COVID-19 - Wuhan Coronavirus (a non-political thread, see pg. 36 #1778)

[Brian Swartz]

Difficult? Not at all. Time-consuming? Yes. That's why we started the vaccine trial a couple weeks ago or whatever but it'll be at least a year until it's widely available. Some of that delay will be producing enough to use in mass quantities. We'll have test results on the effect of various drugs like chloroquine long before that, but you have to wait a certain amount of time in trials like this before you have any actionable information at all.

[panerd]

Originally Posted by Edward64

I agree with you. Because other western-like countries are exploring hydrochloroquine and others, we should be doing the same. I also don't think we can blame Trump on this particular act of Darwin award stupidity.

Trump should be messaging "hope". He thinks he's doing this with his out-of-context statements (with Fauci rolling his eyes behind him). Instead, he should be providing context and saying:

"... hydrochloroquine (and others) has anecdotally shown to be effective. However, we need to go through the process to confirm this. That is why I've asked the CDC/Fauci/Birx to create a specific task force to expedite these studies. We will give you an update on our progress on X date"

My question is how difficult is it to do double-blind tests with these drugs? It would seem with the urgency that we would have some sort of "indicative results" already. Sad to say but there would be no lack of human volunteers.

My impression is they have been using them after the fact to slow down/dampen the effects of COVID and not to prevent you from getting it. And yes it could end up being just a giant placebo but as long as your don't take a fish tank chemical with a similar name you should live!

[whomario]

South Korea certainly isn't doing so well because they use the drug, especially widespread. That's just not the case and highly misleading.

Even in the study from France you see mentioned most often, if you read the fine print, this was not a mircale cure of any sort.

Aside from the small sample size (26 patients), the study also has a lot of issues, not least the fact that they did not actually test if it helps patients recover but only if they are still shed virus (in other words: if they are still contagious). Others:

- 6 of the 26 patients given the drug were 'lost' from follow up after use of the medication because they had to be moved to ICU had to quit it due to bad side effects or died (and one for some reason left the hospital despite still testing positive).
- The average age of patients was also 'only' 51.2.


article on what is the Status Quo of various medications being tried and tested:

Treatments for COVID-19: Drugs being tested against coronavirus | Live Science

[whomario]

Also:

The problem with a guy like Trump is that him deciding that this is the solution without the data actually there to back it up might directly lead to him also deciding other efforts can be put aside. Without actually knowing if the drug is effective enough to allow that.

Say this saves 25% of the severely ill patients from dying and another 25% from getting seriously ill. That would be fantastic ! But not if you spend less attention on protective gear or makeshift-hospitals, quit social distancing regulations and end up with twice the number of patients actually needing hospital care in the first place.

[albionmoonlight]

I'll put this here because I don't think it is a political thought (at least, it isn't a GOP vs Dems thought).

I wonder if we will have trouble dealing with this (as compared to, say, 1918) because we all move so fast now. The idea of a 3 months shutdown seems like forever in a world where we have been moving toward delivery of things in less than 24 hours.

We just aren't used to time frames going this slowly now. Not to make light of it, but "the virus was so last week" seems to be driving some people to already want to move away from social distancing.

[Butter]

The point is, you can't just say shit if you are the President of the United States. Most people get that. But the idea we should just excuse this one because that's how he is. Any other functional adult would've either refrained mentioning the drug specifically, or may have mentioned it as Edward suggests. But no, he just got excited, it's fine. Bullshit.

Ohio and other states have had to start telling doctors either not to prescribe it, or to limit the amount prescribed for people who have conditions who actually need it because there has been a run when there is still limited-to-no data about its effectiveness.

[Edward64]

Originally Posted by Brian Swartz

Difficult? Not at all. Time-consuming? Yes. That's why we started the vaccine trial a couple weeks ago or whatever but it'll be at least a year until it's widely available. Some of that delay will be producing enough to use in mass quantities. We'll have test results on the effect of various drugs like chloroquine long before that, but you have to wait a certain amount of time in trials like this before you have any actionable information at all.

