OG doc. AMA on COVID-19

What about this treatment? Any validity to this?

Great thread. Thank you.

Cliffs?

King Vinny - 

What about this treatment? Any validity to this?



Don't have time to watch the whole thing.

I like to consider myself evidence-based. There are so many treatments out there that make sense. "There's a cystine molecule on the surface", "Anti-oxydants", "Anti-virals"...

That's not enough. Corticoids make a lot of sense but preliminary data is that they're bad. Chloroquine has a shitty safety profile. Quinine? Well, look up immune thrombopenia and blindness. The medical community has been accused of pushing drugs without proper safety and efficacy trials and I agree.

We need robust and transparent longitudinal studies with 2 groups comparing hard outcomes and side-effects (mortality, not length of hospitalization). It is particularly challenging to do these studies but, fortunately, there are so many incident patients that we actually can perform trials with results available in the matter of weeks.

We should get news from China soon. I have a lot to say about that (I have many Chinese colleagues working on guideline panels with me).

mataleo1 -
jotabrav0 - 
Kirik -

Thank you for the thread of the year.

Apologies for the trobinson troll. He was of course shown the door.

I do have a question that for me is huge. I am based in Western Massachusetts. Just yesterday we had the first presumptive cases in the county. I have a fight gym, and am trying to figure out whether to close or not. We have reached out to the town board of health repeatedly for some direction, without a response so far.

Do you think fight gyms should close down? Should they move to stand up only? Stand up only with a limited size and instruction to try to maintain social distancing? Follow the lead of school officials, and close down or limit size and/or programming if K-12 are closed down in the town?

I know it's impossible to answer anything definitively, but any feedback whatsoever would be very gratefully received.

And again, sincerest apologies for the troll. He obviously leads a very miserable life, at the least internally.

I’m in the same boat Kirik. Don’t know what to do with my gym. Others in the area are adding more to spite current events. We are supposed to have a big kids party tomorrow. This whole ordeal is ridiculous. 
 

I think it’s inevitable we will have to close. But when? How long do you wait? 


No reason to wait. Everything else is closing for a reason. Better be safe. I'd think at the minimum 1 month, possibly 2 or more.

It sucks, I know most of you will lose money. For a threat that may never materialize. But this is serious.

Some of my mentors in medicine (those I trust and respect) have said this is what we should do. I defer to them for matters like this.

Damn. That sucks for the bjj gyms / guys. I stopped practicing 10 years ago but I was there 10+ hours a week for years. I'd have been way bummed and the academy owner would probably have folded if it happened in his early days. 

I'm guessing with indoor gyms of all kinds either closing or people afraid to go, outdoor sports will have a possible resurgence. Cycling, tennis, running, pretty much all the ones I can think of don't put you in proximity to others hardly at all.

Either that or people will buy home exercise equipment. There may be hoarding of thighmasters and shakeweights! Zomg! 

Great thread, Mata. Be well. 

iclimb513 - 
mataleo1 -
jotabrav0 - 
Kirik -

Thank you for the thread of the year.

Apologies for the trobinson troll. He was of course shown the door.

I do have a question that for me is huge. I am based in Western Massachusetts. Just yesterday we had the first presumptive cases in the county. I have a fight gym, and am trying to figure out whether to close or not. We have reached out to the town board of health repeatedly for some direction, without a response so far.

Do you think fight gyms should close down? Should they move to stand up only? Stand up only with a limited size and instruction to try to maintain social distancing? Follow the lead of school officials, and close down or limit size and/or programming if K-12 are closed down in the town?

I know it's impossible to answer anything definitively, but any feedback whatsoever would be very gratefully received.

And again, sincerest apologies for the troll. He obviously leads a very miserable life, at the least internally.

I’m in the same boat Kirik. Don’t know what to do with my gym. Others in the area are adding more to spite current events. We are supposed to have a big kids party tomorrow. This whole ordeal is ridiculous. 
 

I think it’s inevitable we will have to close. But when? How long do you wait? 


No reason to wait. Everything else is closing for a reason. Better be safe. I'd think at the minimum 1 month, possibly 2 or more.

It sucks, I know most of you will lose money. For a threat that may never materialize. But this is serious.

Some of my mentors in medicine (those I trust and respect) have said this is what we should do. I defer to them for matters like this.

Damn. That sucks for the bjj gyms / guys. I stopped practicing 10 years ago but I was there 10+ hours a week for years. I'd have been way bummed and the academy owner would probably have folded if it happened in his early days. 

I'm guessing with indoor gyms of all kinds either closing or people afraid to go, outdoor sports will have a possible resurgence. Cycling, tennis, running, pretty much all the ones I can think of don't put you in proximity to others hardly at all.

Either that or people will buy home exercise equipment. There may be hoarding of thighmasters and shakeweights! Zomg! 

