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snowlurker

COVID-19 check-in

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On 3/31/2020 at 8:08 AM, Chubbs said:

This site (UWash) projects hospital loading and deaths for every state updated daily. Pa below is a little better off than NJ or De re hospital resources.

"With strong social distancing this wave of the epidemic could end in June"

https://covid19.healthdata.org/projections

http://www.healthdata.org/news-release/new-covid-19-forecasts-us-hospitals-could-be-overwhelmed-second-week-april-demand-icu

Screenshot_2020-03-31 IHME COVID-19 Projections.png

This is New Jersey this morning, it is better than the one I posted on Saturday and I am praying the social distancing/figures last several days is the reason it is trending in a better direction.

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4 hours ago, colonel_kurtz said:

One big positive is we have a guy like Dr. Fauci working for us, clear that he is phenomenal. Bloomberg channel ran an interview they did with him last year before this mess & hard to believe but I came away even more impressed. He personally treated one of the Ebola patients & seeing him with his arm around & hugging her when she was discharged was priceless.

 

Dr. Fauci wants to delay hydroxycholorquine until there is a three month clinical trail. There will be many dead if we wait for a perfect clinical study. Doctors that don't have proper PPE are taking the drug as a prophlatic safe guard Some state governors have banned it. WHY? Side effects are upper GI problems that are easily manageable. This guy is not God. If you were thinking that you wouldn't make it through the night wouldn't you give it a try?

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24 minutes ago, Harbourton said:

Dr. Fauci wants to delay hydroxycholorquine until there is a three month clinical trail. There will be many dead if we wait for a perfect clinical study. Doctors that don't have proper PPE are taking the drug as a prophlatic safe guard Some state governors have banned it. WHY? Side effects are upper GI problems that are easily manageable. This guy is not God. If you were thinking that you wouldn't make it through the night wouldn't you give it a try?

Just a correction - any physician can prescribe any drug that has been approved by the FDA....including the above...a doctor is allowed based on their own experience to prescribe a product "off label" meaning even thought it is not indicated. This is very common. When I was a Pharma sales director we had a couple products that enjoyed more sales for the "off label" use than the prescribed use. However, as a Pharmaceutical sales representative you cannot "detail" a physician on a non-approved indication. I hope this helps folks understand that even before a clinical trial using currently approved products they can immediately be used for some other disease if the physician deems it appropriate or an only option.

 

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Just now, chescopawxman said:

Just a correction - any physician can prescribe any drug that has been approved by the FDA....including the above...a doctor is allowed based on their own experience to prescribe a product "off label" meaning even thought it is not indicated. This is very common. When I was a Pharma sales director we had a couple products that enjoyed more sales for the "off label" use than the prescribed use. However, as a Pharmaceutical sales representative you cannot "detail" a physician on a non-approved indication. I hope this helps folks understand that even before a clinical trial using currently approved products they can immediately be used for some other disease if the physician deems it appropriate or an only option.

 

to follow up again for clarity - a clinical trial will be necessary to gain the new indication....these traditionally take more than a couple years but since the safety study (Phase I) was already completed for approved products like these it will move a bit quicker as the FDA has really accelerated their approval processes as seen with the amazing turn around on the test kits

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Roger Edwards from SPC knows a doctor in OKC who also talks about COVID-19 on YouTube.   I am paraphrasing him, the hydroxycholorquine seems to work best before symptoms get awful, before having to be transferred into the ICU.  I think the numbers to watch out for from NY State is the number of patients who are getting admitted to the ICU, especially if case and hospital admissions are still rising.  Confirmed cases are still rising, at least for one day their (NY) number dropped.  Admissions to the ICU are jumpier, but their peak is still last Friday.  As for NJ awful new high today and given the positive pending test results expect an awful new high tomorrow.

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1 hour ago, chescopawxman said:

to follow up again for clarity - a clinical trial will be necessary to gain the new indication....these traditionally take more than a couple years but since the safety study (Phase I) was already completed for approved products like these it will move a bit quicker as the FDA has really accelerated their approval processes as seen with the amazing turn around on the test kits

Just for clarity are you saying that a physician can give this drug to a patient even if the governor has banned it for use against coronavirus? Thanks for your expertise. For us laymen what is a new indication? 

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19 minutes ago, Harbourton said:

Just for clarity are you saying that a physician can give this drug to a patient even if the governor has banned it for use against coronavirus? Thanks for your expertise. For us laymen what is a new indication? 

Yes - the FDA controls product labels which contain the approved indication. Governor's have no control over physician prescribing behaviors.

Hydroxychloroquine has multiple indications - it's 1st approved indication is to prevent or treat malaria infections. This product also is indicated for certain autoimmune diseases such as lupus and Rheumatoid Arthritis.

