Future of Division III

[jamtod]

A couple of things from New England Journal of Medicine

https://www.nejm.org/coronavirus?query=main_nav_lg

https://www.nejm.org/doi/full/10.1056/NEJMe2017594?query=featured_home

Looks like an audio interview, without a commute, not sure I'll prioritize listening, would you care to give a cliff notes summary of the observations?

[Ralph Turner]

jamtod, yes, that Didier Raoult.

Did you read (can you read) the article that I cited? 

Didier has 1863 citations of peer-reviewed articles from his research in PubMed as of today.  Dr Anthony Fauci has only 296.

Didier is one of the few people in the world who can take on Big Pharma. Didier showed that both Hydroxychloroquine and Azithromycin were beneficial in lab studies against SARS and MERS.  Even Dr Fauci was thought that those drugs might work back in 2013 against the coronavirus, MERS.

In April, Sermo, "the largest healthcare data collection company and global social platform for physicians, leveraged its capabilities to publish results of a COVID-19 study with more than 6,200 physicians in 30 countries." Hydroxychloroquine was the #1 choice of 37% of physicians of 15 choices listed. Azithromycin (32%) was #2. From the news release cited below, ..."Outside the U.S., hydroxychloroquine was equally used for diagnosed patients with mild to severe symptoms whereas in the U.S. it was most commonly used for high risk diagnosed patients," the survey found.

https://www.sermo.com/press-releases/largest-statistically-significant-study-by-6200-multi-country-physicians-on-covid-19-uncovers-treatment-patterns-and-puts-pandemic-in-context/

Gilead Pharmaceutical announced the pricing structure for Remdesivir today; $3120 for the short course. $5720 for the full course of treatment.  And the FDA only approved the drug for use with COVID-19 because it shortened hospital stays from 15 days to 11 days. It was not shown to save more lives! Hydroxychloroquine, Azithromycin and Zinc costs less than $30 for the full treatment. Remdesivir only costs $9 to make.

No wonder Big Pharma, Big Health, and Big Everyone Else chasing the Big Dollars were out to get him!

[jamtod]

jamtod, yes, that Didier Raoult.

Did you read (can you read) the article that I cited? 

Didier has 1863 citations of peer-reviewed articles from his research in PubMed as of today.  Dr Anthony Fauci has only 296.

Didier is one of the few people in the world who can take on Big Pharma. Didier showed that both Hydroxychloroquine and Azithromycin were beneficial in lab studies against SARS and MERS.  Even Dr Fauci was thought that those drugs might work back in 2013 against the coronavirus, MERS.

In April, Sermo, "the largest healthcare data collection company and global social platform for physicians, leveraged its capabilities to publish results of a COVID-19 study with more than 6,200 physicians in 30 countries." Hydroxychloroquine was the #1 choice of 37% of physicians of 15 choices listed. Azithromycin (32%) was #2. From the news release cited below, ..."Outside the U.S., hydroxychloroquine was equally used for diagnosed patients with mild to severe symptoms whereas in the U.S. it was most commonly used for high risk diagnosed patients," the survey found.

https://www.sermo.com/press-releases/largest-statistically-significant-study-by-6200-multi-country-physicians-on-covid-19-uncovers-treatment-patterns-and-puts-pandemic-in-context/

Gilead Pharmaceutical announced the pricing structure for Remdesivir today; $3120 for the short course. $5720 for the full course of treatment.  And the FDA only approved the drug for use with COVID-19 because it shortened hospital stays from 15 days to 11 days. It was not shown to save more lives! Hydroxychloroquine, Azithromycin and Zinc costs less than $30 for the full treatment. Remdesivir only costs $9 to make.

No wonder Big Pharma, Big Health, and Big Everyone Else chasing the Big Dollars were out to get him!

Yes. I can read. Dude rejects the idea of controlled studies and used a sample size of between 20-30 to draw conclusions, after 6 days. If patients died or their conditions worsened, they "fell out of contact" and were excluded from the study. The dude is a quack, but even he has scaled back on his enthusiasm for HCQ.

Also, he has so many citations because he's notorious for putting his name on all the work that comes out of his group. Not uncommon, but the dude must be a speed reader and never sleep to even read (much less give any insightful feedback) on all of the "studies" he tacks his name onto.

Did you read the articles I cited?

Some additional clarification on the sermo release:
https://fullfact.org/health/covid-19-hydroxychloroquine-chloroquine-treatment/

No doubt there are problems with Big Pharma, but believing that doesn't mean I have to accept faulty claims about HCQ or conspiracy theories about COVID being fake news.

[Oline89]

jamtod, yes, that Didier Raoult.

Did you read (can you read) the article that I cited? 

