Italy still on figurative fire (USA in trouble)

[demlion]

Anecdotal stories are not the same thing as "accurate information". In fact they get in the way of real helpful information getting out there by blurring what's real and what's rumor. They also have a negative impact on the health of patients who really need the drug. The anecdotal stories about hydroxychloriquine have created a shortage in the marketplace which means that people like those suffering from immune deficiency diseases like lupus can't get it. Spreading those rumors does not help.

What? Are you saying that anecdotal horseshit is not just as good as controlled-blind studies? If this drug cannot possibly harm you, if it is NEVER contraindicated, then experiment. It is like homeopathy. But if the stuff is pretty hard on you, the idea would be only to take it if it is going to help you, right? How hard is this to understand?

 

[tlbakernc]

Nobody is mentioning 12-15 months. How about we get over the initial hump and reevaluate with real data? Hopefully the summer slows it down and buys some time to find that vaccine. Could you imagine what it would be like right now without a shutdown?

You’re correct. No one is mentioning a lockdown for 12-15 months. But it will be 12 -15 months for a vaccine. Without a vaccine it’s impossible to stop spread.

Current data is suggesting summer is not going to slow the spread. Even if it does slow the spread what happens in the fall/winter of 2020?

 

[interrobang]

I bet we see an approved vaccine this fall.

 

[demlion]

I bet we see an approved vaccine this fall.

Will it "work" like the flu vaccine "works?"

 

[Delco Lion]

I have seen that something like 25 out of the first 40 patients in Wuhan were connected with the market. So far, that seems like good evidence to me.

You may have seen this article.

https://www.yahoo.com/news/wuhan-seafood-vendor-believed-one-051432500.html

 

[cntblvitsbutter]

Just read that the FDA approved a rapid test made by Abbot Labs. Positive results as quick as 5 mins and negative in 13. Pretty major development for testing.

That would be huge.

 

[DingerzForDaze]

The speculation I heard was that someone brought it to the market, where conditions there let it spread. I wanted to hear more explanation but as usual Shannon Bream on Fox did not press and the interview just ended. So we are left hanging. If this started somewhere else, where was that?

That is the one thing I noticed about her. She doesn't seem to dig in to what people say the way Tucker Carlson does. Shannon always tries to end interviews and debates without the parties angry with each other.

I really like the Tucker Carlson show. Always very level headed, probing, and not just a puppet for the Right Wing message. Probably the best monologue introductions available on any network. No bullsh!t, just straight common sense analysis of the issues.

Carlson is the only person in the mainstream media to both accurately report, interview, and seriously examine some very credible UFO incidents during the last two decades. That tells me he reports what he thinks is right without being manipulated much by what his producers might think. Probably the last of his type. The others, outside of Shannon Breem, have an agenda to convey, especially the ones on the other networks.

LOL! The whole thing, but especially that last paragraph ... no, that tells reasonable people that he knows his audience, and what will pull them in. He knows the folks that tend to watch his show are also the folks who tend to give credibility to UFO sightings.

 

[mjh218]

https://abbott.mediaroom.com/2020-0...ovel-Coronavirus-in-as-Little-as-Five-Minutes

They are talking about production of 5 million tests per month (I think between this test and another recently approved Abbott test).

 

[dailybuck777]

You may have seen this article.

https://www.yahoo.com/news/wuhan-seafood-vendor-believed-one-051432500.html

Couldn't find original article, but wiki describes the numbers:

"Of the initial 41 people hospitalized with pneumonia who were officially identified as having laboratory-confirmed SARS-CoV-2 infection by 2 January 2020, two-thirds were exposed to the market. The market was closed on 1 January 2020 for sanitary procedures and disinfection.[1][5][6] 33 out of 585 environmental samples obtained from the market indicated evidence of coronavirus disease 2019" https://en.wikipedia.org/wiki/Huanan_Seafood_Wholesale_Market#cite_note-Huang24Jan2020-5

Interesting to me that some are referring to it as a seafood market, when it clearly sold a lot more than seafood. The correct term should be wet market.

 

[tlbakernc]

Let's go back to the beginning.

The original post said "Drugs like Hrydrochloroquine are our best bet short term. Lessening symptoms is about the only thing we can hope for."

