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Also issues in Wuhan just now where long lasting COVID-19 led to additional cases. The situation is a lot more complicated than many people want to acknowledge.
Health – I have no idea who you are and not really sure I want to know. Your reference to the American Thoracic Society (ATS) is and your quote of their suggestions has no bearing on my comment. In the very same document that the ATS makes that suggestion (they don’t even call it a recommendation) they explain the rationale for that suggestions which is very different from what you imply. When you quote things out of context and give them meaning, clearly not intended, that is lying.
The ATS suggested hyrdoxychloroquine for patients with pneumonia when various conditions are met. In the actual details they discuss this in the context of hospitalized COVID-19 patients with severe pneumonia, in which case the outcomes were so bad to begin with that there was little concern that hydroxychloroquine will do harm. At no point do they even suggest that there is sufficient evidence to assume that it will help, rather they cast serious doubts on that, but see the value in at least trying it. Notably, they focus very much on collecting data as otherwise there is no way to learn if administering it helps at all.
We can discuss things here, and even something as challenging as medicine, but when people lie about what research studies or medical guidelines mean it is just not helpful to anyone. If your agenda is to simply promote hydroxychloroquine regardless of evidence for or against because you are convinced it works, well just say you think it works but you can’t offer evidence rather than lying about what things mean. On the other hand if you want a serious discussion, then pull out data, or whatever, that legitimately supports your position and you are not misconstruing or overstating and we can discuss that. So far all I have seen is nonsense being promoted, which in my opinion does not do Dr. Zelenko any favors, as rather than allowing his treatment to be considered in a neutral context it is being considered in the context of a bunch of nuts ranting and raving and in general lying about what things mean. It does not make it look good. The same goes for the politicization here of medicine. Trump should have never stepped into the arena to promote medicines that have not (yet) been accepted as proven treatments. Him doing that politicized this and was just not helpful. He is not a doctor and as such he should respect that and leave the medical stuff to the doctors.
Health – Your comments using studies as proof of something should hopefully serve as a reminder to others the danger of people lacking the necessary schooling from interpreting results in scientific studies. I am not a doctor or scientist, but it is evident there are serious issues with the Wuhan study you refer to. You should be ashamed of yourself for using it to promote an idea that Hydroxycholorquine is an effective treatment (I am not saying whether it is or not an effective treatment, but you can’t make that conclusion on insubstantial data and studies).
The study you reference was done a short-time after a different study showing no benefit and accordingly given the small sample size in both, you can conclude that maybe there was a benefit, but you have no real evidence. The study you refer to also was initially intended to have 100 patients in the treatment and control group, but for some reason stopped at 31. How the study size came to be finalized can be a major issue. It seems that they recruited people and had results for a bunch of them before they finished designing the study. You just can’t rely on the results of this study. Maybe it is a basis for a further, properly done study, but for anyone to overly rely on this for a basis for treatment seems incredibly irresponsible.
The details are not clear but the investigation seems to be based on the following series of events:
1. Jerome Corsi who is a “commentor” (e.g. on twitter or other places) sent an e-mail to Zelenko and it said something about Zelenko claiming he had a FDA approved study for his treatment plan.
2. Instead of sending the e-mail to Zelenko it was sent by accident to Zelinsky a federal prosecutor.
3. Zelinsky, looked up on a FDA site for a list of FDA approved studies and did not see any such study approved.
— It should be apparent that the government is tasked with investigating people making false claims regarding medicine. A statement that someone is doing a FDA approved study, when they are not is problematic.
4. Accordingly, Zelinsky the prosecutor, reached out to Corsi’s attorney and requested copies of all communications with Zelenko.
5. Corsi said that Zelenko said he had a FDA approved study to another physician at a training event.
6. Coris said he asked Zelenko about it and he thinks Zelenko meant it was a hospital-panel approved study and did not understand what it meant to have a FDA approved study.
7. Corsi said he is cooperating with the Feds (Zelenko says he has not been contacted by the Feds).
— I don’t think anyone should make a big deal about this investigation. It seems warranted based on the inadvertent e-mail the prosecutor received and assuming Zelenko was not trying to promote a false claim that he had a FDA approved study, little reason to assume that anything will come of this. To say this is about politics is to say that apparently false claims made by people with politics you disagree with should not be investigated ever. If the other communications support that there was no intent here to promote a false claim, this like many other inquiries will be filed away with nothing happening.
