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mtn (Forum Supporter)
mtn (Forum Supporter) MegaDork
4/27/20 8:37 a.m.

I am updating this post for further updates until we have filled page 2 with posts. For updates 1-37, see the first post of page 1 of this thread. 

Warning: Wall of text. I will be updating this first post of the page every time I get a new update until we fill the page with posts. Each update, I will put “X Y Z” without the spaces before the new post, and “Z Y X” at the end (and remove it from the prior post) so you can CTRL+F it and won’t have to scroll for 6 hours to get to the end.

These are updates that a retired MD (internist) who is a friend of the family has been posting. Note that I am just putting this here as I found them extremely educational and I suspect they are more accurate than anything we're hearing from any news outlet.There are also a few updates from his friend and colleague who is a retired pediatrician, Harvard MBA, and full professor of Pediatrics at the U.of Washington. He was involved in vaccine research for a good part of his career, and has actually met Dr. Fauci and said he is the smartest guy he ever met.

Please read through the first post on page 1 before coming here.

 

 

COVID-19  Update #38  A

April 27, 2020

 

The long awaited testing issue has arrived... Topics for today’s discussion:

  1. what their role is
  2. how useful and accurate they are
  3. when should you be tested.

Just back from my weekly visit to the store and post office.

  • Three people were in the post office, none wearing masks. 
  • In the grocery, two of three employees not masked, and the stock girl had neither mask or gloves. 
  • Seven out of ten patrons wore no mask. 
  • Just a reminder... we wear masks predominantly to protect others from us, and to protect our community as a whole.  The life you save might be your grandmother's.

A funny thing happened on the way to writing this.  I looked to see what else might be new out there.  I had already spent hours looking at this the day before.  There was a long article in the NY Times regarding validation of antibody testing.  There was indeed a link to the actual study which was published online on Friday.   I read the article first and then read the study.   Incredible work, very important, I will discuss this first. The title of the Times article was, "Coronavirus Antibody Test: Can You Trust It?"

The FDA has dismally failed in its promise to review the marketed testing materials and to remove those whose tests were inaccurate.   A group of more than 50 researchers in the SF bay area, and at Mass General in Boston, have collaborated to validate the marketed tests.  They have been working around the clock in 3-5 hour shifts.  They use known positives to validate.  What they do is much more complex than this.  They worked on 14 of the 90+ different assays out there.  It took them 30 days. 

  • In their opinion, only 3 of the 14 brands of tests they have so far reviewed, passed muster.  That is not good news.
  • Even the best of them have flaws.  Only one had no false positives, the other two were at 99%.  They also evaluated ELISA testing to a very limited degree, including their own in house assay.
  • The online paper, not yet peer reviewed, was only the SF data.  It was published under the name COVID-19 Testing Project.
  • Sure Biotech, Wondfo Biotech, and the in-house ELISA (enzyme linked immunosorbent assay) had the fewest false positives.  The Bioperfectus test was the only one that picked up 100% of the infected samples.  It took three weeks to get to that level.  None of those reviewed did better than 80% until that time.  There were multiple tests whose specificity was greater than 95%.
  • The group out of Mass General differed in their reading.  They counted all their grade-1 positives as negative.  This drew criticism from the researchers at Mt. Sinai.  They felt since these tests are not quantitative it is an error to exclude those that are weakly positive.
  • Dr. Marson made this comment, "If you train your readers well, they can start to be reliable."
  • Scanwell Health has ordered millions of tests from Innovita, a Chinese company.  This assay picked up only 83% of those infected.  It also had 4% false positives.  Scanwell says it ordered the next generation, which should be better.  As it is, this test is next to worthless.
  • They put up some very useful graphs.  They showed IgM, IgG, and both combined, % positive, versus time.  The good ones were only 90% positive at three weeks using both.
  • Looking at their graphs, it is clear that IgM is persisting far longer than we are used to seeing for infections.  There was little or no drop off at three weeks.  The earlier Chinese work had shown little or no drop off at 30 days.
  • Just a note... persistence of IgM has absolutely nothing to do with being contagious, there is no data that says this is true.  In this case (SARS-Cov-2) having persistent antibodies is nothing but good.  Long may they last.
  • I am going to go ahead and post this after midnight.  Read this first.  I will write what I had planned to write tomorrow morning.
  • Please remember, not all tests are created equal.  Some are very poor.  Accuracy has a great deal to do with the skill of those doing the reading.

 

WEAR YOUR MASK in public.  Don't make me hurt you.

 

 

 

 

Update #38 B

April 27,2020

 

The first test is the test for RNA by PCR (polymerase chain reaction).  

  • When this test is positive, you have the virus.
  • This is the test by swab of the nasopharynx, sputum, or material suction from a tube from the lungs.  This is the test one has when acutely ill. 
  • In the beginning, this took weeks to get back.  The CDC insisted all tests were sent to them in Atlanta.  Those days are over. 
    • Here in [local county], if you are acutely and severely ill in the ER, we can have a result in 15 minutes.
    • The test can be sent to Boise with a turn around of 24 hours if not emergent.
  • The single biggest problem with this test is that its chances of being positive peaks early and then rapidly fades.  On its peak day, it misses 1/3 of people who have the virus.  So, a sick person has the test, is told it's negative, and assumes they don't have the virus when they really do.  This is not good. This is where your doctors, or other clinicians, come in.  If they feel you do have the virus but you want to be sure, they can do one of three things. 
    • They can treat you like you have the virus even though you have a negative test. 
    • They can repeat the RNA test which would eliminate another 2/3 or less of the false negatives, depending on the lag time. 
    • They could order an antibody test.

Antibody tests…

  • If an antibody test for IgM by ELISA is done in conjunction with the RNA test at say, day 6, they will pick up 98.6% of those with the virus, according to one study.  It has been my feeling all along this is the way to go.
  • By day 5.5, the antibody test picks up more patients than the RNA test.  The RNA test declines each day thereafter, while the antibody test for IgM goes up in frequency of detection, and is soon joined by IgG which also begins to go up, albeit later in the disease.
  • This is the where you go back and reread part 1.  The problem with the antibody tests are false positives and false negatives .  At first it was thought that the test peaked at 2 weeks.  The new data is they don't peak until 3 weeks.  The combined IgG/IgM test only picks up about 80% of those who are truly infected at 2 weeks.
  • I would prefer to be told I didn't have antibody, even if I had been ill, than be told I did have antibody and have that not be true, especially if going forward, we tell those with antibody they can go back to work in relative safety.
  • So, you were sick three weeks ago, and you want to know if it was SARS-CoV-2.  You have the antibody test.  You have to ask the person doing your test what the rate for false positives and false negatives is.  If they don't know, or can't find out for you, you are in the wrong place.
  • For the individual, there is a fair amount of uncertainty here.  For those studying the disease and its behavior, if they know the rates of false positives and false negatives, they can factor those numbers into their equations. A lot of very useful data will be obtained, even if these tests are not perfect.
  • The point of care test you are likely to be offered is a lateral flow immunoassay.  The other way to do this is by ELISA.  This usually requires a blood draw, rather than pin prick.  It is felt to be more accurate, and to have fewer false positives.      I looked at the limited data, in the "COVID 19 Testing Project". It didn't look that much better to my eye.  Much more data on this approach will be forthcoming.  The ELISA method is also semi-quantitative, meaning, the stronger the fluorescence, the higher the antibody level.
  • Mt. Sinai has developed a quantitative test for the antibodies. This means they can give it a number, a precise measurement, instead of just positive/negative.  They are permitted to use it for research by our friends at the FDA. Hopefully it will be made available to us all when proven to be reliable. It will be a useful tool in many many ways.

