@calvy28 22 March 2021 more from that month

skl Arrrgh. First COVID-19 death in this new surge for me. I haven't had a death since January and so this unfortunately will be the first of many if we don't contain this surge. The patient had a lot of illnesses including bacteria in the blood so he might have died from that, but the COVID-19 pneumonia made everything worse. These are the patients we need to protect and vaccinate as soon as possible. We also need to double down on people moving around since the higher the community case load, the higher the risk of transmission and multiple superspreader events. Let's review what works and what doesn't: What works: 1. Vaccination - as shown by the Israel experience, vaccination WILL bring down cases AND deaths very fast. Israel has MORE cases than us but half the deaths. They continued vaccinating THROUGH their second wave and it worked. There is NO reason to delay vaccination even in a surge, especially for the most vulnerable. The more people we vaccinate sooner, the more people will be saved. There is NO LINK to vaccination and the emergence of variants. The variants emerged BEFORE widespread vaccination and is a natural phenomenon of the virus. In fact, it is MORE PLAUSIBLE that SURREPTITIOUS USE OF UNAPPROVED AND BASELESS TREATMENTS MAY CAUSE EMERGENCE OF MUTATIONS. We know this very well from HIV literature where haphazard use of meds results in signature resistance mutations. Partially or minimally active meds, just like using antibiotics haphazardly, will lead to unforeseen consequences including more transmissible and deadly variants. DO NOT TAKE UNAPPROVED, UNPROVEN DRUGS. This includes ivermectin and hydroxychloroquine. Ivermectin trials are still ongoing and the preponderance of evidence at this time is that it doesn't work. I would be the first to use it for my patients if I thought it will help, but based on my reading as a trained infectious diseases doctor, there is not enough evidence to think this will work. 2. Remdesivir, dexamethasone, tocilizumab - all three drugs have good RCT data that they work. Remdesivir doesn't seem to affect deaths by much, but it decreases recovery time from moderate to severe disease from 15 to 10 days. That is a BIG deal and can help decongest our hospitals. Dexamethasone helps only for severe disease. It is a steroid and can increase your risk for infection if you take it inappropriately. Never use ANY drugs without talking to your doctor. 3. Face mask, face shield, physical distancing - combined, these three decrease risk of acquiring COVID-19 by over 90%. Face shields are supported by literature since they work not just for eye protection but also dramatically decrease risk of acquiring COVID-19 when combined with masks. A study among Indian healthcare workers going house to house to look for COVID-19 patients showed that infection rates dropped to ZERO after they implemented face shields WITH masks. 4. Avoiding crowds of more than 10 people, staying home - at the height of the Wuhan pandemic, the only intervention that drastically cut transmission was staying home. We have more interventions that are less drastic now, but when infections are high, nothing works better than sheltering in place for 2 weeks. This is the rationale for the current heightened restrictions. What doesn't work: 1. Hydroxychlorquine - it seems even the ivermectin people have already abandoned it despite their rabid adherence in the past. RCTs show NO BENEFIT and it may even ATTENUATE the immune response and decrease the efficacy of vaccines. 2. Ivermectin - the literature is MIXED but the preponderance of PROPERLY PEER REVIEWED EVIDENCE DOES NOT SUPPORT USE FOR TREATMENT OR PROPHYLAXIS. For every "Peru" graph, there is a Brazil which has one of the highest ivermectin usage rates and is now melting down with over 2000 DEATHS per day. There are ONGOING trials so best to wait for these than jumping the gun. It may also drive emergence of mutations (see above) assuming you are able to get the proper human formulations. The DRUG MANUFACTURER MERCK DOES NOT RECOMMEND USING IT FOR COVID-19 and so that should give people pause when even the company that is in a position to profit the most from it doesn't want you to use it. 3. There are many other unproven remedies circulating, some of them potentially more harmful than others. This is an uncertain time and people will cling to whatever seems to offer some efficacy - but just like with life, if it looks too good to be true, it probably is snake oil (useless). It is unfortunate that some healthcare workers who should know better are promoting unsafe and harmful advice against COVID-19. I would like to believe they are just misguided and mean well, but the harm these unproven treatments can cause is REAL. Delaying vaccination for the most vulnerable groups is going to cause a lot of harm as well and I strongly recommend getting vaccinated right away if you are offered ANY properly approved vaccine for your risk group. They ALL work to prevent SEVERE DISEASE and WILL SAVE LIVES. We WILL get through this as long as we keep protecting each other. Stay safe!