。例如，至今没有地方能达到对流感的 herd immunity，for many reasons，是一个追求不到的目标。I'm not sure it's *the* question right now. (That's why nobody is paying me the big bucks to run algorithms.)There are insufficient data for the Panel to recommend either for or against any antiviral or immunomodulatory therapy in patients with severe COVID-19 disease (AIII).
In patients with COVID-19 and severe or critical illness, there are insufficient data to recommend empiric broad-spectrum antimicrobial therapy in the absence of another indication (BIII).
The Panel recommends against the routine use of systemic corticosteroids for the treatment of mechanically ventilated patients with COVID-19 without ARDS (BIII).
对 interferon 的态度是不要用(against)。There are insufficient clinical data to recommend either for or against using chloroquine or hydroxychloroquine for the treatment of COVID-19 (AIII).
If chloroquine or hydroxychloroquine is used, clinicians should monitor the patient for adverse effects, especially prolonged QTc interval (AIII).
There are insufficient clinical data to recommend either for or against using the investigational antiviral drug remdesivir for the treatment of COVID-19 (AIII).
Remdesivir as a treatment for COVID-19 is currently being investigated in clinical trials and is also available through expanded access and compassionate use mechanisms for certain patient populations.
Except in the context of a clinical trial, the COVID-19 Treatment Guidelines Panel (the Panel) recommends against the use of the following drugs for the treatment of COVID-19:
The combination of hydroxychloroquine plus azithromycin (AIII) because of the potential for toxicities.
Lopinavir/ritonavir (AI) or other HIV protease inhibitors (AIII) because of unfavorable pharmacodynamics and negative clinical trial data.
这个医院furlough 员工，减薪，早就是进行时了。 麻州这边至少新闻里面报道了不少。Jun wrote: ↑2020-04-23 7:46最近从几个途径听说很多医院亏损严重，开始裁员或者 furlough 员工，包括一个大学同学被削减工作时间。亏损原因好像是病人实际减少了，除了疑似 COVID-19 之外，其它类型的病人暂时都是能不来就不来，尤其是 elective procedures，例行检查之类的都暂停了。所以大部分医院实际上生意减少了，尤其是利润比较高的生意。
真是令人意外的后果呀。
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Veterans Affairs 的研究数据表明用了 hydroxychloroquine 死得更快。估计 NIH guideline 应该改成“不要用”了 (against)。
https://www.reuters.com/article/health- ... SL2N2C91AU
把这句话反过来看，Is there evidence of second infection in people who have antibodies?There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.
这个"subsequent"用得可圈可点。痊愈后一个月、一年、十年也是 subsequent。我们当然知道有一些病原体的免疫力是不能 last forever 的，例如流感病毒就有可能每年都会感染同一个人，导致 common cold 的冠状病毒也会反复感染同一个人，但其实这些现象也没有经过系统地研究和证明过，到底反复感染的是同一个 strain 呢还是变异过的 strain，以及具体变异多少才会重复感染。所以 WHO 这个说法是理论上滴水不漏但并无实际意义。As of 24 April 2020, no study has evaluated whether the presence of antibodies to SARS-CoV-2 confers immunity to subsequent infection by this virus in humans.
不是完全没证据，有间接证据表明，痊愈带抗体病人大多数有抵抗力，但是暂时不能肯定这个抵抗力跟抗体浓度是否成正比；不能肯定再次感染的几率是多少，但是我们知道这个几率是低的，在短期内（我觉得一年之内是个 safe bet)。
这观点要是被中方看到，呵呵呵。 国内一直在宣传欧美不顾民众死活， 暗地推行herd immunity...
抗体还有个检测的问题， 用有没有抗体来衡量能不能复工我觉得很悬。Jun wrote: ↑2020-04-25 21:53不是完全没证据，有间接证据表明，痊愈带抗体病人大多数有抵抗力，但是暂时不能肯定这个抵抗力跟抗体浓度是否成正比；不能肯定再次感染的几率是多少，但是我们知道这个几率是低的，在短期内（我觉得一年之内是个 safe bet)。
WHO 的立场是继续隔离继续禁足。他们看问题有他们的角度，结论也不一定就是对的。反正这种事没有什么对错可言。I don't think anyone is particularly adept at dealing with uncertainty, and WHO is clearly no expert in this either.
