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Post by ragan on Mar 21, 2020 20:19:42 GMT -6
I know it’s tempting to compare it to the flu, but there are some differences. There is some broad immunity to the flu in the population from yearly exposure. All of us have some flu antibodies, and it’s been going around for so many centuries there’s a decent chunk of people who just don’t get it. Add to that the annual vaccine and suddenly you think... wow... how bad would it be without those things? Well, this is like that. Maybe one case or a thousand is no big deal. But... man, when was the last time we saw the flu just drop kick the healthcare system of a G8 country like it was nothing? Italy, especially northern Italy, isn’t like a backwater. I keep seeing articles saying, half of the total cases were in the last week. Yeah. That’s how it works. Whatever the doubling time, half of the cases will be from that. When you double 2 or 10, ok. But when you double 2,000? 5,000? The 2009 swine flu was an novel influenza a strain, H1N1. 24% of the whole world got it. Super mild, only 0.02% fatality. This seems to be more infectious than that. This is a serious deal. I appreciate your measured, grounded takes dude. |
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Post by saltyjames on Mar 21, 2020 21:51:03 GMT -6
I guess it depends on what we call an expert. If we're talking about pundits on cable news who get trotted out to fill the minutes with blather, you bet, absolutely useless. If we're talking about people who've dedicated their lives to studying and understanding something, like say the PhDs and grad students at UW who are right now working to figure out what the hell makes this virus tick and how we can impede it, then no, not useless. They're our best line of defense against things like this. The most ridiculous part of it is that this cult of anti-expertise will immediately call their mechanic buddy if something's up with their car. Why? Because he knows what the hell is up with cars. Something screwy with the pipes? Call a f*#$&n plumber, talk radio ain't gonna help you. Got a welding question? Your buddy Wayne down the street has been welding since he was a fetus and knows every damn thing there is to know. He's your guy. But something science-y? Well now...can't be trusting these docs and researchers. They're all in the tank for...for...something, not exactly sure what, but I just know they're a bunch of MORONS shilling for Big...something or other...let me just show you this amazing YouTube channel. Blow your f%$#n mind, bro. I'm out of gas for humoring it. Unfortunately science has been raised to the status of a religion in this country and many parts of the world (but not so much as in the USA.)
My take is a bit different because I've grown up around scientists of various sorts - real ones - for the formative years of my life (Not only was I a university brat with many scientists being frequent house guests, my favorite uncle, Dr. Samuel Eppstein, was a researcher for Upjohn Pharmaceutical and his daughter Debbie ran her own biotech company in Salt Lake City.)
Which is why I view both extremes with a certain repugnance.
Do I trust the average doctor to know what's going on? No. Do I believe that there are a lot of very smart people working on this? Most definitely. Do I believe that those smart people are the ones we hear from most often? Not on your life. Do I believe that the ones we hear from have an axe to grind? You bet.
LIke I sasid, I don't believe the timing of this is a coincidence. I tend to not believe in coincidences.
I could give my own pet theory, buty I don't think this is the place.
Well put. Especially considering that Trump didn't seem to want to make a big deal of it until just recently when the whole world went nuts. |
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Post by johneppstein on Mar 21, 2020 22:20:30 GMT -6
OK, that's the simple estimation math ... let's make some assumptions. Infected people until the virus is under control ~80%, let's assume 0.5% fatality. This highly depends on the number of intensive care beds, too ... Germany 0.5% of 64,000,000=~320,000 US 0.5% of 264,000,000=~1,320,000 These are quite shocking numbers, they are a very rough estimate, but if the assumptions are half in the ball park, we have at least the magnitude of deadly infections in our countries. Depending on many factors, death rate numbers might easily differ, say 5x or more higher or lower. Still - quite shocking numbers no matter what. Low percentages matter in big countries. I guess in the meantime there is only the one problem to resolve: How to lock down countries to prevent total collapsing of the healthcare systems. I am pretty happy not to live in Italy in the moment, where triage might be already the only way to save at least some lives. My town has a very low infection rate for it's size right now, but cuts into civil rights are already severe and will most probably even more for some periods of time in the next months at least. Quite a lot of quarantine cases around the city though. Around 1% of people in my area already in quarantine, because all families that had children in a specific school have been taken in quarantine preventively ... And people are quite careful and solidaric in holding social distance in this city. Still not enough. No private happenings with more than 5 people (high penalties when disregarded), no official happenings at all, no school or kindergarten, no sports, no restaurants, no shops open except system relevant like postal service, supermarket with food, banking etc... city government shut down to home office and telephone line except rare core requirements, no public opening at all. No leaving of the federal state, no tourism traveling, no hotels etc.... Quite drastic cuts into the right, but it can and most probably will come even worse with curfews, that are already active in some cities in the south of the country... This all is far from "take it easy". But most probably there is no other way to minimize death rates. Your numbers depend on a static set of variatables. Those death rates depend on the average age of a countries population, the state of its health care system, and the speed at which the disease spreads, not to mention environmental factors like the weather. Also, several treatments are rapidly being found to be greatly effective. So the real rate can only be estimate when taking into account those dynamic factors. The situation is rapidly changing as more data comes in, as we get better treatments, and as more testing becomes available. We won’t really know until the dust settles.. "rapidly being found to be greatly effective"?
