phillysailor

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Everything posted by phillysailor

  1. phillysailor

    US ranked #1 to best deal with a disease outbreak

    Judged by the standard of “when did the America ban international travel from China?” The president did acceptably well. Judged by the standard “how well did the country prepare for, and mitigate the socioeconomic impacts of the COVID pandemic” the President did poorly. Poor planning, poor testing, poor communication.
  2. phillysailor

    US ranked #1 to best deal with a disease outbreak

    Given the circumstances, that's a very well written study. They are appropriately cautious about their results, which on their face look promising. Looking forward to the other studies mentioned, where Remdesivir is partnered with other drugs, different vent strategies and varying treatment protocols and compared to placebos and other drugs being trialled Here is a slightly less rosy critique of the article, which makes several good points. Essentially, the critic (a pulmonary critical care doc) points out that the study was crafted by the drug maker, they collected the data, crunches the numbers and wrote the article. The selection criteria was opaque, few Clinical markers of the dz which would indicate severity were included, and the average time at which Remdesivir was started was day 12 (9-15), and many deaths due to dz occur sooner in the natural history than that. One case known to the author was requiring vasopressors was turned down, then accepted after he was getting better. Hmmm Basically, this critic said this article won’t help him very much, and he insinuated that it was pretty good PR for Gilead in the meantime.
  3. phillysailor

    ROW

    If you’d like to hear a US politician giving excellent briefings, follow Josh Green, MD who is the Lt Gov of Hawaii. He’s still working through the pandemic as an ER doc. He gives great two minute updates on FB, here’s an interview from a couple days ago.
  4. phillysailor

    Subverting democracy

    Voter purges exemplify the assault on democracy that characterizes the GOP. They’ve added judges nominated and approved for lifetime time positions, chosen for youth, Legal, political and cultural reliability but not competence or respect for the law. Hiring and firing Inspector Generals based not on independence and honesty, but because they are known allies (or critics) of the president and his agenda. Removing scientific evidence from its role in guiding policy decisions, and failing to enforce reasonable environmental protections against the fossil fuel industry and other immediate allies of the president. AG Barr is projecting and feeling defensive after ignoring so much subversion of justice that he felt it necessary to create a spoiling “controversy”. Chessie is concerned, Dog is outraged, and Joker is chuckling. Meanwhile, a minority ever shrinking in size and virility is controlling more and more of our gold and rules. Sayanora democracy, and didn’t you read the memo? We don’t live in a democracy: it’s a Constitutional Republic. Please make a note.
  5. phillysailor

    US ranked #1 to best deal with a disease outbreak

    ?? Ignorance is bliss. If you don't have testing, you don't have a pandemic, you just have a few more dead people than usual.
  6. phillysailor

    US ranked #1 to best deal with a disease outbreak

    Given the circumstances, that's a very well written study. They are appropriately cautious about their results, which on their face look promising. Looking forward to the other studies mentioned, where Remdesivir is partnered with other drugs, different vent strategies and varying treatment protocols and compared to placebos and other drugs being trialled.
  7. Good luck to you. I will be hoping you do well. Monitor your symptoms carefully, and know that it can be a bit of a roller coaster with dramatic reversals possible. Do not become sanguine: if you get short of breath, get into a hospital quickly.
  8. phillysailor

    Captain of USS Roosevelt fired.

    I'm getting the sense, from Moldy's "resignation" and the wording of that press release about RIMPAC that the Military is changing their response to COVID, and returning to operational security about releasing stats of the dz at bases. I think Crozier shot a warning across the bow of the civilians in charge of the military that epidemiology and mission goals are going to be part of the response to this pandemic going forward, and a failure of those two to mesh with some degree of cooperation or disrespect shown for the men serving and leading is gonna create a shitshow. I think good is coming out of Crozier's letter, so kudos to him. It'll be fun to watch what happens next. I don't have a dog in the hunt, so will go make some popcorn.
  9. phillysailor

    Bernie is out!

