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I dunno when ASAP is.. there are good arguments on all sides... its a pay me now/pay me later kinda thing. The thing is, it is the economy that allows us to have resources to address crises.. permanent damage to the economy.. and world economy.. needs be avoided. The cost would be way more than deaths from CV19.

So true. My worry is that everything opens up, things get rolling going and then we have a huge wave of deaths forcing things to close down again. Imagine what that would do to the economy.
 
So true. My worry is that everything opens up, things get rolling going and then we have a huge wave of deaths forcing things to close down again. Imagine what that would do to the economy.
perhaps everyone taking the antimalarial drug will allow us to reopen and survive getting CV19.. then we'd all have antibodies and that will be that... until the next crisis.
 
From limited interactions with one major pharmaceutical company, they seem to be very focussed on generating a protective T cell response. T cell responses, such as CD8 "killer" T cells can directly kill virally infected cells. However, it is much more difficult to measure a protective T cell response and, probably more importantly, protective T cell responses are not as durable as protective antibody responses (months, maybe years for T cells, whereas antibody protection can last decades or more).

Don't have much time to post right now (due to some family stuff - not coronavirus - mom's cancer has taken a turn for the worse unfortunately).

However, just came across this promising, but very limited data on CytoDyn's leronlimab ("mab" being monoclonal antibody for those who don't know - lots of those kind of drugs out now in all kinds of indications, including the most famous one, I think, Merck's Keytruda for cancer, which is pembrolizumab).

Bruce Patterson, M.D., Chief Executive Officer and founder of IncellDx, a diagnostic partner and advisor to CytoDyn, stated, “The Day-7 results from these patients demonstrates even more dramatic immune restoration especially in the CD8 T-lymphocyte population, the major immune cell responsible for eliminating virally infected cells. In addition, there is a further dramatic reduction in the critical cytokine storm cytokines IL-6, TNF-alpha. Collectively, these results are correlating with patients’ recovery. Some patients have been removed from ventilators, including one patient who was taken off of a heart/lung bypass machine. Critically ill patients are experiencing the benefit of extubating within 7 days of treatment with leronlimab.”

https://www.cytodyn.com/newsroom/pr...es-at-day-0-3-and-7-for-severely-ill-covid-19

https://www.cytodyn.com/newsroom/pr...es-at-day-0-3-and-7-for-severely-ill-covid-19
 
I'll leave the politcal power part out of the equation, but yeah, figuring out how to reopen this economy is a central part of this. Super important that it get's open as soon as possible, for the country as a whole, not just for the states. The question is: when is as soon as possible?
Need to monitor what happens in Singapore very closely.
 
So New Jersey has 7618 patients in hospitals with 1746 in critical care due to covid19. Claim is only 62 available ventilators remain in stock. Sounds somebody is fudging in numbers. How many ventilators has the state acquired either through Federal government and private industry? Less than 2000k ? Someone is full of it. I cannot believe we did not have over that total since this started. My understanding is ventilators are reusable. Plus we keep extending the anticipated peak figures . Last week 2-3 weeks now again another 2-3 weeks May 11 . Nobody has a clue. Maybe China can help us out of this mess.
 
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Reactions: goru1869
Don't have much time to post right now (due to some family stuff - not coronavirus - mom's cancer has taken a turn for the worse unfortunately).

However, just came across this promising, but very limited data on CytoDyn's leronlimab ("mab" being monoclonal antibody for those who don't know - lots of those kind of drugs out now in all kinds of indications, including the most famous one, I think, Merck's Keytruda for cancer, which is pembrolizumab).

Bruce Patterson, M.D., Chief Executive Officer and founder of IncellDx, a diagnostic partner and advisor to CytoDyn, stated, “The Day-7 results from these patients demonstrates even more dramatic immune restoration especially in the CD8 T-lymphocyte population, the major immune cell responsible for eliminating virally infected cells. In addition, there is a further dramatic reduction in the critical cytokine storm cytokines IL-6, TNF-alpha. Collectively, these results are correlating with patients’ recovery. Some patients have been removed from ventilators, including one patient who was taken off of a heart/lung bypass machine. Critically ill patients are experiencing the benefit of extubating within 7 days of treatment with leronlimab.”

https://www.cytodyn.com/newsroom/pr...es-at-day-0-3-and-7-for-severely-ill-covid-19

https://www.cytodyn.com/newsroom/pr...es-at-day-0-3-and-7-for-severely-ill-covid-19
Very sorry to hear about your Mom.
 
I dunno when ASAP is.. there are good arguments on all sides... its a pay me now/pay me later kinda thing. The thing is, it is the economy that allows us to have resources to address crises.. permanent damage to the economy.. and world economy.. needs be avoided. The cost would be way more than deaths from CV19.
I’m probably speculating out of my rear on this like everyone in the US at this point, but around Memorial Day or early June would be my guess based on the Wuhan lockdown timeline.
 
So true. However, ~85% or more people recover from COVID-19 with no or only supportive treatment. Therefore, definitive trials will take a huge numbers of people - thousands with treatment and thousands as control. That's why any actual clinical trial typically cost millions of $$ and take a long time.
It's definitely a tough situation, but there are hundreds of thousands of patients now in the US so we should be able to cobble together something large enough to give an idea. Might have to be done in places with a lower case load (as opposed to NYC where they're just trying to keep up).

I personally don't want to take the chance I'm one of the 85% (if it's even that percentage., I don't think we really know yet).
 
I’m probably speculating out of my rear on this like everyone in the US at this point, but around Memorial Day or early June would be my guess based on the Wuhan lockdown timeline.
That seems reasonable, I think the Wuhan lockdown was 76 days? But...their lockdown was much more severe than ours, we still have lots of pseudo-essential places open. Until just a couple of days ago the golf courses were open and there were large groups not practicing social distancing. There's almost as much traffic on our road now as there usually is. I don't think people in my area (upstate NY/Rochester) are really taking this as seriously as they should so the US response probably won't be as good as it could be.
 
That seems reasonable, I think the Wuhan lockdown was 76 days? But...their lockdown was much more severe than ours, we still have lots of pseudo-essential places open. Until just a couple of days ago the golf courses were open and there were large groups not practicing social distancing. There's almost as much traffic on our road now as there usually is. I don't think people in my area (upstate NY/Rochester) are really taking this as seriously as they should so the US response probably won't be as good as it could be.
All good points and unfortunately, I see signs of that every day. To couch my initial point, I don’t think we would be rip roaring by that date, but maybe loosening a few restrictions and opening a few more types of businesses.
 
