#(although the first was the one in the Ravager Control hunting trial)

[scrion7]

i am. slightly deranged. do not try this at home. Especially on hard difficulty. soulsborne/monster hunter experience is advised.

*I did use the tearblaster to remove the disc launchers and cannons, because I'm not a masochist. Yet, anyway. It could probably be done...

a how to under the readmore, because my suffering should at least be productive to society.

By staying at the Thunderjaw's flanks, you can limit which moves it can do. If positioned correctly, the only moves it can do are the tail sweep, the tail slam, and the single, double, and quadruple stomps.

The tail sweep cannot be punished well with melee attacks, as it is almost always followed up with a tail slam. Long roll through it and DON'T follow up.

The tail slam is your best opening to attack the tail. Quick roll or walk away from it, then punish with a single heavy. Eventually, the tail will be severed, removing the tail sweep and slam from the Thunderjaw's moveset.

If you accidentally end up in front of the Thunderjaw, it can also do a quick bite, a lunging bite, and a charge, depending on how far away you are. The quick bite can be long rolled through and followed up with a heavy attack, but I would recommend using the time to reposition to bait more stomps. Don't roll away from the Thunderjaw, as that invites a charge or lunging bite.

The lunging bite can technically be punished with a heavy attack if you roll with the Thunderjaw, but it often misses. The full charge can't be punished at all unless the Thunderjaw runs into a wall or something. Try to avoid these attacks entirely by sticking to the Thunderjaw's side.

The stomp is the best move to punish. The issue is that the wind ups for the single, double, and quad stomps are essentially identical, and as such the single and double stomps CANNOT be punished with heavy attacks. ALWAYS assume it's doing the quad stomp. The stomp has a far larger hitbox than you might think too, so don't overextend.

To punish the quad stomp, first long roll away from the first stomp, then immediately light attack back in immediately, as it's doing the second stomp. If you are too close to the Thunderjaw's other leg, don't light attack and instead get back in position. If it raises up its leg again to do the quad stomp, long roll away again and this time, punish with a heavy attack followed by two lights.

NOTE: If still attached, the tail has a hitbox during the stomp attacks as it waves around, although the damage is very light. It is up to you to decide if you want to eat the damage and hit the tail during the stomps, or to be more careful and aim for the legs.

The Thunderjaw I fought was the one in Cauldron Zeta. The limited space mostly hurt me, as I got stunlocked multiple times when it stomped me against the walls of the Cauldron with nowhere to roll to. Get an open arena and remove any additional machines first.

I also had on the Nora protector heavy with melee resist coils, alongside a blue spear damage mod. Probably not necessary but nice to have.

I currently do not know if the RoboRex has any disc launcher or cannon moves it can do when Aloy is in the sweet spot. I'd put good money on it not, though. Edit soon to come?

EDIT: Although there aren't any point blank range cannon attacks, Thunderjaws do in fact have a disc attack when you are underneath them. It's very hard to see coming and even harder to dodge without seeing the launchers fire. Take out BOTH disc launchers before trying to fistfight a RoboRex; It can still do disc attacks with only one attached. On a related note, don't melee Redmaw. Talanah, I love you, but she draws aggro and Redmaw ends up charging all over the place. Redmaw's health buff makes it worse. Still doable, but I gave up and froze/disc launchered Redmaw halfway through. Although that does give me an idea for NG+...

[gordonwilliamsweb]

Must-Reads Of The Week From Brianna Labuskes

The Friday Breeze

Newsletter editor Brianna Labuskes, who reads everything on health care to compile our daily Morning Briefing, offers the best and most provocative stories for the weekend.

We have made it to Friday once again! Where I am doffing my hat to the SEO genius who managed to get “Labradoodle” into one of the more attention-grabbing headlines of the week. (Though any dog-related news is like a shiny object to me, so I may be biased.) Anyway, read on to figure out how they did it!

First, though, here’s what you might have missed in the tsunami of news coverage.

There have now been more than 50,000 deaths in the country (50,031 as of writing this, in fact). But, as a very cool data project from The New York Times shows, that’s likely an undercount. What the NYT team did was look at year-over-year rates to find a percentage of deaths that were either attributed to COVID-19 or related to the pandemic (for example, a patient not having access to care because of an overwhelmed hospital system). New York City is reporting a 300% increase in deaths, which works out to 19,200 “excess deaths.” But only 15,411 have been officially attributed to the coronavirus. That leaves 3,800 that possibly should be included in the totals.

The Friday Breeze

Want a roundup of the must-read stories this week chosen by KHN Newsletter Editor Brianna Labuskes? Sign up for The Friday Breeze today.

Sign Up

Please confirm your email address below:

Sign Up

Now take that reasoning and multiply it across the globe. So far, they’ve identified at least 36,000 “missing” deaths.

I’m not sure Lysol PR folks woke up yesterday thinking they’d have to warn people of the fatal consequences of injecting disinfectant into their bodies, but that’s exactly what ended up happening after President Donald Trump floated the suggestion while spitballing coronavirus treatments in his press briefing. Doctors and other health experts are worried that some might take Trump’s words seriously — especially considering a recent fatality that occurred after Trump championed hydroxychloroquine as a possible treatment.

