Academy Exchange

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  • 1.  COVID19

    Posted 03-29-2020 08:30

    Ordinarily I prefer for my care of HIV to remain scientific and not political as it doesn't just kill gay men or IVDUs. However I find it amazing that we are turning the country upside down for an illness that hasn't come close to killing half as many Americans as the flu this year, yet when HIV was killing more people per day back in the 1990s, only a small group of us took notice and scrambled to help.
    Not saying COVID19 is insignificant, just keeping things in perspective and pointing out how politics can make people ignore science. 

    At least this isn't going to kill a giant fraction of the work force in SFO and other places like HIV when it disproportionately killed young people that worked and paid taxes. I could never understand why conservatives didn't try harder to keep young tax payers healthy back then.
    again, I'm just looking at numbers not saying one life means more than another...

    Thomas Kaspar
    Houston TX

  • 2.  RE: COVID19

    Posted 03-30-2020 02:00
    Thank you for this.  Unfortunately, it is impossible now as then to separate politics from healthcare in this country.  But we should remember that because of what we learned from HIV, we were able to identify and sequence the genome of SARS-Co-V-2 in a week, create a viral load diagnostic test, etc.  Sadly, it is politics & money that kept us from implementing those as other countries did to keep what should have been an outbreak from becoming a full scale pandemic in which hundreds of thousands may die.

    In the early years of the HIV pandemic, it was the partnership of PLWHIV, doctors and researchers who changed the way we do research, how drugs get approved, and how research and care get funded that turned the tide.  It is both ironic and comforting to see Tony Fauci leading that charge again.  It will likely take another collaboration of those affected (bereaved families, sadly) doctors and researchers to advocate for resources to fight this pandemic.  And hopefully for permanent changes that won't allow history to repeat itself like this again.

    Jeff Taylor
    Palm Springs CA

  • 3.  RE: COVID19

    Posted 03-30-2020 13:44
    I agree that it is amazing how drastic some/many/most people are reacting to COVID19 and I understand what you are saying related to how many people died from HIV/AIDS in the 1990's and hardly anyone responded - however, I would also recommend looking at the mortality of COVID19 as opposed to influenza or HIV (not AIDS). I saw some good information for the "lay" person (not healthcare professionals) via this website and I would recommend taking a look:​

    Rachel Klein
    Ashland OR

  • 4.  RE: COVID19

    Posted 03-30-2020 13:56
    I'm unable to open that link. I did see Elton John made a similar comparison to the early HIV pandemic and deaths per day, guess he will join me in the political doghouse for the next few weeks until the curve flattens which should be soon after testing is maxed out.
    still glad this isn't taking out the young and pediatric patients like the flu did this year. 
    I still remember all the orphans created by the early HIV deaths.

    Thomas Kaspar
    Houston TX

  • 5.  RE: COVID19

    Posted 04-24-2020 10:32
    I'm somewhat shocked to hear this from a health care provider.
    You clearly need to brush up on epidemiology and modeling, that said at least you are engaging in dialogue to educate yourself. You are looking at the number of deaths secondary to disease over a period of two months and comparing that to the number from a different disease over the course of a year and saying what's the big deal? The big deal comes from modeling the number of deaths over the entire 12 months which gives you a number MUCH bigger than that of the annual flu. What's more Covid-19 also has a mortality rate that is approximately 20 times higher than the seasonal flu combined with a transmission (R not) rate that is much higher. Perhaps a visual. 

    covid vs other causes of death

    Thomas McQuaid
    Norwalk CT

  • 6.  RE: COVID19

    Posted 04-25-2020 15:05
    Also read about how the virus got here in December or January and fix that fake chart

    Sent from my iPhone

  • 7.  RE: COVID19

    Posted 04-25-2020 15:06
    Mortality no higher than 0.2% probably half that according to serological studies

    Sent from my iPhone

  • 8.  RE: COVID19

    Posted 04-26-2020 03:14

    Dr. Kaspar, 
    I'd invite you to read the rules of this Community Exchange, which asks the we maintain a safe space for discussion with respectful, professional dialogue.  I'm not sure your last two posts adhere to the spirit of these rules. 

    I think there are pitfalls in trying to compare SARS-CoV-2 to Influenza since we have no vaccine, no therapies, and at least 97% of us have no immunity to SARS-CoV-2.  Also, what Thomas McQuaid was trying to show in the chart I believe was the intensity of death from COVID-19 that has been concentrated in recent weeks with nearly 2,000 deaths/day whereas influenza deaths are totaled over a season.  The final numbers are not yet in yet, of course, but we've already passed 50,000 COVID-19 deaths (that we know about) in just the past two months whereas influenza killed only 34,000 through the whole of the 2018-2019 season. 