Definitely not asking for a vaccine but more a treatment. So my basic questions stand ... is the US actually doing tests on these possibly anecdotal treatments (probably) and more importantly, when will they have "indicative" results (and why haven't they published those dates)?

In project management, if you don't have a "target" due date and make someone accountable, it'll never get done (exaggeration but you get the idea).

I think it would help the public (and definitely me) to know "we are doing these tests, you can believe us because we expect some indicative result by X date or we'll provide a status update every Thu etc.".

[JPhillips]

Cuomo is getting frustrated now at the lack of federal support.

NY cases are doubling every 3 days. The peak will be higher and sooner than thought a few days ago. Hospital bed need increasing from 100k to 140k. 30k or more ventilators needed.

[JPhillips]

Originally Posted by Edward64

Definitely not asking for a vaccine but more a treatment. So my basic questions stand ... is the US actually doing tests on these possibly anecdotal treatments (probably) and more importantly, when will they have "indicative" results (and why haven't they published those dates)?

In project management, if you don't have a "target" due date and make someone accountable, it'll never get done (exaggeration but you get the idea).

I think it would help the public (and definitely me) to know "we are doing these tests, you can believe us because we expect some indicative result by X date or we'll provide a status update every Thu etc.".

I just read a story on different medical tests. Some therapeutics will have early results in April. Other drugs through the summer and fall. There are a ton of trials going on all over the world.

[albionmoonlight]

Originally Posted by Edward64

Definitely not asking for a vaccine but more a treatment. So my basic questions stand ... is the US actually doing tests on these possibly anecdotal treatments (probably) and more importantly, when will they have "indicative" results (and why haven't they published those dates)?

In project management, if you don't have a "target" due date and make someone accountable, it'll never get done (exaggeration but you get the idea).

I think it would help the public (and definitely me) to know "we are doing these tests, you can believe us because we expect some indicative result by X date or we'll provide a status update every Thu etc.".

My sister in law works in clinical trial data management. And we haven't talked about COVID-19 treatments, but having talked to her in the past, I learned that the process of bringing a drug to market takes a very long time. Years and decades of time. Lots and lots and lots of trials and tests. And even then, sometimes one slips through with unanticipated side effects.

I am sure that they are rushing everything to the super ultimate max for COVID treatments. But that's still a long time.

[Arles]

If you look back on the comments from the media/experts on march 12-13, all hospital beds should have been overrun by March 23. At a minimum, it looks like social distancing is working.

[Edward64]

Originally Posted by albionmoonlight

My sister in law works in clinical trial data management. And we haven't talked about COVID-19 treatments, but having talked to her in the past, I learned that the process of bringing a drug to market takes a very long time. Years and decades of time. Lots and lots and lots of trials and tests. And even then, sometimes one slips through with unanticipated side effects.

I am sure that they are rushing everything to the super ultimate max for COVID treatments. But that's still a long time.

I get that and that's why I used the phrase "indicative results". If treatment X had indicative results that it seems to work, I'd publish it ... don't over promise, give it the right caveats.

The US public (and world really) needs hope and want to see the light at the end of the tunnel. This hope needs to be backed by science.

[Flasch186]

Originally Posted by Butter

You guys have really lowered the bar on what you expect from the President. I guess you want us to apologize for not doing so, but personally I won't.

He shouldn't be up there touting miracle cures, period. How much better is he than Jim Bakker, really?

Remember when it was the worst that the prez cheated on his wife?

I'll never forget my uncle in very steely terms telling me how awful Clinton was because he was forced to explain to his daughter what Oral Sex was. I concur. IT was terrible that he had to do that before he was ready (or for some of us at all) but that seems high brow now compared to the bowels we've sunk (or been boiled down to).

[NobodyHere]

I daresay traffic today is about 75% of what it normally is.

ETA:

I live in Ohio btw where the mandatory "stay at home" order was issued starting last midnight.

[Arles]

Yeah, driving to work in Phoenix was like Saturday traffic.

[Edward64]

Originally Posted by NobodyHere

I daresay traffic today is about 75% of what it normally is.

Only 75%?

[Edward64]

South Africa and India both going on 3-week lock downs. Not sure how rigorous those will/can be.

[Vince, Pt. II]

Originally Posted by Edward64

Only 75%?

