Coronavirus

[bkp_duke]

For those out there CRAVING DATA on things in the pipeline, and given the recent talk about hydrochloroquine, the attached article is a really good review of the French data. It's a bit long, so for those that don't want to read it all, I'm pasting the relevant paragraph here:

Full article attached for those that want their eyes to bleed and read it all.

 

[PeterJA]

Grading quality of evidence and strength of recommendations

Reference Box 2 for grading criteria.View attachment 525711

Not being a randomized double-blinded trial immediately takes the quality of the evidence to "low". Low means that the absolutely highest evidence grade it could get would be a "C" on the Grade Practice Recommendation system (i.e. how we practice medicine) - see link below (I like this system simply because people understand A through D). When you go into the "Decrease grade if" section and point out more problems like "serious limitation of study qualify" and "high probability of reporting bias" it drags the study down further.

Another review paper for those that care how studies are graded and clinical recommendations made:
The Levels of Evidence and their role in Evidence-Based Medicine

Thanks for the links. I see no evidence of "serious limitation of study quality" and "high probability of reporting bias" unless you are double-counting the fact that the study was not double-blinded. If the subjects were as contemptuous of natural medicine as most folks in this forum, then the placebo effect would be expected to skew the results in the opposite direction from those observed.

I'm glad you read the abstract. Are you willing to read the other link I posted, describing a Chinese medical conference reporting 100% recovery of 50 hospitalized COVID-19 patients treated with high-dose vitamin C (and heparin in some cases)? If you are a practicing physician, your patients might thank you for it.
Hospital treatment of serious and critical COVID-19 infection with high-dose Vitamin C | Cheng Integrative Health Center Blog

 

[EinSV]

This paper falls in the "worth keeping an eye on" category, or possibly the "wishful thinking" category.

The authors' thesis is that second derivative of number of deaths from countries that have implemented social distancing policies is following a path similar to China's, even though the strength of the policies varies. They use this to estimate the total deaths in each country as well as the date when death rate peaks.

Unfortunately other than Italy which seems to be tracking China very well so far, the data presented is very noisy/variable. So it is hard to say with any confidence that their thesis is correct (yet).

If it is, fatality rates will peak in April and plummet by early May.

The three figures copied below are:

(1) actual and projected second order derivative of fatalities for certain countries
(2) table of estimated total deaths and date of maximum death rate by country
(3) chart of three day average death rate by country

https://www.medrxiv.org/content/10.1101/2020.03.25.20041475v1.full.pdf

 

[Dr. J]

They imply Democrats are in world 1 and Republicans in world 2. But Nebraska seems to be in world 1 with no gatherings of more than 10 people and schools closed. Also, only 5% of tests have been positive so these measures were taken very early.

There are Democrats in Nebraska.

And they can all meet and be just under the gatherings limit.

 

[deonb]

Wow, WA only has 118 new cases today down from 248 yesterday.

Won't know whether this is just a side effect of reduced testing, because the state stopped publishing negative test numbers 2 days ago .

 

[Doggydogworld]

My math skills have rusted away, so I need some help here:

if Y = a^t is the curve of interest, then 'a - 1' is the growth rate, correct (where a > 1) ?

Looked at a bit differently, dy/dt = ky,
and after integration y = e^kt

I presume k = a -1
Yet a^t != e^kt

Please point out my dumb error

y=a^t
dy/dt = t * a^(t-1)

Hopefully this is a representative enough sample to answer the "everyone already has it" hypothesis.

At this point there will be very few people in rural areas who had it and got over it.

San Miguel county is home to Telluride Ski Resort, which gets visitors from all over. So while rural it's not some isolated farming outpost. Would it be better to test everyone in a big city with months of known community spread like Seattle? Obviously. But this is better than nothing. Which is basically what we have today.

 

[Norbert]

Wow, WA only has 118 new cases today down from 248 yesterday.

Won't know whether this is just a side effect of reduced testing, because the state stopped publishing negative test numbers 2 days ago .

It looks like some of the data updates are lagging. Not sure though.