So I intentionally used "hope" in my response as a grammatical device to counter his point. Nothing ironic about it at all.

The issue is that this "hope" that you talk about has created a shortage in the market place for the drug. There are people with a real need for the drug who now can't get it because of all this "hope" that is being spread around. Where's your empathy for those people? The impact on them is known. The impact on COVID-19 patients is not.

Hope is not the issue here. Selfishness, greed, and fear are the issues. Hope is a great human trait.

 

[ClarkstonMark]

I bet we see an approved vaccine this fall.

that is awfully optimisitc .... wish I shared your optimism.
Has there ever been a vaccine for a coronavirus?

 

[katchthis]

Seems to me that at this point the Germans are the benchmark of how to do things. Out of any countries reporting with reliable data, they have by far the lowest mortality rate. They are so confident out of not running out of ICU beds and ventilators they are taking in patients from Italy and France.

https://www.foxnews.com/world/germany-takes-coronavirus-patients-from-italy

 

[LaJolla Lion]

If you search for hydroxychloriquine on Twitter, there are two kinds of tweets. 1) It works great and 2) Trump sucks.

Well Titter is the definitive source after all.

 

[rigi11]

Couldn't find original article, but wiki describes the numbers:

"Of the initial 41 people hospitalized with pneumonia who were officially identified as having laboratory-confirmed SARS-CoV-2 infection by 2 January 2020, two-thirds were exposed to the market. The market was closed on 1 January 2020 for sanitary procedures and disinfection.[1][5][6] 33 out of 585 environmental samples obtained from the market indicated evidence of coronavirus disease 2019" https://en.wikipedia.org/wiki/Huanan_Seafood_Wholesale_Market#cite_note-Huang24Jan2020-5

Interesting to me that some are referring to it as a seafood market, when it clearly sold a lot more than seafood. The correct term should be wet market.

Wegmans a wet market?

 

[crazytoadie]

What? Are you saying that anecdotal horseshit is not just as good as controlled-blind studies? If this drug cannot possibly harm you, if it is NEVER contraindicated, then experiment. It is like homeopathy. But if the stuff is pretty hard on you, the idea would be only to take it if it is going to help you, right? How hard is this to understand?

Let’s just be clear that chloroquine actually has a narrow therapeutic window. Look no further than the AZ couple that self medicated using chloroquine phosphate they had to treat fish (also not approved by FDA as an animal drug). He died and she was hospitalized. It does have contraindications and is not a “homeopathic”. It’s appropriate for doctors to prescribe or use as they can give the correct dosage and are aware of the side effects or contraindications and can monitor it. It is foolhardy to self prescribe or use as a prophylactic at this point.

Not saying that demlion was advocating that. Just important to let the decision to use or not to use to a medical professional. And anecdotal evidence is not as good as double blinded studies. Anecdotal studies are useful and may come to the same conclusion but they can also be inadvertently bias or not encompass enough patients.

 

[Little J]

Stepping away from the debate on Chloroquine has anyone broken down the following….

So why is that only 10% of those tested in PA are coming up positive for Covid19? What do the remaining 90% have? A common cold, the flu, hydpochondriacs, inaccurate testing?

Here you have a virus that is reported to have a reproduction number that is 2x that of the flu, so it is easier to catch. Yet, flu season is dying down so there is less flu out there to be “caught”, plus we are social distancing and staying home, yet the % of those tested stays steady at 10% positive?

I get that we started with more flu so at T=0 it is not a surprise that flu is the primary test outcome. Why though isn’t the % of those testing positive coming up higher than 10% as we move along?

It will take a while to move the % of a bigger data set. Has anyone seen such a time factored statistical breakdown? All I have seen the overall % tested Vs % positive ratios and not a day to day comparison.

A few days ago, someone was talking about % positive in NYC being like 30%. Anyone have a link to share for such data?

 

[crazytoadie]

For starters because it's true - and secondly because the spread of anecdotal stories about hydroxychloriquine effectivenesss against the COVID-19 virus being a miracle drug has resulted in a shortage of the drug. That creates REAL problems for people who need the drug to treat existing immune deficiency disorders like lupus.