You watch.. every state should be looking at getting back to work soon for a very good reason... state governments tax income is hurting.. they cannot spend money.. their political power often stems from controlling government spending. That's why Cuomo didn't buy those respirators in 2015.. he had better spending to do, re: political power, upstate. Very soon the political implications of less tax income will become evident.. and a political problem. Instead of PPE and respirators.. the asks will be about money... because only the feds can print money to throw at problems.
What @GoodOl'Rutgers is saying is already beginning to happen.

And that’s all I’m going to say on that.
 
Medscape Logo
News > Medscape Medical News
COVID-19 Hits Physician Couple: Dramatically Different Responses
Kate Johnson
April 11, 2020
0 ADDED TO EMAIL ALERTS
Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.
A physician couple who both had COVID-19 had very different responses — one ending up in intensive care, the other asymptomatic.
Their story, one of two people living together but with such different responses to the infection, illustrates how much is still to be learned about COVID-19, says Noopur Raje, MD, professor of medicine at Harvard Medical School and director of the Center for Multiple Myeloma at Massachusetts General Hospital (MGH) in Boston.
"After experiencing #Covid_19 from the patient/caregiver end despite both of us being physicians at a major academic medical center, this has been a challenge like no other I have experienced," Raje (@NoopurRajeMD) wrote on Twitter.
Noopur Raje
@NoopurRajeMD
· Apr 5, 2020
1/I never tweet about personal issues—but this is way too important—I am COVID positive and asymptomatic and have been a caregiver for my husband @JagSinghMD who was critically ill with #COVID19. I've learned some things - please follow for more 1/25
Noopur Raje
@NoopurRajeMD
2/ He is on day 25 of experiencing symptoms related to being COVID positive. I hope our experience with #coronavirus can be a resource for so many who are being impacted.
1,214
5:00 PM - Apr 5, 2020
Twitter Ads info and privacy
178 people are talking about this
She outlined their experiences in a Twitter thread, and elaborated in an interview with Medscape Medical News.
Raje says that she wants clinicians to know how symptoms can evolve both quickly and suddenly.
She recalls how for 10 days, she cared for her COVID-19–positive husband at home, separated from him by a floor in their Boston townhouse and wearing a surgical mask and gloves to bring him food and fluids, as he was too weak to help himself.
Despite the high fevers, chills, extreme fatigue, and dramatic weight loss, Raje says she felt reasonably confident that her husband was getting better. His temperature had dropped from around 103 to 101, his heart rate was in the 80s, and his blood pressure was "OK," she recalls.
But then Jag Singh, MD, an otherwise healthy 55-year-old Harvard professor and cardiologist, started to cough — and everything suddenly changed.
The cough sounded chesty, and he was weak and unwell. They decided that he needed medical help.
"I was planning on driving him to the hospital, but I ended up having to call 911, although we literally live across the street," she said.
"We have stairs here and I wasn't sure that he would be able to make it coming down with me trying to help him, so the safest thing was for me to call for help."
Singh was admitted straight to the medical intensive care unit (MICU) while his wife waited at home.
"I was blown away when I saw Jag's x-ray and CT scan and the bilateral pneumonia he had developed," she commented. "I would not have believed it, the way he was clinically — and seeing that x-ray.
"Honestly, when I took him in to hospital, I thought he'd be there a couple of days — over the weekend — and I'd get him back Monday. But it didn't turn out that way. He was there for about 9 days."
That first night in the hospital, Singh consented to intubation — should he need it. "He called me then," said Raje. "I said we've got to do what we've got to do, it's OK — it is what it is, and we'll do whatever it takes."
He remained in the MICU overnight and through the next day, still breathing on his own, but with the looming prospect of mechanical ventilation.
"The good news is he maintained his oxygen saturations throughout," said Raje. "I was able to see his vitals with EPIC [remote monitoring]...It was crazy," she recalls. "Seeing a respiratory rate of 26 was difficult. When you see that you worry about somebody tiring with the breathing. His inflammatory markers kept climbing, his fevers persisted."
Thankfully, he never needed the ventilator.
But by this time Raje had another worry: She, too, had tested positive and was now alone at home.
"I was unable to talk to my extended family as they all looked to us as physicians for support," she tweeted. Both children came to Boston to see her, but she saw them only through a window.
Dr Raje: Her kids came to Boston to see her through the window, after she tested positive for COVID-19 while her husband was in the MICU
Alone, she waited for the same symptoms that had slammed her husband; but they never came — something she wants caregivers to know.
"The fear and anxiety of taking care of somebody who's COVID-positive.... I am hoping that can be alleviated a little bit at least," she said. "If you've been taking care of someone, chances are you're probably positive already and if you're not sick, the chances of you getting sick are really low, so don't be afraid to take care of that person."
Singh is recovering well at home now, almost a month into his illness. During the interview, conducted via Zoom, he could be heard coughing in the background.
While in the MICU, Singh was treated with azithromycin and hydroxychloroquine — standard at MGH for critically ill COVID-19 patients — and he was also enrolled into a double-blind, randomized, placebo-controlled trial of the investigational agent remdesivir (Gilead).
Raje is not sure what, if anything, helped him turn the corner.
"I saw his inflammatory markers get worse actually — I don't think we can know if the drugs made a difference," she says. "His first dose of hydroxychloroquine was Friday night when he was admitted, and the markers continued to climb until the next Thursday."
In particular, his C-reactive protein (CRP) kept rising, reaching the 260 to 270 mg/dL range, "which to me was scary," she said. "I do think he had a cytokine storm going, but I didn't see those results."
"Understanding the immune compartment is going to be so, so critically important and what it is that we can do to boost folks' immune systems," she said.
"If you have a very high viral load and your immune system is not 100% even though you're otherwise healthy, you might be the person who ends up with that more serious response to this virus. Trying to study this in a focused way, looking at the immune compartment, looking at the antibody status, looking at the viral load — there's so much more we need to look at. Until we get the vaccine, which is probably a year-and-a-half away, we need to look at how can we develop that herd immunity so we don't have folks getting as critically ill as they do."
Despite feeling perfectly healthy, Raje is still at home. Three weeks after her first test she is still testing positive for COVID-19, waiting for two consecutive negative results 72 hours apart before she is allowed back to work at the hospital.
When she gets the green light, she plans to go work on the COVID-19 floor, if needed. "Its people like us [who have had COVID-19] who have to get back in the trenches and do the work now," she says.
"My biggest concern is that it's a very isolating experience for the COVID-positive patient. We are doing complete-barrier nursing — they are completely alone. The only person who ever walks into the room is the nurse — and the physician goes in once a day. It's so important that we don't lose sight of compassion," she says.
"That's why, in terms of alleviating anxiety, it is so important we do antibody testing so that people can actually go in and take care of these folks."
"Look for Red Flag"
Raje wants physicians to warn their self-isolating patients and caregivers to look for red flags. "There are primary care physicians who reached out to me [after my tweets] and said 'when someone calls me and says it's been 5-7 days and I am still not feeling well, I am going to look at that more seriously.'
"Part of me wanting to share this experience was basically to dispel the notion that 2 weeks into this you're going to be fine," she said, because it is not widely appreciated, she feels that "in week 2 you could become pretty sick."
