Coronavirus

[Thekiwi]

Wonder if Elon could use Tesla to start knocking out ventilators in large volume? Imagine the lives saved and the goodwill towards Tesla.

This is not a stupid idea.

 

[traxila]

Hydrox is just an analog, not better or worse. It's available in the west while chloroquine is more available in the east. Sure there are minor differences but not enough to matter.

The only trial or report we hear from China is a report on 100 pts. They have yet to release specific data besides that it works or has some effect.

HCQ has a cleaner side effect profile and is the major active metabolite of chloroquine. There are multiple reports out there outside of China claiming effectiveness.

 

[Singuy]

HCQ has a cleaner side effect profile and is the major active metabolite of chloroquine. There are multiple reports out there outside of China claiming effectiveness.

Yeah I edited my post.

 

[KSilver2000]

Exactly. The post millennials are working on their Darwin Awards.

As some here know, there’s this minor thing called the Hippocratic oath and EMTALA.

Maybe in national emergencies like now, there would some kind of waiver that dumb sacks are forced to sign eliminating their rights if caught willingly ignoring safety orders for pleasure at the community’s expense. That would definitely wake these suckers up.

 

[SageBrush]

I have made my opinion about face mask use clear. This evening I decided to look around the world via the internet and came across this summary website. It is worth reading, but this table is a good start.

 

[KSilver2000]

Have not heard anything about Remdesivir. Nada. Not even bull anecdotal which most people here are equating HCQ stories too. Being used for a couple of months now and nothing.

Hard to imagine it has been working and no one has shared. Stock has not showed much either.

disclaimer: I own Gilead too.

Formal Remdesivir trials are just starting. It will be a long while to get meaningful results from them.

However, there are reports of compassionate use cases out there in the wild. For example, three from a group of twelve earlier COVID-19 patients in the US were given Remdesivir. They all recovered, but so did rest.
The three that did receive Remdesivir all had transient gastrointestinal symptoms, including nausea, vomiting, gastroparesis, or rectal bleeding, and elevated liver enzymes in the blood.

 

[SageBrush]

Looking for outstanding Public Health advice and general information ?
Read the Singapore Ministry of Health

Disclaimer: I am not asian, but I am a physician and Singapore is a remarkably successful model that has avoided lockdowns and S Korea level authoritarian control.

 

[Causalien]

Have not heard anything about Remdesivir. Nada. Not even bull anecdotal which most people here are equating HCQ stories too. Being used for a couple of months now and nothing.

Hard to imagine it has been working and no one has shared. Stock has not showed much either.

disclaimer: I own Gilead too.

True,

But the science seems sound. It opens the hole in the cells membrane for zinc to get in. In a lot of recommendations, it looks like it's the last resort medicin. But it is actually better to be used early before catastrophic lung damage is already done.

Last I heard is just phase 1 is going smoothly. There's still several phases.

 

[FoverM]

Hope no one here invested in "Pandemic Bonds":

Investors in World Bank's 'pandemic bonds' face big losses due to the coronavirus outbreak

I no idea such a thing existed. Pure gambling.

 

[generalenthu]

So I am getting cautiously optimistic here despite futures going limit down as I write this and Fremont closing up earlier in the night:

Contagion: While R0 estimates are high ,there seems to be some sort of herd immunity already present. Some individuals seem resistant to acquiring the infection. Three items from what I have seen so far:

• The infection rate on Diamond princess is quite low at 20% given centralized HVAC, and how close the passengers were to each other before it was quarantined. One of the Americans on this trip, the radio station owner from California tested positive while his wife did not, despite being in close contact.
• There was a picture of the patients who got infected on the bus. Interestingly, the person next to the carrier was good. And people sitting further away and one who got on 30 mins after were infected. Tells me that while its highly contagious, and potentially travels by air, it cannot infect a majority of people.
• There was the reply tweet from Elon a few hours ago, replying to an article about how the Israeli noble laureate arrived at this conclusion by looking at the Infection rate in Wuhan, which is around 3% from memory
• More clues from a study upthread on how folks of a specific blood group have worse odds and this is with a high p value

