COVID-19 updates

[LesPalenik]

I think this map maybe a little outdated. 

On a Habanos forum I belong to, I have read their are confirmed cases in Cuba now.

The map is there only to show that the virus is now also in the countries with temperatures over 26C.

[Alan Goldhammer]

There is little that is certain and it's currently assumed that once ambient temperatures rise above 26C (80F), the virus will begin to dissipate. It's a bold assumption and not a given. What is safe(r) to assume though is that areas of high humidity provide the environment that allows the virus to fester..

If that is indeed so, it raises the question as to whether the virus can be transmitted via mosquito, as is the case with Dengue and the West Nile Virus

If so, obviously, added high risk in an ongoing pandemic.

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.

[Martin Kristiansen]

We now have 51 cases in South Africa. It’s cooling down as we head into autumn and right now it’s 26 C. I’m in Johannesburg at about 1700m above sea level so we aren’t the warmest part of the country. Most of the country is semi arid or arid although it is the wet time of the year. We had some rain last Friday.

So for what it’s worth. Dry and warm and cases growing at about 20% a day for the last little while. I suppose we can expect it to get worse as it gets colder. We rarely see below freezing in winter but it gets cold. Perhaps the dryness will help. We get no rain for months and months over winter period.

Haven’t noticed any panic. Shops full of people and goods. People are talking about it but mostly just jokes for now. I’m disappointed the rugby season has been shut down.

My concession to stockpiling was to buy 4kg of coffee beans from the DRC and Ethiopia. We will see. 

[Alan Goldhammer]

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.
.

One of the body's natural responses to viral infections is fever.  Fever helps induce the immune system to get going and this results in a slowing down of viral reproduction in the body.  NSAIDS work to inhibit some of the pathways that are part of the fever process and can lower fever.  Paracetamol (Tylenol in the US) does not do this.  It can help reduce aches from a viral infection but does not work to inhibit the protaglandin pathway as NSAIDS do.  My internist's advice was let the fever run its course without intervention if possible.  Of course if you are running a high fever, medical attention is warranted.

[Bart_van_der_Wolf]

On Friday, Trump said 5 million coronavirus tests would be available within a month.
At the current growth rate of the virus (doubling every 3 days in USA), by that time the number of infections could reach 3 millions. Then, in the next 3 days, the infection count would double to 6 millions.

3K, 6K, 12K, 24K, 48K, 96K, 192K, 384K, 768K, 1,536M, 3,072M

IMHO, testing is most effective when trying to contain the virus ("containment phase"). That needs to be done as soon as possible, and that moment seems to have passed when people develop the symptoms without being able to establish the track of individuals that led to that infection. Next comes the "mitigation phase", and then it becomes less relevant to follow the track of infection, if even possible. The tests are mainly needed to test the individuals with severe symptoms, to make sure which curative actions to follow. Those with mild symptoms will recover, whether they have a common flue or Covid-19, regardless of the diagnosis.

And let's face it, 50-60% of the population is likely to contract the virus over time, so it's important to slow down the spread to avoid unnecessary logistical pressure on hospital Intensive Care capacity which is not equipped for treating only Covid-19 patients. There are other patients, e.g. after an operation, who need IC-care as well.

[Robert Roaldi]

"Told you so"s are annoying are not immediately helpful, but it doesn't hurt to hear one now and then if only to keep the ideas front and centre. This is a TED talk by Bill Gates, https://www.youtube.com/watch?v=6Af6b_wyiwI&feature=youtu.be from 2015 about how we weren't preparing well enough for the next pandemic.

One thing that Osterholm brought up in that Rogan podcast I mentioned earlier in the thread was how we fail to follow through when the pressure is off. I now forget which virus vaccine he used as an example (Zika maybe?) but he stated that vaccine development for it has diminished greatly because the disease fell out of the headlines. It is difficult to maintain momentum in a research area when everyone around you, including funding agencies, believe that the problem is gone, but the trouble is that the problem can easily come back. We're not good at long-term funding in some areas. This is odd because we're not bad at in the military arena; we don't start to build aircraft carriers the day AFTER war breaks out, better to build them first and have them ready. So it's not as if we don't know how to do long term. We just make the choice not to. Incentives don't seem to align with what we really need.

