“We’re all looking for answers”

Dr. Robert Cerfolio says his “aha” moment came at the bedside of a COVID-19 patient, who seemed literally to be suffocating to death on his own mucus. After hearing the code for a cardiopulmonary arrest, Cerfolio had rushed into the unconscious patient’s room and pulled out the thin ventilator tube delivering air into his lungs, to find it stopped up with discharge that had hardened to the consistency of concrete.

“Why aren’t we doing a bronchoscopy?” Cerfolio called out, referring to a procedure where physicians snake a thin scope through the tube in a patient’s airwaves and suck out obstructions. “This guy’s not dying of COVID. He’s dying of an obstructed tube!”

It was the early days of the crisis in New York City back when NYU Langone Health still had only a handful of COVID-19 patients. (The hospital declined to give a current number more precise than “hundreds and hundreds.” ) The answer that came back from the doctors in attendance was not what Cerfolio expected to hear. We aren’t allowed to, they told him. The procedure, which involved threading a smaller tube into the respirator conduit and down into the airways—and then pulling it out—could “aerosolize” the virus, dispersing it through the room and possibly infecting all the front-line health care workers around it. Which is why statements instructing against the procedure had been issued by a wide range of surgical and medical professional organizations.

Cerfolio, a thoracic surgeon whose many titles at the sprawling New York City medical center included senior vice president, vice dean and chief of hospital operations, was one of the few NYU Langone medical personnel in a position to override the directive. He was also the past president of the Thoracic Surgeons association, one of the organizations that had come out in opposition to the technique.

Cerfolio overrode the guidance. The patient lived. And Cerfolio and his colleagues at NYU Langone developed a new protocol for protective equipment and other precautions for doctors willing to do the procedure. They have since performed bronchoscopies on hundreds of COVID-19 patients.

Luis Angel, one of Cerfolio’s colleagues, invented a new self-contained method for tracheostomies that can sometimes keep doctors from putting critically-ill patients on ventilators, which requires them to be put in a medically induced coma. The procedure, which requires incisions into the lower neck, is known to place health care providers at risk, but if safely performed allows doctors to use a bigger tube than is used for ventilation, one that is easier to clean.

NYU posted a video demonstrating the procedure and Cerfolio’s phone lines lit up.

“I’ve been called by the head of thoracic surgery at the main academic institution in Spain, I’ve talked to a guy in Italy and we’re doing the exact opposite of what they have done there—even a friend at another hospital called me and said, ‘I heard you guys are doing traches, what the hell you doing?’” Cerfolio says. “We’ve done 63 of these and not a single doctor or nurse has gotten sick—not one. Sixty-two of the patients are still alive. We know we can do it safely and we know we are helping patents.”

As COVID-19 washes over the United States, doctors in hotspots across the nation are still deciding how best to battle a mysterious and deadly disease scientists don’t yet fully understand. And while many are looking to the experience of health care providers in China and Europe, they are also racing to develop new procedures of their own and debating best approaches—often on the fly. In a fast-moving pandemic, there’s not always time to wait for medical journals to publish. And the flood of reading material is growing so vast it’s hard for many to track. So every day, clinicians around the world are helping each other as they find their way, trading and debating tips through social media, over conference calls and even over old medical school email chains. Doctors at Columbia University Medical Center are cautious about the Langone procedures. “The experience we have from China, Italy, Spain, and Iran shows an increased risk to healthcare workers performing airway procedures and caring for patients with tracheostomy,” says Dr. Susannah Hills, a surgeon. “It’s crucial to learn from other countries that have been dealing with this for longer than we have.”

On the other side of the nation, Dr. Tom Yadegar, a pulmonologist and medical director of the intensive care unit at Providence Cedars-Sinai Tarzana Medical Center in California, had his first “aha” moment when he got his first patients last month.

In those early days, he treated both a 60-year-old patient and an 80-something man, both of whom arrived stable, with good vitals, and normal X-rays, then spiraled into a rapid decline for seemingly no reason. Both ended up on ventilators, which drove Yadegar to the literature.

Through his research Yadegar realized that what he was seeing was a “cytokine storm,” a violent inflammatory reaction that often kills the sickest COVID-19 patients. Soon he identified several blood markers, like the levels of ferritin, a protein that contains iron, that seemed to predict which patients were most likely to develop the overactive immune response. He wrote up protocol guidelines for his staffto follow that have them sometimes administering immunosuppressant drugs normally used to avoid organ rejection to patients who seem likely to get in trouble.

“Up until a month ago, I didn’t know about cytokine storms,” he says. “I wasn’t looking for it. And then to treat it, you’re doing something that you probably have never done in your life, which is to give a patient in the ICU strong medications to suppress the immune system. It’s totally counterintuitive.”

Though similar protocols had previously been reported in China, Yadegar’s experience was the first time many of his local peers had heard of the approach. He estimates he’s kept three critically ill patients offof ventilators and removed three more as a result of the protocol. Now he is overseeing COVID-19 response in two affiliated area hospitals. Yadegar shared his experiences with 50 or so fellow graduates of USC Medical School on a weekly call coordinated by his old program director. He then was interviewed about his approach on Fox and Friends, which prompted a flood of inquiries from other caregivers across the nation. “This is such a new disease that all of us are struggling just trying to figure out what’s going on,” he says.

Through these kinds of discussions and experimentation, unexpected observations are emerging that could transform care in the months ahead. One of the more significant is the debate about when best to place patients on ventilators.

Dr. Scott Weingart, a critical care physician at Stony Brook University Hospital, one of the busiest COVID-19 hospitals on Long Island, recently made an observation that he was literally able to broadcast out to the world. The key metric used to move patients to respirators is “oxygen saturation,” which measures how much oxygen is being held in a patient’s blood. Usually, when a patient receiving oxygen through a normal mask can’t get above 80 percent, doctors assume the lungs are compromised and the patient needs to be intubated. But Weingart was noticing that patients at levels that guidelines told him needed immediate ventilation weren’t behaving like patients who were suffocating. Many, though short of breath, were able to speak in complete sentences, give full medical histories and were even cheerful—a state he and his colleagues call “happy hypoxia.”

Although Weingart couldn’t explain the discrepancy, he began to suspect some unknown characteristic of the virus was distorting the results. He began second-guessing the protocols.

“These levels are at numbers that would scare the hell out of us before this,” he says. “But when we started holding off on putting those breathing tubes in and used simple measures like making the patient roll over in bed like you do every night while sleeping, all of a sudden there is a cohort, a group of these patients that didn’t wind up needing the breathing tube.”

Weingart, who hosts a popular podcast and blog followed by tens of thousands of ER doctors and critical care doctors, shared his experience on air and online—and heard from scores of others around the world who were noticing the same thing.

The finding is significant. Not just because it saves ventilators for sicker patients but because in order to go on a ventilator, the patient must be put in a medically induced coma, and there is anecdotal evidence that the pressure exerted by mechanical breathing machines can be injurious to the lungs of COVID-19 patients, Weingart says.

“Supportive care and watchful waiting have worked out in a lot of these COVID-19 patients, as opposed to what I call a knee-jerk response to sticking a tube down their throats,” he says.

For physicians just now seeing their first patients— or still waiting for the full brunt of the pandemic to hit their areas—the experiences of frontline providers like Weingart, Yadegar and Cerfolio are proving invaluable. Sometimes the tips are as simple as telling conscious patients in the hallways to lie on their stomachs, instead of their backs, which results in more effective oxygen delivery to the lungs involved in air-blood transfer. Some are learned through hard experience, such as that the use of the blood thinner heparin seems to help prevent potentially deadly blood clots in patients with a body mass index greater than 40, who seem to be at greater risk of dying. (Both additional modifications were recently adopted at NYU Langone). But the tips can also prove logistical.

In the weeks before she saw her first cases, Michelle Diaz, an ER physician who works at hospitals across New Hampshire through her company EMstaff, tuned in regularly to Weingart’s podcast and others like it where she learned about the changing views on the timing of intubation. She also picked up numerous tips about what to expect and how best to prepare for it through an email chain that had previously been used to announce baby births by colleagues she had met while doing her residency back in the late aughts at Brooklyn’s Kings County Hospital.

“One day somebody wrote that their hospital was still quiet and asked how everybody else was doing, and people just started posting stuff,” Diaz recalls. “People are just sharing their experience, they are saying, ‘I’ve seen this kind of clinical course, I tried this way of helping their oxygenation.’ But also people are sharing ideas about what they’re doing at their hospital to help with the volume and manage flow—‘we have a tent set out over here and we have this personnel over there.’”