While the disinfectant portion of the briefing grabbed the nation and the Twittersphere’s attention, Trump also touted sunlight as a “cure,” pointing to research that showed the virus’s half-life is shortened by heat and humidity. Trump used the study to bolster his belief that the virus will disappear in the summer for good, even though his own health advisers remain insistent that there will be a second wave in the fall, made worse by a likely overlap with the start of flu season.

(Experts have long warned that we shouldn’t count on the weather to be the silver bullet that ends this crisis, pointing to warm states and humid countries where the pandemic has flourished.)

The topic of whether the virus will have another surge in the fall — as well as the idea that sunlight could be used as a cure in the body — were just two of a handful of examples this week of scientists performing rhetorical contortions to present scientifically accurate information while avoiding displeasing the president. The trend was made even more worrisome after a federal official claimed he was ousted from his position because he disagreed about the use of hydroxychloroquine. Scientists are worried the Trump administration’s actions are creating an atmosphere where officials don’t feel free to offer the best information available if it contradicts Trump’s messaging.

Side note: Poison control hotlines have already seen a rise in accidents with cleaning products, so feel free to spread the word that people should not be dosing themselves with Lysol.

Is “everyone who wants a test can get one” going to become Trump’s version of former President Barack Obama’s promise “if you like your health care plan, you’ll be able to keep it”? Trump’s advisers are eyeing his bumpy testing rollout as a major vulnerability in the coming election. One even said that testing could be “another nail in an almost closed coffin.” So why is the country still not at full throttle with testing, even after months of scrambling? A few reasons: It’s extremely expensive to ramp up to the needed level, shortages on the different components are complicating the process, and sometimes fixing one bottleneck creates another.

Meanwhile, the very first stumble all those weeks ago came when the CDC sent out faulty testing kits. Scientists with knowledge of what went wrong say that violations of sound manufacturing practices led to contamination at the CDC facilities.

And the FDA has authorized the first at-home test that will be available with a doctor’s order.

Georgia Gov. Brian Kemp set his state on an aggressive path toward reopening by allowing some nonessential businesses to resume operations Friday. Included in that list are gyms, barbershops, tattoo parlors and bowling alleys (all of which seem like odd choices if you’re still trying to discourage the spread of a highly contagious virus). Even Trump, who has been more eager than other authorities to reopen the country, said he disagreed with the decision and thought it was premature.

The move worried public health experts across the country who look at conditions in the Southern states — and Georgia, in particular — and see the perfect storm for COVID-19. The states were slow to shut down, lag in testing, have rural health systems that are likely to buckle under a surge of patients, and rank among the worst states for medical conditions like obesity that have been linked to poor outcomes in coronavirus patients.

While most states aren’t moving to lift their restrictions yet, they do acknowledge they’ll need to even if there isn’t yet a vaccine or treatment available. In doing so, they’ll have to make cold calculations on just how many deaths are acceptable. Considering the economic devastation can lead to a longer-term increase in deaths from despair, hunger and the loss of health coverage, the answer isn’t always easy.

As governors grapple with that question, protesters continue to take to the streets over the shutdown orders. While the rallies may appear to be grassroots gatherings, a well-financed, influential campaign is being waged to stoke the anger driving them. Meanwhile, polls throughout the week continue to report that most Americans view the restrictions as worthwhile.

Anyone who was holding onto high hopes about a miracle treatment suffered a crushing blow this week when not one but two front-runners were tripped up by cold, hard data. An inadvertent leak (caught by Stat! Kudos!) of trial data showed that Gilead’s antiviral drug remdesivir, which has long been touted as promising, had no benefit for coronavirus patients. The company said the statement misrepresented the results and that more research is needed. But outside experts are not hopeful.

A harsh reality check also came this week for those touting hydroxychloroquine (not long after Trump and Fox News went quiet on the subject). A VA study showed that not only did the drug not benefit patients, it was linked to higher death rates for those who took it. While the small study might not completely rule out the use of the drug, scientists say it’s a reminder not to rush the use of unproven treatments.

(Ahem, for those scavenger-hunting for the aforementioned Labradoodle headline, you have found it!)

Reuters reports that HHS Secretary Alex Azar tapped a trusted aide who was inexperienced in public health matters to lead the day-to-day response efforts in the early days of pandemic. The aide, Brian Harrison, had joined the department after running a dog-breeding business for six years. That decision is just one of several missteps that seem to have gotten Azar sidelined from the fight.

Meanwhile, the crisis and America’s failure to contain it are shaking any remaining global belief in U.S. exceptionalism. “When people see these pictures of New York City they say, ‘How can this happen? How is this possible?’” said one public policy expert in Germany. “We are all stunned. Look at the jobless lines.”

In how-was-that-not-already-happening news: CMS will require nursing homes to report COVID-19 cases to the CDC. Nursing homes have been absolutely ravaged by the pandemic, with at least 11,000 confirmed deaths reported.

Congress managed to pass the $484 billion stimulus package that will supplement the depleted pot of funds to aid small businesses. Banks say the money allocated in the new measure will be used up in a matter of days, at most. But Democrats did manage to secure money for hospitals and expanded testing.

Although this one did take a bit more time and negotiation, it still managed to eke through. But Capitol Hill watchers say it could be the last measure that gets through before the gloves truly come off and the partisan fighting turns brutal. 

