Coronavirus

[FoverM]

Here are the top 20 states in terms of Deaths/Million:

NY is a clear outlier but NJ isn't as bad until the end. LA continues to surprise on the high side.

 

[SMAlset]

There is good news. New York thinks that infections and deaths are starting to level off.
I think the market is way underestimating the length of time required to start relaxing current restrictions.
@Papafox, maybe the market found out that HCQ has Dr. Zelenko's 100% success rate.

There was an article I read today from a NYC doctor, Dr Stuart Ditchek, attending physician at Maimonides Medical Center in Brooklyn and team leader for the New York Pandemic Response Working Group, who disagrees the numbers are leveling off. I found the article again (this source had more info on it than what was reported on Fox News, including his letter to the President, so decided to link to it).

Doctor contradicts Cuomo's assessment that COVID-19 deaths are dropping as he blames 'flawed data' | Daily Mail Online

 

[Daniel in SD]

To be certain I'm still pro cheap mask, just saw this being covered elsewhere and thought it was worth sharing. Anyone pro mask will have to debunk the significance of this for the anti mask crowd.

https://annals.org/aim/fullarticle/...sks-blocking-sars-cov-2-controlled-comparison

"Discussion: Neither surgical nor cotton masks effectively filtered SARS–CoV-2 during coughs by infected patients."

“We do not know whether masks shorten the travel distance of droplets during coughing. “

Seems bad.
Sounds like we better start making some N95 masks. Home Depot used to sell them for 60c a piece for before this debacle. They're made out of oil which is super cheap right now.
I've ordered a roll of hydroknit shop towel, supposedly that work pretty well...
I guess I'll wear my P100 mask if I need to go to the store.

 

[renim]

'Developing a hyperimmune will require plasma donation from many individuals who have fully recovered from COVID-19, and whose blood contains antibodies that can fight the novel coronavirus. Once collected, the “convalescent” plasma would then be transported to manufacturing facilities where it undergoes proprietary processing, including effective virus inactivation and removal processes, and then is purified into the product. '

Australian (CSL) Japanese (Takeda) etc collaboration
Global Plasma Leaders Collaborate to Accelerate Development of Potential COVID-19 Hyperimmune Therapy

 

[wdolson]

'Developing a hyperimmune will require plasma donation from many individuals who have fully recovered from COVID-19, and whose blood contains antibodies that can fight the novel coronavirus. Once collected, the “convalescent” plasma would then be transported to manufacturing facilities where it undergoes proprietary processing, including effective virus inactivation and removal processes, and then is purified into the product. '

Australian (CSL) Japanese (Takeda) etc collaboration
Global Plasma Leaders Collaborate to Accelerate Development of Potential COVID-19 Hyperimmune Therapy

It all needs to be tested too. It appears many of the people who get sickest with this are having cytokine storms in which the immune system basically goes berserk and starts attacking the body. I believe pumping someone full of antibodies could trigger this in at least some cases.

Medicine is innovating at a fantastic rate to try and stop COVID-19, but humans are complex critters. Something that looks promising in the lab could be deadly or ineffective in trials. Even something that works for some people could hurt others.

 

[Bet TSLA]

"Less than perfect" is a galactic understatement for the studies that support HCQ.

The term "polished turds" comes to mind. Shine it up all you want, in the end . . . it's still a turd.

You know, pretty much all medical "science" is crap. Humans make lousy test subjects. The docs are clueless about statistics, and have little to no experience (i.e. even a lifetime of practice is next to nothing). Everybody concerned is constrained to do their best for the patients, not for science.

Give me any day a clinical group that has found a protocol which leads to better outcomes, no matter what their process. I'll go for what they say even if it has nothing to back it up beyond that. I am very much anticipating the advent of AI that can integrate data from all over the world over many decades. The diagnostics and treatments that will come out of that will revolutionize medicine. Current approaches are almost useless for producing good data or good analysis.

It will be the AI guys, not the medical guys, that help people most in the end. You'll no doubt enjoy being told to stuff your opinion because you're only a doctor and what would you possibly have to contribute.

 

[MC3OZ]

You know, pretty much all medical "science" is crap. Humans make lousy test subjects. The docs are clueless about statistics, and have little to no experience (i.e. even a lifetime of practice is next to nothing). Everybody concerned is constrained to do their best for the patients, not for science.

Give me any day a clinical group that has found a protocol which leads to better outcomes, no matter what their process. I'll go for what they say even if it has nothing to back it up beyond that. I am very much anticipating the advent of AI that can integrate data from all over the world over many decades. The diagnostics and treatments that will come out of that will revolutionize medicine. Current approaches are almost useless for producing good data or good analysis.

