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Covid 19 virus inpacts sports, NHL,Season Tix other impacts

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BTW, this whole issue of someone getting the virus is complicated by the fact of the apparently long asymptomatic period.  You can take the player out, but he probably infected his team, or other teams. (You CANNOT social distance Face Offs!)

 

And you can't bubble wrap them.  We've bubble wrapped care homes, and they still get it by the service workers -- many asymptomatic -- coming through.

 

This can all happen even with frequent testing (every few days).  *maybe* daily testing will prevent it.  *maybe*.

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21 hours ago, LakeLivin said:

 

Rem, I'm actually pretty familiar with the principles relating to good clinical trials.  I worked for Glaxo (before all the mergers) and was one of the primary statisticians for the first ondansetron NDA.  Part of my job was reviewing study protocols for exactly the type of flaws you're pointing out. I've been out of the field for quite a while now, and it's a bit surprising and very disconcerting that the science has apparently ended up where it's at.  Aren't reputable publications supposed to be peer reviewed?  Don't protocols for new drug studies still need to go through an IRB (institutional review board for those unfamiliar)? At the places I worked, part of the role of the statistician was to serve as a "check" on the clinicians, who often were so invested in a drug (emotionally, not financially) that subconscious bias could be viewed as understandable.

 

When I first started in the field (early '80s) the FDA had a huge presence.  It was significantly reduced in, what, maybe the early 90s? I wonder if the apparent degradation in standards might be linked to that?  Over regulation can be a big problem. But regulation can serve a valuable purpose.  Like many things, I wonder if the proper balance might have been lost?  

 

As an aside, the regulation thing could be viewed as one example of what I perceive as perhaps the biggest challenge our society now faces, and that's extreme polarization.  Black or white, all or nothing.  Only in an environment like that could a phrase like "alternative facts" could be viewed with anything but complete ridicule.

Very interesting Lake! We use the heck out of ondansetron. 

 

While I have a few publications, I've been out of doing research for a long time. But I do know that hospitals still have IRB's. That would cover any research being done in the hospital setting. Not sure about the outpatient setting. However, IRB's are more focused on hospital liability and patient safety than on the study design in many cases. And especially if the hospital is to be one of several sites. At least that was my experience. 

 

It's interesting that you worked for a huge drug company. I am not anti-drug company at all, but over the years it's become apparent that the need for profit does affect the science as well as the sales people's spin on the science. I wonder if you felt any pressure to design studies set up to give the drug maximal chances of looking effective. You don't have to answer, but I wonder. I don't really know how it's changed, but for the 30 or so years I've been reviewing and listening to reviews, there are so countless many examples of drug company sponsored studies being, uh, a bit tricky, that the reviewer always points out that the study was drug company sponsored so keep that in mind. Not saying that there were not many excellent drug company sponsored studies, because there were, but the bad examples were so bad. 

 

I used to be the medical director of my last ER in El Paso. A drug rep came in one day to try to get us to buy Xopenex, which is basically albuterol, and was brand new at the time. I'm sure many here are familiar with albuterol as the main inhaled drug for asthma and COPD. OK, I'm not a chemist, but there are these things called optical isomers. Basically each drug is made up of roughly half of a molecule and half of it's mirror image. There has been a big move over many years to isolate one or the other of these mirror images and see if it is more effective by itself. Well, Xopenex is one of the mirror images of albuterol. The company claimed(s) that it provided more effect and less side effects than the 50-50 mix of both optical isomers. Anyway, I asked the rep for some studies and data showing this. He pulled out a lap top, and went to an Excel spreadsheet of an internal study done at one small hospital with about 100 patients. It hadn't even been presented as an abstract, let alone published. How can this be their only data? They're already sell it for crying out loud. Well, since it's basically still albuterol, it was already approved. For years I thought about doing a study to show that the claims of the drug company were wrong, but it would have been for free, so nah. Well about 15 years later someone finally did it. But the stuff is still in wide use.

 

This gets to my point about once a drug gets into wide use, further proof of it's lack of efficacy only slows it's roll. It can take years or decades for the drug to stop being used, unless it's shown to cause harm. It is said that it can take up to 19 years for a bad habit to work it's way out of medical practice. Almost need a large chunk of MD"s to retire with some things. And this plays into the Covid thing. As bad science shows a thing to seem to work or not work, it can become standard practice very quickly, and it can be hard to turn that ship around once the opposite is proven. I do think things move much more quickly in and out with Covid than anything else I've seen to date, but it's still a concern.

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If a player gets Covid during this thing, it will not all shut down. The NHL has already said that.