Follow Medscape on Facebook, Twitter, Instagram, and YouTube.
0 Read Comments
Medscape Medical News © 2020
Cite this: Kate Johnson. COVID-19 Hits Physician Couple: Dramatically Different Responses - Medscape - Apr 11, 2020.
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Medscape Logo
News > Medscape Medical News
COVID-19 Hits Physician Couple: Dramatically Different Responses
Kate Johnson
April 11, 2020
0 ADDED TO EMAIL ALERTS
Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.
A physician couple who both had COVID-19 had very different responses — one ending up in intensive care, the other asymptomatic.
Their story, one of two people living together but with such different responses to the infection, illustrates how much is still to be learned about COVID-19, says Noopur Raje, MD, professor of medicine at Harvard Medical School and director of the Center for Multiple Myeloma at Massachusetts General Hospital (MGH) in Boston.
"After experiencing #Covid_19 from the patient/caregiver end despite both of us being physicians at a major academic medical center, this has been a challenge like no other I have experienced," Raje (@NoopurRajeMD) wrote on Twitter.
Noopur Raje
@NoopurRajeMD
· Apr 5, 2020
1/I never tweet about personal issues—but this is way too important—I am COVID positive and asymptomatic and have been a caregiver for my husband @JagSinghMD who was critically ill with #COVID19. I've learned some things - please follow for more 1/25
Noopur Raje
@NoopurRajeMD
2/ He is on day 25 of experiencing symptoms related to being COVID positive. I hope our experience with #coronavirus can be a resource for so many who are being impacted.
1,214
5:00 PM - Apr 5, 2020
Twitter Ads info and privacy
178 people are talking about this
She outlined their experiences in a Twitter thread, and elaborated in an interview with Medscape Medical News.
Raje says that she wants clinicians to know how symptoms can evolve both quickly and suddenly.
She recalls how for 10 days, she cared for her COVID-19–positive husband at home, separated from him by a floor in their Boston townhouse and wearing a surgical mask and gloves to bring him food and fluids, as he was too weak to help himself.
Despite the high fevers, chills, extreme fatigue, and dramatic weight loss, Raje says she felt reasonably confident that her husband was getting better. His temperature had dropped from around 103 to 101, his heart rate was in the 80s, and his blood pressure was "OK," she recalls.
But then Jag Singh, MD, an otherwise healthy 55-year-old Harvard professor and cardiologist, started to cough — and everything suddenly changed.
The cough sounded chesty, and he was weak and unwell. They decided that he needed medical help.
"I was planning on driving him to the hospital, but I ended up having to call 911, although we literally live across the street," she said.
"We have stairs here and I wasn't sure that he would be able to make it coming down with me trying to help him, so the safest thing was for me to call for help."
Singh was admitted straight to the medical intensive care unit (MICU) while his wife waited at home.
"I was blown away when I saw Jag's x-ray and CT scan and the bilateral pneumonia he had developed," she commented. "I would not have believed it, the way he was clinically — and seeing that x-ray.
"Honestly, when I took him in to hospital, I thought he'd be there a couple of days — over the weekend — and I'd get him back Monday. But it didn't turn out that way. He was there for about 9 days."
That first night in the hospital, Singh consented to intubation — should he need it. "He called me then," said Raje. "I said we've got to do what we've got to do, it's OK — it is what it is, and we'll do whatever it takes."
He remained in the MICU overnight and through the next day, still breathing on his own, but with the looming prospect of mechanical ventilation.
"The good news is he maintained his oxygen saturations throughout," said Raje. "I was able to see his vitals with EPIC [remote monitoring]...It was crazy," she recalls. "Seeing a respiratory rate of 26 was difficult. When you see that you worry about somebody tiring with the breathing. His inflammatory markers kept climbing, his fevers persisted."
Thankfully, he never needed the ventilator.
But by this time Raje had another worry: She, too, had tested positive and was now alone at home.
"I was unable to talk to my extended family as they all looked to us as physicians for support," she tweeted. Both children came to Boston to see her, but she saw them only through a window.
Dr Raje: Her kids came to Boston to see her through the window, after she tested positive for COVID-19 while her husband was in the MICU
Alone, she waited for the same symptoms that had slammed her husband; but they never came — something she wants caregivers to know.
"The fear and anxiety of taking care of somebody who's COVID-positive.... I am hoping that can be alleviated a little bit at least," she said. "If you've been taking care of someone, chances are you're probably positive already and if you're not sick, the chances of you getting sick are really low, so don't be afraid to take care of that person."
Singh is recovering well at home now, almost a month into his illness. During the interview, conducted via Zoom, he could be heard coughing in the background.
While in the MICU, Singh was treated with azithromycin and hydroxychloroquine — standard at MGH for critically ill COVID-19 patients — and he was also enrolled into a double-blind, randomized, placebo-controlled trial of the investigational agent remdesivir (Gilead).
Raje is not sure what, if anything, helped him turn the corner.
"I saw his inflammatory markers get worse actually — I don't think we can know if the drugs made a difference," she says. "His first dose of hydroxychloroquine was Friday night when he was admitted, and the markers continued to climb until the next Thursday."
In particular, his C-reactive protein (CRP) kept rising, reaching the 260 to 270 mg/dL range, "which to me was scary," she said. "I do think he had a cytokine storm going, but I didn't see those results."
"Understanding the immune compartment is going to be so, so critically important and what it is that we can do to boost folks' immune systems," she said.
"If you have a very high viral load and your immune system is not 100% even though you're otherwise healthy, you might be the person who ends up with that more serious response to this virus. Trying to study this in a focused way, looking at the immune compartment, looking at the antibody status, looking at the viral load — there's so much more we need to look at. Until we get the vaccine, which is probably a year-and-a-half away, we need to look at how can we develop that herd immunity so we don't have folks getting as critically ill as they do."
Despite feeling perfectly healthy, Raje is still at home. Three weeks after her first test she is still testing positive for COVID-19, waiting for two consecutive negative results 72 hours apart before she is allowed back to work at the hospital.
When she gets the green light, she plans to go work on the COVID-19 floor, if needed. "Its people like us [who have had COVID-19] who have to get back in the trenches and do the work now," she says.
"My biggest concern is that it's a very isolating experience for the COVID-positive patient. We are doing complete-barrier nursing — they are completely alone. The only person who ever walks into the room is the nurse — and the physician goes in once a day. It's so important that we don't lose sight of compassion," she says.
"That's why, in terms of alleviating anxiety, it is so important we do antibody testing so that people can actually go in and take care of these folks."
"Look for Red Flag"
Raje wants physicians to warn their self-isolating patients and caregivers to look for red flags. "There are primary care physicians who reached out to me [after my tweets] and said 'when someone calls me and says it's been 5-7 days and I am still not feeling well, I am going to look at that more seriously.'
"Part of me wanting to share this experience was basically to dispel the notion that 2 weeks into this you're going to be fine," she said, because it is not widely appreciated, she feels that "in week 2 you could become pretty sick."
Follow Medscape on Facebook, Twitter, Instagram, and YouTube.
0 Read Comments
Medscape Medical News © 2020
Cite this: Kate Johnson. COVID-19 Hits Physician Couple: Dramatically Different Responses - Medscape - Apr 11, 2020.
Comments (0)
What to Read Next on Medscape
Recommendations
COVID-19: What's the Impact on Junior Doctors?

