Covid-19 News

Quote from Shane D.

Well tell me, how many are going to die from keeping the economy shut down? Not just in the developed countries, but in the 3rd world countries.

And while you are at it, could you come up with a "misery index", to account for the pain and suffering caused by losing a job, house, future, and put that into reduced life expectancy? Then put it all into a chart, with a "curve", so we can see which path results in more lives lost.

You miss the point. Loosening controls prematurely may not help those people. If the numbers shoot up, the governor will be forced to shut things down again, making all the ills you pointed out worse and more prolonged. Like I said before, you can't fool Mother Nature. She works in mysterious exponential ways.

As to the rhetorical questions, I don't know the answers, you don't either, and yes it's god-awful but

a) it can't be helped without sacrificing a lot of lives from premature release of precautions and

b) when adequate accurate testing in large amounts is available, especially if there is an effective treatment, it may be possible to reopen the society before a vaccine. Otherwise, it will have to wait for the vaccine.

But you know, it's an ongoing experiment. If he goes through with it, the governor of Georgia will have the data in his face fairly soon and nobody will have to guess the outcome. I hope it works out but I much doubt it.

Quote from JedRothwell

This is like a general who orders the troops to surrender without firing a shot. Sort of like the French army in 1940.

Also like a general who sends out his troops with one rifle for every hundred soldiers and the rifles each have 4 bullets and resupply takes weeks and there are no reinforcements.

Quote from JedRothwell

Sort of like the French army in 1940.

Quote

Check (eg) https://nationalinterest.org/b…makes-it-23469?page=0%2C2

For three more days, even as Paris fell on the 14th, Fermont remained under enemy assault but refused to yield. Finally, the Germans ringed the fortress with six batteries of 105mm artillery, two 88mm batteries, three 210mm mortars, and four 305mm mortars. For two solid hours on the morning of June 21, German shells splattered the helpless fortress, but when German infantry attempted to storm the position, they were met with a lethal hail of fire from its gun ports. Later that day, the Germans, under a white flag, asked for a brief cease-fire in order to collect their casualties. The French commander, Capitaine Daniel Aubert, agreed. The attackers had suffered about 80 men dead or wounded; the French had one man injured and another killed.

Although their communications with the outside world had been cut, the defenders of Fermont held out until France agreed to armistice terms with Germany on June 22. It was only after receiving written orders from his superior to abandon the fortress and be taken prisoner by the enemy that Aubert and his men marched out of their scarred and battered fortress, the French Tricolor flying at the head of their proud column.

Quote from THHuxleynew

It is very very unfortunate that COVID response has become a political issue in the US.

Indeed,

Political games should not be played in these times.

In my country (Netherlands) our minister of medical care became overtired during this crisis and had to withdraw hinself from his function.

Instead of picking a new candidate from the coalition parties as usual the governement looked for the best person suited for the job and found out that the best person was from one of the opposition parties.

They invited him to take up the post and he accepted.

He is now our new minister of medical care.

lockdown and the curve

There is a lot of (scientific) uncertainty about the course of the epidemic. In some ways, the US is lucky. It can try out different strategies in different places and so discover how the infection rate changes with different social distancing rules.

But...

(1) These choices risk being so mired in politics that they are not wisely made.

(2) I don't yet see as much scientific investigation of exactly what is the infection rate, how is it spreading.

That Santa Clara study could easily be repeated in places where it mattered (higher infection rate) and with a neutral sampling strategy. That would give accurate info on who has been infected in the first wave. It would put to rest the IFR=0.1% speculation (I now agree with andrea.s - that is too low). But we have just about a range of 0.2% to 1% and where it is matters. (These figures then get scaled according to your population demographics, based on age and BMI/health). From that the epidemiologists can work out how interventions affect the infection rate.

When any place is released (partly) from lockdown massive antigen PCR testing is needed, repeated every seven days, to work out accurately is the infection rate going up or down.

In the UK there was speculation last night that just social distancing and advice to wash hands created a massive drop in R0. I think that was unfounded. But, to know, we need more data.

None of this is rocket science. All this argument about "when do we release lockdown and how much" is not the poiint. No-one can get it right without lots of testing.

Governments need random sample testing of populations. the good ones are doing this.

In the US, apply this at national or state level. I'd hope that both feds and individual states have the powers and resources needed to initiate random sample antigen (PCR) testing?