When you say that people are lying about Trump suggesting that people inject disinfectant, what then do you make of his comment the next day admitting that he did deliberately say that (he is on video saying it was deliberate)? Saying others are lying about Trump saying this (and seemingly meaning it) is just dishonest. I get it that you like Trump, but to twist words and lie to paint him favorably is still lying. To say others are lying when they repeated what Trump said is just not right.
As to calling it a reasonable suggestion (i.e. to inject disinfectant), well I don’t think there is anything Trump could say that you would not consider reasonable. It is like a religious obsession. Most others, I think, were rolling their eyes quite hard when he said this.
@Millhouse – I prefer to stay out of the discussions here as they go on and one aimlessly. At the risk of getting involved, I want to point out your comment about developing immunity is ignoring several considerations. Not going to debate these all but understand the experts trying to figure out how to reopen and move on from this have to contend with these issues and possibly others that I am not thinking of at the moment:
1. Evidence from places like South Korea suggests that if properly managed (i.e. once we are out of the community spread stage and have a handle on testing and how has it) is that we can possibly avoid many people getting it, or at least getting it in the near term.
2. There are many unknowns about people getting this, such as with children, some recent data suggests it is causing some issues there that might best be avoided. From a medical standpoint I believe it is generally considered reckless to suggest exposing people to a disease that is not well understood. Besides children, no one knows the long-term impact to adults who have gotten this.
3. While it makes sense that those who get this should be immune, this is not clearly understood with this virus yet. Even if immune are you immune to mutated strains, which free-run will result in many?
4. Spread of this risks mutation into deadlier forms. Any basic understanding of the history of the 1918 flu pandemic would illustrate this risk (it should be mandatory that you read the history of the 1918 flu pandemic before you offer any suggestions regarding this pandemic).
5. If we are vigilant there still will likely be some spread and eventually the strain that escapes detection will be one that is of minimal concern. That would be a preferred method of how we can get to herd immunity with minimal consequence.
6. Alternatively to #5, if we can slow the spread of this disease for a year or so, there is a chance that a vaccine will be available.
There are many questions here and there are those trying to figure out how to balance the medical concerns with the daily life concerns and it is a difficult balance. A mistake can mean disaster. We already saw the consequence of ignoring the risk when we still had a chance to mitigate this, let’s consider if we can find a path that while it does make life a bit difficult for the near future it reduces the chance of a full-scale disaster.
One final point, there are many that assume the anti-body studies mean much. While they may offer some promising info, jumping to conclusions and acting too soon risks undoing all that we worked towards. An extra few weeks to give up is perhaps better than losing a few more months.
What do you mean he did not say that. It is there. It seems pretty clear that he was suggesting sticking UV or other powerful lights and injecting disinfectant (sorry he did not say bleach… not sure which disinfectant he had in mind) in the body as a possible way to deal with this (otherwise what is he proposing doctors test?). I never suggested my original comment was a word for word quote, if that is what you expect.
Quote word, for word, from his news conference:
“So, supposing we hit the body, with a tremendous, uh, whether it is ultraviolet or just very powerful light. And I think you said that hasn’t been checked but you are going to test it. And then I said supposing you brought the light inside the body which you could do, either through the skin, uh, or in some other way and I think you said you are going to test that too, sounds interesting.
And I see that disinfectant where it knocks it out in a minute, one minute, and is there a way we can do something like that, uh, by injection inside or, or almost a cleaning because you see it gets in the lungs and it does a tremendous number on the lungs, so it would be interesting to check that, so that you are going to have to use medical doctors for. But it sounds, sounds interesting to me.”
About 2 patients out of 450 dying, it can be easily explained by selection bias. Perhaps the majority of patients that will die end up in the ER before they call their doctor. For people that call their doctor before they need to go to the ER the chance of dying is apparently 0.1%-0.5% (for the general population it is likely between 1%-2%, just most get really sick and need the ER before they call their regular doctor). So Zelenko’s numbers are completely consistent with the data, unless you have some data that disputes this conclusion.
As an aside, I have another question with Zelenko. How well did he follow up with his patients as to whether they actually took the protocol as prescribed. That he prescribed it can be believed, but to what extent people completed or even filled the prescriptions and/or took the drugs is not in his data.
Does this need this repeating again? Without a proper study it is really very difficult to tell if Zelenko’s protocol actually works. Further there are now many questions about the safety of taking HCQ so not sure how anyone can recommend this at this time.