HMmmm...
Methinks thou beist somewhat optimistic.
I got in touch with my cousin Debbie today - the one who ran her own biotech company until her recent retirement. She is the one person I personally know who has the contacts in biotech to really know what's going on. She says that vaccines are currently being tested but even if the current rounds of tests prove successful we still face a wait of 12-18 months for approval, and not because of politics. She also said that various antivirals are being tested but there is no indication whether any of these will be effective or how effective they will be and that we have no indication of how it might be before this question is properly answered. So "rapidly being found? I dfon't think so. Being investigated is more like it.
She also said that right now the best course is minimizing contact.
I'll email her back tomorrow and ask some more detailed questions.
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Post by matt@IAA on Mar 21, 2020 22:49:15 GMT -6
Lots of smoke around chloroquine, and then hydroxychloroquine with azythromiacin. Even some rationale about why they may work with the pathways they’re disrupting. Also a lot of smoke about certain antivirals working well like remdesivir. Multiple trials are running now.
These aren’t vaccines but they are treating people.
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Post by christopher on Mar 21, 2020 23:10:30 GMT -6
It’s been super confusing why they are covering it up. I’ve been watching this close since I got sick around Jan 12. China and US totally tried to squash this thing. Obviously trillions of dollars were at stake both would rather just let tens of thousands die no big deal. But the numbers are ugly. We are looking at 60% infected before herd immunity, 1-5% mortality (mostly elderly).. 3 million-ish deaths in US? If it mutates, (which according to my wife who gets briefed at her hospital) it has and there are two strains already.. this will be another yearly flu that we re-catch, on top of the regular flus, bird flus, swine flus etc.. . The news feeds are implying that testing is occurring on a massive scale but it’s not really happening. A local nurse was treating a positive patient and in early March developed symptoms, they refused to test her due to her lack of travel to China. Infuriating, but they changed their tune fast. Yet are still pretty resistant to testing.
But now I realize the coverup is the very best chance to save our butts. All you have to do is look at the toilet paper aisle. Now imagine if everyone you know is testing positive like they would for cold or flu? They would rush the hospitals with any little cough, and want the most treatment possible. 3 days we’d run out. There would be huge lines, they’d all pass all their sicknesses to each other. My theory is I think the medical community in charge of the whole response knows/feels that typical flu treatments help end it and prevent it from becoming a worse case. But there’s not enough meds to go around, they plan for flu numbers for when vaccine isn’t effective.., not 5-10x flu numbers when there is no vaccine. So staying home will slow the spread. Not testing lets people assume they have flu and all mild cases will stay home and won’t demand all the meds, and survive off over the counter meds. If the meds that slow it run out, then there will be more worst cases taxing the system harder.
I’m very hopeful that my whole family already got in in Jan. My sister and I were the only ones who got serious lung infections, everyone else just had mild 24 hour cold and fever. But they never tested us, so we have to assume it was flu. I got Z-pack, it helped. My sister needed 18 days of antibiotics and prednisone. Her doctor told her we are all being lied to, it’s everywhere but they won’t test. But that’s fine, it doesn’t matter. Just stay home and 6 feet away from others really is best we can do.