Given the above, I think UKs estimate of 70-80% of the population acquiring it eventually are absurdly high even if some amount of hygiene and social distancing is practiced

Testing: There is the ability to rapidly scale up testing if not for the bureaucracy around who is allowed to do what. Between ELISA, RT-PCR, and antibody tests, it is possible to setup a mechanism where a quick test (ELISA?) with high sensitivity albeit low specificity can be coupled with a RT-PCR test to rapidly screen large number of people. Scaling this if not for the red tape sounds feasible. The tests are cheap and RT-PCR machines are widespread. Even these machines are not that expensive (Most expensive high throughput RT-PCR machines seem to top out at 100k). The reagents seem to be ~$5 a pop. While it may take time to scale up, I think we will have more than adequate testing in a month.

I am sure Elon is thinking of potentially buying enough of these tests and have employees go through screening every week or so. In the big scheme of things this is a small expense, if this can make the case for the facilities to be reopened. Realistically, Lab techs and Nurses may be in short supply rather than materials in a 4-8 week timeframe

Drugs: Seeing many candidates here - Hydroxychloroquin + azithromycin, Hydroxychloroquin + the HIV antiviral, Remdesivir, all seem to be promising therapies. Even if there are complications, and only an 80% effective rate, this should drop the IFR to seasonal flu levels.

Social distancing has become a thing at least in the neck of my woods, and that should naturally slow down some of this. Italy seems to be a worst case scenario for a developed country. While US totally botched up the response, I think there is a lot of reason for optimism. Especially if there is enough data to show use of any of the drugs above can stop a patient from transitioning to a critical condition, we may be able to avoid the run on ventilators and ICU beds.

Feel free to shoot my theories down. I am just a dilettante who knew nothing about epidemics, drugs, tests, or anything else healthcare related, before this pandemic broke.

 

[SMAlset]

We’ve heard about hospital workers who are facing treating patients without adequate protective equipment. I heard from my doctor friend who lives and works on the East Bay and she said their situation is the same in not having adequate protection plus she’s working crazy hours. She’s very angry and afraid to bring the virus home to her mom and aunts. This Bloomberg article really hits the under protected point home and it is incredibly sad they are forced to improvise like this. They have really been let down and they risk their lives and everyone too they come on contact with as a result. Not America at its finest in failing these health workers.

Bloomberg - Are you a robot?

 

[generalenthu]

Nature on HCQ. While this is in vitro, there is some good discussion on how HCQ stops the virus from taking root.

Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro

 

[wdolson]

So I am getting cautiously optimistic here despite futures going limit down as I write this and Fremont closing up earlier in the night:

Contagion: While R0 estimates are high ,there seems to be some sort of herd immunity already present. Some individuals seem resistant to acquiring the infection. Three items from what I have seen so far:

• The infection rate on Diamond princess is quite low at 20% given centralized HVAC, and how close the passengers were to each other before it was quarantined. One of the Americans on this trip, the radio station owner from California tested positive while his wife did not, despite being in close contact.
• There was a picture of the patients who got infected on the bus. Interestingly, the person next to the carrier was good. And people sitting further away and one who got on 30 mins after were infected. Tells me that while its highly contagious, and potentially travels by air, it cannot infect a majority of people.
• There was the reply tweet from Elon a few hours ago, replying to an article about how the Israeli noble laureate arrived at this conclusion by looking at the Infection rate in Wuhan, which is around 3% from memory
• More clues from a study upthread on how folks of a specific blood group have worse odds and this is with a high p value

Given the above, I think UKs estimate of 70-80% of the population acquiring it eventually are absurdly high even if some amount of hygiene and social distancing is practiced

Testing: There is the ability to rapidly scale up testing if not for the bureaucracy around who is allowed to do what. Between ELISA, RT-PCR, and antibody tests, it is possible to setup a mechanism where a quick test (ELISA?) with high sensitivity albeit low specificity can be coupled with a RT-PCR test to rapidly screen large number of people. Scaling this if not for the red tape sounds feasible. The tests are cheap and RT-PCR machines are widespread. Even these machines are not that expensive (Most expensive high throughput RT-PCR machines seem to top out at 100k). The reagents seem to be ~$5 a pop. While it may take time to scale up, I think we will have more than adequate testing in a month.

