ice9 Profile picture
22 Nov, 4 tweets, 5 min read
@poiThePoi @GephenS @youyanggu @mattparlmer No. But keep in mind 30% is the highest reported figure. Vast majority of counties are lower. So it could make sense roughly given that.

At this point they are just letting it rip. Not enough people cared soon enough with enough coordination.
@poiThePoi @GephenS @youyanggu @mattparlmer Although tbf the average visually at least does appear to be about 20% as you assumed. I agree with that reading of the map colors.

Either something is off, or... the delayed impact from positive test to hospitalization is going to go entirely unmanaged. They are full already.
@poiThePoi @GephenS @youyanggu @mattparlmer If this model is accurate, which it may indeed be, then Iowa CFR is likely to increase materially within the next 2 weeks as staffing ratios fall and admission refusals cut deeper into the scale of severity in spite of overflow capacity.

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More from @__ice9

22 Nov
@drakchaurasia @poiThePoi @GephenS @youyanggu @mattparlmer A combination of quercetin, bromelain, and vitamin C succeeded in an antiviral prophylactic RCT. This surprised me.

Ivermectin works in antiviral prophylaxis RCTs, likely by enhancing T cell response.

Aspirin is effective for thromboprophylaxis in general. Dipyridamole too.
@drakchaurasia @poiThePoi @GephenS @youyanggu @mattparlmer Arbidol (umifenovir) 200mg t.i.d. succeeded in a Chinese antiviral prophylactic study.

Interferon alpha nasal and pharyngeal spray succeeded in another Chinese prophylactic study.

Hydroxychloroquine shows limited impact for post-exposure prophylaxis, partial for pre-exposure.
@drakchaurasia @poiThePoi @GephenS @youyanggu @mattparlmer Combining ambroxol/bromhexine with hydroxychloroquine is extremely likely to be effective in pre- or post-exposure prophylaxis.

Note long-term ambroxol/bromhexine use is known to be safe in e.g. COPD.

Unfortunately they must be used 2-3 times per day, much like Arbidol or IFN.
Read 8 tweets
22 Nov
One of various ways in which COVID-19 is indeed not 'just the flu.' Image
... and here, if so inclined, one can see physically what that actually looks like--

Some other autopsy studies, organizing these links to keep the imagery limited to those indeed so inclined.

Read 4 tweets
22 Nov
Summary note on staging for COVID-19.

This list is not definitive. Just heuristics.

Many authors draw the mild/moderate division around where the patient will soon need oxygen support, SpO2 nearing 90-92% on room air.

Others take a less aggressive stance.

I use the former.
The less aggressive usually draw the moderate/severe line based on need for oxygen support. However, this labels most hospital cases severe, losing granularity. Some add a 'critical' category to compensate, but this is an overloaded term.
In discussions here, I draw the moderate/severe line around onset of hypoxemia on high-flow oxygen, often onset of pulmonary microthrombosis and soon rising D-dimer, with a high risk of ARDS and DAD but not quite there yet. This matches my reading of the literature.
Read 4 tweets
18 Nov
Brazilian dutasteride outpatient RCT (N=130) for mild acute COVID-19:…

Mechanism is impairment of androgen-dependent TMPRSS2 expression ergo viral entry.

I have reservations about this approach, but efficacy is good at least.

Reference via @jamagalha
The paper includes further evidence from observational studies consistent with the RCT result.

It also makes some rather provocative hypotheses about regional susceptibility to the virus:

Male pattern balding may be a significant risk factor and varies widely by ancestry.
For another androgen dependent method of reducing TMPRSS2 expression, while also helping to protect against pulmonary edema, see also--


No trial results yet, but many proposal papers and excellent feedback from practitioners.
Read 8 tweets
17 Nov
Discussion of antiviral properties of acid sphingomyelinase inhibitors vs. SARS-CoV-2 and others.

Examples: fluoxetine, fluvoxamine, flupenthixol, clemastine, dicyclomine, etc.

May inhibit endosomal entry, as one effect.

Fluvoxamine succeeded in RCT.
Note that sufficient concentrations for antiviral effects are likely not attainable at tolerable clinical doses of some.

Fluvoxamine and fluoxetine have shown clinical benefit at ordinary doses.

Flupenthixol is not hittable.
Amitriptyline also works well for preventing SARS-CoV-2 infection, apparently.…

Intriguing study design.

Volunteers were given amitriptyline, then epithelial cells were removed from their noses and inoculated with SARS-CoV-2. Infection was prevented.
Read 4 tweets
17 Nov
Please do not speculatively give linezolid or vancomycin as first-line monotherapy in literal first-glance triage protocols.

Some of us are awfully prone to getting MRSA SSTIs and would appreciate it if fallback antibiotics continue to actually work in the future.
At the very least, please recognize monotherapy as a key contributor to antibiotic resistance.

Add an antibiotic with an independent mechanism so the bacterial population cannot just evolve around it again.

True in more mundane situations as well.…
Read 6 tweets

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