Liberty Posted April 23, 2020 Posted April 23, 2020 "BREAKING: Gilead's drug Remdesivir has "flopped" in its first trial, according to the Financial Times"
orthopa Posted April 23, 2020 Posted April 23, 2020 Let me repost my 5 things that people don't understand. [*]Exponential growth [*]It takes weeks between infection and hospitalization and death [*]Hospitals are not infinitely expandable--if enough people come in, hospitals run out of resources [*]If you're in the ICU with this, you are likely in there for weeks [*]That without ventilators, the death rate increases dramatically Maybe #5 not true Some 88% of Covid-19 patients in the New York City area who had to be placed on ventilators subsequently died. https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study?cmpid=BBD042220_BIZ&utm_medium=email&utm_source=newsletter&utm_term=200422&utm_campaign=bloombergdaily Overall, the researchers reported that 553 patients died, or 21%. But among the 12% of very sick patients that needed ventilators to breathe, the death rate rose to 88%. The rate was particularly awful for patients over 65 who were placed on a machine, with just 3% of those patients surviving, according to the results. Men had a higher mortality rate than women. What a crazy stat. As unpleasant as it sounds the best way to not overload the healthcare system is to not put these pts on a ventilator, try everything else possible and let them expire if unsuccessful. All you end up with is an ICU full of pts destined to die with a 3% survival rate. Actually, this mortality rate is an indication that the health care system in NYC was overloaded. A lot of patients admitted to hospitals went straight on the respirator. They probably had already organ damage from oxygen deficiency at that point. Earlier admission with oxygen supplementation (which is what Boris Johnson got) might saved many. The high mortality rate in NYC also indicates such. Overloaded based on what metric? Beds needed were over estimated by 6x, ventilators x 10 times, etc.
clutch Posted April 23, 2020 Posted April 23, 2020 Hindsight is 20-20, but my thoughts on what as happened: - Experts were looking at what was happening in Italy and updated their model parameters with the metrics from Italy (e.g., lethality) for the "worst-case" scenario. - Experts advised the governments to prepare the hospitals and resources according to the worst-case scenario. - It turns out, while COVID-19 is highly contagious (due to its ability to spread via asymptomatic people), the number of fatal cases was not as high as expected. Health care systems in many places were rarely under a strain. - Meanwhile, the obvious fact that COVID-19's lethality rate was disproportionately higher among older people was largely overlooked. Most governments did not take enough preemptive measures to protect those in long-term care homes (and sometimes counter-productive actions as in NY). In Europe and Canada, half of the number of COVID-19's death have come from long-term care facilities.
Cigarbutt Posted April 23, 2020 Posted April 23, 2020 ... This fits with what data looked like early. 0.5% - 1.0% CFR and highly contagious. If anyone has hospitalization/CFR by age bracket in NYC, please post! I'm not sure using the national age brackets makes sense yet. That's too much extrapolation imo, but a 15x - 20x scalar will probably give a reasonable range. i'm not sure what you're looking for exactly and cannot guarantee the validity of data (and there is a small date discrepancy) but it is possible to derive a range of outcomes for CFR which is in the same ballpark. In NYC, about 10 to 15% of people admitted go to ICU and about 20% of people who get admitted don't leave through the front door. https://www.statista.com/statistics/1109831/coronavirus-cases-rates-by-age-new-york-city/ https://www.statista.com/statistics/1109867/coronavirus-death-rates-by-age-new-york-city/
KJP Posted April 23, 2020 Posted April 23, 2020 https://quillette.com/2020/04/23/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons/ Thanks for the link. I read the Quillette article and the journal article from which the diagram was pulled. I understand the theory about how the AC could have pushed droplets from Table A to Table B. But I don't understand how Table C was infected by Table A, given that Table C was upstream from Table A with respect to the airflow from the AC unit. The other diagram in the journal article shows an exhaust fan adjacent to Table B and a dashed line running in the opposite direction of the airflow from the air conditioner. Are they saying that the exhaust fan recirculated contaminated droplets back into the AC system, rather than ventilating them to the outside?
orthopa Posted April 23, 2020 Posted April 23, 2020 Dont think this was posted before but this does put some trade offs within perspective. Avg length of stay once in a nursing home before death was 5 months. https://www.geripal.org/2010/08/length-of-stay-in-nursing-homes-at-end.html End of life was pulled forward ~5 months for the vast majority of COVID19 deaths it seems. The economic vs life cost discussion can get ugly but.....