Quote from Alan Smith

LDM

Political games come in many forms. Here in the UK I see evidence that office-holders in our current government are seeking to spread the blame for their failures by repeating the mantra 'we are being guided by the science'. Meanwhile the scientists at the front line are saying' the government isn't listening to us'. They have also make an offer to the leader of the (socialist) opposition to help then, which he has agreed to do. This serves to mute critical commentary and spread the inevitable post-crisis accusations of incompetence over a larger group. So it would be wrong to think that party politics has been set aside, it is just that the players are now dealing cards from the bottom of the pack.

I am following the news on BBC TV quite closely during the day and agree with your analysis what is happening in the UK.

I think that that is likely due to having basically only two main politic parties.

However my impression is that in my country, where we have may parties which we can choose from this is not happening.

I see no possible intentions to put the blame for what happens on somebody else, nor comments from opposition parties supporting this, nor intentions to limit blames for after this crisis is over.

On the contrary, most comments/remarks, also from the oppistion parties are mostly sincere questions which get sincere answers.

In the UK the opposition political parties are not much opposing. No political credit to be gained from that, and it would not help the country.

The critical questions nearly all come from the media, and they are about what needs to happen now.

So why is this happening, when there is a strong "get behind the government" mentality?

Because this government was not set up to lead. It was set up to campaign and promote political messages. Most of the time in politics, and especially at elections, that is what works. Not now. This was a point made by commentators before there was any idea that COVID might exist.

Many politicians are good at both styles, and naturally step up to the plate in moments of crisis.

The current government, post Brexit, was chosen from a limited pool of people: most of the heavyweights or just people of strong principle had previously taken some not winning position in the Brexit debate, and therefore either made to resign, or wanted to resign, or not chosen for the new "pro-extreme-Brexit" government. In addition after 3 years of divided government Boris wanted to be absolutely sure his team were loyal. He made them swear loyalty to him in oaths of blood, and with arrangements to enforce this. Not everyone was prepared to stomach that, given that the UK system of checks and balances relies on cabinet joint decision making to keep executive power in check.

So this is Boris's government. But Boris is not a crisis leader. He is good at morale-building, and being liked. He will listen to advisers. I think the jury is out as to whether he can listen to advisers and then make tough decisions. Many people assume not. Evidence is that he does not much like this crisis. That is because he did not chair the first 5 COBRA emergency meetings about it. Delegating to your Health Secretary when this crisis involves everything? What we know is that Boris does not do details. He is just not interested in them. Crisis management requires a huge amount of concentration on details, as well as the big "which way to go" decisions. A wise leader can delegate the details but must be able to manage the people he delegates to, see when things need more attention, make that happen.

Anyway, the Jury is still out because Boris, after breaking, personally, social distancing norms, caught COVID himself and has been out of action for 3+ weeks.

From this morning:

Interviewer: "15 days ago a company wanted to volunteer (PPE/ testing/people to manage testing now badly needed - take your pick) they have not heard back from government. That is just one of many similar stories we hear. Why is that?"

Minister: "I don't know the details here, you would have to ask (some other minister)" + a whole load of good sounding words meaning nothing, and no promises of concrete action.

This is a political "stall and don't reply" answer, and it is deeply distressing to anyone who hopes for leadership.

Here is what the answer could have been, and would have been from a leader.

"I am very sorry if our systems are not yet working as well as they should: but of course I cannot yet know what the problem is. I don't know the details, and I can't reply now because it is not my direct responsibility, but I will talk to X immediately after this. We need to have a system which can accept help from anyone able to give it. I will personally tell you what is the answer within 24 hours if no-one else is able to do that".

No-one expects government to get these things right. We expect them to put politics aside, take responsibility, and do their best.

Quote from Alan Smith

In that case you are doubly blessed. It calls to mind a piece of English vernacular speech, where splitting the bill between diners in a restaurant is called 'going Dutch'.

Oh. We say "facciamo alla Romana", i.e. "we do as the Romans do". I never interpreted that as a flattery, rather as pointing out that nobody offers you a free lunch in Rome.

HCQ effectiveness as found from large meta-analysis of comparable US data.

This is as good as it gets without a large RCT. No clear positive effect for HCT, and some negative effect

(weakly suggested as due to side effects) but not definitive either.