Didier has 1863 citations of peer-reviewed articles from his research in PubMed as of today.  Dr Anthony Fauci has only 296.

Didier is one of the few people in the world who can take on Big Pharma. Didier showed that both Hydroxychloroquine and Azithromycin were beneficial in lab studies against SARS and MERS.  Even Dr Fauci was thought that those drugs might work back in 2013 against the coronavirus, MERS.

In April, Sermo, "the largest healthcare data collection company and global social platform for physicians, leveraged its capabilities to publish results of a COVID-19 study with more than 6,200 physicians in 30 countries." Hydroxychloroquine was the #1 choice of 37% of physicians of 15 choices listed. Azithromycin (32%) was #2. From the news release cited below, ..."Outside the U.S., hydroxychloroquine was equally used for diagnosed patients with mild to severe symptoms whereas in the U.S. it was most commonly used for high risk diagnosed patients," the survey found.

https://www.sermo.com/press-releases/largest-statistically-significant-study-by-6200-multi-country-physicians-on-covid-19-uncovers-treatment-patterns-and-puts-pandemic-in-context/

Gilead Pharmaceutical announced the pricing structure for Remdesivir today; $3120 for the short course. $5720 for the full course of treatment.  And the FDA only approved the drug for use with COVID-19 because it shortened hospital stays from 15 days to 11 days. It was not shown to save more lives! Hydroxychloroquine, Azithromycin and Zinc costs less than $30 for the full treatment. Remdesivir only costs $9 to make.

No wonder Big Pharma, Big Health, and Big Everyone Else chasing the Big Dollars were out to get him!

Yes. I can read. Dude rejects the idea of controlled studies and used a sample size of between 20-30 to draw conclusions, after 6 days. If patients died or their conditions worsened, they "fell out of contact" and were excluded from the study. The dude is a quack, but even he has scaled back on his enthusiasm for HCQ.

Also, he has so many citations because he's notorious for putting his name on all the work that comes out of his group. Not uncommon, but the dude must be a speed reader and never sleep to even read (much less give any insightful feedback) on all of the "studies" he tacks his name onto.

Did you read the articles I cited?

Some additional clarification on the sermo release:
https://fullfact.org/health/covid-19-hydroxychloroquine-chloroquine-treatment/

No doubt there are problems with Big Pharma, but believing that doesn't mean I have to accept faulty claims about HCQ or conspiracy theories about COVID being fake news.

Pretty good studies here:  https://www.nejm.org/doi/full/10.1056/NEJMoa2012410
https://www.nejm.org/doi/pdf/10.1056/NEJMoa2016638

[Gray Fox]

There are currently 230 studies on HCQ in the world out of 2351 total studies as of  today.
I hope they aren't taking resources away  from other possibilities.  They are listed here.

https://clinicaltrials.gov/ct2/results?term=Hydroxychloroquine&cond=COVID-19

Not D3, but related to football.  The Wake Forest coach is isolating from his wife for the season.
https://www.cbssports.com/college-football/news/wake-forest-coach-dave-clawson-to-isolate-from-wife-during-season-because-of-covid-19-concerns/

jamtod,

I listened to the podcast.  It mostly related to how experts review all of the daily input they are getting and how NEJM has to accelerate their reviews but still keep quality.  For us mortals they said to watch the newspapers and read long form articles in places like The Atlantic and the New Yorker.

[Ralph Turner]

Did you read (can you read) the article that I cited?

Point of clarification...

My concern was whether you had access or were at an institution who could get you past the "paywall" of the medical journal to read the entire article.

[OzJohnnie]

American Academy of Pediatrics speaks up.  The voices of 67,000 doctors lost in the din of people screaming on the Internets.

https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/

With the above principles in mind, the AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school...

Finally, policy makers should acknowledge that COVID-19 policies are intended to mitigate, not eliminate, risk. No single action or set of actions will completely eliminate the risk of SARS-CoV-2 transmission, but implementation of several coordinated interventions can greatly reduce that risk.

[OzJohnnie]

https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/0d8bdf9be927459d9cb11b9eaef6101f

Data from the TX dept of health and human services.

RE: Texas.  You'll need to click around the visualization to find the numbers but there are 55.3k hospital beds in TX, of which 41.5k are occupied (75% capacity).  Of those 41.5k bedded patients, 6.5k are with CV (12% of capacity and 16% of demand).  1.4k ICU beds and 5.5k ventilators remained unused.  So it appears that in TX, at least, the covid outbreak can get three times worse before TX must start using additional capacity facilities.