KJP Posted April 23, 2020 Posted April 23, 2020 Have there been any studies on the virus's ability to spread via HVAC systems in office/multi-family buildings? This is no time for definitive answers and there is potential airborne transmission over long distances. The critical variables are virus load, proximity and one's susceptibility. Unlike other infections (example: Legionella bacteria, Legionnaires' disease) which thrives in ventilation systems and transmits this way), CV does not appear to transmit through ventilation systems. But do you own work. References below. Don't hesitate to ask more questions even if answers cannot be provided. :) https://www.nature.com/articles/d41586-020-00974-w https://msystems.asm.org/content/msys/5/2/e00245-20.full.pdf Personal note: spending time on this will invariably cause you to focus on your environment and to the realization that microbes are terribly ubiquitous. Thanks for the links.
orthopa Posted April 23, 2020 Posted April 23, 2020 https://www.nytimes.com/2020/04/23/us/coronavirus-early-outbreaks-cities.html "Hidden outbreaks were also spreading almost completely undetected in Boston, San Francisco, Chicago and Seattle, long before testing showed that each city had a major problem, according to a model of the spread of the disease by researchers at Northeastern University who shared their results with The New York Times. Even in early February — while the world focused on China — the virus was not only likely to be spreading in multiple American cities, but also seeding blooms of infection elsewhere in the United States, the researchers found." "Unseen carriers of the disease, many of them with mild symptoms or none at all, can still spread the virus. For that reason, by the time leaders in many cities and states took action, it was already too late to slow the initial spread." "The virus moved under the radar swiftly in February and March, doctors and researchers said, because few cities or states had adequate surveillance systems in place. And testing, if it was being done at all, was haphazard. Emergency rooms were busy preparing for the predicted onslaught and likely missed some of early virus-related deaths, and didn’t have time or tools to verify infections on the fly, experts said." "In New York, for example, the model shows that the first 10 infected people could have been walking the streets of the city as early as the last week in January, or as late as the middle of February. From there, the infections in the centers of the outbreak grew exponentially." I am biased but this does fit the spread for weeks/months theory I purposed back in the middle of March. No? The virus very well could have been spreading exponentially (I know you guys like that word) for 6 weeks by the middle of March all across the county. That meshes with the antibody testing from Cuomo today too. As noted above back in early March I contributed to you guys that we were seeing a lot of negative flus in Feb/March in our urgent care network(which spans NY). Nice to see what we were seeing was very likely Covid as suspected and that our flu swabs were not defective etc. Testing would have helped but tx was all the same. Go home and self quarantine. My bolded emphasis above was my rational for not running around testing everyone based on what we were seeing in the clinic/ER. It was too late, sad but true. It will serve more utility going back and hopefully some reasonable method goes into effect to track and trace. My original hope/thought was that we were way further up the curve then we thought back in the middle of March. Im glad for everyones /USAs sake evidence continues to come out that this is the case. I also thinks this makes for an interesting exercise why we didnt see massive healthcare overload across the country esp California at any time in March/April and why NYC, Italy, Spain were the exceptions. The Gov of California is also going back to Dec to test the deceased for antibodies. This is smart IMO and may lead some credence to the discussion cubsfan/Liberty were having about the "bad flu season" California had. Very interesting all of this.