I hope this post has helped you understand better where we are with testing. Over the many days I looked at websites and articles, I found one site named assaygenie.com.  It was well written and seemingly accurate, right up until the new info from "Covid-19 Testing Project".   Many of its references were in Chinese characters.  Hard to follow those threads.

When I looked at the CDC website, the last update on evaluation and testing was on 3/24/2020.  The last update on testing specimen collection was on 2/28/2020.  Hard for me to believe.  I can't imagine what they are doing.

Stay safe, isolate, wear a mask in public

 

 

 

 

April 28, 2020

Update from The Professor:

 

Epidemiology

When you feel ill you may elect to see your personal physician or use the Emergency Department. You are evaluated and treated by a Pediatrician, an Internist, a Family Physician, or an Emergency Specialist. This is a personal, intimate encounter. Specific evaluation and testing to confirm or exclude a diagnosis is employed. Therapy to address the problem is prescribed.

 

When a population becomes sick, we turn to the Epidemiologist to help control the illness and lead the society to health. To understand the daily barrage of commentary about Covid-19, we need to examine and understand the underpinnings of this somewhat arcane medical specialty.

 

Epidemiology is defined as the study and analysis of the distribution (who, when, where), patterns, and determinates of health and disease conditions in a population. The discipline began with Hippocrates who coined the terms endemic for diseases always present in the population. Polio, measles, mumps, rubella, and smallpox were endemic before the vaccine era. The common cold, diabetes, heart disease, and asthma are endemic today. Epidemic describe diseases seen at certain times but not others. Covid-19 is epidemic. When an epidemic becomes widespread the World Health Organization (WHO) will label it pandemic.

 

There are variety of training paths to become an epidemiologist. Physicians, pharmacists, and veterinarians may take advanced subspecialty training. There are dedicated masters and doctoral level programs also leading to certification. Epidemiology training is often part of public health social work and advanced nursing programs.

 

The discipline was initially descriptive. Careful analysis of disease patterns led to monumental progress in the study of disease. Successful generals in antiquity through the Napoleonic era noted greater success when they rigidly separated latrines from water sources. Italian and Chinese physicians developed the theory illness could be transmitted by invisible agents. Jon Snow identified the source of cholera in 19th century London by mapping the location of victims. He ended the epidemic by removing the handle from the pump from the contaminated water source. Semmelweis cut the death rate of women from “childbed fever” in half by suggesting physicians wash their hands after examining their patients. For his effort he was censured and expelled from his local medical society. It was twenty years before his ideas began to be incorporated in usual practice!

 

Statistical analysis began to be incorporated in the early 20th century. It remains the core tool of modern study. It has been augmented by recent dramatic advances in molecular biology and genetic analysis. It is also somewhat intimidating as it requires mathematics!

 

Some terms:

  • Incidence: number of new cases in a population over a period of time.
  • Prevalence: number of existing cases in a population at a given time Cost of Illness: initially define as monetary expenditure for medical costs, now frequently including more difficult estimates of loss of work, support care, educational costs, etc. Very germane today.
  • Burden of Disease: Total significance to a society

 

Elaborate statistical models have been developed over the years to help predict how an epidemic will move through a population. In our current pandemic the University of Washington model has achieved notice and notoriety. The model is limited by the accuracy of the data utilized. Early Covid-19 models depended on data provided by other countries. The opaqueness of Chinese society and reporting limited the usefulness of their data. The lack of available and reliable testing in the US plagued early projections. The reporting media and the public were confused by the frequent and dramatic changes of prediction and risk. As more accurate information becomes available the models become more accurate and useful.

 

Early modeling in the United States was limited by testing of active cases. Only the most ill patients got tested and many were missed. Prevalence data was being measured but incidence measures were only inferred. Information on the scope of the outbreak was severely limited.  Ongoing public policy for control of the pandemic is dependent on accurate measures of incidence. Wide availability of accurate and timely antibody testing is required to adequately describe how widespread the infection has been and project the future. This information is just becoming available.

 

Antibody testing comes in two varieties. Qualitative testing gives a simple yes or no answer. This simple point of care or home testing is similar to home pregnancy tests. Quantitative testing measures the actual level of antibody in the serum. It is the information demanded by research groups trying to determine level of antibody necessary to provide immunity. It will also be used to determine efficacy of vaccines studies. It is more involved and requires a high level of technical competence to perform accurately.

 

With accurate measures of prevalence and incidence available epidemiologists will be able ascertain the level of herd immunity necessary to prevent an infectious agent from propagating. Herd immunity reflects the percentage of immune individuals who cannot be infected and then further transmit the virus. A high level of immune population will cause an epidemic to die out. There are not enough susceptible targets for the virus to infect. The more infectious an agent the higher level of herd immunity necessary. For the very infectious measles it is around 90%. A current estimate of infected patients with Covid-19 in NYC is 25% emphasizing the need for continued strategies to end the pandemic.

 

Accurately Test, Accurately Test, Accurately Test.

 

 

 

 

COVID-19  Update #39  

April 28, 2020

 

A sure sign of the total breakdown of society as we know it has emerged.   My wonderful wife had me cut her hair yesterday... a surefire way to guarantee social distancing.

 

One of the many problems we are facing in the developing world, is that there is very little testing, social distancing is not possible, and many die at home. The numbers of deaths will never be close to being accurate.  The number of infected is probably 10X or higher.

 

Dr. T,  the director general of the WHO, "continues to be concerned about the increasing trends in Africa, Eastern Europe, Latin America and some Asian countries."  "This virus will not be defeated if we are not united..." While he is speaking of the world, the same is true for us in the United States.  We need a unified, well thought out approach, and since we do not have it, I think we will be playing wack-a-mole with this virus for the foreseeable future.

 

The estimates for how many tests we need seem to be all over the map. 

  • The Harvard Center for Ethics called for 5 million a day by early June, going up to 20 million a day by late July. 
  • Paul Romer, a Nobel laureate in economics, calls for 25 million a day going up to 50 million if we have a surge. 
  • I don't think we could manufacture that many testing swabs, much less test kits, or be able to administer them.
  • HHS (Health & Human Services) is planning on sending out 12.7 million swabs for the entire month of May.  I think there is a disconnect here.

 

On the bright side, the Oxford group's vaccine is surging ahead.  

  • It has worked in the animal model, six Rhesus monkeys. 
  • The hope is to have 6,000 volunteers vaccinated before the end of May. If safe and effective, it might be as soon as early September for large scale immunizations.
  • I hope they will partner with one of the large vaccine manufacturers to scale this.

 

Google and Apple are perfecting their contact tracking program. 

  • They promise anonymity. 
  • You will have to opt in.
  • I think we should all opt in, if offered.  It will be an important tool.

 

The death count per day has dropped to 337 in New York, and 106 in New Jersey.  These are less than half of what they were at peak.  Stay at home orders will expire on May 15th for New York. Here in [Local county], Idaho, the number of new cases over the past two weeks is averaging about one a day.  Great news.

 

All hospital systems are taking on huge losses to operating income.  This is largely due to loss of elective surgeries and procedures.  They are beginning to furlough workers and cut costs as much as possible to stay solvent.  Do what you can to support your local hospitals.  They are going to need our help.

 

Many states will be reopening in the coming weeks.  The plans are also all over the map.  Rather than going through them in detail, I think that certain states will be petri dishes for us to use as guidance.  Georgia and Texas will lead the way. The beach areas in both Ventura and Orange County in California will be as well, despite the pleas of the Governor of California. The numbers that emerge around the first of June should be telling.

 

I'm still hoping this virus will disappear as SARS-1 did.  I'm still hoping it will be seasonal like the flu.  I'm still hoping Oxfords vaccine will be highly effective, Remdesivir will pan out, and plasma will be highly effective.  It's good to hope, but our plans shouldn't count on any of these things, until they manifest.

