Dr David Gotlieb has been on the money re Covid-19 - what he writes about makes sense ......
The Covid 19 Diaries of Dr David Gotlieb.
Physician, Rheumatologist.
Cape Town. South Africa.
The Covid Diaries of Dr David Gotlieb. Cape Town. South Africa.
Includes original articles of April and follow up articles July, August and October 2020
—————————————————————
COVID conversations October 30 2020.
An update.
The Covid diaries of Dr David Gotlieb.
Rheumatologist, Cape Town. South Africa.
Thoughts and opinions.
October 29 2020 update
People keep referring to the second wave of corona sweeping around the world.
I see it as the third wave.
The third wave looks worse than the second wave.
It’s an unknown pathway and we will need to be cautious about big gatherings.
Israel has been one of the first to see a third wave and its already post peak.
Europe is spiking more than even the first waves.
Massive increases in Belgium and France Netherlands and Italy.
Sweden also is seeing the third wave.
Looking at the Israel experience, Phase 3 is lasting 6 to 8 weeks.
Overseas they are going up largely because of complacency with the mild phase two.
It would seem that winter is an aggravating factor as originally thought.
However note that Israel and the Mediterranean spikes are still in hot weather conditions.
Therefore summer does not make the Southern Hemisphere immune.
Deaths are also slightly increasing although not as bad as the first wave.
Demographic data of the new deaths are necessary.
We must not be complacent.
South Africa is about to get the second wave.
Phase two will last 1 month and then the spike will occur of phase 3.
In South Africa we will accelerate at end of November and deteriorate through December.
People must be aware that big gatherings are a problem at the moment.
if we are not careful, it’s going to take off BIG TIME.
Lockdowns are not appropriate at this time but we must continue to protect the elderly and apply common sense.
Symptomatic people must keep self quarantined.
Therefore:
Beware of big gatherings ... no matter how inconvenient.
We need to be sensible.
Keep safe.
Our hospitals are going to have to get ready again.
Regarding therapy, I remain supportive of early use hydroxychloroquine in standard dose (not high dose), and azithromycin as before. Later use is not beneficial.
Remdesivir in hospital is not as dramatic a response as we would like and neither is plasma antibody therapy.
Supportive oxygen techniques remain the major advances, and ventilation absolute last resort.
Dexamethazone and steroids are the principal therapies for in hospital use plus antibiotics and anticoagulants.
IL6 inhibitors have also been dissapointing.
I still do not see a vaccine coming.
I blame no politicians as it’s a virus and no one can stop transmission, other than common sense.
The virus is NOT fake news.
The virus is NOT just flu.
The virus is NOT a hoax.
If you are symptomatic...stay at home and isolate.
Use of masks is controversial, but I support them for public use when out of the household, and especially for hospital workers.
Dr David Gotlieb
Rheumatologist.
Cape Town
Oct 29 2020
———————————————————
Covid diaries
August 19th 2020.
An update.
My predictions re the covid 19 epidemic seem to be coming true.
The surges are not associated with surges in deaths.
The virus will dissipate by itself.
There are no vaccines coming.
Deaths take place over 4 months no matter where in the world.
In Cape Town, we were first in the country due to the tourism issue, we are 6 weeks ahead of the rest of the country.
Our deaths will subside at end August / early September.
The rest of the country, deaths will subside mid October.
Surges will follow BUT DEATHS WILL NOT DRAMATICALLY SURGE.
In the USA, New York was first and death rates are now VERY low.
The rest of the country, ie Florida, is 6 weeks after New York.
Deaths are already subsiding.
SURGES WILL OCCUR BUT NOT DEATHS.
Economies must opened after the deaths dissipate.
It’s NOT ABOUT CASE NUMBERS.
We will still need to protect the vulnerable, especially the elderly.
A vaccine is not coming and the virus will dissipate by itself, in terms of virulence and increased community resistance.
The economies will slowly recover, but South Africa will battle as our economy is severely affected and we started at a low base level.
We are an african country and are progressively no longer exceptional from the rest of the continent.
Our political leaders require to review our excessive regulatory issues that are holding us back.
We are going to go through hard socioeconomic times.
It’s not too late to reverse our deterioration, but political will is required and I hope our leadership can make the hard choices.
I am not optimistic in that regard.
Dr David Gotlieb.
August 19 2020.
Cape Town
South Africa.
——————————————————————————
Covid report July 2020
July 14 2020
My Covid opinion update to my article from April this year.
Covid and covid therapeutic update
My article from April, remains as relevant now as when I wrote it.
I would not change any aspect of its content, but further addition is required.
This represents an update on how I see it.
I still am a hydroxy/chlo supporter, and a recent study supported it.
