Interview: What we got wrong (and right) about COVID-19

7,290 Views | 86 Replies | Last: 4 yr ago by Picadillo
ORAggieFan
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This is definitely worth a read: https://www.persuasion.community/p/what-we-got-wrong-and-right-about?fbclid=IwAR0W2jwalxMG4u2DtxsofQjEhnMPpTy-hW8K8VCp1uRbChPEANlXoJmtMlo

Interviewed are the following:
Quote:

  • Monica Gandhi, a professor of medicine at the University of California San Francisco School of Medicine. Her expertise includes infectious diseases, epidemiology, and biostatistics;
  • Vinay Prasad, an associate professor in the Department of Epidemiology and Biostatistics at the University of California San Francisco. He is a hematologist-oncologist;
  • Stefan Baral, an associate professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health.


A few highlights, but I suggest just clicking the article:
Quote:

Stefan Baral: We teach this in class: An epidemic is when you have more cases than you would otherwise expect. What's going to have to happen is ensuring that we're adjusting our expectations, so that we can make decisions in a thoughtful way. In the U.S. there should be an expectation that there will be increased cases of COVID-19 come this winter. But if we say that we expect the same number of cases that are happening now to be happening in December, and then cases go up, we're going to declare that we're right back in the thick of it. I worry that yo-yo-based approaches are going to be very difficult for people, and would suggest we update our expectations with a focus on actual health outcomes, and not just test results.

Quote:

SB: We applied a uniform intervention strategy to something that was disproportionately affecting particular communities. We locked down society, but transmission doesn't happen at the level of society: It happens at the level of households and workplaces. And we didn't really do a lot in those places, so a lot of the workplaces declared "essential" continued, and we didn't provide those people options in terms of their households. For example, we could have made temporary living spaces available, especially for people in multi-generational households.
Quote:

VP: Another great failure is that we didn't learn a lot. We did so many different interventions, but we didn't actually study many of them. For example, there are still questions about how much to wear masks, and under what circumstances. We don't know much more about that than when the pandemic began.
Quote:

I think many people think Zoom is what liberated uswere it not for Zoom, how bad would this pandemic have been? But my counterfactual is different. Zoom allowed a lot of upper-middle-class white-collar people the ability to work and make money and not lose their jobs, and to exclude themselves from society. That fundamentally changed the pandemic. If you went back 15 years ago, and you didn't have Zoom, you would be facing unprecedented layoffs of wealthy, upper-middle-class people.
Another Doug
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For those wary of articles from unknown sites. This does look like it is written/conducted by a real journalist.

https://en.wikipedia.org/wiki/Emily_Yoffe
96ags
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Quote:

. I hate to say it, but the moment Donald Trump said he was for schools reopening, I think a lot of people turned their brains off, and they opposed it totally to thwart him. And I think that is one of the worst things that has happened.

It makes me sad that such a large part of our adult population is just pathetically stupid enough to allow this to happen.

Thanks for sharing this article OP.
GAC06
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" Zoom allowed a lot of upper-middle-class white-collar people the ability to work and make money and not lose their jobs, and to exclude themselves from society."

One of the most frustrating parts of the whole debacle was people who could stay home virtue signaling and trying to shame people who needed to actually work. We're all in this together so stay home and go broke unless you're a government selected fRonT liNe eSsenTiAl hErO
coolerguy12
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96ags said:

Quote:

. I hate to say it, but the moment Donald Trump said he was for schools reopening, I think a lot of people turned their brains off, and they opposed it totally to thwart him. And I think that is one of the worst things that has happened.

It makes me sad that such a large part of our adult population is just pathetically stupid enough to allow this to happen.

Thanks for sharing this article OP.


Pretty much the entirety of 2020 was to do the exact opposite of whatever Trump suggested. They even took it so far as to mandate that nursing homes had to take in sick patients.

