Thread on testing & treatment research for COVID-19
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Another question.
NYC is finally on a downward slope for infections. This is largely attributed to social distancing.
So what happens when everyone goes back to work? Are we suddenly less susceptible? If so, why? Is it herd immunity, or warm summer months, or?? What's to stop this thing from another round of exponential infections? Thanks.
NYC is finally on a downward slope for infections. This is largely attributed to social distancing.
So what happens when everyone goes back to work? Are we suddenly less susceptible? If so, why? Is it herd immunity, or warm summer months, or?? What's to stop this thing from another round of exponential infections? Thanks.
Yes, my enthusiasm for Hydroxychloroquine is beginning to wane, as well. Perhaps we're being too impatient.
It is baffling to see studies touting the combo with results it works...no question...and then see studies with not results at all... odd to say the least...No in between... works or not
#1 - We need to have serological testing on a massive scale to see how widespread our exposure has been, and who has some level of immunity. Best news on several levels would be if it was far more widespread than we can currently confirm.
#2 - We need to continue testing recovered patients over time to determine antibody levels, ie how strong is immunity and how long does it last, on average
#3 - We need to start to aggressively test suspected active cases. We are still WAY behind in this area.
If we listen to the know-nothings, the science deniers, and the low-information people and open everything back up before #'s 1-3 are in place, it could result in a second surge just as bad as the one that is peaking now and over the next several weeks. Those types cannot understand what this would look like without the measures already in place, and what would happen if we lost focus too soon.
Question: You have the requisite symptoms, call your doctor (or do a virtual visit) and they tell you to hunker down, quarantine and isolate for 14 days. You obey and have three shitty, bed-ridden days and then slowly recover over the next 2 weeks. Are you counted as a COVID-19 case? If not, how many people meet this criteria and aren’t part of the statistics?
That's the problem with the testing. On a per-capita basis we're very low because capacity still isn't there. Very frustrating.
Latest study indicates that POSSIBLY as low as 1.5% of cases have been confirmed in the US. I'm having trouble swallowing that (it would mean north of 30 million cases so far and a much lower mortality rate), and will just have to wait for widespread serological testing to confirm or refute.
But no, you are not counted as a COVID-19 case and at a minimum there are several million individuals that are not part of the statistics. It's likely an 8-digit number and quite frankly the higher it is the better. We just don't know yet.
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I have yet to see one of the negative articles that includes the full combo, HCL, z-pack, zinc. The negative articles seem to be HCL only or HCL and zinc. The theory is HCL to facilitate better absorption of zinc which stops replication, z-pack to clear out any pneumonia that had formed.
I keep watching and talking to friends all over China. I’m waiting for the second wave to hit as they are all out now. China certainly lies about their numbers. No doubt. But why was it relatively mild there. Shanghai, where I spent a lot of time in January looks like Iowa in numbers. And it is 2x the size of nyc and 10x dirtier. They had social distancing but not to nyc extremes. Bartender I know there had hours cut so she became a barista in the morning. Movies and gyms shut down for awhile. Business decreased but only because no one traveled there
I really think this virus morphed a bit and became more deadly later. Like when the kids bring home a virus. They are out for 1-2 days. Wife then catches it because she is with them 24x7 and is out of it for 2-3 days. Then it hits you like a ton of bricks. You feel shitty for a week (last one to get it suffers the most). There seems to be two avenues. West coast direct from China and nyc direct from Europe. Obviously all just a guess but something is different the longer it goes. We’ll never know if waiting longer really flattens the curve or not. How can China with 5x the people and 10x filthier habits come out of this with minimal impact. Certainly sorry for loss of life, But they lose more people in 2 days from air pollution that this entire episode.
I think the number is very high, could be wrong. We need to get the damn serological testing ramped up ASAP so we know exactly what we are facing. Until then it is a crap shoot.
This is the crap going on in NEPA in two hospitals in Scranton, one where someone very near and dear to me works. Frigging leeches from Tennessee
https://www.washingtonpost.com/heal...isked-infecting-cancer-patients-babies-staff/
https://www.washingtonpost.com/heal...isked-infecting-cancer-patients-babies-staff/
I think you are correct on this point. that is one of the variables among the anecdotal studies. also, the dosage appears to be quite different between locations. The French are using 3-4x what dosage is happening in NYC. Other variables relate to the populations - are they at different disease state when starting, are there different underlying factors among them, etc.
similar things are happening with the other drugs from the bio-pharma companies like Gilead, Roche and others. some very promising results, but then some less so.
in the past when science has had results like this all over the map, it usually means there is efficacy but that it is precise and the approach matters. for example, we have no RCT test double blind that vents work, yet we are using them. Furthermore, there are a lot of factors around the vent and the operator that may influence outcome good/bad.
I'm an exec at one of the larger global medical information and education orgs and have access to a lot of clinical data, research, and medical thought leaders. My significant other is part of senior leadership at a large healthcare system and she has access to what is happening on the front lines and in epidemiology. Most of my information comes from those sources, as well as keeping up on a pretty wide variety of publicly available information.