1) There is a shortage but Mylan and Teva are ramping up production so it is anticipated to be a short term shortage. This is a drug that has been made in high volumes and once production is running they will meet the need. It is not uncommon for tablets to be produced in the millions per batch or manufacturing shift. If this continues to show promise, the manufacturers will be moving it to the front of their production queues to net demand. Until then it shouldn’t be used prophylacticly but should be use in diagnosed cases.

2) Chloroquine has a half life of ~50 days in the body, so a short term unavailability for lupus patients may not result in flare ups as the chloroquine levels will remain therapeutic for weeks or maybe longer in many cases. Not ideal to disrupt use, but if it works for coronavirus then the priority should be: 1) confirmed coronavirus cases, 2) lupus patients, 3) exposed healthcare workers, and in a distant 4) general population (only if prophylactic and only if in sufficient supply).

 

[Little J]

1) There is a shortage but Mylan and Teva are ramping up production so it is anticipated to be a short term shortage. This is a drug that has been made in high volumes and once production is running they will meet the need. It is not uncommon for tablets to be produced in the millions per batch or manufacturing shift. If this continues to show promise, the manufacturers will be moving it to the front of their production queues to net demand. Until then it shouldn’t be used prophylacticly but should be use in diagnosed cases.

2) Chloroquine has a half life of ~50 days in the body, so a short term unavailability for lupus patients may not result in flare ups as the chloroquine levels will remain therapeutic for weeks or maybe longer in many cases. Not ideal to disrupt use, but if it works for coronavirus then the priority should be: 1) confirmed coronavirus cases, 2) lupus patients, 3) exposed healthcare workers, and in a distant 4) general population (only if prophylactic and only if in sufficient supply).

I can't substantiate the claim, but a former colleague at Bayer DE told me earlier in the week that Bayer donated 3 million pills to the US gov.

 

[crazytoadie]

That is true. Mylan has enough to make 50 million tablet at a WV plant, Teva has pledged 16 million tablets to US, Amneal projects 20 million tablets by mid April.

Novartis has committed to 130 million tablets globally pending regulatory approvals. No doubt they are being fast tracked with hope that this treatment works.

 

[jwarigaku]

Crazytoadie,

please do as you and others have recommended and don’t try to play doctor. I’ve had a very long week but let me post the pharmokinetics of Hydroxychloroquine Sulfate below. Half-lives of APIs and their congeners and therapeutic blood levels often have nothing to do with one another. If you want to spout technical opinions please understand at depth what you speak about.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/009768s037s045s047lbl.pdf

Additionally, the reported shortage of the drug is not universal but rather manufacturer specific since it’s produced by multiple manufacturers. Link is below date of most recent report is 3/24 and shows what each manufacturers position is inclusive of resupply data. Again stop fear mongering and start reporting truth...everybody is responsible from the President to individuals posting on this football board.

https://www.ashp.org/Drug-Shortages/Current-Shortages/Drug-Shortage-Detail.aspx?id=646

1) There is a shortage but Mylan and Teva are ramping up production so it is anticipated to be a short term shortage. This is a drug that has been made in high volumes and once production is running they will meet the need. It is not uncommon for tablets to be produced in the millions per batch or manufacturing shift. If this continues to show promise, the manufacturers will be moving it to the front of their production queues to net demand. Until then it shouldn’t be used prophylacticly but should be use in diagnosed cases.

2) Chloroquine has a half life of ~50 days in the body, so a short term unavailability for lupus patients may not result in flare ups as the chloroquine levels will remain therapeutic for weeks or maybe longer in many cases. Not ideal to disrupt use, but if it works for coronavirus then the priority should be: 1) confirmed coronavirus cases, 2) lupus patients, 3) exposed healthcare workers, and in a distant 4) general population (only if prophylactic and only if in sufficient supply).

