COVID-19 Megathread 4: Grandma Got Run Over by the Dow Jones

[Penn_Quaker_Girl]

https://mobile.twitter.com/CGothnerKCCI/status/1246162124428267522

[Penn_Quaker_Girl]

Visualisation of the unemployment numbers. May need to click on the gif
https://twitter.com/DorsaAmir/status/1243235552666824705

Not to make light, but the way that spike at the end just suddenly appears reminds me of:  

[Penn_Quaker_Girl]

https://mobile.twitter.com/BNODesk/status/1246456668315156486?s=19

[Penn_Quaker_Girl]

Just because my brain is incredibly small:  Badger, every time I see your current username iteration, I think that I'm getting yelled at for a half second

--

And just because nobody has told me to stop or to shut up (and y'all are free to), here's a quick update on my condition for today:

Still having some respiratory discomfort (particularly upon inspiration), but it's still nowhere near what I've heard described in other accounts -- our own #TSA stated that it was almost impossible for him to lie down.  

The fever is still raging, but hasn't seen any significant increase across the past few days.  My vitals are also relatively stable, though I saw an unusual and rapid-onset drop in my blood pressure this morning that required me to lie down for a little while.  As I've mentioned, my blood pressure tends to run on the low end of the acceptable spectrum, but it's definitely something that I'll be monitoring.  

My pulse-ox is lower than it should be, but not in the zone where I would require extra O2.  I'm not experiencing any significant shortness of breath or difficulty breathing.  

Overall, I'd say that my case isn't a necessarily a mild one.  In short, it HURTS.  But it's certainly nowhere near the nightmarish cases about which I've read.  

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As a footnote: I mentioned yesterday that my roommate (in the state of Montana) is currently awaiting her test results.   For those unfamiliar, the origin of both my case and her potential case was her ex-boyfriend.  She'd been in contact with him (while he was asymptomatic) just before leaving Philadelphia to drive back home to Billings.  A few days later, he made an unexpected visit at my apartment to try to patch things up with her, not aware that she had left.  I should have been more careful and, looking back on it, he had a chesty, non-productive cough that he claimed was "just allergies".  

Besides her health, the biggest concern right now is that her travels took her through at least six states not including PA and MT: OH, IN, IL, WI, MN, and ND.  She stopped at numerous gas stations and at least one hotel.  

It just shows how easily these things can spread.  

--

Be safe, everybody!

[Penn_Quaker_Girl]

Do we know when things will be back to normal? (meaning: large gatherings, multiple people shopping, non-essential businessis open, no National Gaurd at state boarders, not having to wear masks, etc)?

When the FDA approves remdesivir for broad use, which they won't do.

Remdesivir has shown promise and I'm definitely interested to see its potential, but the FDA approval process is slow and deliberate.  By approving a drug or treatment, the FDA is basically saying "we have conclusively determined that this item's benefits outweigh its risks."  And with something novel like COVID-19, they need to do more thorough testing before upping its status from compassionate use designation. 

[Penn_Quaker_Girl]

Remdesivir has shown promise and I'm definitely interested to see its potential, but the FDA approval process is slow and deliberate.  By approving a drug or treatment, the FDA is basically saying "we have conclusively determined that this item's benefits outweigh its risks."  And with something novel like COVID-19, they need to do more thorough testing before upping its status from compassionate use designation.  

There's no time left. People are dying RIGHT NOW.

I know, I know.  But ethically, medical providers can't just say "let's try it! If it works it works.  If it doesn't, it doesn't" -- especially with a novel drug such as remdesivir.  The "doesn't work" side of the coin isn't restricted to simply not having any effect at all.  It could mean adverse and dangerous side effects.  It could mean unexpected interactions with other drugs.  

The unknown is a major factor in the administration of novel medications.  Politics and money aside (though, hey, it's drug companies, so those are always considerations), that's why testing is so important and so deliberate.  

[Penn_Quaker_Girl]

Have the various drugs that can be used as treatments shown any negative side effects so far?

