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@blamonkey
@bmdrocks21
Suffice it to say, I'm a little over the border wall argument at this point. It seems like the only areas in which we really disagree is the relative levels of border security available here vs. Israel and whether it's most appropriate to go "full steam ahead" without taking appropriate measures that are, admittedly, time intensive. So I'll just wrap those two up.
It's not so much that I'm arguing that those Israeli soldiers are all directly monitoring the border. It's a perceptual thing: someone coming into the country would see military on nearly every street, and it's going to be a very different experience for them than it is for someone coming into the US. There's a sense that you're always being monitored to some degree, even if they aren't specifically there for the purpose of border security. I don't think that's something we can replicate in the US.
As for the latter point, I think the full steam ahead approach is going to cause more harm than good. The way Trump acquired funds for this can be easily reversed by the next administration, not to mention appropriated for use on a variety of projects. Being able to, essentially, pull funds from the military so long as you declare a state of emergency over a given problem is not a good precedent to set, and I expect it will be abused by future presidents, both Democratic and Republican. And, particularly when we're dealing with something as contentious and fraught as the wall, I think the fast and dirty route ensures that it will be stopped the moment a new president comes into power. It makes it very hard to defend its continuation. So, much as it might lead to the construction of some wall, it's probably not going to be the full thing. That's going to be frustrating because it's going to leave substantial holes that can continue to be used. Essentially, it's going to have little benefit, while handicapping any and all efforts to expand that wall.
As for chloroquine, I'm debating this now with christopher_best, so I'll be providing a pretty in-depth analysis there. I'll give a preview here.
I'm not really concerned with the individual story of this woman and her husband, no matter the circumstances. It's one person, it's not a very good representation of the broader population.
Regarding the briefing, approval is very different from allowing doctors to prescribe the medication off-label for "compassionate use". When people hear approved, they hear that its efficacy and safety have been tested and validated by the FDA. I think ti's important for someone delivering the message of what has been done to be very clear on that, particularly as there is a big difference between allowing doctors to prescribe something off -label and having an on-label, thoroughly established use case. I know the clarification was made, but Trump should also be clarifying it, which he has continued to fail to do. He's now recommending that people try the drug because, in his words, "what do you have to lose?" https://www.independent.co.uk/news/world/americas/trump-coronavirus-hydroxychloroquine-anti-malaria-drug-latest-a9447796.html That's not a good message to send on a drug with no proven efficacy and a bevy of side-effects. Saying that "it's not going to kill anybody" is also an overgeneralization that shows misunderstandings of its side-effects, which, as blamonkey points out, can kill (particularly patients with heart problems).https://abcnews.go.com/Health/chloroquine-coronavirus-savior-wild-west-medicine/story?id=69828253 That's a particularly big problem for COVID-19 patients, as the disease may cause its own heart problems. https://www.newsweek.com/previous-heart-problems-covid19-1494730 Saying that he thinks "it could be a game-changer, and maybe not" is not a clarifying point. It muddles the issue.
I've heard a lot about this whole point that Trump being optimistic is somehow inherently beneficial, even when it's clearly contrary to what the experts are saying. I'm not buying that that kind of optimism is beneficial, nor do I agree that addressing the situation using all available facts is inherently pessimistic or, as you said, "offering no potential solutions". I agree, that would be bad as well, but that's a false dichotomy. If Trump wants to point out that there are ongoing trials to establish the safety and efficacy of the drug, say that some doctors are prescribing the drug, and that he's doing everything he can to ensure that those trials move quickly, that would still be positive and accurate. It would also be positive and accurate to point to trials with anti-microbials, broad spectrum antivirals, and numerous other drugs that are being tested for the purpose. Being clear that, yes, we don't have a treatment right now, but we do have a variety of methods to address the pneumonia and the means to keep people alive in the worst of disease states is a good start. Unlike your FDR example, it's not necessary for the president to approach this by presenting uncertainty. It is necessary for them to present the situation as it is, and not as they want it to be. Confidence should be informed by available evidence, not stitched together out of whole cloth. There are reasons to be confident. Trump has done little to present them accurately.
Finally, because I know this is going to come up, no, I don't think that a full set of clinical trials has to be performed before we roll out this drug for wide usage. It would take too long, I get that. The problem I have is that people are jumping on this too quickly. The best study available that I can find supporting it is a French one, which started with a small group of people being treated with chloroquine and azythromycin (all of 6) and found that they cleared the virus, which may be due to either drug. The remainder of that trial group were treated differently, and had a wide variety of outcomes, including deaths and attrition from the program. The follow-up study may look better, as it includes 80 people. However, it's troubled by two factors. First, the absence of any control group. I know it's unethical not to treat a separate group when you think you have an available treatment, but there are other means to manage their disease states. The failure to have that group makes any results suspect because we can't know how many of these people would have recovered absent chloroquine treatment. Second, it's a pretty bad follow-up to the previous trial. Those 6 patients had advanced disease. These 80 people were in the early stages and experiencing relatively few symptoms as compared with that small group. Their recovery may be unsurprising, given that the vast majority of people at that stage do recover. Meanwhile, I've seen a variety of studies that fail to establish any efficacy. I'll post a couple.
These call into question whether there's any evidence of benefit in patients. There is a clear, non-zero risk of treating these patients with chloroquine, so I think any efforts to do so should bear that in mind. If efficacy is uncertain, then the known costs likely outstrip the benefits. It also doesn't help that this draws attention away from other, better tested methods like broad-spectrum antivirals. There are positives out there, and I think focusing too much on this is problematic simply because it focuses our attention on something that looks like it may not bear fruit.