And many on this board just nodded in approval. The ends justified the means.
GAC06
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Stay home. Unless you're looting and burning for justice. That's ok. But don't go to work or church or school. Follow the science.
Old Buffalo
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This is my biggest pet peeve of all. We threw out actual science and research in exchange for political and divisive motives.

  • Mask mandates were implemented based on theoretical applications, but execution of the strategy didn't work.
  • We knew early on (based just on Italy) that this virus impacted those with significant co-morbidities and advanced age, yet scared the younger population.
  • Somehow protests and riots were not super spreader events, but Americans were forced to eat take-out or outside in cold weather.
  • Children showed little risk of spread or impact to the virus, yet we stunted their educational growth to "protect" them.

It even carries on today. We give no credit for natural antibodies or consider the percentage of the population previously infected as we over zealously push for each person to "shut up and take the jab."
“The Party told you to reject the evidence of your eyes and ears. It was their final, most essential command.”
TexasAggie008
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My goal isn't to make this as a pro or anti-trump point - but, id bet just about anything that if we could go back in time and have Trump instead be pro-masks, pro-lockdowns, and pro-school closings - none would be a part of far left orthodoxy as they are now, and instead Trump MAKING people cover their face, supporting school closings that disproportionately impact low income/minority districts, and supporting lockdowns that disproportionately impact lower income workers would all be put on the "reasons Trump is a tyrant dictator whose worse and more dangerous than Hitler" list

One could say yep that's all true - and it's still Trump's fault for failing to establish himself as someone who could be viewed as bipartisan in the event of an emergency (how W was right after 9/11)- and giving (some) people no option but to literally resist at every turn

But could also argue that anyone who would go to such levels to #resist the President in a crisis - at the expense of children and lower wage workers and disproportionate poor/minority communities - has literal mental health issues and should probably see a doctor about it
coolerguy12
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TexasAggie008 said:

My goal isn't to make this as a pro or anti-trump point - but, id bet just about anything that if we could go back in time and have Trump instead be pro-masks, pro-lockdowns, and pro-school closings - none would be a part of far left orthodoxy as they are now, and instead Trump MAKING people cover their face, supporting school closings that disproportionately impact low income/minority districts, and supporting lockdowns that disproportionately impact lower income workers would all be put on the "reasons Trump is a tyrant dictator whose worse and more dangerous than Hitler" list

One could say yep that's all true - and it's still Trump's fault for failing to establish himself as someone who could be viewed as bipartisan in the event of an emergency (how W was right after 9/11)- and giving (some) people no option but to literally resist at every turn

But could also argue that anyone who would go to such levels to #resist the President in a crisis - at the expense of children and lower wage workers and disproportionate poor/minority communities - has literal mental health issues and should probably see a doctor about it


TDS is very real. Your argument would be 100% valid
St Hedwig Aggie
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coolerguy12 said:

TexasAggie008 said:

My goal isn't to make this as a pro or anti-trump point - but, id bet just about anything that if we could go back in time and have Trump instead be pro-masks, pro-lockdowns, and pro-school closings - none would be a part of far left orthodoxy as they are now, and instead Trump MAKING people cover their face, supporting school closings that disproportionately impact low income/minority districts, and supporting lockdowns that disproportionately impact lower income workers would all be put on the "reasons Trump is a tyrant dictator whose worse and more dangerous than Hitler" list

One could say yep that's all true - and it's still Trump's fault for failing to establish himself as someone who could be viewed as bipartisan in the event of an emergency (how W was right after 9/11)- and giving (some) people no option but to literally resist at every turn

But could also argue that anyone who would go to such levels to #resist the President in a crisis - at the expense of children and lower wage workers and disproportionate poor/minority communities - has literal mental health issues and should probably see a doctor about it


TDS is very real. Your argument would be 100% valid


If trump was still the president, we would likely have the same vaccination numbers. The NYT is praising the national progress in recent articles. If it was still president trump, the same nyt reporter would be lamenting how embarrassingly bad the numbers look and the inequality of it all.

