Quote from THHuxleynew

herd immunity

The problem is there may not be much of a herd immunity. There are reports that people who have recovered can become re infected and have not gained long term immunity.--- about a third seem to have decreased lung capacity.

Quote from Max Nozin

reduces mortality rate

but it also increases the infection rate proportionally. The number of dead remains the same.

notice the inflection on the log scale of deaths.

Isn't this what we could expect if there are two strains with different R0;s and CFR's?

we know there are two strains a faster but less lethal S strain and a more deadly but slower L strain.

That is the S may be entering its transformation from exponential to logistic curve.

Quote from Max Nozin

btw did stats account to the fact that testing also grows exponentially?

I do not think so. There was a discussion of this in the Times. In the U.S., testing has not grown exponentially.

I believe these numbers are for people who come to the hospital and are definitely diagnosed with the illness by doctors, then reported to the CDC and other health agencies. In other words, these numbers do not include people who do not know they have the disease, or people who have it but do not go to the hospital. That was true at the beginning of the graph and through to today. So, whatever the hidden percent is, it is roughly the same throughout the history of the graph. Presumably, both detected cases, tested cases (not always the same), and hidden cases are growing at about the same exponential rate. I think that's the story.

People staying at home will not be tested, because there are so few tests. In Seattle, even people who are seriously ill and hospitalized cannot be tested, according to what doctors told the Times. In states with few cases such as Georgia, every suspected patient is tested.

https://www.worldometers.info/coronavirus/usa-coronavirus/

The graph in this article shows the exponential growth in different countries. The U.S. rate is very close to France. Korea has leveled off. Italy remains in crisis.

https://www.cnn.com/2020/03/13…a-lessons-intl/index.html

* Only about 8000 tests have been administered so far, according to one estimate. No one knows. The actual numbers are secret, and have been removed from the CDC website. The Trump administration has classified all discussion and data as top secret. This is unprecedented in U.S. public health history. My late mother, who was a Federal public health and statistics expert, would roll over in her grave to see this, except that we cremated her and spread the ashes in the garden. A public health expert still among the living said:

"This is an unmitigated disaster that the administration has brought upon the population, and I don’t say this lightly,” says Ashish Jha, director of the Harvard Global Health Institute. “We have had a much worse response than Iran, than Italy, than China."

The lack of early testing may ultimately cost hundreds of lives. I am not exaggerating.

https://metro.co.uk/2020/03/11…ings-top-secret-12384299/

The Japanese government has recommended that everyone wear a mask in public. They are distributing masks for free in Sapporo, and they plan to supply washable cloth masks to everyone in the country.

Instructions for making do-it-yourself masks have been widely circulated. They are better than nothing. Here is one that we tried:

https://sonaeru.jp/goods/handiwork/groceries/g-12/

You can Google translate it.

Here is a more complicated Chinese do-it-yourself mask that is supposedly 90% as effective as a commercial mask. This was posted here previously:

https://www.bkreader.com/2020/…own-protective-face-mask/

I believe I read that the Chinese government mandates masks for everyone out in public.

Quote from Max Nozin

Mortality rate

I am not talking about mortality RATE but the TOTAL NUMBER of deaths.

That is, if you test more and find more x times as many cases, then the case number is increased and you would get a

lower number for the newCFR. [ i.e. using CFR'= CFR/x as the new CFR) However when you calculate the number of deaths then

#death = number of cases * CFR

as you find more cases say x times the original number of case then CFR' is now deaths/ original case* X

and new CFR' = CFR/x

but the #of deaths is still

deaths = CFR * original number of case = CFR' * new more cases number =

= (CFR/x) * new more cases number

= (CFR/x) * (original number cases *x

and x/x=1

so the number does not change for how many die.

finding more cases does not change the total number of deaths.

NEWS HEALTH & MEDICINE Coronavirus is most contagious before and during the first week of symptoms

https://www.sciencenews.org/ar…uring-first-week-symptoms

Cruise ship outbreak helps pin down how deadly the new coronavirus is

https://www.sciencenews.org/ar…ss-cruise-ship-death-rate

Quote from oldguy

Isn't this what we could expect if there are two strains with different R0;s and CFR's?