 

[KCLion]

Crazytoadie,

please do as you and others have recommended and don’t try to play doctor. I’ve had a very long week but let me post the pharmokinetics of Hydroxychloroquine Sulfate below. Half-lives of APIs and their congeners and therapeutic blood levels often have nothing to do with one another. If you want to spout technical opinions please understand at depth what you speak about.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/009768s037s045s047lbl.pdf

Additionally, the reported shortage of the drug is not universal but rather manufacturer specific since it’s produced by multiple manufacturers. Link is below date of most recent report is 3/24 and shows what each manufacturers position is inclusive of resupply data. Again stop fear mongering and start reporting truth...everybody is responsible from the President to individuals posting on this football board.

https://www.ashp.org/Drug-Shortages/Current-Shortages/Drug-Shortage-Detail.aspx?id=646

ironically, the shortage fear mongering was not Of Crazytoadies creation.

 

[crazytoadie]

Crazytoadie,

please do as you and others have recommended and don’t try to play doctor. I’ve had a very long week but let me post the pharmokinetics of Hydroxychloroquine Sulfate below. Half-lives of APIs and their congeners and therapeutic blood levels often have nothing to do with one another. If you want to spout technical opinions please understand at depth what you speak about.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/009768s037s045s047lbl.pdf

https://www.ashp.org/Drug-Shortages/Current-Shortages/Drug-Shortage-Detail.aspx?id=646

Chloroquine has a very large volume of distribution of 65,000 L (VD is total drug in body/plasma conc.). This means that significantly more chloroquine is distributed into the tissue than the blood. It is a very lipophilic drug and distributes into the tissues with a long residence time (~ 900 hours). It is readily absorbed into the blood as referenced in the label info you provided with peak blood plasma levels in a couple hours. Then it distributes to the tissue and stays there for a prolonged time (weeks). It takes awhile for the chloroquine levels in the tissue to build up to therapeutic levels. It can take 1 - 3 months to see effects of Plaquenil. Likewise, it has prolonged effects after discontinuation because it is retained for a long time ( hence why the half life, which reflects the rate at which it is cleared from the body, is relevant to therapeutic levels in this case. It is the levels distributed in the tissues are what is important for therapeutic effect not the blood levels. If taken daily the blood levels will be the roughly the same on day 1 as on day 30 but don’t see effect for lupus or RA right away.

In fact, Kaiser Permanente stated that for hydroxychloroquine that “extensive experience and research show that hydroxychloroquinine builds up in the body and continues to work for a average of 40 days after the last dose is taken” in explaining why the weren’t filling routine prescriptions until the temporary shortage is resolved.

Perhaps you like to to read some too, so here you go.

https://doi.org/10.1038/s41584-020-0372-x

 

[demlion]

ironically, the shortage fear mongering was not Of Crazytoadies creation.

Hes a genius doctor, not a reader. Though I must say, he seems awful concerned with everyone telling the truth for a guy whose reading comp. is so weak.

 

[crazytoadie]

Crazytoadie,

Additionally, the reported shortage of the drug is not universal but rather manufacturer specific since it’s produced by multiple manufacturers. Link is below date of most recent report is 3/24 and shows what each manufacturers position is inclusive of resupply data. Again stop fear mongering and start reporting truth...everybody is responsible from the President to individuals posting on this football board.

https://www.ashp.org/Drug-Shortages/Current-Shortages/Drug-Shortage-Detail.aspx?id=646

I find it really ironic that my post is cautioning people to not worry about a drug shortage because it is actively be solved in the next weeks yet you interpret that as me fear-mongering. The shortage is nothing to worry about regardless of whether it is company specific or industry wide. They are short not because they cannot make it but because the didn’t see the demand till the past couple weeks because it is being tried for a new purpose. There are you happy?

 

[crazytoadie]

ironically, the shortage fear mongering was not Of Crazytoadies creation.

Thanks. I was dumbfounded by that accusation.

 

[jwarigaku]

Congrats on your ability to cut and paste. You, Demlion, etc seem to be on doom and gloom patrol. I have rarely posted here over the years but I think that so much of the sensationalism on both sides of this argument is both irresponsible and nauseating.

