Coronavirus

[bkp_duke]

indeed. That's why situations like this are very revealing of people's ability to make decisions under uncertainty and revealing of character generally.

Which one of us has a prescriber's license?

Which one of us has, successfully, treated patients with off-label and compassionate care usages?


Thought so.

 

[Daniel in SD]

The problem at this point isn't that people are still going on cruises (no new trips have left in more than a week). The problem is that the people who were on cruise ships aren't able to get off because no ports want to deal with the infection risks and each country is at most willing to help its own nationals on the ship.

It left after people on the Diamond Princess were quarantined for a month and ~700 people had tested positive. It seems like it's just a risk people are willing to take to go on a cruise.

 

[EinSV]

There are tons on HCQ treatment studies going on right now in many countries.

The study above is not a treatment study, it's a prophylactic study to see if it would prevent people in close contact with COVID-19 patients from contracting the virus in the first place. That takes time unless you specifically try to infect people on purpose.

The point stands though — will we get preliminary results from any of these studies (whether for treatment or as prophylactics) in the next week or two?

If not, why isn’t someone stepping up to make that happen?

Waiting around for months isn’t helping anyone and it’s hard to see why it’s necessary for drugs that act within days and have been on the market for more than 50 years.

 

[hershey101]

I'm really curious where this form ended up on the conspiracy theory that this was a planned biological attack from China's gov't to take control of the financial markets.

 

[N5329K]

Monday update from Dr. Seheult:

Basic points:
1. Asymptomatic shedding likely a result of the COVID-19's early suppression of the immune response;
2. Both high and low core temperatures have a positive effect on amping up immune response;
3. Finns who sauna (meaning, Finns) and then douse in cold water or snow see very low rates of spread and less hospitalization when compared with other Nordic countries;
4. Looks like antimalarial meds have a clinical basis (or a better clinical basis) for use against COVID-19.
Robin

 

[Fobble]

Talking of cruise ships ...

As cruise ship carrying sick and dead passengers moves toward Florida, governor says state can't take them

Why are people still going in cruise ships ? It is an obvious low reward, high risk thing to do now.

Paid for a 7 day cruise and ending up with 3 weeks at the seas low reward?

 

[MXLRplus]

They need to rename the ship the S.S. Minnow.

 

[Cosmacelf]

More specifically


View attachment 527646

Thanks for ferreting that out. Made me smile. I hate it when people argue using talking points culled from headlines, or even worse, press articles. Go to the source if you're going to argue something based on research. Don't rely on a journalist's biased or ignorant interpretation.

 

[Cosmacelf]

They need to rename the ship the S.S. Minnow.

Especially when they eventually disembark on a deserted island

 

[bkp_duke]

The point stands though — will we get preliminary results from any of these studies (whether for treatment or as prophylactics) in the next week or two?

If not, why isn’t someone stepping up to make that happen?

Waiting around for months isn’t helping anyone and it’s hard to see why it’s necessary for drugs that act within days and have been on the market for more than 50 years.

That's just not possible.

First, the course of the virus in most people is 14 days.

Second, you need enough samples for it to be statistically significant to see a small change. We're talking a hypothesis of something along the lines of "does HCQ treatment for X days in patients with a viral load of Y result in A) decreased mortality, or B) a change in days on a ventilator or C) days in a hospital). Think many thousands, possibly tens of thousands, to have to the statistical power to determine with a P value of 0.05 or less that.

Third, you need enough samples to assess for side-effects.



This is not a "someone is sitting on their ass" situation and pulling a Captain Picard "make it so" will speed things up, except for having the available number of patients to power the study.



Now, with that said, historically, if there is a BIG CHANGE you will see that part way through the study. It doesn't happen often, but if the change is significant enough the study will be ended early and the data published early.


Given what we have seen to day with HCQ (and mind you this drug has been around since the 1960s, we've known about antiviral properties of the drug in vitro - test tube, and tried it in human studies from HIV to influenza - all negative), don't get your hopes up for a massive effect from the drug that would warrant studies to be closed early.

