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Discussion thread III - Covid-19 (new coronavirus)

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  • Originally posted by Emily View Post

    That could certainly be the case, gsgs. I saw that 2 deaths are reported now in Germany. I did wonder if they might have a milder strain there. I hope the numbers stay better there for whatever reason. The initial cases in Germany seemed very mild, including the visitor from China and her parents' cases, if I have that right. The initial case in the Seattle area seemed rough for a non-smoker in his 30's with just a history of hypertriglyceridemia.

    The earliest case in Italy also sounds like it was rough for a person that was only 38. So maybe there are strain differences.
    It seems to be the demographics of the earliest cases in Germany. The earliest points of entry seem to have been two festivals and then people returning from ski holidays in Northern Italy. A significant number of these were younger people. There were very few aged in the at risk category 70+. It is likely that once the initial "seeding" is over, Germany will start to exhibit the same patterns that we've seen elsewhere.
    Twitter: @RonanKelly13
    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

    Comment


  • I've seen data from Italy that includes the number of COVID-19 patients who are hospitalized and the number of patients needing critical care.

    Is there any data for the United States detailing how many of those who tested positive are hospitalized? What about ICU patients?

    Also, is there data available about the total number of ICU beds across the country?

    Comment


    • I'm not sure of the source of the data for the graphs posted by @StrategyMacro on Twitter, but the age distribution for those testing positive for the coronavirus in South Korea shows a huge bump in the 20-29 age bracket. Is this type of bump seen in other countries?

      Link to tweet: https://twitter.com/StrategyMacro/st...097590272?s=20

      Comment


      • I don't think there are any important differences in circulating strains. All very similar, no critical mutations, corona does proofreading
        --------------------------------------------
        South Korea is unusual because of all this Shincheonji (or such) sect testing
        I'm interested in expert panflu damage estimates
        my current links: http://bit.ly/hFI7H ILI-charts: http://bit.ly/CcRgT

        Comment


        • Emily
          Emily commented
          Editing a comment
          Thank you, gsgs. Sounds good to me.

      • The @ are the governor and 2 senators.


        FluTrackers.com
        @FluTrackers

        Is it statistically possible no #coronavirus cases in Orlando area?

        "Orlando, Florida, had 75 million visitors last year (2018) as the theme park mecca continued to be the most visited destination in the US." https://usnews.com/news/us/articles/2019-05-09/still-most-visited-place-orlando-had-75-million-visitors…


        @RonDeSantisFL @SenRickScott @marcorubio

        Comment


        • I was looking for NPIs in 1918 , this thread : https://flutrackers.com/forum/forum/...rts-and-graphs

          most of the links no longer work. I found this .pdf on my HD, which I want to share :
          US cities's measures and (their effect on ?) mortality in 1918/19
          http://magictour.free.fr/1918c2.pdf

          they don't consider possible immunity from the spring wave, there should be a picture from me
          about the cities in the spring wave here ~1-2 years ago
          I'm interested in expert panflu damage estimates
          my current links: http://bit.ly/hFI7H ILI-charts: http://bit.ly/CcRgT

          Comment





          • FluTrackers.com
            @FluTrackers

            42s

            Please help us.

            @RonDeSantisFL @SenRickScott @marcorubio

            "Our research indicates that, as of 03/01/2020., it is likely that there are already thousands of individuals in the US infected with SARS-CoV-2." https://medrxiv.org/content/10.1101/2020.03.06.20031880v1…

            #coronavius #COVIDー19 #SARSCoV2 #iloveflorida

            Comment


            • A Must Watch: Coronavirus ‘worse than a bomb’ on Italy, says doctor coordinating response

              https://www.youtube.com/watch?v=9mrPHO-nkVE

              Comment


              • I find it surprising that the median age is 65 in Lombardy...Does anyone recall what is in Wuhan? Could be that Lombardy is very much like Wuhan...it was flying under the radar then took off and deaths began mounting up. The fact that there is a high percentage of elderly in Lombardy could be a factor in the death rate. But I'm wondering if there is more too it...particularly given the median age. In China, there were 2 strands of Covid...one milder, the other aggressive, Could this be at work there?

                Comment


                • Originally posted by Pathfinder View Post

                  4) Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY ‚€œcold-like‚€Ě symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available.

                  I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.

                  I hope these personal thoughts will be helpful during this potentially catastrophic pandemic. You are welcome to share this email. Good luck to all of us!
                  Worth noting here that Dr. James Robb did not intend this to be widely disseminated and did not mean this as an endorsement for a specific product (zinc lozenges). Zinc's role as an antiviral is disputed at best and may be harmful (some of the manufacturers of these zinc lozenges have faced lawsuits for causing anosmia -- loss of smell -- in consumers). https://www.snopes.com/fact-check/zi...s-coronavirus/

                  I would caution against jumping to zinc as a magic bullet on this advice alone.