Most of the food news is pretty grim (like the fact that a ballooning number of cases in meat-packaging plants could lead to shortages) but one cool story that emerged this week is on a potential government matchmaking program between farmers with excess food and hungry Americans. Of course, there are hurdles in the path to success — like transportation issues — but it’s heartening they’re at least trying.

And it’s likely the food banks will need all the help they can get as new unemployment numbers push America closer to Great Depression levels of joblessness. Another 4.4 million filed for benefits last week, bringing the total number of claims in just five weeks to more than 26 million people.

While the health care industry has long been considered “recession-proof” (e.g., people will always need health care), it’s proving, in a very cruel twist, not to be “pandemic- proof.”

I think we all know one or two people who are convinced they had COVID-19 sometime over the winter — and emerging data from the first wave of serological testing might prove them right. Small studies in California suggest there could be somewhere between 221,000 to 442,000 people who were infected in L.A. County (which had fewer than 8,000 confirmed cases at the time). And tests out of New York suggest that 1 in 5 NYC residents have been infected. Those results, in addition to the fact that the first U.S. death that can be confirmed happened in early February rather than at the end of that month, hint that the virus may have been here a lot longer than originally thought.

Experts say to take the results with a grain of salt, though. The serological tests can be an important tool in the battle to contain the virus, but they aren’t infallible. They offer advice on how to “kick the tires” of the research.

So apparently this illness is WEIRD. Every week, doctors are finding out new and strange ways that it’s not acting as it should. The latest revelation: excessive blood clotting that’s causing younger patients to have strokes and is being seen at such consistent rates that some are wondering whether the standard course of treatment should include blood thinners.

Some other medical developments from the week: more data on severe cases and chronic health conditions; rethinking the use of ventilators; and the silent epidemic of people who aren’t getting treated for non-coronavirus illnesses.

And in interesting reads for your weekend:

→ The New York Times: The Coronavirus in America: The Year Ahead

→ Politico: ‘I’m Not Going to Go There and Die’

→ Undark: The Myth of the Disease-Spreading Migrant

→ Politico: Another Time a President Used the ‘Emergency’ Excuse to Restrict Immigration

→ The Marshall Project: Infected, Incarcerated — and Coming to an ICU Near You?

→ The New York Times: Doctors and Governors Vie for Coronavirus Masks in Cloak-and-Dagger Deals

That’s it from me! Have a safe weekend everyone!

Must-Reads Of The Week From Brianna Labuskes published first on https://nootropicspowdersupplier.tumblr.com/

[stephenmccull]

Must-Reads Of The Week From Brianna Labuskes

The Friday Breeze

Newsletter editor Brianna Labuskes, who reads everything on health care to compile our daily Morning Briefing, offers the best and most provocative stories for the weekend.

We have made it to Friday once again! Where I am doffing my hat to the SEO genius who managed to get “Labradoodle” into one of the more attention-grabbing headlines of the week. (Though any dog-related news is like a shiny object to me, so I may be biased.) Anyway, read on to figure out how they did it!

First, though, here’s what you might have missed in the tsunami of news coverage.

There have now been more than 50,000 deaths in the country (50,031 as of writing this, in fact). But, as a very cool data project from The New York Times shows, that’s likely an undercount. What the NYT team did was look at year-over-year rates to find a percentage of deaths that were either attributed to COVID-19 or related to the pandemic (for example, a patient not having access to care because of an overwhelmed hospital system). New York City is reporting a 300% increase in deaths, which works out to 19,200 “excess deaths.” But only 15,411 have been officially attributed to the coronavirus. That leaves 3,800 that possibly should be included in the totals.

The Friday Breeze

Want a roundup of the must-read stories this week chosen by KHN Newsletter Editor Brianna Labuskes? Sign up for The Friday Breeze today.

Sign Up

Please confirm your email address below:

Sign Up

Now take that reasoning and multiply it across the globe. So far, they’ve identified at least 36,000 “missing” deaths.

I’m not sure Lysol PR folks woke up yesterday thinking they’d have to warn people of the fatal consequences of injecting disinfectant into their bodies, but that’s exactly what ended up happening after President Donald Trump floated the suggestion while spitballing coronavirus treatments in his press briefing. Doctors and other health experts are worried that some might take Trump’s words seriously — especially considering a recent fatality that occurred after Trump championed hydroxychloroquine as a possible treatment.

While the disinfectant portion of the briefing grabbed the nation and the Twittersphere’s attention, Trump also touted sunlight as a “cure,” pointing to research that showed the virus’s half-life is shortened by heat and humidity. Trump used the study to bolster his belief that the virus will disappear in the summer for good, even though his own health advisers remain insistent that there will be a second wave in the fall, made worse by a likely overlap with the start of flu season.

(Experts have long warned that we shouldn’t count on the weather to be the silver bullet that ends this crisis, pointing to warm states and humid countries where the pandemic has flourished.)

The topic of whether the virus will have another surge in the fall — as well as the idea that sunlight could be used as a cure in the body — were just two of a handful of examples this week of scientists performing rhetorical contortions to present scientifically accurate information while avoiding displeasing the president. The trend was made even more worrisome after a federal official claimed he was ousted from his position because he disagreed about the use of hydroxychloroquine. Scientists are worried the Trump administration’s actions are creating an atmosphere where officials don’t feel free to offer the best information available if it contradicts Trump’s messaging.