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Post by Tbone81 on Mar 21, 2020 23:29:45 GMT -6
Your numbers depend on a static set of variatables. Those death rates depend on the average age of a countries population, the state of its health care system, and the speed at which the disease spreads, not to mention environmental factors like the weather. Also, several treatments are rapidly being found to be greatly effective. So the real rate can only be estimate when taking into account those dynamic factors. The situation is rapidly changing as more data comes in, as we get better treatments, and as more testing becomes available. We won’t really know until the dust settles.. "rapidly being found to be greatly effective"?
HMmmm...
Methinks thou beist somewhat optimistic.
I got in touch with my cousin Debbie today - the one who ran her own biotech company until her recent retirement. She is the one person I personally know who has the contacts in biotech to really know what's going on. She says that vaccines are currently being tested but even if the current rounds of tests prove successful we still face a wait of 12-18 months for approval, and not because of politics. She also said that various antivirals are being tested but there is no indication whether any of these will be effective or how effective they will be and that we have no indication of how it might be before this question is properly answered. So "rapidly being found? I dfon't think so. Being investigated is more like it.
She also said that right now the best course is minimizing contact.
I'll email her back tomorrow and ask some more detailed questions.
I am somewhat optimistic, cautiously so, but optimistic non the less. I wasn’t referring to vaccines, but rather several antiviral meds, dog ears beat me to it. At my hospital we’re certainly getting better at treating covid with aggressive forms of mechanical ventilation. I could write pages about ARDS, ardsnet protocols vs APRV ventilation and the like but really this isn’t the medium for that type of discussion. And unless you have a really good background in pulmonary pathology, and a good understanding of physics (pertaining to gas laws like Laplace’s law, Dalton, Venturi, Bernoulli etc) it’s going to be over most people’s heads. Suffice to say that a lot of smart people are tackling this with every resource available. The treatment is getting better, not worse. That’s for sure. Have we hit a home run? No. But we’re on base. |
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Post by rowmat on Mar 22, 2020 3:31:40 GMT -6
Two states here in Australia are about to go into lock-down.
The rest will follow quickly.
Make no mistake what is coming is a Tsunami that most are completely unprepared for.
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Post by matt@IAA on Mar 22, 2020 10:33:40 GMT -6
It’s been super confusing why they are covering it up. I’ve been watching this close since I got sick around Jan 12. China and US totally tried to squash this thing. Obviously trillions of dollars were at stake both would rather just let tens of thousands die no big deal. But the numbers are ugly. We are looking at 60% infected before herd immunity, 1-5% mortality (mostly elderly).. 3 million-ish deaths in US? If it mutates, (which according to my wife who gets briefed at her hospital) it has and there are two strains already.. this will be another yearly flu that we re-catch, on top of the regular flus, bird flus, swine flus etc.. . The news feeds are implying that testing is occurring on a massive scale but it’s not really happening. A local nurse was treating a positive patient and in early March developed symptoms, they refused to test her due to her lack of travel to China. Infuriating, but they changed their tune fast. Yet are still pretty resistant to testing. But now I realize the coverup is the very best chance to save our butts. All you have to do is look at the toilet paper aisle. Now imagine if everyone you know is testing positive like they would for cold or flu? They would rush the hospitals with any little cough, and want the most treatment possible. 3 days we’d run out. There would be huge lines, they’d all pass all their sicknesses to each other. My theory is I think the medical community in charge of the whole response knows/feels that typical flu treatments help end it and prevent it from becoming a worse case. But there’s not enough meds to go around, they plan for flu numbers for when vaccine isn’t effective.., not 5-10x flu numbers when there is no vaccine. So staying home will slow the spread. Not testing lets people assume they have flu and all mild cases will stay home and won’t demand all the meds, and survive off over the counter meds. If the meds that slow it run out, then there will be more worst cases taxing the system harder. I’m very hopeful that my whole family already got in in Jan. My sister and I were the only ones who got serious lung infections, everyone