According to this hospital brief by the TX DHS, hospitals in Texas can surge to 20% additional capacity above published numbers before they need to create new facilities.  So thats an additional 11k beds and which brings TX's capacity to treat sick patients with current facilities to almost 5x current CV requirements.  And there are already designated overflow facilities (convention centers and the like, it seems) which add another 4.5k beds in the state if needed and which bring the capacity of the state to almost 6x the current levels.

https://gov.texas.gov/uploads/files/press/PPT_6.16.20.pdf

Interestingly, despite breathless reports of Houston's largest hospital reaching near 100% capacity, overall Houston remains only 78% full, pretty much in line with the overall state numbers.  It's almost as if Houston is following some foolish policy like routing all CV patients to designated facilities in order to reduce cross-contamination and the like.  Crazy.

I think TX will get past the challenge.

[OzJohnnie]

 12%-14% of North Carolinians are CV anti-body positive based on widespread community testing.  1/3 of the way to herd immunity.

https://www.wakehealth.edu/Coronavirus/COVID-19-Community-Research-Partnership/Updates-and-Data

[hickory_cornhusker]

12%-14% of North Carolinians are CV anti-body positive based on widespread community testing.  1/3 of the way to herd immunity.

https://www.wakehealth.edu/Coronavirus/COVID-19-Community-Research-Partnership/Updates-and-Data

Where have you seen herd immunity will only take 36-42% (3 times 12-14)? Everything I've seen is 65% or higher needed for herd immunity.

[OzJohnnie]

No one knows for certain, of course, but this study of populations in Europe pegs it at just under 35% with significantly lower possible based on the actual super spreader effect and well-timed interventions (as if that will happen with the level heads making these lockdown decisions).

https://www.medrxiv.org/content/10.1101/2020.05.19.20104596v1.full.pdf

This one, also out of Europe in which the scientific community is far less politicised and less interested in point scoring on Covid (although very politicised like the scientific community on almost everything else), pegs it at 43%.

https://arxiv.org/abs/2005.03085

There are many more, of course.  I get nothing useful from mainstream news and completely ignore it. Journalists are far too ordinary to understand and summarise complex issues plus they are driven by naked personal agendas I find.  Instead there are universities dedicated to publishing layman accessible discussions on all aspects of Covid. Oxford has been particularly good.  They push no agenda beyond supportable discussion.  There I read many things I want to see and many things I don't. But I never read emotional hype. Interestingly, when Imperial College in London initially said the CV would kill 2.2 million Americans back in mid March and started the whole panic ball rolling, Oxford said they're crazy and they can't believe everyone is accepting such an outlandish, unsubstantiated projections.  They've been on a mission to inform and not advocate ever since.

https://www.cebm.net/oxford-covid-19-evidence-service/

[OzJohnnie]

The main thing to remember with this epidemic is that people are the same everywhere. All things being equal, outcomes in different populations will be the same. So when results and numbers differ it is incumbent upon the inquisitive mind to look for the variables. There are three which will have a huge effect.

1. Timing. Areas that were infected early are on the way down, areas that haven't been hit yet are on the way up. Spain, which at one point seemed about to break off and tip into the ocean, is down to a trickle of deaths per day despite infections still spreading. They are over the hump. Same with Italy. Our parts of the world are weeks away from being in the same spot. (not Australia, unfortunately, because we've had fewer than 8000 infections and only 100 deaths in the whole country it's been locked down so tight. As soon as international travel starts up again we'll light up like a Christmas tree.).

2. Treatment. The later you go up the curve, the better. Because the medical community is getting significantly better at treating this. Remember the war zone like drama from Italy and NYC just six weeks ago?  Where's that gone?  It's gone because doctors aren't panicking anymore. They are far better prepared. Those areas (anywhere other than NYC, basically) getting the bug now are so much better able to deal with treatment from the experience of those that went before.  Also, the vulnerable are better protected which is where the real gains are made.

3. Climate and standard of living. First world countries with great medical systems like ours are fortunate. Also, outside of a few high density urban areas, we don't live check to jowl either.  Plus, if you happened to be in the Southern Hemisphere and enjoying summer when this went wild then you have another bit of luck on top of that.  I'm glad I don't live in a second or third would country, that's for sure.

My point is, enlightened rationality is you friend. Emotional, agenda driven news cycles are not.

[Dave 'd-mac' McHugh]

Let's get back to "Future of Division III" ...

[Pat Coleman]

No, this is OK. I have evaluated this a couple times in the past 24 hours to see if it needs to be split out, but COVID and higher ed are pretty intertwined right now.

[Dave 'd-mac' McHugh]

No, this is OK. I have evaluated this a couple times in the past 24 hours to see if it needs to be split out, but COVID and higher ed are pretty intertwined right now.

Oh I don't disagree that COVID is part of things, this just feels like it has delved into things that can be discussed elsewhere ... I just click in here to see the latest news in case I missed something.