    SANDERS DROPS OUT AND BERNIE BROS IMMEDIATELY PIVOT TO VERMIN SUPREME Vermin promises, once again, if elected President of the United States, he will pass a law requiring people to brush their teeth. He has campaigned on a platform of zombie apocalypse awareness and time travel research, and promised a free pony for every American.
  10. phillysailor

    US ranked #1 to best deal with a disease outbreak

    At Massachusetts veterans' home, coronavirus outbreak and 32 deaths prompts federal probe. Happens all the time.
  11. phillysailor

    US ranked #1 to best deal with a disease outbreak

    This chart stops at... week 11, right? I'm not sure of the reporting for the last week, still not convinced it won't be updated. But we are in week 15 of 2020. Has anything of significance happened to America's death statistics in the last month?
  12. phillysailor

    NYC Mass Graves

    To the OP: the mass graves were contingency planning. From NYT Mayor Bill de Blasio said on Monday that the city would consider temporary burials if the deaths from the coronavirus outbreak exceed the space available in city and hospital morgues, but it had not reached that point. “It’s going to be very tough but we have the capacity,” the mayor said at a news conference at the Brooklyn Navy Yard. ... “If we need to do temporary burials to be able to tide us over to pass the crisis, and then work with each family on their appropriate arrangements, we have the ability to do that,” he said, adding, “We may well be dealing with temporary burials so we can deal with each family later.” Earlier on Monday, the chairman of the City Council health committee, Mark D. Levine, a Manhattan Democrat, had sparked an uproar among city residents when he said on Twitter the that the office of the chief medical examiner was looking into creating temporary mass graves in a public park. ...Last week, the medical examiner’s office rushed 45 new refrigerated trailers to hospitals around the city which had started to report that their in-house morgues were filling up. The delivery of the mobile freezer units came as part of a plan — the “Pandemic Influenza Surge Plan for In- and Out-of-Hospital Deaths” — that the medical examiner has been using to deal with the sharp rise in the number of bodies.
  13. phillysailor

    There’s a Memo, Because of Course There Is

    Hmmm. After a bit of digging, the theory I described upthread describes entry of virus into RBCs via ACE2 receptors causing loss of stability of the porphyrin ring holding iron (the active unit in hemoglobin (HgB). RBCs can't let iron go into blood plasma or tissues, or else you need a bunch of free radical scavengers to clean up the mess. This "release the iron and so lose oxygen carrying capacity" theory should lead lead to iron deposition within endothelial tissues (lining of blood vessels, lung), but a lot of reservations are cropping up. Some lab tests looking for hemoglobinopathies, postmortem lung analysis and urine tests don't seem to bear out the theory. The original Chinese article this theory is based on is taking a hammering. Probably one of those partly-correct but fundamentally wrong headed diversions that's closer than ARDS but farther from "truth." The next theory I'm looking into talks more about clotting cascade abnormalities; it tries to make sense of why "tough it out at home" patients suddenly crash day 10-14 with what looks like pulmonary edema of cardiac origin, or alternatively GI distress with bloody diarrhea. Sounds like what happened to my friend, the journalist & marathon runner, poor guy. He'd told a bunch of friends and colleagues he was on the mend. I've never really liked the clotting cascade, though. Too much complexity for my brain to keep all the whirligigs interacting straight despite the reduction of Zymogen fVII. Or something. If I can't explain it, I don't understand it.
  14. phillysailor