                  Comment


                • Something else to share, here (reproduced exactly as I received it):

                  3/8/2020

                  Notes from the front lines:

                  I attended the Infectious Disease Association of California (IDAC) Northern California Winter Symposium on Saturday 3/7. In attendance were physicians from Santa Clara, San Francisco and Orange Counties who had all seen and cared for COVID-19 patients, both returning travelers and community-acquired cases. Also present was the Chief of ID for Providence hospitals, who has 2 affected Seattle hospitals under his jurisdiction. Erin Epson, CDPH director of Hospital Acquired Infections, was also there to give updates on how CDPH and CDC are handling exposed health care workers, among other things. Below are some of the key take-aways from their experiences.

                  1. The most common presentation was one week prodrome of myaglias, malaise, cough, low grade fevers gradually leading to more severe trouble breathing in the second week of illness. It is an average of 8 days to development of dyspnea and average 9 days to onset of pneumonia/pneumonitis. It is not like Influenza, which has a classically sudden onset. Fever was not very prominent in several cases. The most consistently present lab finding was lymphopenia (with either leukocytosis or leukopenia). The most consistent radiographic finding was bilateral interstitial/ground glass infiltrates. Aside from that, the other markers (CRP, PCT) were not as consistent.
                  2. Co-infection rate with other respiratory viruses like Influenza or RSV is <=2%, interpret that to mean if you have a positive test for another respiratory virus, then you do not test for COVID-19. This is based on large dataset from China.
                  3. So far, there have been very few concurrent or subsequent bacterial infections, unlike Influenza where secondary bacterial infections are common and a large source of additional morbidity and mortality.
                  4. Patients with underlying cardiopulmonary disease seem to progress with variable rates to ARDS and acute respiratory failure requiring BiPAP then intubation. There may be a component of cardiomyopathy from direct viral infection as well. Intubation is considered “source control” equal to patient wearing a mask, greatly diminishing transmission risk. BiPAP is the opposite, and is an aerosol generating procedure and would require all going into the room to wear PAPRs.
                  5. To date, patients with severe disease are most all (excepting those whose families didn’t sign consent) getting Remdesivir from Gilead through compassionate use. However, the expectation is that avenue for getting the drug will likely close shortly. It will be expected that patients would have to enroll in either Gilead’s RCT (5 vs 10 days of Remdesivir) or the NIH’s “Adaptive” RCT (Remdesivir vs. Placebo). Others have tried Kaletra, but didn’t seem to be much benefit.
                  6. If our local MCHD lab ran out of test kits we could use Quest labs to test. Their test is 24-48 hour turn-around-time. Both Quest and ordering physician would be required to notify Public Health immediately with any positive results. Ordering physician would be responsible for coordinating with the Health Department regarding isolation. Presumably, this would only affect inpatients though since we (CHOMP) have decided not to collect specimens ordered by outpatient physicians.
                  7. At facilities that had significant numbers of exposed healthcare workers they did allow those with low and moderate risk exposures to return to work well before 14 days. Only HCW with highest risk exposures were excluded for almost the full 14 days (I think 9 days). After return to work, all wore surgical masks while at work until the 14 days period expired. All had temperature check and interview with employee health prior to start of work, also only until the end of the 14 days. Obviously, only asymptomatic individuals were allowed back.
                  8. Symptom onset is between 2-9 days post-exposure with median of 5 days. This is from a very large Chinese cohort.
                  9. Patients can shed RNA from 1-4 weeks after symptom resolution, but it is unknown if the presence of RNA equals presence of infectious virus. For now, COVID-19 patients are “cleared” of isolation once they have 2 consecutive negative RNA tests collected >24 hours apart.
                  10. All suggested ramping up alternatives to face-to-face visits, tetemedicine, “car visits”, telephone consultation hotlines.
                  11. Sutter and other larger hospital systems are using a variety of alternative respiratory triage at the Emergency Departments.
                  12. Health Departments (CDPH and OCHD) state the Airborne Infection Isolation Room (AIIR) is the least important of all the suggested measures to reduce exposure. Contact and droplet isolation in a regular room is likely to be just as effective. One heavily affected hospital in San Jose area is placing all “undifferentiated pneumonia” patients not meeting criteria for COVID testing in contact+droplet isolation for 2-3 days while seeing how they respond to empiric treatment and awaiting additional results.

                  Feel free to share. All PUIs in Monterey Country so far have been negative.

                  Martha.