StubbleJumper Posted April 23, 2020 Posted April 23, 2020 https://quillette.com/2020/04/23/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons/ Thanks for the link. I read the Quillette article and the journal article from which the diagram was pulled. I understand the theory about how the AC could have pushed droplets from Table A to Table B. But I don't understand how Table C was infected by Table A, given that Table C was upstream from Table A with respect to the airflow from the AC unit. The other diagram in the journal article shows an exhaust fan adjacent to Table B and a dashed line running in the opposite direction of the airflow from the air conditioner. Are they saying that the exhaust fan recirculated contaminated droplets back into the AC system, rather than ventilating them to the outside? I don't particularly buy the notion that most of the spread to the other tables was from breathing. Usually when you go to a meeting, party, banquet or whatever in a hotel conference room consisting of 6 or 8 round tables of 8 people each, you introduce yourself and shake hands with the people at your table before having supper. And then, if you know another 5 or 6 people from different tables at the same event, you'll probably end up shaking hands with them and exchanging a few words. It's possible that it was the breathing that affected the people immediately beside A1, but it's also quite likely that the shaking of hands transmitted virus to some of the people in that room. The author also made reference to the super-spreader event that occurred at the medical practioners' curling bonspiel in Alberta, and suggested that it could be curlers breathing heavily while sweeping rocks that caused the virus to spread. I don't much buy that because when you sweep, you normally only have a couple of different sweeping partners. However, everybody who has curled knows that you always shake hands before the game to wish each of your four opponents a good game, and then when it's over you once again shake hands with each of your four opponents and thank them for having played a good game. And then all eight of you go to the bar, sit at one of those round tables for eight people, and the four winning players walk to the bar to buy a pint for the four losing players, and if there's enough time, the four losing players return the favour by buying a pint for the four winning players. So, did the curlers mostly catch Covid from breathing on each other, or did they mostly catch it from shaking hands and transferring pint glasses? The quillette article was interesting, but I still remain unconvinced about how the virus was transmitted at some of those events. SJ
Liberty Posted April 23, 2020 Posted April 23, 2020 https://www.ft.com/content/0a4872d1-4cac-4040-846f-ce32daa09d99 A potential antiviral drug for the coronavirus has flopped in its first randomised clinical trial, disappointing scientists and investors who had high hopes for remdesivir, according to draft documents published accidentally by the World Health Organization and seen by the Financial Times. The Chinese trial showed remdesivir — developed by California-based Gilead Sciences — did not improve patients’ condition or reduce the pathogen’s presence in the bloodstream. Researchers studied 237 patients, giving the drug to 158 and comparing their progress with the remaining 79. The drug also showed significant side effects in some, which meant 18 patients were taken off it.
Liberty Posted April 23, 2020 Posted April 23, 2020 https://quillette.com/2020/04/23/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons/ Thanks for the link. I read the Quillette article and the journal article from which the diagram was pulled. I understand the theory about how the AC could have pushed droplets from Table A to Table B. But I don't understand how Table C was infected by Table A, given that Table C was upstream from Table A with respect to the airflow from the AC unit. The other diagram in the journal article shows an exhaust fan adjacent to Table B and a dashed line running in the opposite direction of the airflow from the air conditioner. Are they saying that the exhaust fan recirculated contaminated droplets back into the AC system, rather than ventilating them to the outside? Fluid dynamics is complex, air doesn't move in straight lines or predictable patterns, would be my guess.
clutch Posted April 23, 2020 Posted April 23, 2020 On the NY serology tests.. Great. This is how scientific experts should be critiquing each other. At least this testing method was transparent, but how come prediction models are never shared with the public so that others could review and critique them?
