funding and attention. For HCQ-related treatment of COVID-19 specifically, over-hype can cause a politically charged stymying of needed progress and adaptation of the most appropriate and effective therapeutic strategy. So, my plea is that we be level-headed about this. Let's stop the finger-pointing and politically charged statements; rather, let's rationally embrace the positive progress here. Clearly, studies of HCQ-related therapies are ongoing as publications are continuing to appear -- this is great and we want these studies to continue.

I'm open to level-headed, rational comments on what I have shared here. Are there reputable, scientific articles that I have overlooked? I'd love to know about them -- I'm always open to updating my hypothesis.

- this is someone I know who teaches at Duke

Sent from my ONEPLUS A6013 using Tapatalk

[Donuthole]

4) A professor of epidemiology from Yale has published an article reviewing other supportive studies (most of them from outside the US) on the benefits of the combined HCQ + azithromycin treatment strategy for COVID-19. The article can be found here: https://academic.oup.com/aje/article...waa093/5847586 .

This pretty thoroughly exposes the problems with that guy throwing around his inferior Y degree:

I am flummoxed to find, in the midst of a crisis, that a seemingly respected epidemiologist is fighting for a drug that almost certainly doesn’t work based on low quality and anecdotal evidence when far higher quality evidence is becoming available and even the bulk of the observational evidence has been negative, with one notable outlier. I am even more flummoxed to find that Newsweek provided this epidemiologist a platform to promote this argument, particularly given how he based it primarily on a commentary and review that he wrote in May, which is basically ancient history as far as the evidence base for hydroxychloroquine goes.

https://respectfulinsolence.com/2020/07/24/harvey-risch-defends-hydroxychloroquine/

[Jeff Lebowski]

Did I say you live in Alpine? I was just using that as an example. Read closely. I could have said Bainbridge Island or Medina.

[Bo Diddley]

Let's stop the finger-pointing and politically charged statements; rather, let's rationally embrace the positive progress here.

Agree. Let's keep an open mind and let honest science lead the way. People are quick to point to any given study as vindication for their bias when often all it really does is beg for more study.

[UVACoug]

I've decided to trepidatiously dip a toe into the raging cesspool of debate surrounding the use of hydroxychloroquine (HCQ) to treat COVID-19 patients. I'm a scientist; by both career and interest in this topic. I could not be less interested in the dizzying and mind-numbing opinions about conspiracy theories, cover-ups, underlying political motives, etc. If these past 5 months have taught me anything from social media, it's that I love a seriously diverse group of people. It turns out that I love people who think Donald Trump is our nation's political and social savior who does no wrong, while also loving people who think he is the devil incarnate. I have decided not to stop loving people based on whether I actually agree or disagree on this or any other issue. Life's too short and the world needs so much less hate and so much more love, kindness, rationality, and tolerance.

With that out of the way, here are a few of my thoughts and honest questions as a scientist, connected to actual scientific publications, being as objective about the use of hydroxylchloroquine as possible:

1) Good science often requires modification of the hypothesis (i.e., in science, things can change). This may seem like a contradiction, but when you are dealing with a massively multivariable problem, such as effective therapeutic strategies for COVID-19, scientists are going to have to manage fast-moving and occasionally misleading results. So, rather than get caught up on how scientists "flip flopped" on a topic or "changed their minds", it'd be more effective to ask what changed in their hypothesis and what new findings drove that change (e.g., masks were initially hypothesized to do more harm than good when wore by the masses, but this hypothesis changed as more scientific and situational evidence emerged).

2) There are compelling studies showing that certain treatment regiments with hydroxychloroquine can be HARMFUL, actually increasing mortality rate in COVID-19 patients. Perhaps the most discussed example of this is in the Recovery Trial found here: https://www.recoverytrial.net/result...oquine-results (for scientific write-up not yet peer reviewed, see here: https://www.medrxiv.org/content/10.1....15.20151852v1). What stood out to me in this study is that the dosage for HCQ was quite high, with a loading dose (i.e., first day) at 1600mg followed by a daily regiment of 800mg for 9 days, with no additional therapeutic medications.

3) There are compelling studies showing that certain treatment regiments with hydroxychloroquine can be HELPFUL, actually decreasing mortality rate in COVID-19 patients. I think the most legitimate example is from the Henry Ford COVID-19 Task Force in the following report: https://www.ijidonline.com/article/S...534-8/fulltext. Of note is that the dosage for HCQ was 800mg loading dose followed by a daily regiment of 400mg for 4 days (treatment of a total of 5 days). They studied patients on just HCQ and patients on a combination of HCQ and azithromycin. Their results show ~50% drop in mortality rate for patients treated on HCQ alone and ~24% drop for patients on HCQ + azithromycin.

4) A professor of epidemiology from Yale has published an article reviewing other supportive studies (most of them from outside the US) on the benefits of the combined HCQ + azithromycin treatment strategy for COVID-19. The article can be found here: https://academic.oup.com/aje/article...waa093/5847586 .