 

Stay safe, isolate, wear a mask in public.

 

 

 

 

 

COVID-19 Update #40

April 29,2020

 

So, big news today. The drug Remdesivir has been shown to be effective in Covid-19. The NIAID, the part of NIH that Dr. Fauci runs, put out a preliminary report on its huge trial. This study, as you may recall from prior posts, enrolled 6,000 patients in a double blind (neither the patients nor the doctors know who is getting the drug) placebo controlled (some of the enrolled are getting no drug but don't know it) trial. This is the best kind of trial for a treatment.

 

I, and probably everyone else, did not expect a report this soon. These kinds of studies are usually monitored by a group that knows who is who. The purpose of such oversight is usually two fold. First, if the drug in question is hurting people, the study is terminated so further harm is avoided. Secondly, the results are monitored, so that if the drug is highly effective, the placebo arm may be terminated so those patients may also receive the drug. I expect this study reported as there is no effective treatment for the virus, until now.

 

  • Dr. Fauci stated in a press conference, that this was a very important proof of concept.
  • Based on this data, the FDA may issue an EUA (Emergency Use Authorization) for this drug so it may be administered by any physician.
  • The drug efficacy was reported on 397 patients, a small fraction of the 6,000 total. Patients receiving this drug recovered on average, 4 days faster. Five percent of those treated had to stop the med for side effects.
  • Gilead also released preliminary data on its own open label trial in severe patients. The good news, the 5 day treatment, which had a lower side effect profile, was as good as the ten day course. This means Gilead has enough already produced to treat twice as many patients.
  • At day 14 of this study, more than 1/2 of the patients had been discharged, 64.5% had achieved clinical recovery.
  • The data itself has not yet been made available, but I will look for it today and tomorrow. 

 

We have our first weapon, is plasma next?

 

While there is more to write about, I'll put that on hold while I look for the data. I might write again today if I am successful.

 

Stay safe, isolate, wear a mask in public.

 

COVID-19 Update #40 part two

April 29, 2020

 

If you have not yet read part one, scroll down until you find it, and read it first.

 

Gilead's website has not yet been updated. I will look again later. The NIH website has not yet published the report. I have queried as to when it will be available. They did make some additional comments:

  • The treated patients (Remdesivir) had a 31% faster recovery, 11 days vs. 14 in the placebo arm. (p. <0.001). A mortality benefit is also possible, 8% death rate in the treatment arm vs. 11.6% in the placebo arm. (p.=0.059)
  • In my opinion, the drug will be much more effective if given early on. We give anti-virals for influenza, they work best when given very early. The same is true for herpes zoster (shingles).
  • I am anxious to see that data if and when available. It is still good to know it helps in the severely ill.

I look for Professor Luber and Dr. Girman to weigh in.

 

The p values listed above are a way of evaluating data vs. random chance. The lower the number, the more conclusive the data. The first number shows the data on improvement to be highly significant. The mortality data less so. The good news, the longer you run a study, and the more patients you have to evaluate data on, the better the p value becomes. The p value on mortality will change on a daily basis, hopefully for the better. To put it another way, if you flip a coin twice and it comes up heads twice in a row, you might conclude that flipped coins come up heads every time. If you flip that same coin 100,000 times you would conclude the odds are even. That is what the p value gives you.

 

Hopefully the data soon, I am very excited.

 

 

Update from The Professor – more locally focused than his earlier stuff, not as medically, but I enjoyed it. The link was provided by mtn, and he is disappointed he has never heard of Donkey Basketball before.

4/29/2020

[Local Idaho County that once had highest per capita in country] has done a superb job in containing its Covid-19 outbreak. The numbers were frightening as reported in national news media. The medical community performed well with outside support as necessary. Control was implemented by the simple public health measures employed throughout the country. The measures are frustrating, invasive and difficult to maintain over extended periods of time. Stay safe and heed social distancing rituals not as a personal sacrifice or invasion of rights but the essential option to prevent disease and death within your family, your neighbors and friends.

 

County residents are now participating in critical population antibody testing. This commitment is not a surprise. At the very beginning of the AIDS crisis a local resident went to public school when children were ostracized elsewhere. A child from Challis went to NIH with funds from a donkey basketball game when a family home in Indiana was firebombed for the sin of having a hemophiliac child who was infected.

 

Both children were cared for and hospitalized locally as necessary without the slightest hesitation by the nurses, technicians, dietary, and all support staff in the hospital. They were enrolled in earliest antiviral (AZT, DDI) studies supervised by Dr. Anthony Fauci and Dr. Phil Pizzo of NIH. They were warmly supported by their local communities in a very dark and frightening time. Virtually all the children with AIDS in the Intermountain area were eventually cared for in [Local Idaho counties].

 

The local community continues its tradition of contributing to the greater good and embrace measures to protect all its residents. My wife and I hope to be home soon.

 

 

 

Covid-19 Update #44
April 30,2020

I am very anxious to see how the Remdesivir trials unfold over time.

  • The bigger question is how long will it take the FDA to issue its EUA so the drug may be widely used.
  • I expect we will have updates regularly on the NIH study. 
  • The data will evolve over time. 
    • I hope the improvement in mortality will hold up and become statistically more significant. 
    • What was reported was a nearly 25% decrease in mortality.

I read a press release from Gilead.

  • They will publish their data from the severely ill SIMPLE trial, in the coming weeks, in a peer reviewed journal. 
  • They have a second open label trial in patients with moderate disease whose results aren't expected until the end of May.
  • The press release did state that those who were treated less than ten days into their illness, had superior results to those who were treated later. 
  • It further stated that 62% of those treated earlier were ready to be discharged by day 14.
  • The data I would love to see, is patients treated on day one on presentation to the ER.  I think, and The Professor agrees, this is where we will see the greatest effect. Shutting down the virus before the cytokine storm even happens.

I listened to Dr. Fauci's comments from yesterday as well.  He seemed to indicate the placebo arm of the NIH trial would be terminated.  He also commented on other drugs being added on to Remdesivir to see if they would have additive effect. 

  • He was speaking of the group of monoclonals, which would serve to temper the cytokine storm. 
  • It seems very logical to try this. 
  • I hope one of the additions will be plasma with high antibodies.

 

This is all very exciting news.

 

The Oxford vaccine group has contracted with a private manufacturer in India. 

  • They should have capability to produce millions of doses, if it's proven safe and effective. 
  • He did state that he was ramping up production ahead of the trials being completed. 
  • He also stated that most of what he produced would be used in India first.  I hope the Oxford group is contracting with others as well.  I'd like to see all first responders vaccinated first.

The NEJM reported on 5 patients under the age of 50 with large vessel strokes.  The take home message is, if you have stroke symptoms, go to the ER immediately, don't hesitate due to the virus.  We can dissolve the clots if the patients come in right away.

 

Regarding the reopening:

  • Costco will be requiring their customers to wear a mask as of May 4.  They will have special hours for those over 60.
  • 5,200 construction projects are reopening in NYC.
  • In Texas, all retailers will be permitted to have retail to go by next Friday.
  • In Washington State, Boeing will be putting 27,000 people back to work as soon as next week.
  • IHME has changed its projected deaths from 67,000 to 74,000 based on reopening.

 

The prison numbers are a bit confusing.  I have, thus far, only seen hard numbers out of the Terminal Island prison.  They tested all their inmates.  443 out of 1055 were positive. That's greater than 40%.  Only two deaths so far.  Only 10% had symptoms.  What needs to be defined is what symptoms are they speaking of. This is roughly the number I would expect.

 

That's all for now. Be safe, isolate, wear a mask in public...

 

 

 

Covid-19  Update #45  

May 1, 2020

 

I've had a bit of concern regarding the Oxford Vaccine.  How do they plan to scale it?  Dave Prouty, a former HP senior program director, has posted links over the past few days.  The Oxford group has partnered up with AstraZeneca, they have a global development and distribution network.  This is very good news.

