COVID-19

[jacob]

I'm hitting the pause button on this thread for a few days to take a breather and calm everybody's nerves.

For the last 50+ pages positions have become entrenched and repetitive, and several who initially provided useful information have largely given up on the thread. Not that there are any gross violations, but there's an increasing amount of borderline toxicity going on and emotions are running higher and higher. I don't want this contagion to spread to the rest of the forum.

Forum rules reminder: viewtopic.php?f=21&t=6780 especially 5, 7.6, and 8.

[fiby41]

https://cni-iisc.github.io/epidemic-simulator/
City-Scale Epidemic Simulator

[George the original one]

Most people have antibodies after recovery.

But most antibody tests are fraught with false positives — picking up antibody signals where there are none. The new study relied on a test developed by Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai, that has a less than 1 percent chance of producing false-positive results.

https://www.msn.com/en-us/health/other/ ... r-BB13KZiX
https://www.medrxiv.org/content/10.1101 ... 20085613v1 (not yet peer reviewed)


Ventilators not a death sentence.

Physicians from the Palm Beach suburb of Wellington, in Salt Lake City, Boston and elsewhere were stumped and frustrated by a medical journal report last month that 88% of COVID-19 patients placed on ventilators died in a New York hospital system. Their own death rates were more like 20% and nearly always involved people older than 80, especially those with severe chronic health conditions.

https://www.msn.com/en-us/health/medica ... r-BB13HWB5

[CS]

I find myself jealous of countries that test everybody and are handling this so much better.

I think a US passport is going to go from 'opens many doors' to 'most door shut because it's a country of contagion.' Just getting to the airport is a risk here.

To contribute to this thread more meaningfully -

Leaked CDC guidelines for reopening that were blocked by the current admin
http://cdn.cnn.com/cnn/2020/images/04/3 ... elines.pdf

A summary:
https://assets.documentcloud.org/docume ... uments.pdf

I've heard that no state satisfies them, hence the blocking. I haven't taken the time to check myself.

We could have had masks in the US - lots of them:
https://www.washingtonpost.com/investig ... story.html

One hospital's protocol for managing covid patients
https://www.evms.edu/covid-19/medical_i ... #covidcare

From documents linked within the above, here are some specifics:

Prophylaxis
While there is very limited data (and none specific for COVID-19), the following “cocktail” may have a role in the prevention/mitigation of COVID-19 disease.
■ Vitamin C 500 mg BID and Quercetin 250-500 mg BID
Zinc 75-100 mg/day
■ Melatonin (slow release): Begin with 0.3mg and increase as tolerated to 2 mg at night
■ Vitamin D3 1000-4000 u/day

Mildly Symptomatic patients (at home):
■ Vitamin C 500mg BID and Quercetin 250-500 mg BID
■ Zinc 75-100 mg/day
Melatonin 6-12 mg at night (the optimal dose is unknown)
■ Vitamin D3 1000-4000 u/day
■ Optional: Hydroxychloroquine 400mg BID day 1 followed by 200mg BID for 4 days
■ Optional: ASA 81/325mg/day
■ Optional: In highly symptomatic patients, monitoring with home pulse oximetry is recommended

Mildly Symptomatic patients (on floor):
■ Vitamin C 500mg PO q 6 hourly and Quercetin 250-500 mg BID (if available)
■ Zinc 75-100 mg/day
■ Melatonin 6-12 mg at night (the optimal dose is unknown)
■ Vitamin D3 1000-4000 u/day
■ Enoxaparin 60 mg daily
■ Methylprednisolone 40 mg daily; increase to 40mg q 12 if poor response
■ Optional: Hydroxychloroquine 400mg BID day 1 followed by 200mg BID for 4 days
■ Optional: Remdesivir (if available)
■ N/C 2L /min if required (max 4 L/min; consider early t/f to ICU for escalation of care).
■ T/f EARLY to the ICU for increasing respiratory signs/symptoms and arterial desaturations.

Respiratory symptoms (SOB; hypoxia- requiring N/C ≥ 4 L min: admit to ICU):
Essential Treatment (dampening the STORM)
1. Methylprednisolone 80 mg loading dose then 40mg q 12 hourly for at least 7 days and until transferred out of ICU. Alterative approach: Hydrocortisone 50 mg q 6 hourly.
2. Ascorbic acid (Vitamin C) 3g IV q 6 hourly for at least 7 days and/or until transferred out of ICU. Note caution with POC glucose testing.
3. Full anticoagulation: Unless contraindicated we suggest FULL anticoagulation (on admission to the ICU) with enoxaparin, i.e 1 mg kg s/c q 12 hourly (dose adjust with Cr Cl < 30mls/min). Heparin is suggested with CrCl < 15 ml/min.
Note: Early termination of ascorbic acid and corticosteroids will likely result in a rebound effect.

