COVID-19 updates

[BJL]

Extending the curve doesn;t change much.  If everyone that's going to get sick gets sick anyway, just over a longer period, deaths will remain pretty much the same.

On the contrary: the death rate can be greatly affected by adequate access to intensive care; in particular, ventilators.

How many times are you going to repeat that claim and ignore what is repeatedly being said in reply (backed by multiple medical/scientific sources): spreading the case load over more time increases the ability of medical facilities to keep up and saves many more lives, reducing the death rate. China outside the original hot-zone of Hubei province has it down to about 1% — and with weeks of lock-downs, not months; South Korea maybe has it under 1% but the data so far is very fuzzy; in Italy instead it is about 4% or higher, maybe far higher, but hopefully the recent lock-downs will soon start showing benefits.

As I said to Slobodan, it is conceivable that you are right while the epidemiological research community as a whole is wrong, but I severely doubt it.

[BJL]

Jeremy, I though Tylenol is acetaminophen.  Why is it more dangerous?

Aside on the name confusion: the full chemical name is something like para-acetyl-amino-phenol; the USA abbreviates it one way (acetaminophen); much of the rest of the world does it another (paracetamol).

[Alan Klein]

On the contrary: the death rate can be greatly affected by adequate access to intensive care; in particular, ventilators.

How many times are you going to repeat that claim and ignore what is repeatedly being said in reply (backed by multiple medical/scientific sources): spreading the case load over more time increases the ability of medical facilities to keep up and saves many more lives, reducing the death rate. China outside the original hot-zone of Hubei province has it down to about 1% — and with weeks of lock-downs, not months; South Korea maybe has it under 1% but the data so far is very fuzzy; in Italy instead it is about 4% or higher, maybe far higher, but hopefully the recent lock-downs will soon start showing benefits.

As I said to Slobodan, it is conceivable that you are right while the epidemiological research community as a whole is wrong, but I severely doubt it.

Relax.  None of us here are virus researchers and experts on this thing. It's the first time the country is dealing with this problem with such drastic national and international action.  We should be exploring all possibilities, causes, outcomes, and methods.  We should not be taking what a couple of so-called experts said as if it came from God. What if they're wrong?  It become a he said she said kind of thing that we wind up repeating here.  So we're all positing our personal opinions or parroting what we've read from other sources.  In any case, you can't get to all the issues without brainstorming.  That's how we all learn stuff.  Trying to shut people up is not what debate is all about.  That's only allowed among Canon and Nikon fanboys.


Getting back to your point about having enough ventilators spread out over a period of time makes sense. I understand what the flattening of the curve they're talking about.  The problem I see is how long do we have to shut down the country?  Is that possible?  How do we feed and take care of people during that time?  Will the cure wind up being worse than the disease?  I don't think we really know and won't until it's all over and we can look at the data then. 

[chez]

Relax.  None of us here are virus researchers and experts on this thing. It's the first time the country is dealing with this problem with such drastic national and international action.  We should be exploring all possibilities, causes, outcomes, and methods.  We should not be taking what a couple of so-called experts said as if it came from God. What if they're wrong?  It become a he said she said kind of thing that we wind up repeating here.  So we're all positing our personal opinions or parroting what we've read from other sources.  In any case, you can't get to all the issues without brainstorming.  That's how we all learn stuff.  Trying to shut people up is not what debate is all about.  That's only allowed among Canon and Nikon fanboys.


Getting back to your point about having enough ventilators spread out over a period of time makes sense. I understand what the flattening of the curve they're talking about.  The problem I see is how long do we have to shut down the country?  Is that possible?  How do we feed and take care of people during that time?  Will the cure wind up being worse than the disease?  I don't think we really know and won't until it's all over and we can look at the data then.

Well look at China that was locked down for what 2 or 3 weeks...now factories are starting up and new cases are declining...so that should give you an idea. But China was really locked down, not on an honour system like here in North America. I would think it might take longer here.

But you keep bringing up this "how long do we need to lock down" issue. Have you heard of any other plan of attack to control this virus now that containment is out of the picture. You seem not to trust the experts...do you have any other experts saying this is wrong? If not, why not really try understand the math and models behind the science rather than continually be so damn pessimistic.

[degrub]

We are not shutting down the country. Critical supplies will move.
Non essentials will not move.
Let the young folks move and deliver supplies. Even if they are infected, more will keep it moving.
Us older folks stay home and out of exposure.
Slante!

