Covid-19 (WuFlu) News

  • robert bryant Very interesting, the dipyridamole clinical study but awGads it's small. Much sketchier even than the Raoult study of HCQ and Azi! Dipyridamole is sold as Persantine in the US, for use as an adjunct to anticoagulants in preventing clots in such things as artificial heart valves. Surprisingly, it seems to have a low incidence of adverse effects as per prescription information. The usual dose for the anticoagulant role is 200 mg of extended release twice a day or up to 400 mg of the rapid release three times a day (PLEASE! never take anything or decide on dose without advice of your physician!!!!!!). That makes it expensive. A bottle of 100 x 50 mg tablets at McGuff is $90 US for the generic. You don't want to know the cost of the brand product ($600+).


    On the other hand, Montelukast (Singulair brand in the US) is very inexpensive. Less than $5 for 100 tabs from a medical supply house. It is used to treat bronchospasm and asthma (chronically, never for rescue) and seems pretty safe. You can Google prescribing information for dose and side effects and again: NEVER without advice from your physician.


    Thanks for the info- every little bit helps. I only wish they had studied a larger group. The controls for the dipyridamole were only ten patients and they had wildly diverse outcomes.

  • Quote

    Even in the more developed countries, Doctors on the front lines are ahead of the controlled studies. Priority one; save the patient with what works best, and then if it was not the normal standard protocol, follow up with the data, data, and then more data

    No. Putting the cart ahead of the horse. Testing a rocket by firing it into the ground.


    No. Not with ethical doctors. It is always possible to get a terrible surprise. A promising drug may, when the data are sorted, may do more harm than good, even killing people. Without a controlled study, even at least a sketchy one, you know nothing. Anecdotes of individual cases and small, uncontrolled studies tell you virtually nothing. At best, they can point to the need for a study. Might as well reach into a pharmaceutical warehouse and pick something up at random and give that. There is a small, rare exception for anecdotal data and that is when a patient is irrevocably terminal and you thus can do little or no harm.


    Primum non nocere!

  • Quote

    Looks like the evidence for using hydroxychloroquine with azithromycin and Zn supplement is overwhelming now.

    I am learning Richardian Engrish. "Overwhelming" translates to "sort of mildly suggestive."


    And @everyone... when you enter a link, please give us an idea, even a brief one, what it's about so we don't have to click... and wait.

  • With no sign that the coronavirus is going away, researchers are looking to animals to understandCOVID‑19. They are testing monkeys, mice and even ferrets to answer key questions about the disease and to fast-track potential drugs and vaccines for clinical trials.

    Teams in China have reported initial findings from studies in which they infected monkeys and mice engineered to be susceptible to infection by the coronavirus, called SARSCoV-2. And a team at the Australian Animal Health Laboratory in Geelong is studying the infection in ferrets, before testing potential vaccines. Ferrets are a popular model for respiratory infections because their lung physiology is similar to humans’. But no animal model is perfect. “There’s

    going to be a need not just for one animal model, but multiple,” says David O’Connor, a virologist at the University of Wisconsin– Madison.



    https://media.nature.com/origi…-x/d41586-020-00660-x.pdf

  • America No 1.

    The eagle edges out the dragon..in the Year of the Rat

    .


    Unfortunately, almost half - 50% of the US cases is in New York, one city. A third of the fatalities. If not for New York, the US would be close to Germany, with an infection rate per capita much lower.


    I am sure this is stressing the healthcare system there.


    Each state governor and mayor are in charge of their areas, not the federal government in micro management. The described "amazing" leadership in this town and state is not as good as hyped! No where near. The governor said the TWO TRILLION DOLLAR relief bill was not near enough!!!!!!! TWO TRILLION!


    Now the next epi-center in the US is looking to be New Orleans. Four states that contribute over half of the cases are ones that have very big problems with homelessness, crime and overall society issues. Many other large cities in different political climates are no where near as bad.


    There is definitely a connection to how a city or state is ran and it's impact on public health. For instance, in Illinois, the governor signed a sweeping travel ban act. (Politically correct name is "shelter at home") It has very sweeping restrictions..... however the very first paragraph states :

    "Individuals experiencing homelessness are exempt from all directions of this executive order"!


    So in Chicago, panhandlers can urinate on the streets, come up to you and pan-handle, go anywhere they like at anytime and there are no restrictions.