The previous studies were at excessive doses and showed some cardio toxicity.
However normal doses are safe.
I suggest consider the following, with your doctors guidance.
If exposed AND develop symptoms consider start chloroquine sulphate 200mg one daily or hydroxychloroquine 400mg daily. Continue until better.
If start a cough..start azithromycin one daily for 6 days
If become breathlessness..you would need admission and at that time steroids can be started.
I would only use the cortisone in hospital use.
NB
I would also use a cardiovascular dose ecotrin or aspirin if symptomatic.
In hospital low molecular weight heparins should be added to aspirin for more comprehensive anticoagulation.
Oxygen is important monitoring sats, and ventilators are at extremis of coping.
If cytokine storm I recommend possible use of IL6 inhibitor, Actemra, but in hospital and under supervision and preferably intravenous.
Post covid autoimmune disease must require corticosteroid plus immunosuppressants.
Where do I think the future is?
All models and experts have dissapointed.
My non expert opinion is that it’s about the deaths not case numbers.
Analysis seems to show a curve peaking at 2 months and lasting 4 months at which death rates drop despite case numbers.
So USA should be much better in terms of mortality risk at mid to end September.
There is NO vaccine coming.
The virus will become less virulent despite contagion over time and will disappear in the next 6 months with a short less toxic resurgence next February.
Cape Town mortality is going to peak now and subside end August, early sept 2020.
Gauteng mortality will subside 6 weeks after Cape Town.
Our lives and economies will slowly recover over the next year, except South Africa will be economically devastated.
We will be in trouble and it’s going to be hard.
Dr David Gotlieb.
July 14 2020
Cape Town South Africa.
—————————————————————————
Covid 19 Diary.
Personal thoughts and opinions
April 19. 2020
Dr David Gotlieb.
Physician. Rheumatologist.
Cape Town.
South Africa.
There are some terrible harsh realities that the world must accept.
The virus is NOT going away.
The lockdown has been in place, but made us realize that new case numbers persist, and that we are delusional to think we are going to kill this virus.
The lockdown will NOT get rid of the virus.
To this end we have to accept certain realities.
It’s not about getting rid of the virus, it’s about understanding that we will NOT get rid of it for the next year, or more, as it burns it’s way across the world, until we gradually develop a resistance, or even better, some REAL treatments or vaccines against it.
Unfortunately, we will have to literally start normalizing the consequences of the virus. Some people are going to die and we can only do our best to treat them as they come. We have to accept that it’s an ongoing risk for all of us especially the elderly, and social distancing will be needed for the at risk populations.
Other diseases and conditions will also need treatment, and we will see a rebound in these as people start to bring their complaints to the hospitals again.
A country as a whole, and its people, as individuals, cannot continue to exist without income.
We have to resume life and the economy, and the politicians have to start to verbalize this TRUTH.
This TRUTH, is that the virus is NOT going away for a long time, and that some, but in fact, relatively few people, are going to die, compared to the numbers of infections.
It is VERY important to reassure people that the overwhelming majority of people, in fact more than 95% will be fine.
The virus is much more prevalent than people realize.
Spread is already much more than realized, due to failure to count asymptomatic individuals.
The virus is therefore even LESS lethal than thought, since the true ratio of mortality is overestimated, by not including the asymptomatic, as yet, unknown numbers.
Politically...there will be blame:
Of course , people are blaming Donald Trump.
BUT, It’s not Trumps fault.
The media have continued their three year resistance against trump, at all cost, and continue to use the virus to “get him”.
To a degree the media have stirred up emotions, and influenced the world reaction into ongoing lockdowns and staggering destruction of economies, that are leading to incredible poverty, the consequences of which, are still to come.
NO country or government could have been prepared for this.
The expert advisors, ie Dr Fauci, amongst others, did NOT know what the realities of this virus are. There WAS no experience on this issue. Models were and are still, all wrong, because there has NEVER been a similar problem.
The lockdowns have not worked to CURE the virus.
The lockdowns did work in one respect...they lowered the curve of acute admissions and bought time, and enabled the systems to develop a better public health coping ability.
Contrary to media disinformation, Trump HAS listened to the experts. At every stage he followed their advice. Their advice has not worked to CURE the virus.
NOTHING, would have worked.
It’s about EXPECTATIONS of the public.
The ONE mistake, has been, to give the public the expectation that the virus will be GONE. It will NOT go in short or medium term.
The reality is that the lockdown has only enabled healthcare to cope by lowering the rapid spread and mass presentation of acute illness
But the time of lockdowns has passed.
The entire main stream media reaction, has just been aimed at Trump, not the virus.
The media are spreading inappropriate expectations for a political end.