[armand]

I'm going to confine all my comments on this thread to the technical side.  Here is the best paper we have on aerosol and surface stability of COVID-19:  https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v1.full.pdf  It is not clear whether warmer months will reduce the environmental stability of the virus though increased sunlight and UV radiation will help.  It's highly doubtful that the virus can be transmitted by mosquitos as this is a mammalian and not an arbovirus. I'm reasonably confident that this is one thing you don't need to worry about.

I've been doing a lot of reading up on what the biopharma industry (my former employer) is doing to counter the pandemic.  Perhaps the best ongoing discussion comes at Derek Lowe's website:  https://blogs.sciencemag.org/pipeline/  He's a drug discovery researcher in the pharma industry.  I pretty much agree with him that there will not be a short term solution in terms of a drug to halt the pandemic.  There are a few number of drugs in trials right now and Gilead's remdesivir, that was a putative Ebola drug, is in trials in the US and China (my understanding is this drug needs to be infused).  Because it was examined during the Ebola outbreak a lot of testing has already been done.  the big problem is it is a complicated drug to manufacture at scale.  A second drug, camostat, is thought to work by preventing entry of the virus into cells; I think there may be a trial underway in China (this drug is approved in Japan so there may be good data regarding safety that could support quick approval).  As Lowe states, that's about it.  It's going to be a hard slog to screen lots of drugs and coming up with novel new approaches is a multi-year project.

One company represented at President Trump's round table two weeks ago, Regeneron, is working on a monoclonal antibody against COVID and stated they could make this at scale in a couple of months.  This would be used in hospital settings for therapy.  This is probably the best solution at hand and it's important to get this into the clinic ASAP.

The best approach is obviously a vaccine.  There are several new approaches to quickly generating vaccine candidates based on RNA and DNA platforms.  Unfortunately, these technologies have not been tested in humans.  IMO, the one major failing of research agencies it was not funding preliminary trials of these platforms to look at safety and whether they were able to generate antibodies.  This type of research could have been done in small trials to assess whether they really work as promised.  We will start to see some early human trials in the next two months on several new vaccine candidates but this will not help resolve the current pandemic.

Some promising in-vitro data for chloroquine also: https://www.nature.com/articles/s41422-020-0282-0
Considering chloroquine's availability and side profile I will use it for the serious cases. I'm not sure yet how easy to get remdesivir will be.
Another protocol is lopinavir/ritonavir +/- ribavirin but I have yet to see data for this.

[armand]

You and me, both.

Forewarned is forearmed, and IIRC, you're not in the highest risk gouping (I am). Latest advice that needs to be heeded: stay away from Nurofen (Ibuprofen), all NSAIDs, if you can - they weaken your immune sytem and stick to Paracetamol.

If the mosquito risk turns out to be real, come back and I'll give you my 'recipe' for MMEAMFT (my most effective anti mosquito flame thrower) ...

There is a lot of talk that preserving the body's mechanism of producing fever is better but little hard data that confirms it. Obviously, if you don't need you don't take it.


Regarding acetaminophen/paracetamol. Up to 4g/day is safe if you have no liver problems, most will try to keep it under 3g/day. If you drink alcohol significantly expect less tolerance to its use.
In the parts of Europe that I know paracetamol can be bought over the counter. In some parts of Europe they still use metamizole.

[Robert Roaldi]

Has anyone heard/read any explanation for why Italy should be so hard hit?

[armand]

“Flattening the curve” = prolonging the misery.

Let it run its course, be done with it, and move on.

No. Life should be the primary target, not the economics which will rebound.
Overwhelm the system and everybody dies, not the just the Covid19 infections.


The sarcastic  would say that in UK they are choosing the herd way because their pensions need help, most deaths will be in the retired group so less money to pay.

[armand]

Has anyone heard/read any explanation for why Italy should be so hard hit?

I can speculate that for once they reacted too late and another reason is that they got hit earlier than the rest of Europe where the bad is yet to come.

[Robert Roaldi]

We should not be taking what a couple of so-called experts said as if it came from God.

It's not just a couple. What do you mean by "so-called"?

We're not talking about interweb-based flat earth skeptics here.

[LesPalenik]

Has anyone heard/read any explanation for why Italy should be so hard hit?

Could be due to their high consumption of Lambrusco wine and olive oil. Or because they hug and kiss so much.

