What do I need to know about coronavirus?

[thegenius]

They're dead wrong. Show them the sources I linked to. I gave you the report link, page, paragraph and sentence.

I agree. By the way, that original Imperial College model did include the effects of social distancing, predicting 1.2 million American deaths even if recommended actions were taken (Page 16, paragraph 3, last sentence). Currently, they seemed to have zeroed in on something more like 68K, which if true, means the initial estimate was off by 1,748%. The initial prediction without social distancing was 40 million worldwide.

This is from page 16, paragraph 3, of the paper.

Perhaps our most significant conclusion is that mitigation is unlikely to be feasible without emergency surge capacity limits of the UK and US healthcare systems being exceeded many times over. In the most effective mitigation strategy examined, which leads to a single, relatively short epidemic (case isolation, household quarantine and social distancing of the elderly), the surge limits for both general ward and ICU beds would be exceeded by at least 8-fold under the more optimistic scenario for critical care requirements that we examined. In addition, even if all patients were able to be treated, we predict there would still be in the order of 250,000 deaths in GB, and 1.1-1.2 million in the US.




The second sentence mentions their most effective mitigation strategy examined. That is not most of the US is doing. Most of the US keeping everybody at home, not just social distancing of the elderly. So the paper takes into account THEIR version of social distancing, not what the US and most of the world is doing now.

I think it's a great paper. It scared us all, we took the virus seriously, and now we will never know if their prediction would have been correct.

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[Birdstrike]

There are people on this board who predicted at one point there would be 3-9K deaths in the US.

So far, the “experts” at Royal College of London who were quoted by the “experts” on SDN-EM are off by a factor of a factor of 42 (1,200,000/28,000). And “that guy” is off by a factor of 3 (28,000/9,000).

Wrong he is, but still ahead of the curve, and a hell of a lot closer than the experts.

 

[VA Hopeful Dr]

We do know. COVID-19 is here to stay.

Actually we don't know that either.

 

[Birdstrike]

This is from page 16, paragraph 3, of the paper.

Perhaps our most significant conclusion is that mitigation is unlikely to be feasible without emergency surge capacity limits of the UK and US healthcare systems being exceeded many times over. In the most effective mitigation strategy examined, which leads to a single, relatively short epidemic (case isolation, household quarantine and social distancing of the elderly), the surge limits for both general ward and ICU beds would be exceeded by at least 8-fold under the more optimistic scenario for critical care requirements that we examined. In addition, even if all patients were able to be treated, we predict there would still be in the order of 250,000 deaths in GB, and 1.1-1.2 million in the US.




The second sentence mentions their most effective mitigation strategy examined. That is not most of the US is doing. Most of the US keeping everybody at home, not just social distancing of the elderly. So the paper takes into account THEIR version of social distancing, not what the US and most of the world is doing now.

I think it's a great paper. It scared us all, we took the virus seriously, and now we will never know if their prediction would have been correct.

If the US in fact used less social distancing than they recommended then they would have to correct their model and put a higher number in it, like somewhere between 1.2 million and their 2.2 million, which was with no measures take. That’s makes them even farther off.

 

[thegenius]

I think that an equally important question is how many are false positives. I’ve seen amplification run amuck in law enforcement with touch DNA analysis giving false hits (ie Lukis Anderson case) simply because someone came in close contact with a suspect hours before sample collection. It would not surprise me if persons living in close contact with an infected individual have trace viral elements detectable by PCR in their mucus, cilia, etc. but no infection meaning no intracellular entry or replication.

Right they are testing for dead virus.

I've often wondered how someone could have the virus replicate in them for days, perhaps weeks, and they NEVER have a single symptom. Nary a sniffle or cough. I suppose its possible, but testing for fragments of RNA doesn't necessarily mean that that person 1) had the disease, or 2) could infect other people.

It's the same reason why a healthy patient doesn't have a UTI if they have asymptomatic pyuria.
It's the same reason why a healthy patient doesn't have pneumonia if they have a radiographic lobar consolidation but no symptoms.

