View source for SGU Episode 776

== COVID-19 Update <small>(2:49)</small> == 
* [https://theness.com/neurologicablog/index.php/no-benefit-from-hydroxychloroquine-for-covid-19/ Neurologica: No Benefit from Hydroxychloroquine for COVID-19]<ref>[https://theness.com/neurologicablog/index.php/no-benefit-from-hydroxychloroquine-for-covid-19/ Neurologica: No Benefit from Hydroxychloroquine for COVID-19]</ref>

'''S:''' So let's talk a little bit about COVID-19. We've been giving the update every week. We'll start with the numbers. We were just over 5 million cases worldwide, 329,000 deaths. It looks like we're going up by about a million cases a week now last couple of weeks.

'''J:''' A million cases a week? You mean globally?

'''S:''' Yeah. Globally. Yeah, of course. In the U.S., we were at 92,000 deaths. Of course, this will be higher by the time the show comes out. There's a little bit of a downtrend, but I think we mentioned either last week or the week before that that's entirely because New York State peaked early and it's on the downward trend. If you factor out New York State, the rest of the U.S. is actually still on the increase. But at some point, we have to be getting to the other side of this first wave.

'''C:''' Yeah, the problem is now that we're reopening kind of across the country, a lot of experts are saying there's probably going to be a quick second wave just from all of the social distancing, relaxing.

'''E:''' Is it better to have that second wave come earlier or have it come later?

'''C:''' Well, it's not like, oh, a second wave is bound to come. Until we have a vaccine, this is going to keep happening. We're nowhere near herd immunity. As soon as you relax social distancing, more people are going to get sick. It's just how it works. And I wanted to correct, if that's okay, Steve, something that, because a few people reached out, or maybe not correct, but clarify, a few people reached out, because last week I made an offhand comment about, and I think this might be what the people who reached out were referring to, about the fact that there seems to be a correlation between states that are relaxing social distancing and obviously rates increasing and that a lot of those states are southern states or are more conservative states. I wasn't talking about individual people. I think across the board, the mentality on the show, we've sometimes been a little less careful when we say that people want to get back to work because of isolation fatigue, and that's where a lot of this drive is coming from. And we maybe might've made that seem like that was a partisan issue. Of course, people that are struggling financially across the political spectrum are ready to get back to work. The point I was making is that at a policy level, like at a state level, we're seeing that those are where the correlations are, not that individuals want to.

'''S:''' The other thing, I think, that we mentioned in that conversation was the fact that the protests are largely, they're like turf, what do you call that, astroturf kind of movement. They're not really-

'''C:''' Grassroots.

'''S:''' Yeah, I'm sure there are some people who are legitimate grassroots conspiracy theorists out there who are part of those protests, but we're not talking about just somebody who is pushing back against the idea of continued isolation because it's really financially killing them. We're talking about the people with guns and signs, having armed protests against the government. That those demonstrations-

'''C:''' Yeah, saying that this is a mark on their liberty.

'''S:''' Yeah, I mean, those demonstrations, we know that those are more orchestrated.

'''C:''' They're making political statements for sure.

'''S:''' We were not trying to say that anybody who is questioning, like, how long do we have to do this lockdown while they're struggling financially, that it was somehow political or orchestrated or whatever, so just to clarify that. But we are getting into this transition phase now where we're having a serious conversation, and we do also get some pushback, which I think kind of misses pieces of our conversation about it's not all about just the science of the pandemic itself. We have to balance the effect on the economy because that will kill people too versus the effect of the COVID-19 itself. But here's the thing. No one is saying that we're just going to shut down indefinitely or even err on the side of shutting down. We want to carefully calibrate exactly how to shut down and how and when to open up where. There's good ways to do it and not good ways to do it. And again, I will reinforce, however, that nobody knows ultimately. We haven't been here before. This is the first time we're doing this. I don't think anybody could say that we have a clear map on exactly how to do this. We're feeling our way with just logic and evidence as best as we can, but without really the experience to know what the right thing to do is. So what I'm hearing that I think makes the most sense, and these are, I think, a lot of the recommendations coming from the CDC, et cetera, is that you want to use some kind of metric, like declining numbers of cases, hospital admissions, deaths over a period of time to say, OK, then we could start opening up. You open up gradually and you monitor what effect that's having. If the gradual opening up starts to cause another spike in cases, then you've got to shut down again. And then also continuing to use hand-washing, masks and social distancing while we're opening up. And then finally, we need testing and contact tracing in order to do targeted isolation. Atul Gawande wrote a good article about it because he's at Harvard. He said, listen, we have our process. The process is every day you have to indicate whether or not you're having any symptoms. You get your temperature tested. If you have anything, then you get tested for COVID-19 and you stay away from work until you test negative. If you're positive, then obviously you have it, then you're in isolation for whatever two weeks. So they are being very, very careful. We're doing very similar things at Yale as well. I get my temperature taken every time I walk into my clinic, for example. Everyone is wearing a mask. They're wiping down everything between every patient. We're going to be opening up our clinic next week because Connecticut is opening up. And I just got a big email, here's our protocol, this long, elaborate protocol about how we're going to do social distancing in the clinic, fewer patients, longer times, wiping down between every patient, et cetera. We're going to be doing more, continue to do telehealth for those that we can. It's a process. It's going back to business as usual before the pandemic. I can tell you- That's what we're talking about.