So if they complete a valid FDA trial and the results indicated it is effective against the virus....then the labeled approved indication will be updated with a 3rd approved indication (new indication) on the approval date by the FDA. All of that said if a doctor has evidence in what they call peer reviewed papers and decides to prescribe a patient a drug like Remicade or Humira which is only indicated for autoimmune diseases to treat the virus they can write the patient a prescription for that product based on their own clinical evaluation.

Of note if a vaccine is found in the early part of trials to be effective and most importantly safe - the FDA can choose based on President's Trump's compassionate use program to quickly.... meaning in a few months from now have patients getting the vaccine well before the product is approved - since FDA approval would not be till later in 2021 in all liklihood

Hope this helps! Lots of good news on the clinical front with both current products used for other diseases and the new ones coming....this is why if the virus does return in the fall it will be a much much different impact on the nation. We will be well prepared compared to today.

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The news is bad, but would have been much worse without social distancing. Per chart below new US cases have slowed from 29% per day growth to 11% per day.  Hard to see on log chart, but old rate would have given  100,000 cases per day vs 25,000. Fast exponential growth is a b***.

https://tamino.wordpress.com/2020/04/01/social-distancing-works/

 

goodnews_log.jpg

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48 minutes ago, chescopawxman said:

Yes - the FDA controls product labels which contain the approved indication. Governor's have no control over physician prescribing behaviors.

Hydroxychloroquine has multiple indications - it's 1st approved indication is to prevent or treat malaria infections. This product also is indicated for certain autoimmune diseases such as lupus and Rheumatoid Arthritis.

So if they complete a valid FDA trial and the results indicated it is effective against the virus....then the labeled approved indication will be updated with a 3rd approved indication (new indication) on the approval date by the FDA. All of that said if a doctor has evidence in what they call peer reviewed papers and decides to prescribe a patient a drug like Remicade or Humira which is only indicated for autoimmune diseases to treat the virus they can write the patient a prescription for that product based on their own clinical evaluation.

Of note if a vaccine is found in the early part of trials to be effective and most importantly safe - the FDA can choose based on President's Trump's compassionate use program to quickly.... meaning in a few months from now have patients getting the vaccine well before the product is approved - since FDA approval would not be till later in 2021 in all liklihood

Hope this helps! Lots of good news on the clinical front with both current products used for other diseases and the new ones coming....this is why if the virus does return in the fall it will be a much much different impact on the nation. We will be well prepared compared to today.

Was there a study on Remicade or Humira done?  When you posted autoimmune it struck me just reading/seeing accounts on individuals who pass. I don't want  to go down the media rabbit hole, but it almost feels like a Russian roulette game if you get it, depending upon how amok your immune system gets if/once it reaches the lungs.  The circle of people I know who have it is getting closer.  Friends of friends have passed away from it already. I know a spotter (and wife) who have it in Morris County and thank God they are doing fine.  Then meanwhile another Spotter's friend died at 30.  There looks like there is alot of fast tracking going on, so even if not vaccines, I would imagine some anti-viral cocktail would be ready to use come this fall and even a vaccine a year from now (the way it normally works) would be warp 4.

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23 minutes ago, Chubbs said:

The news is bad, but would have been much worse without social distancing. Per chart below new US cases have slowed from 29% per day growth to 11% per day.  Hard to see on log chart, but old rate would have given  100,000 cases per day vs 25,000. Fast exponential growth is a b***.

https://tamino.wordpress.com/2020/04/01/social-distancing-works/

 

goodnews_log.jpg

I have heard different thoughts because of testing limitations and lag time in results.  God rest their souls, there is less debate about people dying. (Well not totally; dying from vs dying with, I just want to bang my head against the wall when I start reading that.) This curve also seems to be bending.  Please don't jinx this Tony, we are not going to be at 10,000 deaths on Friday.

91202817_2961562277234324_7555113203290603520_o.jpg.280cae98e1a284ece8a5c2aa4fe9634e.jpg

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27 minutes ago, Rainshadow5.8 said:

Was there a study on Remicade or Humira done?  When you posted autoimmune it struck me just reading/seeing accounts on individuals who pass. I don't want  to go down the media rabbit hole, but it almost feels like a Russian roulette game if you get it, depending upon how amok your immune system gets if/once it reaches the lungs.  The circle of people I know who have it is getting closer.  Friends of friends have passed away from it already. I know a spotter (and wife) who have it in Morris County and thank God they are doing fine.  Then meanwhile another Spotter's friend died at 30.  There looks like there is alot of fast tracking going on, so even if not vaccines, I would imagine some anti-viral cocktail would be ready to use come this fall and even a vaccine a year from now (the way it normally works) would be warp 4.