I don't necessarily endorse this notion that there are huge swaths of people roaming around who have active viral replication and shedding without a single symptom at all.

 

[Rekt]

I love it when people still rag on modeling. There are people who STILL FEEL this is a hoax, made up by the government to control people. There are people on this board who predicted at one point there would be 3-9K deaths in the US.

I agree that it doesn't make sense for most hospitals, around the nation, to sit around at 1/2 capacity for long periods of time. We can probably start doing some elective cases soon. And that's going to happen according to an email I got from our hospital.

I love it when people still rag on common sense. There are people who STILL FEEL this is either black and white, either a made up hoax or the entire world is about to die. There are people on this board who predicted that it would be worse than the flu, but no where near the 2million deaths the hysteria machine keeps pushing.

. . .

There's a happy medium. Not sure why it's so black and white. There's very much shades of grey in all this, but people like you don't see it.

As much as the people of NYC and media would like us to believe, they aren't the center of the world. Keep them, the elderly, and high risk patients quarantined and restricted and let the rest of the states sitting at 20% hospital capacity, closing floors, cutting hours, etc function normally.

 

[Birdstrike]

Actually we don't know that either.

You may be right. We may completely eradicate COVID-19z. But considering the human race has only eradicated 2 viruses (smallpox and rinderpest) in the history of the world and there are over 300,000 viruses that infect humans and have not been eradicated, I’ll take the 150,000 to 1 odds COVID-19 is here to stay.

 

[thegenius]

If the US in fact used less social distancing than they recommended then they would have to correct their model and put a higher number in it, like somewhere between 1.2 million and their 2.2 million, which was with no measures take. That’s makes them even farther off.

Huh? I don't follow.

Have the Royal, Imperial, Monarchial, Imperatorial, Majestic, and Regal people in England revised their haughty and snooty statistics in a revised paper?

The US did more social distancing than what the recommended. Hence a more than 10x reduction in death. We did good. I am confident that if we did EXACTLY what the snooty brits suggested, we would have exactly 1,200,000 deaths in the US on the nose. But we shall never know.

 

[VA Hopeful Dr]

You may be right. We may completely eradicate COVID-19z. But considering the human race has only eradicated 2 viruses (smallpox and rinderpest) in the history of the world and there are over 300,000 viruses that infect humans and have not been eradicated, I’ll take the 150,000 to 1 odds COVID-19 is here to stay.

Really?

So where is SARS right now?

 

[thegenius]

Really?

So where is SARS right now?

In my backyard, sitting on a fence, just waiting for an unsuspecting person who lowers their guard to walk by. Then it's gonna pounce!

 

[VA Hopeful Dr]

In my backyard, sitting on a fence, just waiting for an unsuspecting person who lowers their guard to walk by. Then it's gonna pounce!

Eating bats and pangolins I assume

 

[Birdstrike]

Have the Royal, Imperial, Monarchial, Imperatorial, Majestic, and Regal people in England revised their haughty and snooty statistics in a revised paper?

Yes, their last revision cut the original estimate by a factor of 1/25 (i.e. from 500,000 predicted U.K. deaths down to 20,000, and so on).

The US did more social distancing than what the recommended. Hence a more than 10x reduction in death. We did good. I am confident that if we did EXACTLY what the snooty brits suggested, we would have exactly 1,200,000 deaths in the US on the nose. But we shall never know.

I accept this. We are going to agree on this.↑



"Don't Worry Be Happy"- Bobby McFerrin

 

[thegenius]

Eating bats and pangolins I assume

I think there is a civet nearby too.

Those three animals should be enshrined in the CoronaVirus HOF.

 

[Birdstrike]

Really?

So where is SARS right now?

COVID-19 (SARS-COV-2) is a SARS coronavirus. Saying "SARS is eradicated" because one coronavirus subtype (SARS-COV-1) hasn't come out of it's bat/panglin/wet market hiding spot for a while is kind of like saying you don't have to worry about Gonorrhea anymore because the drug resistant strain left town. But I'll give you that one on a technicality. We've eradicated 3 viruses then. I'll still take the 300,000:3 odds that we're stuck with the 'rona. I do hope I end up wrong those, because it sounds like a nasty little sucker from what I hear.

