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Medical Needs and the Cruise Industry - Just a Thought


rcdave

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Imagine if the cruise industry, the medical industry, medical academia institutes, hospitals, insurance companies, and yes the government could just have a meeting of the minds there could be thousands of additional hospital beds available worldwide within weeks of the onset of a pandemic.  At the moment, just in the US, look at the number of potential beds/facilities just sitting in ports of some of our most populated cities.  In addition, if the same minds got together, think of what embarkation/ disembarkation port sites could do for testing  - how fast can passengers for an Oasis class ship be processed for boarding – think not boarding,  just a swab swipe and ID.

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25 minutes ago, rcdave said:

At the moment, just in the US, look at the number of potential beds/facilities just sitting in ports of some of our most populated cities.

They have used cruiseships as hotels for large events (Super Bowl) and emergency housing after hurricanes in the past.  Could definitely be a thought if things get out of control with the hospital systems.  

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It's an interesting idea but relative to land buildings I'm not sure cruise ships are a convenient venue for a hospital. 

There are thousands of college dorm rooms becoming available as colleges end their school year and shift to online classes only.  There are thousands of empty hotel rooms.

Comparing the two to a ship it's much easier to accept a patient on a gurney and roll them into a hotel room compared to negotiating a gangway on a ship.  It's much easier to resupply a hotel over time compared to the effort of resupplying a ship that can involve forklifts and cranes then having to deal with small spaces in the bowels of the ship.  If patients succumb I think it's easier to remove them from a hotel compared to a ship.  

I suppose the one benefit would be if they wanted to isolate patients at sea.  Load the ship full of chronically ill and cast them off to keep them away from society.  Pretty drastic measures.  What do you do with the ship afterwards?

Schools are also a possibility.  Easily convert a classroom into a patient ward.  

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21 minutes ago, SpeedNoodles said:

It might help a little if they do that, but unless they  have some secret hoard of ventilators on board, the beds won't be a complete solution.

Like the hospital ships going in they don't plan to use them for infectious diseases rather to shift non-infectious patients to the hospital ships freeing up the land hospital beds for virus purposes.  The folks who were in hospitals for other reasons.

Listening to the president, he never said they would use the Carnival ships, or that they would use them in a medical capacity.  He simply stated Carnival made the offer.  They could house medical personnel brought in to work on the hospital ships.  Or for some other purpose.  The president had no plans to use them, he simply stated the offer was made. 

Good publicity for Carnival and potentially for cruise ships in general if the government took them up on the offer.  Cruise ships being part of the solution.  They must be safe since the government used them, etc.  

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20 minutes ago, Zambia-Zaire said:

Apparently, it's being reported that there's a real possibility that a malaria vaccine will work on the Covid19 Virus.

Fake news. It's already been debunked, and not helped by the fact the President went and then repeated the statement after being TOLD it was not true.

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https://www.reuters.com/article/us-health-coronavirus-bayer/bayer-donates-three-million-malaria-tablets-to-u-s-for-potential-use-against-coronavirus-idUSKBN21637E

 

@JLMoran can you provide a link debunking the use of the drug chloroquine(malaria drug) for Covid-19...have not found anything debunking the possible use of the drug to combat Covid-19.

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2 minutes ago, Zambia-Zaire said:

https://www.reuters.com/article/us-health-coronavirus-bayer/bayer-donates-three-million-malaria-tablets-to-u-s-for-potential-use-against-coronavirus-idUSKBN21637E

 

@JLMoran can you provide a link debunking the use of the drug chloroquine(malaria drug) for Covid-19...have not found anything debunking the possible use of the drug to combat Covid-19.

So here is the link, although you'll have to scroll to the entry for 3:22 PM today (March 19) -- https://www.washingtonpost.com/world/2020/03/19/coronavirus-latest-news/

I will correct my earlier statement, and admit that I got the key part of it wrong -- it has not been debunked that the drug is effective; what was incorrect was that the FDA was approving use of the drug immediately, when in fact they are insisting on extensive clinical trials first. Since I can't directly link to that specific entry and I don't know how far you'll have to scroll to get there in even a few hours, I'm quoting the entire piece here (it's short), with emphasis added for the key points:

Quote

President Trump incorrectly said in a Thursday news briefing that chloroquine, a malaria drug, has been approved by the Food and Drug Administration to fight the novel coronavirus and that there were plans to “make that drug available almost immediately.” But after Trump spoke, FDA Commissioner Stephen Hahn clarified that chloroquine would first need to be tested for use on the virus.

“We want to do that in the setting of a clinical trial, a large pragmatic clinical trial,” Hahn said.

Trump had called the drug a possible “game changer.”

“That’s where the FDA has been so great,” he said. “They’ve gone through the approval process, it’s been approved. They took it down from many, many months to immediate, so we’re going to be able to make that drug available by prescription.”

Later Thursday, during a video teleconference with governors, Trump repeated the incorrect claim several more times. Hahn, Trump said, “got it approved very quickly; I won’t even tell you how quickly."

”But let’s put it this way," Trump added. “It’s approved, and we’re encouraging you to take a look at it. We have ordered a lot of it. And you can do it by prescription.

But Hahn earlier emphasized the importance of testing and safety.

“We need to make sure that with these new treatments, we’ll get the right drug to the right patient at the right dosage at the right time,” he said. “As an example, we may have the right drug, but it may not be in the appropriate dosage from right now, and that may do more harm than good.”

So it's in testing and they are trying to confirm both that it works and that the current dose in use is not excessive.

