Texas City COVID-19 patients receive hydroxychloroquine

Dr. Robin Armstrong, medical director at The Resort at Texas City nursing home, provided hydroxychloroquine to 35 residents who tested positive for COVID-19 but had not shown any symptoms.

TEXAS CITY

At the center of a daily tit-for-tat between President Donald Trump and leading infectious disease specialist Dr. Anthony Fauci, debating the advisability of using the anti-malarial drug hydroxychloroquine to treat COVID-19, is Dr. Robin Armstrong, who is treating elderly patients with it in a Texas City nursing home.

Kathryn Eastburn: 409-683-5257; kathryn.eastburn@galvnews.com.

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(93) comments

Gary Miller

DR's using it say it works. Dr's not using it say it shouldn't be used. If I need a Dr for Covid -19 I'd prefer a Dr. that uses what he thinks works, not one waiting on a bureaucrat to tell him what to do.

Phyllis Rasmussen

[thumbup] If I or a loved one has been suffering, is ill, and dying, I would want myself or the loved one to be given anything that would save me or them. If someone is drowning, are you just going to wait to get permission before someone saves them? No. That would make no sense at all. It's a life and death situation. Dr. Armstrong took care of my mother a few years ago and did a wonderful job. He is very caring and we both think very highly of him.

Terri Abraham

He said none of the people he was treating got worse, How many of the ones NOT being treated got worse?

Carlos Ponce

"[Professor Didier Raoult]'s research team has published data showing that out of 80 mild COVID-19 patients treated with hydroxychloroquine and azithromycin, 93 percent had no detectable levels of the virus after eight days.

According to Les Echos newspaper, Raoult gave [French President] Macron the results of a new study on 1,061 patients showing a 91 percent success rate.

Last week, doctors in Paris reported that they tried to replicate the results of the Marseille study and failed.

Doctors have questioned the value of the Marseille study and several papers from China on the same treatment as being too small or poorly designed to offer hard evidence of benefit."

So thousands of trials are "too small". [rolleyes]

https://www.reuters.com/article/us-health-coronavirus-macron-doctor-idUSKCN21R36R

George Soros

He still used an experimental drug without patient consent, you are okay with this?

Carlos Ponce

The article doesn't say that, Jimmy. The article states he did not get the patient's RELATIVES' consent.

George Soros

"Armstrong said he didn’t inform patients' before using the drug, as the U.S. Centers for Disease Control and Prevention recommends before physicians use any drugs not approved by the FDA for treatment of COVID-19."

Seems pretty clear to me in the article ....

Carlos Ponce

Jimmy left out ONE word:

This is what the article ACTUALLY STATES:

"Armstrong said he didn’t inform patients' relatives before using the drug, as the U.S. Centers for Disease Control and Prevention recommends before physicians use any drugs not approved by the FDA for treatment of COVID-19."

George Soros

Hmmm I copied it straight from the article. Maybe you are editing it to fit your narrative. Wouldnt be the first time I suppose

Carlos Ponce

Jimmy, YOU are editing it to fit your mistake. Now be a MAN and admit it! There is NO WAY you can copy it STRAIGHT out of the article without including the word "relatives".

Here's proof: What you posted was "Armstrong said he didn’t inform patients' before using the drug, as the U.S. Centers for Disease Control and Prevention recommends before physicians use any drugs not approved by the FDA for treatment of COVID-19."

But you left in the apostrophe after the word "patients' " indicating a possessive form of the word. Patients' WHAT??????

You left it out.

Now man up!

Jeffrey Gottlieb

It's not experimental. The FDA approves a drugs indication based on the original drug company's New Drug Application (NDA) and the indications they submit. Once a drug is approved, a physician can use it for "off label" indications based on other research or anecdotal experience. All the label indication means is that the drug company cannot promote the drug for those other uses.

I spent 13 years in the pharmaceutical industry both in sales and research. Hope this helps.

Carlos Ponce

Thank you, Jeffrey. That information is very helpful.

Cindy Milina

How do you know that he treated without patient consent? He only requires the family's consent if the patient is unable to consent himself.

Lisa Gray

Hydroxychloroquine has been around for over 70 years. It is NOT experimental.