 

[VA Hopeful Dr]

COVID-19 (SARS-COV-2) is a SARS coronavirus. Saying "SARS is eradicated" because one coronavirus subtype (SARS-COV-1) hasn't come out of it's bat/panglin/wet market hiding spot for a while is kind of like saying you don't have to worry about Gonorrhea anymore because the drug resistant strain left town. But I'll give you that one on a technicality. We've eradicated 3 viruses then. I'll still take the 300,000:3 odds that we're stuck with the 'rona. I do hope I end up wrong those, because it sounds like a nasty little sucker from what I hear.

the only way COVID is here to stay and poses a continual significant problem is if we: don't come up with a vaccine, it doesn't mutate to a less virulent strain, we don't end up with good herd immunity, don't come up with treatment that actually works, and don't get a better handle on who exactly is high risk.

 

[Birdstrike]

the only way COVID is here to stay and poses a continual significant problem is if we: don't come up with a vaccine, it doesn't mutate to a less virulent strain, we don't end up with good herd immunity, don't come up with treatment that actually works, and don't get a better handle on who exactly is high risk.

Now do measles.

 

[bravotwozero]

from an evolutionary standpoint, there is no significant selective pressure for the virus to mutate to a less deadly, (or even more deadly) strain. It's replicating and spreading like wildfire, long before it kills people.

 

[Birdstrike]

Here's something we can ALL agree on:

Coronavirus sucks, being quarantined sucks and both need to go away as soon as possible!

Good night!

 

[VA Hopeful Dr]

Now do measles.

Ha, sorry forgot to add "have a vaccine but ****heads refuse to get it".

 

[Birdstrike]

Ha, sorry forgot to add "have a vaccine but ****heads refuse to get it".

New strains are popping up every day, now there's a COVID-9.

 

[yeasports]

Full disclosure: As a physician who's been in practice for over 15 years, I am financially able to stay in shutdown mode, much longer than your average American. I, personally and financially, don't need this lockdown to end right now. Actually, it's probably in my best interest the longer it goes on, as I don't want COVID spreading around and back to me and my family, any more than anyone else. However, most people are not going to be able to withstand a shutdown long enough to eliminate all risk of COVID-19. Most people, even middle and many upper middle class, live paycheck to paycheck. Once that stimulus check is gone, which is going to be quick because bills haven't stopped mounting, people are going to be desperate. Social distancing and "flattening the curve" were never about eradicating COVID-19 from Earth, or eliminating all risk. That may not happen, ever. It was about allowing healthcare resources to withstand the peak surge of cases. According to the models which is all we have to guide us, as flawed as they are, show we are post peak nationally, and in the worst hotzones of NY, NJ, MI and LA.

This. We do not know completely but we can assume somewhat who falls into high risk and who falls into low risk. Question is if you fall into high risk what amount of social distancing would keep you from getting exposed? 1yr, 2yr or more? Would you be willing to do this? Lets say we have a vaccine today which we don't it would take at least 6 months or so to make enough doses: Selecting Viruses for the Seasonal Flu Vaccine
Would it be crazy to let people who fall into high risk quarantine as they wanted and allow low risk to have the chance to develop immunity of some sort? Low risk would still have some bad outcomes but could this help develop herd immunity and would this help? some say no: Here's Why Herd Immunity Won't Save Us From The COVID-19 Pandemic

Do I think society in america will continue this level of social distancing for a year? perhaps, but most likely no.

 

[gutonc]

Now do measles.

So, this is one that I'm actually curious about. Our vaccination rates for the "old stuff" have fallen off considerably in certain populations. But back in the day when lots of people got measles (and rubella and...and...and) and folks saw what that looked like on a personal basis, they were lining up down the street to get vaccinated.

I suspect (but can't prove of course) that this is going to be the case if/when we get a SARS-NCoV2 vaccine. Sure, there will still be some true believers who won't do it. But I bet a lot of the "vaccine hesitant" folks will get in line.

