Coronavirus (COVID-19)

[JDBrocks]

2 minutes ago, ramssuperbowl99 said:

Were you expecting Gilead to release it at cost?

In this instance, I would expect them to make the drug affordable, as they were funded by the taxpayers and trusted to come up with lifesaving medication in a short time frame in the midst of a global pandemic.

Sorry the "we could have charged 12k because that's how much in-patient time we expect to save" is trash. I guess I should have lowered expectations given Gilead's track record.

[mission27]

13 minutes ago, JDBrocks said:

We already paid for the R&D. It is a bad price, and it's profiteering on a global pandemic.

$3k just doesn't seem that high. We're talking about 5 IV doses of a scarce life saving medicine. I've been charged $3k for a CT scan.

[TVScout]

Maybe free:

This coronavirus mutation has taken over the world. Scientists are trying to understand why.

Quote

When the first coronavirus cases in Chicago appeared in January, they bore the same genetic signatures as a germ that emerged in China weeks before.

But as Egon Ozer, an infectious-disease specialist at the Northwestern University Feinberg School of Medicine, examined the genetic structure of virus samples from local patients, he noticed something different.

A change in the virus was appearing again and again. This mutation, associated with outbreaks in Europe and New York, eventually took over the city. By May, it was found in 95 percent of all the genomes Ozer sequenced.

At a glance, the mutation seemed trivial. About 1,300 amino acids serve as building blocks for a protein on the surface of the virus. In the mutant virus, the genetic instructions for just one of those amino acids — number 614 — switched in the new variant from a “D” (shorthand for aspartic acid) to a “G” (short for glycine).

But the location was significant, because the switch occurred in the part of the genome that codes for the all-important “spike protein” — the protruding structure that gives the coronavirus its crownlike profile and allows it to enter human cells the way a burglar picks a lock. 

The mutation doesn’t appear to make people sicker, but a growing number of scientists worry that it has made the virus more contagious.

“The epidemiological study and our data together really explain why the [G variant’s] spread in Europe and the U.S. was really fast,” said Hyeryun Choe, a virologist at Scripps Research and a lead author of an unpublished study on the G variant’s enhanced infectiousness in laboratory cell cultures. “This is not just accidental.”

But there may be other explanations for the G variant’s dominance: biases in where genetic data are being collected, quirks of timing that gave the mutated virus an early foothold in susceptible populations.

“The bottom line is, we haven’t seen anything definitive yet,” said Jeremy Luban, a virologist at the University of Massachusetts Medical School.  

https://www.washingtonpost.com/science/2020/06/29/coronavirus-mutation-science/?arc404=true

Why simple cloth masks without valves are better at fighting the spread of covid-19

Quote

Those face masks you see with coin-sized valves on the front may look intriguing but they are not as good at preventing the spread of the novel coronavirus as the seemingly lower-tech, non-valved masks.

 

Some masks designed for hot, dusty construction work — where the intent is to filter out dust before it hits the wearer’s lungs — have “exhaust” valves that allow the exhaled air to flow out more easily, to keep the mask-wearer cooler.

The 3M company, which makes valve masks for such occupations, illustrates on its website how they work: inhaled air is filtered through the fabric part of the mask, and hot, humid exhaled air goes out through the valve. The system may be what you want when tearing out a kitchen for remodeling, but the valve defeats the purpose when you’re trying to slow the spread of a virus. Public health experts have been recommending mask-wearing to prevent respiratory droplets from spreading into the air when you exhale, speak, cough or sneeze, and the valves allow those droplets through. In its guidelines for mask-wearing, San Francisco stipulates that masks with valves do not meet its standards.

https://www.washingtonpost.com/health/why-simple-cloth-masks-without-valves-are-better-at-fighting-the-spread-of-covid-19/2020/06/26/c445fca6-b574-11ea-aca5-ebb63d27e1ff_story.html

 

Covid delirium:

Quote

Kim Victory was paralyzed on a bed and being burned alive.

Just in time, someone rescued her, but suddenly, she was turned into an ice sculpture on a fancy cruise ship buffet. Next, she was a subject of an experiment in a lab in Japan. Then she was being attacked by cats.

