Coronavirus

[dfwatt]

This has definitely been one of the big question marks.

It seems there are two hypothesis floating around to explain why this is not affecting developing countries as much. One is the heat theory - South Asia and Africa have not been hit much. Second is - general prevalence of pathogens that makes bodies used to unknown pathogens frequently and the immune system is better able to cope with them. People I talk to in India buy neither of these - and think the country is in danger if the virus starts spreading locally. The cases & fatalities have increased in the last 5 days - we'll see how it goes in the next 2 weeks.

Well there's always Florida as a case. You can look at fatality by age demographic and certainly Florida is hugely at risk with roughly 5 million people over 65.. Florida is going to be unfortunately dropped kicked by covid-19. Unfortunately the governor has been mostly asleep at the switch has not obtained the expected additional necessary ventilators or surged ICU capacity so we are very concerned that it could get very ugly down here. The notion that warm-weather offers any meaningful protection has no scientific evidence base in relationship to covid-19. It may moderate transmission some by virtue of decreasing the time the pathogen remains viable on surfaces but since most transmission is probably not taking place that way it does not look like it's going to make much difference.

 

[EVNow]

Well there's always Florida as a case. You can look at fatality by age demographic and certainly Florida is hugely at risk with roughly 5 million people over 65.. Florida is going to be unfortunately dropped kicked by covid-19. Unfortunately the governor has been mostly asleep at the switch has not obtained the expected additional necessary ventilators or surged ICU capacity so we are very concerned that it could get very ugly down here.

I don't know whether you saw my post about - possible undercounting of fatalities already.

Hmm ...

Dan weinberger on Twitter

Unexplained increase in ILI be unexplained increase in P&I deaths across states. Spike in mortality is slightly delayed and slower than spike in ILI in many states , as expected
​

Using ExcessILI with US P&I mortality data

There is clearly a spike in deaths in FL (just like in NYC) - but FL doesn't share Influenza like illnesses data.

View attachment 529289

 

[30seconds]

Patents and rights to a drug should be shortened to 3 years or so, without loopholes, in the medical area (counted from approval). And 5 or 10 instead of 20 in general. The times when individual inventors needed that much protection are long over.

No they aren't. This would effectively stop drug development wholesale.

 

[30seconds]

So not true. Google the story of the epipen. That's long out of patent, but the rights of production have all been bought up by one company.

The epipen is a very specialized drug device combo. It has basically zero in common with normal pharmaceuticals.

Once compounds go generic in the US the typical timeline to having multiple competitors is 3-6 months. At that point the pharma company who invented and developed the compound usually no longer sells it at all.

Compounds with small sales or with very unique situations, like the epipen, are not worth investment by the generic drug companies and may not face much competition.

 

[NikolaACDC]

Sorry will try to quote a few points. It is one of the Washington Post subscriber articles that I can’t see there (or even copy the link to) so had to link from AppleNews where it was provided.

A lot has already been discussed here. Maybe someone can provide a direct link to the WP article.

WaPo link:
https://www.washingtonpost.com/inve...d67982-747e-11ea-87da-77a8136c1a6d_story.html

Behind paywall, but one of my OS/browser/blocker combos lets me read most of the articles (albeit presentation is a bit screwed up).

 

[bkp_duke]

Do low death counts in warmer climates suggest summer will help?

I don't have a lot of faith in this hypothesis given the numbers we are seeing out of Florida.

 

[bkp_duke]

For the medical professionals in this thread, what are the odds of the virus mutating into a deadlier strain ?

Low. SARS-CoV-2 has a lower mutation rate by 2.5X to 4X than influenza. This is because SARS-CoV-2 has a copy replication proof-reading mechanism, which Influenza lacks.

 

[sparcs]

for anyone that wants to dissect Tesla's efforts on ventilators. How fast do we think they can get this into some sort of production volume?

I think Tesla may be building two versions? One is an older Medtronic design and I think this video covers a ventilator of their own design using auto parts.

 

[sparcs]

Apple will produce 1 million face shields per week for medical workers

“Our first shipment was delivered to Kaiser hospital facilities in the Santa Clara Valley this past week and the feedback from doctors was very positive.”

apple producing 1 million face shields per week. Unclear on the time frame, but I think it's a sign that collectively many of these corporate actions can start making a difference.

 

[SageBrush]

Studies of influenza have found that, in the middle of a pandemic, real-time fatality counts are often misleading.

It is a mistake to extrapolate from Influenza to Covid for a couple major reasons:

1. The common Influenza test has a sensitivity of ... wait for it ... ~ 50%
2. There was no attempt to constrain the Influenza outbreak with Public Health measures, so the testing was haphazard

---
For a variety of reasons I am too lazy to go into, hospitals and hospital based physicians are highly motivated to not have a single Covid case undiagnosed. Since the lion's share of death in the USA happens in hospitals the fraction of deaths that are Covid related and *potentially* not tested is a rounding error.