 

[Birdstrike]

Where have most COVID-19 outbreaks occurred? Surely outside, at entertainment venues, during transport, or dining, right?

"Indoor Transmission of SARS-Cov-2

Home outbreaks were the dominant category (254 of 318 outbreaks; 79.9%), followed by transport (108; 34.0%; note that many outbreaks involved more than one venue category). Most home outbreaks involved three to five cases. We identified only a single outbreak in an outdoor environment, which involved two case.

Conclusions: All identified outbreaks of three or more cases occurred in an indoor environment, which confirms that sharing indoor space is a major SARS-CoV-2 infection risk."

Indoor transmission of SARS-CoV-2

Background: By early April 2020, the COVID-19 pandemic had infected nearly one million people and had spread to nearly all countries worldwide. It is essential to understand where and how SARS-CoV-2 is transmitted. Methods: Case reports were extracted from the local Municipal Health Commissions...

www.medrxiv.org

 

[bravotwozero]

Where have most COVID-19 outbreaks occurred? Surely outside, at entertainment venues, during transport, or dining, right?

"Indoor Transmission of SARS-Cov-2

Home outbreaks were the dominant category (254 of 318 outbreaks; 79.9%), followed by transport (108; 34.0%; note that many outbreaks involved more than one venue category). Most home outbreaks involved three to five cases. We identified only a single outbreak in an outdoor environment, which involved two case.

Conclusions: All identified outbreaks of three or more cases occurred in an indoor environment, which confirms that sharing indoor space is a major SARS-CoV-2 infection risk."

Indoor transmission of SARS-CoV-2

Background: By early April 2020, the COVID-19 pandemic had infected nearly one million people and had spread to nearly all countries worldwide. It is essential to understand where and how SARS-CoV-2 is transmitted. Methods: Case reports were extracted from the local Municipal Health Commissions...

www.medrxiv.org

I'm not sure what kind of conclusions we can draw from that. Sure, most transmission has been at home, but presumably that's because more people are staying at home and not going out. Pretty sure transmission would be higher outside if more people were out and about....

 

[Birdstrike]

COVID-19 In Healthcare Workers, CDC

-9,282 Healthcare workers have gotten COVID-19.

-90% of them did not require any hospitalization at all.
-98% did not require ICU care.
-99.7% did not die.
-99.9% under age 55, did not die.

 

[Birdstrike]

I post this without any, comment, agreement or disagreement, since I'm not fluent in Hebrew. The findings are certainly counterintuitive, and against the conventional wisdom. I'll leave the final verdict on whether he's on to something or nuts, to whomever on here is fluent in Hebrew.

Israeli Math Professor at Tel Aviv University, Isaac Ben-Israel, is claiming to have shown that COVID-19 has followed a predictable pattern of rise and peak, playing itself out in 70 days, regardless of how strong social isolation measures a country takes, and regardless of if a country takes any such measures at all. Posted below are the original paper and graphs in Hebrew, a summary in Times of Israel and the English google translation.

Analysis in Hebrew, with graphs.

Times of Israel, English summary.


"Is Coronavirus Growth Exponential?

By, Isaac Ben-Israel


Abstract

The following article aims to examine in numbers the development of the disease in Israel in the 50 days since it was discovered and until today. It turns out that the peak of the spread has been behind us for about a week, and will probably fade almost completely in about two weeks. Comparison to other countries shows that this is a permanent pattern in all of them. Surprisingly, it also includes countries that have been severely shut down, including the paralysis of the economy, as well as countries that have continued in ordinary life. The data indicates that the closure policy can be abolished within a few days, and replaced by a policy of moderate social remoteness.