Not yet on Remicade/Humira/Enbrel and all that class but I have heard the MFGs of those products are hearing some success stories in RA/Crohn's Disease patients who contracted the virus but did not advance....Tony I am growing increasingly confident that we are getting ahead of the curve here with multiple existing products that might work and the new agents being worked on - fingers and toes are crossed!!

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14 hours ago, Rainshadow5.8 said:

I have heard different thoughts because of testing limitations and lag time in results.  God rest their souls, there is less debate about people dying. (Well not totally; dying from vs dying with, I just want to bang my head against the wall when I start reading that.) This curve also seems to be bending.  Please don't jinx this Tony, we are not going to be at 10,000 deaths on Friday.

Yes, testing + lag impact data. Many areas have huge backlog of tests with no results available yet. Also US # are heavily weighted by NY, which has been flattening out. Deaths will take much slower to slow because of long lag.

newcases3ny.png

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5 minutes ago, Chubbs said:

Yes, testing + lag impact data. Many areas have huge backlog of tests with no results available yet. Also US # are heavily weighted by NY, which has been flattening out. Deaths will take much slower to slow because of long lag.

newcases3ny.png

New York at least has been aggressive with testing, 221,000.  NJ & PA by comparison around 50K.   I kind of inbetween on confirmed cases results.  I think there is some there, there, not a total waste of a statistic.  But until NY rolls over and Spain rolls over (probably in reverse order), April will be the cruelest month.

The NY doubling time has slowed, they no longer have the statistical impossibility of having more deaths than the U.S. come April 10th.

 

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91759257_2963366203720598_2400854050942746624_o (1).jpg

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My wife and I both work for very large pharma companies, and they are both all in on vaccines/treatments and partnering with other companies to get things done. I can't really go into details though.  Both companies seem pretty upbeat on their data though.  Let's hope!

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16 minutes ago, frankdp23 said:

My wife and I both work for very large pharma companies, and they are both all in on vaccines/treatments and partnering with other companies to get things done. I can't really go into details though.  Both companies seem pretty upbeat on their data though.  Let's hope!

FRANK!!!!!!!!!

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For the first time since God knows when the number of hospital discharges > number of hospital admissions in New York State.   I don't know if that is just COVID or all.  Either way for one day, there are more beds.

1.JPG.34e131fd855004d4728a90f47355a93c.JPG

 

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If you’re looking for a reason to get outside this week is a good opportunity to see the International Space Station in our area. (Attached chart is for Doylestown, PA)

BF683A82-F5EB-410C-BB53-184D0C7C8784.jpeg

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12 hours ago, Rainshadow5.8 said:

New York at least has been aggressive with testing, 221,000.  NJ & PA by comparison around 50K.   I kind of inbetween on confirmed cases results.  I think there is some there, there, not a total waste of a statistic.  But until NY rolls over and Spain rolls over (probably in reverse order), April will be the cruelest month.

The NY doubling time has slowed, they no longer have the statistical impossibility of having more deaths than the U.S. come April 10th.

Per this chart US testing has leveled off, so lack of testing probably is impacting case #.

COVIDApr22020.PNG

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btw, if you see this, don’t be alarmed. This is nothing new or drastic. Most medics/EMt’s /FIrefighters can “work” a code that would give a victim best chance of resuscitation. This includes pushing drugs to restart the heart, shocking the heart If it’s the right Rhythm,  Intubation, oxygen, chest compressions etc... I’ve been on my fair share of cardiac arrest calls, working victims for up to 35/40 minutes... For us, the medics are able to live stream the ECG/life pack directly to the dr’s at the hospital. You will get the best available care at all times. 

 

as for this policy, it’s to protect the hospital staff from needless transportation of a deceased persons Into the environment. When medical command gives the ok to pronounce a death , after an unsuccessful attempt, we leave the victims at the scene(if in a secure place such as a home). It’s nothing new. 

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10 hours ago, Chubbs said:

Per this chart US testing has leveled off, so lack of testing probably is impacting case #.

COVIDApr22020.PNG

At first glance I thought your chart and my table were in conflict, but no they say the same.  Only about 100,000 new test results each day.   The moment Governor Murphy shut NJ down, there were only 20K national tests performed.  That is how one lunges to tackle a running back at midfield while he is leaping into the end zone for a touchdown.

1.JPG.e88f2055b45106bad6a2097568e24e2a.JPG

 

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8 minutes ago, Rainshadow5.8 said:

At first glance I thought your chart and my table were in conflict, but no they say the same.  Only about 100,000 new test results each day.   The moment Governor Murphy shut NJ down, there were only 20K national tests performed.  That is how one lunges to tackle a running back at midfield while he is leaping into the end zone for a touchdown.

1.JPG.e88f2055b45106bad6a2097568e24e2a.JPG

 

Good analogy 

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