What do I need to know about coronavirus?

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Birdstrike said:
What if it's lower than normal?
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then this whole thing has been a farce. But public health officials and politicians will frame it as an amazing success story and that we should be grateful of their infinite wisdom in managing a virus that threatened millions
 
TwoHighways said:
then this whole thing has been a farce
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Farce, or most successful infectious disease response in history? Because right now we're on track to lose 1.6 - 2.2 million Americans according to experts. If we end up with much less than that, or furthermore even less overall deaths than a normal viral season, I think you could just as easily say it's the greatest preventive success and greatest total lives saved in American history. Also, don't discount how many less deaths we may have as a side effect of this national response, from flu, contagious bacterial and other viral pneumonias.
 
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Birdstrike said:
Farce, or most successful infectious disease response in history? Because right now we're on track to lose 1.6 - 2.2 million Americans according to experts. If we end up with much less than that, or furthermore even less overall deaths than a normal viral season, I think you could just as easily say it's the greatest preventive success and greatest total lives saved in American history. Also, don't discount how many less deaths we may have from flu, contagious bacterial and other viral pneumonias due to this national response.
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We should just live in isolation forever and provide economic stimulus to those out of work due to this indefinitely. Our collective health is too important. How can anyone disagree?
 
www.ncbi.nlm.nih.gov

Indomethacin has a potent antiviral activity against SARS coronavirus - PubMed

The results identify INDO as a potent inhibitor of coronavirus replication and suggest that, having both anti-inflammatory and antiviral activity, INDO could be beneficial in SARS therapy.
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

“Unexpectedly, we found that INDO has a potent direct antiviral activity against the coronaviruses SARS-CoV and CCoV. INDO does not affect coronavirus binding or entry into host cells, but acts by blocking viral RNA synthesis at cytoprotective doses. This effect is independent of cyclooxygenase inhibition.”

from 2006.

Guess it shows how far out in the twilight zone we are to even bring this one up. Journal club would have laughed.
 
TwoHighways said:
We should just live in isolation forever and provide economic stimulus to those out of work due to this indefinitely.
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Not forever, only until counts have plateaued and start to decline, and panic is replaced by apathy. Although we don't know when, COVID-19 infection counts and deaths will eventually begin to decline. That it will happen at some point, is guaranteed. As someone who (informally) studies persuasion, people are much more influenced by the direction of something than the severity. Although they are both serious and deadly problems, it's the reason people are panicked over COVID-19 which has killed 92 Americans and apathetic about influenza which has killed 18,000 Americans. It's because the COVID-19 deaths are rising and the flu deaths are flat or dropping. It's the same reason a person who gets a 5% pay cut and now makes $100,000 per year, will view that oppositely from the person who just got a 5% pay raise and now makes $100,000 per year. And it's the same reason that when COVID-19 cased and deaths start to decline, people will feel infinitely better about things, even though the counts are guaranteed to be much higher at that point.

This is why I've made a conscious decision to change my thinking on this. Not because the facts have changed (which they are quickly) but because of factors involving persuasion and framing.
 
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Old_Mil said:
You miss the people who had it and recovered...you also miss the people who had it and died.
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People who are critically ill, dying or have died from pneumonia-like symptoms in the past 2 months, are incredibly more likely to have been tested or be tested for COVID-19, than patients with mild or no symptoms and who recovered uneventfully, possibly without having ever seen a healthcare provider.
 
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A country can only maintain a "lockdown" for a certain period of time before the economic damage becomes permanent and possibly irreparable. An ethical question: Is it worth causing an economic depression, harming hundreds of millions of Americans and reducing our quality of life for 10-20 years in exchange for saving 1.5 million (mostly elderly) Americans?
 
GeneralVeers said:
A country can only maintain a "lockdown" for a certain period of time before the economic damage becomes permanent and possibly irreparable. An ethical question: Is it worth causing an economic depression, harming hundreds of millions of Americans and reducing our quality of life for 10-20 years in exchange for saving 1.5 million (mostly elderly) Americans?
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Yes.
Not doing so might well cause more damage if hospitals are overwhelmed and docs are out of commission.
Problem is we didn't make small changes early to avoid big changes later.
It won't be 10-20 years IMHO.
50% of the ICU patients in France are under 60, FWIW.
 