Data (graph)

A new concept has come into our lives: an exponential growth, namely a geometric column increase. If the corona does expand by an exponential graph, we should have doubled the number of patients every few days. The supplement had to grow at a constant rate. Does this happen in reality? Let's check it out. As of the date of this document, which is the 48th day since the first patient was discovered in Israel, the number of patients discovered rose on February 20, 2020 to 404,9 on April 8. The following is a graphical description of the daily increase in the number of patients in Israel (the horizontal axis is the timeline since the first patient was discovered). Even those who do not do their math can learn from a graph that the number of patients per day does not increase at a constant rate: from the graph above It can be seen that the addition of patients to the peak day (around the 41st day) to about 700 additional patients a day has since waned. The time needed to double the number of patients has dropped from 4-2 days at peak to more than two weeks today, and continues to decline (see next chart)

Addition of patients per day in Israel (graph)


Summary

In the first 4-5 weeks since the disease was discovered in Israel, there has indeed been an exponential increase in the risk of contracting a new virus, but since then it has begun to moderate. The number of extra daily patients peaked about six weeks after the disease was discovered and has been steadily declining since then. From a graphical point of view, this phenomenon is exceptionally exemplary in almost every country where there is data. So for example, 1 for comparison, let's see what happens in the US. The numbers are bigger) There are about 330 million people in the US! (But the fallout is clear: The infection behavior is not only unique to Israel or the US and is a global phenomenon, as reflected In the following drawing, we include the daily addition of patients worldwide (or more precisely in countries that publish data (1 thanks to my friend Ronnie) Aaron (who will flourish which the following graphs and curve adjustments were made by him)

How many days has the number of patients doubled? In Israel, the absolute numbers are smaller but the phenomenon is similar: it is actually a global phenomenon, as can be clearly seen from the drawing that brings together the data of all countries that publish data: the pattern of rising and declining number of patients after a few weeks, also shared by countries Completely different in their behavior during the crisis (such as Italy which imposed a total closure, including paralysis of the economy or Sweden still enacted in such steps), as illustrated in the following two drawings:

Let's go back to the question in the headline: Is the Coronavirus Expansion Exponential? The answer to the numbers is simple: no. The spread begins to rise exponentially but diminishes rapidly after about eight weeks of its breakout.


Analysis

What caused the decline in the number of new patients? Some say that the decline in the number of patients added every day is the result of the tight closure imposed by the government and the health authorities. According to data from other countries around the world, a strong question mark casts on the above statement. It turns out that similar behavior of rising infection - peaking in the sixth week and rapid decay from the eighth week - is common to almost all countries where the disease was discovered, almost regardless of their behavior: some imposed a severe closure That not only "social remoteness" and prohibition of crowds but Even stopping work in the economy (such as Israel); some "ignored" the contagion and continued in almost ordinary lives (such as Taiwan, Korea, or Sweden), and some were initially ignored, however, during their contagion to their complete closure and paralysis (such as Italy or New York). Surprisingly, the rise and decline of the disease, with the same time constants, was common to all.

For example, the calculation shows that the weekly average of the daily increment of patients, which at the beginning of the spread was several tens of percent, decreased in all countries of the world and reached a 10% -5% increase after 6 weeks, as illustrated in the following diagram for 2 selected countries. : Important distinction: A policy of closure that paralyzes the economy must be distinguished) In practice - a ban on work or reduction, as in Israel, to only 15% of the workforce, with a loss of product of about NIS 100 billion per month (and between social and distant policies) Prohibition of large crowds, distance between humans, and the like. (Certainly, closure reduces infection. However, as the data above shows, there is a decline in the number of infections even without closure, and As at the time of the closure, as of the time of writing this document, we do not have enough data to understand the exact reason for this.


Conclusions

The same closure measures that could affect the economy could be eliminated not only in the economy but also in the number of other dead (not expected to rise as a result) At the same time, one can, of course, continue with measures that are not high (such as wearing masks, expanding the testing system, especially for defined populations, banning mass crowds and the like (which is why we recommend that the following day) or April 19, due to the increase in the labor force participation rate to - 50% and a week to 10 days later it will increase to 100% except for a limited number of Cady disease is detected well, which will examine the infection rate growth mode. Removing it that was also signaled upon arrival at a condition where the infection rate would drop dead"

 

[90sportsfan]

So, this is one that I'm actually curious about. Our vaccination rates for the "old stuff" have fallen off considerably in certain populations. But back in the day when lots of people got measles (and rubella and...and...and) and folks saw what that looked like on a personal basis, they were lining up down the street to get vaccinated.

