Coronavirus

[mcliu]

Odds of second wave due to recent protests globally?

[RichardGibbons]

Bonnie Henry, British Columbia's pandemic leader--who's likely the single person most responsible for BC's success against COVID-19--has said that there hasn't been a pandemic in recorded history that hasn't had a second wave.

 

I have no idea if that's hyperbole, or something built into the definition of pandemic (like, if it doesn't have a second wave, it isn't problematic enough to be called a pandemic). But I'm inclined to believe her.

[Spekulatius]

Sweden is interesting on many levels. Yes, the social measures have been applied, in practice, to similar degrees (despite the first level impression) but there are differences. For instance, daycares and schools (age 16 and under) have remained open. Potential bias: the house is full now and i may overestimate the downside to school closures...They have reported higher numbers in relation to a slightly different application of measures but it is interesting to note that this appears to be a (collective) decision made consciously and with a fair degree of consensus. Also, it appears that keeping schools open may have been a good decision because there is good evidence showing that 1-young individuals don't tend to become COVID+ even with exposure which may be related to a relative absence of receptors (specific to entry of CV) on the surface of cells of their respiratory tracts, 2-even when COVID+, young people tend not to become sick and 3-asymptomatic COVID+ kids don't seem to spread very well (for example, there's this reported case of a young (European) person who turned out to be both influenza+ and CV+, who happened to travel places and the person was quite efficient at spreading the flu but not CV).

 

Cigar but, interesting that you bring up that kids (and probably young people) are not very good spreaders of COVID-19. I’d have looked a fair amount and couldn’t come up with an example where a kid (through school or otherwise) was identified as a superspreader. In Germany, the schools have reopened again a couple of weeks ago, but the superspreader events that did occur were in churches and restaurants involving older people. The absence of evidence is not proof ,but somewhat telling.

 

In any case, the main risk with opening schools is not that the kids get infected, it’s them serving as a vector for transmission to more vulnerable people (teachers, parents ). If that risk is low, than opening the schools starting with smaller kids (who likely have younger parents and teachers ! ) should be strongly considered now.

 

I am likely biased as well, since I have a teenage son at home and we noticed  ( despite seemingly taking the quarantine well) a noticeable degradation in academic performance as well as some psychological issues at home. Not sure what to make of it sample size =1), but our small School district is now trying to hire “emotional coordinator” and based on some hints from other parents, they have similar issues as well. In any case,I believe they if we close the schools for another semester and try to continue online only, we are likely creating a disaster here for the kids. As a parent, I would rather take my (fairly good) chances with the Virus, based on what I know.

[samwise]

The spread is now in Brazil and Russia. Even in India, despite an early lockdown, cases are spreading and they are considering opening up. Bill Gates was despondent about the chances of emerging markets to contain the virus. Seems he was right again.

[John Hjorth]

The spread is now in Brazil and Russia. Even in India, despite an early lockdown, cases are spreading and they are considering opening up. Bill Gates was despondent about the chances of emerging markets to contain the virus. Seems he was right again.

 

Yes samwise,

 

The daily WHO sit reports are to me heartbreaking reads [even taking into consideration that they are the aggregations/consolidations/sums of local reports, of which some may be deemed unreliable]. To me, they read like we haven't seen the worst yet globally.

[John Hjorth]

Jyllandsposten [June 3^rd 2020] : Sweden's state epidemiologist: We should have done more against corona.

 

[original source : Ritzau, ref. lower part of the article.]

 

- - - o 0 o - - -

 

Personally, I'm not sure about what to think about this. Is this just rear mirror wiewing [, that is basically useless, unless used for swift changes of prior decisions made as the situation elvolves over time], or is this a public admittal that the Swedish Corona approach has failed [, where the only logical action for Mr. Tegnell - at least to me - would be to turn in his resignation] ?

[mattee2264]

 

My understanding is that the lockdowns have been pretty effective in getting the R rate well below 1 so even with relaxation of lockdowns and mass protests there is not going to be a deluge of new cases.

[Liberty]

https://www.ft.com/content/dae6d006-9adc-46d5-9b4e-79a7841022e8

 

“ Swedish expert admits country should have had tighter coronavirus controls

Shift comes as Stockholm promises a commission to investigate approach to pandemic”

[Spekulatius]

https://www.ft.com/content/dae6d006-9adc-46d5-9b4e-79a7841022e8

 

“ Swedish expert admits country should have had tighter coronavirus controls

Shift comes as Stockholm promises a commission to investigate approach to pandemic”

 

The problem with the Swedish approach is that it still takes a long time to get the herd immunity. Stockholm was at only 7-8% (if Remember correctly) with the rest of the country far behind.