For physicians seeing their first patients, the experiences of frontline doctors is proving invaluable. Diaz even learned how to convert a wall oxygen outlet into a makeshift ventilator if she were to run out of equipment. “It’s been really helpful to see these ideas being exchanged,” she says. “It’s not just informative, it’s inspiring.”

SOURCE 

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Do Lockdowns Save Many Lives? In Most Places, the Data Say No.

Do quick shutdowns work to fight the spread of Covid-19? Joe Malchow, Yinon Weiss and I wanted to find out. We set out to quantify how many deaths were caused by delayed shutdown orders on a state-by-state basis.

To normalize for an unambiguous comparison of deaths between states at the midpoint of an epidemic, we counted deaths per million population for a fixed 21-day period, measured from when the death rate first hit 1 per million—e.g.,‒three deaths in Iowa or 19 in New York state. A state’s “days to shutdown” was the time after a state crossed the 1 per million threshold until it ordered businesses shut down.

We ran a simple one-variable correlation of deaths per million and days to shutdown, which ranged from minus-10 days (some states shut down before any sign of Covid-19) to 35 days for South Dakota, one of seven states with limited or no shutdown. The correlation coefficient was 5.5%—so low that the engineers I used to employ would have summarized it as “no correlation” and moved on to find the real cause of the problem. (The trendline sloped downward—states that delayed more tended to have lower death rates—but that’s also a meaningless result due to the low correlation coefficient.)

No conclusions can be drawn about the states that sheltered quickly, because their death rates ran the full gamut, from 20 per million in Oregon to 360 in New York. This wide variation means that other variables—like population density or subway use—were more important. Our correlation coefficient for per-capita death rates vs. the population density was 44%. That suggests New York City might have benefited from its shutdown—but blindly copying New York’s policies in places with low Covid-19 death rates, such as my native Wisconsin, doesn’t make sense.

Sweden is fighting coronavirus with common-sense guidelines that are much less economically destructive than the lockdowns in most U.S. states. Since people over 65 account for about 80% of Covid-19 deaths, Sweden asked only seniors to shelter in place rather than shutting down the rest of the country; and since Sweden had no pediatric deaths, it didn’t shut down elementary and middle schools. Sweden’s containment measures are less onerous than America’s, so it can keep them in place longer to prevent Covid-19 from recurring. Sweden did not shut down stores, restaurants and most businesses, but did shut down the Volvo automotive plant, which has since reopened, while the Tesla plant in Fremont, Calif., was shuttered by police and remains closed.

How did the Swedes do? They suffered 80 deaths per million 21 days after crossing the 1 per million threshold level. With 10 million people, Sweden’s death rate‒without a shutdown and massive unemployment‒is lower than that of the seven hardest-hit U.S. states—Massachusetts, Rhode Island, Louisiana, Connecticut, Michigan, New Jersey and New York—all of which, except Louisiana, shut down in three days or less. Despite stories about high death rates, Sweden’s is in the middle of the pack in Europe, comparable to France; better than Italy, Spain and the U.K.; and worse than Finland, Denmark and Norway. Older people in care homes accounted for half of Sweden’s deaths.

We should cheer for Sweden to succeed, not ghoulishly bash them. They may prove that many aspects of the U.S. shutdown were mistakes—ineffective but economically devastating—and point the way to correcting them.

SOURCE 

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IN BRIEF

Trump lays out new coronavirus testing "blueprint" as states weigh reopening (NBC News)

U.S. District Judge Roger Benitez tosses California's "onerous and convoluted" ammunition purchase law (AP)

24th Judicial Circuit Judge Judge F. Patrick Yeatts says Gov. Ralph Northam's gun-range shutdown violates state law (The Washington Free Beacon)

Two more people come forward to corroborate account of Joe Biden accuser (Bongino.com)

Michael Flynn files court documents with evidence he was "deliberately set up" by the FBI (The Daily Wire)

Senate will return on May 4 to start Phase 5 coronavirus relief bill (The Hill)

New York cancels Democrat presidential primary, angering Bernie Bros (The New York Times)

Policy: Ending the lockdowns isn't about saving money. It's about saving lives. (Mises Institute)

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here  (Personal).  My annual picture page is here.  Home page supplement

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How sunlight may help us fight coronavirus

People with low levels of Vitamin D are almost twice as likely to get the extreme lung infections that are now killing COVID-19 patients.

Even before the pandemic, acute respiratory tract infections have been a major killer. They were responsible for 2.8 million deaths worldwide in 2015.

In Neale’s review, which encompassed 78,000 participants, it was found that those with low levels of vitamin D — the “sunshine vitamin” — were almost twice as likely as those with high vitamin D levels to get the type of extreme lung infections that now are killing COVID-19 sufferers, and they were even more likely again to be sicker for longer.

And so how does this translate to the pandemic? “Now, more than ever, is not the time to be vitamin D deficient,” Neale says from Brisbane’s QIMR Berghofer Medical Research Institute. “It would make sense that being vitamin D deficient would increase the risk of having symptomatic COVID-19 and potentially having worse symptoms. And that’s because vitamin D seems to have important effects on the immune system.”

Neale was speaking before US President Donald Trump weighed in with his comments last week about disinfectant and ultraviolet light being used to combat the virus. And, as bizarre as it may seem, there is reason to think the President is on to something, at least as far as the sunlight goes.

It’s a message that people seem innately to understand. The carpark at my local beach has been more full in recent weeks than it usually is in the middle of summer school holidays. People are out there soaking it all up, feeling sorry for all those city folk denied access to their shimmering sands, not even allowed to sunbake in parks.

For all vitamin D’s advantages, Neale doesn’t take vitamin D pills. She is cognisant of the emerging evidence that the sun provides more benefits than just the sunshine vitamin.

Those other benefits are varied.  Dermatologist Richard Weller from the University of Edinburgh discovered more than a decade ago that the body got a shot of a molecule called nitric oxide when exposed to sunlight. He has been curious about the notion that nitric oxide and sunlight may have some effect on COVID-19.

Nitric oxide has been shown to cause blood vessels to widen, increasing oxygen flow and lowering blood pressure. The discovery of its role in the human body paved the way for Viagra.

“There are mechanistic reasons to think about benefit,” says Weller. “Ultraviolet light (which produces nitric oxide in the skin) lowers blood pressure and also markers of diabetes. Both of these are risk factors for death from COVID-19.” He points out that most viral infections wax and wane with the seasons, probably because of ultraviolet light, not heat.

The story of nitric oxide goes back to the 1990s when it was a hot molecule that won three scientists the Nobel prize. At that time, Goran Hedenstierna had a PhD student at Sweden’s Uppsala University who was among the first in the world to show that if you gave humans nitric oxide when they were suffering from severe constriction of the lungs, the lungs relaxed and oxygen levels normal­ised. During the severe acute respiratory syndrome outbreak of 2003-04, Hedenstierna had another student, Luni Chen, who wanted to go back to her home country, China, to see if nitric oxide worked to help patients dying of acute respiratory failure from that coronavirus.

“She went there in May 2003 when it was a most severe situation,” recalls Hedenstierna, Skyping from Sweden. “I organised things to be shipped — ventilators and bottles of nitric oxide gas. It took a lot of organising with the local authorities because it was a major intrusion on their crisis.”

Chen managed to get the nitric oxide treatment to six patients and she had eight in a control group receiving placebo. Five of the six who received nitric oxide were on ventilators when the study began. Only one was still on it by the end. Chest X-rays showed their lung congestion improved. One died.

Whereas in the control, six were on ventilators at the beginning and five were still being ventilated at the end. The X-rays showed only two improved, three stayed the same and three worsened. Two died.

The study was only small but Hedenstierna was surprised at the strength of the results. “We most often do see an improvement of oxygenation of 20 per cent or more in people with acute respiratory failure, but these SARS patients, they increased their PAO (the ratio of oxygen in the blood to oxygen that is breathed) almost threefold. I have never seen this big an increase. We never dis­cussed that to any extent at that time.”

To understand why nitric oxide appeared so devastatingly effective against SARS, Hedenstierna was involved in a further study in a high-security lab in Brussels where it was shown that nitric oxide killed the SARS virus in a test tube.

“It had an antiviral effect which was what we had hoped to see in view of the improved chest X-rays. So it’s helping the patient breathe and it’s killing the virus,” he says.

The way forward

Such results are now being picked up. Nitric oxide, this molecule we produce naturally with sunshine, has been used by doctors in Italy with success to help COVID-19 patients, but not in a study format. A trial of 240 COVID-19 patients is up and running in Sweden, the US and Austria.