'''C:''' You're a clinic. You're a medical facility where you obviously have the know-how, you have access to the tests, you have access to all of the necessary PPE. It's going to take time before a hair salon is able to do this. It can't all just be like everything just opens up on the same day and it's pandemonium. People are going to get sick.

'''B:''' Yeah, but I need a haircut.

'''C:''' I know, right?

'''DC:''' One of the things that I think is going to be sort of a hard truth that we're going to have to accept is that regardless of what we end up doing in the long run until this is over, hindsight is always going to make it look like we did something wrong. There's always going to be families that think that we waited too long to reopen and people that lost their jobs because of it. There will also be people who lost family members that think that we should have kept the controls longer. Those people will exist at the same time. It'll always look like we did something wrong.

'''C:''' Yeah. And the sad thing is, we talked about this once on the show, I know, but we've gotten an email since asking if there's a name for this kind of like cognitive bias or this fallacy where basically you look, it's like Y2K, you look at a lack of things being worse and you say, oh look, it wasn't as bad as we thought it was going to be when really it's because of the actions that we're taking are preventing it from being worse.

'''S:''' But it's part of hindsight bias. You're looking for information that you didn't have initially, right?

'''C:''' But it's almost like it's hard to measure a lack of something, you know what I mean? So it's like people say, oh look, we didn't lose as many lives as we thought we were going to. So obviously we shouldn't have been that worried. And it's like, no, because we were worried, we did all the things we needed to do to prevent that loss of life.

'''B:''' Or you could say, or you could say, oh look, the model predicted 2 million dead and we only had 200,000. The models are inaccurate, like no, because you took steps based on the model, so then everything changes.

'''C:''' Exactly. Yeah.

'''S:''' So the other thing to point out, I think we mentioned this, but just to reinforce it, you know, a lot of economists as well as medical experts are saying opening up the economy to restarting the economy is not the overused metaphor. It's not like flipping on a switch. The whole point is people are not going to necessarily listen to what the government is saying if the government is pushing to open up too early. You have to make people feel safe. Even though it might be legal to go to the hairdresser, people still might not go because they don't want to die for their hairdo. So how do you make people feel confident? You have to actually decrease the numbers. It has to actually work. You can't just, you can't make the choice. You can't choose the economy over the pandemic because if the pandemic is still raging, people are not going to do things. They're not going to go out.

'''C:''' Yeah. And that's a big part. Also, the flip side of that is a big part of living in a free society where we have, you know, the right to choose. And we have a lot of these constitutional protections that take care of our privacy and our safety. I mean, I just recently watched a doc about Wuhan and about kind of the early stages in China. And because everybody there is on WeChat, the way that they reopened so quickly is that they have regions in the city that are barricaded with active police enforcement and people have to show a tag in their WeChat. So it's, this is like pure contract tracing. It's kind of amazing. You are either green, yellow, or red because based on your GPS status, they know when you've been within close proximity to somebody who tests positive within a certain period of time. And once that happens, you flip from green to yellow. And once you're yellow, you can't go certain places until you've quarantined for two more weeks. And then, but if you're actively test positive, then you're red. So your movements are affecting other people's movements. And the fact that they have this, like, what we think of as almost like scary black mirror, big brother, but that's how they can actually do such like brilliant tracing and prevent more infection. We don't really have that option in our society. And because of that, a lot of what we're doing is on the honour system.

'''S:''' Yeah, that's true. But we can also be done sort of at the workplace level which can be extremely effective. Another sort of significant update in the last week that I wrote about on Neurologica, there were actually four fairly large studies published of hydroxychloroquine as a treatment for COVID-19. And they were all negative. One of them was a actually a prospective controlled randomized trial, wasn't blinded, but it was randomized and controlled. And then the other three were retrospective, but they were large. So there were two, one in New York State, one in a center in New York City both with over 1,400 patients comparing hydroxychloroquine with and without azithromycin versus usual care. No benefit, none whatsoever for any of these four studies. In fact, if anything, there was a little bit of a trend negative, but it wasn't, nothing was statistically significant. But that is important because you can't even say, oh, if a bigger study would have shown a benefit. No, it's actually trending negative. So there wasn't even like a trend to it being helpful. And there was a meta-analysis of all the studies to date, also published. They're publishing like every week, they're updating the meta-analysis of all the published data about hydroxychloroquine. And again, negative. They're basically just no data that...

'''C:''' And not just negative, but side effects too, right? Like not just negative.