COVID-19 Hits Physician Couple: Dramatically Different Responses

COVID-19 Might Cost Health Insurers Over$550 Billion: Report
BUSINESS OF MEDICINE
Coronavirus Social: Mourning Colleagues Lost to COVID-19
Coronavirus Social: PPE Arguments and Pandemic Prophecies
Boris Johnson in Hospital for Persistent COVID-19 Symptoms
Medscape Consult

Pankaj Arora, MD
Other
COVID-19 prophylaxis for primary care physicians?
Join the Discussion
Recommended Reading
Q&A: Trials Testing BCG Vaccine Against COVID-19
PRACTICE GUIDELINE
COVID-19 Enforcement Policy for Sterilizers, Disinfectant Devices, and Air Purifiers (FDA, 2020)
Prioritizing Ambulatory Gynecology Care During COVID-19: The Latest Guidance
NEWS
COVID-19: The Latest NICE Guidance
Related Conditions & Procedures
Coronavirus Disease 2019 (COVID-19)
Trending Clinical Topic: SARS-CoV-2
Trending Clinical Topic: Social Distancing
Trending Clinical Topic: PPE
Fast Five Quiz: Acute Respiratory Distress Syndrome (ARDS)
COVID-19 Advice From Wuhan Doctors: Dx/Rx in the Elderly
SLIDESHOW
COVID-19 Infographics
Expert Commentary
COVID-19: What's the Impact on Junior Doctors?
COVID-19 Might Cost Health Insurers Over$550 Billion: Report
COVID-19 Hits Physician Couple: Dramatically Different Responses
Most Popular Articles
According to INFECTIOUS DISEASE PHYSICIANS
Topol: US Betrays Healthcare Workers in Coronavirus Disaster
COVID-19: Could Hydroxychloroquine Really Be An Answer?
Coronavirus Stays in Aerosols for Hours, on Surfaces for Days
Coronavirus on Fabric: What You Should Know
'Stealth Transmission' of COVID-19 Demands Widespread Mask Usage
View More

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EDITIONS
English
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All material on this website is protected by copyright, Copyright © 1994-2020 by WebMD LLC. This website also contains material copyrighted by 3rd parties.
Bet he got it on purpose as she sounds like a lot of work...

He could be heard coughing in the background.” - sounds like she was getting on his nerves again LOL

