Gov Cuomo in NY below said they have procured 7k ventilators but need 30k in the next 14 days. They are now trying to split the use of a ventilator between two patients to see how well it works.

Going back to China, they had many more cases than Italy has now but a much lower mortality rate. I believe a large part of this is because they were able to geographically contain the outbreak mostly to Wuhan. Then they sent large numbers of medical personnel and equipment from other parts of the country into Wuhan to fight it. So they brought in ventilators from elsewhere.

Wouldn’t it be great if Gov Cuomo could call the Governors of 10 other states and they all immediately said they would overnight their ventilators to NY because their region was fine and not at immediate risk? But now we have a case where he’s knocking on doors to procure them and probably not getting much of a response.

https://www.cnn.com/world/live…ac5aff1ab76740b71065ac7e5

Interesting read here on the math behind what it means when infections spread exponentially and how it begins to slow down:

https://www.wired.com/story/th…ind-flattening-the-curve/

Quote from RobertBryant

Nigeria advises caution...

after several overdose on CQ... it might be good to check Trump's medical expertise

https://edition.cnn.com/2020/0…p-nigeria-intl/index.html

No, I get it. Chloroquine is a powerful drug. People with certain conditions can have very negative reactions to it. Here is another story that sounds unrelated to the one you are mentioning.

http://bannerhealth.mediaroom.com/chloroquinephosphate

Quote from Dr Richard

Brave New World - none of this would have been necessary if the authorities had acted at the same time as China in mass distribution of anti-viral medicines. The total number of deaths curve in China begins to flatten out on 20 Feb just after chloroquine delivery from Pakistan. Just as Italy was erupting in an exponential rise. Hopefully the three day decrease following chloroquine/azithromycin therapy begun on 20 March will continue in Italy and then can be extended to the rest of us. The question arises though could all of this and the devastating economic meltdown have been avoided if Bayer along with all other big pharma had responded immediately on 20 Feb flooding pharmacies across the World with supplies of hundreds of millions of Chloroquine doses? Why was it just China? Instead of the opposite reaction of UK pharmacies telling everyone that it would never work and trying to restrict people from any access to it and insidiously stockpiling it anyway by restricting any exports?

There’s a lot to unpack with what you are arguing. South Korea went right into chloroquine too, and they had 7 recorded deaths today. China has had recorded deaths over the last week as well.

I hope chloroquine is the answer to all of this. But perhaps it doesn’t alway work for everyone in all cases. We will know a lot more in the coming weeks now that it is being put to widespread use in the West. If it brings the death rate down substantially it will be a huge sigh of relief. Not a home-free by any means, but a better wait to a vaccine.

But Dr. Richard you have been banging the chloroquine drum from early on here. So if it works in a meaningful way, credit to you.

Quote from JedRothwell

Gov. Cuomo -- who I now designate a world-class expert on this subject -- predicts 40 to 80% of the population will get it (video, minute 39). I do not know where he got those numbers from, but as he says, he has been talking to many experts. Anyway, as he explains, these percentages themselves are not the greatest worry. What we need to worry about most is a large fraction of the population getting infected quickly, and overwhelming the hospitals. If 80% are infected over many months, the hospitals can handle the serious cases, and the number of deaths will be low. If 80% are infected over ~6 weeks, it will be catastrophic. (The peak of the 1918 Spanish flu epidemic lasted about 6 weeks.)

That "spreading out" is the first thing he explains in the video, and he goes back to it at minute 39. Listen to that section. His explanation and his tone are superb as I said. This is exactly what everyone needs to hear, and needs to understand.

Not to be doom and gloom, but I don’t think we are out of the woods on your bad case scenario. This story below states what the WHO is saying today, which is that the virus is accelerating. I have seen some people say that they are watching Italy more closely than ever to get a sense of when they can flatten things out. It will suggest how long it takes to get it under control.

https://www.cnbc.com/2020/03/2…ipse-350000-who-says.html

Quote from Shane D.