Nightmarish visions like these plagued Ms. Victory during her hospitalization this spring for severe respiratory failure caused by the coronavirus. They made her so agitated that one night, she pulled out her ventilator breathing tube; another time, she fell off a chair and landed on the floor of the intensive care unit.

“It was so real, and I was so scared,” said Ms. Victory, 31, now back home in Franklin, Tenn.

To a startling degree, many coronavirus patients are reporting similar experiences. Called hospital delirium, the phenomenon has previously been seen mostly in a subset of older patients, some of whom already had dementia, and in recent years, hospitals adopted measures to reduce it. 

Now, the condition is bedeviling coronavirus patients of all ages with no previous cognitive impairment. Reports from hospitals and researchers suggest that about two-thirds to three-quarters of coronavirus patients in I.C.U.’s have experienced it in various ways. Some have “hyperactive delirium,” paranoid hallucinations and agitation; some have “hypoactive delirium,” internalized visions and confusion that cause patients to become withdrawn and incommunicative; and some have both.

The experiences aren’t just terrifying and disorienting. Delirium can have detrimental consequences long after it lifts, extending hospital stays, slowing recovery and increasing people’s risk of developing depression or post-traumatic stress. Previously healthy older patients with delirium can develop dementia sooner than they otherwise would have and can die earlier.

https://www.nytimes.com/2020/06/28/health/coronavirus-delirium-hallucinations.html?campaign_id=9&emc=edit_nn_20200629&instance_id=19843&nl=the-morning&regi_id=127802529&segment_id=32114&te=1&user_id=0ec3b530f45ff5c070e34ae9b6fc8ea1

[JDBrocks]

Just now, mission27 said:

$3k just doesn't seem that high. We're talking about 5 IV doses of a scarce life saving medicine. I've been charged $3k for a CT scan.

And I think that's crazy too. We're not going to see eye to eye here, and this conversation is likely to head in a direction that we aren't allowed to go, so I'm going to drop it. 

[ramssuperbowl99]

Just now, JDBrocks said:

And I think that's crazy too. We're not going to see eye to eye here, and this conversation is likely to head in a direction that we aren't allowed to go, so I'm going to drop it. 

The only thing I would note, because I think everyone in the universe agrees price gouging during a pandemic is the lowest of the low, is that we don't know the true cost of each vial (this could be big given the last minute nature of all of this) and - this is the bigger one - we don't know their plans for countries that would need assistance. Given the insanity that is healthcare pricing, Gilead could offer this at huge cost to the US, and free to less developed countries, and make very little overall money. Effectively it's just the US subsidizing the costs from places that truly couldn't afford it.

 

Pricing pharmaceuticals is complicated. I'm not an expert at all. But given the attention that this drug in particular was going to receive, I'd expect a smart pharma company with a long term vision like Gilead to price it more conservatively.

[mission27]

1 minute ago, JDBrocks said:

And I think that's crazy too. We're not going to see eye to eye here, and this conversation is likely to head in a direction that we aren't allowed to go, so I'm going to drop it. 

Believe me, I think its crazy too. I just think its more of a systemic issue and in the context of our current health care system the pricing is neither surprising nor particularly egregious. I wish we had affordable health care too.

[mission27]

4 minutes ago, ramssuperbowl99 said:

The only thing I would note, because I think everyone in the universe agrees price gouging during a pandemic is the lowest of the low, is that we don't know the true cost of each vial (this could be big given the last minute nature of all of this) and - this is the bigger one - we don't know their plans for countries that would need assistance. Given the insanity that is healthcare pricing, Gilead could offer this at huge cost to the US, and free to less developed countries, and make very little overall money. Effectively it's just the US subsidizing the costs from places that truly couldn't afford it.

 

Pricing pharmaceuticals is complicated. I'm not an expert at all. But given the attention that this drug in particular was going to receive, I'd expect a smart pharma company with a long term vision like Gilead to price it more conservatively.