    I guess the homeless never get sick nor transmit disease! I doubt in China, that was allowed to happen! Yet, I cannot take a bike ride without the possibility of getting a $500 fine!


    Much of the foundation for this crisis was set long before the virus hit.

  • Much of the foundation for this crisis was set long before the virus hit

    A whimsical story


    in the sequel the dragon may mutate into a beautiful butterfly and marry the monkey

    and the duck may rise up like an eagle

    ,,no animals were killed in the making of this story although the golden carp did o/d on natto


    Lane 1 Monkey

    Lane 2 SiberiianTiger

    Lane 3 Dragon

    Lane 4 Old lion

    Lane 5 Old shewolf

    Lane 10 Eagle


    In early winter the greedy dragon killed a pangolin.. But the pangolin gave it a nasty virus.

    The dragon thought it could run away and bumbled slowly forward..trying to burn the virus off itself..

    The Tiger was a little distracted because it was looking to the North..

    Even though it knew the dragon was dangerous.

    And it was hurt by the clumsy bumbling dragon but managed to get away slowly

    Similarly the old lion was distracted .looking westward toward Mecca ..or to Jerusalem

    It was hurt by the writhing dragon as it lumbered forward..and fell over


    But the monkey knew the dragon very well

    From the very first It had its eyes firmly fixed on its noisy steamy neighbour , and masked up early.. and moved too nimbly .

    And kept moving faster and faster away from the steam and fiery froth.. all the while keeping its eye on the dragon and the virus


    Some of the steam from the dragon caught hold of the old wolf and she got very sick

    And needed a ventilator


    And as for the eagle in Lane 10.. it was blinded by R &D blinkers and got hit by steam and fire too.. It didn’t even know it was in Lane 10..

    And never flew away… it was a sitting duck...til the last moment..

  • Sorry to be the bearer of bad news but . . .


    As of March 26, 6:00 p.m. EDT the U.S. now has the most cases: 82,179. China has 81,285. There are 13,968 new cases in the U.S. today, or about 800 per hour. So I expect about 4,800 more today. The total should be around 18,000. My spreadsheet predicted 15,000, so the rate is accelerating again, back up to 1.35.


    I predict ~23,000 new cases tomorrow, and 87,000 new cases on April 1. That is how many there will be unless more serious steps are taken to prevent the increase, and flatten the curve. As far as I know, the Federal government does not plan to take any steps to flatten the curve. As I said, their policy appears to be to let nature take its course, allow the natural increase of the epidemic, and then try to stop the patients from dying. This will quickly overwhelm our hospitals. If the present trend continues, by April 9 there will be over 1 million new cases per day, and there is not the slightest chance our hospitals can deal with that. Nearly all critical patients will have to be turned away and left to die at home.


    (I do not think the present trend will continue unabated, because people will soon be so frightened, they will take more steps to preserve their own lives, even if the Federal government continues to do nothing. Surely, the rate will fall, somewhat.)


    In political news, public opinion polls show that 60% of the U.S. public supports Trump's handling of the epidemic, and Trump is at the height of his popularity since being elected, at 49%. I find this remarkable. The U.S. will soon have more cases, and more deaths, then the rest of the world combined. At this rate, by the end of April we will have about 2,000 times more cases and more deaths than China, a country three times larger than the U.S. It makes me wonder how bad things can get before the public loses faith in the government. Will it take a million deaths? Two million? Six million?


    I suppose 60% of the people support the administration because they do not realize we will soon have millions of cases and hundreds of thousands of deaths. I think that outcome is now unavoidable. People still don't realize what is happening, and how things will be in a few weeks. Whether it will be hundreds of thousands or millions remains to be seen. Perhaps there is still time to prevent millions. I wouldn't know about that. I do not know enough about medicine or the number of hospital beds, or the peak number of patients to guess. But I am sure that if nothing is done, it will be far more than hundreds of thousands, and as far as I can tell from the news, nothing is being done.