    I'm not sure what you mean to suggest regarding the virus getting here in December or January. The chart he posted is showing deaths, which is known to lag well behind introduction of the first cases and even widespread community transmission. Remember incubation average 5 days (range 2-14), then 7-10 days from mild symptoms progressing to severe, then average 2-3 weeks in ICU before death.  So even as we now see cases and hospital admissions declining in some hotspots, deaths are known to lag by a few weeks. While there have been recent reports of a few early deaths in Santa Clara county before the first recorded US death in Seattle, those were sporadic and for some lucky reason didn't result in widespread transmission.   

    Which study is suggesting only a 0.2% case fatality rate for COVID-19?  I would agree that is this has been a difficult number to pin down for several reasons:

    1) initial focus of limited testing resources on only the sickest patients thus inflating CFR by keeping denominator of confirmed cases low
    2) potential for many mild/asymptomatic cases to never be diagnosed if they never present to care

    However, I'd be careful in the interpretation of serologic studies at this point.  Perhaps you're referring to the (as yet not peer reviewed) 'Santa Clara county study' from Stanford researchers or the even less peer reviewed 'Los Angeles county serology study' by the same authors, not even 'pre-published' yet, but rather just a press release.  These studies use assays that are not FDA-approved nor have they even been granted an FDA EUA status and the methods have been criticized roundly.  There are several major methodological problems including selection bias of sampling (Facebook ads), no confirmation of positive results to try to see if misclassified as true positives, and suspect mathematical adjustments that seem to ignore Bayesian statistics to get from 1.5% seroprevalence to >4%.  I've heard other bay area epidemiologists (from UCSF) note that of the 50 samples out of 3,000 that were positive in this study, nearly 1/3 were negative when tested with another assay (suggesting they were false positives), which would bring the estimates of true seropositive way down.  There have been a torrent of COVID-19 serology tests on the market that are of dubious quality, and in this situation, they need to be really good in order to minimize false positives.  For example, even a test with 99% sensitivity and specificity will yield as many false positives as true positives if disease prevalence is around 1%.  

    Putting those two studies aside, another from NYC that Gov Cuomo cited (I haven't seen the data yet and not sure which Ab test was used), suggested 21% COVID-19 seropositivity within the City.  OK, so if 8.4 million in NYC, that means 1.7 million people were actually infected--presuming ZERO false positives.  Johns Hopkins CCSE dashboard reporting 17,126 deaths in NYC alone, which is still a 1.0% case fatality rate, exactly 10-fold higher than influenza. 

    So again, where does the 0.2% fatality rate come from?  I think time will tell that is an inaccurate assumption.  

    Christian Ramers, MD, MPH, AAHIVS
    San Diego CA

  • 9.  RE: COVID19

    Posted 04-26-2020 09:32
    Thank You for explaining in much greater detail and much more eloquently what I was trying to explain.
    Tom McQuaid

    Sent from my iPhone

  • 10.  RE: COVID19

    Posted 07-02-2020 10:35
    I think COVID is making its significance known in Texas at this point and differentiating itself from the common flu. it's unfortunate that data shared was labeled as fake when it could have been used as informative.
    I wonder how many preventable deaths will occur as a result of the cynicism and conspiracy theories that seemed to have rational people doubting the words of experts in favor of amateurs. There is definitely a lesson to be learned here about the age in which we live and the ability of misinformation to permeate at high levels and gain acceptance. I think healthcare professionals need to take measures now to insulate the public dissemination of health information that is evidence-based and life-saving from the onslaught of faux sensational misinformation that seems to be part of the era in which we live. We should as a group have done something when we started to see deaths taking place from vaccine-preventable diseases because of decisions made over fake safety concerns. Now we are seeing people refusing to wear masks or support social distancing over the advice of experts because they personally don't know someone that has died of COVID. The obstinance and failure of some to believe facts have resulted in a failure to control this virus which will now have repercussions well beyond what would have been the case if people had just listened to and trusted the experts. We need to find a way to distinguish for the general public and apparently even to each other the difference between evidence-based facts and biased propaganda before the next big opportunity comes for those with untoward agendas to kill innocent people directly or indirectly with misinformation. Freedom of speech and of the press needs to be clearly outlined as not protecting information that is false and generated with the intent of harm to others or inciting mayhem and discord.

    Thomas McQuaid
    Stamford CT

  • 11.  RE: COVID19

    Posted 07-02-2020 15:13
    Texas has had very little mayhem and discord relative to many other states

    Sent from my iPhone