20-25% here in the Bay Area.

[whomario]

Originally Posted by Arles

If you look back on the comments from the media/experts on march 12-13, all hospital beds should have been overrun by March 23. At a minimum, it looks like social distancing is working.

Of course it is working. It's pure math, less contacts = leass spread = less infected = less needing hospitalisation.

Even this virus isn't spreading everytime you come into contact with someone and if the average times where people come into contact is severely limited (especially large groups), of course that has an effect.

But just because some worst-case curve has not materialized is hardly reason to say it worked well enough. At least New York is on a pretty damn slippery slope right now it seems.

Must admit it surprises me how big a percentage of cases deaths is in New York.

[Arles]

Originally Posted by whomario

Of course it is working. It's pure math, less contacts = leass spread = less infected = less needing hospitalisation.

Even this virus isn't spreading everytime you come into contact with someone and if the average times where people come into contact is severely limited (especially large groups), of course that has an effect.

But just because some worst-case curve has not materialized is hardly reason to say it worked well enough.

The longer we avoid the doomsday scenarios that were everywhere 10 days ago, the more information we get from other countries (and more tests/time we get for treatments). We are kind of just hitting our stride in social distancing in most areas and I don't see too many hospitals overrun. Testing or not, if this thing was spreading like widlfire and the death rates were 2-3%, we would be seeing massive hits on our infrastructure. We have had cases in the US since early March.

At least New York is on a pretty damn slippery slope right now it seems.

Must admit it surprises me how big a percentage of cases deaths is in New York.

The math makes sense. We have 49,000 cases in the US and over half are in New York. So, it seems reasonable that 210 of the 616 deaths are there. I do think a lot of people have or have had this virus (prob in the 500K+ range nationally, if not close to a million). While we are probably also under-counting the deaths, it doesn't appear to be very high with all things considered. The hope is if we keep social distancing and can get more of these quick test kits out, we can maybe setup a situation like S Korea in a month. I know a doc office here in AZ is using their normal flu swab and sending that to Sonora Quest to have them do the CovID test. If that works, it opens more options for testing too.

[albionmoonlight]

Where are we on tests?

It seems like some areas (NYC) might be past the place where testing should be a priority.

But other parts of the country might benefit from testing asymptomatic cases to see who has it but does not realize they have it.

Or are we still in a "If you, personally, did not french kiss someone in Whuan in the last two weeks, you can't get a test" place?

[albionmoonlight]

dola:

And I am wrong about this, or should we actually not be testing people with obvious symptoms? Treat them like they have it.

We should be focusing testing on people without symptoms who are in jobs/situations that do not allow them to socially distance.

Right?

[Arles]

Originally Posted by albionmoonlight

dola:

And I am wrong about this, or should we actually not be testing people with obvious symptoms? Treat them like they have it.

We should be focusing testing on people without symptoms who are in jobs/situations that do not allow them to socially distance.

Right?

Agree 100%. The doctors office in Mesa, AZ I cited above is testing all their new and current patients for Covid-19 by using the normal flu-test swabs and sending it to a private lab (no different than how they would do the flu test normally). They are doing it to help prepare their staff if one of these people needs medical attention, they will know if they tested positive. This seems like something everyone could do.

[Brian Swartz]

I still think we're past the point where tests are the issue. You need sufficient supplies of PPE to justify testing asymptomatic patients without endangering ORs, more critical patients, etc. We don't have that, we don't have the infrastructure & protocols in place to quickly quarantine those who test positive, etc.

[Arles]

I think if you tested 10,000 in a city and 500 tested positive, those people could return home and self-quarantine. It's certainly better than all 10,000 not knowing. We should setup a way for all people working outside of their house to get tested using mobile testing areas or even normal flu swabs administered by a mobile nurse.

[Ben E Lou]

Trump is live on a Fox News town hall making his case for businesses returning to work.

[BishopMVP]

Originally Posted by albionmoonlight

dola:

And I am wrong about this, or should we actually not be testing people with obvious symptoms? Treat them like they have it.

We should be focusing testing on people without symptoms who are in jobs/situations that do not allow them to socially distance.