'''E:''' Side effects and depletion of the supply.

'''S:''' Yeah. So depletion. So people that like for their lupus are having a harder time getting it. We know that it can cause dangerous heart arrhythmias in the extreme. Although I think that physician... These studies were not like people taking it at home. These were in hospitals.

'''C:''' So they're monitored.

'''S:''' And in some of the studies, people were stopped. They were taken off the drug because they had EKG changes. So of course, if they were not being monitored, they could have died as a side effect.

'''E:''' Sure.

'''S:''' It's basically all risk, no benefit is what the data is showing at this point.

'''C:''' Well, and the thing is, there is a drug that is showing positive benefits. And so if our world leaders are going to double down on something, it's kind of a weird thing to put his money on, I think, because there actually is an antiviral that so far is showing some positive benefits.

'''S:''' Well, I think I know. That's the thing.

'''C:''' It's weird.

'''S:''' But I said, here's all, it's remdesivir, by the way. Here's what all the politicians were saying. And here's what all the experts were saying. All the experts were like, we have to be cautious. We don't know. We have to study it. You should not take it outside of a controlled setting. Because when politicians put their nickel down, now they have something politically invested in it. And they can't just listen to the science. Now it's a politically, so essentially, whether or not hydroxychloroquine works for COVID-19, it's a 100% scientific question, but it was made into a political question. And that's bad. And now they're doubling down on it and tripling down on it when the evidence is coming back negative. Whereas the experts, they want it to work. Of course, it would be great if we had an effective drug that could save people's lives, get them off the ventilator. It would be huge. But it just, the evidence is negative. You have to call it like we see it.

'''C:'''  Yeah, when the outcome is life and death, why would you... That's the one time when you can't fall victim to this, like, oh, I'm never wrong. I'm just going to keep pushing. It's like, come on, guys.

'''J:''' Well, the conspiracy theories are flying now. I mean, people are actually believing.

'''B:''' Oh, God, yes.

'''J:''' I actually said this to someone on Facebook, I have to admit.

'''C:''' Oh, God, when's he going to learn?

'''J:''' Who are they, in quotes? Because it's like, they are making money off of these drugs and we can't trust them. And I'm like, who, the entire medical community? What's your premise here that you're being lied to about what specifically and who is benefiting from this? Because to me, it's so obviously just a rush to, who's the next president going to be? This is about getting elected. All the political nonsense that we're hearing is posturing for the next election. But the medical community-

'''C:''' It doesn't even make sense. The arguments don't make sense.

'''J:''' Of course not. They never do, Cara. The problem is that in this circumstance, unlike so many other circumstances, people are dying because of decisions that politicians are making. It's so obvious.

'''C:''' But it's like, if I were a conspiracy theorist, Jay, I would be like, what is Trump getting out of doubling down so hard on hydroxychloroquine? What's going on behind the scenes with that? And I'm not a conspiracy theorist, so I'm kind of like, I just think he's doubling down on not wanting to be wrong. I think that's all it is. But the truth is, if I were a conspiracy theorist, that would be the thing that I'd be sniffing around. I'm like, come on.

'''DC:''' And one of the things is, I think that having worked with people in government offices before, they needed to have an answer of some kind, and they just latched onto the first one. So it happened to be hydroxychloroquine. And then, as Steve mentioned, it's really hard in politics to go back on your initial stance on something. So they put their nickel down, and then they hold it down. And then when they say they need to die, and they say, well, that nickel's fine.

'''S:''' That's why you should put your nickel down on whatever the science says.

'''C:''' Yeah, that's right.

'''E:''' It's always your best bet.

'''S:''' It gives you so much flexibility, too, because if the evidence comes out wrong, it's like, well, the evidence is wrong, and I listen to the evidence. It's a get-out-of-jail-free card. But by putting your nickel down on an answer that, before we have it, you're setting yourself up for being wrong. 

'''E:''' Oh, gosh.

'''S:''' And that's what happened.

'''E:''' History's replete with examples.

'''DC:''' And for better or for worse, we have governors taking up that role where other offices may not be representing as well.

'''E:''' Agreed.

'''C:''' If you're lucky enough to be in a state with a governor who is taking up that role.

'''B:''' Real quick, one other bit of news that came out that was interesting, CDC is now de-emphasizing catching COVID-19 from surfaces and stressing even more it's person-to-person. It seems like it's more of a person-to-person thing, and surfaces is not as involved as they once thought. It's still a risk, but not as a person-to-person.

'''C:''' Still wash your hands.

'''S:''' Wash your hands. Wear a face mask. Keep your distance.

'''E:''' I wouldn't change any of that stuff, right?

'''J:''' [https://www.youtube.com/watch?v=EzNhaLUT520 Watch your kids. Watch your wife].

'''C:''' But yeah, you don't have to irradiate your groceries.

'''E:''' Go into the decontamination booth I built at home.

'''S:''' All right. We're going to try to get through six news items, so let's push forward.