We’ve all been there at some point, Jag. LOL
 
Last edited:
  • Like
Reactions: GoodOl'Rutgers
Medscape Logo
News > Medscape Medical News
COVID-19 Hits Physician Couple: Dramatically Different Responses
Kate Johnson
April 11, 2020
0 ADDED TO EMAIL ALERTS
Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.
A physician couple who both had COVID-19 had very different responses — one ending up in intensive care, the other asymptomatic.
Their story, one of two people living together but with such different responses to the infection, illustrates how much is still to be learned about COVID-19, says Noopur Raje, MD, professor of medicine at Harvard Medical School and director of the Center for Multiple Myeloma at Massachusetts General Hospital (MGH) in Boston.
"After experiencing #Covid_19 from the patient/caregiver end despite both of us being physicians at a major academic medical center, this has been a challenge like no other I have experienced," Raje (@NoopurRajeMD) wrote on Twitter.
Noopur Raje
@NoopurRajeMD
· Apr 5, 2020
1/I never tweet about personal issues—but this is way too important—I am COVID positive and asymptomatic and have been a caregiver for my husband @JagSinghMD who was critically ill with #COVID19. I've learned some things - please follow for more 1/25
Noopur Raje
@NoopurRajeMD
2/ He is on day 25 of experiencing symptoms related to being COVID positive. I hope our experience with #coronavirus can be a resource for so many who are being impacted.
1,214
5:00 PM - Apr 5, 2020
Twitter Ads info and privacy
178 people are talking about this
She outlined their experiences in a Twitter thread, and elaborated in an interview with Medscape Medical News.
Raje says that she wants clinicians to know how symptoms can evolve both quickly and suddenly.
She recalls how for 10 days, she cared for her COVID-19–positive husband at home, separated from him by a floor in their Boston townhouse and wearing a surgical mask and gloves to bring him food and fluids, as he was too weak to help himself.
Despite the high fevers, chills, extreme fatigue, and dramatic weight loss, Raje says she felt reasonably confident that her husband was getting better. His temperature had dropped from around 103 to 101, his heart rate was in the 80s, and his blood pressure was "OK," she recalls.
But then Jag Singh, MD, an otherwise healthy 55-year-old Harvard professor and cardiologist, started to cough — and everything suddenly changed.
The cough sounded chesty, and he was weak and unwell. They decided that he needed medical help.
"I was planning on driving him to the hospital, but I ended up having to call 911, although we literally live across the street," she said.
"We have stairs here and I wasn't sure that he would be able to make it coming down with me trying to help him, so the safest thing was for me to call for help."
Singh was admitted straight to the medical intensive care unit (MICU) while his wife waited at home.
"I was blown away when I saw Jag's x-ray and CT scan and the bilateral pneumonia he had developed," she commented. "I would not have believed it, the way he was clinically — and seeing that x-ray.
"Honestly, when I took him in to hospital, I thought he'd be there a couple of days — over the weekend — and I'd get him back Monday. But it didn't turn out that way. He was there for about 9 days."
That first night in the hospital, Singh consented to intubation — should he need it. "He called me then," said Raje. "I said we've got to do what we've got to do, it's OK — it is what it is, and we'll do whatever it takes."
He remained in the MICU overnight and through the next day, still breathing on his own, but with the looming prospect of mechanical ventilation.
"The good news is he maintained his oxygen saturations throughout," said Raje. "I was able to see his vitals with EPIC [remote monitoring]...It was crazy," she recalls. "Seeing a respiratory rate of 26 was difficult. When you see that you worry about somebody tiring with the breathing. His inflammatory markers kept climbing, his fevers persisted."
Thankfully, he never needed the ventilator.
But by this time Raje had another worry: She, too, had tested positive and was now alone at home.
"I was unable to talk to my extended family as they all looked to us as physicians for support," she tweeted. Both children came to Boston to see her, but she saw them only through a window.
Dr Raje: Her kids came to Boston to see her through the window, after she tested positive for COVID-19 while her husband was in the MICU
Alone, she waited for the same symptoms that had slammed her husband; but they never came — something she wants caregivers to know.
"The fear and anxiety of taking care of somebody who's COVID-positive.... I am hoping that can be alleviated a little bit at least," she said. "If you've been taking care of someone, chances are you're probably positive already and if you're not sick, the chances of you getting sick are really low, so don't be afraid to take care of that person."
Singh is recovering well at home now, almost a month into his illness. During the interview, conducted via Zoom, he could be heard coughing in the background.
While in the MICU, Singh was treated with azithromycin and hydroxychloroquine — standard at MGH for critically ill COVID-19 patients — and he was also enrolled into a double-blind, randomized, placebo-controlled trial of the investigational agent remdesivir (Gilead).
Raje is not sure what, if anything, helped him turn the corner.
"I saw his inflammatory markers get worse actually — I don't think we can know if the drugs made a difference," she says. "His first dose of hydroxychloroquine was Friday night when he was admitted, and the markers continued to climb until the next Thursday."
In particular, his C-reactive protein (CRP) kept rising, reaching the 260 to 270 mg/dL range, "which to me was scary," she said. "I do think he had a cytokine storm going, but I didn't see those results."
"Understanding the immune compartment is going to be so, so critically important and what it is that we can do to boost folks' immune systems," she said.
"If you have a very high viral load and your immune system is not 100% even though you're otherwise healthy, you might be the person who ends up with that more serious response to this virus. Trying to study this in a focused way, looking at the immune compartment, looking at the antibody status, looking at the viral load — there's so much more we need to look at. Until we get the vaccine, which is probably a year-and-a-half away, we need to look at how can we develop that herd immunity so we don't have folks getting as critically ill as they do."
Despite feeling perfectly healthy, Raje is still at home. Three weeks after her first test she is still testing positive for COVID-19, waiting for two consecutive negative results 72 hours apart before she is allowed back to work at the hospital.
When she gets the green light, she plans to go work on the COVID-19 floor, if needed. "Its people like us [who have had COVID-19] who have to get back in the trenches and do the work now," she says.
"My biggest concern is that it's a very isolating experience for the COVID-positive patient. We are doing complete-barrier nursing — they are completely alone. The only person who ever walks into the room is the nurse — and the physician goes in once a day. It's so important that we don't lose sight of compassion," she says.
"That's why, in terms of alleviating anxiety, it is so important we do antibody testing so that people can actually go in and take care of these folks."
"Look for Red Flag"
Raje wants physicians to warn their self-isolating patients and caregivers to look for red flags. "There are primary care physicians who reached out to me [after my tweets] and said 'when someone calls me and says it's been 5-7 days and I am still not feeling well, I am going to look at that more seriously.'
"Part of me wanting to share this experience was basically to dispel the notion that 2 weeks into this you're going to be fine," she said, because it is not widely appreciated, she feels that "in week 2 you could become pretty sick."
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25 days and counting, crap. That sounds absolutely horrible. Hopefully he makes a full recovery but sounds like that is a ways off.

Would be interesting to make a case study out of them, what led to one being (so far) asymptomatic and the other becoming an ICU patient? Initial viral load? Underlying conditions? Some identifiable differences in immune system function?
 
Unfortunately, a new clinical study in preprint (not peer reviewed yet) with chloroquine had enough of a side effect (QT prolongation) that the high dose CQ arm of the study was discontinued. This was a randomized (with respect to high/low CQ dose), double-blind study. The study authors also compared this CQ/azithromycin trial to historical data for similar patients not on CQ and saw no obvious benefit, but that's not a true "placebo-controlled" study, so we need to await results from those ongoing trials, still, to know whether HCQ or HCQ + azithromycin show any efficacy.

With the ethical impossibility of using a placebo arm, we were compelled to use historical data, based on very similar patients not using CQ. Fatality rates observed here were not lower, however one cannot reliably conclude that CQ is of no benefit. Placebo-controlled studies could still be performed in countries not routinely using the drug. Several ongoing trials have been addressing the early use of CQ, in which the anti-inflammatory properties could be more helpful. That information is urgently needed.