I am sure Elon is thinking of potentially buying enough of these tests and have employees go through screening every week or so. In the big scheme of things this is a small expense, if this can make the case for the facilities to be reopened. Realistically, Lab techs and Nurses may be in short supply rather than materials in a 4-8 week timeframe

Drugs: Seeing many candidates here - Hydroxychloroquin + azithromycin, Hydroxychloroquin + the HIV antiviral, Remdesivir, all seem to be promising therapies. Even if there are complications, and only an 80% effective rate, this should drop the IFR to seasonal flu levels.

Social distancing has become a thing at least in the neck of my woods, and that should naturally slow down some of this. Italy seems to be a worst case scenario for a developed country. While US totally botched up the response, I think there is a lot of reason for optimism. Especially if there is enough data to show use of any of the drugs above can stop a patient from transitioning to a critical condition, we may be able to avoid the run on ventilators and ICU beds.

Feel free to shoot my theories down. I am just a dilettante who knew nothing about epidemics, drugs, tests, or anything else healthcare related, before this pandemic broke.

If some people are naturally immune, or get a very mild case that they get over in a day, that's good news for the spread of this. If it's a significant chunk of the population that should make it much more containable. There is so much we don't know right now.

The world is flooded with outright made up nonsense like garlic will kill it, or dangerous nonsense like drinking bleach will kill it. Even medical sources have a lot possibilities coming forward that may pan out or may not and we just don't know enough to be sure right now. Most of the possibilities coming from valid medical sources are probably being tested for reproducibility in many places right now.

 

[marvinat0rz]

Is the consensus here on CFR still 2%?

I'm on 1% if testing is sufficient and healthcare is good, i.e. many non-serious cases are also picked up. But the US doesn't have a good outlook on that front, unfortunately. Note that I'm talking about confirmed cases here. Wouldn't be surprised if the number was greater than 2% for the USA.

 

[bkp_duke]

Have not heard anything about Remdesivir. Nada. Not even bull anecdotal which most people here are equating HCQ stories too. Being used for a couple of months now and nothing.

Hard to imagine it has been working and no one has shared. Stock has not showed much either.

disclaimer: I own Gilead too.

Remdesivir being tried in 5 clinical trials currently:
With the coronavirus, drug that once raised global hopes gets another shot

Basically, they started this drug for Ebola and it did show some promise in that usage, but ebola is a very limited infection in most cases and therefore there was not much market for the drug.

The mechanism of action on this one is sound, and broad enough to be useful for a number of viruses. The compound is a nucleotide analog (basically it looks like a piece of DNA/RNA). It gets incorporated into the genetic material of the virus during replication, but induces a structural defect in the completed copy of the genetic material, preventing that material from being able to be copied or used again.

Because it is a new usage for this drug, it has to go through the clinical trial process, and we are only in Phase 1 (efficacy and safety - although the safety side already has some data from the previous trials for ebola, etc.).

In Vitro - i.e.a test tube - remdesevir is showing to be better than chloroquine/hydroxychloroquine at stopping viral infection.

Like all things, as with chloroquine, things do not always translate well for in vitro to in vivo (patients). We need to see the Phase 1 data to see if this medication can impact the spread.

 

[bkp_duke]

HCQ has a cleaner side effect profile and is the major active metabolite of chloroquine. There are multiple reports out there outside of China claiming effectiveness.

And yet none of those studies have published their data for peer review.

It will come, but until they actually publish the data so that the scientific community can deep dive into it, we should remain skeptical.