Weller says the doses of nitric oxide the patients will receive are much greater than what you could get from sunlight. But the other half of the equation is whether people catch the disease in the first place. He is running a study to see what effects UV radiation has on the flu because there’s still not enough data on COVID-19. “I hope that our epidemiological studies will show whether it (sunshine) makes any difference at population level.”

One of Weller’s collaborators, Prue Hart from Perth’s Telethon Kids Institute, has spent a career pursuing matters of immunity and ultraviolet light and vitamin D. She isn’t so sure that UV light will have a direct effect on the novel coronavirus.

“I think the greater benefits of UV radiation during this pandemic are about our brain health,” she says. “We all know how good we feel after time in the sun, and these good feelings cannot be replaced by vitamin D from a bottle. Now that it is autumn, and the sun is not so intense and burning, I think everyone should be encouraged to get exposed to more sun, as long as they never get sunburnt. In addition, whilst outside getting a little bit more sunshine, they will be exercising.”

She says while the link between sunshine, endorphins, serotonin and mood have been known for years, in 2018 Chinese researchers proved another important piece of the mental puzzle involving a molecule called urocanic acid that resides in the outermost layer of the skin. The researchers proved that after giving shaved mice the equivalent of 30 minutes of sunshine, urocanic acid was released from the skin into the blood, then crossed the blood brain barrier and went into almost all parts of the brain. In the brain, it is involved in making glutamate — the brain’s most abundant “excitatory neurotransmitter” — which has long been known to play an important role in learning and memory.

“This is another reason time outside in the sun is important for children who are now doing online learning at home,” Hart says. Food for thought as police shoo sunbathers out of parks and arrest people lying on beaches.

And it certainly will encourage Neale to continue with her five-to-10 minute routine of midday Brisbane sun. “I personally think the best way of getting vitamin D is sun exposure because we get the other benefits that might be there, but I accept there is a role for pills for people who can’t get out,” she says, adding that she always takes care not to burn.

SOURCE 

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'It's a horror movie.' Nurse working on coronavirus frontline in New York claims the city is 'murdering' COVID-19 patients by putting them on ventilators and causing trauma to the lungs

A frontline nurse working in New York on coronavirus patients claims the city is killing sufferers by putting them on ventilators.

'It's a horror movie,' she said through a friend. 'Not because of the disease, but the way it is being handled.'

And she said relatives of the sick need to make it clear as soon as a person is taken to the hospital that they do not want them hooked up to the breathing machines.

The nurse, who has relocated to New York temporarily to help with the city's COVID-19 crisis, persuaded a friend — a nurse practitioner who is not working on coronavirus patients — to make the video for her in order to tell the world what she says is happening inside hospitals.

'I am her voice here. I'm going to tell you what she has told me,' said the nurse practitioner, who was identified only as Sara NP. 'She wants this to get out.'

'She has never seen so much neglect. No one cares. They are cold and they don't care anymore. It's the blind leading the blind.'

'People are sick, but they don't have to stay sick. They are killing them, they are not helping them,' added the friend in the video posted on YouTube.

'She used the word murder, that coming from a nurse who went to New York City expecting to help. 'Patients are left to rot and die — her words. People are being murdered and no one cares.'

Sara would not reveal which hospital the nurse is working in 'for the safety of those involved.'

More than 12,000 people have died from the virus in New York City, with another 4,300 dying in other parts of the Empire State, which is a far larger number than any other state in the country.

Republican Minnesota state Senator Scott Jensen told Fox News' Laura Ingraham that Medicare pays hospitals three times as much if patients are placed on ventilators.

'How can anyone not believe that increasing the number of COVID-19 deaths may create an avenue for states to receive a larger portion of federal dollars,' Jensen later posted on his Facebook page.

New York Governor Andrew Cuomo has said that around 80 percent of people who go on the machines die, although he's referencing patients who were already in dire conditions before being put on the machines.

 This is not the first time the use of ventilators have been questioned for its efficacy. 

In a YouTube video posted earlier this month New York emergency room doctor Cameron Kyle-Sidell said: 'I've talked to doctors all around the country and it is becoming increasingly clear that the pressure we're providing may be hurting their lungs.

'It is highly likely that the high pressures we're using are damaging the lungs of the patients we are putting the breathing tubes in.

'It's not our fault. We didn't know,' added Kyle-Sidell, saying that is the way other acute respiratory syndromes have been treated.

'We are running the ventilators the wrong way,' he said, calling for the protocols to be changed.

'COVID positive patients need oxygen, they do not need pressure. They will need ventilators, but they must be programmed differently.'

Kyle-Siddell did not return calls from DailyMail.com. He told Medscape on April 6 he stepped down from working in the intensive care unit at Maimonides Medical Center in Brooklyn because he didn't want to follow the hospital's ventilator protocol.

'I could not morally, in a patient-doctor relationship, continue the current protocols which, again, are the protocols of the top hospitals in the country. 'I could not continue those,' he said. 'You can't have one doctor just doing their own protocol.'

Maimonides also did not answer a request for comment.

Sara said COVID-19 patients are placed on ventilators rather than less invasive CPAP or BiPAP machines due to fears about the virus spreading.

She said: 'The patients don't know any better. They don't have family with them. There is no one there with them to advocate for them. So they are scared, and they give consent.

'The ventilators have high pressure, which then causes barotrauma, it causes trauma to the lungs', adding that the best way to survive is to 'buck the system.'

'Your loved one is not going to have you in there advocating for them once they go in, you're not allowed in. 'Do not give consent for intubation if you don't want to be intubated or for your loved one to be intubated… As soon as you give that consent, you might not come out of it.'

And she said if there is a specific medication — such as the hydroxychloroquine that President Donald Trump has touted, the best thing to do is lie.

'A tip from inside the system — if you want a medication to be given, you've got to report that it's an at-home medication, and that you demand that it be continued.'

Sara claimed patients who stop breathing are not resuscitated — again due to fear of the virus spreading. 'Full code, not doing compressions, family is not there. They have no one to answer to. No one is being held accountable.'

She said there are other problems in the 'crappy' hospital where her friend is working, such as lack of personal protective equipment.

'They stay in the same PPE all shift, except for the top pair of gloves… they're only changing the gloves on the outside.'

They keep the same gowns and masks on because the theory is that all patients on a COVID-19 floor will already have the virus. But she says that is faulty logic as some are there to see if the coronavirus can be ruled out.

'So even if they're rule-out COVID and they're not COVID they're going to get COVID because they're using the same PPE all shift and they're carrying that contamination to all of the patients

And she claimed some nurses who have been brought to New York are sitting in hotels never being called.

'Yet they're still understaffed and there are hundreds of people, hundreds of nurses in the hotels waiting to be called on to a shift. So there is manpower enough if the goal were to actually save people, but resources are not being utilized properly or to full capacity in a way that maximizes the patient benefit or improves the outcomes.'

The nurse practitioner also criticized some of the nurses who are risking their own health to treat COVID-19 patients.

'We have nurses being celebrated as heroes who are killing people,' she said.

'They're not heroes, and they're being brainwashed to think they're doing something great just by going to work because they're brave enough to go to work.

'But what are you doing at work? You're certainly not saving people if you're not even running codes. You're not even going into patients' rooms. You're a coward. You're hurting people, you're killing them, you're contributing to the problem.

The nurse practitioner said she knows she will receive hate messages for her comments. 'Frankly, I don't care because this could save someone's life.'

SOURCE 

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here  (Personal).  My annual picture page is here.  Home page supplement

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If Sweden is so wrong to keep pubs open why is its health chief's face the tattoo everyone wants?

Children are still in school, bars and restaurants are open, as are garden centres and shops; crowds of up to 50 are allowed, and no one is chastised for sunbathing, sitting on park benches or daring to flee to countryside boltholes.

It is a strategy aimed at allowing some exposure to the disease to build immunity among the general population, while protecting the vulnerable and ensuring hospitals are not overwhelmed.

But the country’s light touch has incurred criticism. Sweden has a reputation as a ‘moral superpower’ and commentators seize upon any death-toll spike as evidence of a foolhardy gamble that risks lives for the sake of the economy.

Sweden considers the big picture, though, and argues that part of its policy is aimed at preventing an economic crash, as mass unemployment will have dire health consequences. For example, after the 2009 debt crisis, suicides in Greece increased by up to 40 per cent.

But many Swedes feel as if outsiders enduring lockdown are willing them to fail. ‘It makes you defensive,’ says Anglo-Swede Alex McBeath, who works at the Tudor Arms. ‘I’m cautiously optimistic about the future. I support the way we have approached the crisis.’

So does the majority of the country. Anders Tegnell, 63, state epidemiologist with the Public Health Agency of Sweden and the architect of its Covid-19 response, fronts daily press conferences. Inevitably, he receives online vitriol.