In addition to helping patients improve, CQ could be used to decrease the viral load in respiratory secretions, allowing less nosocomial and post-discharge transmission. However, our limited data provided no evidence of such an effect. Patients using CQ (irrespective of dosage) failed to present evidence of viral clearance by the fifth day (Day 4) of positive RTPCR, even with the concomitant use of azithromycin. Therefore, we do not envision such use as an antiviral drug. Viremia dynamics in response to the drug will be further studied in our samples.


https://www.medrxiv.org/content/10.1101/2020.04.07.20056424v1.full.pdf
 
Unfortunately, a new clinical study in preprint (not peer reviewed yet) with chloroquine had enough of a side effect (QT prolongation) that the high dose CQ arm of the study was discontinued. This was a randomized (with respect to high/low CQ dose), double-blind study. The study authors also compared this CQ/azithromycin trial to historical data for similar patients not on CQ and saw no obvious benefit, but that's not a true "placebo-controlled" study, so we need to await results from those ongoing trials, still, to know whether HCQ or HCQ + azithromycin show any efficacy.

With the ethical impossibility of using a placebo arm, we were compelled to use historical data, based on very similar patients not using CQ. Fatality rates observed here were not lower, however one cannot reliably conclude that CQ is of no benefit. Placebo-controlled studies could still be performed in countries not routinely using the drug. Several ongoing trials have been addressing the early use of CQ, in which the anti-inflammatory properties could be more helpful. That information is urgently needed.

In addition to helping patients improve, CQ could be used to decrease the viral load in respiratory secretions, allowing less nosocomial and post-discharge transmission. However, our limited data provided no evidence of such an effect. Patients using CQ (irrespective of dosage) failed to present evidence of viral clearance by the fifth day (Day 4) of positive RTPCR, even with the concomitant use of azithromycin. Therefore, we do not envision such use as an antiviral drug. Viremia dynamics in response to the drug will be further studied in our samples.


https://www.medrxiv.org/content/10.1101/2020.04.07.20056424v1.full.pdf
The more I read about this disease, the less optimistic I become about our prospects for any kind of successful control or treatment in the near term. Most of the drug trial results are at best contradictory, though it seems more and more of them are revealing no positive impact. More and more reports about reactivation or reinfection showing up in South Korea. Reports that recovered patients frequently have low antibody levels. Wildly different symptoms and case progressions from one person to the next (exemplified by the married doctor couple a few posts earlier, one asymptomatic the other in severe condition in ICU for a while). Do we really understand anything about this yet? Almost seems like the answer is no.

Here's what I want to see, directly from the paper:

"trials evaluating its role as a prophylactic drug; (2) trials evaluating its efficacy against progression to severity when administered to patients with mild/moderate disease."

Yes we need an effective way to treat patients who have progressed to severe disease, but what we really need is a treatment that prevents people with milder cases from progressing to severe. If we can do that then the need to treat critically ill patients on ventilators will be reduced.
 
Unfortunately, a new clinical study in preprint (not peer reviewed yet) with chloroquine had enough of a side effect (QT prolongation) that the high dose CQ arm of the study was discontinued. This was a randomized (with respect to high/low CQ dose), double-blind study. The study authors also compared this CQ/azithromycin trial to historical data for similar patients not on CQ and saw no obvious benefit, but that's not a true "placebo-controlled" study, so we need to await results from those ongoing trials, still, to know whether HCQ or HCQ + azithromycin show any efficacy.

With the ethical impossibility of using a placebo arm, we were compelled to use historical data, based on very similar patients not using CQ. Fatality rates observed here were not lower, however one cannot reliably conclude that CQ is of no benefit. Placebo-controlled studies could still be performed in countries not routinely using the drug. Several ongoing trials have been addressing the early use of CQ, in which the anti-inflammatory properties could be more helpful. That information is urgently needed.

In addition to helping patients improve, CQ could be used to decrease the viral load in respiratory secretions, allowing less nosocomial and post-discharge transmission. However, our limited data provided no evidence of such an effect. Patients using CQ (irrespective of dosage) failed to present evidence of viral clearance by the fifth day (Day 4) of positive RTPCR, even with the concomitant use of azithromycin. Therefore, we do not envision such use as an antiviral drug. Viremia dynamics in response to the drug will be further studied in our samples.


https://www.medrxiv.org/content/10.1101/2020.04.07.20056424v1.full.pdf

It's looking more and more that HCQ/CQ is ineffective for patients who are in the severe state of disease progression. However, there still might be a place in the covid therapy world for HCQ for mild to moderate patients.
 
This.
US Intelligence Department had been telling the Federal Government / White House about the dangers of the pending Pandemic back in January. Fake news was the response.
The States take the lead from our Federal leaders. Which was zero.

And... certain Intell agencies with a presence in China no doubt had been confirming the advance of the virus, regardless of what China officially disclosed. But... did recent changes and political tensions within the IC prevent the escalation of the situation, i.e. delay the USA's domestic response?
 
25 days and counting, crap. That sounds absolutely horrible. Hopefully he makes a full recovery but sounds like that is a ways off.

Would be interesting to make a case study out of them, what led to one being (so far) asymptomatic and the other becoming an ICU patient? Initial viral load? Underlying conditions? Some identifiable differences in immune system function?

As I've said before,.it appears there is physiological profile (yet to be determined) for which this virus is deadly. I believe discovering what that is, is one of the keys to us conquering this disease.
 
I’m probably speculating out of my rear on this like everyone in the US at this point, but around Memorial Day or early June would be my guess based on the Wuhan lockdown timeline.
For what the possible reopening of the economy?
 
I dunno when ASAP is.. there are good arguments on all sides... its a pay me now/pay me later kinda thing. The thing is, it is the economy that allows us to have resources to address crises.. permanent damage to the economy.. and world economy.. needs be avoided. The cost would be way more than deaths from CV19.
I think we should just push measures that keep this thing from spreading even when people are out in public. Like making (home made)masks mandatory, making disinfecting mandatory, maintaining social distancing, limiting occupancy.

The masks are super important imo, but a major hurdle as I think people who aren't already wearing them are very reluctant to do so. If you told me 2 weeks ago I'd have to wear a mask everywhere I go, I'd have bristled mightily, but now that I am wearing one I look at people not wearing them as crack pots. Everyone says testing needs to be a key to working this thing, and I don't dispute that, but that is not something the public can control. The key for the public, imo, is masks (and hand sanitizer).