Right?

How much different is the treatment if you have Corona vs a flu (or bronchitis, or a bad cold) with many of the same symptoms?

Mario - I'm willing to bet that the main reason NYC is so high is that it's the one American city where people across incomes & ages really rely on packed public transportation. If you include the Port Authority coming across the river from Newark it's got about 3x the daily ridership of all other US subway systems combined List of United States rapid transit systems by ridership - Wikipedia (yes, that doesn't include trains, but they're generally not quite as packed.) Our spread out, heavily car dependent culture is bad for emissions but probably really helped delay the spread in the rest of the country while states & governors & the CDC got caught up.

[Brian Swartz]

Originally Posted by Arles

I think if you tested 10,000 in a city and 500 tested positive, those people could return home and self-quarantine. It's certainly better than all 10,000 not knowing.

Absolutely … if you have enough PPE to pull that off. We don't.

[miked]

Originally Posted by Edward64

I get that and that's why I used the phrase "indicative results". If treatment X had indicative results that it seems to work, I'd publish it ... don't over promise, give it the right caveats.

The US public (and world really) needs hope and want to see the light at the end of the tunnel. This hope needs to be backed by science.

These trials that are double-blind need to have many centers, thousands of patients, and the unblinding occurs after months. Also, you can't just publish things without review. Local IRB offices, FDA approvals, these things can happen quickly, but you cannot rush science or you get bad science.

[BishopMVP]

Originally Posted by Arles

I think if you tested 10,000 in a city and 500 tested positive, those people could return home and self-quarantine. It's certainly better than all 10,000 not knowing. We should setup a way for all people working outside of their house to get tested using mobile testing areas or even normal flu swabs administered by a mobile nurse.

If I go back to work at Amazon tomorrow (and I'm leaning 80-90% towards going for the rest of the week, might as well get back on the wagon) I just assume I'll either catch it at some point or I already had it the 2nd half of February. Once they develop the quicker & easier tests you can self-administer that can tell you if you have antibodies I'll look into those, but no point testing me (and all of us) when 1000+ people will be working together & would just need to be re-tested again in a few days.

[spleen1015]

Originally Posted by Ben E Lou

Trump is live on a Fox News town hall making his case for businesses returning to work.

It's all good. My parents are going to be dead but I don't care. My 401k and IRAs are going to reach all new heights.

Lord help us.

[miked]

I know quite a few people that have it that can't get testing. In most cases, due to the lack of tests, the only way they are testing people is if it will change their treatment regimen. Right now, it's essentially the assumption you have it and go home and see what happens. So positive tests and mortality should all be taken with a grain of salt.

[Butter]

Originally Posted by Ben E Lou

Trump is live on a Fox News town hall making his case for businesses returning to work.

So we've finally gotten to peak capitalism. Lives be damned, money is at stake!

[Arles]

I'm not sure why more people aren't using the 3-D printing molds out there. They aren't quite as good as regular masks, but are significantly better than nothing and pretty easy to mass produce:

NanoHack, an open-source 3D printed mask against COVID-19 - 3Dnatives

Daniel Martinez, Innovation Director of Copper3D explains: “The current virus has caused a breakdown in distribution chains around the world. We know that 3D printing can help, but it still takes time – typically it takes about 2 hours to print these masks so it forced us to think collaboratively. We needed a distributed manufacturing concept, with networks of 3D printers running 24/7 to make a large quantity of masks in a short period of time. That’s why we decided to coordinate a global network of startups, manufacturers, universities and partner companies to help us print these masks.“

According to Copper3D, NanoHack incorporates a scalable filtration system that uses a copper nanocomposite that has been proven to broadly inactivate viruses. This system would include several layers of different geometries to ensure effective filtration of fine particles. The mask is to be printed in several parts and then assembled; the company gives clear instructions on its site.

We have some 3-D printers and are looking at using this for our manufacturing site (along with fever screening cameras). We make the raw materials that help produce devices that help run things like ventilators and other medical equipment, so I don't see use being able to take any time off.