 

[sparcs]

Pure supposition here, but if I were a betting man, I would guess he had Gigafactory 3 personnel round up all the masks in that facility and ship them over. Then they could replenish the stock locally from China.

And last I heard, he only was able to bring over 50k masks, not the 250k he originally said.

i think he got 250k. It's just being distributed to multiple places. Plus he actually supplied them with other stuff besides masks:

• UCLA Health on Twitter
• Dr. Adams Waldorf on Twitter
• Tesla CEO Elon Musk Donates Truck Load of PPEs (including masks) to UCLA Health

 

[AlanSubie4Life]

My math skills have rusted away, so I need some help here:

if Y = a^t is the curve of interest, then 'a - 1' is the growth rate, correct (where a > 1) ?

Looked at a bit differently, dy/dt = ky,
and after integration y = e^kt

I presume k = a -1
Yet a^t != e^kt

y=a^t
dy/dt = t * a^(t-1)

@SageBrush won't see this since he has me on ignore due to a small disagreement about eye protection...but...maybe someone can pass on the info. Lol.

No. You are confusing this with the case of d/dx (x^n) = n*x^(n-1). y= a^t => dy/dt = ln(a)*a^t

The derivative of an exponential function, the slope, is always proportional to the value of the function itself. The proportionality constant is the natural logarithm of the constant being exponentiated (the value a in this case).

So in the case of e^t it is just e^t.

And chain rule applies as usual.

You can also just realize that y = a^t is just y=e^(t*ln(a)). So you can just worry about e^kt in general.

 

[eevee-fan]

Wow, WA only has 118 new cases today down from 248 yesterday.

Won't know whether this is just a side effect of reduced testing, because the state stopped publishing negative test numbers 2 days ago .

One can hope, the numbers do not update in real time and do get adjusted/reconciled. Best to check back around 10pm PST.

 

[AlanSubie4Life]

One can hope, the numbers do not update in real time and do get adjusted/reconciled. Best to check back around 10pm PST.

They also didn't update their number of negatives yesterday (no idea why not).

Not sure where you are seeing the increased number - can't see it on the Washington DOH website.

Ah:

 

[BornToFly]

My local news just ran a story that data from China shows that 20% of hospitalized survivors show evidence of heart damage from the infection.

 

[Dr. J]

Yes, so many people are struggling with the variables on the whole issue.

On the one hand it seems obvious that a determined and truly concerted effort, as in China and South Korea, (and perhaps in Canada, if it is consistently maintained), such effort can actually halt the virus.

On the other hand, so many variations come into play. Even the political/ideological factors can make all the difference, and can become self-fulfilling prophecies by the actions each of them favour.

In the end, we are dealing with something completely new. Comparisons to past similar occurrences seem obvious, but may be counter-productive.

Goin' all Magic 8 Ball on us, huh?

 

[eevee-fan]

They also didn't update their number of negatives yesterday (no idea why not).

Not sure where you are seeing the increased number - can't see it on the Washington DOH website.

Ah:

View attachment 525744

DOH!

I am talking about the # here, seems WA numbers come from several sources.
Coronavirus Update (Live): 468,644 Cases and 21,191 Deaths from COVID-19 Virus Outbreak - Worldometer

 

[linux-works]

My local news just ran a story that data from China shows that 20% of hospitalized survivors show evidence of heart damage from the infection.

I do know that after I had pneumonia, it was a long time, more than 6 months or a year before I could climb stairs and not be winded. maybe 2 years before I could even jog (lightly jog).

I can imagine having reduced abilities after surviving this thing. maybe you can't do your job as well anymore. "lift that server onto a rack?" - sorry can't. "you're fired, then".

 

[Doggydogworld]

No. You are confusing this with the case of d/dx (x^n) = n*x^(n-1). y= a^t => dy/dt = ln(a)*a^t

Oops, thanks. I was rushing through and for some reason thought his "t" was the constant. Time standing still, ha.

Wow, WA only has 118 new cases today down from 248 yesterday.