GeneralVeers said:
A country can only maintain a "lockdown" for a certain period of time before the economic damage becomes permanent and possibly irreparable. An ethical question: Is it worth causing an economic depression, harming hundreds of millions of Americans and reducing our quality of life for 10-20 years in exchange for saving 1.5 million (mostly elderly) Americans?
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I believe the costs spent attempting to mitigate the spread is worse than the virus itself. That being said, I believe we’re long overdue for a deep recession and don’t think we swallowed our medicine in 2008, opting instead to prop up failing banks, automakers, etc. I believe the run up over the last twelve years was largely predicated on increasing public and consumer debt, and when you realize how the system needs new debt just to continue growing, it’s pretty sobering. I’m sure we’re going to see unprecedented levels of bailouts in an effort to keep it all together, which in turn only makes things worse long term.
 
TwoHighways said:
I believe the costs spent attempting to mitigate the spread is worse than the virus itself. That being said, I believe we’re long overdue for a deep recession and don’t think we swallowed our medicine in 2008, opting instead to prop up failing banks, automakers, etc. I believe the run up over the last twelve years was largely predicated on increasing public and consumer debt, and when you realize how the system needs new debt just to continue growing, it’s pretty sobering. I’m sure we’re going to see unprecedented levels of bailouts in an effort to keep it all together, which in turn only makes things worse long term.
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Agree completely with everything. We didn't "swallow our medicine" though last time. There will now be a push to bail out airlines, financial institutions and other too-big-to-fail corporations. I will definitely be critical of the President if he gives in to big business and does that.
 
miacomet said:
Yes.
Not doing so might well cause more damage if hospitals are overwhelmed and docs are out of commission.
Problem is we didn't make small changes early to avoid big changes later.
It won't be 10-20 years IMHO.
50% of the ICU patients in France are under 60, FWIW.
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Also the 1.5 million deaths are theoretical. I'm never happy making real-world changes and sacrifices to combat theoretical numbers upon even which experts disagree.
 
GeneralVeers said:
A country can only maintain a "lockdown" for a certain period of time before the economic damage becomes permanent and possibly irreparable. An ethical question: Is it worth causing an economic depression, harming hundreds of millions of Americans and reducing our quality of life for 10-20 years in exchange for saving 1.5 million (mostly elderly) Americans?
Click to expand...
I can already see the clickbait headlines:

"Not satisfied with everything else, Millennials finally killed off the Boomers"
 
GeneralVeers said:
A country can only maintain a "lockdown" for a certain period of time before the economic damage becomes permanent and possibly irreparable. An ethical question: Is it worth causing an economic depression, harming hundreds of millions of Americans and reducing our quality of life for 10-20 years in exchange for saving 1.5 million (mostly elderly) Americans?
Click to expand...
You've framed the question as a choice of between two unacceptable choices without any other potential acceptable outcomes. That makes it very dangerous to answer, so I'm not going to answer it, because you've quite perfectly framed it in a way where there's only two ways to lose (mass deaths or devastating economic depression) and no way to win.

What I'll do instead is frame the question differently: Considering the possible worst case secenario of 2.2 million Americans dying, how do we find the sweet spot for a shutdown long enough to save the maximum lives possible, and also short enough to prevent an inevitable depression?

If you frame it that way, you've created a situation where there are two ways to win (millions of live saved and minimizing economic damage) and no ways to lose. That's what I'm talking about, when I refer to persuasion and framing.

If it sounds like crazy talk, read: Influence, by Cialdini, How to Win Friends & Influence People by Carnegie, The Power of Positive Thinking by Peale and Win Bigly by Adams.
 
miacomet said:
Yes.
Not doing so might well cause more damage if hospitals are overwhelmed and docs are out of commission.
Problem is we didn't make small changes early to avoid big changes later.
It won't be 10-20 years IMHO.
50% of the ICU patients in France are under 60, FWIW.
Click to expand...

They never specified the age breakdown of those under 60 yo. I suspect they didnt do this on purpose because they are likely in their 50s. This is only regarding 300 ICU cases btw.

Meanwhile we are about to cause a great depression due to a global economic collapse.
 
Mr. Hat said:
Is it just me that doesn't understand the current testing "guidelines" from all of our amazing health departments and ID groups? I mean, I kind of get the whole travel as a risk factor thing if this was a month ago, but we all know this is all over the community now. It seems to me that what makes the most sense is to be testing: 1) The sickest people 2) Healthcare workers with symptoms 3) People with symptoms exposed to known positive cases. But at my shop for the most part it's still "Hurrr, durrr, have they traveled to China or Europe in the last 14 days? No? Then no test, hurrpedy durrpedy".