 

Their vaccine has the catchy name, ChAdOx1 nCoV-19. Hopefully  it will have something easier going forward.  They copied the vaccine they created for MERS, basically using an adenovirus (which can't make you sick) to carry a protein from SARS-CoV-2, which hopefully will confer immunity.  It may require two doses.  They already have safety data, from the prior vaccine.  This is why they have a target of September to begin large scale immunizations. The vaccine has the same side effects we all know from flu vaccines.  The usual, fever, headache, sore arm, and flu like symptoms, are possible.

 

Donald Trump has announced a warp speed program to develop a vaccine.  The problem is. it takes time to test a vaccine, once developed, for safety and efficacy.  The current U.S. speed record is 4 years.  Twelve to 18 months seems likely, no matter how badly you want it. Once a working vaccine is developed, you would have to gear up every vaccine maker in the world to produce the vaccine. We are going to need billions of doses.  We will also need billions of vials, billions of syringes.  It will be a formidable task.

 

Our idol, Captain Tom Moore, turned 100 on April 30th.

 

President Trump has elected to allow the federal distancing guidelines to expire, leaving it up to the states.  The U.S has thus far, tested only 1.75% of the population.

 

Regarding the reopening:

  • The governor of California is closing all state beaches and parks.
  • The Simon property group is opening 49 shopping centers between today and Monday
  • Macy's is planning on opening all 775 stores over the next 6 weeks.  Sixty eight on Monday, another 50 on May 11th.
  • The beaches in Galveston will open today.
  • Starbucks, McDonalds, Burger King, KFC, and Pizza Hut are opening their stores.  No one inside the restaurants, orders to go at the front door.

 

The numbers game:

  • South Korea reports no new domestic cases.
  • New York is admitting less than 1,000 new cases a day.
  • New Jersey had 460 deaths on Thursday, to lead the country.
  • Hong Kong has had no new cases in 5 days.
  • South America is beginning to ramp up.  It will be hard to get a real handle on what is happening. Poverty and lack of testing complicates everything. 
  • Brazil reports 80,000 cases and 5,300 deaths. 
    • Its president has called covid-19 a "measly cold."  This is not good.  Denial will get his people killed.

 

Stay safe, isolate, wear a mask when out in public

 

 

 

Covid-19 update #45 part two

May 1, 2020

 

On the bright side, the FDA has issued an EUA (emergency use authorization) for Remdesivir. Good work.

  • This means any physician can give the drug, if it's available. The clinical trials are ongoing.
  • Gilead is donating 1.5 million vials of the drug, its hope is that as many patients can be treated as is possible.
  • The down side is that the drug takes 6 months to manufacture. Gilead cranked up manufacturing quite some time ago.
  • I hope that Gilead, as it has with its Hepatitis C drug and its HIV drugs, will license other manufacturers to produce the drug as well. Its goal in the past was to provide treatment in the developing world at very low cost.

 

Please repost this so many can hear the good news.

 

Stay safe, isolate, wear your mask when out in public.

 

 

 

Covid-19  Update #46 

May 2, 2020.

 

First, just a bit of review.  I make these posts public so that anyone can see them.  If you find them useful, please feel free to repost them.  I do not accept friend requests from people I do not know.

 

I am a Board Certified specialist in Internal Medicine.  I was first licensed to practice in 1974.  I practiced in rural Northern California for 10 years, and then in [town] Idaho for another 30-plus years.  I was lucky enough to be trained prior to technology such as CT or MRI.  It made me a better diagnostician.  You had to use your brain and figure things out.

 

I have today, just a few more comments on Remdesivir, and then everything else is bad.  Feel free to skip it if you're not in the mood.

 

Please be very careful about listening to the talking heads out there. They all have an agenda.  It is not giving you information that is useful.  The only one speaking that I completely trust is Dr. Fauci.  Listen to him, if the government will let you.  I have yet to hear him say anything that wasn't measured and accurate.  Even the highly popular Sanjay Gupta, speaks without thinking, and clearly, on the road to becoming a celebrity, has forgotten how to read a scientific article critically.  Don't believe everything you hear or read. Don't believe everything you think.

 

The CDC, has published a 17 page document on reopening.   I will look for this today and read it through.  We should be looking at South Korea, and how they have been so successful.  We will suffer from the sin of pride.

 

Mitch McConnell is reconvening the Senate. They don't seem very happy about it.  There is only enough testing to test the Senators who feel unwell, apparently not enough to test them every day.

 

An article published in "The Journal of Infectious Disease" reported, in a small trial, that high antibody plasma failed to decrease mortality in those critically ill with the virus, with end stage disease.  It did help clear viremia (virus in the bloodstream) and decrease viral shedding.

 

In my opinion, we are treating the wrong end of the disease spectrum and reporting on that.  What I would like to see is, every patient at high risk be treated with high antibody plasma, or Remdesivir for 5 days, or both (my personal favorite) when they hit the door.  For example, all patients with immune deficiencies, all patients on chemo, all patients on high dose steroids, all diabetics, all patients on dialysis, should be treated early and results compared to historical controls. Antivirals and active antibody therapy should do the most good before people are desperately ill.

 

J&J, the recipient of big federal dollars, despite the fact that they are not a vaccine maker, predicts they will have a billion doses of vaccine by the end of 2021.  That is 20 months away, and they don't even have a facility to manufacture vaccine. I will never understand this one.  It smells bad.  We have several mammoth vaccine manufacturers in the U.S.  Why not give them the grant and give them a running start.

 

Case numbers and reopening:

  • Texas had 50 deaths Thursday, the most it's had.
  • On Friday, New York had only 289 deaths, its first time under 300 since the spike.  New Jersey had 311.
  • On Friday Georgia reported 1,000 new cases.
  • India increased it case numbers by 2,293 to 37,336 on Friday. They have extended their lock down another two weeks starting Sunday.  Their testing per capita is extremely low. Hard to know how accurate these numbers are.
  • Idaho is opening houses of worship, daycare, and youth camps.  Makes some sense.  If the plan is to reopen businesses, people are going to need childcare.  Governor Little is being careful and methodical.
  • One of the lessons we have learned from influenza is the older population gets most of its exposure from children bringing the bug back from school, or daycare, or camp.

 

The really bad news is from a report issued by CIDRAP.  This is the Center for Infectious Disease Research and Policy. You should look at its report yourself.  The credentials of those contributing are impressive.  These are people who have spent their entire academic lives studying public health, epidemics and pandemics.  They see this developing in one of three ways:

  1. Multiple small waves of infections starting this summer and going on for years.
  2. A massive, more deadly, second wave in Fall or Winter as we saw in the 1918 pandemic.
  3. A long term persistent smoldering, as we have now, that goes on for years.

 

In any case, the group thinks we will have to have 70% of the population immune before it will go away, or at least into the background.  They believe the pandemic will persist for 18 to 24 months.  They advise that we prepare for the worst, #2 while we have time.  Only the Feds can really do this for us.

 

I don't know about you, but I'm not sure I can live like this for another two years.  I'll still hope it just goes away like SARS-1.

 

On that cheery note, I'll leave you for the day.

Stay safe, isolate, wear a mask in public.

 

 

 

mtn note: This next post is highly political, but I don’t think any of it can be disputed. I fact checked 4 of the points, and they were entirely accurate. Mod team, I am not posting this in retaliation to my earlier post being deleted, and my earlier rant and this post are not related. I did not even see this until after my post in the other thread was removed and our correspondence had taken place. I decided to post this despite your warnings because numerous people have stated to me that this is the only place they’re believing information anymore, and I thought it to be important. I post this fully expecting to be asked to take a week off from the forum.  