So push those things hard(and yeah I think the president throwing on a maga mask would help a ton) and then start opening things up. As Fauci points out it will not be the "light switch" to on, but gradually start the process.
 
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Very sorry to hear about your Mom.

Thanks, appreciate it. I probably should've been clearer. She was diagnosed with stage 4 metastatic bone cancer 3 weeks ago (she "hid" it from us and her doctor never found it over the last year or so, so it spread; it was from her breast cancer, most likely, which she had 20 years ago and came back) and then had some mini-strokes in the last 10 days - those combined with cancer-induced hypercalcemia made things turn dramatically worse in the last week and they're moving her to hospice tomorrow. She likely has days left and barely recognizes anyone; she's in Vero Beach with my sister and I can't really even go see her, plus it wouldn't really matter now anyway. But she had 85 good years and we had a fantastic family visit in January with the whole extended family, so we'll always have those memories (it's been pretty tough on my sister though). I'm also a non-religious fatalist, so this is just the kind of shit that happens - it's tragic but we move on. To quote Jim Morrison, no one here gets out alive. Don't mean to derail the thread, as plenty of people are suffering far worse than I am...
 
Thanks, appreciate it. I probably should've been clearer. She was diagnosed with stage 4 metastatic bone cancer 3 weeks ago (she "hid" it from us and her doctor never found it over the last year or so, so it spread; it was from her breast cancer, most likely, which she had 20 years ago and came back) and then had some mini-strokes in the last 10 days - those combined with cancer-induced hypercalcemia made things turn dramatically worse in the last week and they're moving her to hospice tomorrow. She likely has days left and barely recognizes anyone; she's in Vero Beach with my sister and I can't really even go see her, plus it wouldn't really matter now anyway. But she had 85 good years and we had a fantastic family visit in January with the whole extended family, so we'll always have those memories (it's been pretty tough on my sister though). I'm also a non-religious fatalist, so this is just the kind of shit that happens - it's tragic but we move on. To quote Jim Morrison, no one here gets out alive. Don't mean to derail the thread, as plenty of people are suffering far worse than I am...


RU #s...so sorry to hear this. Strength at this time to you and your family
 
Thanks, appreciate it. I probably should've been clearer. She was diagnosed with stage 4 metastatic bone cancer 3 weeks ago (she "hid" it from us and her doctor never found it over the last year or so, so it spread; it was from her breast cancer, most likely, which she had 20 years ago and came back) and then had some mini-strokes in the last 10 days - those combined with cancer-induced hypercalcemia made things turn dramatically worse in the last week and they're moving her to hospice tomorrow. She likely has days left and barely recognizes anyone; she's in Vero Beach with my sister and I can't really even go see her, plus it wouldn't really matter now anyway. But she had 85 good years and we had a fantastic family visit in January with the whole extended family, so we'll always have those memories (it's been pretty tough on my sister though). I'm also a non-religious fatalist, so this is just the kind of shit that happens - it's tragic but we move on. To quote Jim Morrison, no one here gets out alive. Don't mean to derail the thread, as plenty of people are suffering far worse than I am...
Sorry to hear. Sounds like my Mom - she was having symptoms (difficulty swallowing, then pain in back/leg) for a year or two but refused to go to a doctor. Eventually it got bad enough that she wound up in the hospital and was diagnosed with stage 4 cancer. Probably started in the esophagus but by then it was in the bones, liver, lungs, etc. Two months from date of diagnosis to when she passed. She also had an episode of hypercalcemia and it caused all kinds of hallucinations. We'd be sitting there and she'd say something like "why is there blood all over the floor" (there wasn't any). Then one night after we'd gone home, we got a frantic call from her saying the nurses were trying to kill her. Turns out the other patient in the room had some kind of incident which brought in a lot of people/activity and she misinterpreted that.

Fortunately the last week or two she was mostly unconscious and presumably not in any pain.

Best wishes for you and your family...
 
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In the interests of not getting too political, I'll leave this latest NY Times article here without comment, but will say that just the other day I did make a post of a Times article criticizing Cuomo/DeBlasio for their mistakes and squabbles in dealing with the pandemic (which also included plenty of info on mistakes from the Trump Administration too). However, this article is all about what went on behind the scenes in the Administration. IMO, it's worth a read, but in the interests of keeping this thread focused on where we're going and solving problems (vs. how we got here), I'd suggest to make comments in other threads...

https://www.nytimes.com/2020/04/11/...action=click&module=Spotlight&pgtype=Homepage
 
Thanks, appreciate it. I probably should've been clearer. She was diagnosed with stage 4 metastatic bone cancer 3 weeks ago (she "hid" it from us and her doctor never found it over the last year or so, so it spread; it was from her breast cancer, most likely, which she had 20 years ago and came back) and then had some mini-strokes in the last 10 days - those combined with cancer-induced hypercalcemia made things turn dramatically worse in the last week and they're moving her to hospice tomorrow. She likely has days left and barely recognizes anyone; she's in Vero Beach with my sister and I can't really even go see her, plus it wouldn't really matter now anyway. But she had 85 good years and we had a fantastic family visit in January with the whole extended family, so we'll always have those memories (it's been pretty tough on my sister though). I'm also a non-religious fatalist, so this is just the kind of shit that happens - it's tragic but we move on. To quote Jim Morrison, no one here gets out alive. Don't mean to derail the thread, as plenty of people are suffering far worse than I am...
Thanks so much for your posts!My heart goes out to you.Both my mom and dad passed away in Vero Beach.It is so hard when they are far away especially now.Stay safe.
 
Thanks so much for your posts!My heart goes out to you.Both my mom and dad passed away in Vero Beach.It is so hard when they are far away especially now.Stay safe.
Damn, that's tough to hear, man, especially since my dad lives there too (he's 87 and in decent health, but who knows at that age - at least he's in shut down) - my condolences to you.
 
