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Finally, Light at the End of the Pandemic


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On 10/15/2020 at 2:35 PM, ventana said:

Gotta know your source......

 

from. https://www.allsides.com/news-source/national-review

The National Review, a magazine which some have called the "bible of American conservatism," has a far right bias. One of the National Review’s core convictions is that centralized government should solely exist to protect citizens’ lives, liberty and property. Describing itself as libertarian, it believes all other activities of government tend to diminish freedom and hamper progress. The National Review was given an AllSides Bias Rating™ of far right, a rating with which a majority of community members agree.

 

 

My personal opinion is this is merely a marketing trick by tRump

He knows he failed the response and the only thing he can do is try to say it is over.....

from CNN https://www.cnn.com/videos/politics/2020/10/10/trump-comments-since-testing-positive-covid-coronavirus-orig-me.cnn.  

 

From ABC news

https://abcnews.go.com/Health/live-updates/coronavirus/?id=73623859&cid=clicksource_4380645_7_three_posts_card_hed

 

 

But this takes the cake

 

https://www.cnn.com/2020/10/14/opinions/white-house-herd-immunity-reckless-idea-sachs/index.html

and CNN or ABC is not biased? They won't even talk about Biden's sandal...just to name ONE. All sources are not perfect but it seems hard for some to accept other sources. We do this in medicine so why not with other things? 

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Outta here with your persecution complex.

I'm generally not a big conspiracy guy but I think election season is driving a lot of what is and isn't being done and discussed. I think after election day the whole tone of things will change.

Is conservative thought allowed? Is it ok to have conservative ideas?  Or does having conservative ideas inherently mean one is not worthy?

On 10/15/2020 at 3:46 PM, mcclane said:

Outta here with your persecution complex.

 

On 10/15/2020 at 6:35 PM, mcclane said:

I'm sorry, I thought this was a medical forum. I do not read articles by journalists for medical news about treatments. I subscribe to the NEJM and Medscape and a host of other services to push information to me daily. Reliable sources that do not require that I continuously attempt to parse through propaganda to find the nuggets of truth. That is why no one here should be clicking on your link, period, despite your bizarre pleas for people to do so.

Just like the LANCET....very credible. You cannot out one source but say others are invalid. Just cause it is medical news does not mean physician experts don't review them. Do you believe anything that a physician talks about or comments on for a certain news station?  I like to know where your line is?

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On 10/15/2020 at 7:15 PM, Cideous said:

Chris Christie just out of the unit after being in ICU for 7 days.  He almost died.  He got all the crap that they threw at Trump.  Good for him, I'm glad he's not dead for his wife and family.  His tune though has changed.  Why does it take Republicans having a near death experience to finally listen to what science and scientists are telling them?????  How many average people are going to continue to die because asshats like him have to nearly die to get it through their thick skulls.

 

https://www.nbcnews.com/politics/politics-news/chris-christie-says-he-was-icu-7-days-battling-covid-n1243589

Why are you calling out republicans? So me evidence of this...I work with a democrat that has a Biden sticker on her vehicle that is a anti-masker... Also Chris Christie is a obese comorbid person...shocker he had issues with Covid. Maybe if we focused on HEALTH in this country we wouldn't suffer so much from these terrible illness. Support your immune system and snack cakes/coke do not count...  

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1 hour ago, Joelseff said:

There was a f/u article on remdesivir where a UCSF doc was quoted stating this conclusion was inappropriate since the study's end point was mortality reduction when the largest study was supporting remdesivir reducing hospitalization and convalescent times not mortality reduction. So remdesivir may not reduce (or will not reduce) mortality but will reduce convalescent times... I tried to find the article... I'll edit and post it when I find it.  