 

Update from The Professor

May 2, 2020

 

Timeline I – Warnings

 

The Covid-19 pandemic starts its fifth month. Serious mortality has been for only two months. Though the time seems like an eternity, in historical epidemic terms, it is a truly short time. Anyone and everyone would like to think the substantial stabilization of the Covid-19 pandemic accomplished by social distancing and essential shut-down of much of American economic life means that we have seen the worst of it, weathered it, and can look forward to a return to normal. That is probably not the case. Please read the post by Dr. Mclean discussing scenarios of pandemic life in the foreseeable future. He summarizes and quotes from several resources. Most academic epidemiologists predict significant problems of different natures over the next years. Reviewing past handling of the pandemic for both positive and negatives is essential for planning for future programs. Avoiding past mistakes is essential. The lessons learned must be applied to ANY possible pandemic.

 

Winston Churchill said it best after the British Victory of El-Alamein: “Now this is not the end. It is not even the beginning of the end. But it is perhaps, the end of the beginning.”

 

  • Dec. 31: CDC receives information of a cluster of unknown viral cases in Wuhan
  • Jan. 1: CDC begins developing reports for Department of Health and Human Services (HHS)
  • Jan. 3: CDC Director Robert Redfield officially notified by his Chinese counterpart of a respiratory illness outbreak in Wuhan. He notified HHS Secretary Alex Azar who notified National Security Council (NSC). Warnings are placed in President’s Brief by intelligence community.
  • Jan. 5: World Health Organization (WHO) reported pneumonia unknow cause in Wuhan.
  • Jan. 6: CDC offers to send a team to China January 6 to help but was refused for several weeks with delayed access to the virus.
  • Jan. 6: HHS convenes task force with Dr. Redfield, Secretary Azar, and Dr. Fauci.
  • Jan. 9: CDC issues first public alert
  • Jan. 9: Chinese release full genome of identified Corona Virus to world community.
  • Jan. 14: WHO stated Chinese found no clear evidence of human-transmission.
  • Mid-January: Asst. HHS Secretary instruct subordinates to make contingency plans for implementing Defense Production Act for procurement of critical materials
  • Jan. 17: CDC begins monitoring incoming air passengers at JFK, SFO, LAX. ORD and ATL added later.
  • Jan. 18: Secretary Azar has been trying to see the President is granted access. The president calls him an alarmist and changes meeting focus to control of “vaping”
  • Jan. 20: Chinese President Xi Jinping says the virus “must be taken seriously” and confirms person-to-person transmission Jan. 21: First US identified case in Seattle
  • Jan. 22: The president makes first comments. “And we have it totally under control. … It’s going to be just fine.”
  • Jan. 23: Chinese shut down Wuhan.
  • Jan. 24: Article in Lancet (British Medical Journal) states virus can be carried by people without symptoms.
  • Jan. 26: Chinese report the virus transmissible during incubation. First case identified in US. Most early cases traced to travel from China
  • Jan. 27: Concerned White House Aides meet with Mick Mulvaney to get senior officials to pay more attention
  • Jan 28: Carter Mecher MD at Veterans Affairs summarizes available data and states Covid-19 is as serious a problem as a flu pandemic and states with observed transmissibility death toll could approach one million
  • Jan. 29: White House announce coronavirus task force under Secretary Azar.
  • Jan. 30: China expands Wuhan lockdown to entire Hubei province.
  • Jan. 30: Azar warns President of possible pandemic and states China is not being transparent. Dismissed as alarmist.
  • Jan. 30: The President states: “We think it’s going to have a very good ending for it. So that I can assure you.
  • Jan. 31: President announces travel restrictions from China to start
  • Early February: Some White House officials Call for more forceful response. Grogan raises concerns about number of available tests. There is a push for expanding travel band including Italy, supported by Dr. Fauci. This plan is resisted by Treasury Secretary Steven Mnuchin citing economic concerns.
  • Feb. 3: All tests had to be processed through CDC Atlanta creating unsustainable bottleneck. Director Redfield moves emphasis to local processing. Audit teams found local processing errors and restated tests to be sent to Atlanta. Researchers at Stanford and other labs develop tests following WHO protocols but tight rules at the FDA discourage their use. Rules were not relaxed until early March.
  • Feb. 6: First death in America in Santa Clara, Cal. but only recognized two months later through autopsy.
  • Feb. 7: Secretary of State Pompeo states US has donated 18 tons of medical supplies to China
  • Feb. 10: The President states “I think the virus is going to be — it’s going to be fine.”
  • Feb. 14: NSC with health officials circulate a memo about potential need for isolation measure and quarantine. Scheduled meeting with President cancelled by White House.
  • Feb. 15: Evacuated 338 US citizens from cruise ship Diamond Princess in Japan. 14 are positive for infection and quarantined on Air Force bases.
  • Feb. 21: White House task force “games” the epidemic and concludes massive social distancing will be needed. HHS medical officer concludes we have lost the fight to contain the virus.
  • Feb. 23: Northern Italy begins a major outbreak
  • Feb. 24: Iran becomes a hotspot.
  • Feb. 24: The President states: “I think the virus is going to be — it’s going to be fine.” “CDC and WHO have been working hard and very smart”
  • Feb. 25: Army National Center for Medical Intelligence raises pandemic warning from WATCHCON 2 – probable to WATCHCON 1 -imminent. Azar testifies “the Strategic National Stockpile has 30 million surgical masks and 212 million N95 respirators in reserve” An additional 300 million of each will be required.
  • Feb. 26: Director of National Center for Immunization and Respiratory Disease warns about the inevitable spread of virus and “we need to be preparing for a significant disruption in our lives”. Vice-President Pence replaces Secretary Azar as Task Force leader.
  • Feb. 27: The President states: “When you have 15 people — and the 15 within a couple of days is going to be down to close to zero — that’s a pretty good job we’ve done.”
  • Feb 27: Senate Intelligence Committee Chairman Burr (R-NC) states privately the Corona Virus is “much more aggressive in its transmission than anything that we have seen in recent history” and “is probably more akin to the 1918 [influenza] pandemic,”
  • Feb. 27: Secretary Azar tells House Ways and Means Committee “The immediate risk to the public remains low.” He adds: “It will look and feel to the American people more like a severe flu season in terms of the interventions and approaches you will see.”
  • Feb. 28: The President states: “It’s going to disappear. One day, it’s like a miracle, it will disappear.”
  • Feb. 29: US records first recognized Covid-19 death. Travel restrictions for Iran, Italy and South Korea are now in place. Early US case origins identified with travel but person-to-person community spread in US now documented.

 

My initial impression upon reviewing this sequence is how rapidly a report of a new respiratory virus in China leads to a death in the United States. Two months! It is also clear that many administration aides, staffers, and officials were alarmed by the potential for a major aggressive health crisis and tried to raise active concern in appropriate agencies.

 

Next timeline will be “Crisis” where the Unite States goes from 1 death to 65,000 in two months.

 

 

 

 

Covid-19   Update #47 

May 3, 2020

 

On the menu for today:  statistics, then a discussion of plasma therapy.

 

Statistics:

  • Data from Taiwan suggests we are most contagious 5 days after onset of symptoms.  There is a suggestion, based on modeling, that we are most contagious 2 days prior to symptoms.  Let's hope that is wrong.
  • The WHO states the US had its deadliest day on Friday with 2,909 deaths.  The CDC gives a lower number.  This, as 30 states begin reopening.  By comparison, 2973 people died in the 9-11 terrorist attacks.
  • Texas has had three days in a row of more than 1,000 new cases.
  • Brazil is adding 5,000 new cases a day.
  • Russia added 10,633 new cases on Saturday.  It has had 4 consecutive days of new highs.