 

This is different than the general public in several key ways. 

 

First, these guys will be tested daily in a screening of everyone all the time. We are no where near anything remotely like that in the real world. The idea of asymptomatic spread should be greatly reduced by this. They will most likely know a guy has covid before he has any idea he has it. This is untrue in the real world. Second, they will be practicing all sorts of things to keep from spreading it, from full face screens to social distancing in the locker room, etc etc etc. The r naught, or number of people each Covid patient infects is 2-4. But that number is in people who do not know they have it for at least 5 days, and that's 2-4 people for the entire length of them being infective, usually spread to family members: the majority of people spread it to close contacts (family). Third, they will contact-trace and really zone in on separating contacts of any positives. 

 

Like CC said, if one positive shuts the whole thing down then they wouldn't do it. But it sure looks like they're doing it.

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4 hours ago, remkin said:

If a player gets Covid during this thing, it will not all shut down. The NHL has already said that.

That really does not address my concern totally, as I questioned rem, 1st what about the team on which it occurs? Does it just quarantine the player testing positive, his close contacts as well as him, or the entire team? It would seem that if only a player and his contacts are quarantined, you would quickly affect that teams ability to play? What about if the positive is a coach or assistant coach? Or training staff? So we've been told that "it will not all shut down" but if you eliminate a team that would seem pretty disruptive? And finally, what if it's one of the 2 in the finals? It would be weird to have the Stanley Cup awarded on the basis of forfeiture due to COVID-19, just saying? Lets just hope (and pray) that none of this unfolds, but look at the number of players on the Senators team who've tested positive?

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7 hours ago, remkin said:

Very interesting Lake! We use the heck out of ondansetron. 

 

While I have a few publications, I've been out of doing research for a long time. But I do know that hospitals still have IRB's. That would cover any research being done in the hospital setting. Not sure about the outpatient setting. However, IRB's are more focused on hospital liability and patient safety than on the study design in many cases. And especially if the hospital is to be one of several sites. At least that was my experience. 

 

It's interesting that you worked for a huge drug company. I am not anti-drug company at all, but over the years it's become apparent that the need for profit does affect the science as well as the sales people's spin on the science. I wonder if you felt any pressure to design studies set up to give the drug maximal chances of looking effective. You don't have to answer, but I wonder. I don't really know how it's changed, but for the 30 or so years I've been reviewing and listening to reviews, there are so countless many examples of drug company sponsored studies being, uh, a bit tricky, that the reviewer always points out that the study was drug company sponsored so keep that in mind. Not saying that there were not many excellent drug company sponsored studies, because there were, but the bad examples were so bad. 

 

I used to be the medical director of my last ER in El Paso. A drug rep came in one day to try to get us to buy Xopenex, which is basically albuterol, and was brand new at the time. I'm sure many here are familiar with albuterol as the main inhaled drug for asthma and COPD. OK, I'm not a chemist, but there are these things called optical isomers. Basically each drug is made up of roughly half of a molecule and half of it's mirror image. There has been a big move over many years to isolate one or the other of these mirror images and see if it is more effective by itself. Well, Xopenex is one of the mirror images of albuterol. The company claimed(s) that it provided more effect and less side effects than the 50-50 mix of both optical isomers. Anyway, I asked the rep for some studies and data showing this. He pulled out a lap top, and went to an Excel spreadsheet of an internal study done at one small hospital with about 100 patients. It hadn't even been presented as an abstract, let alone published. How can this be their only data? They're already sell it for crying out loud. Well, since it's basically still albuterol, it was already approved. For years I thought about doing a study to show that the claims of the drug company were wrong, but it would have been for free, so nah. Well about 15 years later someone finally did it. But the stuff is still in wide use.

 

This gets to my point about once a drug gets into wide use, further proof of it's lack of efficacy only slows it's roll. It can take years or decades for the drug to stop being used, unless it's shown to cause harm. It is said that it can take up to 19 years for a bad habit to work it's way out of medical practice. Almost need a large chunk of MD"s to retire with some things. And this plays into the Covid thing. As bad science shows a thing to seem to work or not work, it can become standard practice very quickly, and it can be hard to turn that ship around once the opposite is proven. I do think things move much more quickly in and out with Covid than anything else I've seen to date, but it's still a concern.

 

In my experience I never saw any of the issues you're concerned about.  The clinicians I worked with were all ethical scientists, and I never sensed pressure from the corporation to compromise the integrity of the studies.  FDA scrutiny of phase III studies is pretty intense, at least it was at the time I was working.  The type stuff you're talking about would have easily disqualified a study from supporting an NDA.  Couple things to keep in mind, though.