Side note: Poison control hotlines have already seen a rise in accidents with cleaning products, so feel free to spread the word that people should not be dosing themselves with Lysol.

Is “everyone who wants a test can get one” going to become Trump’s version of former President Barack Obama’s promise “if you like your health care plan, you’ll be able to keep it”? Trump’s advisers are eyeing his bumpy testing rollout as a major vulnerability in the coming election. One even said that testing could be “another nail in an almost closed coffin.” So why is the country still not at full throttle with testing, even after months of scrambling? A few reasons: It’s extremely expensive to ramp up to the needed level, shortages on the different components are complicating the process, and sometimes fixing one bottleneck creates another.

Meanwhile, the very first stumble all those weeks ago came when the CDC sent out faulty testing kits. Scientists with knowledge of what went wrong say that violations of sound manufacturing practices led to contamination at the CDC facilities.

And the FDA has authorized the first at-home test that will be available with a doctor’s order.

Georgia Gov. Brian Kemp set his state on an aggressive path toward reopening by allowing some nonessential businesses to resume operations Friday. Included in that list are gyms, barbershops, tattoo parlors and bowling alleys (all of which seem like odd choices if you’re still trying to discourage the spread of a highly contagious virus). Even Trump, who has been more eager than other authorities to reopen the country, said he disagreed with the decision and thought it was premature.

The move worried public health experts across the country who look at conditions in the Southern states — and Georgia, in particular — and see the perfect storm for COVID-19. The states were slow to shut down, lag in testing, have rural health systems that are likely to buckle under a surge of patients, and rank among the worst states for medical conditions like obesity that have been linked to poor outcomes in coronavirus patients.

While most states aren’t moving to lift their restrictions yet, they do acknowledge they’ll need to even if there isn’t yet a vaccine or treatment available. In doing so, they’ll have to make cold calculations on just how many deaths are acceptable. Considering the economic devastation can lead to a longer-term increase in deaths from despair, hunger and the loss of health coverage, the answer isn’t always easy.

As governors grapple with that question, protesters continue to take to the streets over the shutdown orders. While the rallies may appear to be grassroots gatherings, a well-financed, influential campaign is being waged to stoke the anger driving them. Meanwhile, polls throughout the week continue to report that most Americans view the restrictions as worthwhile.

Anyone who was holding onto high hopes about a miracle treatment suffered a crushing blow this week when not one but two front-runners were tripped up by cold, hard data. An inadvertent leak (caught by Stat! Kudos!) of trial data showed that Gilead’s antiviral drug remdesivir, which has long been touted as promising, had no benefit for coronavirus patients. The company said the statement misrepresented the results and that more research is needed. But outside experts are not hopeful.

A harsh reality check also came this week for those touting hydroxychloroquine (not long after Trump and Fox News went quiet on the subject). A VA study showed that not only did the drug not benefit patients, it was linked to higher death rates for those who took it. While the small study might not completely rule out the use of the drug, scientists say it’s a reminder not to rush the use of unproven treatments.

(Ahem, for those scavenger-hunting for the aforementioned Labradoodle headline, you have found it!)

Reuters reports that HHS Secretary Alex Azar tapped a trusted aide who was inexperienced in public health matters to lead the day-to-day response efforts in the early days of pandemic. The aide, Brian Harrison, had joined the department after running a dog-breeding business for six years. That decision is just one of several missteps that seem to have gotten Azar sidelined from the fight.

Meanwhile, the crisis and America’s failure to contain it are shaking any remaining global belief in U.S. exceptionalism. “When people see these pictures of New York City they say, ‘How can this happen? How is this possible?’” said one public policy expert in Germany. “We are all stunned. Look at the jobless lines.”

In how-was-that-not-already-happening news: CMS will require nursing homes to report COVID-19 cases to the CDC. Nursing homes have been absolutely ravaged by the pandemic, with at least 11,000 confirmed deaths reported.

Congress managed to pass the $484 billion stimulus package that will supplement the depleted pot of funds to aid small businesses. Banks say the money allocated in the new measure will be used up in a matter of days, at most. But Democrats did manage to secure money for hospitals and expanded testing.

Although this one did take a bit more time and negotiation, it still managed to eke through. But Capitol Hill watchers say it could be the last measure that gets through before the gloves truly come off and the partisan fighting turns brutal. 

Most of the food news is pretty grim (like the fact that a ballooning number of cases in meat-packaging plants could lead to shortages) but one cool story that emerged this week is on a potential government matchmaking program between farmers with excess food and hungry Americans. Of course, there are hurdles in the path to success — like transportation issues — but it’s heartening they’re at least trying.

And it’s likely the food banks will need all the help they can get as new unemployment numbers push America closer to Great Depression levels of joblessness. Another 4.4 million filed for benefits last week, bringing the total number of claims in just five weeks to more than 26 million people.

While the health care industry has long been considered “recession-proof” (e.g., people will always need health care), it’s proving, in a very cruel twist, not to be “pandemic- proof.”