Additional Treatment Components (the Full Monty)
4. Melatonin 6-12 mg at night (the optimal dose is unknown).
5. Magnesium: 2 g stat IV. Keep Mg between 2.0 and 2.4 mmol/l. Prevent hypomagnesemia (which increases the cytokine storm and prolongs Qtc).
6. Optional: Azithromycin 500 mg day 1 then 250 mg for 4 days
7. Optional: Atorvastatin 40-80 mg/day.
8. Broad-spectrum antibiotics if superadded bacterial pneumonia is suspected based on procalcitonin levels and resp. culture (no bronchoscopy).
9. Maintain EUVOLEMIA
10. Early norepinephrine for hypotension.
11. Escalation of respiratory support; See Graphic.
12. Treatment of Macrophage Activation Syndrome (MAS)
■ A sub-group of patients will develop MAS. A ferritin > 4400 ng/ml is considered diagnostic of MAS. Other diagnostic features include increasing AST/ALT and increasing CRP.
■ Methylprednisolone 120 mg q 8 hourly for at least 3 days, then wean according to Ferritin, CRP, AST/ALT (see Figure 6). Ferritin should decrease by at least 15% before weaning corticosteroids.
Find the latest version at evms.edu/covidcare
13. Monitoring: Daily: PCT, CRP, IL-6, BNP, Troponins, Ferritin, Neutrophil- Lymphocyte ratio, D-dimer and Mg. CRP, IL-6 and Ferritin track disease severity closely. Thromboelastogram (TEG) on admission and repeated as indicated.
14. Post ICU management
a. Enoxaparin 40-60 mg s/c daily
b. Methylprednisone 40 mg day, the wean slowly c. Vitamin C 500 mg PO BID
d. Melatonin 3-6 mg at night

I found the C, Quercetin, Zinc and Melatonin surprising.

Also, getting a pack of Famotidine from Target wouldn't be a bad idea. They are limiting to one box for online orders so are doing a decent job of managing their supply.

[George the original one]

Johns Hopkins director says too difficult to isolate the most vulnerable.

The director of the Johns Hopkins Center for Health Security said Sunday that too many people are in the groups most at-risk for the coronavirus to quarantine them from the rest of the country, as some have demanded.

The number of people over the age of 65 combined with those with underlying conditions represent about one-third of the U.S. population, Tom Inglesby said on "Fox News Sunday," and "there really isn't any clear way to separate that third of adults with the rest of the country."

"I think we need kind of a strategy that works for everybody," he added, noting: "I don't think it'll work logistically or practically" to continually quarantine those most at-risk.

He's also of the opinion that there's a lot of virus still ahead of us in the USA.

"I think we're still in the early stages of the pandemic," Inglesby added, noting "we still are now about five weeks into a national plateau."

While the average of new coronavirus cases in the U.S. is overall on the decline, he added that "the national averages don't necessarily tell the whole story," noting that the national trend is largely driven by declines in New York and New Jersey.

"It's a mix around the country but overall a national plateau," he said. "We're not diagnosing enough cases and we're not tracing their contacts."

https://www.msn.com/en-us/news/politics ... r-BB13RSBZ

[steveo73]

@CS- Personally I wouldn't have any confidence in any sort of vitamin supplements being able to protect us from COVID-19. It's a new virus and we won't have antibodies.

He's also of the opinion that there's a lot of virus still ahead of us in the USA.

This is the problem with the herd immunity argument. Just say there has been a 5% infection rate so far. The official figures now are more like .5%. There are potentially a lot more cases to come to get to even say a 60% infection rate. Imagine this virus times 10. That is being really optimistic on the figures as well.

We should know by now though that just blindly calculating numbers and stating this is how bad it is going to be doesn't work. So everyone needs to calm down and hopefully we make smart decisions going forward and we are well managed. Of course some countries/communities are going to be lucky or unlucky as well.

[CS]

@steveo73
The data on Vitamin D helping with respiratory illnesses is statistically significant. There is some talk that is why Northern Italy was so hard hit (less sunshine). Dr. John Campbell puts references on his videos if you want to learn more.

There must be reasons a hospital would included these vitamins along with blood thinners and steroids - but unlike Dr. John, they didn't include references.

[thrifty++]

NZ has 3 new cases today. But connected to people coming back in the border or existing clusters.

1497 cases in total so far but active cases are down to only 90. All other cases are recovered.

4% of the population has been tested so far.