Chloroquine has a very large volume of distribution of 65,000 L (VD is total drug in body/plasma conc.). This means that significantly more chloroquine is distributed into the tissue than the blood. It is a very lipophilic drug and distributes into the tissues with a long residence time (~ 900 hours). It is readily absorbed into the blood as referenced in the label info you provided with peak blood plasma levels in a couple hours. Then it distributes to the tissue and stays there for a prolonged time (weeks). It takes awhile for the chloroquine levels in the tissue to build up to therapeutic levels. It can take 1 - 3 months to see effects of Plaquenil. Likewise, it has prolonged effects after discontinuation because it is retained for a long time ( hence why the half life, which reflects the rate at which it is cleared from the body, is relevant to therapeutic levels in this case. It is the levels distributed in the tissues are what is important for therapeutic effect not the blood levels. If taken daily the blood levels will be the roughly the same on day 1 as on day 30 but don’t see effect for lupus or RA right away.

In fact, Kaiser Permanente stated that for hydroxychloroquine that “extensive experience and research show that hydroxychloroquinine builds up in the body and continues to work for a average of 40 days after the last dose is taken” in explaining why the weren’t filling routine prescriptions until the temporary shortage is resolved.

Perhaps you like to to read some too, so here you go.

https://doi.org/10.1038/s41584-020-0372-x

 

[TheGLOV]

Congrats on your ability to cut and paste. You, Demlion, etc seem to be on doom and gloom patrol. I have rarely posted here over the years but I think that so much of the sensationalism on both sides of this argument is both irresponsible and nauseating.

You can thank me for be a moderate sir!

 

[katchthis]

You can thank me for be a moderate sir!

That’s an oxymoron Glov and moderate

 

[TheGLOV]

Chloroquine has a very large volume of distribution of 65,000 L (VD is total drug in body/plasma conc.). This means that significantly more chloroquine is distributed into the tissue than the blood. It is a very lipophilic drug and distributes into the tissues with a long residence time (~ 900 hours). It is readily absorbed into the blood as referenced in the label info you provided with peak blood plasma levels in a couple hours. Then it distributes to the tissue and stays there for a prolonged time (weeks). It takes awhile for the chloroquine levels in the tissue to build up to therapeutic levels. It can take 1 - 3 months to see effects of Plaquenil. Likewise, it has prolonged effects after discontinuation because it is retained for a long time ( hence why the half life, which reflects the rate at which it is cleared from the body, is relevant to therapeutic levels in this case. It is the levels distributed in the tissues are what is important for therapeutic effect not the blood levels. If taken daily the blood levels will be the roughly the same on day 1 as on day 30 but don’t see effect for lupus or RA right away.

In fact, Kaiser Permanente stated that for hydroxychloroquine that “extensive experience and research show that hydroxychloroquinine builds up in the body and continues to work for a average of 40 days after the last dose is taken” in explaining why the weren’t filling routine prescriptions until the temporary shortage is resolved.

Perhaps you like to to read some too, so here you go.

https://doi.org/10.1038/s41584-020-0372-x

https://inside.mountsinai.org/blog/...qY7yCqV14wT-HgTtanXzAfsnZ0riR4KGRaFNk5wHrPnxw

 

[TheGLOV]

That’s an oxymoron Glov and moderate

Sorry, my fan cub is all full sir.

If we get an opening, I'll let ya know sir!

 

[TheGLOV]

https://inside.mountsinai.org/blog/...qY7yCqV14wT-HgTtanXzAfsnZ0riR4KGRaFNk5wHrPnxw

 

[crazytoadie]

Congrats on your ability to cut and paste. You, Demlion, etc seem to be on doom and gloom patrol. I have rarely posted here over the years but I think that so much of the sensationalism on both sides of this argument is both irresponsible and nauseating.

What is gloom and doom about reassuring people that their won’t be a drug shortage. What is gloom and doom about saying that people should try chloroquine? What is gloom and doom about saying that more testing should be to know who has it?

And if you have a problem with anything I said and the pharmacokinetics or pharmacodynamics, then put it out there. If you think I’m wrong then show me what’s right. I don’t say that in an aggressive way, so don’t misinterpret it. I just cannot stand when people are so eager to cut something done but so reluctant to defend their point with any substance.

 

[jwarigaku]

As I said it’s been a long week, I read your posts as aligning with Demlion...if I’m wrong I’m wrong. I believe testing is good as well, but people need to understand that the gross number of of positive cases are going to continue to increase as we increase testing levels. The key data can be extracted from the granularity I spoke of in my previous post yesterday about the hospitalization rate, but more over, classifications of type of hospitalization required and duration.