I think we all know one or two people who are convinced they had COVID-19 sometime over the winter — and emerging data from the first wave of serological testing might prove them right. Small studies in California suggest there could be somewhere between 221,000 to 442,000 people who were infected in L.A. County (which had fewer than 8,000 confirmed cases at the time). And tests out of New York suggest that 1 in 5 NYC residents have been infected. Those results, in addition to the fact that the first U.S. death that can be confirmed happened in early February rather than at the end of that month, hint that the virus may have been here a lot longer than originally thought.

Experts say to take the results with a grain of salt, though. The serological tests can be an important tool in the battle to contain the virus, but they aren’t infallible. They offer advice on how to “kick the tires” of the research.

So apparently this illness is WEIRD. Every week, doctors are finding out new and strange ways that it’s not acting as it should. The latest revelation: excessive blood clotting that’s causing younger patients to have strokes and is being seen at such consistent rates that some are wondering whether the standard course of treatment should include blood thinners.

Some other medical developments from the week: more data on severe cases and chronic health conditions; rethinking the use of ventilators; and the silent epidemic of people who aren’t getting treated for non-coronavirus illnesses.

And in interesting reads for your weekend:

→ The New York Times: The Coronavirus in America: The Year Ahead

→ Politico: ‘I’m Not Going to Go There and Die’

→ Undark: The Myth of the Disease-Spreading Migrant

→ Politico: Another Time a President Used the ‘Emergency’ Excuse to Restrict Immigration

→ The Marshall Project: Infected, Incarcerated — and Coming to an ICU Near You?

→ The New York Times: Doctors and Governors Vie for Coronavirus Masks in Cloak-and-Dagger Deals

That’s it from me! Have a safe weekend everyone!

Must-Reads Of The Week From Brianna Labuskes published first on https://smartdrinkingweb.weebly.com/

[dinafbrownil]

Must-Reads Of The Week From Brianna Labuskes

The Friday Breeze

Newsletter editor Brianna Labuskes, who reads everything on health care to compile our daily Morning Briefing, offers the best and most provocative stories for the weekend.

We have made it to Friday once again! Where I am doffing my hat to the SEO genius who managed to get “Labradoodle” into one of the more attention-grabbing headlines of the week. (Though any dog-related news is like a shiny object to me, so I may be biased.) Anyway, read on to figure out how they did it!

First, though, here’s what you might have missed in the tsunami of news coverage.

There have now been more than 50,000 deaths in the country (50,031 as of writing this, in fact). But, as a very cool data project from The New York Times shows, that’s likely an undercount. What the NYT team did was look at year-over-year rates to find a percentage of deaths that were either attributed to COVID-19 or related to the pandemic (for example, a patient not having access to care because of an overwhelmed hospital system). New York City is reporting a 300% increase in deaths, which works out to 19,200 “excess deaths.” But only 15,411 have been officially attributed to the coronavirus. That leaves 3,800 that possibly should be included in the totals.

The Friday Breeze

Want a roundup of the must-read stories this week chosen by KHN Newsletter Editor Brianna Labuskes? Sign up for The Friday Breeze today.

Sign Up

Please confirm your email address below:

Sign Up

Now take that reasoning and multiply it across the globe. So far, they’ve identified at least 36,000 “missing” deaths.

I’m not sure Lysol PR folks woke up yesterday thinking they’d have to warn people of the fatal consequences of injecting disinfectant into their bodies, but that’s exactly what ended up happening after President Donald Trump floated the suggestion while spitballing coronavirus treatments in his press briefing. Doctors and other health experts are worried that some might take Trump’s words seriously — especially considering a recent fatality that occurred after Trump championed hydroxychloroquine as a possible treatment.

While the disinfectant portion of the briefing grabbed the nation and the Twittersphere’s attention, Trump also touted sunlight as a “cure,” pointing to research that showed the virus’s half-life is shortened by heat and humidity. Trump used the study to bolster his belief that the virus will disappear in the summer for good, even though his own health advisers remain insistent that there will be a second wave in the fall, made worse by a likely overlap with the start of flu season.

(Experts have long warned that we shouldn’t count on the weather to be the silver bullet that ends this crisis, pointing to warm states and humid countries where the pandemic has flourished.)

The topic of whether the virus will have another surge in the fall — as well as the idea that sunlight could be used as a cure in the body — were just two of a handful of examples this week of scientists performing rhetorical contortions to present scientifically accurate information while avoiding displeasing the president. The trend was made even more worrisome after a federal official claimed he was ousted from his position because he disagreed about the use of hydroxychloroquine. Scientists are worried the Trump administration’s actions are creating an atmosphere where officials don’t feel free to offer the best information available if it contradicts Trump’s messaging.

Side note: Poison control hotlines have already seen a rise in accidents with cleaning products, so feel free to spread the word that people should not be dosing themselves with Lysol.

Is “everyone who wants a test can get one” going to become Trump’s version of former President Barack Obama’s promise “if you like your health care plan, you’ll be able to keep it”? Trump’s advisers are eyeing his bumpy testing rollout as a major vulnerability in the coming election. One even said that testing could be “another nail in an almost closed coffin.” So why is the country still not at full throttle with testing, even after months of scrambling? A few reasons: It’s extremely expensive to ramp up to the needed level, shortages on the different components are complicating the process, and sometimes fixing one bottleneck creates another.