Gary Miller

Lisa. You are correct. The number one drug in the world has been used for decades on off label uses without concern. It's not CDC label approved for most things it's sucessfuly used for without patient or family notification. What drug? ASPIRIN!

Charles Douglas

I don't know this doctor personally, but I do know members of his family from way back! All of the ones I know are very bright and smart people! All I have heard about Dr. ROBIN is that he is no different! I have heard many good things about him, but one thing I am not sure he has contemplated is that there are thousands, maybe millions of individuals who DONT want these cures and treatments to work! Oh they lie and say all the right things, but they are rubbing their hands together like they are getting ready to eat a juicy steak at dinnertime, in anticipation that this is the tool they have waited on to get what God ALMIGHTY is not going to allow them to have! Shame to say this country is busting wide open with Chinese Communist sympathizers, spies, & socialism worshipers! In a few years if steps are not taken to rein in ...and root these individuals out of our schools, colleges, and university systems, we are going to have an America which reflects the values of Cuba, Venezuela, and Communist China. While there are those who have been laser focused on Russian interference in American affairs, .. China, has been operating unchecked, bribing, lobbying, and manipulating individuals and groups inside America in order to steal secrets, patents, kill factories, and jobs here ..seemingly with little resistance! I personally wondered why or HOW could this be so. Then, out of the blue it came to me. MONEY vs GOD!!!!! It is written, " No man can serve two masters..for either he will hate the one, and love the other, or he will hold to the one and and despise the other. You cannot serve God and Money." (....Matthew 6:24 ) If you bother to check, you will learn that China is the principal holder of AMERICA'S TRILLIONS & TRILLIONS of our borrowed debt! You may be thinking .." SO WHAT?" I will tell you so what. I'll answer you in the WORD of GOD! " Owe no man nothing but to love him.......( Romans 13:8 ) I will follow that up with, " The rich ruleth over the poor, and the BORROWER is a SLAVE to the LENDER!" Yes I see slaves to China here everyday! Movie Stars, Pro Basketball Players like Curry, James, and Barkley ..to name a few! I see high ranking government officials on the state levels as well as in Washington DC operating secretly as slaves to China! I see great American Media Companies as well as companies like Twitter, Facebook and Goggle kowtowing to Chinese music being handed down! WHY? WHY ...would people become so corrupted, unpatriotic, and wicked that they would turn on the very nation where they live? " For the LOVE of MONEY is the root of all evil........" ( 1 Timothy 6:10 ). Money is a horrible master, but a terrific servant! The insinuation here is simple! When a man quit having money, and proceed to allow money to HAVE him then bad things are on the way for that man. In ( Luke 12: 15-21) ..this is the Parable Of The Rich Fool! He learned by experience instead of by Godly wisdom! What an exciting time we have today to have a door of utterance, or an OPPORTUNITY, to do things different than a FOOL who allowed himself to be lured into being POSSESSED by MONEY!

Gary Miller

Charles> You are correct on most of your post but wrong on one thing. China holds $1 trillion of the 22 trillion US debt. China is not the principle holder of US debt. American PROGRESSIVES are. They hold more than half of US debt. A greater danger than any country holding it.

Gary Scoggin

"American PROGRESSIVES"? I didn't know Treasury bonds are being tracked by poltiical affiliation. I guess you don't own any -- or have any investments or savings that are backed by them. I guess we PROGRESSIVES are more patriotic because we are willing to invest in America.

Carlos Ponce

"I guess we PROGRESSIVES are more patriotic..." Hardly.

Charles Douglas

Say amen to that!!!! This was free no offering asked for on this one.

Gary Scoggin

I’ve got no problems with doctors trying emerging therapies like hydroqcantspellit. It appears as if Dr. Armstrong is monitoring for side effects, etc. and is following a good standard of care. It is important that these results get added to the medical community’s knowledge about this therapy in the form of a clinical note or other public mechanism.

I am concerned about the lack of informed consent for many of these patients as was reported elsewhere. Dr. Armstrong’s assertion that he was too busy to notify the patients’s families rings hollow. He should have gotten some help, then.

Also, I’ll take Dr. Armstrong at his word that his medical decisions and political decisions are separate.

George Soros

Exactly. The issue is not whether the drug works or not (which is still being evaluated) its the fact that he did not inform any patients that he was using a drug that was NOT approved by the FDA for this virus. I am sure nothing will come of this since he is a big republican, but there should be repercussions from using an experimental (for this virus) on patients without consent.