You mean the change in the slope from Feb. 17 to March 1. Nope. That was caused by the Chinese effectively ending the epidemic in China, followed by the European outbreaks which now exceed the peak of Chinese outbreak in new cases per day. The peak in China was 5,000 new cases per day; there are now 11,000 new cases per day. (The other peak of 14,000 in China was an adjustment catching up with previous data, not an actual increase.)

In other words, the situation was under control. The epidemic was stopped in China, Korea and Japan where it had previously been most prevalent. But the Europeans and the U.S. ignored the methods and recommendations from China, Korea and Japan, and the U.S. government refused to allow German and other test kits, so the situation went out of control.

By March 25, 11 days week from now, there will be ~11,000 new cases per day in the U.S. if nothing is done to slow down the infection rate. The increase has been 1.3 X per day, steadily since March 2:

So far, nothing has been done. Nothing has even been proposed by the Trump administration, except testing, which has been repeatedly promised but not implemented. Without testing there is no hope of controlling the epidemic. It is like flailing in the dark. In Asia, the rate was slowed down by massive testing, following up on all cases, quarantines and so on. Not a single one of these steps has been taken in the U.S. The mechanisms to allow them, such as an internet reporting system and headquarters, are not being made. Or even planned as far as I know, but all such deliberations have been declared top secret by the administration. (Whereas they are featured in the national news broadcast every day in Japan and Korea.)

This is why Jha and other experts say, "this is an unmitigated disaster that the administration has brought upon the population." This is why our experts are projecting 400,000 to 1 million dead, whereas in Japan there will be ~12,000 dead when a vaccine becomes available, if present trends continue. (THIS WAS ~400 in Japan in 12 months -- my mistake.) We will sacrifice up to a million lives on the altar of anti-science stupidity. Not just in the administration, but everywhere in modern U.S. society, as you see from opposition to vaccinations, to national healthcare, sick leave, global warming initiatives, energy conservation, science in general, and cold fusion. To think that the U.S. was once the world leader in science and technology! It makes me weep.

As I said, I am glad my late mother never lived to see this. All that she and her generation of scientists worked to build up, and to make this country great, has been swept aside in a torrent of ignorance. Her generation invented computers and internet. She was one of the first to use a computer! She brought me to see it when I was 6 years old. The internet is now savings hundreds of thousands of lives in Asia, but we are doing nothing to use it.

Info on my mother, in case you are wondering. This is accurate, unlike much else in in Wikipedia:

https://en.wikipedia.org/wiki/Naomi_D._Rothwell

Jed

If your Mother and others of her generation where alive you would

see action.

WW 2 and going to the moon are

two examples of the USA showing

how to get it done.

This is terrible and looks just as bad here in the UK - in the absence of any quarantine measures the only way of saving lives now is mass distribution of antiviral drugs.......Maybe ask China to send supplies ASAP?

Quote from Dr Richard

This is terrible and looks just as bad here in the UK - in the absence of any quarantine measures the only way of saving lives now is mass distribution of antiviral drugs......

Antiviral drugs are a last resort for critically ill patients. So far, they have not had much of an effect. Drugs and therapy will never slow down the epidemic, because they are only used when it is too late -- when the patient already has the disease. You must prevent people from getting sick in the first place. Otherwise, the U.S. will have ~150 million sick people, with 20% critically ill (albeit over time, not all at once.) There is no possible way to prevent massive deaths in that case. There are not enough hospitals or doctors in the whole world to treat that many people. At the peak of the epidemic in China, they had 58,000 active cases. It is now 12,000, with 3,600 critically ill. The numbers are falling rapidly.

https://www.worldometers.info/coronavirus/country/china/

Doctors and public health experts in China, Korea, Japan, the U.S. and the W.H.O. China survey team have repeatedly said the only way to control this epidemic is by testing, following up, and rigorously quarantining patients. Including patients with mild cases. Not only did they say this, they proved it! Look at the numbers.

https://www.worldometers.info/coronavirus/

Oh great news - some common sense at last:

13 MARCH 2020
COMMENT

UK bans parallel export and hoarding of three Covid-19 drugs

By GlobalData Healthcare
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The UK government has banned the parallel export and "hoarding" of three drugs in anticipation of shortages in Britain following the Covid-19 pandemic. Credit: Billion Photos on Shutterstock.