 

  • I've been out of the business for over 20 years so I don't know what might have changed.
  • I only worked for 2 drug companies, and they were big ones (Bristol Myers and Glaxo). Who knows what the culture might be like at a small company headed by someone like that human-cockroach cross breed Martin Shkreli?  
  • Ondansetron was a good drug right from the get go, so there was never the need for pressure. 
  • I only worked on phase III studies. Ours was a whole different division from the one that did postmarketing studies, which had much closer ties to sales and marketing.  In general, I trust the sales and marketing guys about as far as I can throw them (reference your experience with sales reps).

One note on the concerns about the questionability of the statistically significant finding in that remdesivir study. Even if it's invalidated (and if they fished for significance among a number of different endpoints, it would be) I don't know that's necessarily as discouraging to me as it was to the ED in the video.  I'd love to be able to look at the data.  If they cherry picked one of the few endpoints that showed better results from remdesivir, that would be really discouraging.  But if the vast majority of endpoints showed positive trends towards remdesivir, even without valid statistical significance due to study design flaws, the numbers are getting big enough that, given the current environment, it would seem to justify continued use as they fix the design issues and formally confirm that the trends aren't random noise.  And while, hopefully, they come up with the next iteration that is more effective.  All subject to an acceptable safety profile, of course.

 

Oh, and one ironic note about ondansetron; I had hernia surgery a while back, and post-op ondansetron didn't work for me.  If there was much of an effect, I hate to think what I'd have been like without it, lol.  

 

 

Edited by LakeLivin

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I haven’t seen any mention of this yet. Since it seems like we’re going to go ahead with the playoffs and they’re going to be in alternate site arenas, what are they doing about showing all of the playoffs in a manner where we can see even our home team which is normally on a black out?

Edited by caneswincup

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14 hours ago, KJUNKANE said:

That really does not address my concern totally, as I questioned rem, 1st what about the team on which it occurs? Does it just quarantine the player testing positive, his close contacts as well as him, or the entire team? It would seem that if only a player and his contacts are quarantined, you would quickly affect that teams ability to play? What about if the positive is a coach or assistant coach? Or training staff? So we've been told that "it will not all shut down" but if you eliminate a team that would seem pretty disruptive? And finally, what if it's one of the 2 in the finals? It would be weird to have the Stanley Cup awarded on the basis of forfeiture due to COVID-19, just saying? Lets just hope (and pray) that none of this unfolds, but look at the number of players on the Senators team who've tested positive?

Exactly, KJUN.  This is where Bundesliga and NHL are praying.

 

Bundesliga 2 had a team shut down due to a player or 2 on a team going positive.  There are complaints about fairness and equity specifically since one of the opponents of the team needed a win to move them close to promotion.  I.e. "We need to play that crummy team and move up!"  Forfeits apparently are not part of the plan (good thing, I think).  They are still trying to figure out what to do about the missing game.

 

But since it is the "AHL" equivalent, nobody cares much.  They would care if it were the big league.

Edited by wxray1

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10 hours ago, caneswincup said:

I haven’t seen any mention of this yet. Since it seems like we’re going to go ahead with the playoffs and they’re going to be in alternate site arenas, what are they doing about showing all of the playoffs in a manner where we can see even our home team which is normally on a black out?

Not sure what you mean, caneswincup.  The playoffs are typically widely televised.  The last few years NBC has made it a point to televise every game, even throwing alternates on stations like CNBC (financial network).  There shouldn't be blackouts.

 

As for the "play in" round of 5, that may be different.  I dunno.  I presume you are talking about the NHL network and "center ice" or whatever it is called? 

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Quote

DOCTORS CONCERNED OVER RISING HOSPITAL NUMBERS

The number of North Carolinians hospitalized with COVID-19 on any given day has jumped in the last two weeks to more than 600. It’s exceeded 700 four times since May 25, hitting a new high of 717 on Friday [yesterday].

 

That’s concerning for some doctors, who say hospitalizations are a better measure of slowing the spread than case numbers.

 

“If we’re seeing people get sick enough to be admitted to the hospital, that’s telling you we have not flattened the curve,” Dr. David Wohl, an infectious disease physician at the UNC School of Medicine in Chapel Hill, told The News & Observer.

Full daily update here.

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1 hour ago, wxray1 said:

Not sure what you mean, caneswincup.  The playoffs are typically widely televised.  The last few years NBC has made it a point to televise every game, even throwing alternates on stations like CNBC (financial network).  There shouldn't be blackouts.