 

Edit found it! https://www.google.com/amp/s/www.sfchronicle.com/health/amp/Study-says-popular-COVID-drug-remdesivir-is-not-15654316.php

 

Here's a quote from the doc:

 

“Tell me something new because nobody has shown a mortality benefit with remdesivir,” Chin-Hong said. “The previous studies have shown decreased time to recovery, so people got better faster. I think it was on the order of 4 or 5 days, and that is pretty significant.”

 

Sent from my SM-G975U using Tapatalk

 

 

 

 

 

If they powered the study for that specific end point then there is nothing inappropriate about it. Think it's reasonable to assess for a mortality benefit.

The striking thing from the WHI study (from what it sounds like) is the lack of earlier symptom resolution or reduction in time for hospitalization.

I'm still throwing it at folks in the hope that it sticks, much more faith in my trust steroids though! (I've been team Annane for a long time)

We'll see when the actual peer review is published!

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MediMike

Are you putting dexamethasone in nebulizers?

A Respiratory Therapist asked my permission years ago in the ER for a patient with very bad asthma.

I really liked the results.

Does it do any better than oral/IV?

Some local doctors are putting high risk but walking COVID patients on oral dex 6 mg TID for 5-7 days. I think they just pulled that out of an orifice but I think everyone feels the need to try something - keep folks out of the hospital or off supported breathing. 

I do not work first line with COVID folks - I do feel very lucky, by the way. I am very high risk myself.

Just curious what works best in your eyes so far with the walking wounded or on the verge of hospital/resp support.

Thanks

 

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1 hour ago, Reality Check 2 said:

MediMike

Are you putting dexamethasone in nebulizers?

A Respiratory Therapist asked my permission years ago in the ER for a patient with very bad asthma.

I really liked the results.

Does it do any better than oral/IV?

Some local doctors are putting high risk but walking COVID patients on oral dex 6 mg TID for 5-7 days. I think they just pulled that out of an orifice but I think everyone feels the need to try something - keep folks out of the hospital or off supported breathing. 

I do not work first line with COVID folks - I do feel very lucky, by the way. I am very high risk myself.

Just curious what works best in your eyes so far with the walking wounded or on the verge of hospital/resp support.

Thanks

 

I've been putting Dex in nebs for years.  Really worked great for RAD exacerbations.

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2 hours ago, Reality Check 2 said:

MediMike

Are you putting dexamethasone in nebulizers?

A Respiratory Therapist asked my permission years ago in the ER for a patient with very bad asthma.

I really liked the results.

Does it do any better than oral/IV?

Some local doctors are putting high risk but walking COVID patients on oral dex 6 mg TID for 5-7 days. I think they just pulled that out of an orifice but I think everyone feels the need to try something - keep folks out of the hospital or off supported breathing. 

I do not work first line with COVID folks - I do feel very lucky, by the way. I am very high risk myself.

Just curious what works best in your eyes so far with the walking wounded or on the verge of hospital/resp support.

Thanks

 

By the time they reach me they're breathing through plastic, but depending on the hospitalist I'll get consulted for "COVID Management".

Reading the RECOVERY trial what you see is modest benefit for those on oxygen and pretty great benefit when you're on mechanical ventilation. There was no benefit in patients who didn't require oxygen with an actual trend towards harm, so I don't recommend it.

In the setting of acute reactive airway dz with underlying COPD I personally lean towards budesonide as my ICS of choice, with asthma the evidence is more for systemic via oral or IV routes. I'd have to dig but I think inhaled steroids for asthma showed little to no efficacy in multiple trials...I think.

With all that being said, if it's a patient you would normally prescribe a course of dex to for RAD then don't deviate from your practice (my wife and I had a fight about this), but I wouldn't start it for a patient simply because they are COVID+.

There just aren't any data supporting any therapies other than symptom based management in the ambulatory patient. Cough suppressants, staying hydrated, APAP etc. Our normal viral stuff 🙂

Edit: Just saw the tid part of your colleagues' dosing regimen. I have no idea where that came from. "COVID Dosing" is 6mg qd x10

Edited by MediMike
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