Xiden and Kamala would go around low income communities injecting Covid into minorities and it would be explained as equalizing and inclusive.
Make Mental Asylums Great Again!
ORAggieFan
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I hope this doesn't become to political for this board as this would be a mess if it's moved. But, it's interesting the take of these experts interviewed and they view themselves pretty left. But, they also recognize science versus politics and the need to keep this based on science, something we failed to do so often and many continue to do (Fauci).
96ags
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ORAggieFan said:

I hope this doesn't become to political for this board as this would be a mess if it's moved. But, it's interesting the take of these experts interviewed and they view themselves pretty left. But, they also recognize science versus politics and the need to keep this based on science, something we failed to do so often and many continue to do (Fauci).
I hope you don't mind, but I posted the article on the politics board (with credit to you) because I thought it was a very honest article.

Reviewing the good/bad, right/wrong is the only way we will learn and it would be awful not to do that just to avoid being seen as wrong politically.
94chem
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Quote:

But we exacerbated disparities, and we made the rich richer through our approach. And that wasn't talked about by the left.
This was a quote from someone self-described as "left of left," referring to how Zoom allowed the upper class to check out of society, keep making money, and not speak up to get schools and jobs back open. It's a great insight, except the person making the point fails to notice that it's the LIBERAL upper class who make the decisions in this country. It was LIBERAL elites who dropped the ball when it came to speaking up for their minions.
94chem,
That, sir, was the greatest post in the history of TexAgs. I salute you. -- Dough
94chem
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Public Health is the field/discipline where the most logical responses should have originated. It was true all along. It is true now. Not doctors, not epidemiologists, not politicians. If responding to epidemics isn't in the wheelhouse of Public Health, what is?
94chem,
That, sir, was the greatest post in the history of TexAgs. I salute you. -- Dough
gratitudeandacceptance
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This thread is going to get torpedoed.
ORAggieFan
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96ags said:

ORAggieFan said:

I hope this doesn't become to political for this board as this would be a mess if it's moved. But, it's interesting the take of these experts interviewed and they view themselves pretty left. But, they also recognize science versus politics and the need to keep this based on science, something we failed to do so often and many continue to do (Fauci).
I hope you don't mind, but I posted the article on the politics board (with credit to you) because I thought it was a very honest article.

Reviewing the good/bad, right/wrong is the only way we will learn and it would be awful not to do that just to avoid being seen as wrong politically.
I don't mind, I just hope we stay on topic here.
gratitudeandacceptance
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And I fear the "system" won't improve so that we'll do better when the next one comes around. This is beyond my brain power so do not have a suggestion about how things should work differently, but i'm curious if there are any PH experts on this forum and what they think.
J. Walter Weatherman
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GAC06 said:

" Zoom allowed a lot of upper-middle-class white-collar people the ability to work and make money and not lose their jobs, and to exclude themselves from society."

One of the most frustrating parts of the whole debacle was people who could stay home virtue signaling and trying to shame people who needed to actually work. We're all in this together so stay home and go broke unless you're a government selected fRonT liNe eSsenTiAl hErO


Really interesting article and it's great to see them actually be really self reflective. And this to me is one of the key reasons why there was so much virtue signalling with people who were working from their couch tweeting about how everyone should "stay home for their neighbor" while never missing a paycheck.

The other half of that equation is that no government official, elected or otherwise, ever missed a paycheck despite being singlehandedly responsible for ruining tens of thousands of businesses and millions of lives, all to score political points. All of these power hungry local officials got to tell everyone what to do to pad their political resume without ever feeling even a tiny fraction of the consequences.
Infection_Ag11
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Quote:

but the moment Donald Trump said he was for schools reopening, I think a lot of people turned their brains off, and they opposed it totally to thwart him.