With hydroxychloroquine (and I can attest to this as I remember being informed of this before being administered the drug for malaria) -- one of the more notable side effects is a disruption of the heart's rhythm (an elongation of the QT interval).  

It may take months to know the true outcomes from larger trials,[4,5] but what we do know is the safety profiles of these medications. Both hydroxychloroquine and chloroquine have been U.S. Food and Drug Administration (FDA) approved for lupus erythematosus, rheumatoid arthritis, and malaria.[6] Years of safety data show that these medications can cause cardiac ECG QT prolongation and subsequent arrhythmias, including torsade de pointes.[9] These medications can prolong the QT correction (QTc), even when taken as recommended.[9] With limited treatment options how can providers proceed with treatment options?

Now it's worth noting that these side effects occur primarily as a result of chronic intake or overdosing.  Those testing HCQ in the fight against COVID-19 have to determine (a) if it's truly effective against the virus, (b) what is the dosage necessary to be effective against the virus and (c) is that dosage safe enough to administer on a widespread scale? There is an array of other factors too (including the patient's medical history, the interactions when taken on a concomitant basis, etc), but I won't get into those. 

Source: https://www.dicardiology.com/article/covid-19-hydroxychloroquine-treatment-brings-prolonged-qt-arrhythmia-issues

[Penn_Quaker_Girl]

I though the safety trials had already been completed for Remdesivir from its Ebola testing days and they were primarily testing for efficacy now?

That's what I thought too. I thought they also said the efficacy for this drug was fantastic.

Sorry, Bandit, I should've been more specific to Remdesivir (I was referring to drugs currently being tested as potential breakthroughs in general).  

From what I've read, Remdesivir's efficacy has definitely been promising, but we really won't conclusively know until China's trials yield their results:

the World Health Organization labeled it as “the most promising” antiviral during the early days of the outbreak. But its effectiveness won’t be known until a slate of clinical trials reads out, with the first expected from China in the coming weeks.

And there are concerns about sample size and the bottleneck-effect of dozens-and-dozens of clinical tests needing a limited number of participants:

However, there have been concerns about whether those trial findings will be conclusive. As the virus was quickly contained in China, there simply may not be enough patients there—especially severely sick ones—for the remdesivir trial. Plus, hundreds of clinical trials are fighting for participants, including tests of other promising antivirals such as chloroquine, Fujifilm’s flu drug Avigan and AbbVie’s HIV combo Kaletra, as well as for meds that aim to manage potentially life-threatening complications, including Roche’s IL-6 inhibitor Actemra.

.

Source:  https://www.fiercepharma.com/pharma/gilead-ceo-pledges-affordable-remdesivir-as-promising-covid-19-drug-expects-clinical-data

(On a side note, Avigan is a pretty interesting drug, but I'll leave that for another time )

It's a gigantic tangle and one that doesn't just fall on the FDA.  It's the coordination of those who peer-review these clinical trials, drug companies, government agencies, etc. etc.  

[Penn_Quaker_Girl]

Remdesivir has shown promise and I'm definitely interested to see its potential, but the FDA approval process is slow and deliberate.  By approving a drug or treatment, the FDA is basically saying "we have conclusively determined that this item's benefits outweigh its risks."  And with something novel like COVID-19, they need to do more thorough testing before upping its status from compassionate use designation.  

There's no time left. People are dying RIGHT NOW.

I know, I know.  But ethically, medical providers can't just say "let's try it! If it works it works.  If it doesn't, it doesn't" -- especially with a novel drug such as remdesivir.  The "doesn't work" side of the coin isn't restricted to simply not having any effect at all.  It could mean adverse and dangerous side effects.  It could mean unexpected interactions with other drugs.  

The unknown is a major factor in the administration of novel medications.  Politics and money aside (though, hey, it's drug companies, so those are always considerations), that's why testing is so important and so deliberate.  

I never got the fact why it isn't possible for a patient to say let me try it, I accept every possible risk...

