Wapsi Square Forum

If anything, conditions in Washington state have gotten more restrictive... unless you are part of ANTIFA- currently ANTIFA is in full control of six blocks of Seattle including a Police Precinct station that the Mayor ordered abandoned on Sunday. I guess it's because they wear masks...

COVID-19 underreporting?

CDC wants states to count ‘probable’ coronavirus cases and deaths, but most aren’t doing it

Fewer than half the states are following federal recommendations to report probable novel coronavirus cases and deaths, marking what experts say is an unusual break with public health practices that leads to inconsistent data collection and undercounts of the disease’s impact.

A Washington Post review found that the states not disclosing probable cases and deaths include some of the largest: California, Florida, North Carolina and New York. That is one reason government officials and public health experts say the virus’s true toll is above the U.S. tally as of Sunday of about 1.9 million coronavirus cases and 109,000 deaths — benchmarks that shape policymaking and public opinion on the pandemic.

{more}

Full story at Washington Post: https://tinyurl.com/ya39zsaz

Well, if it's "probable" covid-19 deaths under discussion, then pretty much by definition some are and some aren't. CDC is wrong to insist that they all be counted as covid-19 deaths, same as if they were confirmed. The states that refuse to count any of them are equally wrong. But without the ability to pin that "probable" down to a verifiable numeric probability, having some states do one way and some states do the other way is likely to get closer to the correct answer than either extreme is.

There are 34,826,510 little blue demons hiding in my basement. They can predict winning horse races, lottery numbers, and rainfall for Sidney, Australia, up to three months in advance. Sadly, they're not really talking to me, and they're invisible. Prove me wrong!

Warrl wrote: ↑Thu Jun 11, 2020 7:07 pm Well, if it's "probable" covid-19 deaths under discussion, then pretty much by definition some are and some aren't. CDC is wrong to insist that they all be counted as covid-19 deaths, same as if they were confirmed. The states that refuse to count any of them are equally wrong. But without the ability to pin that "probable" down to a verifiable numeric probability, having some states do one way and some states do the other way is likely to get closer to the correct answer than either extreme is.

Possibly so. However, I think there are problems with that approach, and perhaps better ways to tackle the issue of getting an accurate count.

A part of the problem is that some jurisdictions are taking what amounts to a "guilty beyond a reasonable doubt" standard - they won't list a death as COVID-related unless there's a positive lab test result. In many areas, the coroner or medical examiner simply can't perform all those tests - either for cost reasons or because the tests are in short supply and are being reserved for use on the still-living. So, even if a competent ME rules that it's a death due to COVID (based on signs, symptoms, exposure, and/or a physical examination of the body) it doesn't show up in the statistics.

This means that jurisdictions that are doing worse on testing, end up with artificially-low COVID-death numbers... not quite an "if we don't look, it's not there" situation, but with much the same effect. This can send a misleading message to people who live there... "we don't have to protect ourselves here because so few people are dying of it." It can also hurt the ability to do good contact-tracing, or persuade people to self-isolate after exposure.

There are a couple of good ways to come up with a reasonably reliable estimate, even in the absence of complete testing:

1. Statistical. Do tests on a reasonable number of people in the county of die of COVID-like symptoms. Make a note of the percentage who test positive. Assume, for number-gathering purposes, that a similar percentage of those you don't test who died of those sorts of symptoms were probably COVID-positive, and report a number based on this percentage. Re-sample periodically to keep your percentage numbers up-to-date.
2. Excess-death rates. Look at the number of people who have historically died of respiratory-related illnesses and pneumonia in (e.g.) May, in your county. Take an average over several years. To be conservative, weight it up towards a moderately-bad flu year. Then, look at the number who died of such illnesses this May. Subtract the former number from the latter. This "excess" is (under current conditions) probably COVID-related deaths.

If you do both of these sorts of estimations at the same time, you can sanity-check the two estimates against one another... and I suspect they'll probably line up pretty well, unless there's another mystery respiratory virus running around killing people in significant numbers this month.

As I understand it, the CDC uses both of those sorts of techniques to analyze flu deaths in a typical year (with the excess-death comparison being based on flu-season months vs. non-flu-season months).

That's called "science".

Actually, that's called "valid science".