Great thread, Mata. Be well. 


Yeah, it sucks for a lot of people. I'm lucky in the circumstances: I'm not fearing for my job, but I know a lot are suffering. It's a time for us to support eachother. Be safe brother.

mataleo1 -
kappakeen - 

Thanks for the AMA Matleo1


In your opinion what are the best practices we can do if we have to go to work? Obviously working from home is ideal but a lot of us don’t have that option.


What I’m doing is wiping my work station down with a Clorox wipe (throughout the day), wearing gloves, and practicing social distancing.  When I get home I change into clothes I have in the garage and place my work clothes in a plastic garbage bag, before I get in the house.  I then jump into the shower as soon as possible.  I work in a fairly high risk environment (corrections) but I don’t have to interact with a large number of people.
 


Do you have any other recommendations?


 


Thanks again


I'm not an expert on infectious control but from what I've read:

-Keep a safe distance from co-workers
-Wash hands often (or sanitizer)
-Don't go in if you're sick
-Don't go in if anyone else is sick
-Gloves will eventually have droplets if you keep them long enough.
-Limit contact (hand shaking)

You seem to be doing your best!

avoiding touching the face is gonna be hard as it is natural act for all of us. For what its worth, i use nitrate gloves and it actually helps in reminding me not to touch my face.

Kona Silat -
mataleo1 -
kappakeen - 

Thanks for the AMA Matleo1


In your opinion what are the best practices we can do if we have to go to work? Obviously working from home is ideal but a lot of us don’t have that option.


What I’m doing is wiping my work station down with a Clorox wipe (throughout the day), wearing gloves, and practicing social distancing.  When I get home I change into clothes I have in the garage and place my work clothes in a plastic garbage bag, before I get in the house.  I then jump into the shower as soon as possible.  I work in a fairly high risk environment (corrections) but I don’t have to interact with a large number of people.
 


Do you have any other recommendations?


 


Thanks again


I'm not an expert on infectious control but from what I've read:

-Keep a safe distance from co-workers
-Wash hands often (or sanitizer)
-Don't go in if you're sick
-Don't go in if anyone else is sick
-Gloves will eventually have droplets if you keep them long enough.
-Limit contact (hand shaking)

You seem to be doing your best!

avoiding touching the face is gonna be hard as it is natural act for all of us. For what its worth, i use nitrate gloves and it actually helps in reminding me not to touch my face.

Good trick. I play chess so putting my hands on my face is a second job. Time to change this 

Thought this was an interesting twitter thread from a Harvard PhD.  Maybe you can comment on it mataleo

 

MayorPirkle -

Hey Mata I'm also in Montreal. I'm immunosuppressed with infliximab and work in a job where we share a workstation (rotating shifts using the same mouses and keyboards, phones, etc..) so I've told my bosses I'm isolating. They're checking with occupational health services so I'm waiting for their response, but how long do you estimate before I can safely return to work and not worry about this virus? 2 weeks? More?


 


Thanks

Hey Mayor, not sure if it helps, but when I get into work I spray the shit out of the keyboards and mice with cleaner.  If work doesn't provide them get your own.

Great thread!

Im a MD in Europe doing a PhD in epidemiology and was considering going out of my lurking ways to do an AMA - now I’ll just join this thread, if that’s okay.

If anybody wants input from a European point of view - AMA.

2 Likes
robbie380 - 

Thought this was an interesting twitter thread from a Harvard PhD.  Maybe you can comment on it mataleo

 

















I'm going to repeat myself here.

As much as I want to recommend a treatment, and as much as I've read several papers related to COVID treatment, all of these are still a guess, at best.

He mentions methylprednisone, but I'm reading conflicting data (worse outcomes).

Iron is very controversial and is associated with pro-inflammatory cascade (in fact it's been shown to increase mortality in sepsis).

Colchicine: not a benign drug!

There's a difference between lab medicine and clinical medicine. All these hypotheses need to be backed up by data (AKA a randomized trial).

Until then, it's all speculation. Clinicians need to be modest in their claims and admit so.

1 Like

Job Security - 

Great thread!


Im a MD in Europe doing a PhD in epidemiology and was considering going out of my lurking ways to do an AMA - now I’ll just join this thread, if that’s okay.


If anybody wants input from a European point of view - AMA.


Fantastic. Welcome to the party. Please join in, your expertise will help!

Job Security -

Great thread!


Im a MD in Europe doing a PhD in epidemiology and was considering going out of my lurking ways to do an AMA - now I’ll just join this thread, if that’s okay.


If anybody wants input from a European point of view - AMA.

What is your take on ‘herd immunity’ and how does that approach affect those in the vulnerable category? It seems this is essentially cutting them adrift but in all honesty I don’t understand enough about it.