This is getting into law and pharma industry (which is far outside of my wheelhouse), but there is something called the "Right To Try". 

So I'll let Dr. FDA explain:

The Right to Try Act permits/allows eligible patients to have access to eligible investigational drugs.

An eligible patient is a patient who has:

1.  Been diagnosed with a life-threatening disease or condition

2.  Exhausted approved treatment options and is unable to participate in a clinical trial involving the eligible investigational drug (this must be certified by a physician who is in good standing with their licensing organization or board and who will not be compensated directly by the manufacturer for certifying)

3.  And has provided, or their legally authorized representative has provided, written informed consent regarding the eligible investigational drug to the treating physician

An eligible investigational drug is an investigational drug:

1.  For which a Phase 1 clinical trial has been completed

2.  That has not been approved or licensed by the FDA for any use

3.  For which an application has been filed with the FDA or is under investigation in a clinical trial that is intended to form the primary basis of a claim of effectiveness in support of FDA approval and is the subject of an active investigational new drug application submitted to the FDA

4.  Whose active development or production is ongoing, and that has not been discontinued by the manufacturer or placed on clinical hold by the FDA

https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/right-try

[Penn_Quaker_Girl]

Anybody have any insight into that gargantuan spike in France's daily cases yesterday?

I seem to recall reading it had something to do with a dump of data from nursing homes, but I haven't been able to find follow-up on that. 

[Penn_Quaker_Girl]

Anybody have any insight into that gargantuan spike in France's daily cases yesterday?

I seem to recall reading it had something to do with a dump of data from nursing homes, but I haven't been able to find follow-up on that. 

Yep, the past 3 days they have added 800, 500 and 600 deaths respectively from a backlog of deaths from nursing homes.

Thank you, my dear.  Welcome to TE btw!

[Penn_Quaker_Girl]

First confirmed case of Covid-19 in South Sudan

The first confirmed case of Covid-19 has been recorded in South Sudan, one of the world’s poorest states where decades of war and hunger have already devastated infrastructure.

The news was announced by Riek Machar, one of the country’s vice presidents, Reuters reports.

https://www.theguardian.com/world/live/2020/apr/05/coronavirus-live-news-cases-approach-12m-as-trump-tells-americans-to-expect-a-lot-of-death?page=with:block-5e8987988f08c35a1d11a325#block-5e8987988f08c35a1d11a325

Leaving only one nation (Lesotho -- one of only three countries on Earth that is completely landlocked inside of another country) on the entire African continent that has not recorded a case.  

The other two African nations without confirmed cases are Comoros and Sao Tome & Principe; both are islands.  

[Penn_Quaker_Girl]

Not US, but still a rather interesting historical event:

https://twitter.com/KayBurley/status/1246783959658377223

[Penn_Quaker_Girl]

To our posters who have gotten this virus (TSA, PQG, maybe someone else), are you feeling any better?

No, not really.  On the bright side, though, my symptoms haven't really progressed.  

The fever is still very uncomfortable (even without physical exertion, I'm sweating through at least five or six shirts a day) and there's a sharp pain in my chest when I breath in.  This cough is heavy and wakes me up during the night, too.  But it's still nothing that I can't handle.  

Thank you for asking!

[Penn_Quaker_Girl]

To our posters who have gotten this virus (TSA, PQG, maybe someone else), are you feeling any better?

No, not really.  On the bright side, though, my symptoms haven't really progressed.  

The fever is still very uncomfortable (even without physical exertion, I'm sweating through at least five or six shirts a day) and there's a sharp pain in my chest when I breath in.  This cough is heavy and wakes me up during the night, too.  But it's still nothing that I can't handle.  

Thank you for asking!

I had the same experience some years ago when I had the common flu. When this whole thing goes away, be prepared to feel like sh**t for another week or two before your body recovers.
This kind of illnesses take a heavy toll even on young, healthy individuals.

I've had the flu before - I've never experienced this level of respiratory discomfort. 