Carlos Ponce

"he did not inform any patients" The article doesn't say that, Jimmy. It states, "Armstrong said he didn’t inform patients' relatives".

Gary Scoggin

In many cases the patients are not capable of giving informed consent and the authority to do so rests with a relative holding a power of attorney. He did not clear this with those relatives. Carlos, I assume you know this and are just engaging in one of those rationalization you often have to resort to to defend the President.

Carlos Ponce

Gary Scoggin posts, "just engaging in one of those rationalization you often have to resort to to defend the President". Now that is a STRETCH in a post about a local doctor to state it involves the president!

I've been asked several times as medical power attorney to approve of treatment but rare is the time they specify what drug is to be used. If in the treatment a doctor uses a particular drug I leave it up to her or his medical discretion.

C. Patterson

He’s only legally obligated to consult with the patient or power of attorney

Cindy Milina

Mr. Winston, I'm pretty sure if it was YOU laying in a hospital bed unable to breathe that you'd give your consent to try whatever the doctor suggested as a treatment. Sheesh...

Gary Miller

Gary S. He had the approval he needed on the admission forms each patient signed.

Gary Scoggin

You must have remarkable access if you were able to look at all the forms.

Carlos Ponce

I have admitted my brother to 3 nursing homes Baywind, The Resort and Ashton Parke. The forms are not identical but similar and have what Gary Miller posted.

Carlos Ponce

"graduate of La Marque High School" - An excellent role model for all in LMHS! The GDN shows he was a receiver for the La Marque Cougars (number 13) and ran on the track relay team. He was also a Moody Scholarship winner in 1987 and a DAR Good Citizen Award recipient . Good job, La Marque Cougar!

Andy Aycoth

[thumbup]

Ted Gillis

Can someone give me the Cliff notes for what Charles is trying say. Good Grief.

And for the record, I commend Dr. Armstrong for the treatment and care of these patients.

I too keep my politics and my profession separate.

Carlos Ponce

Cliff notes version:

Dr. Armstrong is a GOOD Doctor.

Too many politicians, elitists are going to ignore that China screwed the world with this pandemic and CONTINUES.

Charles Douglas

[thumbup][thumbup][thumbup]

C. Patterson

He’s not obligated to inform the family if he has consulted with the patient (Or if there is an MPA on file) Drs often use medicines “Off Label” from their specific stated use, this is not illegal. This is a very old drug and it’s side effects are very well known. The hype over this topic is way overblown to the point of ridiculousness( and we all know why) and the implication that Dr. Armstrong’s use of this medication is somehow politically motivated are insulting, disrespectful and ignorant. There are absolutely no reasons to doubt that what he’s done, he’s done so in the best interest of his patients. Here’s a thought, why don’t you let Drs be Drs and get out of the way?

Connie Patterson

Charles Douglas

[thumbup][thumbup][thumbup]

Lorraine Jones

Why is this doctors political affiliation mentioned? What does that have to do with being a good doctor?

Cindy Milina

Thank you. This article drove me to cancel my subscription yesterday. I don't want to read anymore of the Daily News' biased, slanted bs. I hope the doctor sues for defamation of character. I have never known, nor been interested, in my doctor's political affiliations and don't see why it had anything to do with the story other than to discredit him.

Ted Gillis

Just stick with the sign language from now on Charles. Thank you Carlos for the interpretation.

Lorraine, I totally agree with you. The article’s author is clearly trying to make a point about something. I respect Dr. Armstrong’s professionalism, and his decision on how to treat his patients should not be challenged by others not in his profession.

It would be like an electrician trying to tell a plumber on how pipe up a bathroom, because he saw it done differently on the some home improvement show.

Lisa Gray

Ted you are spot on!

Charles Douglas

Hey Gillis, stop trolling me please I'm already in a relationship.

Bailey Jones

Looks like all of last November's constitutional law experts are now epidemiology experts.

I'm not an expert in either, but as a freedom loving American, I think I should have the right to take whatever drugs I want - as long as I informed of the risks, and accept them.

Lisa Gray

"On April 10, the Fort Worth Star Telegram published a glowing endorsement of the president’s leadership of the COVID-19 emergency response, penned by Armstrong."