It will be the AI guys, not the medical guys, that help people most in the end. You'll no doubt enjoy being told to stuff your opinion because you're only a doctor and what would you possibly have to contribute.

I agree, another way of looking at this is our medical system isn't optimised for gathering and processing data fast, humans are very variable in terms of their genetics, life history, age, habits, fitness levels, medical history, treatment history, disease progression, etc.

This is an usual situation where we need accurate data fast, if we could pool an accurate set of data for all humans treated so far and accurately determine the likely outcome or best path for a particular patient based on all of the variables, that would be great.

I think you are right it is an AI Neural Network problem similar to FSD, it would be good if a doctor could get an opinion from the AI expert and the doctor can also apply their judgement as we know AI isn't always perfect. In any case medicine is never perfect, there are so many variables it is hard to get it right every time, and sometimes even getting it right doesn't help.

 

[renim]

In australia approx 42% of the covid19 cases are now classified as recovered.

More serum, for Commonwealth Serum Labs.

 

[dfwatt]

There was an article I read today from a NYC doctor, Dr Stuart Ditchek, attending physician at Maimonides Medical Center in Brooklyn and team leader for the New York Pandemic Response Working Group, who disagrees the numbers are leveling off. I found the article again (this source had more info on it than what was reported on Fox News, including his letter to the President, so decided to link to it).

Doctor contradicts Cuomo's assessment that COVID-19 deaths are dropping as he blames 'flawed data' | Daily Mail Online

There is an increasing sense that actual deaths all around the world are being significantly underreported, as people are dying in their homes and it's unclear how many of those folks are consistently being counted at all. I think this guy Ditchek is right in any case and what he saying is not that different from what Cuomo is saying which is that the system can't run at Redline indefinitely. Things in New York are very precarious and I think NYS/NJ are close to some kind of breaking point for the systems there. Let's hope they've actually peaked. Because the implications otherwise are terrifying.

 

[jerry33]

A pastor in LA is encouraging his flock to congregate in mass gatherings. As a reader of medical science he had this to say

He fits in well here, as another layperson who does not have enough sense to heed the actual experts.
His lawyer says that social distancing of 6 feet was maintained, but according to the article 1,800 people were inside a space that I measure as 100 ft by 100 ft on Google maps.

Hmmm

He obviously wanted the money before people got out of the habit.

 

[Dreadnought]

Gabriel Leung (@gmleunghku) is an epidemiologist and dean of medicine at the University of Hong Kong.

He says “we must all prepare for several cycles of a “suppress and lift” policy — cycles during which restrictions are applied and relaxed, applied again and relaxed again, in ways that can keep the pandemic under control but at an acceptable economic and social cost.”

In this letter to the editor, he presents a “formal framework for how governments could monitor the state of this pandemic much more accurately than many seem to be doing now, and how then, acting on the evidence, they could tune their interventions quickly enough to stay ahead of the outbreak trajectory.”

Opinion | Lockdown Can’t Last Forever. Here’s How to Lift It.

Repeated cycles of lockdown would still have a considerable impact on the economy and society. Preferable would be containment measures but infected people being contagious before onset of symptoms makes this difficult. A prerequisite is, obviously, that the overall number of active cases has first to be reduced to a level where test capacity suffices to check all suspected cases repeatedly. This is achievable; a WAG at the time frame would be weeks rather than months for countries that push hard on both fronts.

Now, for the contact tracing, I am hopeful that apps like https://www.pepp-pt.org/ can do this job if some conditions are met:
Usage is mandatory. Minimum usage rate to be effective will depend on active cases and test capacity but I have no idea how to calculate it.
Average number of contacts with a contagious person is low enough to not overwhelm test capacity. As it depends on two factors, the threshold is dynamic. With a known rate of toal contacts per contact with an infected (or suspected) contact, the allowed number of total contacts can be adjusted. In other words, you get a budget of getting in contact with X people per week, with X being adjusted regularly.

Please don't hesitate to poke holes into this scenario. I promise to not take it personally. You're also invited to amend and extend if you consider this a viable approach until vaccination or a medication that reduces CFR significantly becomes available.

 

[dfwatt]

It all needs to be tested too. It appears many of the people who get sickest with this are having cytokine storms in which the immune system basically goes berserk and starts attacking the body. I believe pumping someone full of antibodies could trigger this in at least some cases.

Medicine is innovating at a fantastic rate to try and stop COVID-19, but humans are complex critters. Something that looks promising in the lab could be deadly or ineffective in trials. Even something that works for some people could hurt others.