[Brian Swartz]

Deaths in Italy spiking again today, and the rise continues in Spain as well

[Ironhead]

Originally Posted by Arles

The 14 days is a "possible" range, but most seem to be from 4-6 days. At which point the 1 week lag probably hits a vast majority of cases.

This was a fair point. I was curious what the numbers looked like today and the CDC has started incorporating additional data into the chart using estimated illness dates. They have also increased the suggested lag in the data by a few days.

Cases in U.S. | CDC

[miami_fan]

So since we being rebellious what happens if I refuse to go home after coming to work obviously showing symptoms?

[whomario]

Originally Posted by Arles

I'm not sure why more people aren't using the 3-D printing molds out there. They aren't quite as good as regular masks, but are significantly better than nothing and pretty easy to mass produce:

NanoHack, an open-source 3D printed mask against COVID-19 - 3Dnatives


We have some 3-D printers and are looking at using this for our manufacturing site (along with fever screening cameras). We make the raw materials that help produce devices that help run things like ventilators and other medical equipment, so I don't see use being able to take any time off.

Doesnt the snippet pretty much explain why not with regard to the time it takes ? Dont you have to swap them out very regularly ? As i understand it in hospitaly, ideally, you should not even wear the same mask for different patients so i assume there is a risk of spreading it after the mask stopped the virus going into your lungs. So at the very least it seems that in a company everybody would have to wear them and only at work.

Might be a solution for a company to produce what they need, but considering the numbers a hospital burns through every day ...

And have they been tested ? Because it is only natural to be less careful when you wear one so if protection ends up being minimal one might actually be worse off. Which is Part of why a lot of scientists are very wary of widespread use of subpar masks in the publics.

Covid-19: 3D-Printed Face Masks for Mass Screening - MedicalExpo e-Magazine

Just to give an idea of the process and timetable even now. Of course you can just print them, but is it really helping then ?

[NobodyHere]

Originally Posted by Edward64

Only 75%?

Ohio has a lot of exemptions to its order.

[JAG]

Originally Posted by Edward64

I get that and that's why I used the phrase "indicative results". If treatment X had indicative results that it seems to work, I'd publish it ... don't over promise, give it the right caveats.

The US public (and world really) needs hope and want to see the light at the end of the tunnel. This hope needs to be backed by science.

WHO launches global megatrial of the four most promising coronavirus treatments | Science | AAAS

EDIT: Or if you prefer NIH studies, here are two:

NIH clinical trial of investigational vaccine for COVID-19 begins | National Institutes of Health (NIH)

NIH clinical trial of remdesivir to treat COVID-19 begins | National Institutes of Health (NIH)

That said, this is a small subset of what are probably hundreds if not thousands of studies currently underway.

[Radii]

Regarding New York, their shortage of beds, ventilators and PPE that is coming very soon is going to cause some disaster scenarios, obviously. I just cannot get over my anger at the specific situation where our federal government will not take the lead on managing and distributing critical equipment and protective gear for doctors to the right places. New York is about to see deaths spike in a devastating way, and worst of all since they're running out of PPE we are going to start seeing doctors and nurses getting sick. It does sadly seem inevitable that some level of this would always happen, but the way this is happening is just incredibly maddening.

I wonder if the national view of the situation will begin to change with this.

Indiana finally went to stay at home orders today, along with Ohio it sounds like. Its equally maddening to see a country like India go on lockdown early because they recognize what's happening elsewhere, while we are still being so incredibly lax in every regard.

[RainMaker]

Originally Posted by panerd

I thought there have been pages upon pages of this thread devoted to how South Korea is handling this and we aren't? South Korea uses this and it may be effective, not exactly magic beans? But good thing JPhillips is on top of worrying about a person that didn't even have COVID19 but went ahead and chose to take his own concoction and died. Useful.

I don't think that drug is why South Korea is succeeding. The article above goes into detail on how they were successful. Just a superior system to ours all around.

There has been one tiny study on the drug and it was quite misleading. Maybe it'll help but I highly doubt this is going to be some miracle drug.