 

As for the "play in" round of 5, that may be different.  I dunno.  I presume you are talking about the NHL network and "center ice" or whatever it is called? 

Yes, I don’t own a TV so was thinking Center Ice and specially the play in round, which wouldn’t be covered probably by the network’s contract with the league.

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4 minutes ago, caneswincup said:

Yes, I don’t own a TV so was thinking Center Ice and specially the play in round, which wouldn’t be covered probably by the network’s contract with the league.

Ah, I see.  I don't think they've announced anything.   Let's hope they are more permissive during these odd times so you can see the games.

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19 hours ago, KJUNKANE said:

That really does not address my concern totally, as I questioned rem, 1st what about the team on which it occurs? Does it just quarantine the player testing positive, his close contacts as well as him, or the entire team? It would seem that if only a player and his contacts are quarantined, you would quickly affect that teams ability to play? What about if the positive is a coach or assistant coach? Or training staff? So we've been told that "it will not all shut down" but if you eliminate a team that would seem pretty disruptive? And finally, what if it's one of the 2 in the finals? It would be weird to have the Stanley Cup awarded on the basis of forfeiture due to COVID-19, just saying? Lets just hope (and pray) that none of this unfolds, but look at the number of players on the Senators team who've tested positive?

I think if a player tests positive they will quarantine him, then try to determine if he had an very high risk exposure to another person. If not, they'd remove that player and go on. 

 

The thing is that they're testing everyone daily and they're going to have things in place to limit spread. Again, one person gives Covid to 2-4 people over the entire course of their disease mostly close contacts. In this case the person would be identified very early and removed. Also, everyone will be tested for 2 weeks prior to arriving. So everyone arriving should be disease free. These are not minor things. 

 

Is it possible that it spreads through a team? It is. If it does, this would derail that team. Is there a contingency for that? Probably, but I haven't heard it. 

 

Everyone arrives disease free, many social distancing and other precautions are in place, everyone is tested every day. I wish I worked in that setting.

 

 

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28 minutes ago, remkin said:

Everyone arrives disease free, many social distancing and other precautions are in place, everyone is tested every day. I wish I worked in that setting.

I mentioned much earlier that by the time the team is getting frequent testing, we better damn well have it for our health care folks.

 

It is looking more and more like capacity is becoming less of a problem than -- you guessed it -- MONEY, $$$$$$$$$$$$.  They can't even find enough people to test in some places.

 

Yes, testing capacity is still short in some places.  But let's say that's solved in the next month.  Then it will be all about $$$$.  If private enterprises like the NHL and NBA are testing daily, but our service workers in long term care facilities are getting no testing, then it is broken.  

 

What the NHL should do is dump an equivalent amount of $$$$ into a pot to allow our health care professionals to be tested more frequently. I.E., for every one test the players/coaches get, donate one for our front line works.   I'm specifically worried about LTC workers who go from facility to facility.  The NHL needs to give back in this effort.  It would be a fine time for management and players to cooperate on this, too.  They both have a few bucks I'm sure they could let go of.

 

 

Edited by wxray1
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2 hours ago, remkin said:

Again, one person gives Covid to 2-4 people over the entire course of their disease mostly close contacts. In this case the person would be identified very early and removed. Also, everyone will be tested

Okay, and I completely understand the scrutiny under which these games are being envisioned to proceed, however just this one snippet "one person gives Covid to 2-4 people" demonstrates how this is an apples to oranges rational. That ratio applies to everyday, non stressful activities, NOT to high impact, physically demanding sport of hockey, ratcheted up even more so during playoffs. And testing, no matter how frequent is not inerrant.

 

The other thing you mention rem also, like much of my thoughts is rather nitpicking, but "determine if he had any high risk exposure", I'm just not sure where you draw the line here? Oh well, I suppose there's nothing completely "risk free" and tremendous thought has been put into this venture, but I just see where things could go south fast. 

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38 minutes ago, KJUNKANE said:

 but I just see where things could go south fast. 

Someone mentioned mumps earlier?  Mumps went through the league like a knife through butter a few years ago.  Even among previously vaccinated guys (guess it weakened).  They say the R0 is 10 for mumps in a vulnerable population, but since this was a primarily vaccinated group, it had to be lower.  It still spread like wildfire.

sidney-crosby.jpg

Sidney says, "I'm fine.  No mumps.  What mumps?"

Edited by wxray1

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40 minutes ago, KJUNKANE said:

Okay, and I completely understand the scrutiny under which these games are being envisioned to proceed, however just this one snippet "one person gives Covid to 2-4 people" demonstrates how this is an apples to oranges rational. That ratio applies to everyday, non stressful activities, NOT to high impact, physically demanding sport of hockey, ratcheted up even more so during playoffs.