This is definitely accurate

It was true of HCQ as well, it just turned out that that truly didn't work. Most people saying it didn't work way back when though we're doing so for the wrong reasons, which of course skewed public perception regarding all further commentary.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Another Doug
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Infection_Ag11 said:

Quote:

but the moment Donald Trump said he was for schools reopening, I think a lot of people turned their brains off, and they opposed it totally to thwart him.


This is definitely accurate

It was true of HCQ as well, it just turned out that that truly didn't work. Most people saying it didn't work way back when though we're doing so for the wrong reasons, which of course skewed public perception regarding all further commentary.

If we are upset about people saying HCQ didn't work (which it didn't) for the wrong reason. What does a MD make of the leader of the free world tweeting a video that it was "The cure" on July 29th.





Infection_Ag11
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Another Doug said:

Infection_Ag11 said:

Quote:

but the moment Donald Trump said he was for schools reopening, I think a lot of people turned their brains off, and they opposed it totally to thwart him.


This is definitely accurate

It was true of HCQ as well, it just turned out that that truly didn't work. Most people saying it didn't work way back when though we're doing so for the wrong reasons, which of course skewed public perception regarding all further commentary.

If we are upset about people saying HCQ didn't work (which it didn't) for the wrong reason. What does a MD make of the leader of the free world tweeting a video that it was "The cure" on July 29th.



He intentionally overstated the potential based on small, poorly designed trials and anecdotes for political gain. And yes, it was just as wrong when we he did as when anyone else does. The fact is though all politicians do this. For every lie and embellishment made by Trump, similar examples can be shown for Biden (such as taking credit for meeting a vaccine goal that was before which actually entered office).
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Another Doug
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Infection_Ag11 said:

Another Doug said:

Infection_Ag11 said:

Quote:

but the moment Donald Trump said he was for schools reopening, I think a lot of people turned their brains off, and they opposed it totally to thwart him.


This is definitely accurate

It was true of HCQ as well, it just turned out that that truly didn't work. Most people saying it didn't work way back when though we're doing so for the wrong reasons, which of course skewed public perception regarding all further commentary.

If we are upset about people saying HCQ didn't work (which it didn't) for the wrong reason. What does a MD make of the leader of the free world tweeting a video that it was "The cure" on July 29th.



He intentionally overstated the potential based on small, poorly designed trials and anecdotes for political gain. And yes, it was just as wrong when we he did as when anyone else does. The fact is though all politicians do this. For every lie and embellishment made by Trump, similar examples can be shown for Biden (such as taking credit for meeting a vaccine goal that was before which actually entered office).


No that was March 21st. I am talking about July 29th. At the peak of our 2nd wave (what would then be dwarfed by a 3rd wave). The president tweeted a video that said we had a cure and we didn't need to get sick. That video not based on any trials whatsoever and everyone knew is was horse**** at the time (for the right reasons).
HowdyTexasAggies
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Fact, there are many Drs that believe HCQ with Zinc works.
96ags
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That is completely off topic. Do you have any thoughts on the article?
Infection_Ag11
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HowdyTexasAggies said:

Fact, there are many Drs that believe HCQ with Zinc works.


There are many doctors that believe lots of incorrect things
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
96ags
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Infection_Ag11 said:

HowdyTexasAggies said:

Fact, there are many Drs that believe HCQ with Zinc works.


There are many doctors that believe lots of incorrect things
The problem isn't being wrong, it's being unwilling to admit it and learn from it.

That is where the big fail is in regards to Covid.
HowdyTexasAggies
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Infection_Ag11 said:

HowdyTexasAggies said:

Fact, there are many Drs that believe HCQ with Zinc works.


There are many doctors that believe lots of incorrect things

Including the incorrect belief they are never wrong.
Infection_Ag11
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HowdyTexasAggies said:

Infection_Ag11 said:

HowdyTexasAggies said:

Fact, there are many Drs that believe HCQ with Zinc works.


There are many doctors that believe lots of incorrect things

Including the incorrect belief they are never wrong.