 

[bkp_duke]

I'm really curious where this form ended up on the conspiracy theory that this was a planned biological attack from China's gov't to take control of the financial markets.

Two words - not likely.

 

[hershey101]

Two words - not likely.

So you are saying there's a chance :thinking-face: Lol

 

[Norbert]

So back of the napkin math . . . if there is any validity to these numbers.

Taking Italy since they are about 10% through their population being infected. To date that's about 11,500 deaths.

To get to herd immunity levels, 60% immune in the population, you are looking at a potential 6X increase in the number of deaths, but lets say they get caught up and stop overwhelming their hospital system, and cut that in half. 34,500 deaths with those assumptions, till herd immunity is reached. That's about 575 deaths per 1 million.

If that translates to the US - we see where the administration got their 200,000 deaths number . . . and gives us some insight into their (potential modeling).

/ramblings of a man stuck in front of a computer and bored

With this calculation I'm afraid there are problems, at least regarding the administration's numbers. Herd immunity is their worst case, not the best case. As far as I understood, their current model assumes a max infection rate of 50% (optimistic in comparison). For that case, they model up to 2.2 million deaths, not 200K.

By the way, I think that translates to an assumed IFR of up to 2.2M / (50% * 330M) = 1.3333 %.

 

[KG M3]

Thanks, that is what I was looking for!

 

[wdolson]

I'm really curious where this form ended up on the conspiracy theory that this was a planned biological attack from China's gov't to take control of the financial markets.

That's a pretty out there theory. I have seen China experts speculate that the current government in China might not survive this pandemic.

The Chinese have already been on the way towards dominating the world economy. Doing a "hail Mary" to take control quickly is outside their historic MO. It's highly risky to themselves and the slow drip method was working fine.

The accepted theory that this jumped from animals to humans in a wet market in Hunan both fits the known data well and is very plausible. Sometimes viruses in animals that may or may not not cause serious illness in the animals figures out how to jump species and infects us. MERS and SARS are two previous coronaviruses that jumped species.

Hunan province is home to China's premiere infectious disease lab and there has been speculation that someone at the lab was making some money on the side selling animals from the lab in the local wet market. It's possible they were studying a new coronavirus strain found in bats and it got out this way, or it's possible the bat with the virus was caught in the wild and made its way to the market.

We really should leave bats alone. They are an important part of the ecosystem, but they are also a reservoir for viruses. Bats don't tend to get sick with viruses very often, but their immune systems are not very good at killing them off either. So they can get infected with something and it just stays in their system. Living in colonies, one bat with an infection can infect the entire colony.

When a bat gets into someone's house or some kids are found playing with a dead bat health officials tend to freak out because they have the highest incidence of rabies in the US. About 20 years ago a bat got into the governor's mansion in Washington State and the governor's family went through the rabies vaccination process as a precaution.

With this calculation I'm afraid there are problems, at least regarding the administration's numbers. Herd immunity is their worst case, not the best case. As far as I understood, their current model assumes a max infection rate of 50% (optimistic in comparison). For that case, they model up to 2.2 million deaths, not 200K.

By the way, I think that translates to an assumed IFR of up to 2.2M / (50% * 330M) = 1.3333 %.

The 2.2 million was the estimated death toll if the virus was allowed to free range and a lot of people died because the health care system's capacity was exceeded. Slowing down the spread with social distancing may still get the US to 50-60% herd immunity by the time the vaccine is available, but because the cases were spread out over more time fewer people died because they couldn't get the care they needed.

The hospital capacity may still be exceeded in places. New York is on the edge now. New Oreleans is in trouble too. I expect severe problems soon in the parts of the country where social distancing was not mandated, or they started late.

 

[EVNow]

Since we have discussed sensitivity of PCR tests. Here is an interesting paper.