Meanwhile, the very first stumble all those weeks ago came when the CDC sent out faulty testing kits. Scientists with knowledge of what went wrong say that violations of sound manufacturing practices led to contamination at the CDC facilities.

And the FDA has authorized the first at-home test that will be available with a doctor’s order.

Georgia Gov. Brian Kemp set his state on an aggressive path toward reopening by allowing some nonessential businesses to resume operations Friday. Included in that list are gyms, barbershops, tattoo parlors and bowling alleys (all of which seem like odd choices if you’re still trying to discourage the spread of a highly contagious virus). Even Trump, who has been more eager than other authorities to reopen the country, said he disagreed with the decision and thought it was premature.

The move worried public health experts across the country who look at conditions in the Southern states — and Georgia, in particular — and see the perfect storm for COVID-19. The states were slow to shut down, lag in testing, have rural health systems that are likely to buckle under a surge of patients, and rank among the worst states for medical conditions like obesity that have been linked to poor outcomes in coronavirus patients.

While most states aren’t moving to lift their restrictions yet, they do acknowledge they’ll need to even if there isn’t yet a vaccine or treatment available. In doing so, they’ll have to make cold calculations on just how many deaths are acceptable. Considering the economic devastation can lead to a longer-term increase in deaths from despair, hunger and the loss of health coverage, the answer isn’t always easy.

As governors grapple with that question, protesters continue to take to the streets over the shutdown orders. While the rallies may appear to be grassroots gatherings, a well-financed, influential campaign is being waged to stoke the anger driving them. Meanwhile, polls throughout the week continue to report that most Americans view the restrictions as worthwhile.

Anyone who was holding onto high hopes about a miracle treatment suffered a crushing blow this week when not one but two front-runners were tripped up by cold, hard data. An inadvertent leak (caught by Stat! Kudos!) of trial data showed that Gilead’s antiviral drug remdesivir, which has long been touted as promising, had no benefit for coronavirus patients. The company said the statement misrepresented the results and that more research is needed. But outside experts are not hopeful.

A harsh reality check also came this week for those touting hydroxychloroquine (not long after Trump and Fox News went quiet on the subject). A VA study showed that not only did the drug not benefit patients, it was linked to higher death rates for those who took it. While the small study might not completely rule out the use of the drug, scientists say it’s a reminder not to rush the use of unproven treatments.

(Ahem, for those scavenger-hunting for the aforementioned Labradoodle headline, you have found it!)

Reuters reports that HHS Secretary Alex Azar tapped a trusted aide who was inexperienced in public health matters to lead the day-to-day response efforts in the early days of pandemic. The aide, Brian Harrison, had joined the department after running a dog-breeding business for six years. That decision is just one of several missteps that seem to have gotten Azar sidelined from the fight.

Meanwhile, the crisis and America’s failure to contain it are shaking any remaining global belief in U.S. exceptionalism. “When people see these pictures of New York City they say, ‘How can this happen? How is this possible?’” said one public policy expert in Germany. “We are all stunned. Look at the jobless lines.”

In how-was-that-not-already-happening news: CMS will require nursing homes to report COVID-19 cases to the CDC. Nursing homes have been absolutely ravaged by the pandemic, with at least 11,000 confirmed deaths reported.

Congress managed to pass the $484 billion stimulus package that will supplement the depleted pot of funds to aid small businesses. Banks say the money allocated in the new measure will be used up in a matter of days, at most. But Democrats did manage to secure money for hospitals and expanded testing.

Although this one did take a bit more time and negotiation, it still managed to eke through. But Capitol Hill watchers say it could be the last measure that gets through before the gloves truly come off and the partisan fighting turns brutal. 

Most of the food news is pretty grim (like the fact that a ballooning number of cases in meat-packaging plants could lead to shortages) but one cool story that emerged this week is on a potential government matchmaking program between farmers with excess food and hungry Americans. Of course, there are hurdles in the path to success — like transportation issues — but it’s heartening they’re at least trying.

And it’s likely the food banks will need all the help they can get as new unemployment numbers push America closer to Great Depression levels of joblessness. Another 4.4 million filed for benefits last week, bringing the total number of claims in just five weeks to more than 26 million people.

While the health care industry has long been considered “recession-proof” (e.g., people will always need health care), it’s proving, in a very cruel twist, not to be “pandemic- proof.”

I think we all know one or two people who are convinced they had COVID-19 sometime over the winter — and emerging data from the first wave of serological testing might prove them right. Small studies in California suggest there could be somewhere between 221,000 to 442,000 people who were infected in L.A. County (which had fewer than 8,000 confirmed cases at the time). And tests out of New York suggest that 1 in 5 NYC residents have been infected. Those results, in addition to the fact that the first U.S. death that can be confirmed happened in early February rather than at the end of that month, hint that the virus may have been here a lot longer than originally thought.

Experts say to take the results with a grain of salt, though. The serological tests can be an important tool in the battle to contain the virus, but they aren’t infallible. They offer advice on how to “kick the tires” of the research.

So apparently this illness is WEIRD. Every week, doctors are finding out new and strange ways that it’s not acting as it should. The latest revelation: excessive blood clotting that’s causing younger patients to have strokes and is being seen at such consistent rates that some are wondering whether the standard course of treatment should include blood thinners.

