{"id":27725,"date":"2020-07-07T13:16:00","date_gmt":"2020-07-07T17:16:00","guid":{"rendered":"https:\/\/philip.greenspun.com\/blog\/?p=27725"},"modified":"2020-07-06T21:33:20","modified_gmt":"2020-07-07T01:33:20","slug":"the-settled-science-of-coronaplague","status":"publish","type":"post","link":"https:\/\/philip.greenspun.com\/blog\/2020\/07\/07\/the-settled-science-of-coronaplague\/","title":{"rendered":"The (settled) science of coronaplague"},"content":{"rendered":"\n<p>From Massachusetts General Hospital (&#8220;the Massive Genital&#8221; to some of my physician friends), a <a href=\"https:\/\/www.massgeneral.org\/assets\/MGH\/pdf\/medicine\/infectious-diseases\/COVID-19%20School%20and%20Community%20Resource%20Library_July%206%202020.pdf?fbclid=IwAR3oGCMaaNeB8-OuMtUm6btH3m2cA6ImqWZKbwyCqq6Q9-AlvPEymOEBCBc\">50-page summary<\/a> of what is known regarding Covid-19 risks and mitigation in schools. A fwe excerpts:<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>Based on early data, schools do not appear to have played a major role in COVID-19 transmission. Based on data at this time, transmission from students to staff and from students to other students (especially younger students) appears to be rare, and will likely be even more rare with appropriate risk mitigation strategies.<\/p><\/blockquote>\n\n\n\n<p>(conclusion after reading the above: let&#8217;s keep schools closed anyway! #AbundanceOfCaution)<\/p>\n\n\n\n<p>#MasksWork:<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>There are few data about mask use, specifically in schools. The available data about masks usually come from a combination of studies on COVID, SARS, and MERS. There are no data about the combined effectiveness of masks plus face shields plus physical distancing<\/p><\/blockquote>\n\n\n\n<p>HEPA filters like those mandated by Governor\/Hero Cuomo will save us:<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>Low-efficiency filters (e.g., less than MERV 8 according to ASHRAE Standard 52.2 or less than ePM2.5 20% according to ISO 16890-1:2016) are very unlikely to make a difference. Of note, high-efficiency filters may be counter-productive since frequent filter changes are needed and a high-pressure drop filter can also diminish the amount of air supplied into the environment, making the filter less effective<\/p><\/blockquote>\n\n\n\n<p>I.e., American schools will never get organized to change the HEPA filters often enough.<\/p>\n\n\n\n<p>Also.. don&#8217;t ride the bus and don&#8217;t sing on the bus!<\/p>\n\n\n\n<p>And, in the ongoing debate about whether to follow advice from Dr. Donald J. Trump, M.D. &#8230; <a href=\"https:\/\/www.ijidonline.com\/article\/S1201-9712(20)30534-8\/fulltext\">&#8220;Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with COVID-19&#8221;<\/a> (<em>International Journal of Infectious Diseases<\/em>):<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>According to a protocol-based treatment algorithm, among hospitalized patients, use of hydroxychloroquine alone and in combination with azithromycin was associated with a significant reduction in-hospital mortality compared to not receiving hydroxychloroquine.<\/p><\/blockquote>\n\n\n\n<p>How do experts characterize a falling death curve?<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>The United States is in <strong>an acceleration phase<\/strong> of the COVID-19 pandemic. Currently there is no known effective therapy or vaccine for treatment of SARS-CoV-2, highlighting urgency around identifying effective therapies.<\/p><\/blockquote>\n\n\n\n<p>Here&#8217;s the acceleration (<a href=\"https:\/\/www.nytimes.com\/interactive\/2020\/us\/coronavirus-us-cases.html\">nytimes<\/a>):<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large is-resized\"><a href=\"https:\/\/philip.greenspun.com\/blog\/wp-content\/uploads\/2020\/07\/image-10.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/philip.greenspun.com\/blog\/wp-content\/uploads\/2020\/07\/image-10.png\" alt=\"\" class=\"wp-image-27726\" width=\"476\" height=\"230\" srcset=\"https:\/\/philip.greenspun.com\/blog\/wp-content\/uploads\/2020\/07\/image-10.png 967w, https:\/\/philip.greenspun.com\/blog\/wp-content\/uploads\/2020\/07\/image-10-300x145.png 300w, https:\/\/philip.greenspun.com\/blog\/wp-content\/uploads\/2020\/07\/image-10-768x372.png 768w\" sizes=\"auto, (max-width: 476px) 100vw, 476px\" \/><\/a><\/figure><\/div>\n\n\n\n<p>Results?<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>Of 2,541 patients, with a median total hospitalization time of 6 days (IQR: 4-10 days), median age was 64 years (IQR:53-76 years), 51% male, 56% African American, with median time to follow-up of 28.5 days (IQR:3-53). Overall in-hospital mortality was 18.1% (95% CI:16.6%-19.7%); by treatment: hydroxychloroquine\u2009+\u2009azithromycin, 157\/783 (20.1% [95% CI: 17.3%-23.0%]), hydroxychloroquine alone, 162\/1202 (13.5% [95% CI: 11.6%-15.5%]), azithromycin alone, 33\/147 (22.4% [95% CI: 16.0%-30.1%]), and neither drug, 108\/409 (26.4% [95% CI: 22.2%-31.0%])\u200b. &#8230; <strong>Hydroxychloroquine provided a 66% hazard ratio reduction, and hydroxychloroquine\u2009+\u2009azithromycin 71% compared to neither treatment (p\u2009&lt;\u20090.001).<\/strong><\/p><\/blockquote>\n\n\n\n<p>Maybe we have to dig into the paper for adjustments, but it looks as though a higher percentage of those on hydroxychloroquine\u2009+\u2009azithromycin died (20.1 percent) compared to those only on hydroxychloroquine\u2009(13.5 percent).<\/p>\n","protected":false},"excerpt":{"rendered":"<p>From Massachusetts General Hospital (&#8220;the Massive Genital&#8221; to some of my physician friends), a 50-page summary of what is known regarding Covid-19 risks and mitigation in schools. A [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[61],"tags":[],"class_list":["post-27725","post","type-post","status-publish","format-standard","hentry","category-coronapanic"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The (settled) science of coronaplague - Philip Greenspun\u2019s Weblog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/philip.greenspun.com\/blog\/2020\/07\/07\/the-settled-science-of-coronaplague\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The (settled) science of coronaplague - Philip Greenspun\u2019s Weblog\" \/>\n<meta property=\"og:description\" content=\"From Massachusetts General Hospital (&#8220;the Massive Genital&#8221; to some of my physician friends), a 50-page summary of what is known regarding Covid-19 risks and mitigation in schools. 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