Why did the Fort Worth Star have to print this and not the GDN??

DAVID MOSS

Lisa most of us know why. Dr. Robinson is not only a respected Dr. but a fine individual.

Charles Douglas

Right you are Mr. Moss, and as I stated earlier in on this thread, this doctor comes from fine stock!

Diane Turski

Doctors are not gods. They are human beings with medical training and varying amounts of medical experience. Because doctors are required to make important judgement calls that affect their patients' health, I think the most important consideration for patients is whether they trust a doctor's judgement. In this case, if my doctor stated that Trump is doing a great job handling this pandemic, then I would have to question his judgement, since all independent evidence contradicts his judgement.

DAVID MOSS

I guess in the future we will need to ask if our caregivers they have an R,D,or I following their names.

Carlos Ponce

Dianne Turski posts, "Doctors are not gods". That's fine as long as it includes Dr. Anthony Fauci. Many on the Left have deified when in 1990 they demonized him for his actions concerning AIDS treatment.

Now, Dr. Nicole Saphier is a goddess!!!![love]

Andy Aycoth

If my Doctor was a left wing extremist Democrat then I would have to question his or her judgment.

Andy Aycoth

Gary Scoggin

If you picked your doctor based upon their political affiliation, I’d have to question yours.

Mike Zeller

Carlos you are wrong and Jimmy Winston, you are correct. Carlos is well known to cherry-pick and not tell the whole story. This is copied directly from the article, "Armstrong has said that some of the patients he is treating were given the medication without that kind of beforehand discussion, either with them or their families." Jimmy Winston [thumbup]

Carlos Ponce

Mike, it's too late for an April Fool's day joke.

Cindy Milina

It is really disheartening to see even local reporters such as this politicize important news in an obvious attempt to discredit the giod doctor for gasp, being a Republican. I expect it from the AP and WP, but this type of jaundiced journalism makes me want to cancel my subscription altogether, and it might be time to.

If the doctor were a Democrat, the headline would read 'Prominent Black Physician blah blah blah.'' I am FED UP with this divisive reporting and if reporters such as this can't deliver the facts without slanting and planting a narrative, I will no longer support this paper. Adios Daily News.

Dalton Logan

[thumbup]

John Merritt

This is the worst news story I have ever read, by far. You have accused a MD of prescribing medicine based on his political beliefs. i hope he sues you. Absurd.

Terri Abraham

If it hadn't been mentioned in the article can you imagine the uproar when a reader brought that point up. Then we have comments about the reporter trying to hide the fact, and being accused of bias in the opposite direction. Not sure if the reporters political beliefs, and I am also not sure if she chose the headline.

I would still like to know how the rest of the covid-19 positive people at The Resort have faired. Sicker, or also o.k.?

Dr. Armstrong is not conducting a clinical trial so there is not a control group of those who received the drug and those that did not. He chose patients who were symptomatic because hydroxychloroquine has been shown, in some cases, to slow symptoms of COVID-19 in some patients. Asymptomatic patients were not included. So it would be comparing apples to oranges. He has said whatever observations he makes about how his patients recover — or don't recover — is anecdotal, not a clinically tested result. The drug is not meant to be a cure but a treatment for symptoms.

Terri Abraham

Thank you for the response.

Gary Miller

Staff>The drug is not meant to be a cure but a treatment for symptoms. All else said is just opinion.

Dalton Logan

I think that not only The GDN but Ms. Eastburn owes Dr. Armstrong an apology. He took an initiative to try and save lives because he is a Dr., nothing else. If history shows that due to his taking this course of action he saved lives will the story read, Dr. Armstrong an acclaimed Republican affiliated doctor saves lives at local nursing home, I bet not?

As a side note, I just read where the State of South Dakota has adopted the procedure of giving hydroxychloroquine to The States Covid-19 patients per a recommendation by the Governor.

Carlos Ponce

One thing the article does, it dispels the Liberal myth that the Republican party is a "whites only" club. Many prominent African Americans and other "minority" Americans are Conservative and many are not only Republican but prominent in the party. Dr. Ben Carson, Supreme Court Justice Clarence Thomas to name a couple.

Gary Scoggin

That’s three.