else just had mild 24 hour cold and fever. But they never tested us, so we have to assume it was flu. I got Z-pack, it helped. My sister needed 18 days of antibiotics and prednisone. Her doctor told her we are all being lied to, it’s everywhere but they won’t test. But that’s fine, it doesn’t matter. Just stay home and 6 feet away from others really is best we can do. Some the test is can’t - not enough. Maybe that’s test kits maybe it’s ppe maybe it’s people. The other is won’t. If you’re a mild case being tested puts a nurse we need at risk. It wastes ppe and their time. Docs I know have said they are knowingly contributing to the lack of reporting because they simply don’t care to report if it means putting staff at risk. If you’re a mild case, STAY HOME. don’t go to to the ER. A test gives you peace of mind but you run the risk of infecting others in the ER - staff and patients. Flu treatment is basically tamiflu, and it will not help for this. I know China tried to squash it. I don’t think the US did. most of us were all distracted watching an impeachment trial. That mutation paper was withdrawn upon peer review. It’s very unlikely you got it in January. We know this from genetic sequencing of the virus along points in time. If it had been spreading widely here for a long time we’d see a lot of novel mutations in the genome that belong only to the US virus’ family tree. We don’t see it, so it probably didn’t happen. You probably had the flu, especially if a Z-pack helped. Flu normally causes a bacterial pneumonia late stage, ncov causes direct viral pneumonia. Z-pack treats one but won’t help the other directly. There was a bad strain of influenza B going around along with a late wave of influenza A this year (I got flu A in February with basically my whole family). |
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Post by matt@IAA on Mar 22, 2020 10:57:23 GMT -6
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Post by christopher on Mar 22, 2020 11:22:08 GMT -6
Good post. It’s impossible to find reliable information. I was exposed to sick Chinese tourists first week of January, they were hacking next to me in line at the grocery store. There was nowhere for me to go, the whole family got in line behind me, about 1-2 feet away at most, all of them ejection style coughing with their tongues sticking out, the grandparents and wife didn’t cover their mouths, only the man sort of tried to use his elbow. I LOL’d to myself and thought.. f-me.. .. thanks dudes! Awesome! I saw quite a few Asian tourists that weekend, and every group I saw had multiple people hacking up a lung and Jesus nobody covers their mouth.. that’s partly why it’s easy to see they were obvious tourists. it’s a very weird sight to see violent full body coughs with tongues sticking out! Well whatever it was, that’s what I got. Someone I know who works in healthcare says there already are multiple strains of CV, that’s partly why the testing is not accurate and not being done widespread.. maybe this person is not supposed to tell me that, would explain why that’s not news. Much of this thing is not in the news. Ive been looking since January and I can’t find detailed reports of symptoms, the few I’ve found are mild cases or just say “fever and dry cough, shortness of breath”. What has been going around this state is “fever dry cough, shortness of breath” but then what is this super hacking thing that practically kills you? Flu normally hits everyone the pretty much same.. I was hacking like nuts , my wife and kids had a small fever and were fine next day.
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Post by matt@IAA on Mar 22, 2020 11:42:45 GMT -6
Could be that you were infected if you were around a bunch of people who were from China. I was just more talking about people saying "well, I had a bad cold last month..." or people who think it's been here for "months and months."
There are not multiple strains of CV right now. I haven't seen any reliable info that says that. There was a paper put out that talked about S and L strains but it was withdrawn. The test they're using now is about 70% accurate, it is what it is. They're working on better ones.
Reported symptoms include:
Fever/chills
Dry cough
Muscle aches
Fatigue
Pain / soreness around eyes
Shortness of breath
Loss of appetite
Diarrhea
Loss of taste/smell
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Post by EmRR on Mar 22, 2020 12:41:57 GMT -6
Reported symptoms include: Fever/chills Dry cough Muscle aches Fatigue Pain / soreness around eyes Shortness of breath Loss of appetite Diarrhea Loss of taste/smell Another example of the potential confusion, I just had the Shingrix vaccination 10 days ago, and for a couple of days I had a number of those symptoms as a result. Then here comes heavy pollen season in the south..... |
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Post by matt@IAA on Mar 22, 2020 13:39:17 GMT -6
I’ve had a cough for a week. No fever.