其实我觉得这次疫情给我的reality check 就是中国和美国其实非常像， 虽说一个是所谓独裁国家，一个是所谓民主国家， 从政府到民众， 都特别像。Jun wrote: ↑2020-04-27 10:54假阴性就算了，假阳性真的挺危险的。这个 cross-reactivity 的问题到底多难搞，我不是做这个的也不知道。
其实FDA也很松，批了不少没经过正式 validation 的抗体检验，大概两星期前才开始 validate。慢慢地会过滤掉不少。
中国的市场确实挺混乱的，但是我看看美国最高指示那丑态也就不好意思说什么了 ...
今天看到新闻说 Regeneron 的 anti-IL-6 药好像没啥效果，所以看上去对 tocilizumab 的前景也有点不妙。病毒的 pathogenicity 尚未搞清楚之前，估计不会出现 silver bullet 那种灵丹妙药。
Stanford 搞这个最拿手了，特有钱。
很唏嘘的是， 前斯坦福校长，也是前FDA头头，前science主编，刚刚在湾区的老人院感染covid-19去世了。Jun wrote: ↑2020-04-28 7:33Stanford 搞这个最拿手了，特有钱。
欧洲的COVID-19死亡几乎一半是 nursing home 里的老人，美国的数据估计也差不多。真是很悲惨，又不能见到家人亲友，就这么孤独地死去。It's no country for old man.
https://www.washingtonpost.com/world/eu ... story.html
太拙劣了。我知道他们是想把智商低的受众筛选出来回信，但是这是打算把真的中国人都筛掉么？...Officials from KCDC's clinical committee for emerging disease control said the pattern does not necessarily reflect a reoccurrence of active infection. Committee head Oh Myoung-don instead attributed positive test results following recovery to "dead," or inactive, virus components still present in patients' cells, multiple outlets based in South Korea reported on Wednesday.
"RNA fragments still can exist in a cell even if the virus is inactivated," Oh said during the conference, according to government-funded media organization Yonhap News Agency. "It is more likely that those who tested positive again picked up virus RNA that has already been inactivated," he continued, going on to explain that the coronavirus' biological interactions with human DNA strands show its lack of ability to "create chronic infections."
换言之，痊愈者可能遇到 secondary exposure，但是体内的免疫力可以干掉它，只不过，viral fragments 仍然会被测试发现为阳性。非常有道理，跟目前所知的病理一致。KCDC shared preliminary findings of an investigation into the retests on April 17, saying the average time between a recovered coronavirus patient's discharge and positive test result was roughly 13.5 days, with an overall range of one to 35 days. Of 137 cases studied, KCDC reported that 61 patients showed mild symptoms, 72 were asymptomatic and four were still being explored. The disease control center also said there were no secondary infections identified in any successive cases.
Slow Medicine 的态度跟很多主流医生的态度是不大一样的。Rather than predominately relying on laboratory testing to diagnose COVID-19, we instead favor careful clinical assessment. This approach not only helps avoid many of the pitfalls of laboratory testing but also promotes the connection between clinicians and their patients. When patients are tested -- which may occur commonly and appropriately for public health purposes -- it is important to be mindful of the possibility of false positives and negatives, particularly if test results are inconsistent with clinical findings. From an infection control standpoint, it should be assumed that all patients with common COVID-19 symptoms are infected, and appropriate precautions should be taken regardless of test results (e.g., home quarantine, mask use, notification of those who may have been exposed).
我还真是高估美国社会了。一个半月前，我还觉得就湾区封城，其他地方不封，这样拖拖拉拉经济停顿时间长了，美国社会会暴乱。原来也不用时间长，三个星期就够了。
