November 9, 20204 yr Behind with this one: COVID-19 Update from 11/1/20 https://www.nothingbutthetruthmd.com/2020/11/11120-covid-19-update.html PREVENTING THE SPREAD OF SARS-CoV-2 WITH MASKS AND OTHER "LOW TECH" INTERVENTIONS A. Lerner, MD, G. Folkers MPH, A. Fauci, MD JAMA 10-26-20 Modalities in the combination prevention "toolbox" against the spread of SARS-CoV-2 include; 1. Wearing masks 2. Physical distancing 3. Hand Hygiene 4. Prompt testing (along with isolation and tracking) 5. Limits on crowds and gathering I do not understand why JAMA would waste the space publishing an article like this. There is absolutely nothing new that this article brings to light. The fact that this article is still attempting to rationalize the use of NPI and referencing articles that are months old speaks volumes about the problems we have in this country. After reading about this virus on a daily basis, working with this virus, and writing about this virus since February I have come to the firm conclusion that even if Moses (or any religious deity) came down from the sky with 5 commandments etched in stone, the people of western civilizations would not listen or comply. They will not wear masks and distance with sufficient compliance. They will not wash their hands more than usual. Testing will slow down the virus only if people isolate and quarantine, AND THEY WILL NOT. "I am just going to the Wawa for a pack of cigarettes" Tuesday night, the third baseman for the Dodgers was removed from the World Series game in the seventh inning because his Covid-test had just come back positive.. Knowing that he has tested positive, he is not wearing a mask while running out to join the after game celebration. He refuses the request of security sent out by MLB, to leave the field. A UK study concluded that 75% of folks in quarantine are non-compliant. The debacle of NCAA football is further evidence. Hundreds of student athletes have tested positive and there are tens of thousands of fans in the stands weekly without masks, does anyone care? Not the parent, the coaches, or the administrators! You cannot track and trace when you have 60,000+ new cases a day, especially when advanced technology is not a consideration because many of the folks in this country have the secrets of life on their phones. Pennsylvania has a population of 13 million. The state offers a free Covid Alert for phones to help track close contacts with those infected. Only 393,250 have signed up for the free app. Most people I tell about the app are worried about their privacy. What do they do that is so secret?? Anybody that has viewed the pictures or read of summertime celebrations, weddings, rallies, protests, and house parties knows that limiting crowds or celebrations is just out of the question. We will be rid of this virus when it tires of us and not before. CONVERSATIONS WITH DR. HOWARD BAUCHNER Michele Walensky, MD. MpH Head of Infectious Disease, Massachusetts General Hospital 10-22-20 Young people are dying at a 50% increased rate due to Covid Bars are open Schools are closed! NPI likely to be needed through 2021 THE CHALLENGE OF EXPANDING RAPID TESTING TO CURB COVID-19 R. Rubin JAMA 10-28-20 "The test would cost around a dollar." Wrong, the tests cost around $20. "A negative test would mean it was safe to go to work or to school, as long as other mitigation measures - wearing masks, social distancing and had washing were practiced." If we practiced mitigation measures we wouldn't need the tests because we wouldn't have the virus! The author does not touch upon the problem of false negative tests, which are significant. "A positive test result, seconded by a second test (the more reliable RT-PCR) would necessitate self-isolation." There is no evidence to suggest that people are self-isolating compliantly, in fact it is just the opposite. We cannot test our way out of this problem. The problem is not with testing or the lack thereof, but with the people. No amount of testing is going to fix that problem. Academicians, from Fauci on down, should stop talking about increased testing, get out of their ivory towers and see what is going on at street level. Faint hearted politicians, and leadership at all levels need to mandate ENFORCEABLE MITIGATION MEASURES AND STOP TALKING ABOUT TESTING WHICH IS NOT GOING TO BRING THE VIRUS TO A HALT. Not today or tomorrow or next week. NURSING HOMES' NEXT TOOL - VACCINATING WORKERS AGAINST COVID-19 M. Jaklevic JAMA 10-28-20 Long Term Care Facilities account for 8% of the cases but account for 40% of the deaths as of 10/8/20. In mid October the current administration announced the new Pharmacy Partnership for Long Term Care Programs with CVS and Walgreens agreeing to vaccinate Long Term Care residents and staff on site at no cost. CVS and Walgreens have agreed to maintain the cold chain storage of the vaccine. It remains for workers to be willing to vaccinate and for facilities to opt into this program. Many organizations have made Long Term Care Facilities, residents and their staff a top priority for vaccination. SARS-CoV-2 NEUTRALIZING ANTIBODY LY-Co-555 IN OUTPATIENTS WITH COVID-19 P. Chen NEJM 10-31-20 In a randomized, double blinded, placebo controlled study the antibody was tested for safety and efficacy. 