The NYT's has a "doubling rate" graphic out. It will be updated daily as deaths are reported, and covers countries, then breaks out the US by individual states. Will be good for spotting trends:

https://www.nytimes.com/intera…us-deaths-by-country.html

Unfortunately I think the thing to anticipate here in the U.S. is that 4-5 more States will join WA, CA and NY as States with major outbreaks. The virus started in populated coastal areas and will increasingly work its way into new areas. So the effort to contain it will become more widespread (kind of like the forest fire analogy). It looks like New Jersey and Louisiana might be on that list plus 2-3 others. There is some decent amount is social distancing going on. But the virus will still course through the population for the coming weeks.

And the same thing is likely to happen in France, Germany, and Spain.

Quote from artefact

Today there was a message to doctors in at least parts of Germany that from tomorrow on only bad cases should be tested to save resources from tomorrow on. The new cases will look more declining than they are here.

It feels like something similar is happening in parts of the U.S. Perhaps this is out of necessity and testing capacity. The problem as I see it with this is that people have a high viral load right after they are infected, but they still feel still fine. So it’s a combination of being very contagious and asymptomatic.

How do you get in front of this if people aren’t being tested until they need hospitalization? People need to be tested and isolated much earlier in the process or they will just keep infecting more people.

The whole process of epidemiology and contagion seems very complicated to me. The simple way to calculate the spread is with a multiple, which has been 1.3. But just think, if that multiple continues we will have over 50k new cases per day here in the U.S. a week from today. I sure hope that isn’t the case.

And posted new cases today in the U.S. are approaching 8k. I want to believe in some strange way that this is not bad news because it means they are finally rolling out more high-throughput testing.

Italy’s number of new cases is actually down from yesterday, but it has been reported that they are no longer testing at the level they were because their health system is at a breaking point. Hopefully their number of daily deaths finds a way to go down.

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

Reading the news in this article today is just painful. At this hospital in Italy patients over 60 are no longer being helped. It’s a wake up call for the rest of this world to stamp this thing out early with heavy testing and staying at home. No half hearted measures.

https://www.jpost.com/Internat…help-those-over-60-621856

Quote from JedRothwell

I do not know enough about medicine to follow this discussion of hydroxychloroquine. I could not judge whether it might be effective. However, since it has been approved for other uses, I suppose it is reasonably safe in the correct dosage. Even if it does no good, I don't suppose it would do much harm. If doctors feel it helps, I would encourage them to use it. I would ask that it be used on me if I were sick. I understand that in normal circumstances you have to do double-blind testing and you have to be careful when deploying a new drug. You even have to be careful when using an old drug in new ways. But these are not normal circumstances. In this situation, I think we should put aside the rules and use whatever the doctors think is best. They may be judging by intuition, but the intuition of a professional is often a good thing to go by. You want ship captains and airplane pilots to pay close attention to their intuition.

We can always do double blind tests for a reserved set of people while many doctors outside the study go ahead and use the drug before the test results are in.

Since this situation is so extraordinary, I think we should skip some steps in the development of a vaccine, too. Or accelerate steps, even to the point of recklessness. As reported the other day, tests of vaccines on human volunteers has already begun. This might hurt the test subjects, but they are willing to take that risk. I would be willing too, even if they told me there is a significant risk of harm. In this case, the harm of delaying far outweighs the harm that a few dozen volunteers might suffer.

I believe in normal circumstances, they would not have started the human tests so soon. I guess they would still be inoculating mice or primates?

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Choloroquine has been around since the 1940’s I believe. So it’s well known. But in rare circumstances it can cause blindness and even death. It’s definitely not your run of the mill antiviral drug. It’s powerful stuff. See article below.

https://slate.com/news-and-pol…navirus.html?via=taps_top

Quote from seven_of_twenty

Coronavirus, far as I know, is not a rhinovirus. It is a picornavirus. Structure is somewhat similar. I'm not a virologist but I am pretty sure antiviral action is highly specific to the type of virus so I would not rely on the above report.

https://en.wikipedia.org/wiki/Rhinovirus

I think Dr. Swartz is a medical doctor (is he ?) but he seems to be promoting consistently sketchy/dubious/premature information without appropriate qualification.

From my understanding coronaviruses are their own distinct family. There were 6 of them known to transmit to humans, with COVID-19 now becoming the 7th.

https://www.cdc.gov/coronavirus/types.html

It appears here that Trump is really pushing this cocktail today - see below. It’s hard to know if he is doing this because he is being fed private data on it that we all don’t know about, or he is simply seeing the same public reports we are.