    US ranked #1 to best deal with a disease outbreak

    Of course not. Last year had average numbers of deaths at home and in the hospital, which are nothing like what is happening now. Mikey is still ignoring the impact of stay at home orders and social distancing. He is avoiding acknowledging that the changes made by society have left us with R0 falling below what it could be. Any plans based on his flawed analysis would lead to all metro hospitals being overwhelmed to a degree far behind that which is happening now, followed soon thereafter by rural hospitals, followed perhaps by the collapse of society. He is still comparing data from this year to data from last year as if they are meaningful comparisons. He has not accounted for time lag in reporting and likely errors in data collection during a pandemic; those two "oh so significant" point on the graphs which trail downward are meaningful only if they are accurate. He still has no plan for how society should have managed this problem, just some palaver about "the economy". But, he is the object of attention, which appears to be his goal. It certainly isn't intellectual honesty or being helpful, it isn't about societal structure or about the economy. If he cared about the economy he would speak about the costs of keeping old folks alive, the cost of days of lost labor and production, the cost of X number of healthcare workers lost, and metrics of damage to social fabric from millions dying. He's no analysis which bears scrutiny at the micro or macro level. His entire argument rests on two apparently falling data points which are the most suspicious of any on his charts due to recent acquisition and no time for double checking. His data compares apples and oranges, because our world and our society and all the persons within it are behaving completely differently from previous years. It's all for Mikeys self gratification, but its amusing! What I want to know, is will he fell embarrassment later? Or will he be a Trump, and be incapable of such emotion? Will he try and blame China, the WHO or some IG who fed him bad data? I'm thinking it won't be his fault when he's forced to admit he screwed up on the basics.
  15. phillysailor

    US ranked #1 to best deal with a disease outbreak

    Dr. Serino, April 3 There’s another refrigerated truck outside the hospital. It doesn’t feel as startling as the first. It feels inevitable, now. Of course there would be two. The fancy ones have shelving so that the bodies don’t have to be piled on top of each other.
  16. phillysailor

    Trump stopping funding for the WHO

    WHO is a cheap tripwire, warning us of stuff happening over there. The donation of 0.02% of our recent bail out bill shows how useful accurate interpretation of WHO reports can be. The Senators who sold stocks & Peter Navarro could tell you, but the former are chuckling quietly and the latter knows his head is on the chopping block for having warned the president that a pandemic might kill 2 million Americans. Strange days when Senators are at a loss for words and someone’s job is in jeopardy for trying to help a president save voters’ lives.
  17. phillysailor

    US ranked #1 to best deal with a disease outbreak

    I agree with Joker. Mikey should feel free to post his erroneous analysis here and make incorrect conclusions ad nauseum. But he should have a reason or a plan, dammit!
  18. phillysailor

    There’s a Memo, Because of Course There Is

    ECMO is to lungs what dialysis machines are to kidneys. Giving the body time to rest while the lungs aren't working is the ultimate in supportive care for pneumonia. During cardiac surgery we use a similar machine which also maintains blood pressure "cardiopulmonary bypass" but requires much more invasive access... cutting open the chest and putting hoses into great vessels is not for the faint of heart. Couldn't resist the pun. I crack myself up. Exiting now, sorry.
  19. phillysailor

    US ranked #1 to best deal with a disease outbreak

    NYT today: Mayor Bill de Blasio said on CNN Wednesday morning that there were “100 to 200 people per day” in the city who die at home and are presumed to be virus victims. ”There is no question the Coronavirus is driving this”, “we didn’t see this during normal times.” So, even with social distancing and stay at home orders, folks are just dying in numbers not seen during normal times, and what, exactly, is Mikey’s point? He still has yet to provide a plan that could be implemented or a helpful result from doubting that a pandemic is presently occurring. All the data he is analyzing comes from a world at war with COVID, but he wants to compare today with last year, even though the two data sets are obviously different: one is based on travel restrictions, dying healthcare workers burning through PPE at an extraordinary rate, cancelling routine surgery, digging mass graves, closing schools and turning car parts manufacturers into ventilator production facilities and the other happened last year. Try being intellectually honest, Mike
  20. phillysailor