So how can #1 be efficiently done? Quite an undertaking and obviously it's not reasonable to expect a large chunk of society to go to their doctor or whatever lab to take the test. Can it be reliably done to have it be totally self-service?
What is the top global medical information and education org in the USA? Who is top in Pennsylvania?
Good question. First, we need for it to be embraced across all levels of the public and private sectors. There is still way too much interference and resistance to widespread testing. Which is just so foolish. I could go on a rant but won't.
Private sector is all over this. There are dozens of manufacturers submitting tests for approval and validation and as they get approved we will have plenty of production capacity.
You're right; getting the testing completed and results returned will be a large undertaking. But worth it, I promise. I'm hearing that some will be simple self-assays although I'll believe that when I see it. We'd still need reliable reporting on those results to be able to consolidate enough data to make good policy decisions, and there's the rub.
So in short, I'm not sure yet. Let's get validations and approvals done, and let the private sector ramp up production and the reading and reporting capacity. Best we can do with what we know today.
Maybe tell people that if they test positive and with a high enough titer, they can start going to bars again. That'd take care of the demand side
Follow up question: How many people had the requisite symptoms and didn’t call their doctor because it was prior to the first known case in the USA in late January or, after it, but before we were scrutinizing like today?
What a fantastic question. I have that question too.
We. Have. No. Idea.
The answer matters. A lot. Hopefully the answer is very, very, very many.
Maybe tell people that if they test positive and with a high enough titer, they can start going to bars again. That'd take care of the demand side
Ooh, a titer bar!
I don't think there is opposition to testing just that we don't have enough tests for everyone. I would like to see most everyone tested as I think this was going around in January. If so a lot more people have been exposed to it already.Good question. First, we need for it to be embraced across all levels of the public and private sectors. There is still way too much interference and resistance to widespread testing. Which is just so foolish. I could go on a rant but won't.
Private sector is all over this. There are dozens of manufacturers submitting tests for approval and validation and as they get approved we will have plenty of production capacity.
You're right; getting the testing completed and results returned will be a large undertaking. But worth it, I promise. I'm hearing that some will be simple self-assays although I'll believe that when I see it. We'd still need reliable reporting on those results to be able to consolidate enough data to make good policy decisions, and there's the rub.
So in short, I'm not sure yet. Let's get validations and approvals done, and let the private sector ramp up production and the reading and reporting capacity. Best we can do with what we know today.
Maybe tell people that if they test positive and with a high enough titer, they can start going to bars again. That'd take care of the demand side
It's also puzzling that a couple of million with symptoms have tested negative at an 80% rate.
What is the top global medical information and education organization in the usa?
This is exactly what happened to me from 2/1 - 2/12. I was very sick for about 4 days with headaches, fever, uncontrollable cough and fatigue. Then I slowly felt better and went back to work. Is it possible that I had COVID-19, I guess I won’t know until I get tested.
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You find that is it not suspicious? China- when most of their industrial cities weren't affect by this virus. They blamed on the wet markets but yet opened them. They "arrested" the doctor who warned about the virus and then we found out he was dead soon. Their leaders seem to be intact when Trudeau and Johnson got it. Suddenly military ships personnel also got it. then the famous bat eating story, people in south east of asia eat bats too but have you heard any new virus outbreak from this region? You think this region doesn't have wet markets too?
I read that the wet markets have large political lobbying power in China - for some reason - and the government is reluctant to do much about them.
Preliminary German Study Shows a COVID-19 Infection Fatality Rate of About 0.4 Percent
Preliminary results are out from a COVID-19 case cluster study in one of the regions worst hit by Germany's coronavirus epidemic. They are somewhat reassuring.
One often-heard statistic is the "case fatality rate"—that is, the percentage of people diagnosed with a disease who will die of it. This afternoon that figure stands at 3.5 percent for COVID-19 in the U.S., but this rate is significantly inflated because it does not count asymptomatic cases or undiagnosed people who recover at home. What we really need to know is the infection fatality rate: the percentage of all the people infected who eventually die of the disease. That's what the German study attempts to do.
Over the last two weeks, German virologists tested nearly 80 percent of the population of Gangelt for antibodies that indicate whether they'd been infected by the coronavirus. Around 15 percent had been infected, allowing them to calculate a COVID-19 infection fatality rate of about 0.37 percent. The researchers also concluded that people who recover from the infection are immune to reinfection, at least for a while.
For comparison, the U.S. infection fatality rates for the 1957–58 flu epidemic was around 0.27 percent; for the 1918 Spanish flu epidemic, it was about 2.6 percent. For seasonal flu, the rate typically averages around 0.1 percent. Basically, the German researchers found that the coronavirus kills about four times as many infected people than seasonal flu viruses do.
The German researchers caution that it would be wrong to extrapolate these regional results to the whole country. But they also believe these findings show that lockdowns can begin to be lifted, as long as people maintain high levels of hygiene to keep COVID-19 under control.
https://reason.com/2020/04/09/preli...infection-fatality-rate-of-about-0-4-percent/
Preliminary results are out from a COVID-19 case cluster study in one of the regions worst hit by Germany's coronavirus epidemic. They are somewhat reassuring.