Yet he is so popular that some in Stockholm have had his face inked on to their arms and legs. Tattooist Zashay Tastas, who designed the image, says: ‘Tegnell has become the face of Sweden’s approach. This is the first time a real nerd is being idolised.’

Or as Dr Tegnell himself puts it: ‘It is the first time in history that an epidemiologist has been considered famous.’ He modestly notes, however, that he is just one of 15 experts meeting daily to analyse data and make recommendations.

But have Dr Tegnell and his colleagues got it wrong? Is managing coronavirus impossible without a lockdown?

Sweden has recorded 2,192 deaths, more than twice as many as neighbouring Denmark, but it has almost twice the population, at ten million. In Britain, the toll has topped 20,000. So far Sweden has defied forecasts saying that, unless it changed course, it would suffer 50,000 to 180,000 deaths.

Arne Elofsson, a biologist at Stockholm University, initially estimated that the nation’s health system would be quickly swamped, but now concedes: ‘It appears the epidemic is plateauing and that the catastrophic scenarios predicted by some will never appear in Sweden.’

Dr Tegnell is cautious by nature but declares himself ‘satisfied’ the strategy appears to be working, even if there are some things he would have done differently, especially in care homes.

Nationally, the number of new cases rose sharply last week – due mainly to increased testing – and stands at 18,177. Most are in Stockholm and its suburbs, with very small numbers in the thinly populated areas elsewhere.

Every country, one way or another, has to reach herd immunity so the chains of transmission break, says Dr Tegnell. He believes Stockholm could do so in weeks – but acknowledges he doesn’t have all the answers as so much about the virus is still unknown.

In a way, the story of Sweden’s response to the crisis begins in Britain. Dr Tegnell studied in London and his team’s approach is based on models developed here.

In mid-March, both Dr Tegnell and Bjorn Eriksson, Stockholm’s director of health, believed Britain and Sweden ‘were on the same page’. On March 12, ITV political editor Robert Peston wrote about Government thinking, saying ‘herd immunity’ was the key phrase and warning against shutting schools.

But a fortnight later the UK abruptly changed tactics and imposed a draconian lockdown, having been unnerved by a study suggesting that without it, up to 250,000 people might die.

Today the Cabinet is divided between ‘doves’ such as Health Secretary Matt Hancock, cautious about easing restrictions, and ‘hawks’ led by Chancellor Rishi Sunak who want a quick end to lockdown.

Sweden stayed the course, based on the understanding that the disease can only be managed not eradicated. Social distancing and working from home were suggested, not ordered, as the elderly were encouraged to stay at home.

Stockholm’s mayor, Anna Konig Jerlmyr, told us: ‘We trust our citizens and treat them with respect. In return we expect them to take responsibility and I’m proud that the majority have done so. In other European cities I was saddened to hear how the police watch people and enforce rules. That is not our way. Also we are as transparent as possible. It is important to share information and all the figures.’

Anna Erdunbelau, a 46-year-old shopping in Stockholm last week, agrees. ‘We are generally a sensible people who usually do the right thing. We are treated like adults. And you have to understand this is all built on trust.’

Key to this is the independence of public bodies such as Dr Tegnell’s Public Health Agency. It ensures decisions are based on expertise, prevents ministers meddling and explains why it is Dr Tegnell leading press conferences while politicians take a back seat.

Politicians didn’t try to block his suggestion that schools remain open, a decision partly taken because younger children are not a major cause of the transmission, and partly so health workers don’t need to stay home to look after their children. ‘We need every healthcare worker we can get,’ says Mr Eriksson.

At the moment, hospitals are coping. Sweden had an enviable health care system in place before the outbreak, which has helped. And it hasn’t been beset by quite the same PPE shortages seen in the UK.

‘We think we are at a peak of infections in Stockholm and *we are not at full capacity in hospitals*, so I’m pleased,’ adds Mr Eriksson. ‘But we must not be complacent. The weather is getting warmer, more people will be outside and they will need to be disciplined about social distancing.’

Ministers have warned that bars and restaurants that failed to follow guidelines would be closed. But all around the city, people go about their business, shopping, cycling, watching the world go by while drinking outside bars and cafes.

‘It sometimes seems as if coronavirus doesn’t exist,’ says Andreas Hatzigeorgiou from Stockholm’s chamber of commerce. ‘Things are moving normally. People do observe social distancing – though we did it before Covid-19, it is in our DNA!’

He knows Sweden’s economy will suffer – it is doing so already – but believes it stands a chance of avoiding the kind of crash predicted elsewhere. Consumer spending is down 27 per cent, but’s that compared to 66 per cent in Denmark.

SOURCE 

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California Docs Say Lockdown vs. Non-Lockdown 'Did Not Produce a Statistically Different Number of Deaths'

On Wednesday Dr. Dan Erickson and Dr. Artin Massihi, who own seven Accelerated Urgent Care facilities in Kern County, Calif., gave a press conference to local media. They extrapolated from their own COVID-19 data, along with data sets nationwide and globally. Using this data, their own medical knowledge and information gathered from conversations with their colleagues around the country, they presented a compelling case, which included unreported health risks related to sheltering in place, for ending the severe shutdowns.

Both doctors understand and support the initial reactions to the COVID-19 outbreak by the federal, state and local governments. It was a novel virus and there was very limited information. However, now they assert that the data is telling them that the disease pattern of COVID-19 is more like the flu. Dr. Erickson phrased it this way, “Millions of cases, a small number of deaths.” He specifically noted that the difference in the number of deaths between Sweden, with limited restrictions, and Norway, which locked down, is not statistically significant.

"Lockdown versus non-lockdown did not produce a statistically different number of deaths. That is the bottom line," said Erickson.

Throughout the briefing he emphasized that decision making going forward needs to be based on data, not predictive models. This echoes comments made by Dr. Anthony Fauci during press briefings. And we have all watched the predictive models be radically adjusted as actual data has been loaded into them.

Their data extrapolations, using a method similar to the one the CDC uses for influenza, suggest that death rates for COVID-19 are similar to those for the flu. According to their analysis, both Kern County and the state of California have likely experienced a widespread viral infection. They both agreed this is almost certain in New York as well. Based on their analysis, the death rate varies from 0.03% in California to 0.1% in New York state. This will be confirmed by additional testing finding new cases for the same number of deaths.

In addition to asserting that this is much more comparable to the flu than originally thought, the doctors present additional information to support their point of view. First, they discussed the rise in mental illness and abuse their clinics and local providers are seeing. This includes an increase in child molestation, domestic abuse, alcohol and drug-related emergencies, and mental health diagnoses.

Next, they were very clear on how self-isolation can actually compromise the immune system in otherwise healthy people. Dr. Erickson explained that the immune system is actually built by exposure to pathogens. Coming in contact with viruses and bacteria in the environment fires the body’s system for fighting infection. Additionally, the normal flora, or good germs we have on and in us all the time, also drop when we isolate.

Here Comes the Sun: The Good News about COVID-19 the Media Apparently Doesn't Want You to Know
The combination of reducing regular exposure to pathogens in the environment and lowering the good bacteria that helps us fight off infection, concerns both physicians. By reserving nearly all healthcare system assets to treat COVID-19, the available capacity of the system in their area has actually contracted. Two hospital floors are closed. Healthcare workers have been furloughed. In this environment, they worry about an increase in opportunistic infections that will strain the remaining resources as people get back to more normal activities if the isolation of healthy individuals continues.

Next, they say the current guidelines are not backed by science. Dr. Erickson repeated the finding that COVID-19 can live on plastic for three days. So, when you go to Costco or Home Depot, you pick up needed items that may carry COVID-19. He added that it is because of these fomites, inanimate objects that can carry and transfer disease, it is highly likely COVID-19 would be found if your home or car were sampled.

Additionally, there is no science that says it is safer to go to Costco than it is to go to the small local restaurant for lunch. In the opinion of both doctors, the current guidelines are not based on rational thinking. They also think people should absolutely be spending time outside. Dr. Massihi said keeping people indoors can cause Vitamin D deficiencies which further impact immune function and can cause a depressed mood.

Dr. Erickson then explained that the vast majority of people were dying with COVID-19, not from COVID-19. He said after viewing hundreds of autopsies in his career, people rarely die for one reason. A body that has been weakened by chronic disease is not as able to fight off infection. He compared this to deaths with the flu. Most often it is just one of a number of illnesses a patient is suffering with.