All doctors are wrong sometimes. I'm confident much of my knowledge in the fields of say, rheumatology and neurology is outdated or incorrect because I don't practice in these fields every day and keep as up to date. THIS topic however deals with a condition specific to my specialty and one in which I've seen an extremely high number of patients of all clinical presentations for, and have looked over almost all the meaningful literature regarding this condition for the last 18 months. On THIS matter, I am correct in my assessment of the data regarding HCQ.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
HowdyTexasAggies
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Infection_Ag11 said:

HowdyTexasAggies said:

Infection_Ag11 said:

HowdyTexasAggies said:

Fact, there are many Drs that believe HCQ with Zinc works.


There are many doctors that believe lots of incorrect things

Including the incorrect belief they are never wrong.


All doctors are wrong sometimes. I'm confident much of my knowledge in the fields of say, rheumatology and neurology is outdated or incorrect because I don't practice in these fields every day and keep as up to date. THIS topic however deals with a condition specific to my specialty and one in which I've seen an extremely high number of patients of all clinical presentations for, and have looked over almost all the meaningful literature regarding this condition for the last 18 months. On THIS matter, I am correct in my assessment of the data regarding HCQ.

How are you treating COVID patients?
96ags
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Infection_Ag11 said:

HowdyTexasAggies said:

Infection_Ag11 said:

HowdyTexasAggies said:

Fact, there are many Drs that believe HCQ with Zinc works.


There are many doctors that believe lots of incorrect things

Including the incorrect belief they are never wrong.


All doctors are wrong sometimes. I'm confident much of my knowledge in the fields of say, rheumatology and neurology is outdated or incorrect because I don't practice in these fields every day and keep as up to date. THIS topic however deals with a condition specific to my specialty and one in which I've seen an extremely high number of patients of all clinical presentations for, and have looked over almost all the meaningful literature regarding this condition for the last 18 months. On THIS matter, I am correct in my assessment of the data regarding HCQ.
God complex is real.
Infection_Ag11
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HowdyTexasAggies said:

Infection_Ag11 said:

HowdyTexasAggies said:

Infection_Ag11 said:

HowdyTexasAggies said:

Fact, there are many Drs that believe HCQ with Zinc works.


There are many doctors that believe lots of incorrect things

Including the incorrect belief they are never wrong.


All doctors are wrong sometimes. I'm confident much of my knowledge in the fields of say, rheumatology and neurology is outdated or incorrect because I don't practice in these fields every day and keep as up to date. THIS topic however deals with a condition specific to my specialty and one in which I've seen an extremely high number of patients of all clinical presentations for, and have looked over almost all the meaningful literature regarding this condition for the last 18 months. On THIS matter, I am correct in my assessment of the data regarding HCQ.

How are you treating COVID patients?


A majority of my care is provided on the inpatient side, so my COVID patients are generally much sicker than average. I'm dealing with a lot of patients requiring oxygen and getting some combination of steroids, remdesivir, immunomodultors and occasionally antibiotics if they have a superimposed bacterial pneumonia.

On the outpatient side, most of the care is just supportive. Lower risk patients will virtually all recover no matter what you do and the NNT would be so high for any medication so as to render it not worth the risk, no matter how "low risk" the medication and even if there were some good evidence of benefit. Some higher risk outpatients will benefit from monoclonal antibodys such as bamlanivimab, but most patients won't have immediate access to this even if they are in the category that benefits. A ton of experimental drugs for inpatient and outpatient care are still ongoing but little has clear benefit at present.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Windy City Ag
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Quote:

God complex is real.
Maybe with some doctors somewhere but you can't bat down or ignore every inconvenient medical research finding by accusing doctors of God Complex.
Infection_Ag11
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96ags said:

Infection_Ag11 said:

HowdyTexasAggies said:

Infection_Ag11 said:

HowdyTexasAggies said:

Fact, there are many Drs that believe HCQ with Zinc works.


There are many doctors that believe lots of incorrect things

Including the incorrect belief they are never wrong.