Poorly tested antibodies perhaps but the distinction between the Adaptive vs. Innate branches of the immune system is critical here. They actually can have both a competitive as well as an agonistic relationship as the Adaptive branch is kick-started by the innate branch in the first place with the Adaptive Branch coming in to do most of the final mop up in relationship to most viral infections. See previous discussion of this here: Coronavirus. I believe that the laboratory data from China supports the hypothesis that folks died because they never achieved this transition in other words the innate Branch continues to activate more and more strongly, particularly as it does more and more damage, which creates a deadly form of positive feedback driven by DAMP receptors. Folks that survive successfully recruit adaptive immunity. Most forms of innate immunity on the other hand are significantly less targeted, and create more Hazard to bystander tissues. The innate immune system is capable of targeting cells that have been co-opted to become viral factories but it also might whack many uninfected cells next door to those adding in a sense to the challenge of the person who has to rebuild those cells as well

It's actually much more likely that a successful antibody therapy would effectively short circuit high levels of innate immune activation. There also are different forms of IgG with some tending to have significantly less inflammatory signal, such as IgG4. Antibodies whether designer antibodies or from convalescent plasma are literally our best hope in relationship to covid-19. Until there is an effective vaccine and of course that depends totally on the successful recruitment of the Adaptive branch of the immune system.

 

[jerry33]

You know, pretty much all medical "science" is crap.

Certainly. That's why smallpox is still around, polio and tuberculosis are real threats, etc. Sheesh.

 

[SageBrush]

ECDC data through Apr 6

The downward trend continues in Europe (during lockdown)
The US slope has decreased but remains positive; and is heavily influenced by NY/NJ

 

[dfwatt]

You know, pretty much all medical "science" is crap. Humans make lousy test subjects. The docs are clueless about statistics, and have little to no experience (i.e. even a lifetime of practice is next to nothing). Everybody concerned is constrained to do their best for the patients, not for science.
.

In Forum posts do you routinely try to assault an entire field? As for the false dichotomy between doing what is best for your patients verses doing what is the best science it's obvious based on that statement alone that you don't know all that much about health care, medicine or for that matter biology. You describe Physicians as clueless, but can you be absolutely sure that's not a projection?

 

[SageBrush]

To be certain I'm still pro cheap mask, just saw this being covered elsewhere and thought it was worth sharing. Anyone pro mask will have to debunk the significance of this for the anti mask crowd.

I haven't read the article yet. Is the table saying more virus particles on the outside of the mask than the inside ?

That is hard to believe.

 

[dfwatt]

'Developing a hyperimmune will require plasma donation from many individuals who have fully recovered from COVID-19, and whose blood contains antibodies that can fight the novel coronavirus. Once collected, the “convalescent” plasma would then be transported to manufacturing facilities where it undergoes proprietary processing, including effective virus inactivation and removal processes, and then is purified into the product. '

Australian (CSL) Japanese (Takeda) etc collaboration
Global Plasma Leaders Collaborate to Accelerate Development of Potential COVID-19 Hyperimmune Therapy

If the plasma you are collecting from patients still has active virus in it you really s*** the bed so to speak. There should not be detectable virus in the plasma of anyone who's fully recovered from covid-19. At least that's my understanding.

 

[renim]

To be certain I'm still pro cheap mask, just saw this being covered elsewhere and thought it was worth sharing. Anyone pro mask will have to debunk the significance of this for the anti mask crowd.

https://annals.org/aim/fullarticle/...sks-blocking-sars-cov-2-controlled-comparison

"Discussion: Neither surgical nor cotton masks effectively filtered SARS–CoV-2 during coughs by infected patients."

“We do not know whether masks shorten the travel distance of droplets during coughing. “

Interesting, so their cotton masks reduced corona by 30%, but the surgical masks were effectively useless. (distance was 20cm, ie doctor patient swabbing distance)

 

[SageBrush]

https://annals.org/aim/fullarticle/...sks-blocking-sars-cov-2-controlled-comparison

Interesting article, but the context is important

Infectious patients coughed directly or through a mask towards a petri dish 20 cm (8 inches) away. Cotton and 'surgical' masks are not expected to stop aerosols so the finding of virus on the dish should not come as a surprise. A repeat study at 100 and 200 cm distance would be very interesting. I have read elsewhere that infectivity drops off rapidly at viral concentrations below 10^6/ml

As for the finding of more virus on the outside of the mask than the inside, that is something else. Perhaps the inside of the mask is treated differently during manufacture ? Or there are basic methodological or technical flaws in the study.

Last, the results appear to be either ND or ~ 2M/ml. I wonder about the lab detection protocol. A count after 6 or 12 hours of incubation would be a lot more informative than say 3 or 5 days.

 

[renim]

The authors noted
'These observations support the importance of hand hygiene after touching the outer surface of masks.'