With the predictable negatives of self-isolation and the economic pain they are causing, the doctors are calling on political leaders to begin letting the healthy adults return to normal activities. They even say that this should happen without masks and other types of PPE. For those with preexisting conditions or who are immunocompromised, the use of PPE and self-isolation may still be the correct advice. However, for the 95% of individuals who will recover without significant intervention, they say it’s time to end the restrictions and continue testing.

Dr. Massihi said the fear of the unknown is understandable. But giving people accurate information is a way that fear can be reduced. According to the data on deaths for otherwise healthy individuals, the number of deaths is “infinitesimal.” He is equally worried about the person who has abdominal pain and fever and is too scared to seek care. So their appendix ruptures at home and they end up hospitalized with a severe infection. Or any individual with a minor medical problem that will have a bigger impact because care is delayed.

While most of the press conference remained focused on the science and medicine, they did share that their colleagues in emergency medicine around the country report they are being pressured to add a diagnosis of COVID-19. They did not speculate as to why this was happening, but indicated they found it odd.

And Dr. Erickson did hit back at journalists who were challenging his assumptions. At the end of the briefing, he was challenged on why he thought he was smarter than the Dr. Faucis of the world and state health officials. He was clear this was not about being smarter or right. He is using data and his own clinical experience to make these recommendations for his own community and others like them. Essentially pretending everyone is going to be New York is not the correct approach.

He also shot back at reporters who are being paid while their fellow citizens are not. His closing was also a caution worth taking note of:

Who says what’s safe? Are you smart enough to know what is safe for you? Or is it the government gonna tell you what’s safe for you? As soon as they use the word safe, that means control. 'We know what’s safe for you. You’re too dumb to understand disease. We know what’s safe.' And so, they are going to use this model for different things. 'We got a bomb threat from China. Everybody stay in their home for three months.' They [the government] are using this to see how much of your freedom can they take from you. Will you roll over and stay in your house? And it’s working.
Amen, sir. Let’s get America back to work.

SOURCE 

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here  (Personal).  My annual picture page is here.  Home page supplement

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Eight reasons to support reopening our country

Several governors are beginning to engage in opening their states. Good. They should wait no further. As each day goes by, we learn more and more about the coronavirus and its effects, and the facts lead toward getting adults back to work and children back to school. We suggest a focus away from the blare and glare of raw death tolls and worst-case scenarios. Instead let’s look at less-alarming truths that are generally being ignored by a media more invested in shock and frenzy. Perhaps we should start with these:

The first numbers we heard were that the coronavirus would kill up to 2.2 million Americans. This dire prediction was the first out of the box and it stuck in too many minds, struck too much fear, and still lingers.

The correction came late in March, as we were told to expect between 100,000 and 240,000 deaths in the U.S. But the death toll estimates keep coming in lower and lower. We are being told this is because of mitigation and distancing orders. Forgotten is that those six-figure numbers included and factored in mitigation and social distancing orders. That is, experts and government officials now tell us our numbers are lower because we are doing what they told us to do, but social distancing was always part and parcel of their high predictions.

The same model used to predict 100,000 or more deaths now tells us to expect something closer to 60,000 deaths. Now, some health departments are artificially inflating their numbers. New York City’s Health Department is now counting “probable” COVID-19 deaths. As Dr. Deborah Birx put it, unlike other countries, “We’ve taken a very liberal approach to mortality . . . if someone dies with COVID-19, we are counting that as a COVID-19 death.”

The per capita infection and death rates and dates of lockdown in various states confirm our questioning of not only one-lockdown-fits-all policies, but also the effectiveness of lockdowns themselves. Lockdowns don’t appear to be highly correlated with infection and death rates. Look at the timing. California, our largest state by far, locked down only three days before New York. Per capita, California’s infection rate is 6% that of New York’s, and its death rate is 4%. Florida, also more populous than New York, locked down almost two weeks after New York. Per capita, Florida’s infection rate is 9% that of New York’s, and it has had 4% of its death rate. Ohio locked down one day after New York, and yet Ohio’s death rate is only 5% that of New York’s. Missouri locked down more than two weeks after New York, but its infection rate is 7% of New York’s, and it has 4% the death rate. The rest of the country is not New York.

A recent Stanford University study reveals the virus is 50-85 times less deadly than initially thought. The infection/mortality rate of COVID-19 is not the 2% to 5% rate others have surmised, wrongly, but one somewhere in the small hundredths-of-a-single-percent range. An even newer study done at the University of Southern California comes to the same conclusion for Los Angeles County.

The closing of our schools is an increasing curiosity. We drastically transfigured over 55 million children’s educational and social lives to protect them from a virus that affects them less than the annual flu. As of this writing, a total of three children have died from the virus in New York City -- each of whom had underlying health conditions. Fewer than 10 children have died nationally from COVID-19, although about 80 have died from the flu. The argument that children could spread the new coronavirus to adults is true, but that is true of the flu as well. This has put an additional burden on families, children, and, for our poorest, has ripped millions of them from nutritious meals and trusted adults and institutions.

All perspective was lost. We have needed to hospitalize just over 80,000 people for this illness. The previous two flu seasons in America required nearly half a million hospitalizations. As Dr. Jonathan Geach has written: “Our health care system is now underwhelmed and health care workers are being laid off and furloughed in droves as a result of health care centers having neglected patient care not related to COVID-19 in fear of a COVID-19 surge that failed to materialize on a nationwide basis. This means tens of millions of patients are failing to receive the medical care they need in a timely manner. Almost every hospital outside of the hot spots is empty.” At the Mayo Clinic, as one example, he reports “65% of the hospital beds are empty, as are 75% of the operating rooms.”

Our overreaction to this epidemic will create myriad other health problems. California Rep. Tom McClintock put it well: “How many of the 1.8 million new cancers each year in the United States will go undetected for months because routine screenings and appointments have been postponed? How many heart, kidney, liver, and pulmonary illnesses will fester while people’s lives are on hold? How many suicides or domestic homicides will occur as families watch their livelihoods evaporate before their eyes? How many drug and alcohol deaths can we expect as Americans stew in their homes under police-enforced indefinite home detention orders? How many new cases of obesity-related diabetes and heart disease will emerge as Americans are banished from outdoor recreation and instead spend their idle days within a few steps of the refrigerator?”

If you don’t want to listen to a Republican congressman, how about the United Nations: “The economic hardship experienced by families as a result of the global economic downturn could result in hundreds of thousands of additional child deaths in 2020, reversing the last 2 to 3 years of progress in reducing infant mortality within a single year.”

The political posturing, while predictable, is hypocritical and often one-sided. The Trump administration did not neglect this virus. Instead, Democrats criticized the administration for doing too much and for too little at the same time. The travel ban from China was “xenophobic” in late January, but his declaration of a national emergency in early March was too late. Meanwhile, not one word about this virus was uttered at the February Democratic presidential debate in Las Vegas, even though China was brought up several times in other contexts, such as in trade and defense policy.

As late as Feb. 24, House Speaker Nancy Pelosi was telling people, “We think it’s safe to come to Chinatown and hope others will come.” And, on the last day of February, the principle expert on whom the president relies and the press reveres, Dr. Anthony Fauci, stated: “Right now, at this moment, there is no need to change anything you are doing on a day-by-day basis.”

Almost all of us are interested in the health, safety, and well-being of the American people. The daily death rate should decline dramatically in the next two weeks, and, by the end of the summer, most of this will be in the rear-view mirror. Already, we are being warned that a second wave of the virus will hit us in the autumn. Perhaps, but this is a certainty: There will be a second wave of this crisis that will result from massive unemployment and all the mental and social illnesses and deaths that will come from that and the other policies the lockdowns and shutdowns are bringing.

In short, there will be more pain and hardship -- and perhaps more deaths -- from the convulsing of our country as a result of the response to the coronavirus than from the coronavirus itself. The governors of our 50 states have real jobs — so do almost all other Americans. They should all be given them back while they still exist.

SOURCE 

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Wuhan laboratory scientists 'did absolutely crazy things' to alter coronavirus and enabled it to infect humans, Russian microbiologist claims

A leading Russian microbiologist has claimed the coronavirus is the result of Wuhan scientists doing 'absolutely crazy things' in their laboratory.

World renowned expert Professor Petr Chumakov claimed their aim was to study the pathogenicity of the virus and not 'with malicious intent' to deliberately create a manmade killer.

Professor Chumakov, chief researcher at the Engelhardt Institute of Molecular Biology in Moscow, said: 'In China, scientists at the Wuhan Laboratory have been actively involved in the development of various coronavirus variants for over ten years.  'Moreover, they did this, supposedly not with the aim of creating pathogenic variants, but to study their pathogenicity.

'They did absolutely crazy things, in my opinion. 'For example, inserts in the genome, which gave the virus the ability to infect human cells.