The UK government has banned the parallel export and “hoarding” of three drugs being used to treat coronavirus patients in China in anticipation of shortages in Britain following the Covid-19 pandemic.

The export of the US-based AbbVie’s Kaletra / Aluvia, a combination lopinavir and ritonavir, the generic drug chloroquine phosphate and the generic drug hydroxychloroquine is being restricted to meet the needs of UK patients, the government said.

Hydroxychloroquine was placed on the restricted list from 14 March and Kaletra and chloroquine phosphate were added on 26 February.

The three drugs are marketed for other indications but are being administered to Covid-19 patients in clinical trials in China. For a list of Covid-19 clinical trials, search the GlobalData Pharma Intelligence Center Clinical Trials database.

Kaletra is a small-molecule, fixed-dose combination antiviral drug marketed in the EU, US and other regions in combination with other antiretroviral agents for human immunodeficiency virus (HIV). It is under investigation in 16 ongoing or planned clinical trials for Covid-19 in China, according to the GlobalData Clinical Trials database. Kaletra is formulated as capsules, tablets, coated tablets, film-coated tablets and solution for oral route of administration.

Chloroquine phosphate is a generic antimalarial drug derived from quinolone, marketed in the UK by Alinter Ltd in Essex, Crescent Pharma Ltd in Hampshire and The Boots Company in Nottingham and by other companies in multiple other regions. It is in 10 trials for Covid-19 in China, including one in combination with Kaletra, as chloroquine phosphate is believed to have broad-spectrum antiviral activities, although it is not approved as an antiviral agent. It is formulated as a syrup for oral administration. Recipharm, based in Stockholm, Sweden, manufactures the drug under the brand name Klorokinfosfat RPH Pharma for marketing in Sweden by Astimex Pharma. In March, the chief medical officer (CMO) noted increased demand and said it is securing a supply of the product in case of demand suddenly rose.

Hydroxychloroquine is an aminoquinoline derivative which acts as an anti-infective and antirheumatic agent. It is marketed for rheumatoid arthritis, discoid and systemic lupus erythematosus and juvenile idiopathic arthritis and is manufactured as film-coated tablets for oral administration.

What Is Parallel Export?

Parallel exporting is when wholesalers buy medicines already placed on the market in the UK to sell them in another country in the European Economic Area (EEA). Parallel exporting and hoarding of medicines by wholesale dealers can create or worsen medicine shortages.

UK wholesalers and drug companies will be allowed to export Kaletra and chloroquine phosphate and other medicines restricted for parallel export if they were originally manufactured with the intention to export to foreign markets.

Additionally, wholesalers can continue to stockpile drugs if it is part of arrangements agreed with marketing authorisation holders and this will not be considered hoarding by the government. This includes companies building up Brexit stockpiles at the request of the UK Department of Health and Social Care (DHSC).

If wholesalers break the restrictions, they risk regulatory action by the Medicines and Healthcare products Regulatory Authority (MHRA). Wholesalers’ licences could be suspended and continued breaches could be prosecuted as a criminal offence.

Brexit Restrictions

The UK government also added azathioprine, in its tablet form only, to its list of medicines that cannot be parallel exported on 26 February. The generic drug is a purine derivative that acts as an immunosuppressant and is marketed for preventing the rejection of kidney transplants and for rheumatoid arthritis. It is not being studied in coronavirus trials. UK suppliers of azathioprine 25mg tablets went temporarily out of stock in January 2020.