In the end I’m a huge fan of blood serum testing for antigen response, I will be having mine done as soon as possible to see my immunity status, and be a serum donor if possible.

What is gloom and doom about reassuring people that their won’t be a drug shortage. What is gloom and doom about saying that people should try chloroquine? What is gloom and doom about saying that more testing should be to know who has it?

And if you have a problem with anything I said and the pharmacokinetics or pharmacodynamics, then put it out there. If you think I’m wrong then show me what’s right. I don’t say that in an aggressive way, so don’t misinterpret it. I just cannot stand when people are so eager to cut something done but so reluctant to defend their point with any substance.

 

[crazytoadie]

As I said it’s been a long week, I read your posts as aligning with Demlion...if I’m wrong I’m wrong. I believe testing is good as well, but people need to understand that the gross number of of positive cases are going to continue to increase as we increase testing levels. The key data can be extracted from the granularity I spoke of in my previous post yesterday about the hospitalization rate, but more over, classifications of type of hospitalization required and duration.

In the end I’m a huge fan of blood serum testing for antigen response, I will be having mine done as soon as possible to see my immunity status, and be a serum donor if possible.

That’s fair. Antigen testing will very useful to see if the mortality rate estimates are close or much lower. As more testing is done, the numbers of cases will rise so I agree that the hospitalization rate, duration, mortality rate, etc will be better barometers.

I disagree with demlion as often as I agree. In this case, I spoke up more because of what other people said than what he did (although I agree with him on this point). I just found those arguing that more testing isn’t needed because it cannot cure it or because we should just quarantine anyway as completely disingenuous.

 

[SoParkLion]

The leak is projected to hit April ~20. A few days after that the situation will be reassessed.

This is also a potential real path forward:

 

[KnightWhoSaysNit]

LOL! The whole thing, but especially that last paragraph ... no, that tells reasonable people that he knows his audience, and what will pull them in. He knows the folks that tend to watch his show are also the folks who tend to give credibility to UFO sightings.

If you've seen the Carlson show it was probably just a glimpse between watching that really in-depth stuff on CNN. Here is the clip for your review...

https://bwi.forums.rivals.com/threads/ufo-evidence-that-demands-a-verdict.237902/

Fravor was one of the most respected pilots within the U.S. Navy. He is not a drunken crackpot sighting lights in the night sky. Fravor's testimony, and the video, have been corroborated by other naval witnesses, including the chief radar officer. It was broad daylight. The History Channel even did a series on this.

To me it is very telling that this was aired on Fox. That speaks volumes to Carlson's reporting when we consider the belief systems of many who watch the channel. (You obviously don't know based on your post.) I can't imagine a channel like CNN airing something that would spin the minds of their fanbase. They would not risk it. It's the difference between reporting facts and spinning the facts for propaganda.

 

[TheGLOV]

https://www.snopes.com/news/2020/03...d4iL_3z-qoaQbvgTQpjr117jyhz67SGNkkM_4xKnP80o4

 

[demlion]

The leak is projected to hit April ~20. A few days after that the situation will be reassessed.

This is also a potential real path forward:

View embedded media

AGGRESSIVE TESTING??? Contact tracing??? Oh, no. The experts here told me that will NEVER work.

 

[Obliviax]

AGGRESSIVE TESTING??? Contact tracing??? Oh, no. The experts here told me that will NEVER work.

CDC screwed up the test kits. Even at that, it took a lab and supplies and several days. In the end, even if they didn’t screw up the kits, they didn’t have capacity.

locally at the Cleveland clinic they didn’t have enough transport or labs/technicians. So they built their own that they didn’t have to send out but that took weeks. Abbot Is now making one that works in five minutes

https://www.google.com/amp/s/amp.usatoday.com/amp/4930932002

 

[Delco Lion]

We have 232 cases in Delaware County PA. 37% are ages 50 to 69. Only 14% are over 70 and older. We have 5 deaths. No real reports on any issues in the hospitals.


https://chesco.maps.arcgis.com/apps...4Lx_knTtZsQ#/bce5af8a6f454ee78e00b5adc67f4c4a