The thing to keep in mind is that any drug cocktail that is shown to be effective is still 6-8 weeks from widespread use. I don’t see the experimental phase being able to move any faster than that. There needs to be a clinical trial phase with good data and published results. Compassionate use and Approved use are two different things, as they should be.

Put me in the camp that there is a decent possibility that we will have some kind of antiviral drug cocktail in the next 8 weeks that is shown to be somewhat beneficial. But it’s also good not to have too much false hope. Nothing is guaranteed at the moment. And it’s still a month or two where testing and isolation are the action steps to take.

https://www.mediaite.com/news/…-the-history-of-medicine/

Still concerns about getting testing off the ground here in the U.S. Below is just one line from the article. There aren’t nearly enough people being tested here. It seems like kind of a mess still.

“On Friday, New York City health officials directed medical providers to limit COVID-19 testing to people sick enough to require hospitalization, saying wider testing is exhausting supplies of protective equipment.“

https://apnews.com/4aac3a10664097f38633149367ac3928

It’s articles like the one below that make the mind rattle a bit. It says that Italy is now calling in its military to enforce the lockdown, and Chinese medical experts who are in Italy say that Italy is not doing enough to contain it. Unreal

Also below is a quote from the article from an Italian Doctor. With thousands of new cases per day I don’t see how their health system won’t seriously buckle under the weight of it all very soon. And no other country can really help them with ventilators etc. because these countries need them for themselves. This is a real tragedy.

"I would say that we are at the end of our strength," he said. "This is a small hospital and we are taking in a lot of people, I would say the capacity is finished. We do not have sufficient resources and especially staff because apart from everything else now the staff are beginning to get sick."

https://www.cnn.com/2020/03/20…ronavirus-intl/index.html

Quote from JedRothwell

The only bright spot I see in today's data is Spain, with two days stable followed by a substantial decline. I do not know if it is significant. But at least the daily new cases did not double in three days, as it has been doing. The number of new cases from the last 3 days are: 2943, 3308, 2335.

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

It will be very interesting to see what happens in China over the next couple of weeks. The CEO of Starbucks was on TV saying they just opened a new store in Wuhan yesterday and life was basically back to normal there.

The virus is still in China obviously so will they be able to live relatively normal lives and keep the number of new cases negligible? South Korea is going through the same thing. Even if we got it down to 50-100 new cases per day here in the U.S. I have to imagine that would still keep this on everyone’s minds everyday. We have a long ways to go to get it down to that number so kind of premature talk.

This is a really interesting product - a thermometer that uploads your temperature to a database which is projected on a map. They are currently selling 10,000 per day. I would never have thought to look at something like this before now. It’s interesting here in the U.S. how many fevers are being shown in Florida. That’s where a lot of people go for Spring Break.

https://www.nytimes.com/2020/0…s-fever-thermometers.html

https://healthweather.us/

Over 5k new cases in the U.S. today. Yes it’s just a number but crossing that 5k mark has to have a psychological impact. We are almost at the same level of daily new cases as Italy.

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

Quote from JedRothwell

Here is a N.Y. Times editorial saying what I have been saying:

The Epic Failure of Coronavirus Testing in America

China and South Korea offer lessons in how to curb this pandemic.

https://www.nytimes.com/2020/0…/coronavirus-testing.html

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As stated above, hopefully today’s jump in cases is a sign that more testing is finally starting to happen here in the U.S. It can’t come soon enough. We could see some big numbers of new cases in the coming days. But the increase in testing may be at the heart of it.

Just saw over 4K new cases in the U.S. today. It’s making me think our multiplier should go from 1.3 to 1.4

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

Quote from ZenoOfElea

It has occurred to me that if I lived in a country where I thought the health service was likely to get swamped and disfunctional with the number of cases in a few weeks then maybe the logical thing to do is to make sure that I would catch the Corona virus now while there is access to the best care.

Not a great choice to have to consider and hopefully in the UK not a likely scenario.

I have thought this too. Are the people who got it early and needed hospitalization better off for having caught it early, if that’s the right way to put it. There is capacity now. That’s what you want.