The government placed restrictions on parallel export and hoarding of 30 other medicines in October and November 2019 in anticipation of Brexit-related shortages. These include multiple hormones, such as conjugated estrogens, estradiol, levonorgestrel and progesterone, as well as adrenaline and hepatitis and pneumococcal vaccines.

Latest reports from

• Severe Acute Respiratory Syndrome (SARS) Coronavirus Infection Global Clinical Trials Review, H2, 2014

Or to search over 50,000 other reports please visit

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I have a flight booked for April.

This is what you find on the airline

website concerning C19.

https://www.flyswoop.com/coronavirus/

Quote from JedRothwell

At the peak of the epidemic in China, they had 58,000 active cases.

Which the U.S. will have on March 25, if present trends continue.

I do not think the trend will continue at this exact rate, increasing 1.3 times per day. People will take action themselves, even though our government is frozen in grotesque ignorance and denial. Local governments will take action. But the total numbers are sure to increase without decisive action by Federal and state governments, and national planning and coordination, in things like tracking cases. That's the main thing the Asian governments have done.

I hope the situation in Italy stabilizes! That would be a good sign.

By the way, I have made no comments about the medical and biological aspects of this, because I know little about these things. I appreciate other people's contributions. I do know about epidemiology, trends and statistics. I never studied them formally at college, but I grew up in a house filled with books about them. (Filled with books about everything. Hundreds of books!)

But as you have been saying, its too late now for effective quarantine measures to work. So anti-viral drug therapy at all stages of the illness will be the only effective option. Sure the WHO figures show that quarantine works but isn't it just common sense to treat with antivirals as welll? Better treated obviously in the initial stages before pneumonia sets in, so a prophylactic distribution would be the most effective with instructions to take the medicine as the initial symptoms arise. Requires a massive quantity which China should supply.

I am amazed at the amount of stupid attempts at prediction, conspiracy theories and just plain wrong claims posted here, mostly by one or two people. I will note that most of what is posted by robert bryant and JedRothwell seems to me to be well documented and worth reading. Also some other folks are posting good information. You can usually tell the difference between good stuff and garbage by inclusion of links and references in the good stuff and insane theories in the bad. I don't have time any more to refute all the crap.

However, one point is worth discussing. And that is "herd immunity." At the moment, it is not clear that the infection with COVID-19 confers lasting immunity. It is not clear that giving very sick patients convalescent serum helps. So maybe we will herd immunity and maybe not (as per NPR News Brief this morning).

Another interesting issue from NPR today: Mice are excellent for virus studies because they grow relatively quickly and have plenty of offspring. But it is not possible to study coronaviruses in "ordinary" mice because they are not susceptible. There is, however, strains of transgenic mice incorporating human and other DNA were developed to combat the 2004-5 viruses. Sperm from these mice was preserved in LN and is now used to breed a lot of susceptible mice to use for studying both therapeutic agents and the issue of herd immunity. The mice experiments are convenient and quick but of course need to be confirmed, perhaps first in primates (apes and monkeys) and humans.

See for example: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1140478/ "Development of a transgenic mouse model susceptible to human coronavirus 229E"

sam12 : I note that you booked an April flight. You may wish to reconsider. Is the need to make the trip so critical that it is worth risking a higher probability of infection? (rhetorical)

Quote from seven_of_twenty

At the moment, it is not clear that the infection with COVID-19 confers lasting immunity.

There has been a lot of discussion of this in Japanese mass media. They found a patient who seemed to get sick a second time. The medical establishment and the public freaked out. The other day, an expert on national TV said "we now think she still had a reservoir of viruses, which our test were not sensitive enough to detect." I think that means they sent her home too soon. She wasn't actually better.

In China they have also observed some recovered patients who did not acquire immunity. Some Chinese doctors warn that acquired immunity is not as much a sure thing as it is with some other infectious diseases.

A description of the Japanese patient and some comments by Chinese doctors are here:

https://www.businessinsider.co…isk-of-reinfection-2020-2

Apparently, there is a new video game around...