Category: health

Hydroxychloroquine and chloroquine are not only useless in treating Covid-19, but very harmful

May 22, 2020 • 10:30 am

UPDATES: The discussion of this paper has gone back and forth, and the cause is that neither Alex nor I read the paper carefully. I just skimmed it, and Alex read it quickly but paid most of his attention to the tables. That led to this first update in which he concluded (and I agreed) that the study wasn’t very useful at all:

UPDATE 1:

In two comments below, my own physician, Dr. Alex Lickerman, who carefully read the study I describe below  (see his first comment and his second), noted that the sickest patients were the ones more likely to be given the chloroquine drugs, and were also the patients with the highest comorbidities—factors like heart disease that would tend to make them sicker. In other words, as Alex notes,

So–was it the drugs that were responsible for their increased likelihood of death or the risk factors already known to increase the likelihood of death? We simply can’t tell from this study. This is the problem with the observational study design. We CAN almost certainly say that hydroxychloroquine and its ilk don’t improve survival in COVID-19, but whether or not they increase mortality in COVID-19 we don’t yet know.

This is only part of his analysis; read the whole thing in comment 1. He also notes in his second comment that there is no evidence that using hydroxychloroquine as a preventive has any benefit.

I am guilty of not having detected the flaws in the study, which are, I found, not even clearly pointed out by its authors in the traditional “here-are-some-weaknesses-in-this-study” part of the paper, and I thank Alex for the clarification. But even more culpable are the reviewers of that study, who did not insist on a clear outline of its limitations, as well as the medical/science journalists, who touted the study uncritically (like me!) Alex has helped me learn that many medical studies, even in journals as reputable as The Lancet, are pitifully weak or even fatally flawed.

UPDATE 2: In a very useful comment, reader BillyJoe noted that the paper does indeed say that the paper controlled to some extent for comorbidities, so its conclusions are stronger than we thought: we can have more confidence in its conclusions that hydroxychloroquine and chloroquine are positively dangerous when given to people sick with Covid-19.  Alex then said yes, he was wrong about the study not taking into account comorbidities, and has posted this comment in the thread:

Yikes! I’m guilty of the same criticism I made of others: not reading the trial carefully. You are absolutely correct that the authors made good-faith attempts to control for the inequalities/confounding variables between treatment groups. This is still a statistical adjustment, not a direct measurement as would be done in a randomized trial, so must be taken with a grain of salt, but to the authors’ credit, they address that.

The problem does remain that when you do the randomized trials, results are often different because of confounding variables the authors didn’t know about and therefore weren’t able to statistically adjust for—but also because sometimes their multivariate analysis (meant to adjust for known confounding variables)–also wasn’t adequate. So we still need a randomized trial to really know the answer definitively.

Nevertheless, I withdraw my criticism of the authors and the Lancet reviewers. I guess this is a good example of why science and statistics should always be done by more than one person! I’m quite embarrassed to have made this mistake. I apologize to readers and to our host, who must now fall on his sword with me.

___________________

 

Well, it’s official (I mean, of course, “provisional”): a new and large study published in the medical journal The Lancet (second link below; click screenshots to go to both articles) confirms that hydroxychloroquine and chloroquine not only don’t help patients seriously ill with Covid -19, but increases their mortality (in other words, kills them). Below is the CNN report, with a more layperson-y summary (my emphasis):

Researchers analyzed data from more than 96,000 patients with confirmed Covid-19 from 671 hospitals. All were hospitalized from late December to mid-April, and had died or been discharged by April 21.

Just below 15,000 patients were treated with the antimalarial drugs hydroxychloroquine or chloroquine, or one of those drugs combined with an antibiotic.

All four of those treatments were linked with a higher risk of dying in the hospital. About 1 in 11 patients in the control group died in the hospital. About 1 in 6 patients treated with chloroquine or hydroxychloroquine alone died in the hospital. About 1 in 5 treated with chloroquine and an antibiotic died and almost 1 in 4 treated with hydroxychloroquine and an antibiotic died. 