I guess this is the key issue in a way. How high risk is the actual play of hockey? The arenas are in many ways like being outside really. There is tons of open space with circulated air. The most risk would probably be on the benches I would think. Yes, scrums and the usual gather at the goalie to grab a guy and push and shove and stuff would also be a risk. This is where I wonder if there might not be a rule change for fighting and the usual playoff scrums and face washes and stuff like that. 

 

I think they can figure the rest out. Maybe even no showers in the building. Just throw on sweats and go shower at home. Distance in the locker room and masks in the locker room. Heck they could drop plexiglass between locker room stalls. 

 

But the highest risk is living closely with someone. 

 

I don't think it's perfect. I don't think it has to be perfect though. I don't think a player getting Covid is the end of everything. Clearly if it spreads through a team though, that would be a practical problem. 

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33 minutes ago, remkin said:

I guess this is the key issue in a way. How high risk is the actual play of hockey? The arenas are in many ways like being outside really. There is tons of open space with circulated air. The most risk would probably be on the benches I would think. Yes, scrums and the usual gather at the goalie to grab a guy and push and shove and stuff would also be a risk. This is where I wonder if there might not be a rule change for fighting and the usual playoff scrums and face washes and stuff like that. 

 

I think they can figure the rest out. Maybe even no showers in the building. Just throw on sweats and go shower at home. Distance in the locker room and masks in the locker room. Heck they could drop plexiglass between locker room stalls. 

 

But the highest risk is living closely with someone. 

 

I don't think it's perfect. I don't think it has to be perfect though. I don't think a player getting Covid is the end of everything. Clearly if it spreads through a team though, that would be a practical problem. 

I think there will be a rule change for fighting since it was announced that everybody is going to wear a full plastic cage like the one JW wore after scoring a goal with his face

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1 hour ago, Bonivan said:

I think there will be a rule change for fighting since it was announced that everybody is going to wear a full plastic cage like the one JW wore after scoring a goal with his face

Playoff hockey with no fights or scrums. *Yawn*

 

Edit to add: Oh, and the "winner" gets an asterisk next to their team name forever. Zzzzzzzzz.

Edited by top-shelf-1

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I am so excited to be blessed to see hockey again. Can’t wait.

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7 hours ago, remkin said:

I guess this is the key issue in a way. How high risk is the actual play of hockey? The arenas are in many ways like being outside really. There is tons of open space with circulated air. The most risk would probably be on the benches I would think. Yes, scrums and the usual gather at the goalie to grab a guy and push and shove and stuff would also be a risk. This is where I wonder if there might not be a rule change for fighting and the usual playoff scrums and face washes and stuff like that. 

 

I think they can figure the rest out. Maybe even no showers in the building. Just throw on sweats and go shower at home. Distance in the locker room and masks in the locker room. Heck they could drop plexiglass between locker room stalls. 

 

But the highest risk is living closely with someone. 

 

I don't think it's perfect. I don't think it has to be perfect though. I don't think a player getting Covid is the end of everything. Clearly if it spreads through a team though, that would be a practical problem. 

Good points rem, and the players might just be our "canaries"? Or Gladiators of the 21st Century.

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6 hours ago, top-shelf-1 said:

Playoff hockey with no fights or scrums. *Yawn*

 

Edit to add: Oh, and the "winner" gets an asterisk next to their team name forever. Zzzzzzzzz.

As I pointed out to rem, top, these are our modern day gladiators, so that we can live vicariously thru them?

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14 hours ago, top-shelf-1 said:

Playoff hockey with no fights or scrums. *Yawn*

 

Edit to add: Oh, and the "winner" gets an asterisk next to their team name forever. Zzzzzzzzz.

There really isn't a lot of fighting in the playoffs.  Eliminating it though may lead to more cheap shots if the refs don't have a minimal tolerance for that kind of stuff.  Brad Marchand, I'm eyeballin' you.  No licking

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I doubt Marchand licks anyone because that would put him at risk and he wouldn't want that. 

 

It will be interesting to see how typical hockey, and especially playoff hockey stuff is policed. TBH after a while one starts to realize that all of the facewashing and scrum yelling in the playoffs is more theater than actual violence. But in this Covid sense, that's the riskiest thing these guys might do. I have to think this issue  is being considered, but so far I don't recall hearing much about it. There will have to be some severe limitations on it, and that might look as odd as the empty arenas. 

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I think they tried for years to ban fighting in the NHL I know that much. But never passed. It entertains everyone. I know players wouldn't want that.

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