Coronavirus

[Cosmacelf]

Ohio Department of Health (ODH) says there are 100k infected in Ohio alone: Ohio Department of Health believes 100,000 Ohioans are carrying coronavirus

None of the data make sense to me. Mortality rate in Germany is currently 0.175% (which is a drop from a few days ago). Italy's at 6.8%. South Korea at 0.46% (using confirmed cases) or 0.9% (using suspected cases). In fact, in all of the countries I've been following, mortality rate seems to be holding roughly steady even though the responses of each individual country have been very different. As far as I know, Germany hasn't implemented any extreme measures like France/Italy. Why aren't they being overwhelmed?

Our lab made our own model the other day. Since we're dealing with exponential growth, the numbers change a lot depending on your assumptions. Our numbers were similar to ODH's but a bit higher...and they still don't make sense. The geographic area I live in is the epicenter of one of the outbreaks in the US. There should be thousands dying here right now, if our model is right, since our ICUs run at capacity on a good day.

If we don't start seeing major outbreaks in Shanghai* and other parts of China soon then the only conclusion that makes sense to me is that 1) the mortality rate is far lower than suspected 2) the number of recovered is enormous. In other words, the virus may have already run its course in some parts of the world and areas are starting to reach herd immunity.

I'm not in any position to make policy decisions and I fully admit my analysis could be wrong. My main concern now is what effects the policies we're implementing world-wide will have on the economy. I think we're racing past recession and now a global depression is on the table. It's to the point that we should be considering how many will die because they've become poor and unemployed and weighing it against our public health options. I know there will be a lot of poor, hungry kids in my area tomorrow, since their families have come to rely on free lunch at public schools. There will be thousands of these knock-on effects and we won't be able to consider them all.

*Shanghai did not start isolating international travelers until 2 weeks ago.

Could it be that doctors are figuring out effective therapies? And that use of therapies is inconsistent across countries?

 

[Fact Checking]

CoronaVirus does not have the mutation frequency of Influenza. The latter lacks replication fidelity mechanisms

Yes, coronavirus has stronger error-correction:

"Over the length of its 30,000-base-pair genome, SARS-CoV-2 accumulates an average of about one to two mutations per month, Rambaut says. “It’s about two to four times slower than the flu,” he says."​

The aspect I find most troubling about Covid-19 is that in severe cases it apparently creates a cytokine storm, which would make it more difficult to create a vaccine that doesn't trigger a cytokine storm in older patients.

On the other hand this gives a chance for immunosuppressants to be effective treatment, if the infection is caught early enough, or if it's introduced deliberately.

 

[AlanSubie4Life]

And they're constantly surrounded by one highly infectious patient after the next, in close range, all day. It's not even remotely the same situation. And even still, most stay protected - even if protection measures fail some, for one reason or another.

One should never let perfect be the enemy of the good. It's almost impossible to reduce the rate of transmission to zero. But masks help greatly. The virus "wants" to be in your lungs, and the easiest and most common way for it to get there is riding on droplets from infectious patients and being breathed in by you. A mask is a barrier for those droplets. This is a very good thing. It's not 100% protection, but it's still significant protection.

We don't need to get R0 to precisely zero. We need to get it to less than 1. Heck, even greater than 1 is fine, so long as it's not so high that it overwhelms the medical system.

Sure. But I keep saying exactly that. Unfortunately there are not any masks. When they are plentiful and cheap, then I will buy them, knowing that I am not taking one from someone who really needs it.

I happen to have a handful (I think 8-10) of N95 from a few years ago for household stuff, but I am holding those in reserve, so I can donate them, or provide them to someone who may need them (they may provide emotional comfort and real protection to an at-risk individual) in the coming weeks.

I should add that droplets can land in your eyes and on your hands. So that is presumably why the authorities recommend that sick people wear them - it stops the droplets. I would strongly recommend wearing protective goggles as well as a mask, if you are wearing one.

 

[Fobble]

Meanwhile in America.... lines due to people queuing for the CDC "enhanced screening" due to the US travel ban....

Travelers stuck in long lines at DFW due to CDC questionnaire and enhanced screening, airport says

Hello, super-seeding events....

There you go, community distancing ....
That little girl on the floor is the smartest, keeping a good radius from the crowd.

 

[SageBrush]

Hello, super-seeding events....

Exactly. Who needs a cruise ship when you have the DHS ?

 

[KarenRei]

That's what China and Korea did, and it worked.

I'm not sure about Korea, but China only extended the national holiday by one week (but of course it came on top of an existing holiday). Only Wuhan got locked down for significantly longer. The biggest things they did was forcing change in terms of social distancing, masks, workplace health monitoring, etc combined with expansive testing and isolation programmes.

We don't have to shut down the global economy. But we do have to make changes. Relatively minor sacrifices can make a huge difference in how this plays out.