Researchers also found that serious cardiac arrhythmias were more common among patients receiving any of the four treatments. The largest increase was among the group treated with hydroxychloroquine and an antibiotic; 8% of those patients developed a heart arrhythmia, compared with 0.3% of patients in the control group.

Note that the mortality in the control group was about 9%, rising to about 16% with chloroquine or hydroxychloroquine alone, and 20-25% when either of the chloroquine drugs was supplemented with an antibiotic (remember, antibiotics kill bacteria, not viruses like Covid-19. Clearly, refraining from using these drugs is the wisest course of action.

Here’s The Lancet study that went online today, and the findings and summary, while more comprehensive, are the same (“macrolides”, as is meant here, refers to a class of antibiotics that includes erythromycin). If you can’t access the paper, a judicious inquiry will yield it.

 

Findings:

96 032 patients (mean age 53·8 years, 46·3% women) with COVID-19 were hospitalised during the study period and met the inclusion criteria. Of these, 14 888 patients were in the treatment groups (1868 received chloroquine, 3783 received chloroquine with a macrolide, 3016 received hydroxychloroquine, and 6221 received hydroxychloroquine with a macrolide) and 81 144 patients were in the control group. 10 698 (11·1%) patients died in hospital. After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity), when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531), chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each independently associated with an increased risk of in-hospital mortality. Compared with the control group (0·3%), hydroxychloroquine (6·1%; 2·369, 1·935–2·900), hydroxychloroquine with a macrolide (8·1%; 5·106, 4·106–5·983), chloroquine (4·3%; 3·561, 2·760–4·596), and chloroquine with a macrolide (6·5%; 4·011, 3·344–4·812) were independently associated with an increased risk of de-novo ventricular arrhythmia during hospitalisation.

Interpretation:

We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.
You know the upshot: DO NOT TAKE HYDROXYCHLOROQUINE as a Covid-19 drug, as it causes heart problems and, overall, is much worse than standard treatment, doubling your chance of dying. This also means that since there’s yet no evidence that the drug staves off the virus, the side effects on those taking it as a preventive (like Trump) will also include heart issues. That’s been known from earlier but smaller studies.

What Trump is doing is not only injurious to himself (I suspect his heart is a ticking time bomb given his weight and penchant for McDonald’s food), but sets a terrible example to the public. It’s a President flaunting quackery, and of course his supporters are more likely to dose themselves or ask for the drug if they get the virus. The saving grace is that no decent doctor will give an infected patient hydroxychloroquine.

But remember, Trump’s osteopath official physician, Sean Conley, in consultation with Trump, decided that the potential benefits outweighed the risks when prescribing Trump the drug as a preventive. That’s doubly shameful: a faux President being treated by a quack physician with a useless drug, and the President bragging about it and lying about the drug’s “benefits.” No wonder other countries look upon the U.S. with pity! 

Trump’s doctor, an osteopath, approved his patient’s use of hydroxychloroquine. That’s quackery, regardless of the doctor’s credentials.

May 20, 2020 • 11:00 am

As you know, last week Donald Trump asserted that he was taking hydroxychloroquine as a preventive for coronavirus, said that thousands of front-line medical workers were also taking it for the same reason, and argued that the drug had proved efficacious against the virus.  Yesterday I thought that all three claims might be lies (the first two certainly are), but now the president’s physician, Sean Conley, has weighed in saying that the Prez is indeed dosing himself with the nostrum, and on Conley’s advice.

It turns out that Sean Conley is an osteopath, as outlined in this Guardian article (click to read the screenshot). Here are his credentials:

Conley received his Doctor of Osteopathic Medicine degree from the Philadelphia College of Osteopathic Medicine in 2006. He is a 2013 graduate of the Emergency Medicine Residency Program of Naval Medical Center Portsmouth in Portsmouth, Virginia. He received the Honor Graduate Award, Nurses’ Choice Award for Outstanding Senior Resident Award, and the Resident Research Award.