[Alan Klein]

Well look at China that was locked down for what 2 or 3 weeks...now factories are starting up and new cases are declining...so that should give you an idea. But China was really locked down, not on an honour system like here in North America. I would think it might take longer here.

But you keep bringing up this "how long do we need to lock down" issue. Have you heard of any other plan of attack to control this virus now that containment is out of the picture. You seem not to trust the experts...do you have any other experts saying this is wrong? If not, why not really try understand the math and models behind the science rather than continually be so damn pessimistic.

I'm 75 years old and certainly concerned about getting this disease.  On the other hand, at 75, I can't count the number of times I heard experts give totally wrong advice in my life.  I remember when 99% of economists said we were in great shape right before the 2008 recession and collapse of home values and stock prices. All the experts said we were winning in Vietnam and certainly we all remember the Iraq Mission Accomplished sign.

In any case, maybe you're the one being so pessimistic assuming the worst is going to happen, that we should shut down the world to protect ourselves. The argument that there aren't enough ventilators seems to be a rather weak argument and limited tool to shut down the entire country and world.  Maybe we can get 10,000 workers who aren't working now to build what we need in one month so we can get back some normalcy.  Wouldn't that be a better approach?

[Alan Klein]

Could be due to their high consumption of Lambrusco wine and olive oil. Or because they hug and kiss so much.

What a way to go!

[Alan Klein]

I'm 75 years old and certainly concerned about getting this disease. On the other hand, at 75, I can't count the number of times I heard experts give totally wrong advice in my life.  I remember when 99% of economists said we were in great shape right before the 2008 recession and collapse of home values and stock prices. All the experts said we were winning in Vietnam and certainly we all remember the Iraq Mission Accomplished sign.

In any case, maybe you're the one being so pessimistic assuming the worst is going to happen, that we should shut down the world to protect ourselves. The argument that there aren't enough ventilators seems to be a rather weak argument and limited tool to shut down the entire country and world.  Maybe we can get 10,000 workers who aren't working now to build what we need in one month so we can get back some normalcy.  Wouldn't that be a better approach?

Oh I forgot my heart doctor who told me I was in great shape a week before I had a triple bypass. 

[chez]

I'm 75 years old and certainly concerned about getting this disease.  On the other hand, at 75, I can't count the number of times I heard experts give totally wrong advice in my life.  I remember when 99% of economists said we were in great shape right before the 2008 recession and collapse of home values and stock prices. All the experts said we were winning in Vietnam and certainly we all remember the Iraq Mission Accomplished sign.

In any case, maybe you're the one being so pessimistic assuming the worst is going to happen, that we should shut down the world to protect ourselves. The argument that there aren't enough ventilators seems to be a rather weak argument and limited tool to shut down the entire country and world.  Maybe we can get 10,000 workers who aren't working now to build what we need in one month so we can get back some normalcy.  Wouldn't that be a better approach?

Sorry...I'm out. You win. Let's all go hug our neighbours...screw all the people who have been studying pandemics and how they spread their whole lives...what do they know that we don't. Let's all follow Italy's lead...seems things worked out fine for them. Open up those American institutions like McDonalds, Starbucks and Dunkin Donuts...let's all have a party.

[Alan Klein]

Sorry...I'm out. You win. Let's all go hug our neighbours...screw all the people who have been studying pandemics and how they spread their whole lives...what do they know that we don't. Let's all follow Italy's lead...seems things worked out fine for them. Open up those American institutions like McDonalds, Starbucks and Dunkin Donuts...let's all have a party.

OK  I'll give you a hug.  It sounds like you need one. 

[Alan Klein]

CDC recommends people shut down gatherings of all groups of 50 or more for the next 8 weeks.  I suppose that doesn;t include McDonalds or most places of business.
https://www.npr.org/2020/03/15/816245252/cdc-recommends-suspending-gatherings-of-50-or-more-people-for-the-next-8-weeks

[chez]

OK  I'll give you a hug.  It sounds like you need one. 

Nah...not really man. I ain't the one that seems to have been f'd up by everyone around him...especially the "so called" experts.

[Alan Klein]

The Fed to print $700 billion in currency adding to our deficits and debt.
https://www.cnbc.com/2020/03/15/federal-reserve-cuts-rates-to-zero-and-launches-massive-700-billion-quantitative-easing-program.html