 

[AlanSubie4Life]

Exactly. Who needs a cruise ship when you have the DHS ?

Yeah, a total disaster for those people. It is worth noting that they are all under mandatory 14-day quarantine orders, so only they and their immediate families should be at risk (though obviously there will be room for many “accidental” escapes, and not everyone will follow the orders, it is not as bad as unrestrained superspreading).

 

[KarenRei]

Sure. But I keep saying exactly that. Unfortunately there are not any masks. When they are plentiful and cheap, then I will buy them, knowing that I am not taking one from someone who really needs it.

I happen to have a handful (I think 8-10) of N95 from a few years ago for household stuff, but I am holding those in reserve, so I can donate them, or provide them to someone who may need them (they may provide emotional comfort and real protection to an at-risk individual) in the coming weeks.

I begged one off the kitchen staff. Just one. I steam sterilize it after each time I go out (on a vegetable steaming rack in my pressure cooker). These days I'm also putting my hair covering in along with it, because it fits and why not?

One good-quality mask per person should be an easily achievable task. When I was out shopping the other day, I was the only person in a mask, but I did see a woman constantly holding her scarf over her mouth and nose. I felt bad for her, as I'm sure that she knows that the scarf will do little, but it's clearly all she had.

 

[SageBrush]

The aspect I find most troubling about Covid-19 is that in severe cases it apparently creates a cytokine storm, which would make it more difficult to create a vaccine that doesn't trigger a cytokine storm in older patients.

So called 'cytokine storms' occur in Influenza also, although the frequency varies season to season and there is a large individual component. The last Influenza season with considerable mortality from this mechanism was the 'swine flue' of 2008-9. The 'SARS' and 'MERS' CoronaVirus outbreaks are much more prototypical 'cytokine storm' diseases. We actually got lucky this time around with Covid-19.

 

[Yuri_G]

I wish I could get away with taping a 2-meter diameter circle on the floor around my desk with a "do not chat within this space" sign in it.

Oh well, at least I have a mask. Helps me tolerate the misbehavior of others which I can't control better.

No option to work from home?

 

[KarenRei]

No option to work from home?

Not even when I'm not working shifts. And for the next six weeks I'll be working shifts.

 

[AlanSubie4Life]

One good-quality mask per person should be an easily achievable task. When I was out shopping the other day, I was the only person in a mask, but I did see a woman constantly holding her scarf over her mouth and nose. I felt bad for her, as I'm sure that she knows that the scarf will do little, but it's clearly all she had.

I added to my post. Be sure to wear your protective full coverage goggles too. The droplets can just as easily end up in your eyes as in your nose or mouth (in fact, more likely, due to surface area, unless you have your mouth open). And the eyes are directly connected to the nose of course.

The goggles would presumably need to seal well above your eyes - due to gravity, that is where the droplets would be sneaking around them.

This of course is why it’s better that sick people wear them. In the case of COVID-19, due to it being so relatively benign for many people, THAT may well be the main reason widespread mask used helped (if it actually helped). People who were sick (and did not know it) would have been much less likely to pass on the illness.

So long term perhaps we should produce billions of masks and everyone should wear them. Should cut the impact of the sick people, even if no one is wearing goggles.

 

[SOULPEDL]

Watching Fareed Zakaria this morning. Former head of CDC claims that all the people and management are still in tact since Obama, but that "for some reason" they responded very late.

IMO, there was a coverup because Trump was taking his playbook from Boris in the UK who thinks we should all get the virus so it doesn't return (I kinda agree, need to evolve, but has other problems too). Plus his obvious election worries with any market crash from a "War of the Worlds" repeat scenario. I mean, just look at how stupid ppl are overreacting. The mistake was saying everything was under control when it was clearly not.
Now we're screwed with a higher number of cases and panic ahead of this b/c of lost trust. He is done.

 

[SageBrush]

I'm not sure about Korea, but China only extended the national holiday by one week (but of course it came on top of an existing holiday). Only Wuhan got locked down for significantly longer. The biggest things they did was forcing change in terms of social distancing, masks, workplace health monitoring, etc combined with expansive testing and isolation programmes.

We don't have to shut down the global economy. But we do have to make changes. Relatively minor sacrifices can make a huge difference in how this plays out.

EXACTLY

I find it depressing how few people get this basic message, even in the relatively well informed in this thread. Perhaps I can ask the Mods to insert this PSA every 3-4 posts ?

PSA
WASH you hands
WEAR A MASK in public buildings and when social distancing is not possible
GET tested for any URI or LRI symptoms

 

[SageBrush]

Be sure to wear your protective full coverage goggles too.

Stop playing physician.

My eyeballs do not breathe. Do yours ?