 

Here’s the letter testifying to Trump’s use of the drug on the advice of Conley:

Now I’m not going to say that Conley is a quack just because he’s a DO rather than an MD, though it is odd. Many osteopaths have training nearly identical to that of MDs, and some, I’ve heard, are fine physicians. But this one isn’t.

For Conley is violating the first part of the Hippocratic Oath (well, the revised version of that oath): “First do no harm.” And that’s the problem with hydroxychloroquine: it’s not only not efficacious against coronavirus, but it can be dangerous, causing heart problems, hallucinations, paranoia, and other “neuropsychiatric symptoms” (see article below), which gives one pause.

And Trump isn’t exactly the picture of health. According to the Guardian, he weighs around 239 pounds, just at the threshold of being “obese” (not “morbidly obese”, though, as Nancy Pelosi stated), sleeps 4-5 hours per night, eats a lot of junk food (especially from McDonald’s), and gets no exercise save golf (he probably uses a cart).

Only a fool, I think, would prescribe a useless drug that could be dangerous for someone in Trump’s condition—indeed, for someone in any condition.  Conley is not practicing evidence-based medicine, and in behaving this way is endangering his only patient. But give Trump some “credit”, too, for he knows the stuff doesn’t work and is still taking it—perhaps to reassure Americans that there can be a preventive. As Trump argued, “What do you have to lose?” My answer, “Your life, fool!” Conley’s claim in the letter that “the potential benefit from treatment outweighed the relative risks” is pure cant—in fact, the statement cannot possibly be true based on the data we have.

The FDA itself has declared that hydroxychloroquine “has not been shown to be safe and effective”. What on earth is Trump’s doctor doing?

At any rate, the article below from Just Security (click on screenshot), ends with 9 questions for “Dr.” Conley.

Yes, it would be good if Conley answered those questions, but he won’t. Here are four of them:

4. What is the complete medical record of Donald Trump that might put him at risk of dangerous side effects in taking the drug? More specifically, does Trump have any history of heart trouble or disease, or any other medical condition that would make it dangerous for him to take this drug?

5. Conley’s memo states: “After numerous discussions…we concluded the potential benefit from the treatment outweighed the relative risks.” The use of “we” in this sentence is notable. Is Dr. Conley saying that he would not have recommended use of the drug? In other words, is Dr. Conley hiding that Trump’s views outweighed the physician’s sound medical advice of the risks? Why did it take numerous discussions?

6. If it is true that Trump is taking this drug, why has Dr. Conley knowingly prescribed a drug that the FDA and other authorities have determined is potentially fatal, and, moreover, whose beneficial effects on treating COVID-19 are unproven? Why has Dr. Conley prescribed a drug possibly risking the life of the president and in violation of FDA guidelines, medical standards, ethics, and professionalism?

9. Medical researchers have concluded that hydroxychloroquine may cause neuropsychiatric symptoms, “including agitation, insomnia, confusion, mania, hallucinations, paranoia, depression, catatonia, psychosis, and suicidal ideation.” Has Dr. Conley properly assessed his patient, President Trump, for his susceptibility to these symptoms? Since Trump has been taking the drug has Dr. Conley observed that it has produced or exacerbated any of these symptoms in President Trump?

I know that some people will be wishing for Trump’s demise from this drug (you can see it among the usual-suspect bloggers). I don’t wish for anyone’s demise, though I want Trump to be defeated in November. But by putting his imprimatur on the use of hydroxychloroquine to prevent Covid-19 infection, Conley is setting a terrible example not just for those worried about the virus, but for anyone who has confidence in modern medicine.