 

Plasma Therapy:

In the April 30th issue of JAMA, published online, there was a very well done review article about convalescent plasma therapy.   It discussed many trials treating patients late in the course of their disease.  It doesn't work well, if at all when given late.  I was feeling discouraged about how we are, once again, treating the wrong end of the disease. I then came to a part of the article headed Timing and Dosing.

  • In this section, there were many quotes and statements from Beth Shaz, M.D.   Doctor Shaz is the Chief Medical Officer for New York's Blood Center.  As you may recall, this is the largest blood center in the U.S.  The blood center is banking plasma from recovered patients.  It has already sent out thousands of units.
  • Dr. Shaz says that plasma seems to be more effective when given early.  "It appears to slow progression of disease and keep people out of the ICU.  Some are getting extubated shortly after transfusion."
    • This makes perfectly good sense to me, but we need data.
  • Stanford is soon to begin testing of plasma in the emergency room.  They hope to enroll 206 patients who are having respiratory symptoms, but are not yet sick enough to be admitted.  The trial will be double-blinded and placebo controlled. 
    • It seems like a small number, but we will see what the results look like.  Perhaps they will expand it, if the results are encouraging. 
    • There should be an oversight committee that will terminate the placebo arm, if the results are highly significant.  We'll hope for that.  Sure would be nice to keep people out of the hospital.
  • Johns Hopkins is taking early therapy one step further.  They plan to treat patients who are at high risk, who have been exposed, but are not yet sick.
  • Dr. Shaz suggests that two units be given 24 hours apart to circumvent the antibody level problem.  It is further suggested that a bit of plasma be held back for later antibody levels to answer the question if higher antibodies give better results.
  • Patrick Wilson, PhD. out of the University of Chicago, is trying something new.  He is isolating B cells from the white blood cells of those donating convalescent plasma.  Every B cell produces unique antibodies.  He plans on cloning antibody genes to see which are most effective.  Sounds incredibly complicated, but wouldn't it be nice to isolate and mass produce a highly effective antibody?

 

It's Sunday, so enough for one day.

 

Stay safe, isolate, wear a mask in public.

 

 

 

Covid-19   Update #48  

May 4, 2020

 

I looked for the CDC's 17-page document, but had been unable to find it.  The reason given was that it had been sent on to the White House, where it was stalled.  The president apparently is unhappy with any plan that does not result in the old normal.  I too, hope the old normal is possible, but it won't be anytime in the near future. I was finally able to find a copy through a link provided by CNN.  I read through the entire document.  I was a bit surprised that it didn't discuss the criteria for initiating stages, but rather, informed the states of what should happen in each stage.

 

The CDC document provides interim guidance for 

  1. Child Care Programs 
  2. Schools and Day Camps 
  3. Communities of Faith 
  4. Employers with Vulnerable Workers
  5. Restaurants and Bars
  6. Mass Transit Administrators

 

Each of these sections is comprehensive with many links provided on a variety of topics. I then pulled the White House plan for reopening, and reviewed that document.  It has well thought out criteria for reopening and stage advancement. Taken together, they represent a comprehensive, well thought out, how-to manual for all of the states.  It is my belief that if we follow it, we can reopen the economy in relative safety. While it might make a wave at each level, it would be a low roller at worst.  We'd all still need masks in public and social distancing to make it work.

 

The thirty-plus states that are entering Phase 1 are all too early with one or two exceptions.  Looking at my own state, which is very close to meeting guidelines for phase 1, Governor Little has many items which are designated as phase 2 under the CDC guidance. My limited experience is that people are ignoring guidelines, both for masks and social distancing, at least in my neck of the woods. In my opinion, the path we are taking, as opposed to the path that is outlined, will result in a surge in cases that will be unacceptable, and will lockdown the economy all over again.

 

One could argue that everyone under 50, provided they were otherwise healthy, should just go for it and allow themselves to have the virus.  A very low percentage would become severely ill, small  numbers would die. The rest of us would hide under the bed until it was over, or until we had a vaccine.

 

The middle path we seem to have chosen, will not accomplish what we want.  It will be a learning experience.  We'll learn the lessons already taught to Sweden, the UK, and Singapore. Pretending it's not real is not a strategy.

 

I hope the White House releases the unredacted CDC document soon, and all those in power pay attention.  We know what happens when we don't pay attention.  (If you don't, read The Professors timeline on the pandemic posted below above.)

 

Stay safe, wear a mask in public, isolate, social distance, wash your hands. Be part of the solution

 

 

 

19   Update #48/Part 2  

May 4, 2020

 

Just a few interesting pieces of news, and then statistics from the weekend.

 

  • Roche, one of the major pharmas, has an EUA from the FDA for its antibody test.  They are planning on ramping up production to 100 million a month by the end of the year.  That should help a lot.
  • J. Crew has filled for bankruptcy, the first of many to come, I fear.
  • The best quote of the weekend, "If the pandemic were a baseball game, this would be the second inning."
  • The New York Times has rolled out new graphics.  They give an excellent visual on what is happening in the U.S. for both new cases and deaths.  We have flattened the curve, but unlike many countries in Europe and Asia, we have not declined much.  The number of new cases in the U.S. remains near its peak.  Given our approach, I don't expect that to last.
  • Washington D.C. looks like the latest metro hotspot.  Despite this, the Senate is reconvening, the House is staying away.
  • Looking at the curves for new cases state by state is interesting to say the least.  Seventeen states are on an upward trajectory. 
    • Texas and Illinois are among them. Georgia looks flat, but not for long.  Idaho looks flat and way below its peak.  Hawaii and Montana look the best.  Pretty amazing what has happened in Hawaii, Montana is a bit easier to understand.  I think social distancing in Montana is 6 miles not 6 feet.
  • New York and New Jersey are among the states with decreasing cases, but their total numbers are still horrible.
  • Germany had only 697 new cases, and 54 deaths over the past 24 hours.  These are 5 week lows.  They are very slowly reopening.  They require masks in public where distancing is not possible.  Their R naught is down to 0.74.  Again, this means every new case infects 3/4 of another person, or every 4 newly infected create only three new cases.  We will have to see if this holds as they open up.
  • Spain and Italy have their lowest death tolls since their lockdowns began.  They are also very slowly reopening.
  • Looks like Germany is the new country to try to emulate.  I hope someone is paying attention.

 

Stay safe, isolate, wear a mask in public.

 

 

 

mtn note: This is again, highly political. That being said, I think the only possible error in it is the March 26th factoid – I think it is pretty well suspected among many that China has not been reporting all of its cases and deaths; therefore I believe we should take that point with a grain of salt, not that it really changes anything.

 

Update from The Professor

May 4, 2020

 

Timeline II – Crisis

Reviewing the first two months of the Covid-19 epidemic we glimpse at the number of agencies involved responding to Covid-19 and the difficulties in mounting a coordinated plan of defense. It becomes clear that plans need to be in place before a pandemic threat occurs. There is no time to conceptualize and develop a response after the epidemic begins. A single designated director of response to potential threats with high-level authority and an established chain of command needs to be in place before the crisis. This person needs to be able to coordinate and direct all agencies involved. Logistical planning and coordination need to flow from the established response team. The cost of preparedness looks high to budget analysts but pales in comparison to potential human and economic cost of a pandemic.

 

There will be future challenges. There are thousands of identified infectious agents catalogued by the CDC.  Many may require only a geographic translocation or simple mutation to achieve epidemic proportion. HIV jumped from green monkeys to humans with jet airline travel facilitating its penetration to the United States and Europe. Most viruses are species specific. They have evolved to thrive in a single designated host. Viral mutation may facilitate human-to human transmission for a prior animal specific virus. There are a variety of avian influenza species that are highly virulent and lethal in humans which have appeared in various locations in the world. Fortunately, they only transmit with direct animal contact. These viruses do not support human-to-human transmission but a relatively simple mutation may provide that function.