P.s., Trump suggested yesterday something about sticking powerful lights in your body and injecting yourself with bleach or some other disinfectant to cure this. Just be wary about anything he suggests.
See 2scents reply. For Trump or any politician to demand the FDA should approve or disapprove a drug for any reason is very troublesome as it would add a political dimension to medical decisions. The FDA has to made medical decisions outside political concerns. This has long-reaching implications for safety in medicine that go well beyond the current situation.
As an aside, a doctor can prescribe HCQ without the FDA doing anything. The issue here I understand is limited supply of HCQ (hence various restrictions placed on prescribing it) and questions about its safety. Not saying anything about whether the dosage that Zelenko uses poses any real safety issues or not, but there are safety issues with HCQ and several studies using HCQ have been stopped due to safety issues.
Going back to the evidence issue here about whether this works. I discussed a bit above why I think results Zelenko and others have with this might not mean anything much. Without a proper study it is difficult to know what to make of all this. There is a study that is starting or has started already that is looking into this as a preventative treatment with medical workers (as Dr. Zelenko recommends), but initial results are not expected to be published until a year from now. Perhaps if there are results that really stand out in a short-time they may provide an update sooner, but we are likely talking about a few months at minimum, not weeks.
Saying people will try to disprove something because Trump said it, means you have to suspect that others will try to prove something because Trump said it. Basically, your very criticism negates what you are trying to argue for.
How many days from when someone 65 or older first has symptoms till they end up in the ICU?
How many of them are feeling ill enough to bother calling their primary care doctor first before ending up in the ER?
How many people with mild cases call their primary care doctors before they need to go to the ER and then in the next few days progress to going to the ER?
There are just so many questions here that Zelenko does not address and why without a proper study his results are hard to make heads or tails out of.
If lack of oxygen occurs sometime between the 5th-8th day from first symptoms and that is when most go to the ER, it raises a very significant question, by what day of symptoms do people typically consult a doctor. I suspect that the first few days people don’t worry and then when it progresses or remains about a week they finally call their doctor (in numerous of Zelenko’s cases where they details the case history there have been symptoms for 4+ days as reported by the patient). But if that is the case, then by the time people call their doctor, if they are not being told to get to the ER, they are most likely not in the cohort that will ever go to the ER.
Further, when you look at actual cases Dr. Zelenko put out, there is a significant question as to what percent of his cases are not actually COVID-19. Recall he is treating almost anyone over 60 with symptoms of a cold, it is only those under 60 that have to present more serious symptoms to be treated.
Basically, if he treated about 400 patients with his treatment (while he had over a 1,000 patients, he only treated the ones over 60 or those younger with stronger signs of COVID-19, which was closer to 400), and 50% of them actually don’t have COVID-19 (whatever data he had from KJ does not necessarily extrapolate to the general population, hence his conclusions that people likely have COVID-19 are questionable), that means he only treated 200 patients with COVID-19. If the majority of the cases that result in death already went to the ER before they call him, then perhaps it is equivalent to treating 50 or so older patients. If 5% of these patients are expected to die, well that brings us to 2-3 deaths. Well I think he said 2 patients died…
Play with the numbers however you like (I acknowledge my numbers are likely off, but without better data, kind of hard to know exactly how), but without an proper study here, it does not take much to argue his results are anecdotal.
Any family doctors here, who get calls from patients over 60 with COVID-19 symptoms (not just confirmed tests) before you have to recommend they go to the ER? What percent of those patients eventually go on to being intubated or dying? That would perhaps help make some sense out of Zelenko’s data. Not saying that is enough by itself, but maybe it can tell us if his numbers are within what we would expect or they are truly off-the-chart and worthy of consideration.
Look, I want his treatment to work and if someone was sick with this would be open to trying this treatment, however the science matters. If this does not actually work, then we need to focus on other solutions. If it does work then we can reopen the country. You can’t make these decisions just based on his anecdotal results.
FYI, update from a hospital in France that they stopped the hydroxychloroquine and azithromycin combo due to adverse cardiac effects.
Don’t know enough about the specifics there but if this combo is not good for the 1% with high-risk of cardiac effects, then it is not effective on the population that might be the highest risk of dying from this. Just another point to keep in mind when evaluating outcomes with this treatment and how this is a bias in the people selected for the treatment.