I suspect (but can't prove of course) that this is going to be the case if/when we get a SARS-NCoV2 vaccine. Sure, there will still be some true believers who won't do it. But I bet a lot of the "vaccine hesitant" folks will get in line.

I was discussing this with a friend recently. Many people who proudly claim to never get vaccinations (or refuse to vaccinate their children), will not be acting so tuff now and will be lining up with everyone else when a vaccine is available. Sad that a situation like this had to humble people, but this will likely greatly improve our overall vaccination rates a herd immunity.

 

[Fart Daddy Smooth]

What we need to do now, right now, is to also test as many people as possible who aren't sick. If we test 10,000 asymptomatic people and find 36% are infected or already have been infected with most showing no symptoms, we're done. "Done," meaning everything we're doing is futile at this point and time to gradually transition back to normal life. If, that is.

Hi, not an MD here but I thought it was important to risk stratify your patients to maximize pre-test probability, thereby reducing the effective rate of false negatives/positives.

Wouldnt mass testing of the general population lead to too much false information to be much use?

 

[Birdstrike]

Hi, not an MD here but I thought it was important to risk stratify your patients to maximize pre-test probability, thereby reducing the effective rate of false negatives/positives.

Wouldnt mass testing of the general population lead to too much false information to be much use?

For individual patients in day to day clinical practice, yes. But for epidemiological use, it would provide valuable information. Comprende, Fart Daddy?

 

[Birdstrike]

Stanford, 4/17/2020: COVID-19 case fatality rate much lower than previously thought, at 0.1%-0.2%. Infection 50-85 times more widespread than previously thought.

 

[bravotwozero]

The link to the article you posted talks about antibody prevalence in Santa Clara County, and makes no mention of case fatality rate....

 

[Birdstrike]

The link to the article you posted talks about antibody prevalence in Santa Clara County, and makes no mention of case fatality rate....

It's in the body of the full paper, not the abstract. Here's a more direct link >>> PDF. Relevant sections, below.

From Abstract, Results:

"The unadjusted prevalence of antibodies to SARS-CoV-2 in Santa Clara County was 1.5% (exact binomial 95CI 1.11-1.97%), and the population-weighted prevalence was 2.81% (95CI 2.24-3.37%). Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%). These prevalence estimates represent a range between 48,000 and 81,000 people infected in Santa Clara County by early April, 50- 85-fold more than the number of confirmed cases.


From Discussion:

"We can use our prevalence estimates to approximate the infection fatality rate from COVID-19 in Santa Clara County. As of April 10, 2020, 50 people have died of COVID-19 in the County, with an average increase of 6% daily in the number of deaths. If our estimates of 48,000-81,000 infections represent the cumulative total on April 1, and we project deaths to April 22 (a 3 week lag from time of infection to death22), we estimate about 100 deaths in the county. A hundred deaths out of 48,000-81,000 infections corresponds to an infection fatality rate of 0.12-0.2%. If antibodies take longer than 3 days to appear, if the average duration from case identification to death is less than 3 weeks, or if the epidemic wave has peaked and growth in deaths is less than 6% daily, then the infection fatality rate would be lower. These straightforward estimations of infection fatality rate fail to account for age structure and changing treatment approaches to COVID-19. Nevertheless, our prevalence estimates can be used to update existing fatality rates given the large upwards revision of under-ascertainment."

 

[Birdstrike]

IHME is in the process of updating some of the states on their model, right now. The forecast for my state has improved, having gone from predicting a peak in deaths 4/28, to saying we're 8 days post-peak. Also, the total project deaths just dropped by over 50%.