Nz is shifting to level 2 alert from Thursday 14 May. This will be a gradual shift out of the level 3 alert semi-lockdown.

So we are coming out of lockdown now. It will be gradual. So Thursday 14 May public places like shops,cafes, gyms, malls and cinemas etc can open but with social distancing requirements. Then on Monday 18 May schools will completely reopen. Bars can open a bit later, on 21 May. Things will be done on a gradual reopening basis but there will be restrictions on group gatherings.

Gatherings must be less than 10 people max.

[steveo73]

@CS - I think I understand what statistically significant means. The result is statistically significant within the data-set that was analyzed. We have to understand the value of studies that were completed on the available data that we have in relation to Vitamin D (or any other vitamins) and COVID-19.

I think we need to have a degree of skepticism in relation to the studies that have been performed.

[classical_Liberal]

I'm going to post a few statistics from ND. I realize it's the sticks, but there may still be important information here. Mainly because we have a very high PCR test penetration rate, 5.9% of total population in completed tests (just under NY as percentage of population). However, our cases by percentage of population is almost at the current US average. Also, I know for certain our healthcare situation has not been in a state of overwhelm, it's functioning well. Lastly, our economy is 10 days into reopening, but still has some very strong self selected isolation going on. So far new cases have remained flat. I get that it's still early on.

Daily new cases since reopening on May 1st-9th: 46,38,34,41,56,49,53,40,27

Total mortality rate:
Age 70+ 19.48%
Age <70 0.37%
Age <60 0.33%
Age <50 0.21%
Age <40 0%

[tonyedgecombe]

Lastly, our economy is 10 days into reopening, but still has some very strong self selected isolation going on. So far new cases have remained flat. I get that it's still early on.

There is a Harvard report with some interesting insights on this.

Consistent with previous analyses (Bartik et al. 2020, Villas-Boas et al. 2020), hours of work begins to fall prior to the formal date of the state-level shut-down. We also see similar declines in other series such as consumer spending, small business spending, and time spent at work, all well before the shutdowns. Broadly, these patterns suggests that the decline in economic activity was not driven directly by the formal shut-downs themselves, but rather a general response to the onset of the national COVID-19 epidemic.

Which makes for an interesting problem for government. In the UK we have had some appalling communication from the state and media over the last few days. My guess is a lot of people are looking at it and wondering if they can trust what they are being told.

[steveo73]

steveo: no, that's not what statistical significance means. Actually it's almost the opposite in a way.

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

Maybe it's better to discuss this in a real life example. I think it's an important point. Do you believe that those COVID-19 studies in relation to vitamin D are statistically significant and we can therefore believe the conclusions from those studies.

Personally I don't consider that evidence at all. I'd expect a much higher bar in relation to taking action. That is just my opinion. You are entitled to a different opinion. I would really hope that any government who were reviewing actions to take in relation to COVID-19 also exercised some skepticism in relation to vitamin D being a panacea to the worlds problems.

I think that is exactly what people are talking about when it comes to science. It's not something that is set in stone. That is why we require risk management approaches to making decisions.

[7Wannabe5]

Most useful bit I’ve happened upon recently:

https://www.erinbromage.com/post/the-ri ... 1f08290ede

Restaurants: Some really great shoe-leather epidemiology demonstrated clearly the effect of a single asymptomatic carrier in a restaurant environment (see below). The infected person (A1) sat at a table and had dinner with 9 friends. Dinner took about 1 to 1.5 hours. During this meal, the asymptomatic carrier released low-levels of virus into the air from their breathing. Airflow (from the restaurant's various airflow vents) was from right to left. Approximately 50% of the people at the infected person's table became sick over the next 7 days. 75% of the people on the adjacent downwind table became infected. And even 2 of the 7 people on the upwind table were infected (believed to happen by turbulent airflow). No one at tables E or F became infected, they were out of the main airflow from the air conditioner on the right to the exhaust fan on the left of the room. (Ref)

[jennypenny]

Yuval Harari's take on where we go from here (23 min video)

--government surveillance goes from what we do in the world to what's under our skin
--false choice between health and privacy
--democracy is not dead
--might be good that US abdicated it's role as world leader
--still need global safety net

[IlliniDave]

...
From documents linked within the above, here are some specifics:
...
I found the C, Quercetin, Zinc and Melatonin surprising.

Also, getting a pack of Famotidine from Target wouldn't be a bad idea. They are limiting to one box for online orders so are doing a decent job of managing their supply.

That was interesting. I was inadvertently tipping the odds in my favor. Vitamin C is a staple in my regimen, and so is D3 and zinc (during the colder half of the year). Vitamin D also seems to help me sleep. I dunno if it interacts with melatonin or not.