Some other medical developments from the week: more data on severe cases and chronic health conditions; rethinking the use of ventilators; and the silent epidemic of people who aren’t getting treated for non-coronavirus illnesses.

And in interesting reads for your weekend:

→ The New York Times: The Coronavirus in America: The Year Ahead

→ Politico: ‘I’m Not Going to Go There and Die’

→ Undark: The Myth of the Disease-Spreading Migrant

→ Politico: Another Time a President Used the ‘Emergency’ Excuse to Restrict Immigration

→ The Marshall Project: Infected, Incarcerated — and Coming to an ICU Near You?

→ The New York Times: Doctors and Governors Vie for Coronavirus Masks in Cloak-and-Dagger Deals

That’s it from me! Have a safe weekend everyone!

from Updates By Dina https://khn.org/news/friday-breeze-health-care-policy-must-reads-of-the-week-from-brianna-labuskes-april-24-2020/

[gordonwilliamsweb]

Must-Reads Of The Week From Brianna Labuskes

The Friday Breeze

Newsletter editor Brianna Labuskes, who reads everything on health care to compile our daily Morning Briefing, offers the best and most provocative stories for the weekend.

We have made it to Friday once again! Where I am doffing my hat to the SEO genius who managed to get “Labradoodle” into one of the more attention-grabbing headlines of the week. (Though any dog-related news is like a shiny object to me, so I may be biased.) Anyway, read on to figure out how they did it!

First, though, here’s what you might have missed in the tsunami of news coverage.

There have now been more than 50,000 deaths in the country (50,031 as of writing this, in fact). But, as a very cool data project from The New York Times shows, that’s likely an undercount. What the NYT team did was look at year-over-year rates to find a percentage of deaths that were either attributed to COVID-19 or related to the pandemic (for example, a patient not having access to care because of an overwhelmed hospital system). New York City is reporting a 300% increase in deaths, which works out to 19,200 “excess deaths.” But only 15,411 have been officially attributed to the coronavirus. That leaves 3,800 that possibly should be included in the totals.

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Now take that reasoning and multiply it across the globe. So far, they’ve identified at least 36,000 “missing” deaths.

I’m not sure Lysol PR folks woke up yesterday thinking they’d have to warn people of the fatal consequences of injecting disinfectant into their bodies, but that’s exactly what ended up happening after President Donald Trump floated the suggestion while spitballing coronavirus treatments in his press briefing. Doctors and other health experts are worried that some might take Trump’s words seriously — especially considering a recent fatality that occurred after Trump championed hydroxychloroquine as a possible treatment.

While the disinfectant portion of the briefing grabbed the nation and the Twittersphere’s attention, Trump also touted sunlight as a “cure,” pointing to research that showed the virus’s half-life is shortened by heat and humidity. Trump used the study to bolster his belief that the virus will disappear in the summer for good, even though his own health advisers remain insistent that there will be a second wave in the fall, made worse by a likely overlap with the start of flu season.

(Experts have long warned that we shouldn’t count on the weather to be the silver bullet that ends this crisis, pointing to warm states and humid countries where the pandemic has flourished.)

The topic of whether the virus will have another surge in the fall — as well as the idea that sunlight could be used as a cure in the body — were just two of a handful of examples this week of scientists performing rhetorical contortions to present scientifically accurate information while avoiding displeasing the president. The trend was made even more worrisome after a federal official claimed he was ousted from his position because he disagreed about the use of hydroxychloroquine. Scientists are worried the Trump administration’s actions are creating an atmosphere where officials don’t feel free to offer the best information available if it contradicts Trump’s messaging.

Side note: Poison control hotlines have already seen a rise in accidents with cleaning products, so feel free to spread the word that people should not be dosing themselves with Lysol.

Is “everyone who wants a test can get one” going to become Trump’s version of former President Barack Obama’s promise “if you like your health care plan, you’ll be able to keep it”? Trump’s advisers are eyeing his bumpy testing rollout as a major vulnerability in the coming election. One even said that testing could be “another nail in an almost closed coffin.” So why is the country still not at full throttle with testing, even after months of scrambling? A few reasons: It’s extremely expensive to ramp up to the needed level, shortages on the different components are complicating the process, and sometimes fixing one bottleneck creates another.

Meanwhile, the very first stumble all those weeks ago came when the CDC sent out faulty testing kits. Scientists with knowledge of what went wrong say that violations of sound manufacturing practices led to contamination at the CDC facilities.

And the FDA has authorized the first at-home test that will be available with a doctor’s order.

Georgia Gov. Brian Kemp set his state on an aggressive path toward reopening by allowing some nonessential businesses to resume operations Friday. Included in that list are gyms, barbershops, tattoo parlors and bowling alleys (all of which seem like odd choices if you’re still trying to discourage the spread of a highly contagious virus). Even Trump, who has been more eager than other authorities to reopen the country, said he disagreed with the decision and thought it was premature.

The move worried public health experts across the country who look at conditions in the Southern states — and Georgia, in particular — and see the perfect storm for COVID-19. The states were slow to shut down, lag in testing, have rural health systems that are likely to buckle under a surge of patients, and rank among the worst states for medical conditions like obesity that have been linked to poor outcomes in coronavirus patients.