'Now all this has been analysed. 'The picture of the possible creation of the current coronavirus is slowly emerging.'

He told Moskovsky Komsomolets newspaper: 'There are several inserts, that is, substitutions of the natural sequence of the genome, which gave it special properties.

'It is interesting that the Chinese and Americans who worked with them published all their works in the open (scientific) press. 'I even wonder why this background comes to people very slowly.

'I think that an investigation will nevertheless be initiated, as a result of which new rules will be developed that regulate the work with the genomes of such dangerous viruses.

'It's too early to blame anyone.'  He said the Chinese scientists created 'variants of the virus … without malicious intent' possibly aiming for an HIV vaccine.

Professor Chumakov is also connected to Russia's Federal Research Centre for Research and Development of Immunobiological Preparations.

Vladimir Putin's spokesman warned this week against allegations that coronavirus was manmade. 'In the situation where there is not enough information that has been supported and checked by science ... we think it is unacceptable, impossible, to groundlessly accuse anyone,' said Dmitry Peskov.

SOURCE 

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Mesoblast treatment achieves "remarkable" results for critical Covid-19 patients

An Australian-developed stem cell treatment has drastically increased survival rates in trials for ventilator-dependent patients suffering from acute respiratory distress syndrome (ARDS) due to Covid-19.

Melbourne-based regenerative medicine company Mesoblast (ASX: MSB, NASDAQ: MESO) has been engaged in trials with New York City's Mt Sinai hospital to intravenously infuse its product remestemcel-L in patients, and the early signs are promising.

The sample size of 12 patients may be small, but 83 per cent (10) of them have survived after the stem cell treatment compared to a 12 per cent survival rate for ventilator-dependent Covid-19 patients with the condition at a major referral hospital network in the city.

Mesoblast reports 75 per cent of the patients (9) were able to come off ventilator support within a median of 10 days, compared to a 9 per cent rate for patients treated with standard of care during March and April.

Seven of the patients, who were given remestemcel-L within five days under emergency compassionate use, have been discharged from the hospital.

Using bone marrow aspirate from healthy donors, Mesoblast's proprietary technology is currently used to treat a condition called acute graft versus host disease (aGVHD), which many suffer after receiving a bone marrow transplant (BMT).

But as the Covid-19 pandemic took centre stage, the company hypothesised Remestemcel-L would be able to treat what is known as a cytokine storm in the lungs that often occurs with serious Covid-19 cases.

The company then quickly mobilised plans for trials in the US, Australia, China and Europe.

"The remarkable clinical outcomes in these critically ill patients continue to underscore the potential benefits of remestemcel-L as an anti-inflammatory agent in cytokine release syndromes associated with high mortality, including acute graft versus host disease and Covid-19 ARDS," says Mesoblast chief executive Dr Silviu Itescu.

"We intend to rapidly complete the randomized, placebo-controlled Phase 2/3 trial in COVID-19 ARDS patients to rigorously confirm that remestemcel-L improves survival in these critically ill patients.

The company's chief medical officer Dr Fred Grossman emphasises a significant need to improve the "dismal survival outcomes in COVID-19 patients who progress to ARDS and require ventilators".

"We have implemented robust statistical analyses in our Phase 2/3 trial as recommended by the US Food and Drug Administration (FDA) in order to maximise our ability to evaluate whether remestemcel-L provides a survival benefit in moderate/severe COVID19 ARDS," he says.

SOURCE 

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IN BRIEF

Republican states Georgia, Tennessee, and South Carolina announce plans to reopen some businesses, wind down coronavirus stay-at-home orders (Fox News)

Good news: Los Angeles County antibody study produces more evidence of widespread COVID-19 (Power Line)

Nearly three-quarters of adults fear losing personal liberties because of coronavirus (Washington Examiner)

Sixty percent of Democrats blame Trump more than Communist China for coronavirus (Rasmussen Reports)

Phase 4 relief emerges: $500 billion state and local bailout (Hot Air)

The Supreme Court correctly holds that jury verdicts in state criminal cases must be unanimous (National Review)

Publicly traded firms get $300 million in small-business loans (AP)

Feast or famine, part I: Walmart announces another huge round of hirings (The Daily Wire)

Feast or famine, part II: United Airlines posts $2.1 billion loss, seeks more federal aid (CNBC)

Historic buying opportunity: With oil below zero, Trump to fatten up Strategic Petroleum Reserve (Fox Business)

South Korea: No reason to think Kim Jong Un gravely ill despite U.S. media report (USA Today)

Policy: Why Has the Voice of America become a voice of confusion? (National Review)

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here  (Personal).  My annual picture page is here.  Home page supplement

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Five Problems With the Study That Claims 'More Deaths' From Treating Coronavirus With Hydroxychloroquine

It's not a study at all.  Only the sickest patients were given Hydroxychloroquine.  So they were naturally more likely to die

On Tuesday, the results of a study on the benefits of hydroxychloroquine as a treatment for the coronavirus were released. The study analyzed the impact of hydroxychloroquine with and without the antibiotic azithromycin and compared that to patients receiving standard care. The study found there were "more deaths" among those given hydroxychloroquine than those who just received standard care.

As you could expect, the media pounced on the study. The Washington Post,  CNN, Salon, TIME Magazine, and plenty of others were just itching to claim that Trump had been wrong or even irresponsible for touting hydroxychloroquine in the first place. International Business Times even wrote: "Trump's Hydroxychloroquine Caused More Deaths, Study Reveals."

But, if you actually read through the reporting, even read through the study itself, it becomes clear that the media, which was quick to downplay or ignore earlier studies showing the drug worked, were too quick to hype this study's findings. Here are five problems with the study that should give you pause before you turn your back on hydroxychloroquine.

5. It was a small, non-peer-reviewed study, not a clinical trial
Previous studies showing the promise of hydroxychloroquine in treating the coronavirus have been downplayed by the media because they were small studies, not large-scale clinical trials. This study was not a controlled clinical trial, but an analysis of medical records, and it hasn't been reviewed by other scientists yet.

Even the Associated Press noted that the difference in fatality between those given hydroxychloroquine plus azithromycin "was not considered large enough to rule out other factors that could have affected survival." You think?  I'm willing to bet that upon peer review, scientists will acknowledge similar faults with this study that I've identified.

4. The patients were not representative of the entire population
By now there are a number of things we've learned about the coronavirus: It has a higher fatality rate with males, older people are more likely to be affected by it, most who die from it had other illnesses. The patients whose records were analyzed for this study were all male. The patients' ages ranged from 59 to 75, with a median age of 70 (for those treated with hydroxychloroquine), 68 (for those treated with hydroxychloroquine and azithromycin), and 69 (for those receiving standard treatment alone). The patients were also disproportionately black. According to the census, 13.4 percent of United States population is black, but in the study, 68% (HC), 59% (HC+AZ),  and 65% (No HC) of the patients were black. There is a known racial disparity in how the coronavirus impacts those who contract it that isn't fully understood yet.

The prevalence of comorbidities in those who have died from the coronavirus tell me that a study done on VA hospital patients was never going to give an accurate representation of the drug's efficacy. This study was exclusive to a high-risk group of individuals, involving a drug that, like every other drug, has side effects. Could hydroxychloroquine or hydroxychloroquine plus azithromycin have side effects that are disproportionately more severe, or even marginally fatal, to older patients? Maybe it does.  That wouldn't make it unique. But this study doesn't tell us anything about how the drug works with the overall population.

3. The most severe cases disproportionately received the drug
The study itself acknowledges that "hydroxychloroquine, with or without azithromycin, was more likely to be prescribed to patients with more severe disease." In such a small study that isn't representative of the entire population, this would likely impact the results. For starters, there is a direct correlation between advanced age and the severity of side effects. If more severe cases were more likely to be prescribed the drug, it's possible that these patients were more likely to be fatal cases regardless of the treatment, and perhaps the drugs weren't administered early enough to alleviate the symptoms to result in recovery. "The findings should not be viewed as definitive because the analysis doesn’t adjust for patients’ clinical status and showed that hydroxychloroquine alone was provided to VA’s sickest COVID-19 patients, many times as a last resort," a spokeswoman for the Department of Veterans Affairs told Fox News.

2. Other studies and anecdotal reports suggest it helps
As PJM's Tyler O'Neil noted earlier this month, "Doctors and patients across America have reported positive results" with hydroxychloroquine in treating the coronavirus. Dr. Anthony Cardillo, the CEO of Mend Urgent Care in Los Angeles, reported seeing "significant success" with the drug in treating coronavirus patients. New York Governor Andrew Cuomo even requested more hydroxychloroquine from the Trump administration after seeing promising results. Democratic Michigan state Rep. Karen Whitsett says the drug saved her life. Were they all just lucky? Unlikely. while these studies were small, and the reports anecdotal, I'd be willing to bet the patient base for all of them were more demographically diverse than the VA hospital study.