I take OTC famotidine for the usual reasons, but watch my diet in an effort to minimize it (sugar and flour-based carbs go hand-in-hand with heartburn for me). I didn't see which stage of treatment it was linked with, but I always have a supply. I noticed last week it was nearly sold out and grabbed one while I was there (big $ for the name brand, ugh). Thanks for putting up the info--nice to have some ideas for prevention. May not save me in the end but I'd rather go down swinging than looking.

[Alphaville]

received an interesting marketing email, so i thought i’d post it as a non-spam thing, given the ongoing discussion here:

https://www.newscientist.com/science-ev ... t-science/

Join us for the latest New Scientist online event, an unmissable panel discussion on the limits of science during the pandemic.

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Can we still trust the science? Discover how and why the outbreak is testing the limits of the scientific process, what can be done to fix it and how to spot the warning signs of weak science for yourself.

Following the fascinating discussion, you’ll have the opportunity to ask the panellists questions.

Your ticket includes:

Live discussion lasting 40 minutes
Q&A with panellists
Watch-on demand access for 12 months
Exclusive access to an additional 40-minute lecture on genetics filmed at our Instant Expert masterclass in London
Bonus content from New Scientist

About the speakers:

Graham Lawton is a staff writer and columnist at New Scientist. He is interested in biomedicine, health, the environment, wildlife and food. He is author of This Book Could Save Your Life and The Origin of (Almost) Everything.

Naomi Oreskes is professor of the history of science at Harvard University. Her research focuses on environmental sciences with a particular interest in understanding scientific consensus and dissent. Her latest book Why Trust Science? is about why the social character of scientific knowledge makes it trustworthy.

Stuart Ritchie is a lecturer at the Social, Genetic and Developmental Psychiatry Centre, King’s College London. His research looks at how peoples’ intellectual abilities develop and change across their lives, how it relates to aspects of the brain, and how it is influenced by both genetics and the environment. His upcoming book Science Fictions is about exposing fraud, bias, negligence and hype in science.

The event will be hosted by Valerie Jamieson, New Scientist Events’ creative director.

[BMF1102]

Apparently Dr. Birx does not trust the CDC, believes they are inflating Covid19 numbers. Tried to pull up the original Washington post article but it was behind a paywall.

https://www.thesun.co.uk/news/11599541/ ... -inflated/

Interestingly

Mark Hayward, a sociology professor at the University of Texas at Austin who advises the CDC on its mortality statistics, told the Independent it’s possible 160,000 may have died – double the current official of 80,000.

"I think the undercount is enormous,” Hayward said, explaining the count is likely off as it does not include the number of fatalities from conditions such as heart failure, strokes or cancer from patients who failed to get medical help during the pandemic.

It appears this guy wants to blame Covid19 for deaths which in some cases were caused by policies, no? I understand some people may have made a decision to cancel or post pone appointments out of fear, certainly not all of these types of deaths were from this though.

[classical_Liberal]

@BMF1102
I don't think it's the policies, per se. Emergent nonCOVID procedures continue. Rather, it's that people who are symptomatic of other conditions, either chronic exacerbation or acute, are not coming to the ER or consulting a walk-in clinic as they normally would, out of fear of COVID. This means they may not get diagnosed in a timely manner and hence not receiving the interventions in time to achieve the best outcomes.

[jacob]

Yet another tracker

https://www.endcoronavirus.org/countries
https://www.endcoronavirus.org/states (US)

[steveo73]

I was inadvertently tipping the odds in my favor. Vitamin C is a staple in my regimen, and so is D3 and zinc (during the colder half of the year). Vitamin D also seems to help me sleep. I dunno if it interacts with melatonin or not.

I would be really really careful with this assumption. To me this is providing you with a false sense of security. It would take me a lot more studies and proof to believe that popping vitamins is going to help anything.

The efficacy of vitamins is far from clear cut. There have been numerous cases over the years of various supplements not working at all. Just as an example the statistical significance with Vitamin D consumption may just be that the people with lower vitamin D were black and had in general more health problems.

We need to realize the flaws within science. I'd love Bigato to respond to the point of statistical significance. I think this clearly illustrates the point that was made within this thread in relation to the science of exponential growth in the case of COVID-19.

I think that the problem is with people's understanding of the concept of something being statistically significant. I think Bigato believes the theory that if a study is statistically significant it means that the sample data-set can be used to provide correlations to the entire population. That might be the theoretical model but it doesn't work like that in reality. There are examples of this process failing all the time. Our knowledge changes over time.