While most states aren’t moving to lift their restrictions yet, they do acknowledge they’ll need to even if there isn’t yet a vaccine or treatment available. In doing so, they’ll have to make cold calculations on just how many deaths are acceptable. Considering the economic devastation can lead to a longer-term increase in deaths from despair, hunger and the loss of health coverage, the answer isn’t always easy.

As governors grapple with that question, protesters continue to take to the streets over the shutdown orders. While the rallies may appear to be grassroots gatherings, a well-financed, influential campaign is being waged to stoke the anger driving them. Meanwhile, polls throughout the week continue to report that most Americans view the restrictions as worthwhile.

Anyone who was holding onto high hopes about a miracle treatment suffered a crushing blow this week when not one but two front-runners were tripped up by cold, hard data. An inadvertent leak (caught by Stat! Kudos!) of trial data showed that Gilead’s antiviral drug remdesivir, which has long been touted as promising, had no benefit for coronavirus patients. The company said the statement misrepresented the results and that more research is needed. But outside experts are not hopeful.

A harsh reality check also came this week for those touting hydroxychloroquine (not long after Trump and Fox News went quiet on the subject). A VA study showed that not only did the drug not benefit patients, it was linked to higher death rates for those who took it. While the small study might not completely rule out the use of the drug, scientists say it’s a reminder not to rush the use of unproven treatments.

(Ahem, for those scavenger-hunting for the aforementioned Labradoodle headline, you have found it!)

Reuters reports that HHS Secretary Alex Azar tapped a trusted aide who was inexperienced in public health matters to lead the day-to-day response efforts in the early days of pandemic. The aide, Brian Harrison, had joined the department after running a dog-breeding business for six years. That decision is just one of several missteps that seem to have gotten Azar sidelined from the fight.

Meanwhile, the crisis and America’s failure to contain it are shaking any remaining global belief in U.S. exceptionalism. “When people see these pictures of New York City they say, ‘How can this happen? How is this possible?’” said one public policy expert in Germany. “We are all stunned. Look at the jobless lines.”

In how-was-that-not-already-happening news: CMS will require nursing homes to report COVID-19 cases to the CDC. Nursing homes have been absolutely ravaged by the pandemic, with at least 11,000 confirmed deaths reported.

Congress managed to pass the $484 billion stimulus package that will supplement the depleted pot of funds to aid small businesses. Banks say the money allocated in the new measure will be used up in a matter of days, at most. But Democrats did manage to secure money for hospitals and expanded testing.

Although this one did take a bit more time and negotiation, it still managed to eke through. But Capitol Hill watchers say it could be the last measure that gets through before the gloves truly come off and the partisan fighting turns brutal. 

Most of the food news is pretty grim (like the fact that a ballooning number of cases in meat-packaging plants could lead to shortages) but one cool story that emerged this week is on a potential government matchmaking program between farmers with excess food and hungry Americans. Of course, there are hurdles in the path to success — like transportation issues — but it’s heartening they’re at least trying.

And it’s likely the food banks will need all the help they can get as new unemployment numbers push America closer to Great Depression levels of joblessness. Another 4.4 million filed for benefits last week, bringing the total number of claims in just five weeks to more than 26 million people.

While the health care industry has long been considered “recession-proof” (e.g., people will always need health care), it’s proving, in a very cruel twist, not to be “pandemic- proof.”

I think we all know one or two people who are convinced they had COVID-19 sometime over the winter — and emerging data from the first wave of serological testing might prove them right. Small studies in California suggest there could be somewhere between 221,000 to 442,000 people who were infected in L.A. County (which had fewer than 8,000 confirmed cases at the time). And tests out of New York suggest that 1 in 5 NYC residents have been infected. Those results, in addition to the fact that the first U.S. death that can be confirmed happened in early February rather than at the end of that month, hint that the virus may have been here a lot longer than originally thought.

Experts say to take the results with a grain of salt, though. The serological tests can be an important tool in the battle to contain the virus, but they aren’t infallible. They offer advice on how to “kick the tires” of the research.

So apparently this illness is WEIRD. Every week, doctors are finding out new and strange ways that it’s not acting as it should. The latest revelation: excessive blood clotting that’s causing younger patients to have strokes and is being seen at such consistent rates that some are wondering whether the standard course of treatment should include blood thinners.

Some other medical developments from the week: more data on severe cases and chronic health conditions; rethinking the use of ventilators; and the silent epidemic of people who aren’t getting treated for non-coronavirus illnesses.

And in interesting reads for your weekend:

→ The New York Times: The Coronavirus in America: The Year Ahead

→ Politico: ‘I’m Not Going to Go There and Die’

→ Undark: The Myth of the Disease-Spreading Migrant

→ Politico: Another Time a President Used the ‘Emergency’ Excuse to Restrict Immigration

→ The Marshall Project: Infected, Incarcerated — and Coming to an ICU Near You?

→ The New York Times: Doctors and Governors Vie for Coronavirus Masks in Cloak-and-Dagger Deals

That’s it from me! Have a safe weekend everyone!

Must-Reads Of The Week From Brianna Labuskes published first on https://nootropicspowdersupplier.tumblr.com/