The comparative superiority of IgM-IgG antibody test to real-time reverse transcriptase PCR detection for SARS-CoV-2 infection diagnosis : COVID19

Of 133 patients with SARS-CoV-2 infection, there were 44 moderate cases, 52 severe cases, and 37 critical cases with no significant difference of gender and age among three subgroups. Overall, the positive ratio in IgM antibody test was higher than in RT-PCR detection. In RT-PCR detection, the positive ratio was 65.91%, 71.15%, and 67.57% in moderate, severe, and critical cases, respectively. Whereas, the positive ratio of IgM/IgG antibody detection in patients was 79.55%/93.18%, 82.69%/100%, and 72.97%/97.30% in moderate, severe, and critical cases, respectively. Moreover, the concentrations of antibodies were also measured in three subgroups.​

 

[Todesbuckler]

I updated the data for the daily hospitalization change for large US states with available data.
Consistent with arguably inaccurate infection rate data, the growth is reducing.
Data is sourced from The COVID Tracking Project.

Caveat: data quality might not be great and some states only update every second day (adjusted in the data)

Included data attached.

 

[EinSV]

That's just not possible.

First, the course of the virus in most people is 14 days.

Second, you need enough samples for it to be statistically significant to see a small change. We're talking a hypothesis of something along the lines of "does HCQ treatment for X days in patients with a viral load of Y result in A) decreased mortality, or B) a change in days on a ventilator or C) days in a hospital). Think many thousands, possibly tens of thousands, to have to the statistical power to determine with a P value of 0.05 or less that.

Third, you need enough samples to assess for side-effects.



This is not a "someone is sitting on their ass" situation and pulling a Captain Picard "make it so" will speed things up, except for having the available number of patients to power the study.



Now, with that said, historically, if there is a BIG CHANGE you will see that part way through the study. It doesn't happen often, but if the change is significant enough the study will be ended early and the data published early.


Given what we have seen to day with HCQ (and mind you this drug has been around since the 1960s, we've known about antiviral properties of the drug in vitro - test tube, and tried it in human studies from HIV to influenza - all negative), don't get your hopes up for a massive effect from the drug that would warrant studies to be closed early.

You're describing the usual platinum-plated clinical trials process, but that's almost completely useless here given the timelines involved.

And there are quite a few clinical trials in the pipeline that are not structured like that.

For example, the HYDRA trial only has 500 participants and treatment lasts only 10 days.

Hydroxychloroquine Treatment for Severe COVID-19 Pulmonary Infection (HYDRA Trial) - Full Text View - ClinicalTrials.gov

There is no reason this trial couldn't be done in a matter of a few weeks and preliminary results released a couple days later, with complete results and analysis coming later.

If the results aren't clear enough after smaller trials, then so be it. Or spend some more money and expand the trials -- there are no shortage of patients as others have mentioned.

Either way, nothing ventured, nothing gained.

You could duplicate this approach for other approved anti-virals that show promise for covid-19 (or other approved, well-characterized drugs). It would also make sense to add higher doses of HCQ, plus HCQ+azithromycin. Trials like this are in the works, but they all seem to be on comfortable but nearly useless timelines (fall 2020-summer 2021).

There is nothing to lose and everything to gain by accelerating these trials.

 

[Norbert]

The 2.2 million was the estimated death toll if the virus was allowed to free range and a lot of people died because the health care system's capacity was exceeded. Slowing down the spread with social distancing may still get the US to 50-60% herd immunity by the time the vaccine is available, but because the cases were spread out over more time fewer people died because they couldn't get the care they needed.

The hospital capacity may still be exceeded in places. New York is on the edge now. New Oreleans is in trouble too. I expect severe problems soon in the parts of the country where social distancing was not mandated, or they started late.

People will certainly die if capacity is exceeded, but I don't remember any indication that this part of that model. Certainly I doubt that this would account for a factor of more than 10x (2.2M / 200K).

A number like 200K can only be achieved if we stop far short of herd immunity, I am certain.

 

[SageBrush]

The 2.2 million was the estimated death toll if the virus was allowed to free range and a lot of people died because the health care system's capacity was exceeded.

That is getting very close to becoming a given in my opinion because the stay at home structure is broken without masks and compliant behavior outside the home.

My state in under SAH orders, but shopping (and I presume essential services) are wide open avenues for disease propagation.

I doubt if the relevant authorities will ever get it, and they only have ~ 3 -4 weeks before the majority of populace is infected.