[Lathum]

Originally Posted by Radii

Regarding New York, their shortage of beds, ventilators and PPE that is coming very soon is going to cause some disaster scenarios, obviously. I just cannot get over my anger at the specific situation where our federal government will not take the lead on managing and distributing critical equipment and protective gear for doctors to the right places. New York is about to see deaths spike in a devastating way, and worst of all since they're running out of PPE we are going to start seeing doctors and nurses getting sick. It does sadly seem inevitable that some level of this would always happen, but the way this is happening is just incredibly maddening.

I wonder if the national view of the situation will begin to change with this.

.

I don't think it does. The only thing that may change it is when the really red states, the Alabamas, Mississippis, Texas, etc. start getting hammered. I think a lot of people in those areas are currently seeing this situation as happening in NY, Seattle, LA, etc...and not really worried about it. For a lot of them that may as well be another country, hell, a lot of them are probably thinking those liberals are getting what they deserve. Trump spouts off about game changing cures, so they probably think even if it does get to them they will be able to take some pill and be ok. When it hits them hard, and if Trump continues his rhetoric it will, maybe then they will change their tunes.

[ISiddiqui]

Ugh.. went to check the mail and this woman who was already at the mailbox basically decided to walk past me the other way on the sidewalk so having maybe 2-3 ft of distance... I turned my head the other direction while walking past (and no one was coughing or sneezing) so probably ok, but c'mon lady wait (there is a good amount of space around the mailbox that one can back away and give 6 ft to anyone walking to it)

[spleen1015]

Originally Posted by Radii

Regarding New York, their shortage of beds, ventilators and PPE that is coming very soon is going to cause some disaster scenarios, obviously. I just cannot get over my anger at the specific situation where our federal government will not take the lead on managing and distributing critical equipment and protective gear for doctors to the right places. New York is about to see deaths spike in a devastating way, and worst of all since they're running out of PPE we are going to start seeing doctors and nurses getting sick. It does sadly seem inevitable that some level of this would always happen, but the way this is happening is just incredibly maddening.

I wonder if the national view of the situation will begin to change with this.

Indiana finally went to stay at home orders today, along with Ohio it sounds like. Its equally maddening to see a country like India go on lockdown early because they recognize what's happening elsewhere, while we are still being so incredibly lax in every regard.

Yeah but that's on Cuomo. He could have bought 16k ventilators in 2015 at a discount. Why should the federal government help them now when they didn't help themselves then?

/sarcasm

[sterlingice]

Originally Posted by miked

I know quite a few people that have it that can't get testing. In most cases, due to the lack of tests, the only way they are testing people is if it will change their treatment regimen. Right now, it's essentially the assumption you have it and go home and see what happens. So positive tests and mortality should all be taken with a grain of salt.

Boulder of salt?


SI

[sterlingice]

Originally Posted by RainMaker

I don't think that drug is why South Korea is succeeding. The article above goes into detail on how they were successful. Just a superior system to ours all around.

There has been one tiny study on the drug and it was quite misleading. Maybe it'll help but I highly doubt this is going to be some miracle drug.

The narrative that has been forming for a while is that South Korea is succeeding because of "trace, test, and treat" not chloroquine

SI

[Ironhead]

I was looking for some information around how long patients who die in ICU typically last after being placed on a ventilator and came across this article that talks a little bit more about what the disease actually looks like if you reach that stage of care. Scary stuff.

A Medical Worker Describes Terrifying Lung Failure From COVID-19 — Even in His Young Patients — ProPublica

[SirFozzie]

So Trump is saying that by easter he wants us to be back to normal.

Apparently we're giving up on older people and the immunocompromised for Lent.

There's a class of "christians" who do not worship God. They worship Mammon. (no one here, before people think I'm referring to them)

[Arles]

If the feds just got 10,000 ventilators, who should get them? Should NY get 5K, Seattle get 2K, LA 1K and maybe the rest split? It's kind of a mess if the Feds manage this. IMO (and this may be what they are doing now), the Feds should be a big expense account for supplies. If Wisconsin finds a way to buy 200,000 masks and 2,000 ventilators, the Feds reimburse them. You could also have the reimbursements occur up to a certain level to make sure one state doesn't hoard everything.

I think expecting the feds to manage the distribution of all the equipment and PPE for all the states is a disaster. Hopefully that is not what is going on.