 

[Causalien]

View attachment 521985

Whoa, cool. Who is this like minded comrad

 

[Krugerrand]

Geotagging individuals would have the civil
Liberty folks screaming from the rooftops. I doubt we will see that either here or in Europe.

We already tag people - sex offenders and most everyone with a cellphone and credit card etc...

I know different, but not.

 

[AlanSubie4Life]

Stop playing physician.

My eyeballs do not breathe. Do yours ?

Yes. Seriously. Literally I can blow air out of my eyes if I pinch my nose shut.

You don’t have to be a physician, man.

Have you ever wondered why your nose gets stuffy when you cry?

Look up nasolacrimal duct. This is not that hard.

 

[SageBrush]

I can’t prove it.

I am a physician, and trust me, you are spewing FUD.

Healthcare workers do indeed receive training, including directives to be clean shaven in order to be compliant with N95 use. However, you have to understand the context: these are people who are peering into the throats of infected, coughing people; and more importantly, the directives are meant to provide protection not just against respiratory droplets but so called 'airborne' infectious particles, meaning the mask has to be air tight around the edges so that all the air passes through the filter. To a very large degree that is not relevant to smart public health measures for Covid-19.

 

[dfwatt]

A paper from 2012 about 4 different sars vaccines tested on animals:
Immunization with SARS Coronavirus Vaccines Leads to Pulmonary Immunopathology on Challenge with the SARS Virus

They found that the vaccines worked as intended i.e. exposure to the virus after vaccination trigger antibodies production as expected. However, they also found that the vaccinated animals immune system becomes hypersensitive when exposed to the virus leading to cytokine storm (and therefore severe inflammation specifically in the lung tissues)

Pure speculation:
Risk of severe symptoms increases with age because the older you are, the more likely you would have contracted a similar enough virus in your lifetime to cause hypersensitivity. From what I see the leading cause of death are due to pneumonia, suggesting that this could be caused by a hypersensitive immune system induced by exposure to the coronavirus, which leads to cytokine storm and therefore severe pneumonia.

There has also been reports on China and Italy using arthritis drug on covid19 patient with good outcome. This seems to suggest that suppressing your immune system when they become hypersensitive (i.e. prevent cytokine storm) is one likely treatment for the disease.

i.e. patients dying from the disease are killed by their own immune system reacting too strongly to the virus.

This would be very problematic if re-exposure to the same virus triggers hypersensitivity in people who have previously recovered from the disease. So far I don't see any evidence suggesting this is the case yet, so hopefully the findings from the sars vaccine paper does not apply in this case.

I haven't been able to find any papers on mechanisms of how certain viruses seem to trigger immune system hypersensitivity more often.

Your speculation may have merit but there is a long and tortuous scientific path to a better understanding of how and why elderly immune systems appear to be a bad match with this virus. There are so many ways in which the immune system has the potential to damage our own tissues in the context of defense against Invaders. In theory, immunization enhances the adaptive branch of the immune system and produces a more targeted against a pathogen ostensibly reducing the potential for damage to self from the less targeted innate immune system, but this research paper provides a potent counterexample. It is indeed a very interesting speculation that a semi recognition of the pathogen may predispose older immune systems that have more immune memory to a more self-destructive response. I can tell you however that even if that proves to be true, it is a long and difficult slog to get to an effective and scientifically well validated treatment that incorporates that insight.

We have known for a long time that in the famous quote of an immune researcher decades ago that your immune system is simultaneously your best friend and your worst enemy, and that this janus-faced function appears particularly characteristic of immune systems as they age. Case examples may include not simply immunopathological attack on our own tissue in the context of various types of infection but Alzheimer's disease, type 2 diabetes, heart disease, and even cancer where background inflammation appears to be a promoting variable. Alzheimer's disease has been my primary scientific bailiwick for several decades, and it's been a struggle to get the research Community to consider inflammation as a variable as opposed to simply a monocular focus on amyloid. Which by the way is an antimicrobial protein, among its other evolutionarily conserved functions.

What's interesting about this earlier report based on the predecessor SARS virus is that immunization using any component of the virus other than the S proteins promote immuno pathologic damage to lung tissue upon viral re-challenge. It does suggest significant cautions about human vaccination trials. It also suggests that various cytokine Inhibitors, steroids, and other ways of backing off the immune system may have utility in the elderly population that show the greatest vulnerability to severe pneumonia and respiratory failure. Which appears to be clearly the primary and dominant pathway into fatal outcomes. It will also be interesting to see whether various forms of interferon, various antivirals, and the combination of chloroquine and zinc which is potently inhibitory in vitro of ribosome translation machinery prove out in clinical trials. There's a lot of interesting and even fascinating science in all this. Unfortunately all this takes time and time seems short to develop an effective treatment to prevent the worst manifestations of this infection.