Assuming half of the deaths occur before peak, and half after, I'm going to conservatively assume my county's total deaths will still double by the time this is done, even thought iit should be less than that since we're supposedly 8 days post peak. My county has had 9 deaths from COVID-19. Conservatively, let's say my county hits 18, no let's say 20 deaths by the end of this. With a population of 354,081, that means 0.01% will have died from COVID-19, and 99.99% of us will not have died from it.

 

[veaselhaufen]

Regarding the antibody tests, isnt the specificity somewhere around 95%? If you apply this test to a population with a low prevalence wouldnt you expect a lot of false positive antibody tests? Does this really mean 1-4% of people have really been exposed?

IHME forecasts deaths until August 4. Do you really expect COVID to stop on August 4?

 

[Birdstrike]

Regarding the antibody tests, isnt the specificity somewhere around 95%? If you apply this test to a population with a low prevalence wouldnt you expect a lot of false positive antibody tests? Does this really mean 1-4% of people have really been exposed?

IHME forecasts deaths until August 4. Do you really expect COVID to stop on August 4?

No. Although we may be well past peak August 4th, I'm of the opinion COVID-19 is here to stay.

 

[thegenius]

So whats the deal with the news from Gilead and remdesivir? This wasn't an RCT, right?

There was no placebo group from what I can tell.

So is the purpose of these initial trials to prove that the drug is safe?

 

[thegenius]

IHME is in the process of updating some of the states on their model, right now. The forecast for my state has improved, having gone from predicting a peak in deaths 4/28, to saying we're 8 days post-peak. Also, the total project deaths just dropped by over 50%.

While I think it's helpful to know, in general, that we might be over the peak for deaths and cases, I suspect there is going to be a long tail past the median, or a skew, for cases and deaths.

It's helpful for hospitals and health care workers especially. As long as there isn't rampant spread, then I doubt there will be any more NYC's or Lombardy's in the future.

Look at Italy's data. They had their peak but the data doesn't fit a normal distribution. There is a long tail for both cases and deaths.

At this point I don't really care about models or total number of deaths. We got through the surge, people died, and now it's time to make adjustments to the new life of wearing masks and gloves at work, and getting our temperature taken on a daily basis.

Who is signing up to go on a cruise in the next two years?

 

[thegenius]

So whats the deal with the news from Gilead and remdesivir? This wasn't an RCT, right?

There was no placebo group from what I can tell.

So is the purpose of these initial trials to prove that the drug is safe?

Remdesivir is a nucleotide analog, specifically an adenosine analogue, which inserts into viral RNA chains causing their premature termination.

I wonder if Remdesivir can be given to stop SVT?

Maybe it has a very long half-life, which means it has a very long half-life for binding to the AV node, which means it will stop SVT and that patient permanently. Excellent!!!

 

[thegenius]

We currently have about 36K deaths in the US. Not sure if we are at the peak, we could be. hard to tell from the world-o-meters website. Apparently there was a spike in deaths due to how we count them.

Anyway...if we have 36K and we are more or less at the peak, then we are probably going to end up with 85-100K deaths total in the next 4 months or so.

 

[bravotwozero]

how much exposure is needed to reach 'herd immunity'?

 

[thegenius]

how much exposure is needed to reach 'herd immunity'?

We don't know.

And it's different for a spectrum of viruses. I heard on an UCSF IM Grand Rounds that herd immunity for measles is 96%. I think it has something to do with R0 (as the R0 for measles is between 8-12), but I don't know.

A guesstimate is it's probably at least 50%.

 

[Birdstrike]

So whats the deal with the news from Gilead and remdesivir? This wasn't an RCT, right?

There was no placebo group from what I can tell.

So is the purpose of these initial trials to prove that the drug is safe?

No drug is proven to work for COVID-19, yet. But, of all the drugs in the running to be named first line for treatment of COVID-19, guess which one’s still on patent?

You guessed it, remdesivir! Expect that drug to be the media darling for a long time coming. I’m sure the reps are lining the pockets of media, researchers and doctors already. It likely at least partly explains why the media is trashing plaquenil. It’s the main competition to those looking to sell remdesivir and since it’s off patent, can’t make nearly the profit for any one company. Same with chloroquine, Zithromax and zinc.