It's become laughable. The real incidence and prevalence has got to be so different than anything we're being told. Which raises another question, why isn't anyone trying to figure this out? Maybe I'm oversimplifying this, but it seems like it wouldn't be that hard to find 500 or 1000 volunteers in a community to consent to giving samples, and to test them all for active virus and for antibodies. Wham, now you've got at least some numbers on incidence and prevalence. The recent New York Times piece on the doc in Seattle who retrospectively found community-acquired Covid from flu swabs she had taken weeks to months ago highlights the fact that it's clearly out there, and has probably been out there for quite some time.
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Yeah it's what they said when they first started requiring travel to China as a criteria for testing in Italy..."WE are the risk zone now".
 
Mr. Hat said:
The recent New York Times piece on the doc in Seattle who retrospectively found community-acquired Covid from flu swabs she had taken weeks to months ago highlights the fact that it's clearly out there, and has probably been out there for quite some time.
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I said this was likely early on in this thread and people acted as if I had killed a baby seal. Do you have a link to the article?
 
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erdoc00 said:
They never specified the age breakdown of those under 60 yo. I suspect they didnt do this on purpose because they are likely in their 50s. This is only regarding 300 ICU cases btw.

Meanwhile we are about to cause a great depression due to a global economic collapse.
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So, if we ignored it (which we tried to do, with little success), there would have been no collapse?
 
Mr. Hat said:
I don’t have NYT access but here’s a link to a story which references it:
www.mynorthwest.com

How Seattle Flu Study defied federal government to test for coronavirus

The Seattle Flu Study tried testing for coronavirus in Washington for weeks, defying the federal government in a bid to track the illness back in February.
www.mynorthwest.com www.mynorthwest.com

Here’s the original NYT piece if you’re able to read it:
www.nytimes.com

‘It’s Just Everywhere Already’: How Delays in Testing Set Back the U.S. Coronavirus Response (Published 2020)

A series of missed chances by the federal government to ensure more widespread testing came during the early days of the outbreak, when containment would have been easier.
www.nytimes.com www.nytimes.com
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Yeah, there's going to be no way to trace back how many people had it for how long, here, or even in China. There's too high a proportion with mild illness and too easy to have written off earlier severe cases, pre-COVID-19 discovery, as "non-specific viral pneumonia." This is how new diseases are discovered. They blend in for a while; how long, no one knows, until there's a dense enough cluster, often in a place with high population density, that it stands out and gets enough attention to be investigated as something different than the usual background noise.
 
erdoc00 said:
Meanwhile we are about to cause a great depression due to a global economic collapse.
Click to expand...
There is an economic retraction happening for sure, but it's too early to tell if once we past peak on this, whether it'll bounce back quickly or stay depressed. Personally, I'd bet on a strong bounce back, but I can't predict that with certainty anymore than I could have predicted this viral pandemic. People are not going to want to stay isolated and at a stand still for very long. I know I won't.
 
Birdstrike said:
There is an economic retraction happening for sure, but it's too early to tell if once we past peak on this, whether it'll bounce back quickly or stay depressed. Personally, I'd bet on a strong bounce back, but I can't predict that with certainty anymore than I could have predicted this viral pandemic. People are not going to want to stay isolated and at a stand still for very long. I know I won't.
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Seriously. I'm bored.
Any thoughts on when PPE will ramp up?
 
miacomet said:
So, if we ignored it (which we tried to do, with little success), there would have been no collapse?
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We can address the virus and implement reasonable precautions such as social distancing without causing widespread irrational panic and economic collapse.
 
erdoc00 said:
We can address the virus and implement reasonable precautions such as social distancing without causing widespread irrational panic and economic collapse.
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I would like to know how you would implement social distancing without huge economic problems. Meaningful social distancing is not compatible with open restaurants, bars, sporting events, stores, salons, casinos, movies, tourist attractions, non-emergent travel, or gyms. Shutting down all of those things at once is not compatible with a healthy economy.
 
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GeneralVeers said:
Also the 1.5 million deaths are theoretical. I'm never happy making real-world changes and sacrifices to combat theoretical numbers upon even which experts disagree.
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I agree. But I honestly think that at this point, the best way out of this is to embrace the worst case scenarios, however theoretical they may be, work to beat them (which should be easy because they’re as high as the North Star) then as soon we’ve blunted the rise of this enough that it becomes clear out health systems are not collapsing like Wuhan or Italy, open things up as quickly as possible at a point we can still bounce back economically. Then declare massive and unprecedented victory in lives saved when we’ve beaten the extremely dire predictions.

I don't see any other good way out of this.
 