150 patients received placebo infusions on day four of their disease 317 patients received either 700 mg, 2800 mg, 7000 mg infusions on day four of their disease 70% of the patients had at least 1 risk factor for increased severity of Covid-19 By day 29, 6.3% of the patients who had received placebo and 1.6% of the patients who had received the antibody required hospitalization. This is extremely encouraging. In a related but separate study, not surprisingly, when started later in the disease the antibody had no beneficial effect. I would assume that the earlier the antibody is given after inoculation the more effective it will be. NUMBERS Deaths - 230,566 Hospital bed utilization - every state that I track had an increase in bed utilization. The overall increase for all states was 13.3% very similar to that of last week of 13.2% Weekly new cases - all states that I track experienced an increase in weekly new cases except for Alabama, and Louisiana. New Jersey was up for the tenth week in a row. Illinois was up 32%, Michigan 32%, Pennsylvania 32% and Ohio 28%. CASE FATALITY RATE: For the time period 10/11 to 10/31 there were 1,358,679 new cases and 15,715 deaths. One person in every 86 who tested positive died. (1.1%) For the time period 5/11 to 5/31 there were 442,457 new cases and 22,987 deaths. One person in every 19.2 who tested positive died. (5.1%) This disease while becoming much more prevalent is much less lethal. Two likely explanations: 1. The percentage of people infected is a MUCH less vulnerable, younger 2. The virus has become much less lethal. Enjoy the day Live Safer Be Well
November 9, 20204 yr And here's yesterday: COVID-19 update for 11/8 https://www.nothingbutthetruthmd.com/2020/11/11820-covid-19-update.html Household transmission, Cardiac Evaluation in athletes after Covid-19 Infection The Covid-19 pandemic is raging with previously unrecorded new highs in infections on an almost daily basis. At the street level, this does not surprise me in the least. As a result of these postings, I get frequent, almost daily questions about the disease, and of late, many of them have been from households (individuals) with a positive index patient. The lack of understanding of what to do is certainly contributing to the spread of the disease along with non-compliance with what is supposed to be done. The impetus for the first report. I am personally involved with some indoor sporting events. In the last 14 days, there have been 33,371 new infections in the state of Pennsylvania. One in every 389 citizens in the state, man, woman and child has been infected in just 14 days! Seven percent of new tests are reported as positive. The state has recently given permission for fan presence at these events in a reduced number. I was present at an event recently where at least 50% of the fans did not wear masks. They cheer and scream (both high risk activities for the transmission of the disease) but they do it without masks. Given the present circumstances, that the State permits this, is sheer lunacy, that I am present is even crazier!! It does not appear that the Governor, or the Department of Health or the Mayor of the city know or are concerned about the spread of virus in their citizens. This is why I am not surprised with the rapid accelerating number of infections. Little wonder that things are spiraling out of control. TRANSMISSION OF SARS-COV-2 INFECTIONS IN HOUSEHOLD - TENNESSEE AND WISCONSIN, APRIL - SEPTEMBER 2020 MMWR (CDC) 11/6/202 C. Grijalva, MD Increased understanding of the transmission of SARS-CoV-2 within households could aid control measures. A case study performed in Nashville, Tennessee and Marshfield, Wisconsin was conducted from April 2020 to September 2020 to improve this understanding. Index patients were identified as the first household member with Covid 19 compatible symptoms who received a positive RT-PCR test and who lived with at least one other household member. After enrollment index patients and household members were tested daily for 14 days. A total of 191 enrolled household contacts of 101 index patients were symptom free at the index patient's illness onset. During follow up, 102 of these 191 tested positive in follow up, a secondary infection rate of 53%. Among 14 households where the index patient was less than 18 years of age, the secondary infection rate from index patients less than 12 years old was 53%, and in index patients aged 12 - 17, the secondary infection rate was 38%. Seventy five percent of the secondary infections were identified within five days of the index patient illness. This information is certainly different from what was appreciated back in March or April of this year. Something has changed. RECOMMENDATIONS (CDC) 1. Persons should self isolate immediately at the onset of Covid 19 like symptoms, at the time of testing, as a result of high risk exposure or at a time of a positive test. 2. All members of the household should wear masks when in shared spaces in the household. This is an ongoing prospective study. In my experience there is very little compliance with these recommendations. SCREENING OF POTENTIAL CARDIAC INVOLVEMENT IN COMPETITIVE ATHLETES RECOVERING FROM COVID-19 AN EXPERT CONSENSUS STATEMENT JOURNAL PRE-PROOF JACC D. Phelan, MD CORONAVIRUS DISEASE 2019 AND THE ATHLETIC HEART EMERGING PERSPECTIVES ON PATHOLOGY, RISKS AND RETURN TO PLAY (RTP) JAMA 10-26-20 J KIm, MD 1. Athlete defined - any individual who places a premium on training, competition and sports achievement. For me, this assumes training that involves heart rate elevations into the aerobic range on a regular basis. Using the five heart rate zones in defining this, would mean elevations into the 70% to 80% of maximum heart rate. Maximum heart rate has traditionally been defined as 220 - age. More recently the effect of aging on heart rate has been appreciated and a newer calculation taking into consideration the effects of age on decreasing the heart rate is 207 - (0.67 X age) = MHR 2. In May 2020 the American College of Cardiology Sports and Exercise section generated recommendations to promote the safe return to play (RTP) for athletes involved with competitive sports after Covid 19 infection. I think that athletes as defined above, should fall into these recommendations. (these can be googled) 3. Many/most athletes will remain totally asymptomatic with Covid 19 infections. 4. What constitutes normal adaptive cardiac remodeling in an athlete? 5. There are documented cases of myocardial injury in both athletes and non-athletes after asymptomatic or mildly symptomatic cases of covid 19. 6. Reasonable assessment after Covid 19 in this population might include EKG, Bio-markers, echocardiography 7. The prevalence and significance of cardiac abnormalities in this population are not well defined at this point in time. 8. Certainly, ANY athlete recovering from Covid 19 with or without symptoms at the time of infection, who experiences decreased performance, unusual fatigue or atypical/unusual shortness of breath, or heart rate irregularities after recovery and returning to play should cease exercise and seek consultation with a Sports Cardiologist for evaluation. Professional athletes are being treated by these guidelines (along with very strict testing protocols), probably most of the big 5 NCAA conferences are following their athletes according to these guidelines, but the smaller colleges and high school athletes get very little in the way of testing and follow up. (this post was primarily for the the coaches, athletes and parents of these athletes in the latter categories.) NUMBERS Deaths - 237,123 Hospital Bed Utilization - In the states that I track every state but South Carolina experienced an increase in bed utilization. Michigan had the largest percentage increase at 40%, followed by Illinois at 32%. Texas has the largest absolute number at 6068. New Weekly Cases - Every state but Georgia experienced an increase in weekly new cases. Illinois had both the largest absolute number of new cases at 19,767 for the week, and the greatest percentage increase at 40%.. New Jersey has the longest string of weekly increases at 11 weeks in a row and closely followed Illinois at a 39% increase for this week. Enjoy the day Live Safer Be Well Case fatality rate - from October 11 until today the rate is 1.0% down from 1.1%
November 9, 20204 yr 10 hours ago, NOTW said: COVID risk: small family funerals, fireworks in your driveway, Thanksgiving with family, going to the beach, surfing or kayaking by yourself. No COVID risk: protesting, looting, celebrating Biden's win with thousands of people on top of each other. you can’t make this sheet up
November 9, 20204 yr 1 hour ago, Dawkins 20 said: 😬 I just wrapped up our youth football season yesterday. Managed 3.5 months without incident. We had two brothers on the team who were close contacts with a barber and they tested negative and sat out 10 days. Now it's just karate for the winter. I'll be in hibernation. Kids have been in school full time for a month and no shutdowns yet either. We'll see.
November 9, 20204 yr 42 minutes ago, Seventy_Yard_FG said: Pfeizer reports vaccine 90% effective F'ing awesome news! Would like to see the data though, but this is still a huge win for all of us. A bit curious on the timing, but I imagine they'll be submitting for EUA very soon. Just need to get through the winter and we'll be in much better shape in the spring!
November 9, 20204 yr 1 minute ago, rambo said: I just wrapped up our youth football season yesterday. Managed 3.5 months without incident. We had two brothers on the team who were close contacts with a barber and they tested negative and sat out 10 days. Now it's just karate for the winter. I'll be in hibernation. Kids have been in school full time for a month and no shutdowns yet either. We'll see. That's great to have no incidents in 3.5 months. Must be almost a relief to have it over and done with even though I'm sure it's quite enjoyable. Our kids haven't done a whole lot of stuff outside of piano for the oldest. It's actually been nice not running around all over the place for swimming lessons and baseball and dance and you name it.
November 9, 20204 yr 1 minute ago, we_gotta_believe said: F'ing awesome news! Would like to see the data though, but this is still a huge win for all of us. A bit curious on the timing, but I imagine they'll be submitting for EUA very soon. Just need to get through the winter and we'll be in much better shape in the spring! Think it was on 60 minutes last night that I watched. Military is involved with the logistics and safeguarding of the vaccine. Only cost the taxpayers $18-27 billion to implement their plan.