 

The current challenge is how to reopen American economic life without exacerbating the viral epidemic. Epidemiologists have stated the best path to economic recovery is to control the pandemic. The average American citizen who is losing his or her job, associated medical insurance, experiencing small business failure and facing financial disaster may not be able to afford that recipe. State Governors are directing the phased reopening recognizing the risks and tradeoffs. We know there will hotspots, false starts and a probable increase in the Fall with potential school openings. I do not envy the Governors and their responsibilities. It is almost a guaranteed lose/lose situation. They are literally balancing lives lost to illness to lives lost to financial ruin! We need to learn from our past experiences to avoid missteps as the Governors walk this tightrope.

 

  • March 1: New York announces its first case – a traveler from Iran. Rhode Island identifies a case from Italy. Oregon’s first case is a contact from the New York case.
  • March 2: U.S. case count now 100. The President presses for a vaccine timeline.
  • March 3: Ohio Governor cancels the Arnold Golf Classic. Washington Post describes this action as radical! Covid cluster identified at Dartmouth School of Business from a traveler to Italy. Health and Human Services (HHS) announces intent to purchase 500 million N95 respirators over 18 months.
  • March 6: States now identifying infection Colorado, Maryland, Tennessee, Hawaii, Utah, Nebraska, Kentucky, Indiana, Minnesota, Connecticut, South Carolina, Pennsylvania, Oklahoma, Nevada. Washington has 31 new cases primarily from a nursing home in Kirkland. Travel from identified international hotspots appears to be the primary source with Cruise Ships identified as major vectors. The President states: “anybody that wants a test can get a test”
  • March 8: Virginia, Kansas, Missouri, Washington DC, Iowa, and Vermont now identify cases. Total U.S. deaths 22.
  • March 9: Ohio Governor Mike Devine (R) declares a state of emergency. Ohio State University cancels face to face instruction. Public press reports the White House postponed Director of National Intelligence (DNI) annual U.S. World Wide Threat Assessment which warns the U.S. remains unprepared for a global pandemic. It was to be delivered to the House Intelligence Subcommittee Feb. 12.
  • March 10: Mitigation measures are expanded in New York, Massachusetts and Washington. First containment zone designated in New Rochelle, NY. Transition begins to online classes at colleges and universities. Harvard orders students to vacate campus. The President states: “Just stay calm. It will go away”.
  • March 11: WHO made the assessment that Covid-19 can be characterized as a pandemic. The President states: “The vast majority of Americans, the risk is very, very, low”.
  • March 12: Total U.S. cases are now 1500. Public School closures in 12 states. Major sports leagues suspend seasons. NCAA cancels “March Madness” and suspends all collegiate spring sports. There is widespread closure of public schools. HHS places first order for N95 respirators for $4.8 million. Former HHS Secretary states: “We basically wasted two months”.
  • March 13: House passes aid package supported by President. The President declares a national emergency. HHS states Covid-19 “pandemic will last 18 months or longer and could include multiple waves of illness” and that resultant “supply chain and transportation impacts” would “likely result in significant shortages”. This report was “not for public distribution.” Germany orders 10,000 ventilators, Italy 5000.
  • March 15: CDC issued guidance against gatherings of 50 for 8 weeks. Increasing closure of schools, public places are now widespread.
  • March 16: The President issues guidelines urging people to avoid social gatherings of 10 people and restrict discretionary travel. He acknowledges the country may be headed toward a recession. Stock market continues its precipitous drop.
  • March 17: All states now have Covid-19 cases. Multiple states begin limiting dine-in food service. Northern California counties have “mandatory shelter in place.” U.S. Customs vessel manifest tracking shows a steady flow of medical equipment out of the country. Federal Emergency Management Agency (FEMA) “has not actively encouraged or discourage companies from exporting overseas.”
  • March 18: The President signs executive order allowing use of Defense Production Act but states he will not use the act. Florida beaches are flooded with spring-break celebrations. First members of Congress screen positive. Severe limitations of testing widely reported.
  • March 19: CDC issues guidelines for homemade Personal Protective Equipment (PPE) with reports of widespread shortages. The President states responsibility of supplying PPE to medical professionals lies with state governors, not federal responsibility. “You know we are not a shipping clerk.”
  • March 20: U.S. with 19,285 confirmed cases with 249 deaths. Continued direction for widespread closure of public facilities. Several states activate the National Guard. Massachusetts reports “dire” shortage of PPE.
  • March 21: The President tweets about potential therapies specifying Hydroxychloroquine and Azithromycin. (Plaquenil and Z-Pack)
  • March 23: Principal Inspector General Department of Health and Human Services (HHS) surveys 323 hospitals and reports widespread shortages of PPE, difficulty maintain adequate staffing, and shortages of critical supplies. Mt Sinai Hospital nurses wear garbage bags as PPE. White House labels report ”another fake dossier” and questions political motive of Inspector.
  • March 24: WHO director states “Using untested medicines without good evidence could raise false hope and do more harm than good”.
  • March 25: Senate Republicans and Democrats concur on stimulus legislation.
  • March 26: U.S. cases now 85,000 making it the country with most cases surpassing China. USNS hospital ship Comfort ordered to New York City.
  • March 27: The President signs Coronavirus Aid, Relief and Economic Security Act. University of Chicago economist panel states “Abandoning severe lockdowns at a time when the likelihood of resurgence in infections remains high will lead to greater total economic damage than sustain the lockdowns to eliminate resurgence risk.”
  • March 31: US with 164,620 confirmed cases and 3170 deaths. New York Times (NYT) reports massive shortages of testing, delayed results and critical limitation of swabs, reagents, staff and machines to run the tests.

 

I personally find by reviewing the day to day reporting of this epidemic now labeled pandemic, I get a better feel for the varied state-by-state numbers, problems, and social and governmental responses to the increasingly problematic Covid-19 pandemic. The lack of a unifying theme and strategy is striking. Now as states begin to relax social distancing and legitimately try to restart their economies, even in the face of often rising numbers; I am frightened for our future. I have tried to make the reporting as factual as possible recognizing the philosophies of “red” and “blue” government may diverge. However, it is striking how similar most of the governor’s responses have been putting public health and general welfare ahead of political consideration. It is easy to get blindsided by the minutiae while reading these posts. What one wants is a “feel” for the flow of history as it is literally being written. You may have noted I do not use the President’s name in these discussions in order to avoid triggering emotional responses either positive or negative.

 

For my quote today I look to President George W. Bush (R). ”Let us remember how small our differences are in the face of this shared threat. In the final analysis, we are not partisan combatants; we are human beings, equally vulnerable and equally wonderful in the sight of God. We rise or fall together and we are determined to rise. God bless you all.” Well said President Bush!

 

Next chapter will be either labeled Climax or Catastrophe depending on how I feel after I review the month of April!