Atomic wrote: ↑Thu Jun 11, 2020 7:19 pm There are 34,826,510 little blue demons hiding in my basement. They can predict winning horse races, lottery numbers, and rainfall for Sidney, Australia, up to three months in advance. Sadly, they're not really talking to me, and they're invisible. Prove me wrong!

Can I get some cannabis from you?

Florida just broke its record for most new coronavirus cases in a day. The state, which launched a new phase of reopening last week and which has allowed amusement parks to reopen, reported 1,698 new cases of COVID-19 on Thursday—topping its previous high of 1,419 a week ago.
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beach.jpg (22.43 KiB) Viewed 7685 times

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Gov. Ron DeSantis says the relaxation of lockdown isn’t the cause of the spike; he insists it’s increased testing. Not everyone agrees. In Seminole County, Emergency Manager Alan Harris said their uptick can’t have anything to do with testing because testing numbers have actually dropped, the Orlando Sentinel reported.

{The picture above looks as if someone is making money renting face shields to beach-goers; notice the number stenciled at the top of the woman's, and the fact that the out-of-focus guy in the background appears to be wearing something similar}

The suit might be a rental too, judging from the fit.

One size fits most.

One size fits most.

One size fits Al. But I'm not Al.

Sgt. Howard wrote: ↑Thu Jun 04, 2020 11:47 am

jwhouk wrote: ↑Thu Jun 04, 2020 10:43 am Within the next few weeks? Cases have already gone up again in AZ.

Is that like in New York where it was discovered that ALL DEATHS were being listed as 'Covid-19' because of the $$$ the hospitals would receive? Hospitals are not allowed to do elective procedures at this time, so making a Covid diagnosis becomes a matter of fiscal survival...

This is as good a place as any to put this:

FactCheck.org says:

The initial comment was made by Minnesota State Sen. Scott Jensen, a family physician, who spoke with Fox News host Laura Ingraham on April 8 about the idea that the number of COVID-19 deaths may be inflated. Jensen was responding to National Institute of Allergy and Infectious Diseases Director Anthony Fauci, who — while answering a reporter’s question about that theory — said “you will always have conspiracy theories when you have very challenging public health crises. They are nothing but distractions.”

{snip}

Jensen himself said in a phone interview that he was not alleging widespread medical fraud.

“Do I think people are misclassifying? No,” Jensen said. He said his concerns centered on what he deemed “less precise standards” for certifying deaths promulgated by the U.S. Centers for Disease Control and Prevention, and how deaths classified as COVID-19 without corroborating positive test results could lead to an over-counting.

The Food and Drug Administration on Monday withdrew emergency use authorizations for two coronavirus treatments promoted by President Donald Trump despite concerns about their safety and effectiveness.

The agency revoked the authorizations for hydroxychloroquine and chloroquine after a request from Gary Disbrow, acting director of the Biomedical Advanced Research and Development Authority.

After reviewing new information from large clinical trials the agency now believes that the suggested dosing regimens "are unlikely to produce an antiviral effect," FDA chief scientist Denise Hinton said in a letter announcing the decision.

Critics have accused the agency of caving to political pressure when it authorized use of hydroxychloroquine and chloroquine in hospitalized Covid-19 patients in late March despite thin evidence. More recent randomized controlled trials have found the drugs do not benefit coronavirus patients, and doctors have reported that hydroxychloroquine can cause heart problems.

Because hydroxychloroquine is approved for other uses — treating lupus and arthritis — doctors could still use it "off label" to treat coronavirus patients, and clinical trials examining their use against Covid-19 can continue. The FDA noted that the version of chloroquine that had been authorized for emergency use is not approved in the U.S. so all use of that drug, donated by Bayer, will now end.

The administration’s focus on the malaria medicines in the early months of the pandemic deepened a divide between the White House and its health agencies. Several administration officials told POLITICO they felt the drugs got outsized attention while FDA scrambled for solutions in March. Other current and former Health and Human Services officials later said that the emergency authorities and White House demands cast a shadow on FDA as it struggled to remain independent.

Rick Bright, the former BARDA director whom Disbrow replaced, has accused health officials of removing him from his role overseeing millions of dollars to develop treatments and vaccines because he raised health concerns about hydroxychloroquine and resisted its widespread use.

Drugmakers donated millions of the pill to the government’s strategic national stockpile after Bright wrote to the FDA requesting for emergency use, a move he now says he was pressured to make.