RichardGibbons Posted April 23, 2020 Posted April 23, 2020 I am biased but this does fit the spread for weeks/months theory I purposed back in the middle of March. No? The virus very well could have been spreading exponentially (I know you guys like that word) for 6 weeks by the middle of March all across the county. That meshes with the antibody testing from Cuomo today too. My original hope/thought was that we were way further up the curve then we thought back in the middle of March. Im glad for everyones /USAs sake evidence continues to come out that this is the case. This is quite a clever way of moving the goalposts. Nobody was disputing that the virus was spreading in the USA in March--or even in February. The thing everyone disagreed with was that there hundreds of thousands or millions of cases in March. So I guess this is admission you were wrong while trying to rewrite what you said and what the actual disagreement was about? (Like, good grief--why is it so hard for you to say that your speculation was wrong? It was a speculation, and speculations are often wrong. Why the heck would you allow a random speculation to bias you in such a huge way for everything that came afterward, rather than say, "Hey that speculation was wrong, but this is my view on what's happening now"? So brutal!)
RichardGibbons Posted April 23, 2020 Posted April 23, 2020 Bill Gates' State of the Pandemic essay. https://www.gatesnotes.com/Health/Pandemic-Innovation?WT.mc_id=20200423060000_Pandemic-Innovation_BG-EM_&WT.tsrc=BGEM Other than the obvious (the content), there are a couple things I find interesting. First, the language is simple to the extent that I find it distracting. Maybe it's written at something like a 3rd-4th grade reading level? I think he wants this to be accessible to everyone possible, even those with poor English skills. Second, the reference to opening churches isn't consistent with the rest of the essay, since there's negligible economic value to opening churches, and therefore it's pretty obvious that they should be among the last things open. Rather, I think he threw that in there so that the religious people have a better chance of supporting the approach he proposes.
Gregmal Posted April 23, 2020 Posted April 23, 2020 Well researched to whomever noted the options activity and bs-factor on the GILD study last week.
StubbleJumper Posted April 23, 2020 Posted April 23, 2020 I am biased but this does fit the spread for weeks/months theory I purposed back in the middle of March. No? The virus very well could have been spreading exponentially (I know you guys like that word) for 6 weeks by the middle of March all across the county. That meshes with the antibody testing from Cuomo today too. My original hope/thought was that we were way further up the curve then we thought back in the middle of March. Im glad for everyones /USAs sake evidence continues to come out that this is the case. This is quite a clever way of moving the goalposts. Nobody was disputing that the virus was spreading in the USA in March--or even in February. The thing everyone disagreed with was that there hundreds of thousands or millions of cases in March. So I guess this is admission you were wrong while trying to rewrite what you said and what the actual disagreement was about? (Like, good grief--why is it so hard for you to say that your speculation was wrong? It was a speculation, and speculations are often wrong. Why the heck would you allow a random speculation to bias you in such a huge way for everything that came afterward, rather than say, "Hey that speculation was wrong, but this is my view on what's happening now"? So brutal!) Richard, there are 800k+ confirmed covid cases in the US. Some of the population studies that have recently come to light over the past week suggest that 10x or 20x the confirmed number might be carrying antibodies. If that's actually true (big if), the number of people in the US with antibodies today could be 8 to 16 million. Now, suppose the number of cases has been doubling every week for the past 3 weeks while we have all been social distancing. Working the exponential growth backwards, how many people had antibodies on April 2 if there actually are 8m to 16m that have antibodies today? My rough math is 1 or 2 million in the US? How is that inconsistent with hundreds of thousands or millions during March? SJ
Liberty Posted April 23, 2020 Posted April 23, 2020 Bill Gates' State of the Pandemic essay. https://www.gatesnotes.com/Health/Pandemic-Innovation?WT.mc_id=20200423060000_Pandemic-Innovation_BG-EM_&WT.tsrc=BGEM Other than the obvious (the content), there are a couple things I find interesting. First, the language is simple to the extent that I find it distracting. Maybe it's written at something like a 3rd-4th grade reading level? I think he wants this to be accessible to everyone possible, even those with poor English skills. Second, the reference to opening churches isn't consistent with the rest of the essay, since there's negligible economic value to opening churches, and therefore it's pretty obvious that they should be among the last things open. Rather, I think he threw that in there so that the religious people have a better chance of supporting the approach he proposes. "If every infection goes from causing 2.0 cases to only causing 0.7 infections, then after 40 days you have one-sixth as many infections instead of 32 times as many. That’s 192 times fewer cases." "Entire sectors of the economy are shut down. It is important to realize that this is not just the result of government policies restricting activities. When people hear that an infectious disease is spreading widely, they change their behavior. There was never a choice to have the strong economy of 2019 in 2020."