 

 

 

 

Covid-19  Update #49
M
ay 5, 2020

 

  • The FDA has put companies manufacturing antibody tests for SARS-CoV-2 on notice.  They have 10 days to prove their products work, or pull them from the market place.  This should help, the only thing worse than no data is bad data.  I'll have to go looking for what their criteria are.
  • Germany has put a number out there.  They, based on testing, feel there are 10 cases for every PCR positive documented case.  I have been using that number for awhile.  While it may hold for the developed world, I feel the number will be far greater in the developing world.  We will need to support testing through the WHO.
  • U.S. hospitals are losing 1.4 billion dollars per day.  This is from Becker's Hospital Review.
  • Costco is now limiting meat sales... three fresh items per customer.  Kroeger is following suit in some of its stores.  I am a vegetarian and expect there will be a run on frozen soon, and on fake meat as well.  Time will tell.  I am not sure I understand why meat packing plants have been such hot spots.
  • The United States has had at least 22,000 new cases and 1,000 deaths a day since April 2nd.  The IHME modelers out of the U of W, are now predicting 135,000 U.S. deaths based on relaxation of social distancing and increased mobility.
  • World wide, deaths are more than 1/4 of a million.  The U.S. had 22,335 new cases reported yesterday.  The number of documented cases world wide is 3,600,000.  If we multiply by 10, that's 36 million cases.  That would imply a 0.75% death rate.  Seems about right.
  • The first human monoclonal antibody which neutralizes SARS-CoV-2 in vitro, named 47D11, has been produced.  Researchers feel it will be of help in antigen detection and in serological assays.
  • Gilead is going to charge $4,500.00 per course of therapy with Remdesivir.  By way of comparison, they charged $100,000.00 per course of therapy for their Hep C cure.  The donated doses will be distributed by the feds.  This seems like a really bad idea.
  • Hong Kong reports its last local transmission case of Covid-19 was on April 19th.  They had a second wave in February.  They contained and then eradicated it.  Their experts want to wait a full 28 days before declaring victory.  This represents two cycles of incubation, if we assume the long end of the range to be 14 days.  The public is not waiting.
    • We could duplicate their performance, but never will.  It would take an extremely tight, federally controlled policy, with strict adherence.  Unfortunately, "every day is a new reality in the White House" without much attention being paid to the past or the future.

 

Stay safe, isolate wear a mask in public.

ZYX

Javelin (Forum Supporter)
Javelin (Forum Supporter) MegaDork
4/27/20 8:41 a.m.

In reply to mtn (Forum Supporter) :

Page 2 posts until it fills up.

Pete Gossett (Forum Supporter)
Pete Gossett (Forum Supporter) MegaDork
4/27/20 9:34 a.m.

In reply to mtn (Forum Supporter) :

I like the idea of the first post on each page containing the updates. 

NOT A TA
NOT A TA SuperDork
4/27/20 10:42 a.m.
Pete Gossett (Forum Supporter) said:

In reply to mtn (Forum Supporter) :

I like the idea of the first post on each page containing the updates. 

^^^  And thanks mtn for taking the time to make it easily to read here.

mtn (Forum Supporter)
mtn (Forum Supporter) MegaDork
4/27/20 10:56 a.m.

Updated for 4/27, sounds like there may be another coming today. 

NOT A TA said:
Pete Gossett (Forum Supporter) said:

In reply to mtn (Forum Supporter) :

I like the idea of the first post on each page containing the updates. 

^^^  And thanks mtn for taking the time to make it easily to read here.

You're welcome!

glueguy (Forum Supporter)
glueguy (Forum Supporter) Dork
4/27/20 11:28 a.m.

Yes, thank you thank you thank you.  This is the only source I use to understand progress and combat efforts.

mtn (Forum Supporter)
mtn (Forum Supporter) MegaDork
4/27/20 3:04 p.m.

Updated again for today

mtn (Forum Supporter)
mtn (Forum Supporter) MegaDork
4/28/20 4:23 p.m.

Updated 4/28, along with a post from THe Professor on epidemiology. 

wheelsmithy (Joe-with-an-L)
wheelsmithy (Joe-with-an-L) UltraDork
4/28/20 6:07 p.m.

Another Thank You to all involved.

 

914Driver
914Driver MegaDork
4/29/20 8:02 a.m.

Anyone else experiencing the absence of RoboCalls since this started?

EvanB (Forum Supporter)
EvanB (Forum Supporter) MegaDork
4/29/20 8:53 a.m.
914Driver said:

Anyone else experiencing the absence of RoboCalls since this started?

Nope, I've had more than ever. 

wvumtnbkr
wvumtnbkr UberDork
4/29/20 12:14 p.m.

In reply to EvanB (Forum Supporter) :

Same.

mtn (Forum Supporter)
mtn (Forum Supporter) MegaDork
4/29/20 4:14 p.m.

Big update, in my opinion, today - 2 updates actually, along with one from the Professor.

slowride
slowride Dork
4/30/20 8:15 a.m.

Hey, thanks for posting these. So much better than the clickbaity articles I've been reading.

mtn (Forum Supporter)
mtn (Forum Supporter) MegaDork
4/30/20 3:41 p.m.

Updated 4/30

mtn (Forum Supporter)
mtn (Forum Supporter) MegaDork
5/1/20 4:39 p.m.

Updated 5/1

mtn (Forum Supporter)
mtn (Forum Supporter) MegaDork
5/2/20 11:50 a.m.

Updated 5/2, with a "part 2" update from yesterday and todays update. I'm hoping for a second one today, because it sounded like he was going to update on Remdesivir, but didn't really. 


If anyone wants to see these in the flesh on facebook, find me and friend me as I share them all. Send me a PM and I'll share my name. I just don't feel comfortable sharing his name and location on the internet, even if he's already shared it on facebook (I know, facebook is the internet, but you know what I mean).

 

EDIT: The CIDRAP Report he referenced: https://www.cidrap.umn.edu/sites/default/files/public/downloads/cidrap-covid19-viewpoint-part1_0.pdf

And the chart they provided showing what the differenent scenarios would look like:

 

 

In my undeducated opinion, if we find that early treatment with Remdesivir and plasma (or some other drug, maybe we find a better way to attack it) is successful, we could see any of these, but the death rate would, theoretically, drop - but keep in mind that we're not really seeing significant drop in mortatlity rate from Remdesivir yet (8% death rate in the treatment arm vs. 11.6% in the placebo arm. (p.=0.059))

mtn (Forum Supporter)
mtn (Forum Supporter) MegaDork
5/3/20 11:59 a.m.

Updated with a post from the Professor and from the Clinician for May 3. The Professors post is highly political. I ask that we do not discuss it to keep this thread open. If you want to discuss it, please take it to PM or facebook (PM me and we'll connect on facebook).

wheelsmithy (Joe-with-an-L)
wheelsmithy (Joe-with-an-L) UltraDork
5/3/20 1:01 p.m.

In reply to mtn (Forum Supporter) :

Be well, Brother.

mtn (Forum Supporter)
mtn (Forum Supporter) MegaDork
5/4/20 12:06 p.m.

Updated 5/4 with 3 updates from this morning

mtn (Forum Supporter)
mtn (Forum Supporter) MegaDork
5/5/20 12:29 p.m.

Update for Cinco de Mayo

tuna55 (Forum Supporter)
tuna55 (Forum Supporter) MegaDork
5/5/20 12:41 p.m.

Did I miss an explanation of the CDC halving the death count? I really want to know more about what that was all about. It was too sudden.

mtn (Forum Supporter)
mtn (Forum Supporter) MegaDork
5/5/20 12:51 p.m.
tuna55 (Forum Supporter) said:

Did I miss an explanation of the CDC halving the death count? I really want to know more about what that was all about. It was too sudden.

He hasn't touched on that, I don't know if he will or not. In any case, the CDC has not adjusted its numbers; rather, the department has two separate death toll counts going, which is causing confusion. Someone on twitter found the lower number and it blew up and went "viral". That lower number is delayed because it is based on fully processed death certificates, which can take weeks to complete. Check back in (to be safe) 4 weeks, and the number for the period that people are referencing will be pretty close to the number that Johns Hopkins is reporting (and the CDC is reporting on other parts of its webpage).

nderwater
nderwater UltimaDork
5/5/20 12:53 p.m.

I'd like to see the cases/deaths curves state by state -- does anyone know where to find those?

mtn (Forum Supporter)
mtn (Forum Supporter) MegaDork
5/5/20 1:39 p.m.
nderwater said:

I'd like to see the cases/deaths curves state by state -- does anyone know where to find those?

JHU Website or individual states health departments. 

 

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