Sean Conley, quack

h/t: David

Faith-soaked physician to conduct study of prayer in curing Covid-19

May 2, 2020 • 10:30 am

Does prayer work to cure diseases? Anecdotal evidence from Lourdes, where amputees and the eyeless aren’t cured, suggest not. And we all know the results of the Templeton-funded study of the effects of intercessory prayer on recovery of cardiac patients, the most thorough study of intercessory prayer yet, involving over 1800 patients (Benson et al. 2006). Those results: no effect of prayer; or, as the study notes:

Our study had 2 main findings. First, intercessory prayer itself had no effect on whether complications occurred after CABG. Second, patients who were certain that intercessors would pray for them had a higher rate of complications than patients who were uncertain but did receive intercessory prayer.

In other words, the only effect even close to being statistically significant was that patients who knew they were being prayed for had more complications than patients not prayed for. Prayer worked in the wrong direction! That must have disappointed Templeton!

Further, a 2006 meta-analysis of 14 studies of medical effects of intercessory prayer showed no significant effects overall. The results and conclusions are in a red box below; note that the authors advise “that further resources not be allocated to this line of research.” (Click on screenshot to go to the study.)

But someone disagrees about there being no more need for research: Dr. Dhanunjaya Lakkireddy, a cardiologist at the Kansas City Heart Rhythm Institute. Lakireddy is doing a double-blind study of the effect of intercessory prayer on the mortality rates (and other indices of “being cured”) from Covid-19. NPR, which always has a weakness for the numinous, highlights it in the article below (click on screenshot):

There’s no audio yet, but the site says there will be. UPDATE: The online version is here, and it’s short (2 minutes) and not the same as the transcript. But there’s little difference between them.

Lakkireddy plans a study of 1000 patients in intensive care with Covid-19. Lakireddy is a true believer, and it shows in his comments to NPR (below). The emphases are mine.

“We all believe in science, and we also believe in faith,” Lakkireddy says. “If there is a supernatural power, which a lot of us believe, would that power of prayer and divine intervention change the outcomes in a concerted fashion? That was our question.”

We believe in faith? What does that mean? Faith is belief—belief without strong or convincing evidence! Perhaps Lakkkireddy means he believes that faith can cure, which is what he’s testing. But saying that we “believe” in science is a bête noire of mine, and bothered me enough that I wrote an article in Slate arguing that “faith” in science really means “confidence in the reliability of the methods and its outcomes”, not “blind adherence to unevidenced claims,” which is what religious faith is.

But wait! There’s more! Lakkireddy, who has dipped his toes into several faiths, and clearly has a weakness for the numinous, goes on:

The investigators will assess how long the patients remain on ventilators, how many suffer from organ failure, how quickly they are released from intensive care and how many die.

Lakkireddy describes himself as “born into Hinduism,” but he says he attended a Catholic school and has spent time in synagogues, Buddhist monasteries, and mosques.

“I believe in the power of all religions,” he says. “I think if we believe in the wonders of God and the universal good of any religion, then we’ve got to combine hands and join the forces of each of these faiths together for the single cause of saving humanity from this pandemic.”

He already knows that religion will help with the pandemic! Is this the right guy to conduct a double-blind study on Covid-19? He has an interest in the outcome, of course, but one can only hope that he’s being supervised by other people to ensure rigorous, double-blind methodology. But wait! There’s still more!

Scientific studies of the power of prayer have been attempted before. Lakkireddy’s description of his study lists six previous clinical trials involving religious intervention. Some showed slight improvement for patients receiving prayer. Other studies have found no significant prayer effect.

Note that the “other studies” links to the meta-analysis above: a summary of ALL studies, and a summary that shows no effect of prayer overall. As far as I can see, previous studies cited by Lakkireddy were already incorporated into that meta-analysis. Shame on NPR for pretending that a meta-analysis of 14 studies is the same thing as a group of studies.

Lakkireddy says he can not explain how people praying remotely for someone they don’t know (or a group of people,) could actually make a difference in their health outcomes, and he acknowledges that some of his medical colleagues have had “a mixed reaction” to his study proposal.