[degrub]

Several sources, here's one:
https://www.theguardian.com/world/2020/mar/14/anti-inflammatory-drugs-may-aggravate-coronavirus-infection

Ok, thanks, knew about the fever reduction issue and was thinking there might be some other issue at work. I take naproxen sodium for pinched nerves, but i should be able to tolerate not using it for a week if need be. Fever delirium has its uses  .

[Jeremy Roussak]

UKGOV have just worked out that they'll need additional ventilators (currently 5,000 total in the UK - SKY news this morning), hard on the heels of a blanket ban on mass gatherings - thanks entirely and solely to the intervention of the relevant sporting authorities.  Today, they're now talking about no gathering of more than a 100 people. They should change the 'getting it done' refrain to 'ahead of the curve'

There is no blanket ban on mass gatherings, seemingly for the reasons I explained above. I'm not sure who the "they" talking about no gatherings of more than 100, to which you refer, might be.

It's easy to fall into false analysis: "something must be done; this is something; therefore we must do it". Governments, provoked by the press, do it time after time. Happily, it seems not to be happening in the UK on this occasion.

Gone is the testing for all suspected cases, - you'll only be tested if you are seriously ill in hospital - they now feel the best course to take is achieving herd immunity, basically allowing 80% of the population to succumb to Covid 19 whilst "protecting" those most at risk. This approach is being challenged by many as taking unnecessary risks with the UK population, especially those at increased risk.

The rationale behind not testing all suspected cases is that to be tested, the possibly infected person has to go to the tester, thus potentially spreading the disease. Since treatment is supportive, testing is indicated for epidemiological, not therapeutic, reasons; it doesn't benefit the individual.

And the percentage of infected to deaths will increase? If only the seriously ill get a test....Or am I not reading this correctly?

Yes, inevitably. Those with mild symptoms will not be diagnosed as having coronavirus.

And let's face it, 50-60% of the population is likely to contract the virus over time, so it's important to slow down the spread to avoid unnecessary logistical pressure on hospital Intensive Care capacity which is not equipped for treating only Covid-19 patients. There are other patients, e.g. after an operation, who need IC-care as well.

I'm not sure where you get the 50-60% figure from, but slowing spread is the theme behind the UK government's stepped response.

Jeremy

[Alan Goldhammer]

The Washington Post has a very interesting story about how a single infected person on a Nile River cruise ship led to lots of infections. Several of those live in our Maryland county and traveled widely before they came down with COVID.

[Alan Klein]

New cruise offer

That reminds me of the joke of the old time comedian W.C. Fields.  He really hated Philadelphia and thought it was a disgusting place to live.  So he would quip, "They had a contest.  First prize was a free stay in Philadelphia for one week.  Second prize was two weeks."

His other joke about  Philly was when he said his epitaph should read, "I'd Rather Be Here than in Philadelphia." 

[Alan Klein]

My apologies to my Philadelphia friends.  Actually Philly is a nice place - to visit.  It's less than 2 hours from me. 

[Alan Goldhammer]

One thing that Osterholm brought up in that Rogan podcast I mentioned earlier in the thread was how we fail to follow through when the pressure is off. I now forget which virus vaccine he used as an example (Zika maybe?) but he stated that vaccine development for it has diminished greatly because the disease fell out of the headlines. It is difficult to maintain momentum in a research area when everyone around you, including funding agencies, believe that the problem is gone, but the trouble is that the problem can easily come back.

Osterholm's comments are not entirely correct.  The US Dept of Defense has had a robust research program into vaccines and other treatments for a long time.  Some of the vaccines that will be going into testing came from DOD funded research.  As I said in my earlier post, it was the early stage human trials where data is needed. HERE is a good article on Zika vaccine development and you can see how much work has been done.  I don't know if the results from trials are available.  Look at table 2; some of the companies listed have already announced that they have COVID-19 candidate vaccines.  There are lots of partnerships being formed right now to see how fast things can be developed.

[Alan Klein]

One of the body's natural responses to viral infections is fever.  Fever helps induce the immune system to get going and this results in a slowing down of viral reproduction in the body.  NSAIDS work to inhibit some of the pathways that are part of the fever process and can lower fever.  Paracetamol (Tylenol in the US) does not do this.  It can help reduce aches from a viral infection but does not work to inhibit the protaglandin pathway as NSAIDS do.  My internist's advice was let the fever run its course without intervention if possible.  Of course if you are running a high fever, medical attention is warranted.