Worse, the media are to blame for the ongoing attack and demise of hope.
Hope is a human requirement.
The media need to look at themselves and stop their ongoing negativity, which is simply based on their hatred for Donald Trump.
If anything China bares largest responsibility for this literal viral Chernobyl facing the world, be it spread from their disgusting wet markets, or even worse, the claims of viral construction in a lab, that got out into communities.
The truth has not come out of China and still does not do so, and in all likelihood, will NEVER do so.
The world health organization, W.H.O, also bears a major responsibility for underestimating the severity and the contagious component of corona virus, and inappropriately defending Chinese disinformation, and failing in the early response to spread of the virus.
So what is going to happen?
The virus will stay in the communities, until either natural resistance increases, or less likely, a vaccine is developed.
The virus will spread and many people will get sick, but MOST will be fine.
Some people who are at risk will get the virus, and regrettably may not survive.
We have to accept that it’s an ongoing risk for all of us especially the elderly, and social distancing will be needed for these at risk populations.
The economies will have to open up.
Life will go on.
Humanity will survive.
Hopefully humanity will learn from this.
Humanity must henceforth look after the entire planet including wildlife, the environment and preserve it.
People need to learn the fundamentals of life, especially togetherness and caring and thought for the less fortunate.
There is hope, because at the end, hope is all we as a species have.
The road ahead is going to be very hard.
Keep strong. Keep safe.
Hold on to your hope.
And for those who have faith...keep that too!
David Gotlieb.
Physician, Rheumatologist.
Cape Town.
April 19th 2020.
—————————————
—————————————————————
COVID conversations August 19th 2020.
An update.
The virus is dissipating. Deaths are reducing despite surges.
It’s not about numbers, it’s about the deaths.
We still need to protect the vulnerable especially the elderly..
My predictions re the covid 19 epidemic seem to be coming true.
The surges are not associated with surges in deaths.
The virus will dissipate by itself.
There are no vaccines coming.
Deaths take place over 4 months no matter where in the world.
In Cape Town, we were first in the country due to the tourism issue, we are 6 weeks ahead of the rest of the country.
Our deaths will subside at end August / early September.
The rest of the country, deaths will subside mid October.
Surges will follow BUT DEATHS WILL NOT DRAMATICALLY SURGE.
In the USA, New York was first and death rates are now VERY low.
The rest of the country, ie Florida, is 6 weeks after New York.
Deaths are already subsiding.
SURGES WILL OCCUR BUT NOT DEATHS.
Economies must opened after the deaths dissipate.
It’s NOT ABOUT CASE NUMBERS.
We will still need to protect the vulnerable, especially the elderly.
A vaccine is not coming and the virus will dissipate by itself, in terms of virulence and increased community resistance.
Dr David Gotlieb.
August 19 2020.
Cape Town
South Africa.
——————————————————————————
Covid report July 2020
July 14 2020
My Covid opinion update to my article from April this year.
Covid and covid therapeutic update
My article from April, remains as relevant now as when I wrote it.
I would not change any aspect of its content, but further addition is required.
This represents an update on how I see it.
I still am a hydroxy/chlo supporter, and a recent study supported it.
The previous studies were at excessive doses and showed some cardio toxicity.
However normal doses are safe.
I suggest consider the following, with your doctors guidance.
If exposed AND develop symptoms consider start chloroquine sulphate 200mg one daily or hydroxychloroquine 400mg daily. Continue until better.
If start a cough..start azithromycin one daily for 6 days
If become breathlessness..you would need admission and at that time steroids can be started.
I would only use the cortisone in hospital use.
NB
I would also use a cardiovascular dose ecotrin or aspirin if symptomatic.
In hospital low molecular weight heparins should be added to aspirin for more comprehensive anticoagulation.
Oxygen is important monitoring sats, and ventilators are at extremis of coping.
If cytokine storm I recommend possible use of IL6 inhibitor, Actemra, but in hospital and under supervision and preferably intravenous.
Post covid autoimmune disease must require corticosteroid plus immunosuppressants.
Where do I think the future is?
All models and experts have dissapointed.
My non expert opinion is that it’s about the deaths not case numbers.
Analysis seems to show a curve peaking at 2 months and lasting 4 months at which death rates drop despite case numbers.
So USA should be much better in terms of mortality risk at mid to end September.
There is NO vaccine coming.
The virus will become less virulent despite contagion over time and will disappear in the next 6 months with a short less toxic resurgence next February.
Cape Town mortality is going to peak now and subside end August, early sept 2020.
Gauteng mortality will subside 6 weeks after Cape Town.
Our lives and economies will slowly recover over the next year, except South Africa will be economically devastated.
We will be in trouble and it’s going to be hard.