    US ranked #1 to best deal with a disease outbreak

    First thing I notice is the trend over the last several years is decreasing rates of death from year to year attributed to these two causes. That is great to see, but I wonder what causes of deaths are rising as a result. The second is the trend appears to be exaggerated this year, by several hundred per week, culminating in a huge drop off the last two weeks. Two questions spring to mind: 1. Is there a delay in reporting? I’d suggest the last two data points may represent undercounting because of incomplete data collection. There is a little pandemic happening, and developing statistics for Mikeys pleasure palace analysis may not be the first priority right now. 2. What proportion of the enormous numbers patients rapidly falling ill in huge numbers requiring mass graves to be dug in NYC parks are related to background rates of pneumonia and flu deaths? The answer to this second question is “I don’t give a shit.” We are dealing with a pandemic. Your inability to see the forest for the trees proves you are educated, but not very smart. Stay off the front lines and remain in your house masturbating to charts and numbers. Those with a clue are working hard to keep you safe.
  21. phillysailor

    Failure of leadership

    So, Trumps major accomplishment was to impose travel bans, which only slowed the spread. His endorsement of social distancing came only after weeks of dithering and governors demonstrating real leadership made him look bad because the numbers were proving the governors right. He resents someone else’s ideas, tho, so immediately started to chafe against stay at home orders because this pandemic and the economy is all about him. He fires IGs who dare reveal disappointing numbers: Narcissistic fools are poor managers in the best of times. During pandemics they kill people.
  22. phillysailor

    Failure of leadership

    So, if we can’t trust China, if we know we cannot rely on them to protect us then how can we blame our lackluster response on them? WE pulled our epidemiological troops/spies out of China WE disbanded our pandemic team WE ignored the implications of data promulgated by the WHO which prompted Peter Navarro’s memo and Senators to sell their stock holdings WE ignored warning flags raised by our intelligence agencies using their technological wizardry WE failed to make use of the limited breathing space created by the travel ban to get testing up and running and start social distancing to prevent our economy from crashing NONE of our important mistakes which are under our control can be blamed on China. If we don’t take responsibility for our actions we can’t fix problems.
  23. phillysailor

    Fuck You Republicans

    Your simplistic arguments are an excellent example of reductio ab absurdum. I am not a Chinese fan, and wish that Trump was able to make the tariffs stick it to the Chinese: but first we have to wean ourselves off bank loans in yen and shifting our manufacturing base overseas to maximize profits. If we begin to recognize national security is tied to the wage/ wealth gap, domestic manufacturing base and equitable taxation, then maybe we can balance our budget and prepare for the next national security issue ahead of time, rather than continuously reacting badly and only putting bandaids on our last missteps. Fundamental change in approach, like in the post you wrote about how this ain’t the time to play politics, but to focus on greater priorities. You talked a good game in that post, but this drivel is more your style.
  24. phillysailor

    There’s a Memo, Because of Course There Is

    Actually, new thinking is that this disease isn’t best treated as ARDS, although the radiographic evidence causes us to treat it that way. Its more about the virus causing reduced oxygen carrying capacity leading to dyspnea (shortness of breath) but some patients can tolerate seemingly ridiculous low levels of oxygen pulse oximetry which measures saturation of hemoglobin, as opposed to oxygen dissolved in blood. Think of hemoglobin in RBCs as trucks carrying O2 to tissues and returning with loads of CO2. There are some passenger cars on the roads as well (dissolved oxygen) but they don’t carry much of the cargo. This virus seems to attack the trucks, and treating it like ARDS fixes the pulse ox numbers to ones we like better, but those ventilator strategies end up causing a lot of damage, due to the high airway pressures required. So, clinicians are trying to stave off intubations for as long as possible and reduce entry of virus into RBCs via ACE2 receptors, hence treatment with HCQ and continuing patients on their ACE inhibitors and ARBs, which are always stopped when patients are in ARDS which we associate with sepsis and low blood pressure: why continue anti-hypertensives when the patient is hypotensive? We are starting to make inroads on understanding the dz, another benefit of flattening the curve.
  25. phillysailor

    Fuck You Republicans

    Well, you guys put the shmuck who sold US steel to foreigners in charge of the Crmmerce Department and the family whose daughter runs our Dept of Transportation funded a Chinese maritime institute and is college buds with Chinese premiers. But pointing out facts is a librul concern. Stick with hypocrisy and wear that made in China MAGA hat with pride.