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erdoc00 said:
We can address the virus and implement reasonable precautions such as social distancing without causing widespread irrational panic and economic collapse.
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I think we tried that, and people were partying all night in NYC
 
Birdstrike said:
Some interesting notes on hydroxychloroquine and other emerging possible treatments including update on vaccine development. Out today:

"Coronavirus Disease 2019 (COVID-19) Treatment & Management"

Coronavirus Disease 2019 (COVID-19) Treatment & Management: Approach Considerations, Complications, Prevention

emedicine.medscape.com emedicine.medscape.com
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Hydroxychlorquine (Plaquenil) or Chorloquine Phosphate (Aralen)? Or both? The latter is the anti malarial agent, the former is the immunosuppressant given to people with rheumatologic conditions...? I don’t think I’ve ever written a script for either of them.
 
Old_Mil said:
Hydroxychlorquine (Plaquenil) or Chorloquine Phosphate (Aralen)? Or both? The latter is the anti malarial agent, the former is the immunosuppressant given to people with rheumatologic conditions...? I don’t think I’ve ever written a script for either of them.
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unless there is something new out in the last few days, these are all in vitro studies which failed in vivo against prior coronaviruses.
 
What about remdisivir? Any good data on that?
 
bravotwozero said:
What about remdisivir? Any good data on that?
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"Remdesivir

The broad-spectrum antiviral agent remdesivir (GS-5734; Gilead Sciences, Inc) is a nucleotide analog prodrug. It has been shown to inhibit replication of other human coronaviruses associated with high morbidity in tissue cultures, including severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012. Efficacy in animal models has been demonstrated for SARS-CoV and MERS-CoV. In addition, remdesivir is in clinical trials for Ebola virus infections.


Several phase 3 clinical trials are underway for testing remdesivir for use in COVID-19 in the United States, South Korea, and China.

An in vitro study showed that the antiviral activity of remdesivir plus interferon beta (IFNb) was superior to that of lopinavir/ritonavir (LPV/RTV; Kaletra, Aluvia; AbbVie Corporation). Prophylactic and therapeutic remdesivir improved pulmonary function and reduced lung viral loads and severe lung pathology in mice, whereas LPV/RTV-IFNb slightly reduced viral loads without affecting other disease parameters. Therapeutic LPV/RTV-IFNb improved pulmonary function but did not reduce virus replication or severe lung pathology."

Coronavirus Disease 2019 (COVID-19) Treatment & Management: Approach Considerations, Complications, Prevention

emedicine.medscape.com emedicine.medscape.com
 
Just making a point... the mortality rate is steadily dropping. Not making an speculations, but at least we can rejoice in that 🙂
 
erdoc00 said:
They never specified the age breakdown of those under 60 yo. I suspect they didnt do this on purpose because they are likely in their 50s. This is only regarding 300 ICU cases btw.

Meanwhile we are about to cause a great depression due to a global economic collapse.
Click to expand...

News out of Iran is that 15% of fatalities are people under 40. You really think we can just ignore this and it will go away like magic? The economic hit would have come either way. I'd rather it come now as a result of purposeful policies that save lives than 2 months from now as a result of sheer, unadulterated panic as hospitals are overwhelmed and tens of thousands die every day across the world from an unchecked pandemic.

HoosierdaddyO said:
Just making a point... the mortality rate is steadily dropping. Not making an speculations, but at least we can rejoice in that 🙂
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This means absolutely nothing. Both testing and new infections are rising. We're experiencing exponential growth, which means each generation of "new" cases is much larger than the preceding generation of "mature" cases. Since mortality occurs only in "mature" cases who have been sick for weeks, the mortality rate will drop as the epidemic spreads and more people are diagnosed in the early stage of the disease. This is neither good news or bad news, just a mathematical artifact.
 
Money-Moniker said:
News out of Iran is that 15% of fatalities are people under 40. You really think we can just ignore this and it will go away like magic? The economic hit would have come either way. I'd rather it come now as a result of purposeful policies that save lives than 2 months from now as a result of sheer, unadulterated panic as hospitals are overwhelmed and tens of thousands die every day across the world from an unchecked pandemic.



This means absolutely nothing. Both testing and new infections are rising. We're experiencing exponential growth, which means each generation of "new" cases is much larger than the preceding generation of "mature" cases. Since mortality occurs only in "mature" cases who have been sick for weeks, the mortality rate will drop as the epidemic spreads and more people are diagnosed in the early stage of the disease. This is neither good news or bad news, just a mathematical artifact.
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Well I beg to differ... when numbers like 2.5, 3 percent mortality where being tossed around whilly nilly and the rate is around 1.7ish and expecting to drop further.... I consider that to be a tiny positive.
 