 

[NikolaACDC]

https://www.cattaneo.org/wp-content/uploads/2018/03/Colombo-Impicciatore-Covid-09_eng.pdf

Study from Italy

"The results of the analysis we present provide an empirical basis for the hypothesis that the number of deaths due to Covid-19 is different from that established on the basis of the indicator used so far, or the number of patients who died positive in Covid -19. The detection of the number of deaths in excess of the average of the previous five years allows not only to overcome the distinction between deaths "caused by" and deaths "with" Coronavirus, but also to estimate the size of the "dark number" of mortality attributed to Covid-19. The number of deaths is typically quite stable over time, and its variations, under normal conditions, can only depend on the aging of the population. We will then compare the number of deaths that occurred from February 21st to March 21st, 2020, the date of the first ascertained death for Covid-19 in Italy, with the average number of deaths that occurred in the same interval of days in the five-year period 2015-2019
...
The analysis conducted showed that an increase in the number of deaths occurred in the period considered, which can only be attributed to the intervention of an external cause, specifically Covid-19. The growth is very consistent and appears to be higher than what is detectable by the data disclosed so far by the Civil Protection. In fact, at 21stMarch 2020 in Italy there were 4,825 deceased positive patients at Covid-19, but the difference, detected by our analysis, between deaths in 2020 and the average deaths in the period 2015-2019, for the period from 21st February to March 21st, it was already 8,740. And this value refers to a sample that includes only one thousand of the over 8 thousand Ital-ian municipalities, equivalent to 12.3 million inhabitants out of a total of 60.4 million. Even under a very cautious assumption, according to which in the remaining 7 thousand municipalities there should be no deviations from the average mortality of the previous years, the number of deaths attributable to Coronavirus in Italy is still double the number calculated on the basis of the patients who died positive for the Covid-19 test, communicated by the Civil Protection."

 

[winfield100]

Well there's always Florida as a case. You can look at fatality by age demographic and certainly Florida is hugely at risk with roughly 5 million people over 65.. Florida is going to be unfortunately dropped kicked by covid-19. Unfortunately the governor has been mostly asleep at the switch has not obtained the expected additional necessary ventilators or surged ICU capacity so we are very concerned that it could get very ugly down here. The notion that warm-weather offers any meaningful protection has no scientific evidence base in relationship to covid-19. It may moderate transmission some by virtue of decreasing the time the pathogen remains viable on surfaces but since most transmission is probably not taking place that way it does not look like it's going to make much difference.

@dfwatt
Anecdote single data point.
SW Florida
2/5 hip replacement. Zero concern about SARS-CoV-2
3/10 cardio doc, schedules cardio version for 3/20
Zero concern abt virus
3/16 hospital call, I a sk them if want to reschedule, they say No
3/19 hospital call. Locked down, only me allowed in temp first.
I Asked them again if they want to reschedule, they say no
3/20 hospital (Gulf Coast regional) locked down.
One nurse came, left, escorted to surg.
Empty halls, few if any masks
Finally locked down state except for religious services
Much clearer skies due to few planes out of RSW (fl sw intnl)
>~ 3% mortality of reported cases.
Single data point tho, anecdotal

 

[tander]

for anyone that wants to dissect Tesla's efforts on ventilators. How fast do we think they can get this into some sort of production volume?

I think Tesla may be building two versions? One is an older Medtronic design and I think this video covers a ventilator of their own design using auto parts.

Makes me wonder if find some way to disrupt ventilators now. Maybe a battery powered version?

Here's a recent article about using convalescent plasma to treat Covid-19 patients and the trials that are now beginning. Fortunately, the use of convalescent plasma is allowed by emergency authority as we patiently await the results of the tests. Anecdotal evidence from China suggest hope, as does the age-old use of convalescent plasma with other viruses.

Meanwhile, Elon Musk's suggestion (maybe it was just a "like") of offering a COVID-19 antibody test to blood donors makes sense to me. Not only would such a strategy encourage more blood donors (who are very much needed) but it would help identify which blood donations might be suitable for a more detailed analysis to see if they're suitable for convalescent plasma studies.

Can plasma from recovered COVID-19 patients treat the sick?

That's a great idea! I was planning to give blood a couple weeks ago until I got a cold, or maybe the plague so I'm holding off. Would love to get tested for corona and donate plasma to help someone once I feel better. Would love to donate to my Grandparents especially if it works as a preventive.