“Even from my wife, who’s a physician herself,” he says. “She was skeptical. She was, like, ‘OK, what is it that you’re looking at?”

Lakkireddy says he has no idea what he will find. “But it’s not like we’re putting anyone at risk,” he says. “A miracle could happen. There’s always hope, right?”

Yes, there’s always hope of a miracle. But given the meta-analysis above, which recommends that “we should stop this nonsense”, there are no data to give us hope. There are data to give us no hope. And hope is really something that should not be entertained by a principal investigator, for that gives rise to confirmation bias. You could, for example, do p-hacking, hoping that at least one outcome will be in your favor, reaching statistical significance.

You can learn more about Lakkireddy’s study at the “clinical trials” section of the National Institutes of Medicine, which registers all proposed and ongoing trials. It also adds the interesting tidbit that Lakkireddy’s prayers will involve those of five different denominations. Is Lakireddy testing which religion is “right”, i.e., prayers to its god are the only ones that work?

I can find no information about funding on the site.

Brief Summary:

This is a multicenter; double blind randomized controlled study investigating the role of remote intercessory multi-denominational prayer on clinical outcomes in COVID-19 + patients in the intensive care unit. All patients enrolled will be randomized to use of prayer vs. no prayer in a 1:1 ratio. Each patient randomized to the prayer arm will receive a “universal” prayer offered by 5 religious denominations (Christianity, Hinduism, Islam, Judaism and Buddhism) in addition to standard of care. Whereas the patients randomized to the control arm will receive standard of care outlined by their medical teams. During ICU stay, patients will have serial assessment of multi-organ function and APACHE-II/SOFA scores serial evaluation performed on a daily basis until discharge. Data assessed include those listed below.

I’m torn between thinking this is a waste of time, as an overview of previous studies shows no effect of prayer—not surprising in view of the inefficacy of God in “faith based healing” as practiced by various Christian sects, of the failure of prayer to restore missing limbs and eyes, and of no evidence for the presence of any God)—and, on the other hand, wanting it to proceed because, if the study is done properly and with sufficient rigor, it’s not going to support evidence for a prayer-answering God. (I do think that, as a true believer, Lakkireddy should let others run the study and analyze its results).

Now it is possible that the study will “work”: either prayer will have a significant effect, or prayers for one religion will have a significant effect. (If only Jewish prayers work, for example, will Christians, Hindus, and Muslims immediately abandon their faith? I wouldn’t bank on it!).

In Faith Versus Fact I detail what kind of results would make me (tentatively) accept a deity. Consistent effects of one kind of prayer (or all kinds of prayers) on healing would make me sit up and take notice, that’s for sure. But we haven’t had that.

Two more points. First, if the study shows no effect of prayer, I expect NPR to do a followup reporting that result. (They surely would if they find a positive effect!). And I will badger them about this after the study ends in August.

Finally, the mere existence of this study gives the lie to religionists’ claim that “Science cannot study the supernatural, for that realm is off limits to naturalistic analysis.” But, as even Lakkireddy admits, this is a case in which science can indeed study supernatural claims! But we shall see if they’re supported. These studies usually have a one-way effect: if they show an effect, the faithful trumpet it to the skies. But if they show no effect, the faithful quietly shelve the results and speak no more of them.

h/t: Bob

More deaths caused by religion: 12 states exempt religious services from “stay at home” strictures

April 5, 2020 • 11:15 am

The Ohio woman interviewed in the tweet below is insane: she think sthat being “covered in Jesus’s blood” protects her from infection by coronavirus. And she’s not alone: as the CNN report says, 14 (now 12) states are exempting religious gatherings from “stay in place” orders. Then she brags about going to the grocery store, WalMart, and the Home Depot. That means she could easily infect people who aren’t religious, or aren’t of her faith. That’s irresponsible if not immoral. And it should be illegal.

Here’s the CNN article about which states are being idiotic about this, giving religion a pass and putting unevidenced faith above public health. The article, though, names 12 rather than 14 states. (Click on screenshot.)