[Penn_Quaker_Girl]

Wow, look at the tracker today. Nearly every state seeing decreases in new cases compared to yesterday. Looks like the tide has turned more quickly than anyone expected and Trump has saved the country from disaster, expect a big approval bump.

One day is hardly a trend here. The same happened weeks ago in Germany and I actually thought it might be a gamechanger, and the rise hasn't stopped yet despite contact ban. To see trend emerging, this needs to be the case over at least a week  It can also be assumed the increase drops on weekends because less people go to work.

In ID classes, we were taught that a pattern can be considered significant after 4-10 days.  (The range is so broad because it depends on the illness, along with a bunch of other factors).

[Penn_Quaker_Girl]

If a troll makes a post and everyone has them on ignore, does it make a sound?

Geez, Georgia I know we've had our differences, but that hurts

[Penn_Quaker_Girl]

If a troll makes a post and everyone has them on ignore, does it make a sound?

Geez, Georgia I know we've had our differences, but that hurts

LOL.  Definitely not; you're more of an anti-troll.

(A llort?)

I believe a "llort" is a cryptid half-bear/half-man beast that is said to prowl the bogs of Wales. 

[Penn_Quaker_Girl]

No thread subtitle, Virginia?

"AntIViral?"

"IV Drip?"

(Working with what I have here.)

[Penn_Quaker_Girl]

Not a Brit, but the Queen's address was quite moving.

https://mobile.twitter.com/BBCBreaking/status/1246876720952639492

[Penn_Quaker_Girl]

The question for everybody here is why do y'all pay attention to what limo liberal or Russian Bear have to say

How are you feeling btw, TSA? You've definitely been in my thoughts.

[Penn_Quaker_Girl]

https://mobile.twitter.com/AlexDiPrato/status/1246881635821371392

[Penn_Quaker_Girl]

https://twitter.com/BBCBreaking/status/1246894412472483841

From the reassurance of the Queen's speech, to this.

The official statement says he plans to remain in charge of the government, and this is not an emergency appointment. Isn't really all that reassuring though. Nothing like the PM being admitted to hospital on a Sunday night (21.30 local time)

That "admitted to hospital" (vs. taken to hospital, etc.) is troubling to me, especially ten days after initial diagnosis.  

[Penn_Quaker_Girl]

Concerning Johnson, this is quite worrying.

Johnson is in his mid-50s and significantly overweight - putting him into the at-risk category. Add on the impact that stress has on the immune system, given his national role, and this could get ugly.

Johnson is determined not to give up his position, so there could be some issues with continuity of government, if his condition worsens.

If I'm honest, I'm freaking out right now. If Johnson's health worsens, or God-forbid he doesn't make it, there's going to be uncertainty and panic, just as we head into the peak of the infection here.

I'll defer back to your knowledge of British English.  But from what I know about healthcare terminology, "admitted to hospital" carries a weight to it.  

And just putting on my med student cap here, if he's being "admitted to hospital" ten days after initial diagnosis, it might be precautionary just on the basis of persisting and unrelenting symptoms.  It could be serious but not necessarily an emergency.  

But you're right about the after-hours timing.  The thing that apparently causes people to seek urgent medical attention in the context of COVID is respiratory distress and pneumonia. Of course, there's no way for me to know if that's the case here.  

[Penn_Quaker_Girl]

https://twitter.com/BBCBreaking/status/1246894412472483841
From the reassurance of the Queen's speech, to this.

The official statement says he plans to remain in charge of the government, and this is not an emergency appointment. Isn't really all that reassuring though. Nothing like the PM being admitted to hospital on a Sunday night (21.30 local time)

That "admitted to hospital" (vs. taken to hospital, etc.) is troubling to me, especially ten days after initial diagnosis.  

What's the difference?

Usually when someone is admitted to hospital, it means that he or she requires extra observation -- often overnight (and, thus, becoming an inpatient).  IOW, he or she is not an outpatient. An outpatient is someone that recieves clinical care without being admitted.  

Basically, if you're being admitted, it won't be a simple "alrighty, everything checks out! You're good to go!"-visit.