Carlos Ponce

You really want a list of thousands? Here's a list from Newsweek:

https://www.newsmax.com/BestLists/african-american-republicans-influential-newsmax/2017/02/22/id/774949/

Past and present from Wik:

https://en.wikipedia.org/wiki/List_of_African-American_Republicans

(Dr. Robin Armstrong is on that one!)

From Ranker.com "Famous African-American Women Who Are Republican"

https://www.ranker.com/list/famous-black-republican-women/famous-conservatives

Buzzfeed gives a list of celebrities some who are African American.

https://www.buzzfeed.com/mjs538/40-celebrities-who-are-republicans

Gary Scoggin

There are so few of them that you can list them, huh?

Carlos Ponce

I only listed a few of them. There are far more.

Casey Alan

This is out rages. Testing it on patients without consent. He should be kicked out of the medical field. On top of that he writes a glowing letter to a Dallas paper on how wonderful Trump is. You cannot tell me this man isn’t kissing up, trying to take dr. Fauci’s place. If the patients and their family had agreed to it it would be a different situation. Families have the right to decide on how a family member is treated. No one should be forced to take a treatment or be lied about what they’re being treated with. It is horrifying that a doctor would do this.

Carlos Ponce

Casey posts, "Testing it on patients without consent." The article clearly states "patients' relatives". I'm beginning to realize Liberal anti-Trumps have a reading problem. That explains much.

Casey Alan

He didn’t inform patients relatives. He didn’t say anything about the patients themselves why is that? Also most people who are in nursing homes has given power of attorney to a relative. Why didn’t he want the relatives to know about it? Giving this drug out without patients and our relatives consent who may have power of attorney which I’m sure most of them did is wrong. You do not use people as your personal Lab rats. You do not use people for your own personal gain whether it’s successful or not. It’s obvious that people who got their head up trumps rump, like yourself, doesn’t believe in morals. That explains much.

Carlos Ponce

"He didn’t say anything about the patients themselves why is that?"

Patient confidentiality. It would be illegal for him to say anything except in general terms.

Gary Miller

Casey> Your TDS is clouding your judgement.

Mike Zeller

Carlos Ponce has a selective reading problem(par for the course). This came directly from the article, "Armstrong has said that some of the patients he is treating were given the medication WITHOUT that kind of beforehand discussion, either with THEM or THEIR families." He DID NOT get consent.

Carlos Ponce

The discussion in question refers to one with the relatives, Mike:

What came before your out of context selection???

"Since Armstrong’s use of hydroxychloroquine has become national news, some medical experts have argued that not informing relatives or formally obtaining informed consent, a requirement in a clinical study, should be expected among a vulnerable patient population such as the already ill nursing home residents."

But he was not doing a clinical study.

Gary Miller

Mike he had signed consent on their admission forms.

Ted Gillis

The article does not dispel any liberal myth.

The man’s ethnicity has nothing to do with him being a physician, nor a republican.

His glamor shot photo is just a stock photo that all organizations have on file for the executive employees. If it hadn’t been for that photo, and the one showing him in face shield and mask I would have never known he was black.

The article does “not” dispel any liberal myth, because no such liberal myth exists. Only made up conservative myths, maybe.

Carlos Ponce

I met Dr. Armstrong when he was treating my brother at UTMB three years ago. He looks like his photo.

" no such liberal myth exists" I wish it didn't but remember a Democrat politician said "he's[Romney's] gonna put you all back in chains" to an African American audience. Don't you remember? It was 8 years ago this August.

https://www.youtube.com/watch?v=vYtEuuhFRPA

Lee Glover

The article clearly states the doctor did not get consent from patients or family members. That is currently the subject of national debate. Dr. Armstrong also said he screened the patients and chose the 39 that he thought had the best chance of healing. These people probably would have survived with or without this medication. What about the ones who are critically ill and dying? Why didn't he treat all of them? Because he has a political agenda to continue to sell the lie instigated by Trump, a shareholder in the company that produces this drug. Fact check me please. Trump stands to gain from the use of this drug. Do not believe that Trump does anything for the good of anyone other than himself. That's not the way narcissists work.

Carlos Ponce

"The article clearly states the doctor did not get consent from patients or family members." Not really.

The article clearly states the doctor did not get consent from patients' family members.