In April, roughly a month after the FDA authorized emergency use of the drugs, the agency warned against using hydroxychloroquine outside of hospitals and clinical trials because of potentially fatal cardiac side effects. Trump toned down on mentions of the pills during his White House briefings around the same time, but in May told reporters he was taking a course of hydroxychloroquine after a White House aide was diagnosed with the coronavirus.

This month two randomized controlled trials, considered the gold standard for determining whether a drug is effective, concluded that the drug does not prevent coronavirus infection and did not help hospitalized patients.

AnotherFairportfan wrote: ↑Mon Jun 15, 2020 11:40 am

FDA ends emergency use of hydroxychloroquine for coronavirus
SARAH OWERMOHLE | Politico | 06/15/2020

The Food and Drug Administration on Monday withdrew emergency use authorizations for two coronavirus treatments promoted by President Donald Trump despite concerns about their safety and effectiveness.

The agency revoked the authorizations for hydroxychloroquine and chloroquine after a request from Gary Disbrow, acting director of the Biomedical Advanced Research and Development Authority.

After reviewing new information from large clinical trials the agency now believes that the suggested dosing regimens "are unlikely to produce an antiviral effect," FDA chief scientist Denise Hinton said in a letter announcing the decision.

Critics have accused the agency of caving to political pressure when it authorized use of hydroxychloroquine and chloroquine in hospitalized Covid-19 patients in late March despite thin evidence. More recent randomized controlled trials have found the drugs do not benefit coronavirus patients, and doctors have reported that hydroxychloroquine can cause heart problems.

Because hydroxychloroquine is approved for other uses — treating lupus and arthritis — doctors could still use it "off label" to treat coronavirus patients, and clinical trials examining their use against Covid-19 can continue. The FDA noted that the version of chloroquine that had been authorized for emergency use is not approved in the U.S. so all use of that drug, donated by Bayer, will now end.

The administration’s focus on the malaria medicines in the early months of the pandemic deepened a divide between the White House and its health agencies. Several administration officials told POLITICO they felt the drugs got outsized attention while FDA scrambled for solutions in March. Other current and former Health and Human Services officials later said that the emergency authorities and White House demands cast a shadow on FDA as it struggled to remain independent.

Rick Bright, the former BARDA director whom Disbrow replaced, has accused health officials of removing him from his role overseeing millions of dollars to develop treatments and vaccines because he raised health concerns about hydroxychloroquine and resisted its widespread use.

Drugmakers donated millions of the pill to the government’s strategic national stockpile after Bright wrote to the FDA requesting for emergency use, a move he now says he was pressured to make.

In April, roughly a month after the FDA authorized emergency use of the drugs, the agency warned against using hydroxychloroquine outside of hospitals and clinical trials because of potentially fatal cardiac side effects. Trump toned down on mentions of the pills during his White House briefings around the same time, but in May told reporters he was taking a course of hydroxychloroquine after a White House aide was diagnosed with the coronavirus.

This month two randomized controlled trials, considered the gold standard for determining whether a drug is effective, concluded that the drug does not prevent coronavirus infection and did not help hospitalized patients.

???... and... HOW many decades has this drug been prescribed by VA and Civilian MD's, and NOW they need to run trials?

Sgt. Howard wrote: ↑Mon Jun 15, 2020 11:50 am ???... and... HOW many decades has this drug been prescribed by VA and Civilian MD's, and NOW they need to run trials?

These drugs have been prescribed, for decades, for malaria and for lupus. These are diseases for which there is plenty of historical data (and lots of previous trials) to show that they are actually effective. Even in those applications, the trials showed that these drugs do come with some significant risks (in particular, heart problems) and the prescribing doctors have been well aware of those risks. For those diseases, the effectiveness and benefit usually outweighs the risks.

Over the last few decades, CQ and HCQ have been tried experimentally as possible treatments against a number of viruses. If I recall correctly, there's long been some evidence that they have some anti-viral properties when used in vitro ("in the test tube"). However, they have not shown actual anti-viral benefits in vivo (when used in medical treatment of actual living patients). That's true of a lot of drugs - things that work in the lab often don't work out well in treatment trials. Sometimes the level of drug required to act as an antiviral is impossible to deliver in a human body, or the drug can't reach or penetrate the cells properly, or the body eliminates it too quickly, or it is unacceptably toxic.