Thanks, appreciate it. I probably should've been clearer. She was diagnosed with stage 4 metastatic bone cancer 3 weeks ago (she "hid" it from us and her doctor never found it over the last year or so, so it spread; it was from her breast cancer, most likely, which she had 20 years ago and came back) and then had some mini-strokes in the last 10 days - those combined with cancer-induced hypercalcemia made things turn dramatically worse in the last week and they're moving her to hospice tomorrow. She likely has days left and barely recognizes anyone; she's in Vero Beach with my sister and I can't really even go see her, plus it wouldn't really matter now anyway. But she had 85 good years and we had a fantastic family visit in January with the whole extended family, so we'll always have those memories (it's been pretty tough on my sister though). I'm also a non-religious fatalist, so this is just the kind of shit that happens - it's tragic but we move on. To quote Jim Morrison, no one here gets out alive. Don't mean to derail the thread, as plenty of people are suffering far worse than I am...

Ugh...thoughts with you
 
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RU #s...so sorry to hear this. Strength at this time to you and your family

Sorry to hear. Sounds like my Mom - she was having symptoms (difficulty swallowing, then pain in back/leg) for a year or two but refused to go to a doctor. Eventually it got bad enough that she wound up in the hospital and was diagnosed with stage 4 cancer. Probably started in the esophagus but by then it was in the bones, liver, lungs, etc. Two months from date of diagnosis to when she passed. She also had an episode of hypercalcemia and it caused all kinds of hallucinations. We'd be sitting there and she'd say something like "why is there blood all over the floor" (there wasn't any). Then one night after we'd gone home, we got a frantic call from her saying the nurses were trying to kill her. Turns out the other patient in the room had some kind of incident which brought in a lot of people/activity and she misinterpreted that.

Fortunately the last week or two she was mostly unconscious and presumably not in any pain.

Best wishes for you and your family...

Sorry to hear that you went through something similar. Cancer sucks.

Ugh...thoughts with you

Thanks guys. While we don't all have the same opinions on things, I know we all share our love of RU sports, but another reason I think most of us still love this board (mostly, lol) is that people never fail to step up to lend a hand or make a nice gesture for folks in need or those going through a tough time.

You know, it would be really nice if things turn around enough for fall RU sports. We need it man and we finally have the right coaches to really start making some noise on the national stage. Keep chopping and pounding nails! Kind of cool how complementary those sayings are.
 
Sorry to hear that you went through something similar. Cancer sucks.



Thanks guys. While we don't all have the same opinions on things, I know we all share our love of RU sports, but another reason I think most of us still love this board (mostly, lol) is that people never fail to step up to lend a hand or make a nice gesture for folks in need or those going through a tough time.

You know, it would be really nice if things turn around enough for fall RU sports. We need it man and we finally have the right coaches to really start making some noise on the national stage. Keep chopping and pounding nails! Kind of cool how complementary those sayings are.

Thoughts with you my friend.
Lost my mom to a heart condition and extended struggle.
7 months later we lost my wife’s mom to cancer.
A month later lost my wife’s sister to cancer way too young. All in a blink of an eye.

Hope you get thru it all and things get better. Heart goes out to you.
 
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Just some anecdotal hearsay from my gf, but she heard from a couple local nurses that they have been seeing good results with the hydroxychloroquine when used on patients with mild symptoms. Seems to be having a nip it in the bud effect.
 
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In the interests of not getting too political, I'll leave this latest NY Times article here without comment, but will say that just the other day I did make a post of a Times article criticizing Cuomo/DeBlasio for their mistakes and squabbles in dealing with the pandemic (which also included plenty of info on mistakes from the Trump Administration too). However, this article is all about what went on behind the scenes in the Administration. IMO, it's worth a read, but in the interests of keeping this thread focused on where we're going and solving problems (vs. how we got here), I'd suggest to make comments in other threads...

https://www.nytimes.com/2020/04/11/...action=click&module=Spotlight&pgtype=Homepage
Sorry to hear about your mom. It’s great to hear she had 85 wonderful years. Thanks for the article and thoughts on the other board.
 
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Thanks, appreciate it. I probably should've been clearer. She was diagnosed with stage 4 metastatic bone cancer 3 weeks ago (she "hid" it from us and her doctor never found it over the last year or so, so it spread; it was from her breast cancer, most likely, which she had 20 years ago and came back) and then had some mini-strokes in the last 10 days - those combined with cancer-induced hypercalcemia made things turn dramatically worse in the last week and they're moving her to hospice tomorrow. She likely has days left and barely recognizes anyone; she's in Vero Beach with my sister and I can't really even go see her, plus it wouldn't really matter now anyway. But she had 85 good years and we had a fantastic family visit in January with the whole extended family, so we'll always have those memories (it's been pretty tough on my sister though). I'm also a non-religious fatalist, so this is just the kind of shit that happens - it's tragic but we move on. To quote Jim Morrison, no one here gets out alive. Don't mean to derail the thread, as plenty of people are suffering far worse than I am...
Sorry about your mom. I'm glad she had a good life and you and your family will have a lifetime of fond memories to look back on. :Pray: :Praying:
 
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perhaps everyone taking the antimalarial drug will allow us to reopen and survive getting CV19.. then we'd all have antibodies and that will be that... until the next crisis.

And this is why unproven claims based on gut feelings should not be promoted - they confuse everyone and give false hope. There is no cure and there is no preventative other than not allowing yourself to be exposed to the virus
 
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As of today, there is no KNOWN cure and there is no KNOWN preventative other than not allowing yourself to be exposed to the virus
FIFY

Also unknown at this time is the fatality rate.
 
And this is why unproven claims based on gut feelings should not be promoted - they confuse everyone and give false hope. There is no cure and there is no preventative other than not allowing yourself to be exposed to the virus

I vehemently disagree on this one. If there is anything that can help - do it! We don't have time to wait for some double blind multi center full blown phase III trial to conclude before you can ok a therapy. People are dying. People who are against HCQ is letting their anti-Trump feelings get in the way of common sense. Nobody is saying HCQ will save the day. But if it can help in any way, take it!!!
 
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FIFY

Also unknown at this time is the fatality rate.
This seems akin to saying, I don't know that there is no pirate treasure buried in my backyard.

At best there looks to be potential treatments.
 
Whatever is the fatality rate, it's too many. Just learned today of another person I know who passed away.
Well we do need to consider the difference between the number of fatalities, and the rate of fatalities. He was speaking more of the latter.

Now I think do think his focus is on the media response as opposed to the issue itself. Which to me is not focusing on what is really important.
 
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