The list of the Stupid States who do this (the article gives details):

  • Arizona
  • Colorado
  • Delaware
  • Florida
  • Kentucky
  • Michigan
  • New Mexico
  • North Carolina
  • Pennsylvania
  • Texas
  • West Virginia
  • Wisconsin

Now some of these are worse than others: Wisconsin, for instance, allows no more than ten people in the worship space, and they have to adhere to social-distancing requirements. However, most of the rest of the states consider religious services to be “essential activities” and exempt them from any strictures, even saying that they’re protected by the First Amendment.

But they aren’t—not in my view. For these people aren’t just risking their own health and lives by going to services—they’re endangering the entire community, religious or not. These people, after they leave church, will go to grocery stores, pharmacies, and, like the woman above, WaMart and Home Depot. I can’t see any sensible view, or interpretation of the First Amendment, that allows religious services that pose a serious risk to the health of the nation, and, indeed, could lead to the death of those who don’t go to those services.

These crazy exemptions resemble those of the many states (discussed in Faith Versus Fact) that allow exemptions from vaccines if you have religious objections, or those states who go easy on parents who kill their children by using faith healing rather than scientific medicine. In fact, all but five of the 50 U.S. states allow parents to get religious exemptions from vaccinating their children (the enlightened states are Mississippi, California, West Virginia, Maine, and New York).

We know that religious congregating is dangerous; there are plenty of reports of illnesses and deaths of those who congregate to worship their benevolent and powerful god. They could, for the time being, worship remotely. Wouldn’t a benevolent God want them to do that? Nope, he seemingly wants his sheep to go out into the pastures and kill other sheep.

At any rate, if Hitchens were alive he’d have something to say about this. Without his eloquence, I can merely point this out and ask you to pass it on. Or, if you live in one of these states, complain to your representatives.

Straight talk about coronavirus, and a chance to ask questions of a primary-care doctor

April 3, 2020 • 9:00 am

I don’t intend to fill this site with information or bad news about coronavirus, as you can get that most everywhere, including the New York Times, and most of the detailed stuff is above my pay grade. But I thought the information below was well worth passing along.

Are you tired of hearing the advice to wash your hands and keep social distance, given that you’ve already heard it a gazillion times on Facebook and we already know what to do? Then it’s time to educate yourself further.  My primary care physician, Dr. Alex Lickerman, is the best doctor I’ve ever met, and I’ve known many. He’s not only extremely knowledgeable (he’s young but was head of primary care at the University of Chicago Hospital for seven years, leaving because he didn’t like the strictures of rapid patient turnover), but reads the scientific literature thoroughly and bases his advice on both that and his own experience. He also posts on his two-doctor practice’s website (he calls it a “blog”), ImagineMD, and has been putting up his thoughts and recommendations about Covid-19, updating them as new information becomes available. (You can sign up for a free email subscription.)

The post below, which just came out, is the sixth update in a Covid-19 series that started in February (links to the first five are at the bottom of this post).

Now I know that not everyone will be on board with any doctor’s take (it seems that everyone is an expert on coronavirus!), but do read it and take what you want from it (click on screenshot). I asked Alex if he’d be willing to answer readers’ questions, and he said “Yes. My aim is to stamp out misinformation and spread correct information wherever possible. I’ll answer as I have time.”

So I can’t guarantee that all readers’ questions will be answered or addressed, but if you want to know something, by all means put your query in the comments. But first read the article (click on the screenshot).

Topics covered in the post above include:

  • What are the symptoms and typical course of the disease?
  • How does testing for the virus work and how reliable is it?
  • How is the virus transmitted?
  • Should you wear a mask in public?
  • Can pets carry coronavirus?
  • How do you deal with “coronachondria”—the extreme anxiety associated with people experiencing this pandemic?
  • How do you deal with the possibility of gaining weight now that our normal activities, and much of our exercise, has been curtailed?
  • How long is this pandemic going to last?