1. The study concluded that controlled trials are still needed
The study's conclusion states quite clearly that "These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs." It seems to me that the authors of the study were aware of its faults when they published. This study was too small and non-representative of the population. Yet we saw the media pounce on its results so they could fault him for promoting hydroxychloroquine. The bottom line here is that we now have studies that say it works and that it doesn't work. Hydroxychloroquine might not be as effective as the small studies with positive results that say it is, and it most likely isn't as ineffective as this VA hospital study suggests. Obviously, it's worth getting a reliable answer.

SOURCE 

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Virginia:  The naked face of the Democratic party

We see what horrors Democrats are when the constraints are off

Virginia Democrats are incapable of being courteous even in the midst of a pandemic. Due to the coronavirus, the House of Delegates will reconvene this week in a tent; but the Democrat majority did not even have the decency to inform Republican delegates of important matters, such as how votes would be taken and whether voting remotely would be permitted. Consequently, Republican delegates have been learning about the Democrats’ plans through the media. This is disgraceful, but it is typical of the way that arrogant Democrats have acted since they managed to seize full control of Virginia – with the substantial assistance of liberal billionaires.

For generations, politics in the Commonwealth have been conducted the Virginia Way – meaning that lawmakers acted civilly toward each other, listened to opposing viewpoints, and compromised when necessary. The Virginia Way helped make the Commonwealth a good place to live and helped us steer clear of the toxic politics of Washington. Those days are gone.

One of Democrats’ most shameful displays occurred in February when a black pastor, who had been invited by a Republican delegate, gave the opening prayer for the House of Delegates. The pastor’s prayer expressed his traditional family values, which offended Democrat legislators. Some responded by heckling him and walking out as he prayed. Even more egregiously, the House Speaker, Eileen Filler-Corn (D-Fairfax County), silenced the pastor by gaveling his prayer to an end and abruptly beginning to lead the chamber in the Pledge of Allegiance.

When Democrat legislators are not busy disrespecting a pastor or passing left-wing legislation, they are busy practicing the politics of spite and retribution. For example, Sen. Bill Stanley (R-Franklin County), proposed legislation to increase the pay for sheriffs’ departments by three percent. Every Senate Democrat voted against the bill. After the bill was defeated, Sen. Dick Saslaw (D-Fairfax County), the octogenarian Majority Leader, told Stanley that the bill had been defeated because sheriffs had informed legislators that they would not enforce unconstitutional gun laws.

Democrats who dare to step out of line may also suffer retaliation from their own party. After a Democrat state senator voted against a sweeping gun control bill, a Democrat-run committee in the House of Delegates killed a noncontroversial bill sponsored by that senator – without regard for those who would have benefitted from the bill. The legislation, which passed unanimously in the Virginia Senate, would have allowed part-time police officers to purchase their service weapons when they retire. (The law currently allows full-time officers to purchase their service firearms upon retirement.)

Things are so bad that Democrat senators felt the need to threaten the Democrat House Speaker’s agenda to persuade her to do her job. After running on redistricting reform last fall, many House Democrats were suddenly not interested in real reform once they grabbed power. As this year’s regular legislative session neared its end, nine House Democrats broke with their party and voted with the House Republicans for a state constitutional amendment to reform redistricting. However, after the amendment passed the House, Speaker Filler-Corn refused to transmit the amendment to the Senate prompting fears that the bill would be killed. In response, Senate Democrats, who supported the amendment, threatened to retaliate by killing several liberal House bills. Eventually, Filler-Corn relented and transmitted the amendment.

Unfortunately, the lack of decency in the Virginia Democrat Party extends to the Governor’s mansion. Despicably, he supported a bill to make it easier to kill a baby right up until birth – an extreme position only supported by a fraction of the electorate. As if that were not bad enough, we learned early last year that Northam had the nickname “Coonman” in college; absurdly, he claimed not to know how he had acquired this moniker. We also learned that there was a photo of two individuals with one in a KKK outfit and another in blackface on his page in his medical school yearbook. At first, Northam admitted he was in the photo – without saying whether he was wearing blackface or dressed as a klansman – then quickly reversed himself and claimed not to know how the photo appeared on his page. This is the same man who, during his campaign for governor, smeared Republican voters as murderous racists.

The good news is that next year there will be elections for governor, lieutenant governor, attorney general, and the House of Delegates. Because these thuggish Democrats have shown themselves to be unfit to serve, perhaps Virginia’s voters will take them to the woodshed and deliver a thrashing they will not soon forget.

SOURCE 

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Trump Orders Navy to Destroy Any Iranian Gunboats That Harass US Ships

About time

On Wednesday morning, Earth Day no less, when any responsible president would have been hectoring people about global warming, President Trump had other concerns on his mind. “I have instructed the United States Navy,” he tweeted, “to shoot down and destroy any and all Iranian gunboats if they harass our ships at sea.”

Predictable scorn ensued from the Left. Writer Nick Jack Pappas was just one of the many who focused on Trump’s choice of words, tweeting, “Trump is giving the order to shoot down boats. I didn't realize Iran had flying boats now.” They ignored the fact that one can shoot a man down without his being able to fly, but anything will do for a dig at the President.

Iranian freedom activist and journalist Heshmat Alavi was more focused, tweeting: “The mullahs' regime ruling #Iran harasses UN [sic] Navy ships for propaganda purposes. Thank you, President Trump, for reminding this regime that the Obama years are gone. And BTW, this regime does not represent the Iranian people."

Alavi was right. The Iranian mullahs, apparently having forgotten that Barack Obama is no longer President, were at it again just last week. According to Business Insider, “nearly a dozen Iranian Islamic Revolutionary Guard Corps Navy vessels sailed out Wednesday to harass a collection of US Navy and Coast Guard vessels conducting operations in international waters.”

The U.S. Navy stated that eleven Iranian boats of the Islamic Revolutionary Guards Corps Navy (IRGCN) “conducted dangerous and harassing approaches,” and added that “the IRGCN’s dangerous and provocative actions increased the risk of miscalculation and collision.” The Iranians, said the Navy statement, were violating the “rules of the road.”

SOURCE 

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IN BRIEF

Trump's 60-day immigration pause, which exempts temporary foreign workers, falls well short of full ban, but the White House's goal is to allow more jobs to be filled by U.S. citizens (Politico)

U.S. deaths top 45,000, doubling in a little over a week (Reuters)

The first stateside death was in California on February 6 — weeks earlier than initially believed (NBC News)

CDC chief warns second wave may be worse, arriving with flu season (Reuters)

NIH panel recommends against combining the drugs hydroxychloroquine and azithromycin (NPR)

"An appalling campaign of deceit, concealment, misfeasance, and inaction": Missouri becomes first state to sue China over coronavirus (The Washington Free Beacon)

Trump says he will ask Harvard, which boasts a $40 billion endowment, and big businesses to return relief funds (The Hill)

For the record: Filthy-rich Harvard isn't the only university taxpayers shouldn't bail out (The Federalist)

Michigan Gov. Gretchen Whitmer awards (then rescinds after being busted) coronavirus contract to Democrat consulting firm (The Washington Free Beacon)

Navy deploys two ships to South China Sea amid tensions (The Hill)

Policy: The world's bad actors see coronavirus as an opportunity (Bloomberg Opinion)

Policy: How public transit makes the nation more vulnerable to disasters (The Federalist)

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here  (Personal).  My annual picture page is here.  Home page supplement

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'Nobody wants to die but we've got to take risks and get back in the game': Texas Lt Gov defends decision to reopen the economy amid coronavirus pandemic after saying it was worth risking lives to save jobs

The lieutenant governor of Texas says there are more important things than living as he defended the decision to reopen the state's economy amid the coronavirus pandemic.

Lt. Gov. Dan Patrick, who was heavily criticized last month for suggesting it was worth risking lives to save jobs, doubled down on his stance in an interview with Fox News' Tucker Carlson on Monday night.

'There are more important things than living and that's saving this country for my children and my grandchildren and saving this country for all of us,' the 70-year-old said.

'I don't want to die. Nobody wants to die. But man, we've got to take some risks and get back in the game and get this country back up and running.' 

He had implied in an interview with Carlson on March 23 that he would rather die from COVID-19 that see the economy destroyed due to what he suggested was an overreaction to the disease.  In that interview, Patrick suggested that older people like himself, who are more at risk, would take care of themselves.