November 9, 20204 yr Just now, rambo said: Think it was on 60 minutes last night that I watched. Military is involved with the logistics and safeguarding of the vaccine. Only cost the taxpayers $18-27 billion to implement their plan. Only... that’s only double the annual budget for my state
November 9, 20204 yr Just now, Dawkins 20 said: That's great to have no incidents in 3.5 months. Must be almost a relief to have it over and done with even though I'm sure it's quite enjoyable. Our kids haven't done a whole lot of stuff outside of piano for the oldest. It's actually been nice not running around all over the place for swimming lessons and baseball and dance and you name it. It's a fricken grind. 2 hour practices 4 nights a week in August then down to 2 practices and a game on the weekend. I was logging about 8-10 hours a week on football for 5-7 year olds. Both my kids are in karate which is twice a week plus my daughter is on the performance team which is at least another night a week and she's doing her black belt review which is another night a week. I Fing very relieved football is over. I'll be hanging up the coaching hat until softball and baseball in the spring.
November 9, 20204 yr Well they're gonna give any vaccine to the military guinea pigs first so I'll let you all know if I grown another arm. Or lose one.
November 9, 20204 yr 19 hours ago, EagleVA said: You globers never fail to show your intelligence, freaking cartoon brain fools you guys are. It not a globe, it a dinosaur
November 9, 20204 yr 24 minutes ago, rambo said: Think it was on 60 minutes last night that I watched. Military is involved with the logistics and safeguarding of the vaccine. Only cost the taxpayers $18-27 billion to implement their plan. Biggest issue with the BioNTech candidate is that it's an mRNA vaccine which needs to be kept super cold. Any hiccups in the process could mean massive amounts of doses spoil and must be thrown out. Very difficult to manage logistically. 11 minutes ago, Bear Grylls said: It not a globe, it a dinosaur
November 9, 20204 yr 24 minutes ago, devpool said: Well they're gonna give any vaccine to the military guinea pigs first so I'll let you all know if I grown another arm. Or lose one. Yet another service for your country for which we are indebted to you. Side effects seem consistent among the mRNA candidates, including fever, chills, and a headache. Almost certainly more pronounced than any flu vaccine you've had before, but nothing that lasts longer than a few hours, or a day, at the most. Safety profile looks promising from what they've said so far. I considered signing up for this actual trial from Pfizer when they sent out info at work about it, but I didn't want to risk having to follow through on 2 years of the study if I ended up in the control arm which meant I'd be stuck without being able to get an actual vaccine until the study completed.
November 9, 20204 yr 5 minutes ago, we_gotta_believe said: Biggest issue with the BioNTech candidate is that it's an mRNA vaccine which needs to be kept super cold. Any hiccups in the process could mean massive amounts of doses spoil and must be thrown out. Very difficult to manage logistically. Yeah. I think they said it has to be -80 degrees celsius or something crazy like that. Then you have to figure out what facilities can accommodate the vaccine and population centers for distribution, etc...It's no easy task.
November 9, 20204 yr 31 minutes ago, rambo said: It's a fricken grind. 2 hour practices 4 nights a week in August then down to 2 practices and a game on the weekend. I was logging about 8-10 hours a week on football for 5-7 year olds. Both my kids are in karate which is twice a week plus my daughter is on the performance team which is at least another night a week and she's doing her black belt review which is another night a week. I Fing very relieved football is over. I'll be hanging up the coaching hat until softball and baseball in the spring. i did football, baseball (rec league, AAU, USSSA), boys and girls basketball. looking back, those were the best years of my life. kudos to you for making the time for your kids.
November 9, 20204 yr Just now, NCTANK said: i did football, baseball (rec league, AAU, USSSA), boys and girls basketball. looking back, those were the best years of my life. kudos to you for making the time. Don't get me wrong, I enjoy it but I've literally had no down time the last 3 plus months. I need a mental break.
November 9, 20204 yr 32 minutes ago, devpool said: Well they're gonna give any vaccine to the military guinea pigs first so I'll let you all know if I grown another arm. Or lose one. You and medical professionals on the frontline. They polled Drs and nurses. 60% of doctors said they'd get it right away to 40% of nurses. I mean obviously there's a lot of concern over new vaccines from people and rightfully so. Vaccine process usually takes years and years, this is probably gonna be just over a year for development. I'm a bit apprehensive about it.
November 9, 20204 yr 2 hours ago, Dawkins 20 said: 😬 Stupid right-wing leadership that doesn't listen to science.
November 9, 20204 yr So my boss is at home with a fever and isn't going to get tested and coming back into work tomorrow..... Guess I won't be seeing my mom for a couple of weeks. These people just don't get it.
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