Maybe it’s oak pollen
Maybe it’s covid 19
Maybe I’m born with it
Maybe it’s maybelline
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Post by drbill on Mar 22, 2020 14:05:56 GMT -6
I’ve had a cough for a week. No fever. Maybe it’s oak pollen Maybe it’s covid 19 Maybe I’m born with it Maybe it’s maybelline yup. Allergy season is RIGHT around the corner. Never had allergies in my youth, but the last few years after having a bad case of chronic bronchitis one year / flu season, I do seem to suffer from the post nasal drip - and resultant cough - most years. This year (knock on wood) has been remarkably clear breathing for me. (PS - I'm surrounded by hundreds of Oak trees.  ) |
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Post by the other mark williams on Mar 22, 2020 14:35:41 GMT -6
A good friend of mine from high school (we sang together back then) is actually a virologist/vaccinologist/infectious disease doc who runs (well, ran) a vaccine research lab at Duke University. She posted this on Facebook a couple days ago, and I meant to share it here.
*******
I am adding some new thought bubbles here in this #COVID19 era as a virologist/vaccinologist/infectious disease doc/parent/and human living it:
1. As a virologist: this is fascinating that a 30 kilobase RNA virus is creating this much havoc on the globe. I always thought it would be a novel flu reassortment, like H1N9, that would be the next 1918 pandemic. Have to say I did not respect the coronavirus family like I should have - we were much more ready for a flu pandemic than this. I even felt sure when this came out that it would "disappear" like SARS1. I am a kid of the 80s, the HIV epidemic went over our heads - but seeing its impact on the African continent is what drew me into what I do today. While I know many HIV researchers, I know very few CoV researchers, we clearly did not appropriately fund pandemic preparedness despite being warned... #hindsight2020
2. As an immunologist: I know the only 2 pathways back to life as we knew it is herd immunity or a vaccine. Social distancing is helping not overwhelm the hospitals, but it is not helping us achieve herd immunity. China just had 0 cases for the 1st time today, so it will be critical to see what happens when they relax the social distancing, now ~5-6 mo into their epidemic. We are months behind and still on the way up... The brightest news of the week is the first SARS2 vaccine trial started on Monday. But vaccine trials are a long road of safety and efficacy check points where corners cannot be cut: vaccines are held to the highest safety scrutiny. With this 12-18 mo timeline, I know my son will only "virtually" graduate from 5th grade, I don't expect summer camps or summer travel will happen, I only hope we will start school in the fall with the recognition that we may have to go back to social distancing.
3. As a vaccinologist: it is with a heavy heart that I am closing down my lab operations that work towards diseases we have not solved: HIV, congenital CMV, Zika, in the name of social distancing. But my colleagues, trainees, and I are writing our hearts out on grants that will enable us to study why COVID19 is less pathogenic in children, which population will the best target of vaccination, and novel vaccine platforms. My current grants for other viruses have become funnels for new funding related to COVID19 - the only work will be be able to pursue in the short term. I am using all my connections in industry, NIH, academia to see where we can plug in to be most helpful. Let's hope the funding can move swiftly. Though if it is like the COVID19 testing roll out in this country, I am not so optimistic...
4. As an infectious disease dr: I am both proud of and scared for my profession. We are on the front lines of diagnosing and treating new infections - yet there is currently not enough personal protective equipment (PPE) to protect us and other providers. Hospitals are using not-recommended strategies for reusing masks, a problem that our federal government is not taking control of. Our infection control colleagues are being asked to "build the plane while flying it" to prepare our hospitals and keep the doctors and patients as safe as possible, in the midst of scarce resources. Children seem to be mostly spared from severe disease, but new data shows a large proportion of US hospitalizations are in young adults. The fastest strategy for having any therapies is repurposing currently approved medications - there is data that an anti-malarial drug works in a test tube against the virus, so infectious disease doctors are using it, without human data that it works - because we don't have anything else. Next week, I go on the front lines to see patients with infections in the hospital - and I worry about what that means for my family.
5. As a parent, I have always relied on "group parenting" via grandparents, cousins, teachers, Y counselors, babysitters, church members and our kids benefitted - and now we are nearly all of those things to our children, while working a full schedule virtually. Thank goodness there are 2 of us in our household. I can't imagine how this situation can last, yet I can't imagine how it will end. Kids will be forever changed by this - my solace is that this time will inspire future virologists and vaccinologists, which we will only need more of in their lifetimes. I'd like think I have 2 in my home - we learned what a placebo controlled trial was today.