Patrick said on Monday that the economic hardships felt in Texas - who started reopening some businesses on Monday - and across the country as a result of the coronavirus lockdown measures had 'vindicated' him.

'When you start shutting down the economy and people start losing their paychecks and businesses can't open and governments aren't getting revenues... I'm sorry to say I was right on this,' Patrick said. 'I'm thankful that we are now... finally beginning to open up Texas and other states because it's been long overdue.

Patrick questioned the science and projected death toll of COVID-19 after an influential model relied on by the White House and health officials has seen the number of possible fatalities lowered since the outbreak first started.

'I mean, at the end of January, Dr Fauci, who I have great respect for, said this wasn't a big issue. Three weeks later, we were going to lose 2 million people. Another few weeks later, it was 1 to 200,000. Now it's under 60,000,' he said.

'We've had the wrong numbers. The wrong science. I don't blame them but let's face reality of where we are. 

State parks reopened on April 20 and hospitals can start resuming surgeries on April 22.

From April 24, retailers can reopen but only if they can deliver their goods or services to people at home or in their cars to minimize contact.

'In Texas, we have 29 million people.... and every life is valuable but 500 people out of 29 million.

'We're locked down and we're crushing the average worker. We're crushing small business. We're crushing the markets. We're crushing this country.'

In Texas, there are currently more than 20,000 infections and 520 deaths as a result of the coronavirus.

Patrick's comments came after Republican Governor Greg Abbott became the first in the country to announce the state would start lifting coronavirus restrictions.

As of Monday, retailers were allowed to sell items for curbside pickup, while elective surgeries could resume and state parks could reopen.

Abbott said last week that future decisions on reopening more of Texas would be guided by testing.

Although he assured that testing would 'go up quite a bit' in late April or early May, he did not provide a number.

Georgia, South Carolina and Tennessee have all since announced partial reopenings of state economies.

South Carolina opened some retail stores from yesterday, Georgia has announced plans to reopen gyms, beauty salons and barber shops this Friday, and Tennessee is set to ease stay-at-home orders within days.

Such a swift reopening runs counter to the advice of many experts, including Dr. Anthony Fauci, the government's top authority on infectious diseases, who warned again Monday that resuming business too soon risked a fresh spike in infections. 

SOURCE 

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A similar debate in Australia too

Most Australians accept that temporarily shutting down large parts of the economy is a difficult but necessary part of beating the coronavirus.

But others are using the tough measures as an excuse to engage in a cruel debate that pits the lives of Australia’s elderly against the cost to the economy.

The journal Science first floated the question in late March when it published research under the headline: Experts weigh lives versus economics.

The article discussed the dilemma being faced by macroeconomists who were “more familiar with gauging how interest rates might influence employment”.

“If it turns out a lot of people get infected and have few symptoms, the economically sensible approach might be to let the infection spread and accept that there will be some death toll,” researchers wrote.

Less than two weeks later, the following headline appeared in the Australian Financial Review: Lives matter but at what cost?

The author, John Kehoe, wrote that “there is a high economic and social price being paid” for Australia’s efforts to flatten the curve and save lives.

“Unemployment is surging, businesses are closing, incomes are being slashed. People are hurting,” he wrote.

Then he took it one step further by making the case that Australians over the age of 70 aren’t worth as much as younger Australians.

“Many seniors have had time to enjoy careers, children and grandchildren,” he began. “My father is 68 and insists he’s had a good run. With the swimming pool and tennis club in his Victorian town now closed, his daily pursuits are off limits. His physical fitness and mental wellbeing are suffering.

“Some seniors like him would not put their own life above the livelihoods of their children and grandchildren, if the economic and social costs become too great.”

Unsurprisingly, the piece caused outrage. Journalist Jan Fran was among those who hit back at the “reductionist” argument. “Maybe I’m wrong but none of the spicy ‘let the virus spread to save the economy’ hot takes are written by poor, sick, old or disabled people,” she wrote on Twitter.

“They’re always written by some legend in a suit who did some maths and worked out that your nan is probs not worth saving as much as — say — a young, healthy person who will contribute more to the economy.

“This is true if you think a human being’s value should be measured by their economic contributions. “If that’s the case then just cut the sh*t and say you think some lives are worth more than others because of the money/capital they make/earn/produce. Actually, say it!”

She argued that those willing to sacrifice the elderly to keep the economy running have “flattened what it means to be human”.

But Kehoe isn’t the only one pushing hard to remove strict quarantine laws and reopen businesses. The Institute of Public Affairs was slammed when it released a bizarre video on April 7 arguing that reopening churches, restaurants, cafes, bars and community sport was a “sensible” idea, despite experts everywhere saying the opposite.

“Our response to the coronavirus outbreak has decimated our society, ruined thousands of lives, turned Australia into a police state and, worst of all, put hundreds of thousands of Australians out of work,” the think tank’s policy director Gideon Rozner argued.

He said it was time for state and federal governments to come up with a plan to win the lockdown and let people rebuild their lives.

“Do it safely with appropriate social distancing measures in place, but do it now, not in six months, not in one month. Now, because Australians were not meant to live like this, and we cannot allow this to go on any longer,” he says. “Enough is enough. It is time to begin to end this lockdown now.”

Of course, to do so would be catastrophic. New modelling from the Doherty Institute and Monash University shows that Australia, plainly, is not ready.

It reveals that if Australia’s reproduction number — how many people could be infected by just one case — increased from below one to somewhere around 2.5, there could be more than 70 deaths in just three weeks’ time.

“If we lift measures, and it depends how much you lift them, but if we were to lift all of them and we get back to a reproduction number of 2.5, then we’re back on an exponential curve,” Victoria’s Chief Health Officer Brett Sutton said.

“The numbers would get up to 10,000 in a matter of weeks. So we have to keep the reproduction number below one in order to maintain the pressure down on the numbers that we have in Victoria.”

SOURCE 

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AG Barr Says the DOJ May Take Legal Action against States if Lockdowns Are Deemed Excessive

Attorney General William Barr on Tuesday said the Justice Department could take action against states whose coronavirus lockdowns are deemed too strict.

“We have to give businesses more freedom to operate in a way that’s reasonably safe,” Barr said in an interview on The Hugh Hewitt Show. “To the extent that governors don’t and impinge on either civil rights or on the national commerce–our common market that we have here–then we’ll have to address that.”

Barr said states should enforce lockdowns and business closures only until the spread of coronavirus has halted. Then, states should eventually reopen in line with the Trump administration’s guidelines, he said.

“These are very, very burdensome impingements on liberty, and we adopted them, we have to remember, for the limited purpose of slowing down the spread, that is bending the curve,” Barr went on. “We didn’t adopt them as the comprehensive way of dealing with this disease….You can’t just keep on feeding the patient chemotherapy and say well, we’re killing the cancer, because we were getting to the point where we’re killing the patient.”

While most U.S. states have adopted some form of business and school closures, several have seen protests against the lockdown measures. President Trump has repeatedly clashed with state governors on reopening the economy, urging them to do so as soon as possible.

Trump has called on protesters to “liberate” certain states, all with Democratic governors. Washington governor Jay Inslee subsequently accused Trump of “fomenting domestic rebellion.”

Protests have been particularly strong in Michigan, whose governor Gretchen Whitmer has instituted some of the most stringent lockdowns in the U.S. Whitmer on Tuesday compared protesters to Americans who objected to the World War II production effort.

SOURCE 

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IN BRIEF</.b>

More than a dozen killed during shooting rampage in heavily gun-controlled Canada (New York Post)

More U.S. protests call for lifting restrictions as governors push back (Reuters)

Trump says "governors have gone too far" with restrictions (New York Post)

President says he'll end Obama-era funding to Wuhan lab (The Daily Caller)

U.S. officials confirm full-scale investigation of whether coronavirus escaped from Wuhan lab (Fox News)

Department of Defense travel ban extended to June 30 (Military Times)

What could possibly go wrong? Chinese-made drones are monitoring streets in 20 states to enforce social distancing (The Daily Wire)

Gov. Cuomo hires firm with close ties to the Chinese Communist Party to develop reopening plan (Hot Air)

"Anonymous" Trump slanderer identified as former Deputy National Security Adviser Victoria Coates (RealClearInvestigations)

As we've long suspected, antibody research indicates coronavirus may be far more widespread than known (ABC News)

Illinois takes advantage of pandemic, pleads for multibillion-dollar pension bailout (The Daily Wire)

Policy: Trump administration should double down on deregulation to relaunch economy (Washington Examiner)

Policy: After repeated failures, it's time to permanently dump epidemic models (Issues & Insights)

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here  (Personal).  My annual picture page is here.  Home page supplement

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