"Do not believe that Trump does anything for the good of anyone other than himself." So that's what this post is all about. Another Trump hater. Haters gotta hate.

Lisa Gray

Carlos, you are so correct. There are those out there so afflicted with Trump derangement syndrome, that they would not take a life jacket from him if they were drowning. Really sad and scary that people can be that blind.

Lisa Gray

https://www.nationalreview.com/2020/04/the-lefts-ugly-reaction-to-hydroxychloroquine/

I don't know who Dr. Armstrong said that to. He told me he chose to treat patients who'd tested positive and were exhibiting symptoms, not those with the best chance of healing. He said his goal was to alleviate symptoms to keep them out of the hospital.

Dalton Logan

How about a follow up Ms. Eastburn, GDN on how the patients in the nursing home that were treated by Dr. Armstrong are progressing. Maybe interview some of the family.

Carlos Ponce

Interviewing family members may be a problem due to patient confidentiality. But if they read the paper and volunteer their experiences to Ms. Eastburn....

If you know family members who would like to talk about residents' experiences, please send them my way. Patient names are protected by law. I will continue to follow up with anyone I can reach. Kathryn.eastburn@galvnews.com

Dalton Logan

KHOU (11) has an article also and states that the 39 patients had all given permission to be treated with the drug and all are doing well. Interesting to say the least.

Carlos Ponce

"Fifty-six residents at this senior facility in Galveston County contracted the novel coronavirus. Dr. Robin Armstrong said 39 of them gave him permission to treat them with hydroxychloroquine pills."

"On Sunday, those 39 patients finished five days of treatment with hydroxychloroquine. Dr. Armstrong said no one experienced any side effects."

https://www.khou.com/article/news/health/coronavirus/texas-elderly-hydroxychloroquine-coronavirus-treatment-texas-city/287-7383185c-940c-4cb2-82ea-c4a5ffad3ffb

"Dr. Robin Armstrong said 39 of them gave him permission to treat them with hydroxychloroquine pills." That answers the question if Dr. Armstrong had the patients' permission.

Gary Miller

Carlos> Should close the issue. Will not for the TDS in this forum. They will twist something to match their sick ideas.

Ted Gillis

I wasn't inferring that he didn’t look like his photo, Carlos. A “glamour shot” is just another way a saying a “head shot photograph”. The term is not meant to imply that he is either handsome or not. It’s just a term for a type of photograph.(I see the real estate industry use these types of photos a lot in their advertising).

I’m sure he is a fine looking man. I was just stating that without the use of this photograph, and the mention of him being black there is no reason to assume he is black. The author could have left his ethnicity “a myth” and have had the same impact in her article. Just Sayin!

Carlos Ponce

Whatever you say, or "Just Sayin!".

He looks like his photo.

Bailey Jones

The results of the largest assessment so far of the efficacy of this treatment was just released.

https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v1.full.pdf

"Conclusion - In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with

hydroxychloroquine alone. These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs."

Carlos Ponce

If we wait, people die.

Bailey Jones

"Rates of death in the HC, HC+AZ, and no HC groups were 27.8%, 22.1%, 11.4%, respectively."

I'd prefer to be in the no HC group.

Carlos Ponce

"The Association of American Physicians and Surgeons (AAPS) presented data on 2,333 patients treated with hydroxychloroquine - including two supervised by Dr Oz - across the globe that shows 91.6 percent of those who got the drug fared better after treatment."

http://freerepublic.com/focus/chat/3839996/posts?page=1

https://www.dailymail.co.uk/health/article-8266737/Doctors-group-claims-hydroxychloroquine-helps-91-coronavirus-patients.html

"Association of American Physicians and Surgeons (AAPS) stated patients who were given hydroxychloroquine spent less time in the hospital than those given other forms of medication such as antiviral drug Avigan."

https://www.thesun.co.uk/news/11506712/trump-hydroxychloroquine-does-help-coronavirus-patients/

"The HCQ-AZ combination, when started immediately after diagnosis, appears to be a safe and efficient treatment for COVID-19, with a mortality rate of 0.5%, in elderly patients. It avoids worsening and clears virus persistence and contagious infectivity in most cases."

https://docs.google.com/document/d/1545C_dJWMIAgqeLEsfo2U8Kq5WprDuARXrJl6N1aDjY/preview

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