    There are signs popping up around the neighborhood, "EVERYTHING WILL BE OKAY." I guess that explains the 60% support. People sincerely believe things will be okay. It reminds me of Japan in late 1944, when U.S. bombing raids were beginning. There were signs everywhere, and government pronouncements saying "we must win, we will win, 100 million souls united cannot be defeated" and so on, and so forth. Total denial of reality. A pathetic attempt to erase facts with wishful thinking. It is pitiful, but I guess it is the human instinct to do that. I myself don't have it in me. I don't have the knack for wishful thinking. I only ever want to know the facts, however bad they may be. Especially when dealing with matters of life and death, such as when my friends are relatives are dying -- or when I myself come to die.

  • Sorry to be the bearer of bad news but . . .


    As of March 26, 6:00 p.m. EDT the U.S. now has the most cases: 82,179. China has 81,285. There are 13,968 new cases in the U.S. today, or about 800 per hour. So I expect about 4,800 more today. The total should be around 18,000. My spreadsheet predicted 15,000, so the rate is accelerating again, back up to 1.35.


    I predict ~23,000 new cases tomorrow, and 87,000 new cases on April 1. That is how many there will be unless more serious steps are taken to prevent the increase, and flatten the curve. As far as I know, the Federal government does not plan to take any steps to flatten the curve. As I said, their policy appears to be to let nature take its course, allow the natural increase of the epidemic, and then try to stop the patients from dying. This will quickly overwhelm our hospitals. If the present trend continues, by April 9 there will be over 1 million new cases per day, and there is not the slightest chance our hospitals can deal with that. Nearly all critical patients will have to be turned away and left to die at home.


    I try not to think emotionally about any of this and to be more analytical, and yet I still have days like yesterday where I’m upbeat and think we will turn the corner here in the U.S. In 2-3 weeks we will be seeing the light at the end of the tunnel. And there are other days, like today, where this feels like a storm that’s not going to let us out. It’s a tough thing to go through mentally day to day. I don’t think enough people are doing enough personal distancing here in the U.S. If you go by the Costco near me the parking lot is packed, as is the store. It’s just not enough. It’s too little too late.


    The main political thing I would say is that our government failed us. It failed us on 9/11 because it didn’t connect the dots on that attack, it failed us in the 2008 financial crisis because it took the reigns off the banks and turned them into casinos, and it failed us here because if it had simply started testing people, and tracing cases back to their origin, this could have been contained much better. Now we are facing a nightmare scenario. Our government could have stepped up and saved the day and it failed spectacularly. Some people may not want to believe that, or will refuse to believe it for some reason. But history will record it that way.

  • For what it's worth, a neurologist on a medical forum made this suggestion-- I hope New York thought of it:


    Quote

    Can we learn something about plaquenil [hydroxychloroquine] for covid by looking at those already using the product for various rheum conditions in New York? Pharmacies have the data.


    I wish there were a decent effective way to communicate suggestions to US-NIH or CDC or the task force in the US. Sure, they would have to do a lot of screening but it might be worth it to catch suggestions like that one.

  • I predict ~23,000 new cases tomorrow, and 87,000 new cases on April 1. That is how many there will be unless more serious steps are taken to prevent the increase, and flatten the curve. As far as I know, the Federal government does not plan to take any steps to flatten the curve

    Jed, with a latency of average 7 days (incubation) you will see no change in the increase unless the old measured somehow work.


    But undetected cases are difficult to count in, as these people still can spread unnoticed. This you also can see in country statistics that now should go down significantly but more look like flattening. E.g. Switzerland goes down slowly despite hard measures.


    Countries like UK or Spain that only catch 1/5 of the active cases will see no change even after 2 weeks lockdown.


    Switzerland did close to 100'000 tests so far an 1/9 was positive. With this you can estimate the undetected cases in most countries as Korea did more more less the same amount of tests. with 3 time less positives.

    The other number you can use for better projection is the ratio of found cases/death. Here USA looks quite normal but they are in the raising peek and this could change soon very dramatically as in Italy.

  • JedRothwell


    Is there a copy of your spreadsheet somewhere to download?


    Also, I realize everything looks bleak but man, try to cheer up a bit. You're taking good care of yourself, right? The majority (by far) of people in any age group who acquire the virus will survive it. There are anecdotal reports not infrequently of people in their 80's who do fine.


    Maybe a little distraction will dispel some of the gloom for you? Hell, what do I know!

  • Quote

    not now...