No effective therapy for Covid-19 has yet been identified. Given the longer development, testing,
and approval times for novel chemical entities, repurposing drugs already approved for other
indications is a promising approach to rapidly identify an effective therapy. Hydroxychloroquine
is at the forefront of drug repurposing candidates Although ongoing randomized, controlled
studies are expected to provide more informative evidence about hydroxychloroquine in the
coming months, the outcomes observed in our study represent the best available data. This
nationwide retrospective study of the largest integrated healthcare system in the United States
provides the largest dataset yet reported of the outcomes of Covid-19 patients treated with
hydroxychloroquine, with or without azithromycin, anywhere in the world. Specifically,
hydroxychloroquine use with or without co-administration of azithromycin did not improve
mortality or reduce the need for mechanical ventilation in hospitalized patients. On the contrary,
hydroxychloroquine use alone was associated with an increased risk of mortality compared to
standard care alone.

Baseline demographic and comorbidity characteristics were comparable across the three
treatment groups. However, hydroxychloroquine, with or without azithromycin, was more likely
to be prescribed to patients with more severe disease, as assessed by baseline ventilatory status
and metabolic and hematologic parameters. Thus, as expected, increased mortality was observed
in patients treated with hydroxychloroquine, both with and without azithromycin. Nevertheless,
the increased risk of overall mortality in the hydroxychloroquine-only group persisted after
adjusting for the propensity of being treated with the drug. That there was no increased risk of
ventilation in the hydroxychloroquine-only group suggests that mortality in this group might be
attributable to drug effects on or dysfunction in non-respiratory vital organ systems. Indeed,
hydroxychloroquine use in Covid-19 patients has been associated with cardiac toxicity.4
Hydroxychloroquine has been reported to inhibit SARS-CoV-2 replication in vitro with a 50%
maximal effective concentration (EC50) ranging from 4.5 μM to 17 μM.17 However, the approved
dosing regimens for hydroxychloroquine in patients with rheumatoid arthritis or lupus generate
substantially lower peak serum drug concentrations (~1 μM).18,19 Administering higher doses of
hydroxychloroquine to achieve presumed antiviral concentrations might increase the risk of
adverse events. Interestingly, a randomized, controlled trial of high-dose chloroquine, the parent
compound of hydroxychloroquine that also has been reported to have in vitro antiviral activity
against SARS-CoV-217 and similar peak serum concentrations in humans, was halted
prematurely due to cardiac toxicity and higher fatality rates in the high-dose chloroquine-treated
Covid-19 patients.

Our study has certain limitations including those inherent to all retrospective analyses
such as non-randomization of treatments. We did, however adjust for a large number of

Covid19-relevant confounders including comorbidities, medications, clinical and laboratory
abnormalities. Despite propensity score adjustment for a large number of relevant confounders,
we cannot rule out the possibility of selection bias or residual confounding. Our study cohort
comprised only men whose median age was over 65 years. Therefore, the results may not
necessarily reflect outcomes in women or in younger hospitalized populations, nor can they be
extrapolated to pediatric patients. Our findings may also be influenced by the demographic
composition of patients in our cohort, the majority of whom were black. Disproportionately
higher rates of Covid-19-related hospitalization among the black population have also been
reported in the United States as a whole.21

Our study also has certain strengths. Because we studied data from a comprehensive
electronic medical record rather than from an administrative health insurance claims database,
we used rigorously identified covariates and outcomes. We studied patients in an integrated
national healthcare system; therefore, the data are less susceptible to biases of single-center or
regional studies.

Quote from THHuxleynew

HCQ effectiveness as found from large meta-analysis

Why do you repost this nonsense ?? We discussed already about the value of a meta study that might occur only after some years of experience !!!

To many fake studies are made today most likely to divert the attention....

New Study Finds Coronavirus Has Mutated Into at Least 30 Strains

Read Newsmax: New Study Finds Coronavirus Has Mutated Into at Least 30 Strains | Newsmax.com

https://www.newsmax.com/health…mic/2020/04/21/id/963896/

Some of the mutated strains were extremely aggressive, say the authors, generating 270 times the viral load as weaker strains.

The information confirms a recent report that the U.S. was hit with two different clusters of the virus, with type A dominating the West Coast and the deadlier type B in New York,

About politisising.

Sweden's handling of the corona outbreak is run by experts and there is a daily update from these experts. The government

mostly just adapt for requests from these governments institutions in order to prepare laws so that e.g. closing schools

is possible. The Swedish people like the approach and the support is around 70%. The target is not to reach herd immunity

but we will reach that in the Stockholm area but probably not the rest of the country. Although the lock down is informally

done via recommendations, if I compare with friends in Illinois, the difference is not much in practice. The target is to keep

the cases down not to overwhelm the health care be sustainable, and protect the vulnerable. Pictures of people in the street

is miss-leading in practice most people e.g. a high fraction do not go to restaurants and pubs, but we do adapt and businesses

tend to take measures to keep the spread low. The death rate in Sweden is not much different to USA. The difference is that in

USA there seam to be a big pressure to open up, very politisized and stricter lock downs. This urgent need to open up is not seen

here and we can keep this kind of lock down going into august if we must. We think that the rest of Europe will land in this kind

of setup as more countries now open up. The modellers say that around 30% of Stockholm will have had the Corona in beginning

of may some other models suggests that it is already like this in Stockholm. One expert say that 99% is not noticing that they have

had the Corona virus. However people tend to loosen up now, the weather is extreamly nice now and people are longing to socialize

again so personally I expect the numbers to start climb again and we will see new measures taken to keep the social distance up.