The data becomes more complete each and every day.... and with that comes lower mortalities rates. Unless there is something that I didn’t learn while getting my MPH... still not sure how a lowering mortality rate is a bad thing. Yes this needs to play out, but all I’m saying is the numbers could be getting worse as far as percentages, but for now that doesn’t seem to be the case!!!

And let me be clear... I’m learning to accept that maybe on the scale of millions of people will get this virus, but if the mortality rate drops as the denominator grows greater than the numerator as a rate. Then to me... that’s all that matters 🙂).
 
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HoosierdaddyO said:
The data becomes more complete each and every day.... and with that comes lower mortalities rates. Unless there is something that I didn’t learn while getting my MPH... still not sure how a lowering mortality rate is a bad thing. Yes this needs to play out, but all I’m saying is the numbers could be getting worse as far as percentages, but for now that doesn’t seem to be the case!!!

And let me be clear... I’m learning to accept that maybe on the scale of millions of people will get this virus, but if the mortality rate drops as the denominator grows greater than the numerator as a rate. Then to me... that’s all that matters 🙂).
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You're missing the obvious point that during an exponential growth phase of an epidemic the mortality rate will display a FALSE decline as the number of people who have just become sick explodes. These newly sick people are not even close to reaching their eventual outcome (recovery or death) so it's inappropriate to use them as the denominator of a mortality calculation.

Look instead at the number of deaths compared to the number of recoveries. We currently have 8000 deaths compared to 81,000 recoveries. In other words, out of ~90,000 cases where the disease has run its course, the mortality rate is almost 9%! This is the number to watch and the one that tells us something real about the mortality rate versus the number you're using, which is just telling us that thousands of new patient a day are falling sick.
 
Money-Moniker said:
You're missing the obvious point that during an exponential growth phase of an epidemic the mortality rate will display a FALSE decline as the number of people who have just become sick explodes. These newly sick people are not even close to reaching their eventual outcome (recovery or death) so it's inappropriate to use them as the denominator of a mortality calculation.

Look instead at the number of deaths compared to the number of recoveries. We currently have 8000 deaths compared to 81,000 recoveries. In other words, out of ~90,000 cases where the disease has run its course, the mortality rate is almost 9%! This is the number to watch and the one that tells us something real about the mortality rate versus the number you're using, which is just telling us that thousands of new patient a day are falling sick.
Click to expand...

But what is a "recovery"? If it meanshospitalized people that have been discharged and those who are re-tested and are negative after a positive, then it doesn't include most mild cases. With the limited test kits, I doubt they are retesting every positive to confirm they are "cured". this means the actual recoveries are probably much higher.
 
Money-Moniker said:
Look instead at the number of deaths compared to the number of recoveries. We currently have 8000 deaths compared to 81,000 recoveries. In other words, out of ~90,000 cases where the disease has run its course, the mortality rate is almost 9%! This is the number to watch and the one that tells us something real about the mortality rate versus the number you're using, which is just telling us that thousands of new patient a day are falling sick.
Click to expand...
With the understanding that that number is falsely high, for the same reason the other number is falsely low. Case 'resolution' takes weeks if the resolution is recover, and can happen in days if the resolution is death. So you are tracking a lot of the recent exponential growth in the 'death' number but not the resolution number.
 
miacomet said:
50% of the ICU patients with COVID-19 in France are under 60.
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Yeah but look at the mortality rate in germany - 0.25%! I have to stay we're still quite early in 'uncharted territory' to really draw statistical conclusions here...time will tell.
 
Perrotfish said:
With the understanding that that number is falsely high, for the same reason the other number is falsely low. Case 'resolution' takes weeks if the resolution is recover, and can happen in days if the resolution is death. So you are tracking a lot of the recent exponential growth in the 'death' number but not the resolution number.
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This is a valid point. This number is far from perfect, but I still think it gives us a somewhat better idea of how the mortality rate is evolving if only because it's a lagging indicator.
 
bravotwozero said:
Yeah but look at the mortality rate in germany - 0.25%! I have to stay we're still quite early in 'uncharted territory' to really draw statistical conclusions here...time will tell.
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If you look at figures for 'recovered' patients in Germany, the number is incredibly low (~100), which to me gives creedence to what Zurned said above, that they may only be counting hospitalized patients who were ultimately discharged.

Otherwise, I agree that the mortality rate in the recovered group worldwide is currently quite disconcerting, but will yet change considerably once all the numbers are in.
 
A few days ago we were told to test whoever we wanted. Now we're told the US is running low on reagent to run the test, so only test patients being admitted, high risk groups, healthcare workers and to tell everyone else to stay home.
Dr Mantis Toboggan said:
anyone else running low on swabs?
Click to expand...
 
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