 

[njac]

So whats the deal with the news from Gilead and remdesivir? This wasn't an RCT, right?

There was no placebo group from what I can tell.

So is the purpose of these initial trials to prove that the drug is safe?

They’re trying to tell us that the previous Ebola trials told us the drug was safe.

But the lack of comparator group makes this data nearly worthless


Sent from my iPhone using SDN

 

[MediMike]

It likely at least partly explains why the media is trashing plaquenil. It’s the main competition to those looking to sell remdesivir and since it’s off patent, can’t make nearly the profit for any one company. Same with chloroquine, Zithromax and zinc.

Is the other reason the vociferous endorsement and overprescribing of it in the face of no evidence of efficacy?

 

[Birdstrike]

Is the other reason the vociferous endorsement and overprescribing of it in the face of no evidence of efficacy?

Yes. But to say there’s “no evidence of efficacy” is misleading. There’s inconclusive and inconsistent evidence of efficacy. There is some evidence. But It’s low level evidence.

 

[Birdstrike]

‪Mass General tested 200 people for Coronavirus antibodies in a Massachusetts town. 1/3 were positive and didn’t even know it.

https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/‬

 

[deleted65604]

‪Mass General tested 200 people for Coronavirus antibodies in a Massachusetts town. 1/3 were positive and didn’t even know it.

https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/‬

Could some of these seropositive tests be false positives because of seasonal coronavirus?

Interesting article:

Projecting the transmission dynamics of SARS-CoV-2 through the post-pandemic period

There is an urgent need to project how transmission of the novel betacoronavirus SARS-CoV-2 will unfold in coming years. These dynamics will depend on seasonality, the duration of immunity, and the strength of cross-immunity to/from the other human coronaviruses. Using data from the United...

www.medrxiv.org

“Immunity to HCoV-OC43 and HCoV-HKU1 appears to wane appreciably within one year”

“The betacoronaviruses can induce immune responses against one another: SARS infection can

generate neutralizing antibodies against HCoV-OC43 (15) and HCoV-OC43 infection can

generate cross-reactive antibodies against SARS”

“the overall impact of cross-immunity could still be

substantial if the cross-immunizing strain had a large outbreak (e.g. HCoV-OC43 in 2014-15

and 2016-17).”

“thebasic reproduction number for HCoV-OC43 and HCoV-HKU1 varies between 1.4 in the summer

and 2 in the winter, the duration of immunity for both strains is about 40 weeks, and each strain

induces cross-immunity against the other, though the cross-immunity that HCoV-OC43 infection

induces against HCoV-HKU1 is stronger than the reverse.”

“Low levels of cross immunity from the other betacoronaviruses against SARS-CoV-2

could make SARS-CoV-2 appear to die out, only to resurge after a few years. Even if SARSCoV-2 immunity only lasts for two years, mild (30%) cross-immunity from HCoV-OC43 and

HCoV-HKU1 could effectively eliminate the transmission of SARS-CoV-2 for up to three years

before a resurgence in 2025, as long as SARS-CoV-2 does not fully die out”

 

[GeneralVeers]

Saw zero Coronavirus patients out of 27 with me and my PA yesterday. It's about a 10-fold decrease in my area over the past 2 weeks. There is zero reason to be on lockdown any more. We need to get back to business.

 

[Birdstrike]

Saw zero Coronavirus patients out of 27 with me and my PA yesterday. It's about a 10-fold decrease in my area over the past 2 weeks. There is zero reason to be on lockdown any more. We need to get back to business.

Our hospitals never collapsed like Italy. 2.2 million Americans didn't die. And yes, we need to get back to business.

 

[Birdstrike]

According to the CDC, from 2/12/20 to 4/9/20:

∙Only 27 out of 18 million (0.00015%) healthcare workers (HCW) died from COVID-19.

∙That means 99.99985% healthcare workers did not die from COVID-19.

∙Even of the HCWs that got COVID, 99.7% do not die. Of those under age 55, 99.9% did not die.