One often-heard statistic is the "case fatality rate"—that is, the percentage of people diagnosed with a disease who will die of it. This afternoon that figure stands at 3.5 percent for COVID-19 in the U.S., but this rate is significantly inflated because it does not count asymptomatic cases or undiagnosed people who recover at home. What we really need to know is the infection fatality rate: the percentage of all the people infected who eventually die of the disease. That's what the German study attempts to do.
Over the last two weeks, German virologists tested nearly 80 percent of the population of Gangelt for antibodies that indicate whether they'd been infected by the coronavirus. Around 15 percent had been infected, allowing them to calculate a COVID-19 infection fatality rate of about 0.37 percent. The researchers also concluded that people who recover from the infection are immune to reinfection, at least for a while.
For comparison, the U.S. infection fatality rates for the 1957–58 flu epidemic was around 0.27 percent; for the 1918 Spanish flu epidemic, it was about 2.6 percent. For seasonal flu, the rate typically averages around 0.1 percent. Basically, the German researchers found that the coronavirus kills about four times as many infected people than seasonal flu viruses do.
The German researchers caution that it would be wrong to extrapolate these regional results to the whole country. But they also believe these findings show that lockdowns can begin to be lifted, as long as people maintain high levels of hygiene to keep COVID-19 under control.
https://reason.com/2020/04/09/preli...infection-fatality-rate-of-about-0-4-percent/
Nice find. Thanks for sharing. This municipality was a hot spot. How long until someone claims that these findings are anecdotal?
No you're not counted without a positive test and in most places you won't get a test unless you're in the hospital with clear symptoms.
Also not counted, obviously, are all the people who are asymptomatic (which might be 75 percent of cases). So really "cases" is a meaningless statistic that roughly means "positive tests" -- which is going to be higher in countries that have an actual testing program and lower in countries like the US which do not.
When the epidemic is over (or maybe before it's over) there will be programs to randomly test people for antibodies. That will give them a better idea of how many people were infected.
In northern Italy they started doing this and were surprised to find out that something like 2/3 of people who thought they had not been infected in fact were infected but had no symptoms. You project it out, it would mean just northern Italy had 5 million more cases than had been officially reported..
Which is sort of good news -- it means the death rate for infected people is a lot lower than the ~40% death rate for hospitalized people.
Also not counted, obviously, are all the people who are asymptomatic (which might be 75 percent of cases). So really "cases" is a meaningless statistic that roughly means "positive tests" -- which is going to be higher in countries that have an actual testing program and lower in countries like the US which do not.
When the epidemic is over (or maybe before it's over) there will be programs to randomly test people for antibodies. That will give them a better idea of how many people were infected.
In northern Italy they started doing this and were surprised to find out that something like 2/3 of people who thought they had not been infected in fact were infected but had no symptoms. You project it out, it would mean just northern Italy had 5 million more cases than had been officially reported..
Which is sort of good news -- it means the death rate for infected people is a lot lower than the ~40% death rate for hospitalized people.
No proof of course but circumstantially.... More people leaving ICU in New York than coming in. Deaths will probably start to trend down soon.
Cases are still high so probably something is working better at the treatment level. Not just HCQ but it's part of it. Thousands, maybe tens of thousands of people are getting HCQ in New York and New Jersey now -- in trials and outside of trials. Nobody will say it publicly but it has become the de facto standard of treatment.
There other refinements in ICU protocols that could be making a difference as well. So it's not proof of anything. But the statistics in New York and the declining death rates in Italy and Spain are super encouraging. The social distancing works but it sure looks like something has happened with the treatments as well.
Cases are still high so probably something is working better at the treatment level. Not just HCQ but it's part of it. Thousands, maybe tens of thousands of people are getting HCQ in New York and New Jersey now -- in trials and outside of trials. Nobody will say it publicly but it has become the de facto standard of treatment.
There other refinements in ICU protocols that could be making a difference as well. So it's not proof of anything. But the statistics in New York and the declining death rates in Italy and Spain are super encouraging. The social distancing works but it sure looks like something has happened with the treatments as well.
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Some states count you as a positive if you show symptoms (but haven't taken a test) and have extended direct contact w/someone who has tested positive.
Not to be a negative Nancy,u bthe article doesn't address the infection rate. If covid is 10x (made up #) more infectious than the seasonal flu, it would be 40x more deadly.
So what happens when everyone goes back to work? Are we suddenly less susceptible? If so, why? Is it herd immunity, or warm summer months, or?? What's to stop this thing from another round of exponential infections? Thanks.
Well hopefully we have the people that have recovered and are immune so when they get exposed they won't get sick and spread it. The question is are there enough of those people in population to make a difference? Hard to tell without testing.
There is also the theory that people with vitamin D deficiency have a greater chance of getting sick. Your body can create all the vitamin D it needs via skin exposure to the sun. Of course in winter time people in the US get much less exposure to the sun and vitamin D deficiency increases. With summer coming people will get more sun, will that make difference? Who knows, but I suggest taking vitamin D supplements.
Also just slowing it down should give us some time to determine how to best treat those that get really sick. I'm sure the treatment for patients with covid-19 won't be the same 4 months from now as it is today.
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