Lets also not forget that to date, every dose of this drug that has been taken around the world & saved thousands of lives has been donated. Gilead is in the business of moonshot life saving drugs. They wouldn't be in the business if they couldn't make some sort of profit when one of those moonshots hits. Most of the price for this drug is going to be born by private insurance companies and governments of rich, developed countries (who will get this at a lower cost of ~$2300 per treatment course) and I'm sure to your point they will continue to provide doses to poorer countries at a lower or no cost. Its true that some people in the US may face high out of pocket costs for this which is a separate issue and should be addressed, but not an issue Gilead has caused. At the end of the day without knowing what their economics look like on this drug its hard to make a judgement call one way or another about the pricing. But its no higher than I would've expected tbh.

[mission27]

1 hour ago, WizeGuy said:

Bars are going to give many governors head aches because so much of the regulation falls on bar owners enforcing the rules and the general public complying.

We allowed indoor dining two weeks ago. People can take their masks off when they eat at a table or at the bar, but once you stand up and start lollygagging around- you have to wear a mask. Every employee must wear a mask as well. From what I've heard- most of the bars have been pretty strict on this- but there have been a few pushing the boundaries. Many fear losing their liquor license, so they comply. Also, it's limited capacity (50% inside); every other booth is taped off to promote social distancing and bar stools are placed in a way that keeps 6 ft of distance. No clubs are allowed open. Gyms aren't allowed open either. 

Of course, this is still very risky, and it's incredibly hard to enforce, so a lot of the 'follow through' falls on the bar owners. I haven't been out to a bar yet, but I will say- outside dining seems to be pretty safe. We've had patios open at bars for the past month or so, and numbers are still decreasing. That being said, I'm seeing more photos on my facebook feed of people getting together and partying (at their homes) without masks on, so that's worrisome. 

Fingers crossed, but if we're still looking good through July, then I'm going to be a happy man. Phase 4 is not bad at all, and I'd personally be very happy if we were in this phase until a vaccine is available, though others may disagree. 

I'd be surprised if it got as bad up here as its getting down south, because we do have higher levels of immunity in our most exposed populations and are taking more precautions. But there's no way there wont be some seepage. I do think cases will go up across the country as we're arguably already starting to see.

[MWil23]

@LETSGOBROWNIES surprise presser from DeWine at 2 today. He wasn’t scheduled until the 1st 😓.

[LETSGOBROWNIES]

3 minutes ago, MWil23 said:

@LETSGOBROWNIES surprise presser from DeWine at 2 today. He wasn’t scheduled until the 1st 😓.

He’s shutting ish down I bet.

[MWil23]

7 minutes ago, LETSGOBROWNIES said:

He’s shutting ish down I bet.

He will follow suit to Florida and Texas I bet. I'm foreseeing the shutdown of bars/clubs with alcohol sales. Keep the restaurants open but no more in person alcohol.

[theJ]

1 minute ago, MWil23 said:

He will follow suit to Florida and Texas I bet. I'm foreseeing the shutdown of bars/clubs with alcohol sales. Keep the restaurants open but no more in person alcohol.

I'd love for him to get some nads and do a mask mandate too.

[MWil23]

6 minutes ago, theJ said:

I'd love for him to get some nads and do a mask mandate too.

Tbh, I’d love for him to get some nads and say “Our goal was to flatten the curve in March and we have done that to date. Our hospitals aren’t overwhelmed. We knew more testing means more positives, and yet hospitalization ratios are down. We will maintain status quo for the next 3 weeks and then reevaluate.” 

JMHO

[LETSGOBROWNIES]

4 minutes ago, MWil23 said:

Tbh, I’d love for him to get some nads and say “Our goal was to flatten the curve in March and we have done that to date. Our hospitals aren’t overwhelmed. We knew more testing means more positives, and yet hospitalization ratios are down. We will maintain status quo for the next 3 weeks and then reevaluate.” 

JMHO

So we wait for a problem before we address the issue?

[LETSGOBROWNIES]

It’s just odd as most of what people want to be able to do, and our economy needs, can be done relatively safely if we just wear masks, but for some reason we feel the need to appease people who think their uneducated opinions are valid.