Dr David Gotlieb.
July 14 2020
Cape Town South Africa.
—————————————————————————
Covid 19 Diary.
Personal thoughts and opinions
April 19. 2020
Dr David Gotlieb.
Physician. Rheumatologist.
Cape Town.
South Africa.
There are some terrible harsh realities that the world must accept.
The virus is NOT going away.
The lockdown has been in place, but made us realize that new case numbers persist, and that we are delusional to think we are going to kill this virus.
The lockdown will NOT get rid of the virus.
To this end we have to accept certain realities.
It’s not about getting rid of the virus, it’s about understanding that we will NOT get rid of it for the next year, or more, as it burns it’s way across the world, until we gradually develop a resistance, or even better, some REAL treatments or vaccines against it.
Unfortunately, we will have to literally start normalizing the consequences of the virus. Some people are going to die and we can only do our best to treat them as they come. We have to accept that it’s an ongoing risk for all of us especially the elderly, and social distancing will be needed for the at risk populations.
Other diseases and conditions will also need treatment, and we will see a rebound in these as people start to bring their complaints to the hospitals again.
A country as a whole, and its people, as individuals, cannot continue to exist without income.
We have to resume life and the economy, and the politicians have to start to verbalize this TRUTH.
This TRUTH, is that the virus is NOT going away for a long time, and that some, but in fact, relatively few people, are going to die, compared to the numbers of infections.
It is VERY important to reassure people that the overwhelming majority of people, in fact more than 95% will be fine.
The virus is much more prevalent than people realize.
Spread is already much more than realized, due to failure to count asymptomatic individuals.
The virus is therefore even LESS lethal than thought, since the true ratio of mortality is overestimated, by not including the asymptomatic, as yet, unknown numbers.
Politically...there will be blame:
Of course , people are blaming Donald Trump.
BUT, It’s not Trumps fault.
The media have continued their three year resistance against trump, at all cost, and continue to use the virus to “get him”.
To a degree the media have stirred up emotions, and influenced the world reaction into ongoing lockdowns and staggering destruction of economies, that are leading to incredible poverty, the consequences of which, are still to come.
NO country or government could have been prepared for this.
The expert advisors, ie Dr Fauci, amongst others, did NOT know what the realities of this virus are. There WAS no experience on this issue. Models were and are still, all wrong, because there has NEVER been a similar problem.
The lockdowns have not worked to CURE the virus.
The lockdowns did work in one respect...they lowered the curve of acute admissions and bought time, and enabled the systems to develop a better public health coping ability.
Contrary to media disinformation, Trump HAS listened to the experts. At every stage he followed their advice. Their advice has not worked to CURE the virus.
NOTHING, would have worked.
It’s about EXPECTATIONS of the public.
The ONE mistake, has been, to give the public the expectation that the virus will be GONE. It will NOT go in short or medium term.
The reality is that the lockdown has only enabled healthcare to cope by lowering the rapid spread and mass presentation of acute illness
But the time of lockdowns has passed.
The entire main stream media reaction, has just been aimed at Trump, not the virus.
The media are spreading inappropriate expectations for a political end.
Worse, the media are to blame for the ongoing attack and demise of hope.
Hope is a human requirement.
The media need to look at themselves and stop their ongoing negativity, which is simply based on their hatred for Donald Trump.
If anything China bares largest responsibility for this literal viral Chernobyl facing the world, be it spread from their disgusting wet markets, or even worse, the claims of viral construction in a lab, that got out into communities.
The truth has not come out of China and still does not do so, and in all likelihood, will NEVER do so.
The world health organization, W.H.O, also bears a major responsibility for underestimating the severity and the contagious component of corona virus, and inappropriately defending Chinese disinformation, and failing in the early response to spread of the virus.
So what is going to happen?
The virus will stay in the communities, until either natural resistance increases, or less likely, a vaccine is developed.
The virus will spread and many people will get sick, but MOST will be fine.
Some people who are at risk will get the virus, and regrettably may not survive.
We have to accept that it’s an ongoing risk for all of us especially the elderly, and social distancing will be needed for these at risk populations.
The economies will have to open up.
Life will go on.
Humanity will survive.
Hopefully humanity will learn from this.
Humanity must henceforth look after the entire planet including wildlife, the environment and preserve it.
People need to learn the fundamentals of life, especially togetherness and caring and thought for the less fortunate.
There is hope, because at the end, hope is all we as a species have.
The road ahead is going to be very hard.
Keep strong. Keep safe.
Hold on to your hope.
And for those who have faith...keep that too!
David Gotlieb.
Physician, Rheumatologist.
Cape Town.
April 19th 2020.
——————————————————
Data from worldometers.info