5) Much of the critique of the evidence for efficacy in using HCQ is related to the lack of a more complete or extensive trial/study. These criticisms are valid if you compare to historical processes for developing therapeutic regiments; however, as the saying goes, "desperate times call for desperate measures" and this perhaps should translate to our willingness to embrace a less-vetted treatment for this runaway virus. This point is subjective and open to discussion. See response from the author connected to point 4 above on this topic here: https://academic.oup.com/aje/article...waa152/5873640

6) There is also some evidence that adding zinc sulfate to an HCQ + azithromycin treatment regiment reduces the need for ventilation and further reduces the mortality rate. There is less extensive evidence for this addition to the suggested therapeutics, but this particular study can be found here: https://www.medrxiv.org/content/10.1....02.20080036v1

7) No study is perfect. All of the examples I cited above have limitations, some of which are openly acknowledged in the scientific articles. Even still, analysis of the key takeaways between just these few studies suggests the appropriate use of HCQ can improve mortality in COVID-19 patients while misuse can have an exacerbating effect on the course of the disease.

8) Where does this leave me? Well, from my few hours of digging into the scientific literature on this, it seems there is evidence that proper use of HCQ (combined with other therapeutics) has the potential to improve mortality of patients with COVID-19. What I did not find is evidence of this being a flawless, universal cure. To me, that seems like dangerous and troubling rhetoric. HCQ is part of what appears to be a potentially effective therapy, but it does not appear to be a cure.

9) Based on point 8, I see no scientifically supported basis for using the growing evidence of HCQ's therapeutic efficacy as a reason to stop taking precautions that help limit the rampant spread of the coronavirus. I'm not interested in turning this post into a debate about wearing masks or opening schools (perhaps a different day); my point is simply that I do not see the scientific support for a therapy that is complete enough to warrant the dismissal of all caution.

Based on these points, what happens now? My hope is for continued studies around the use of HCQ that builds on the myriad positive results cited above. Meanwhile, I hope this good news does not get overblown -- many solid scientific findings have died a hype-caused death, being suffocated by media-driven rhetoric overstating certain claims and ignoring remaining challenges and pitfalls. For science generally, hype-caused death keeps many promising findings from receiving sufficient funding and attention. For HCQ-related treatment of COVID-19 specifically, over-hype can cause a politically charged stymying of needed progress and adaptation of the most appropriate and effective therapeutic strategy. So, my plea is that we be level-headed about this. Let's stop the finger-pointing and politically charged statements; rather, let's rationally embrace the positive progress here. Clearly, studies of HCQ-related therapies are ongoing as publications are continuing to appear -- this is great and we want these studies to continue.

I'm open to level-headed, rational comments on what I have shared here. Are there reputable, scientific articles that I have overlooked? I'd love to know about them -- I'm always open to updating my hypothesis.

- this is someone I know who teaches at Duke

Sent from my ONEPLUS A6013 using Tapatalk

This is the concern I have about HCQ. I read some articles that made it sound like a promising therapy before Trump ever said a word about it. But Trump exaggerated its potential as a cure and the left/media seems to have taken the approach of downplaying any positive news about HCQ and exaggerating any less than positive news. I don't know if this is just to spite Trump or because they feel like they need to counteract his positive rhetoric about HCQ (I imaging it is a mixture of both), but it would shame if the current politicization of HCQ prevented any positive use of it as a therapy that could save lives. I can totally see how that could happen and I'm concerned that it already has.

[Jarid in Cedar]

This is the concern I have about HCQ. I read some articles that made it sound like a promising therapy before Trump ever said a word about it. But Trump exaggerated its potential as a cure and the left/media seems to have taken the approach of downplaying any positive news about HCQ and exaggerating any less than positive news. I don't know if this is just to spite Trump or because they feel like they need to counteract his positive rhetoric about HCQ (I imaging it is a mixture of both), but it would shame if the current politicization of HCQ prevented any positive use of it as a therapy that could save lives. I can totally see how that could happen and I'm concerned that it already has.

I am not going to speak of the media, but Trump's declaration put a ton of pressure on physicians to prescribe the medication to patients even though there wasn't a lick of data that it would help reduce death, reduce hospitalization, or even reduce the severity or length of illness. At the time he made his game changer proclamation, the only medical science out there was two studies that suggested, not proven, but suggested that it could reduce the amount of virus in the snot of people who were administered the medication.

In medicine, we call that DOE (Disease oriented evidence). DOE evidence is researcher level stuff. It basically says "Hey, this is something we need to look until further" not "Hey, we need to base/alter entire public health responses based on this data"

As a clinician, you are looking for POE (Patient oriented evidence) to direct patient care. Studies that show improvement in death, severity of illness, hospitalizations, etc. That data right now is mixed, at best, for hydroxychloroquine

[Jarid in Cedar]

MRD, I will do a deep dive on hydroxychloroquine later today or late tonight.

[Commando]

This is the concern I have about HCQ. I read some articles that made it sound like a promising therapy before Trump ever said a word about it. But Trump exaggerated its potential as a cure and the left/media seems to have taken the approach of downplaying any positive news about HCQ and exaggerating any less than positive news. I don't know if this is just to spite Trump or because they feel like they need to counteract his positive rhetoric about HCQ (I imaging it is a mixture of both), but it would shame if the current politicization of HCQ prevented any positive use of it as a therapy that could save lives. I can totally see how that could happen and I'm concerned that it already has.

Obviously I'm all for anything that helps and is proven to do so. Trump standing up there and pleading, almost sounding desperate for people to take it? Saying that he has been shooting back a couple HCQ daily? Just so we're clear he's not a Dr., a pharmacist, an epidemiologist? And nobody on his cabinet or advisors is telling him to push HCQ, right? Just weird.