Since I was mistaken about that, I did a bit of searching to learn more. Here's another article that covers some basics about the drug, what's known, and what isn't yet. And another article from Wired that goes into more depth about the roots of the document that started all of this speculation. Per both articles, the biggest problem right now is that none of the work that's indicated it may be beneficial was done in a double-blind study. In fact, after reading the Wired article, it seems that wasn't even any actual testing done by the authors; instead it's more of a "meta study" looking at the results of a bunch of other studies and making an effort to extrapolate efficacy against Covid-19. So there is a lot of risk of confirmation bias or other bias in the document's authors that might result in overstating the real effects of the drug. This is why the FDA is (rightly) insisting on proper double-blind clinical trials. Key quote from that Wired article:

Quote

“Many drugs, including chloroquine or hydroxychloroquine, work in cells in the lab against coronaviruses. Few drugs have been shown to work in an animal model,” says Matthew Frieman, a microbiologist who studies therapeutics against coronaviruses at the University of Maryland. What happens if you put the drugs into animals? No one knows yet. Probably nothing bad, because they’ve been used for decades. But maybe they don’t actually help a person fight off the virus.

Chloraquine’s action, Frieman says, “has been known for some time for other coronaviruses but never developed as a tested therapeutic in humans. There is reason to believe that will change now, along with other therapeutics that have efficacy in the lab.” That’s because the new coronavirus is encouraging research to pick up again on just about anything that has ever shown any effect on coronaviruses, and some new ideas too.

So it may have potential use, from the sound of it more as a way to reduce the symptoms than to outright kill the virus. If true, that'll be fantastic so we have a way to reduce the number of hospitalizations, or at least shorten them while patients' immune systems get a chance to fight off the virus. But like with so much else, it's going to take time and careful study to confirm one way or the other. I'll hope for it to work along with you, but in the meantime we'll have to keep calm and carry on.

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@JLMoran this article on the use of Chloroquine you provided in your post, confirms all the information I've been researching, on why the potential of the drug come highly recommended. The FDA Commish Hahn appear, imho, to be shorting Trump's suggestion the FDA looking into the use of this drug, in both the CNBC & Washington Post articles, for some apparent reason; and, hiding behind needing trials, when the drug is not only widely known(use since 1940); but, has been used effectively in treating SARS, a coronavirus cousin of Covid-19, as well as against malaria & autoimmune disorders. The drug is already in generic form with little to no history of "Side Effects"...so it boggles the mind why commissioner Hahn, appear to be resisting on reporting of its potential use, in this battle...the dosage is not difficult to determine. The drug "Remdesivir" is another potential drug, an anti-viral, that's already in current use in China, in combatting Covid-19.

However, great find & thank you for posting...I suggest everyone should read all three article, you linked to your post. ?

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34 minutes ago, Zambia-Zaire said:

The FDA Commish Hahn appear, imho, to be shorting Trump's suggestion the FDA looking into the use of this drug, in both the CNBC & Washington Post articles, for some apparent reason; and, hiding behind needing trials, when the drug is not only widely known(use since 1940); but, has been used effectively in treating SARS, a coronavirus cousin of Covid-19, as well as against malaria & autoimmune disorders.

So while I understand your desire for a rapid release of some medical option to treat this novel virus, I've actually been involved in presenting the trials of new drugs to the FDA (WAAAAY back when I was getting my Masters degree and doing whatever basic temp work I could find to pay the bills). Yes, it's a bureaucracy of byzantine proportions. But it's very much built on the rigors of science and thorough testing. The FDA is probably looking at a few really important points that must be clarified before they start instructing doctors to administer it en masse:

  1. Just because this drug is effective against SARS does not guarantee it's going to be effective against Covid-19. As you noted, the two are cousins. A big difference is that Covid appears to include genetic material from a virus that infects bats, which is something that does not normally happen and could lead to big differences in the drug's efficacy.
  2. If it is effective against Covid-19, what is the minimum effective dose? It could be a lot higher than what's needed to treat SARS, so much so that the side effects rapidly outweigh the benefits and severely limit the apply to supply the drug to a broad population. OR it could be (a lot) lower, meaning there's more to go around and patients get fewer side effects. What side effects? Look here; they aren't pleasant.
  3. If it's effective, how much does administering the drug reduce the patient's symptoms vs. no drug? And how much does it reduce the duration of the illness?
    1. When I was helping to put together a presentation on a new weight-loss drug to the FDA, this was a big topic during the presentations. You have to show statistically significant reduction in one, the other, or both to get approval. Why? Because...
    2. even a cheap drug will make the manufacturer a ton of money at times like these with high demand and tightening supply, and people will find ways to price gouge without crossing the legal border. And if it's only minimally effective at treating the disease, there's little reason to separate the patients who are already facing possibly large medical bills from this disease from even more of their money.

The same line of questioning will apply to the drug Remdesivir, along with additional questions about how safely purely it's manufactured. Don't scoff at this; compounding pharmacies, especially overseas ones, have been taking a beating over the poor quality of their products as certain states in the US that still support the death penalty have been going to them more and more in their quest for the lethal injection cocktails they need to perform executions, which have been outlawed here and in many countries and require novel alternatives.

Believe me, we all want something that will let us get out of our homes faster and back to normal ASAP. But science and tests for safety and efficacy don't care about that; the research takes as long as the research takes. Yup, I've been on that side of the work in my past as well (though not for anything nearly as urgent). Some regulations can be loosened to help speed things along a bit, but the work still has to be done and proven. Consider the flip side: We rush out this drug without fully testing it, and it's not just ineffective but leads to thousands of deaths as people who would have been hospitalized were given the pills and sent home instead of being admitted to the hospital. No one in the FDA who's a licensed MD and scientists wants that on their conscience.

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There are valid reasons why the FDA approval process is lengthy. 

While cutting red tape sounds great in a press conference, if that cuts corners in the FDA approval process that may not be a good thing for a lot of valid reasons.  If additional funding is provided so some phases of the approval process can be accelerated that's another matter.

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