When SARS-CoV-2 showed up, the old interest in the chloroquines arose again... since there was no effective drug treatment for this new virus at all, researchers pulled it off the shelf and started testing it to see if it might work better on this virus. There were one or two small, early, and poorly-controlled "field trials" which seemed to show some benefits. These early studies have received some serious criticism, and everybody agreed that bigger, longer, and more-carefully-controlled tests were required to know how much benefit (if any) CQ and HCQ show against CIVID-19.

(It's very common for early, small tests, and anecdotal reports to claim that drugs have a benefit, while larger, carefully-controlled "blind" tests later show that this benefit wasn't actually there, but was the result of random statistical jitter, bad reporting, pre-selection of patients, etc. That's why we do controlled tests. There's a huge corpus of knowledge about how you run a good controlled test, to make sure that you're measuring the thing you want to learn about, and aren't being confused or mislead by other factors.)

On the basis of those early trials, the FDA issued an "emergency use authorization" for broad-scale distribution and use of CQ and HCQ. This allowed the manufacturers to make and distribute the drugs for the specific purpose of treating COVID-19 rather than for just the diseases which they'd previously been approved for. The FDA did this to allow for CQ/HCQ treatment (which might, possibly, save lives) while the longer tests were being run. This would (I believe) also create a presumption of legitimacy for doctors prescribing it. This might have saved lives, if CQ/HCQ were actually effective in practice.

Well, a bunch of the longer and better-controlled tests have reported in. And, unfortunately, the results say "No significant benefit" - not for acutely-ill patients, and not for the mildly-ill either. As before, CQ/HCQ's anti-viral properties seem to work out better in the lab than they do in actual patients.

Some of the tests also showed that the death rate among seriously-ill patients was higher for those who took CQ/HCQ than for those who took a placebo. This is not what we wanted to hear.

So, the FDA has rescinded the "emergency use" authorization for the use of CQ/HCQ as a treatment for COVID-19. It is no longer recommended, and (if I understand correctly) its manufacturers can no longer claim that it's an effective treatment.

It can still be prescribed for the uses for which the FDA approved it as being effective (non-resistant malaria, lupus, etc.). And, individual doctors are free to prescribe it "off-label" to COVID-19 patients, if they choose to do so and if their patients want or agree to it (just as other "off-label" uses of most drugs are possible).

But, due to the lack of effectiveness, and the (known-for-decades) risks, it's not now considered a "mainstream" treatment. I imagine that many hospitals and health-care organizations will discourage their doctors from prescribing it off-label, due to the risk of liability if the patient becomes sicker or dies.

So, in the end, two drugs which had been touted as being a "game-changer" against COVID-19 didn't change the game in any good way. They don't work for this purpose. That's a damned shame. It's not a big surprise to the scientific community (they've been tried against related viruses in the past, and didn't work there either) but it's still a shame.

From what I can see, the FDA's decision to issue an EUA for CQ/HCQ against COVID-19 was a reasonable one. Their decision to revoke this EUA was also a reasonable one. The difference between the two, was the time required to go from "There are theoretical reasons to believe it might work, and some weak evidence that it does" to "More complete evidence shows that it does not work."

Sgt. Howard wrote: ↑Mon Jun 15, 2020 11:50 am ???... and... HOW many decades has this drug been prescribed by VA and Civilian MD's, and NOW they need to run trials?

They have NEVER been prescribed for any viral disease.

They are properly prescribed for malaria and auto-immune conditions.

They are known to cause dangerous heart arrhythmia.

Before they can be prescribed as a cure/preventative for something new, they have to be tested.

The tests have shown no benefit for COVID-19.

Dave wrote: ↑Mon Jun 15, 2020 2:16 pm These drugs have been prescribed, for decades, for malaria and for lupus. These are diseases for which there is plenty of historical data (and lots of previous trials) to show that they are actually effective. Even in those applications, the trials showed that these drugs do come with some significant risks (in particular, heart problems) and the prescribing doctors have been well aware of those risks. For those diseases, the effectiveness and benefit usually outweighs the risks.

From Wikipedia:

The most common adverse effects are nausea, stomach cramps, and diarrhea. Other common adverse effects include itching and headache.

The most serious adverse effects affect the eye, with dose-related retinopathy as a concern even after hydroxychloroquine use is discontinued.