6. As a human: the epidemic is hitting home: a friend whose mom is in ICU with the virus, a physician that I know of succumbing to the virus. We will all be touched by the casualties - it will be bigger than 9/11. And I worry for those who are without their social supports - there will be casualties from that as well. Look for the silver linings - like we have jumped into telehealth as a feasible option literally overnight after fighting it for years, our globe is catching a break from the lack of human movement and perhaps we can keep the commuting down in the future. But we will all need to look for who around us needs that virtual touchpoint, the new hug.
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Post by chessparov on Mar 22, 2020 23:23:51 GMT -6
Great thread. Still following. With all due respect, IMHO there won't be a million+ deaths... In the USA.
Playing it smart though, will save quite a few elderly and/or those who already have serious health issues.
Also many lives will be saved, from Conventional Viruses, with the upgraded level of precautions going on now.
Chris
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Post by matt@IAA on Mar 23, 2020 7:31:16 GMT -6
An epidemiologist / infectious disease doc who practices in Dallas I know through our alumni group has said taking the most optimistic slant on everything puts this in the ~500k range without action. Worst case is 2 million+ outcome without intervention - over the next 12-18 months.
He said if we can keep it under 100,000 in the US it will be a remarkable moment of human achievement.
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Post by matt@IAA on Mar 23, 2020 11:13:53 GMT -6
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Post by johneppstein on Mar 23, 2020 19:58:51 GMT -6
I’ve had a cough for a week. No fever. Maybe it’s oak pollen Maybe it’s covid 19 Maybe I’m born with it Maybe it’s maybelline Let's hope it's Maybelline. |
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Post by chessparov on Mar 24, 2020 0:16:49 GMT -6
"Why can't you be true"  Chris |
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Post by saltyjames on Mar 24, 2020 14:55:33 GMT -6
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Post by rowmat on Mar 24, 2020 15:09:13 GMT -6
For those who still believe this is a hoax or overblown I suggest you watch the reports coming out of the hospitals.
The UK will likely have exceeded ICU capacity in many hospitals in around a week and in two weeks it will be hell on earth in almost every hospital on the planet.
“The greatest shortcoming of the human race is our inability to understand the exponential function.” - Dr Albert Bartlett
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Post by Tbone81 on Mar 24, 2020 15:17:12 GMT -6
For those who still believe this is a hoax or overblown I suggest you watch the reports coming out of the hospitals. The UK will likely have exceeded ICU capacity in many hospitals in around a week and in two weeks it will be hell on earth in almost every hospital on the planet. “The greatest shortcoming of the human race is our inability to understand the exponential function.” - Dr Albert Bartlett Is it really necessary to keep harping on this, over and over, ad nauseam? Everyone gets it. The people that don't, don't. All it does is ad to the anxiety and stress. |
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Post by chessparov on Mar 24, 2020 15:50:58 GMT -6
AFAIK no deaths (yet), in Orange County, CA. It's been mentioned the LA School system, may return as early as May 1st. But I kinda doubt it. Chris |
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Post by Deleted on Mar 24, 2020 18:39:42 GMT -6
Dr. Wodarg was a serious doctor and politician back in time.
His former colleages at the SPD party are horrified by what he does now.
Nowadays he let's himself beeing interviewed by a news speaker that had been fired, because she thought "that not all under Hitler was bad" regarding familiy politics. Both are in the realm of right wing conspiracy theories and nobody should take them serious anymore. He actually came from my federal state in Germany.
It is a shame how much money he now gets with his speculative and misleading videos. This guy shot himself in the out of the aluminium hat people, but it seems to pay. Dangerously misleading. Delusional.
He is no specialist in virology at all, and the general reception of his new videos in science world range from "pure bullshit" to "fake news" - because this is, what it is.
The Robert Koch Institute at the Charite in Berlin, that officially informs the public and advises the government, are those who can actually get this hard job done seriously at this moment, and their best virologists have proven their competence for a long time. Their information and official actual statistics is public and transparent, so there is no "conspiration" anyway.
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