Guest cherzeca Posted April 23, 2020 Posted April 23, 2020 21% tested positive for antibodies in NYC. 3000 person sample. isn't that consistent with the NYC pregnant woman test? yes cigarbutt, this is akin to the flu.
Gregmal Posted April 23, 2020 Posted April 23, 2020 I find it amusing how everyone wrote off orthopa after a couple days worth of fear driven Twitter posts and bs models. Within a few weeks he was largely mocked. And now all the data is seemingly validating what he said. The notion that there were significantly more cases than testing implied, and that the rise of testing coincided with the rise is confirmed cases, was, or should I say, should have been common sense. Oh well
Liberty Posted April 23, 2020 Posted April 23, 2020 Remember, the sensitivity and specificity of these antibody tests matters a lot, and NYC is very different from the rest of the country, as the epicenter of the epidemic. There's got to be a lot of false positives in those tests even if 99%, and you can't extrapolate it to the rest of the country.
Guest Schwab711 Posted April 23, 2020 Posted April 23, 2020 21% tested positive for antibodies in NYC. 3000 person sample. isn't that consistent with the NYC pregnant woman test? yes cigarbutt, this is akin to the flu. 15% of pregnant woman were actively infected. Larger, random study suggests 21% of NYC population had antibodies. Stock vs flow. I think the pregnant woman study suggests that spread is occurring at the hospital/doctors office ass opposed to representative of the broader population. If pregnant woman were representative, then COVID spreads like measles (even in lockdown) and antibody tests should show some much higher % (or you can be reinfected).
Guest cherzeca Posted April 23, 2020 Posted April 23, 2020 Remember, the sensitivity and specificity of these antibody tests matters a lot, and NYC is very different from the rest of the country, as the epicenter of the epidemic. There's got to be a lot of false positives in those tests even if 99%, and you can't extrapolate it to the rest of the country. who needs to extrapolate to the rest of the country, for goodness sakes!!! apples to apples. NYC is the epicenter of the crisis, and because major media is NYC-centric, the mass hysteria was exported. why does the governor of michigan go stalinesque? because she wants to look like she is on top of things like cuomo. so of course this doesnt have to be extrapolated nationwide, because NYC's experience isn't the nation's experience. this 20% antibody positive rate makes covid less deadly than the flu. and if this result doesnt comport with how you want to think, then just call it a bad test. an inhale some more sand
clutch Posted April 23, 2020 Posted April 23, 2020 Seriously, we should hope that these antibody testing results are accurate. It means that fewer people will die than expected over the course of the pandemic and there is a good chance that we will reach herd immunity before any vaccine is produced. But when you are political, any findings that go against your original narrative is bad news.
Guest cherzeca Posted April 23, 2020 Posted April 23, 2020 Remember, the sensitivity and specificity of these antibody tests matters a lot, and NYC is very different from the rest of the country, as the epicenter of the epidemic. There's got to be a lot of false positives in those tests even if 99%, and you can't extrapolate it to the rest of the country. who needs to extrapolate to the rest of the country, for goodness sakes!!! apples to apples. NYC is the epicenter of the crisis, and because major media is NYC-centric, the mass hysteria was exported. why does the governor of michigan go stalinesque? because she wants to look like she is on top of things like cuomo. so of course this doesnt have to be extrapolated nationwide, because NYC's experience isn't the nation's experience. this 20% antibody positive rate makes covid less deadly than the flu. and if this result doesnt comport with how you want to think, then just call it a bad test. an inhale some more sand NYC: 11,267 deaths divided by 21% of 8,000,000 people=mortality rate of 0.67%. just like the flu.
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