I would LOVE for chloroquine to have a significant positive effect in the sick. It's cheap, readily available, easy to manufacture. But a lot of people are putting the cart before the horse here until the data is out and available. Not just claims, but the RAW, HARD data.

 

[bkp_duke]

I'm on 1% if testing is sufficient and healthcare is good, i.e. many non-serious cases are also picked up. But the US doesn't have a good outlook on that front, unfortunately. Note that I'm talking about confirmed cases here. Wouldn't be surprised if the number was greater than 2% for the USA.

IFR = 0.7-1% for COFID-19
CFR = 2-3%

CFR by definition is cases severe enough to present to a medical professional for evaluation, and varies by country, and other factors.

IFR is the underlying base infection rate, which varies only by intrinsic factors (age, sex, etc.)

 

[bkp_duke]

If some people are naturally immune, or get a very mild case that they get over in a day, that's good news for the spread of this. If it's a significant chunk of the population that should make it much more containable. There is so much we don't know right now.

The world is flooded with outright made up nonsense like garlic will kill it, or dangerous nonsense like drinking bleach will kill it. Even medical sources have a lot possibilities coming forward that may pan out or may not and we just don't know enough to be sure right now. Most of the possibilities coming from valid medical sources are probably being tested for reproducibility in many places right now.

Actually, we know a lot right now about this virus. And there is ZERO innate / natural immunity to this that anyone has been able to show. Because a large chuck on the population is over 60, and at what we as a doctors would call "extreme" risk, the idea of letting this blow through the population to generate immunity has been largely discredited (the number of severe cases requiring hospitalization would overwhelm the medical system - in all countries). The UK initially followed this idea, and then quickly backed off once they got an idea of the impact to their medical system. They probably saw what happened in Italy, that didn't take social distancing serious until too late, and rightly decided to change their minds.

15% death rate in 80+ group with ZERO comorbidities is absolutely enough in and of itself to overwhelm most countries.
Coronavirus Age, Sex, Demographics (COVID-19) - Worldometer

 

[bhtooefr]

What I don't know is - what is the end game for Covid-19 ?

Because as soon as the restrictions are listed, we are back to square one. Without a vaccine or herd-immunity level infections (40% to 70%) - how does the infection stop ?

So, there's a simple strategy here.

Complete ban on leaving your home, for the entire nation, for 3-4 weeks. Exceptions for survival-related staff (who will be required to stay at the location they are working, forbidden from traveling home) - this means emergency workers, medical workers, medical production, food production, military, and any logistics staff needed that aren't provided by the military (think USPS).

Military is in charge of logistics and any hospital construction needed, as well as enforcing the ban. War footing and all.

One of two strategies for keeping households financially afloat during this emergency: compensating 100% for lost income, or reducing expenses. The former looks like the government guaranteeing pay even for those laid off or those unable to secure childcare, the latter looks like things like rent holidays (possibly with compensation for actual reasonable costs incurred during the rent holiday for landlords) and bans on lenders accruing interest or requiring payments for the pandemic period.

This should stop the virus's spread dead in its tracks within the nation. But, what about it being reimported? After the ban on leaving your home is lifted, a complete ban on anyone entering the nation - citizen or not - without going through the same 3-4 week period of isolation, unless it's a nation that has completed the same protocol and has the same restrictions (and people arriving from those nations need to be in a separate arrival queue from other international arrivals, ideally in separate airports entirely, otherwise they're potentially exposed and would need to be sent through the 3-4 week isolation protocol).

If a successful vaccine is created, the whole protocol can be relaxed.

 

[bhzmark]

Highlights from this interesting presentation (again, avert your eyes if you trigger yourself in response to others daring to share info other than RCTs in Nature)

https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-19.pdf

• Per capita measure of testing. Note US at bottom

Viral shedding for 37 days:

As a public service to the easily offended, I'll refrain from translating the French but the smart people will get the gist: HCQ+ABX

But careful the QT interval:

Plaquenil (hydroxychloroquine sulfate) dose, indications, adverse effects, interactions... from PDR.net