Then why do we always try to get down the temperature if fever kills viruses?  Also, doesn;t Tylenol had bad effects on the kidney?

[Alan Goldhammer]

Then why do we always try to get down the temperature if fever kills viruses?  Also, doesn;t Tylenol had bad effects on the kidney?

Tylenol is toxic to the liver in high doses.  It's a very problematic drug.  I cannot answer your first question; only that I try to let fevers run their course.  I get the flu vaccine every year and haven't had seasonal flu in a lot of years.

[Slobodan Blagojevic]

Then why do we always try to get down the temperature if fever kills viruses?...

That's just our, human, overreaction to symptoms. I observed that rule for me and my daughter, i.e., not to immediately try to lower the temperature, unless it gets critically high.

[Bart_van_der_Wolf]

I'm not sure where you get the 50-60% figure from, but slowing spread is the theme behind the UK government's stepped response.

It comes from several sources, including the Dutch National Institute for Public Health and the Environment (RIVM):

It led to shock reactions, the statement of Chancellor Angela Merkel this week that up to 70 percent of the German population will be infected with the coronavirus. But the National Institute for Public Health and the Environment (RIVM) is also taking into account that half of the Dutch population will receive Covid-19 in the coming years, says director of infectious disease control Jaap van Dissel. "That won't happen in a few months, but we're now in a global pandemic. The virus will stay with us, we will have to go through this as a society."

Van Dissel bases his estimate on the so-called international 'reproduction number', the figure that indicates how many people on average become infected by one sick person. This currently fluctuates between 1.5 and 2. If you cross that line, 50 to 60 percent of the Dutch get the virus. That doesn't have to be a disaster, says Van Dissel. "Most people get mild symptoms." However, the RIVM does want to prevent a peak of infections and too much pressure on care by slowing down the spread of the virus. That is the goal of the policy from now on. "Can we spread the wave of infections in such a way that we can continue to provide care to vulnerable patients who need it most?"

https://en.wikipedia.org/wiki/Basic_reproduction_number

We're passed the point of prevention, we need to manage the spread, flatten the curve.

https://upload.wikimedia.org/wikipedia/commons/transcoded/f/f4/COVID19_in_numbers-_R0%2C_the_case_fatality_rate_and_why_we_need_to_flatten_the_curve.webm/COVID19_in_numbers-_R0%2C_the_case_fatality_rate_and_why_we_need_to_flatten_the_curve.webm.480p.vp9.webm

[LesPalenik]

The "doubling" rate for Covid-19 infection cases varies greatly from one country to another.
For example, 33 days in China, 13 days in South Korea, 7 days in Iran, 5 days in Italy, 3 days in Germany, USA, and a few other countries. 27 days globally.
Why are there such huge differences? Is the growth rate accelerating?

https://ourworldindata.org/coronavirus

[Robert Roaldi]

Osterholm's comments are not entirely correct.  The US Dept of Defense has had a robust research program into vaccines and other treatments for a long time.  Some of the vaccines that will be going into testing came from DOD funded research.  As I said in my earlier post, it was the early stage human trials where data is needed. HERE is a good article on Zika vaccine development and you can see how much work has been done.  I don't know if the results from trials are available.  Look at table 2; some of the companies listed have already announced that they have COVID-19 candidate vaccines.  There are lots of partnerships being formed right now to see how fast things can be developed.

Good news.

I might listen to parts of that podcast again, it could have been something else, not Zika. I was in the car at the time.

[chez]

The "doubling" rate for Covid-19 infection cases varies greatly from one country to another.
For example, 33 days in China, 13 days in South Korea, 7 days in Iran, 5 days in Italy, 3 days in Germany, USA, and a few other countries. 27 days globally.
Why are there such huge differences? Is the growth rate accelerating?

https://ourworldindata.org/coronavirus

When you don't test, you don't know. People dying most likely get chalked up to the seasonal flu. What better way for a country to look good...don't test and don't know.

[Alan Klein]

When you don't test, you don't know. People dying most likely get chalked up to the seasonal flu. What better way for a country to look good...don't test and don't know.

Enough of politics already.