Regarding number of people transported to ER’s…
Info from Wikipedia:
Population KJ – 25,292
Median Age KJ – 15 years old
1.6% are 65 or olderPopulation Lakewood – 104,000
Median Age Lakewood – 23.9 years old
12.2% are 65 or olderDo some math…
KJ about 322 people 65 or older
Lakewood about 12,688 people 65 or older
In other words lakewood has close to 40X the number of people who are 65 or older.
Someone said 20 people from KJ went to the ER vs 250 people from Lakewood, well that is 12.5X the amount, when we would perhaps expect 40X the amount.
Basically, the populations are so different that comparing them is much more difficult than cherry-picking one number.
Also, given that people in KJ are young overall and the chances of them dying from COVID-19 are much less I have no idea what you can extrapolate from that population with regard to Zelenko’s work with them.
Curious does anyone know Dr. Zelenko’s screening procedure? How do we know there is no bias in his screening as to who to take on as a patient? That can make a huge difference. Did he turn away patients? If yes, why and who.
Dr. Zelenko said he had over 900 patients. Anyone know the number of them that actually had a confirmed COVID-19 diagnosis, not just a guess based on clinical presentation?
He said he treated with his cocktail over 300 patients who he classified as high risk. What exactly does he classify as high risk, did any of these high-risk patients have a positive test, how long did they have this, what type of symptoms did they have?
How fast does COVD-19 progress from the point when he would prescribe his cocktail till when they need to go to the ICU?
There are lots of questions and without careful controls, even the most well-meaning, can make mistakes.
I have not seen anyone recommend against taking this for people with breathing symptoms and if it helps, it is great. But this is unproven, despite Dr. Zelenko’s videos about this.
As to why the Governor limited prescribing this to some extent is because there will be a shortage affecting people who these drugs are proven to work on. Apparently, there can’t be such a major restrictions on prescribing this as Dr. Zelenko has managed to prescribe this to 300+ patients.
Too soon to say for sure what will be by July or August, but assuming no proven treatment for this by then, I can’t see anyone risking another shutdown by allowing this to have massive community spread again. How this affects camps, I am not sure, but I imagine it would mean at minimum camps being subjected to increased scrutiny by health departments and stricter limits on the number of campers.
I doubt anyone is okay with this policy, but when they are not able to put people coming in on ventilators who have a chance of living because they are trying to revive a patient who died already (which probably also carries a bigger risk of COVID-19 spreading due to whatever coughing results) not sure what is better (also you need the staff to deal with this). Hopefully does not come to this, but this is what Italy went through.
thetruththis eek – You are corrupting Judaism with this thinking. The holocaust was a time of shmad when the Nazis were targeting Jews. There is much to be said about risking lives to engage in a minyan at such a time. This time is an epidemic and not shmad. When you participate in the minyanim you are causing the deaths of yidden. Also I have no idea to what extent people engaging in minyanim during the holocaust resulted or changed in any way whether other people die. In this time, if you engage in minyanim you are a rodef. Enough with the stupidity and murder being caused by people who are willfully blind to what is going on. The other day, a UK study suggested that a 26 foot distance is necessary for social distancing.
It should also be mentioned that social distancing is not a solution at this time. When there is community spread, isolation is the solution. As it is impractical to not have people get some exercise, get food, and take care of some other minimal essentials, social distancing is recommended as a way to minimize the spread (not to stop it.. and we are in a time when medical supplies are in short-order, so this is a big deal). Perhaps when there is no community spread and testing and contact tracing can be an effective method to contain this, then social distancing can be relied on to help prevent another breakout.
som1… Take your meds you sound hysterical. Btw, how long did you waste on your list?
Have you followed the news at all?
TCJA – penalized democratic states by removing the SALT deduction
He tried to get Ukraine to announce that they are investigating Biden (not actually investigating, just announce they are investigating) and seemingly held up aid to Ukraine to accomplish this.
He denied that there was a serious pandemic facing the US until mid-March. He was comparing it to the flu and saying the US is doing a great job. How can we trust that his lies here did not impact the US’s ability to respond to an epidemic that is killing a lot of people in our community. – I would go further and suggest that deep seated support of Trump in our community resulted in a very partisan view of COVID-19 by many and as a result many were late to the game in recognizing the threat posed here. At the same time “liberals” and the “MSM” were warning about this, yet too many get their news from Brietbart, Fox, and the opinion column in the FJJ.
So yes, I would be very wary that he would put personal ambition over country. Guess what, every Governor is acting this way and they are being very careful in their messaging as they are afraid Trump will be petty and decide to penalize a State and let people die. No one would have been concerned about Obama, Bush, Clinton, Bush Sr, Carter, or Reagan being so petty.
