@Creekland – I remember reading in the early days that both heart attacks and appendectomies were down, and I did not understand how appendectomies could decline. Read a later report that said that the incidence of severe appendectomies increased b/c of delaying treatment.
I thought that heart attacks had declined in the early days b/c people were not working, but I also know that many were called at home in NYC boroughs b/c the hospitals were swamped so the EMTs couldn’t even transfer the unresponsive heart attack victims. I have not been following this so I am sure that your son’s info is more current and more correct.
@CT1417 I do believe heart attacks and strokes were both down in the earlier days - more “vacation” and less stress. Our neighbor (who is an ED nurse) said they were bored on some days. I haven’t asked him lately if life locally is back to normal, better, or worse because we’ve been home very little. The few times our paths have crossed we’ve been keeping up on family “news.”
My guy’s EM rotation was far more recent. They were getting more “bad” cases instead of “typical” cases from what he said.
More like, in pre-COVID-19 times, much of the driving was in 5-15mph commute traffic where it is unlikely to have a fatal car crash, although car crashes are probably quite common in these conditions. With less traffic, people can drive at speeds where a car crash could be fatal.
Gym exercise is presumably way down, because of closures and people being afraid to go. However, outdoor exercise appears to be up from my observations. Additional evidence for that is a shortage of bicycles.
The article had mentioned many states lowering their police presence on the highways due to Covid and excessive speeds being noted with the accidents, sometimes exceeding 100mph.
I’m sure some has been due to fewer logjams allowing normal speeds of 70 or so, but not all. Google can probably still pull up the article if anyone is interested enough to search for it.
I suppose the question then becomes, are the same people who are prone to heart issues or stroke the ones who are choosing to exercise outside vs the gym or were they the ones only “moving” because work forced them out and down the hall or whatever? I suspect couch potatoes are still out there.
Regardless, where he is and while he was in EM, fewer people seemed to be coming in quickly when they have chest pain. It’s an anecdote for sure. I don’t know if the data would show that to be common or an outlier.
Just saw on NBC news that in England they are running a trial where they have young volunteers, give them a trial Covid vaccine, then intentionally expose them to Covid to see if the vaccine works.
I think it’s ethically questionable. If subjects get the virus, can they give them the Regeneron monoclonal antibody treatment in the first week? I assume they can give them steroids if their oxygen levels drop below 90% in the second week.
However, steroids are only moderately effective, and we don’t have the data on the Regeneron antibody cocktail yet (nor is it approved for anything other than compassionate use.) Data on anticoagulants for the clotting phase is not great either.
If we had more reliable therapies, I would be more inclined to think challenge trials would be okay. As it is, I’m not sure. If someone dies of the virus this way, it is a lot more ethically questionable than vaccinating volunteers and sending them out to live their lives as they normally would. I know they are volunteering to get infected, but I don’t see how a young person is really fully informed on the potential consequences. They just figure, it won’t happen to me.
Another ethically gray area is how much they are getting paid.
I think they are heros and people have risked their lives on alot dumber riskier behavior then this. I commend the volunteers who will help save lives.
A. First, trials to determine how large a virus dose will cause infection. They will start at low doses, and try increasing doses until they get most of the volunteers infected. (But what if the low doses have a variolating effect of inducing partial or full immunity?)
B. Once the infectious dose is found, it will be used for vaccines and placebos.
C. Only volunteers age 18-30 with low risk will be used, and will be given remdesevir at the first positive test of infection (along with presumably close medical monitoring and treatment in the isolation facility).
Perhaps some 18-30 year old people may believe that they are at high risk due to occupational factors, so they may want to variolate themselves in the least dangerous possible way (with close medical monitoring and treatment in an isolation facility, or possibly getting vaccinated as well).
Data for remdesivir shows no reduction in mortality. It’s a broad spectrum anti-viral. I’d feel better if they were getting monoclonal antibodies specifically engineered for SARS-CoV-2. Maybe also the interferon spray. Also, best if they treat them as early as possible in the infection, which does sound like the plan.
Yes, but doctors were not helping those people risk their lives. If they decide to get vaccinated and then go out and party like it’s 1999, okay. But, to have a doctor expose them to a virus with no cure? It’s a gray area. If I were a doctor or scientist, I would refuse to be part of a challenge trial. We can get the answers without one.
The problem with the remdesivir study is that it was given to patients who were already hospitalized. Anti-virals need to be given earlier in the infection.
Remdesivir is given by IV so is it not yet accessible to patients still at home.
There is also a supply problem: which patients with no symptoms as yet are asymptomatic, and which are presymptomatic? Who should get it n the earlier phase of infection?
The ideal would be to give remdesivir within 48 hours of infection, as with Tamiflu. But with COVID that is problematic, since both symptoms and positive testing may not show up that early in the infection.
More frequent testing might help the situation.
I hope they don’t give up on remdesivir but instead increase supply and offer it at home with home IV until an oral form is available.
Since the beginning of time we’ve had volunteers who have risked their lives to try to save others. They join the military, National Guard, police forces, fire departments, or none of the above, but run into burning buildings or jump into lakes/creeks, etc, to save someone they see in danger knowing full well that they could be killed themselves in the process. Some are paid, others aren’t.
My thoughts put this in the same category and I wish for the best for all who volunteer. It’s fine with me if they are paid.
I’m not saying that no one should do challenge trials. I’m saying that it is ethically gray. To me, it’s far more problematic than careers in the military, fire department, etc. If people in those occupations started deliberately putting civilian volunteers in harms way for the public good, wouldn’t that be ethically questionable?
Doctors really need to maintain public trust in order to do their jobs. People literally put their lives in the hands of doctors. Infecting people with a potentially life-threatening virus with no sure rescue has a great potential for harm. Also, our country has had a fraught relationship with patient consent for research in the past, and I have seen Covid patients recruited for research trials in unethical ways since March. These decisions should be examined and challenged.
I can see this from both sides, but I think we should proceed with extreme caution. The virus is quite prevalent in many regions, and likely to grow even more widespread as we go into winter. Are challenge trials really going to end up being so much faster that it’s worth the ethical risks?
There’s usually a lot of legalese behind these agreements, before things formally proceed.
Many do volunteer; there are stories of drug trials on prisoners who receive some consideration in return. I doubt they’re standing outside the market, hoping to lure in some complete innocents.
Anyone who agrees to clinical trials on anything is taking a chance they could be in a control group or testing something that proves ineffective.