After you read it, feel free to leave questions on these topics and others related to coronavirus in the comments.

Finally, the video below is proffered by Professor Ceiling Cat (Emeritus): Masks may soon be required or recommended for anyone going out in public, at least if you’re to meet other people. I found this video on how to make a dust mask, and given that it’s not easy for non-doctors or non-scientists to buy “regular” masks, this one looks acceptable, and has the advantage of being washable and therefore reusable. I offer this, again, for what it’s worth: I’m not a doctor or epidemiologist. It’s surely not great protection from inhaling aerosolized virus, but will keep you from touching your face (except for your eyes), and it should be a good reminder, when worn, not to do so.

 

Advice about Covid-19 from a pulmonary critical-care doctor

March 29, 2020 • 11:15 am

Reader Rick sent me this video, which I’ve listened to in its entirety (57 minutes). It’s made by Dr. David Price, a critical pulmonary-care specialist at Weill Cornell Hospital in New York City. Usually he deals with all kinds of respiratory ailments, but, as he says, now he’s dealing only with COVID-19 patients. Here Price offers advice, and it’s somewhat reassuring, as the precautions you need are not onerous but are IMPORTANT. Reader Rick added this information.

I found this encouraging.

Dr. David Price is a critical care pulmonologist. He does a conference call describing  his experience.  It’s a long video, but quite valuable.

Bottom line: COVID-19 is becoming well understood.  If you practice good hand cleanliness procedures and distancing, you have nothing to worry about.

  1. Hand to face is the critical path. Spray, rarely.
  2. Get into the habit of knowing where your hands are and be sure they are clean. (sanitizer)
  3. Wear a mask, not to protect you, but simply to avoid hand to face contact.
  4. You don’t need an N-95 mask. Anything will do.  Give N-95 to your local hospital.
  5. Carry sanitizer with you when you go out.
  6. Be friendly and social, just stay 6′ away.
  7. Shrink your social circle.  You don’t want to be in large groups.
  8. Go to the hospital only if you are short of breath. Headache, fever, muscle ache, cough – stay home.
  9. Course of the disease is 7 -14 days. Immunity then follows.

If  you follow the simple rules, you will not get COVID-19.  This should be liberating.

Again, I’m not a doctor and so you must make your own judgment about this doctor’s advice.  The first 20 minutes of the video are recommendations for general behavior (i.e., wear a mask in public, but only to keep you from touching your face. Price doesn’t mention gloves).  From 20-30 minutes in, Price discusses what you should do if you think your’e infected, or if you have a family member who is infected. From 30 minutes to the end, Price deals with general questions.

How to remove latex gloves without touching the outsides

March 28, 2020 • 12:00 pm

I’m not a doctor, though the advice not to wear gloves while shopping or going about in public was given to me by my doctor.

Doing grocery shopping while wearing latex gloves (some of my friends use cotton gloves, which doesn’t seem to be any better) is, the doctor said, a waste, for the ultimate object is to avoid getting virus in your eyes, nose, or mouth, usually by touching your face. If you touch your face in the market or on the way home while wearing gloves, you’re just as liable to be infected as if you do it without gloves. More important, glove-wearing doesn’t relieve you of the burden of washing your hands, since you’d have to do that anyway after removing your gloves. That involves touching the outsides of the gloves and thus potentially getting your hands contaminated.

But for those who want to wear gloves and discard them without washing your hands, this video tells you how to do it. That said, even if I did this I’d still wash my hands afterwards. That’s just a quick second line of defense.

Medical workers, of course, have to wear gloves as they can’t wash their hands every two minutes, and they constantly change gloves not to avoid contaminating themselves but infecting other patients. In that case the video below is good practice, but I’m sure they adhere to it already.

As for me, I’ll eschew the gloves until I hear a good reason to wear them. In their place I’m washing my hands after every task that could potentially contaminate them.

Needless to say, I’m not touching other people nor shaking their hands.