The WA site hasn't updated yet, I think the 118 comes from adding the three biggest counties - King, Snohomish and Pierce. The others are only 20-25% of the total, and Snohomish showed a big drop in new cases (if I'm reading it right). King also went down some. The 118 will probably rise, but unless I'm missing something probably no higher than 150-170.

 

[PeterJA]

Grading quality of evidence and strength of recommendations

Reference Box 2 for grading criteria.View attachment 525711

Not being a randomized double-blinded trial immediately takes the quality of the evidence to "low". Low means that the absolutely highest evidence grade it could get would be a "C" on the Grade Practice Recommendation system (i.e. how we practice medicine) - see link below (I like this system simply because people understand A through D). When you go into the "Decrease grade if" section and point out more problems like "serious limitation of study qualify" and "high probability of reporting bias" it drags the study down further.

Another review paper for those that care how studies are graded and clinical recommendations made:
The Levels of Evidence and their role in Evidence-Based Medicine

Here is another study linked by Dr Cheng's blog. This one is a randomized double-blinded trial of viral disease in 1444 subjects published this month.
Vitamin C supplementation reduces the odds of developing a common cold in Republic of Korea Army recruits: randomised controlled trial. - PubMed - NCBI

Again I'm sure the study is not perfect, but suggests that further studies are warranted (along with therapeutic trials in dying patients with no alternatives in the current emergency)... warranted if one's motives are humanitarian and scientific rather than profit-oriented.

 

[X Fan]

My local news just ran a story that data from China shows that 20% of hospitalized survivors show evidence of heart damage from the infection.

That's troubling...I wonder (hope) if many of them had preexisting cardiac conditions that was a factor in their hospitalization.

 

[AlanSubie4Life]

If we're very "lucky," we'll pass 1000 deaths in the United States tonight.

And if we're very very lucky, it looks like we'll be #1 (in identified cases) in the world by Friday! 'Murica! We're #1! We have the best numbers!

Based on recent behavior, I'm sure the stock market will take this as a sign that things are nearly over! But sadly, we'll be at 10,000 deaths or so Wednesday of next week. I would assume at some point next week we'll see sporadic stories of people dropping in the street.

If we have 1000 deaths, it's pretty likely our case count 7 days ago or so was ~100k cases (since the hospitals have so far been able to handle the load - though that is starting to change in New York).

Maybe we're not quite doubling every 5 days now due to the measures put in place two weeks ago starting to have an effect, so we're probably at closer to 200k cases nationwide at this moment (130k or so not identified).

By the end of the weekend, we should be over 300k cases nationwide.

Hopefully all these numbers are fantastically pessimistic. But to me they seem realistic. They did say they need 30k ventilators in NY...so....

I wonder how many of those 130k (150-180k unidentified next week I suppose) cases won't be locked in place? I wonder what will happen...?

 

[PeterJA]

If we're very "lucky," we'll pass 1000 deaths in the United States tonight.

And if we're very very lucky, it looks like we'll be #1 (in identified cases) in the world by Friday! 'Murica! We're #1! We have the best numbers!

Based on recent behavior, I'm sure the stock market will take this as a sign that things are nearly over! But sadly, we'll be at 10,000 deaths or so Wednesday of next week. I would assume at some point next week we'll see sporadic stories of people dropping in the street.

If we have 1000 deaths, it's pretty likely our case count 7 days ago or so was ~100k cases (since the hospitals have so far been able to handle the load - though that is starting to change in New York).

Maybe we're not quite doubling every 5 days now due to the measures put in place two weeks ago starting to have an effect, so we're probably at closer to 200k cases nationwide at this moment (130k or so not identified).

By the end of the weekend, we should be over 300k cases nationwide.

Hopefully all these numbers are fantastically pessimistic. But to me they seem realistic. They did say they need 30k ventilators in NY...so....

Elon is less pessimistic.

Elon Musk @elonmusk
C19 testing in the US over the past week has grown much faster than C19 positive cases. I think we may have passed the inflection point for US cases (excluding NY) already.
12:17 PM · Mar 25, 2020
Elon Musk on Twitter

I tend to trust his grasp of the situation more than someone who posts unsupported numbers and laughs at randomized double-blind controlled clinical trials.