I'm going to take a break from the thread for a little while. But I'll answer questions tomorrow AM.

A lot of backlash (and now backtrack) on the Herd immunity approach of the UK.

1 Like

mataleo1 -

I'm going to take a break from the thread for a little while. But I'll answer questions tomorrow AM.

A lot of backlash (and now backtrack) on the Herd immunity approach of the UK.

Get some rest man. I’m in the UK. Not at all happy with the approach so far. It’s almost as if we’re waiting for it to really hit the fan before putting any significant measures in place.

Dragunov -
Job Security -

Great thread!


Im a MD in Europe doing a PhD in epidemiology and was considering going out of my lurking ways to do an AMA - now I’ll just join this thread, if that’s okay.


If anybody wants input from a European point of view - AMA.

What is your take on ‘herd immunity’ and how does that approach affect those in the vulnerable category? It seems this is essentially cutting them adrift but in all honesty I don’t understand enough about it.

Good question.


Aiming for herd immunity with this virus is an uncertain (and likely a very deadly) path to take for a couple of reasons:


Traditionally, herd immunity is defined to be achieved/effective when at least 95% of a population is immune to a certain infectious disease. When only 5 % of a population can be infected, every case/cluster of disease will quickly be self-limiting (it can only spread to one in 20 people at any given contact, and that person - if infected - can only spread the disease to one in 20 of his/her circle of contact).


The problems in a Covid-19-context are:


1. It won’t be effective:


No western country has 95% of it’s population in the non-vulnerable category (age under 80, no comorbidities etc.). So until the virus has infected the majority of the vulnerable group, herd immunity will not be achieved, and transmission from cluster to cluster will continue to happen.


2. It’s dangerous:


Normally, when talking about herd immunity, it’s related to vaccine uptake rates. Vaccinated people don’t die in the process of achieving herd immunity, which would be the case with Covid-19, even in the non-vulnerable groups (mortality is substantial even in the 50+ age group).

2 Likes

Will this affect people with Lyme disease any worse than regular folks?

ScreenName22 -

It's possible that COVID-19 isn’t as fatal as most people think. And stockpiling hand sanitizer and masks could hurt people who are truly at risk: the elderly and those with weak immune systems.


“Kids and adults have done extremely well in terms of recovery so far,” said Dr. Jeremy Faust, an emergency medicine doctor at Brigham and Women’s Hospital in Boston. “It’s so critical that we do not waste resources among the young and healthy and that we really focus on the areas where this might really get out of control.”


 


https://abcnews.go.com/Health/early-mortality-rates-covid-19-misleading-experts/story?id=69477312

It’s a fair point that mortality risk is dependent on case definition and case numbers. If we only look at hospitalised cases it’s going to be high, and if we look at all infected regardless of symptoms it will be low. It’s very context-dependent.


And he’s right that special care should be given to the vulnerable groups.


However, I disagree that the cruise ship cases are valid for predicting age-specific mortality. It’s just a very selected population. With no data to back up my claim and having never been on a cruise, I’m willing to bet that the average 70-year old cruise ship-goer is much fitter than the average 70-year old (perhaps even than the average 60-year old) in the general population.

Job Security -
Dragunov -
Job Security -

Great thread!


Im a MD in Europe doing a PhD in epidemiology and was considering going out of my lurking ways to do an AMA - now I’ll just join this thread, if that’s okay.


If anybody wants input from a European point of view - AMA.

What is your take on ‘herd immunity’ and how does that approach affect those in the vulnerable category? It seems this is essentially cutting them adrift but in all honesty I don’t understand enough about it.

Good question.


Aiming for herd immunity with this virus is an uncertain (and likely a very deadly) path to take for a couple of reasons:


Traditionally, herd immunity is defined to be achieved/effective when at least 95% of a population is immune to a certain infectious disease. When only 5 % of a population can be infected, every case/cluster of disease will quickly be self-limiting (it can only spread to one in 20 people at any given contact, and that person - if infected - can only spread the disease to one in 20 of his/her circle of contact).


The problems in a Covid-19-context are:


1. It won’t be effective:


No western country has 95% of it’s population in the non-vulnerable category (age under 80, no comorbidities etc.). So until the virus has infected the majority of the vulnerable group, herd immunity will not be achieved, and transmission from cluster to cluster will continue to happen.


2. It’s dangerous:


Normally, when talking about herd immunity, it’s related to vaccine uptake rates. Vaccinated people don’t die in the process of achieving herd immunity, which would be the case with Covid-19, even in the non-vulnerable groups (mortality is substantial even in the 50+ age group).

Thank you. Both of my parents are in that category. I’m planning to keep them isolated for as long as possible. They’re both retired so shouldn’t be too difficult!

1 Like