Quote from Wyttenbach

Why do you repost this nonsense ?? We discussed already about the value of a meta study that might occur only after some years of experience !!!

To many fake studies are made today most likely to divert the attention....

That meta-analysis was of a large uniform set of data from US vets. Therefore many of the confounding factors were fixed and a lot can be concluded from it.

For example, it is clear that HCQ, at least as used in these cases, does not make much difference.

No great precision because the propensity score can suffer selection bias given that it will be the more serious cases that get drugs. Even though initial confounding factors are all recorded quantisation issues + this asymmetry can make these results a bit wrong.

They still have a lot more value than Raoult's small study.

THH

Interesting, maybe the weaker type A immunizes against the more deadly type B coronaviruses. Could also be why repeated infections are occurring if the different strains are inactivated by different antibodies. So a broad spectrum of Viruses will need a broad spectrum of anti viral drugs and vaccine cocktails. The shotgun approach of Z-pak Anti Bat (iV) (H) combo (HCQ, AZM, Zn, Avigan, ivermectin, sutherlandia, angelica, sceletium, liquorice) may turn out to be the only effective therapy if given early enough in the illness at the first sign of viral loading signified by the most prominent initial symptom, fever. No point in pussy - footing around with just HCQ when we have a potential arsenal of different anti virals sitting on pharmacists shelves. Sure it would be nice to do the clinical trials on individual compounds, publish lots of papers and over the years establish a profound knowledge base for treatment - but we're out of time, all countries want to end the economic chaos so a shotgun approach looks like the only workable solution coupled with WHO approved Mass Fever Treatment. I agree with Wyttenbach especially if the authors of the report have vested interests in cheap available drugs being made to look ineffective so protecting sales of Remdesivir for example. Apart from any other political bias. European studies and doctor's opinions seem more positive than in US where HCQ seems to be treated as a drug of last resort, used when all else has failed, so no wonder their patients are dying in droves whether given HCQ or not after irreversible pathology has occurred.

To those who want faster "opening" of poorly performing states in the US:

I have been in touch with some health workers, in particular, ICU nurses who care for COVID-19 patients. They have posted on Facebook and elsewhere what it really means to care for very sick COVID-19 patients. The toll on their bodies and minds is immense. Many will decide to quit, particularly if they feel the government is ignorantly increasing their work load and risk levels. So Shane D. and like thinkers, if there is a lot of "opening" of states as the President says he wants, when you or your loved ones get sick with the virus, there may be nobody there to take care of you.

I have asked permission to repost their Facebook messages and if I get it, I will post some of them here. I think some people who post here have no idea whatever what this disease is like and how terrifying it is to care for the patients in ICU's, especially when some of your co-workers are among them. Health workers will continue to give care despite the personal danger to themselves as long as they feel they have the support of the public and of the government and that those are acting in their interest. If they lose that impression, many of them will simply quit in favor of sheltering in place with their families. That would greatly amplify the crisis and the disaster.

FDA news- touted as a home test for COVID-19, what this actually is is a home collection kit for sample acquisition. Of course, the required RT-PCR actual test has to be done in a lab with the appropriate complex technology. This is a test for virus shedding, not for antibodies. If positive, it indicates that the patient has COVID-19, and is contagious. The article does not make clear the cost and availability. Both the title and the photo accompanying the article are misleading. The photo is of blood collection for an antibody test which is not what the announcement is about. This is typical of the poor reporting which often messes up public understanding of any technical subject. Nonetheless, this is a very interesting development.

Quote

“This reissued EUA for LabCorp's molecular test permits testing of a sample collected from the patient's nose using a designated self-collection kit that contains nasal swabs and saline,” explained the FDA, in its statement. “Once patients self-swab to collect their nasal sample, they mail their sample, in an insulated package, to a LabCorp lab for testing.”

https://www.foxnews.com/scienc…-at-home-coronavirus-test