There are no broken rules. The only ones who think there are broken rules here are those whose yiddishkeit is an external social act and not an internal understanding of what God demands from them. Not sure how you can teach your children what yiddishkeit is better than a situation like this where the norms are called into question. There is much to learn. If instead you were running to minyanim when doctors and then rabbonim were saying not to, as your kids get older and understand more what occurred at this time they may really wonder what you were thinking.
Don’t promise anything. Assume that any lockdown provisions will be as much as they are now if not stronger (and possibly with enforcement) at that point. The earliest we can hope to see some freedom will be the end of the week following pesach. Maybe something will change between now and then, hopefully.
Trying to kill people this year with your siyum?
Regardless, as Pesach is a couple of weeks away, I think you will change your mind by then.
If you run any sort of projection here, you would realize that the number of cases each day now, will increase 10 – 20 times the amount (if not more in our community due the extensive social mixing) towards the second half of next week.
Keep on looking for ways to be smarter than everyone else… Good going. Just know that for every additional person that gets sick and needs intubation (an unfortunately high percent need that), will mean a doctor having to choose which person gets that tube and which one does not.
Of course if the medical supplies can be ramped up or this talked about treatment is effective it may not be that dire, but that is where we stand right now.
Be smart, think about your civic duty to your fellow yid and everyone in society, even if you can’t think about yourself and your family. The situation we are in is a lot worse than many of you realize. If you realized you would not even suggest that you are making an illicit siyum following the guidelines.
Abba_s – I am not commenting on the issue of people needing to work. This is a real problem that has to be balanced between the cost to life here (some businesses are essential to life, such as people in food and medicine). Mitt Romney today suggested giving every adult in the US $1,000. Might not be enough for a Jewish family contemplating Pesach (people facing financial uncertainty here need to find ways to cut costs NOW… as we have no way of knowing how long till things return to some normalcy) but will help people put food on their table for a bit.
All I am pointing out is that every additional transmission of this diseases adds to the burden on our medical system which is very likely going to fail in short order. I pray and hope that it does not come to this but without question if this thing is not stopped we will be there. Hence, to the extent any one of us can avoid being in a situation where they contribute to the spread of this, they are saving lives. Unfortunately, it is hard for me to contemplate right now, where sufficient testing is not in place, how our shuls can still be open without strict social distancing enforced (at least social distancing can slow this, however given the levels this may be at already, that might not be enough and I think the proper action is to close them). Shuls, Churches, Mosques, and other places where people are in close contact and moving around are definite hot spots for this thing to spread. When you walk into a shul, that does not have proper distancing (if that is even sufficient) you are contributing definitely to this epidemic. Much like you can’t daven in middle of Ocean Pky and hope your tefillos will protect you there, I don’t think you can rely on your teffilos to stop what is a definite that your very action of congregating together is contributing to.
I would point out further that we as a community in the coming days may find out that between Purim and this past shabbos this thing has spread far wider in our community than we realize. I fear that in two weeks people will be saying or thinking like the folks in Italy are saying now, if only we took this more seriously sooner.
Hashem Yishmar.
Irresponsible behavior by the rest of the world is a very odd measure to hold ourselves to.
The facts… Keeping shuls open, especially without social distancing enforced, will contribute to more people getting sick and dying (due to lack of available medical care as the medical system will likely be ovewhelmed in short order). This is a certainty, not a question at this time. Anyone that says otherwise is not informed of the facts.
The question… if keeping shuls open at this time will definitely contribute to more people dying what is the appropriate response for a jew?
If anyone suggests that people will not die and therefore we should all go about business as usual, well I would wonder then, at what point is a yid obligated to seek out the emes?
Joseph – your comment is nonsense. The CDC says where there is significant community spread (e.g. Brooklyn) school systems should consider closing to slow and stop the spread. In fact the risk of transmission with kids is plenty high, what you mean is the risk they die from it is low. That said, they will contribute to the spread throughout the community with the associated dire consequences. Even Trump, the messiah to so many here, is saying that everything should shut-down and people should not be in groups of more than ten and you should practice the necessary social distancing. If Trump a huge doubter of this epidemic at first (look at his comments from just the first half of last week) with access to the all the resources on this has come around in a big way, you should be very concerned about this as well. Our actions today will save lives in the coming weeks or cost them. Which side of the equation do you want to be on?