All doctors are wrong sometimes. I'm confident much of my knowledge in the fields of say, rheumatology and neurology is outdated or incorrect because I don't practice in these fields every day and keep as up to date. THIS topic however deals with a condition specific to my specialty and one in which I've seen an extremely high number of patients of all clinical presentations for, and have looked over almost all the meaningful literature regarding this condition for the last 18 months. On THIS matter, I am correct in my assessment of the data regarding HCQ.
God complex is real.


There's a reason the physicians advocating for HCQ and ivermectin either never actually see COVID patients or are seeing them in non-specialty specific fields (IM, FM, etc.). You have to look far and wide to find any ID physician who would argue for either therapy. I actually don't know of any, though I suspect such a person exists somewhere. That's not because everyone in our field wants patients to die to prove a point and all the other fields contain more honest physicians. It's because we're treating more of these patients than anyone (many primary care docs actually refuse to see them in their office and refer them to us, and we see most of those that come through any given hospital) and we HAVE to stay up to date on all the data for various therapies.

And it's important to recognize that among ANY field, the numbers of physicians arguing for these therapies is very, very small relative to the total body of physicians. It's well under 5% in any given field.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
TXTransplant
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96ags said:

Infection_Ag11 said:

HowdyTexasAggies said:

Infection_Ag11 said:

HowdyTexasAggies said:

Fact, there are many Drs that believe HCQ with Zinc works.


There are many doctors that believe lots of incorrect things

Including the incorrect belief they are never wrong.


All doctors are wrong sometimes. I'm confident much of my knowledge in the fields of say, rheumatology and neurology is outdated or incorrect because I don't practice in these fields every day and keep as up to date. THIS topic however deals with a condition specific to my specialty and one in which I've seen an extremely high number of patients of all clinical presentations for, and have looked over almost all the meaningful literature regarding this condition for the last 18 months. On THIS matter, I am correct in my assessment of the data regarding HCQ.
God complex is real.


If that's your takeaway after that post (and everything else that doctor has posted over the course of the last year+), you might as well just put your healthcare in the hands of acupuncturists, reflexologists, and witch doctors. And I'm sure there are some essential oils out there that will cure any ailment you may have.
HowdyTexasAggies
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Infection_Ag11 said:

96ags said:

Infection_Ag11 said:

HowdyTexasAggies said:

Infection_Ag11 said:

HowdyTexasAggies said:

Fact, there are many Drs that believe HCQ with Zinc works.


There are many doctors that believe lots of incorrect things

Including the incorrect belief they are never wrong.


All doctors are wrong sometimes. I'm confident much of my knowledge in the fields of say, rheumatology and neurology is outdated or incorrect because I don't practice in these fields every day and keep as up to date. THIS topic however deals with a condition specific to my specialty and one in which I've seen an extremely high number of patients of all clinical presentations for, and have looked over almost all the meaningful literature regarding this condition for the last 18 months. On THIS matter, I am correct in my assessment of the data regarding HCQ.
God complex is real.


There's a reason the physicians advocating for HCQ and ivermectin either never actually see COVID patients or are seeing them in non-specialty specific fields (IM, FM, etc.). You have to look far and wide to find any ID physician who would argue for either therapy. I actually don't know of any, though I suspect such a person exists somewhere. That's not because everyone in our field wants patients to die to prove a point and all the other fields contain more honest physicians. It's because we're treating more of these patients than anyone (many primary care docs actually refuse to see them in their office and refer them to us, and we see most of those that come through any given hospital) and we HAVE to stay up to date on all the data for various therapies.

And it's important to recognize that among ANY field, the numbers of physicians arguing for these therapies is very, very small relative to the total body of physicians. It's well under 5% in any given field.

Isn't the usage of HCQ and ivermectin being recommended for widespread preventive care, and not for use in the type of patients you are seeing? Also, doesn't the data suggest that countries doing so are seeing macro results better than those that are not?
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