Serious reported neuropsychiatric adverse effects of hydroxychloroquine use include agitation, mania, difficulty sleeping, hallucinations, psychosis, catatonia, paranoia, depression, and suicidal thoughts. In rare situations, hydroxychloroquine has been implicated in cases of serious skin reactions such as Stevens–Johnson syndrome, toxic epidermal necrolysis, and Drug reaction with eosinophilia and systemic symptoms. Reported blood abnormalities with its use include lymphopenia, eosinophilia, and atypical lymphocytosis.

So, lessee - it can make you crazy.

It can cause suicidal thoughts.

It can kill you with heart arrhythmia.

Or it can blind you.

And there are NO real studies that indicate it might be effective for COVID-19.

On the Good News front... the BBC just reported on an Oxford-University-led study which indicates that dexamethasone (an inexpensive steroid) significantly reduces the death rate for COVID-19 patients ill enough to need oxygen or ventilators. "For patients on ventilators, it cut the risk of death from 40% to 28%. For patients needing oxygen, it cut the risk of death from 25% to 20%."

https://www.bbc.com/news/health-53061281

As a steroid, it acts to reduce inflammation, and thus the "cytokine storm" of inflammation which damages the lungs of those seriously ill with COVID-19. It has a long history of medical use (as part of chemotherapy for cancer, for one). It's cheap, widely available "on the shelf", easy to make, and the required dosage is small.

If confirmed, this is very very good news indeed... it's going to save a lot of lives.

It doesn't seem to have significant benefits for those who are only mildly ill (those whose lungs aren't that badly affected) and that's probably not surprising... it's not an antiviral. So, it's not being recommended for at-home treatment of mild cases, or for pre- or post-exposure prophylaxis... as with most drugs there are potential side effects and it shouldn't be used unnecessarily.

The study which reported this was a good-sized, randomized and controlled study of several different treatment alternatives, including chloroquine and hydroxychloroquine. Dexamethasone helped, the various chloroquine drugs and combinations did not.

Heh. This is exactly what i came here to report.

Was gonna quote the same BBC report.

I'm not proclaiming it a cure; given the reported percentages, it's a palliative, but a pretty good one.

A quote from the BBC:

The UK government has 200,000 courses of the drug in its stockpile and says the NHS will make dexamethasone available to patients.

Lucky Brits.

...and, i think, they have a lower infection rate, too.

In another item: a study by a Texas A&M group suggests that face-masks are more useful in preventing COVID-19 infection than had previously been realized. Wearing a mask significantly reduces the risk that the wearer will pass on an infection via aerosols (that's been recognized for months), but apparently a simple cloth mask will significantly reduce the risk to the wearer of being infected after contact.

"Our results clearly show that airborne transmission via respiratory aerosols represents the dominant route for the spread of COVID-19," Zhang said. "By analyzing the pandemic trends without face-covering using the statistical method and by projecting the trend, we calculated that over 66,000 infections were prevented by using a face mask in little over a month in New York City. We conclude that wearing a face mask in public corresponds to the most effective means to prevent inter-human transmission.

"This inexpensive practice, in conjunction with social distancing and other procedures, is the most likely opportunity to stop the COVID-19 pandemic. Our work also highlights that sound science is essential in decision-making for the current and future public health pandemics."

(This research is based on statistical analysis and modeling, not a controlled or blinded study, so it's not on as solid a footing as the chloroquine and dexamethasone studies reported recently.)

https://www.sciencedaily.com/releases/2 ... 172200.htm

Arizona, Florida, Oklahoma, and Texas reported record numbers of new coronavirus cases on Tuesday. Arizona saw an increase of 2,392 cases since Monday, while Florida saw a bump of 2,783 new cases, Oklahoma reported 228 new cases and Texas had 2,622 new cases. Texas, following another concerning trend, has reported a record number of hospitalizations for the fourth straight day Tuesday, marking 2,326 hospitalized coronavirus patients in the state.

The upward case trend across several states comes as all 50 states work to ease restrictions.

Florida crossed the 80,000 case mark Tuesday, while Arizona’s weekly average of daily cases has nearly tripled compared to two weeks ago. President Donald Trump is set to host a campaign rally in Tulsa, Oklahoma, this week, despite the spike in cases. Vice President Mike Pence lied about Oklahoma’s coronavirus data on Tuesday and said that the campaign will be taking some safety precautions, including temperature checks.