    Yes its an idea.. the cohort that takes HCQ for rheum. arthritis is the 60-85 age range..

    but this will be only retrospective in 2022 when enough of that age group has been exposed to covid

    unfortunatel

    Well, RA is not limited to old people. Perhaps you are thinking of osteo. And then there is lupus erythematosis (LE) and other conditions where Plaquenil is used.


    If you take a place where the disease is making fast progress, like Italy or New York or Louisiana, there may be enough infected people who take the drug to make this work. I'm guessing at the "n" which would work but an old teacher of mine used to mutter in a strong Germanic accent: "Series ist von hundredt" Should be possible to get a couple of hundred if HIPAA doesn't preclude it.

  • "Should blood pressure meds.. acei's and arbs ... be ceased for Covid 2.?


    Thorough Swiss answer =No.


    "Therefore, based on currently available data and statistics, the assumption of a causal relationship between ACE-I or ARB intake

    and deleterious outcome in COVID-19 is not legitimate. In fact, in a case of reverse causality, patients taking ACE-Is or ARBs

    may be more susceptible for viral infection and have higher mortality because they are older, more frequently hypertensive, diabetic,

    and/or having renal disease."


    https://academic.oup.com/eurhe…eurheartj/ehaa235/5810479


    Should be possible to get a couple of hundred if HIPAA doesn't preclude it

    Good luck. Italy is a mess.. maybe Germany is in ordnung..

    but the European HiPAA=patient confidentiality? may be 'zu schwer"

  • Good luck. Italy is a mess..


    According wiki:


    On 22 March, 2020 Italy has approved the drug (favipiravir) for experimental use against COVID-19 and has begun conducting trials in 3 regions most affected by the disease.[22] The Italian Pharmaceutical Agency, however, has reminded the public that the existing evidence in support of this drug is scant and preliminary.

  • Is there a copy of your spreadsheet somewhere to download?

    It is such a mess, I would be embarrassed to upload it. The first two columns are the data from Worldmeters for the U.S. I will copy that here. The other columns are things like today's cases divided by yesterday's, and today's cases multiplied by a constant at the top of the sheet [$F$2], such as 1.3 or 1.1.


    Here is another useful number for the top of the sheet: U.S. population 327,200,000.


    The whole thing stops working in mid April. That is to say, it stops agreeing with models from professionals. Such as:


    https://neherlab.org/covid19/


    It stops working because other parameters begin to play larger roles. I threw in a few of these in various columns, just to learn how these professional models work.


    All of these models -- professional and my amateur one -- assume a steady state situation with no changes to the level of intervention. The interventions are set for none, moderate or severe. That is unrealistic. Interventions will increase in severity as the number of cases increases.


    Anyway, here are the numbers. I add the "New cases" from Worldmeters daily. Everything from March 26 on is speculative. I just now put in 18,000 (bold, underlined) but that's only an estimate. (The actual number as of 9:30 p.m. is 17,166.) The numbers below March 26 are:


    Previous day new cases * Constant [$F$] (which happens to be 3.1)


    DateTotal casesNew cases
    March 175
    March 210025
    March 312424
    March 415834
    March 522163
    March 631998
    March 7435116
    March 8541106
    March 9704163
    March 10994290
    March 111,301307
    March 121,697396
    March 132,247550
    March 142,943696
    March 153,680737
    March 164,663983
    March 176,4111,748
    March 189,2592,848
    March 1913,7894,530
    March 2019,3835,594
    March 2124,2074,824
    March 2233,6079,400
    March 2343,79610,189
    March 2454,87111,075
    March 2568,22613,355
    March 2686,22618,000
    March 27109,62623,400
    March 28140,04630,420
    March 29179,59239,546
    March 30231,00251,410
    March 31297,83566,833
    April 1384,71786,883
    April 2497,664112,947
    April 3644,496146,832
    April 4835,377190,881
    April 51,083,522248,145
    April 61,406,111322,589
    April 71,825,477419,366
  • By the way, this spreadsheet has an amateur mistake. The columns are in the wrong order. Column B (total cases) is the previous day's total cases plus today's (example: B24+C25). Way back in the day, spreadsheets scanned strictly left to right, top to bottom, one pass, so that would screw things up. It would evaluate B before C, so it would miss C being increased by 1.3. I recall seeing spreadsheets change every time you forced a re-evaluation. "Non-procedural my ass," I thought.


    Yeah, yeah . . . As I said, it is embarrassing.