Edit: Just looked at the red cross page and they are talking about ithttps://www.redcrossblood.org/donate-blood/dlp/plasma-donations-from-recovered-covid-19-patients.html

 

[SageBrush]

, at 21stMarch 2020 in Italy there were 4,825 deceased positive patients at Covid-19, but the difference, detected by our analysis, between deaths in 2020 and the average deaths in the period 2015-2019, for the period from 21st February to March 21st, it was already 8,740.

Interesting, but confounded by overrun hospitals.

The cautious way to interpret that data is to say that ~ 4,000 excess deaths occurred for reasons unknown to the researchers. They could have started by first finding out if the deaths were tested for Covid, and to look into the cause of death. Untested respiratory deaths above baseline would be a more interesting starting figure.

 

[alloverx]

Also possible that in the USA we will see in the medium term
-more temperature checking in places with large crowds: schools, malls, sporting events
-perhaps free masks for 60+
-Home/clinic 15min testing via finger prick.

Also noticed that an Australian medical person mentioned that FLU cases were lower than normal due to social distancing measures.

Cuomo said this morning they had no contact from Tesla and weren't expecting ventilators in time from any new manufactures.

 

[Oil4AsphaultOnly]

Spitballing here, just bear with me.

What if it were a quasi-government institution with a mandate? Something like the medical equivalent of the Federal Reserve or Fannie Mae / Freddie Mac? And that mandate means that it cannot be profitable, and the people running it had term limits and salary caps.


I've literally seen patients at VA hospitals DIE and the nurses continue to chart vitals for them when they were in rigor, because said government employees could not be fired and were too lazy to actually do their jobs.

Healthcare in the US would become 3rd world for all but the rich if the US Gov ran it like they do the VA system.

I feel that we're already mostly there. Many have already expressed how they've received better healthcare elsewhere. And medicare is NOT the VA hospital system, so equating the two is just extrapolation to the absurd.

But in the interest of moving this forward, let's discuss some solutions.

The ultimate goal we're trying to achieve is to ensure that every US citizen have basic health care, regardless of income or employment status. Ideally, it should cover as many health conditions as reasonable. It should probably also be run HMO style with more emphasis on preventative care.

So I propose MMFA (modified medicare for all), but the following change:
- re-imbursement rates for preventative care/checkups are 100% of the average of the PUBLISHED pricing for doctors/hospitals within a county. Prices exceeding 133% of the next neighboring county should trigger an audit for collusion.
- doctors/hospitals that accept MMFA needs to publish their prices to the MMFA system.
- elective procedures have a co-pay / coverage-limit
- medicare expense shortfalls should covered by the treasury (since the primary beneficiary, a healthy economy, is dependent on healthy citizens).

This way, MMFA isn't involved in the delivery of care, only the payment of it (much like insurance). You might still have a point about how inefficient MMFA is run, but the WH, Congress, and Supreme Courts are pretty inefficient too and we still pay for it.

 

[EV-lutioin]

Low. SARS-CoV-2 has a lower mutation rate by 2.5X to 4X than influenza. This is because SARS-CoV-2 has a copy replication proof-reading mechanism, which Influenza lacks.

Can you go into a bit more detail on this, I thought both influenza and SARS-COV-2 were RNA viruses making replication errors common to both.

 

[bkp_duke]

And medicare is NOT the VA hospital system, so equating the two is just extrapolation to the absurd.

No, it's not absurd. Medicare is very limited in the number of physicians that take it, simply because the reimbursement rates for docs is so low (and no, we are not greedy bastards - when I practiced I literally paid money to see medicare patients - the reimbursements are stupid low). Many docs will retire if medicare rates are forced upon them, simply because they would go out of business, even after slashing staff.

The ONLY reason Medicare doesn't reach levels of outcomes as poor as the VA system is because the US Gov does not directly administer Medicare, states do.

 

[SageBrush]

Can you go into a bit more detail on this, I thought both influenza and SARS-COV-2 were RNA viruses making replication errors common to both.

Try googling 'rna virus replication proofreading'

 

[bkp_duke]

Can you go into a bit more detail on this, I thought both influenza and SARS-COV-2 were RNA viruses making replication errors common to both.

The polymerase for SARS-CoV-2 has a proof-reading function built into it, influenza does not.

https://www.researchgate.net/figure...mplex-SARS-Pol-and-exonuclease_fig7_322075142
Structure of the SARS-CoV nsp12 polymerase bound to nsp7 and nsp8 co-factors

DNA vs. RNA has ZERO impact upon REPLICATION FIDELITY (i.e. mutation rate).

DNA vs. RNA has a LARGE impact upon stability of the virus genome when packaged and put into the virus particle.