                  Martha L. Blum, MD, PhD

                  Comment


                  • JJackson
                    JJackson commented
                    Editing a comment
                    Thanks Dexxy these kinds of accounts are very helpful in understanding the severity of the problems faced by HCWs in hot spots. Looking at the big picture numbers can make you forget the reality that most come from very small geographical areas where a hand full of hospitals are swamped while an hours drive away you could be forgiven for not realising anything was going on.

                • Shiloh, http://magictour.free.fr/study17.pdf
                  ~55.4 in Wuhan , 52.3 in Hubei , 50.5 in China

                  [travelers, HCW, residents(family infection]
                  Last edited by gsgs; March 11, 2020, 05:41 AM.
                  I'm interested in expert panflu damage estimates
                  my current links: http://bit.ly/hFI7H ILI-charts: http://bit.ly/CcRgT

                  Comment


                  • Shiloh
                    Shiloh commented
                    Editing a comment
                    Thank you!

                • Hi guys, just a few questions I was hoping someone might have some leads on for me. I'm wondering if anyone has seen any recent data on the routes of spread of the virus? I know in the WHO conference last week they said they were working on studies for this, I'm just wondering if it is out and I just haven't seen it yet. (I saw one of the early ones out of China, but it sounded like the studies they were doing were far more extensive). Also has anyone heard anything about the follow up antibody testing(probably called something else)? When the surveillance team came back from China they mentioned that this will be an important follow up to see if there was truly more people infected than what was caught in testing (although if I recall correctly they did not find this very likely due to the number of people being tested in the country at that time). Not sure if anyone has seen when they might start that work. With Xi going into Wuhan this week I figured things must have calmed down to a level where they might be doing this work now.

                  I'm just stumped right now on the spread we have been seeing, as I know many of you have commented on as well. When you look back at the early cases in the US I would have expected more cases from those original ones. I get the thought that maybe there is greater unknown spread, but don't you think we would have seen at least more severe cases pop up in those unknown groups? Probability wise it seems pretty lucky that more have not sprouted. You had infected people on airplanes, taking transportation, etc. and yet it appears that no one in their path was infected and I have not seen any of the groups being watched due to those cases come up positive (except the husband in Chicago). Just seems odd and doesn't add up to what we saw in Wuhan or now Italy.

                  Comment


                  • Emily
                    Emily commented
                    Editing a comment
                    Good questions! I wondered about the differences between Germany and Italy. Gsgs thinks it could be timing. That makes sense since Seattle was the first case in the US and now we see havoc in nursing homes there.
                    I've wondered also about population differences as far as previous infections and chronic infections.
                    https://www.biorxiv.org/content/10.1...841v1.abstract
                    There could be many factors we don't understand.

                  • Vibrant62
                    Vibrant62 commented
                    Editing a comment
                    Also - pure supposition at the moment - it is possible that the early cases were predominantly the S type variant (less transmissible, less virulent) and these latter ones are more closely related to the L type variant. Has there been genetic analysis of these later and earlier cases to compare?

                  • JJackson
                    JJackson commented
                    Editing a comment
                    The serology testing is underway but there are no results yet and I have not seen any ETA. re routes are you asking about fomites/droplets or where new cases came from (air routes). I have not seen anything very reliable on the former, the later can be derived from the phylogenic tree at nextstrain.org

                • re
                  Also - pure supposition at the moment - it is possible that the early cases were predominantly the S type variant (less transmissible, less virulent) and these latter ones are more closely related to the L type variant. Has there been genetic analysis of these later and earlier cases to compare?
                  I saw this claim but am not sure how they came to the ORF8 L84S virulence change conclusion. The Lysine branch is active in the US, Canada and Korea while the Serine is causing European & Aus/NZ cases. All of these are fairly new and the stage of outbreak, and different health care settings & measures, are going to make it difficult to say anything definitive about differences in virulence i.e. there is a lot more going on than the one AA genetic change. There is one sequence, collected in S Korea on the 6th Feb., which is in the middle of the L sequences which independently also underwent L84S, which might mean this has some function, but its branch seems to have no progeny. N.B GISAID only has 326 sequences out of 100k cases so it may still be alive and well but not sampled. Iran still has no sequences and very little is coming out of China as they only reported 20 cases yesterday, 17 coming from Hubei. There some graphics showing this data here https://flutrackers.com/forum/forum/...rs-cov-2%C2%A0
                  Last edited by JJackson; March 11, 2020, 09:27 AM.

                  Comment



                  • Officially a Pandemic.

                    1) Review your personal situation. Get prepared.

                    2) Ask work what their plan is.

                    3) Get a "Flu" Buddy and/or a small group together for support.

                    4) There will be disruptions to your life.

                    5) Plan strategies for extended period.

                    #coronavirus

                    Comment

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