 

They also have no the problem they the rest of Europe or at least the part who have contained the Virus to very low levels may not allow free border movement from states like Sweden or the UK out of concern of importing cases. They probably need to way of testing everyone coming in.

 

I posted already upstream that the Swedish economy is not doing any better than the rest of Europe anyways. I do think there is a large benefit fit of keeping the schools open and we have to find a way to do this too.

 

Anyways, the Swedish way is sort of a success because they avoided total disaster like Italy, NYC or Spain and their citizens followed the guidelines from the government voluntarily. Their approach seems to be supported by their citizens, so who are we to judge. However, their path Forward seems to be as murky as anyone else’s with a huge economic tolls to pay.

[Cigarbutt]

Jyllandsposten [June 3^rd 2020] : Sweden's state epidemiologist: We should have done more against corona.

[original source : Ritzau, ref. lower part of the article.]

- - - o 0 o - - -

Personally, I'm not sure about what to think about this. Is this just rear mirror wiewing [, that is basically useless, unless used for swift changes of prior decisions made as the situation elvolves over time], or is this a public admittal that the Swedish Corona approach has failed [, where the only logical action for Mr. Tegnell - at least to me - would be to turn in his resignation] ?

That was interesting (the article and your comment). FWIW, i have distant connections to people working in public health who, these days, tend to have difficulty sleeping and who sometimes watch evolving morbid statistics in the middle of the night. From some limited interactions with the Swedish posture, a recurring comment is that their relatively contrarian approach has created "tensions" with their neighbors. Sometimes the best way to get together is to converge. If i'd be the leading figure in Sweden (i'm just a noob though), i'd hope the head of the independent policy office to tender his resignation but would still refuse it by writing "Keep at it" on it.

[John Hjorth]

Cigarbutt,

 

Thank you for your contributions to this topic over time. As an almost total ignorant person in this scientific space it's to me a pleasure and a privilege to read your stuff on the matter at hand.

 

Perhaps my personal opinion about the Swedish Corona approach did shine through in my last post, however I tried to phrase it as carefully as I could, taking my own ignorance into consideration.

 

Today I took the time to actually read the Danish Doctor's Pledge, also ending reading about the WMA Declaration of Geneva, the Hippocratic Corpus & the Hippocratic Oath.

 

Based only on common sense - and with my personal ignorance as basis - I was surprised to see, that just by reading the Danish Doctors Pledge literally and straight out, the application of the Swedish Corona strategy here in Denmark would not be in non-compliance with the Danish Doctors Pledge. [The Danish Doctors Pledge does not mention potential patients, only "patients" [, which I understand as "actual patients"].

 

- - - o 0 o - - -

 

So based on my limited understanding of World Wide ethics among health care professionals I dare ask for some comments and considerations from you - and certainly comments and considerations from the other doctors who have been active in the discussions in this topic are most welcome - on the ethical dimensions of the Swedish Corona strategy.

 

Perhaps needless to post it, but as a layman, I consider it problematic, ref. "Do not do any harm." I sincerely hope this post does not appear as rubbish among the doctors here on CoBF.

[Investor20]

https://www.washingtonexaminer.com/news/influential-hydroxychloroquine-study-used-suspect-data-from-company-run-by-pornographic-model-and-sci-fi-author

 

A study showing that the anti-malaria drug touted by President Trump, hydroxychloroquine, harmed COVID-19 patients is likely based on fabricated data.

 

An investigation by the Guardian found that the study, published in the Lancet (a prestigious medical journal), relied on data from a company called Surgisphere that appears to be highly suspect. The Lancet released an "expression of concern" about the study during the investigation.

 

https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine

Governments and WHO changed Covid-19 policy based on suspect data from tiny US company

 

Surgisphere, whose employees appear to include a sci-fi writer and adult content model, provided database behind Lancet and New England Journal of Medicine hydroxychloroquine studies

 

.........................................

 

While proper studies by NYU Grossman using HCQ, Zinc and Azithromycin showing 44% less deaths in certain Covid patient population and Indian ICMR studies of prophylactic use of HCQ have been ignored.

 

[Cigarbutt]

Perhaps my personal opinion about the Swedish Corona approach did shine through in my last post, however I tried to phrase it as carefully as I could, taking my own ignorance into consideration.

 

Today I took the time to actually read the Danish Doctor's Pledge, also ending reading about the WMA Declaration of Geneva, the Hippocratic Corpus & the Hippocratic Oath.

 

Based only on common sense - and with my personal ignorance as basis - I was surprised to see, that just by reading the Danish Doctors Pledge literally and straight out, the application of the Swedish Corona strategy here in Denmark would not be in non-compliance with the Danish Doctors Pledge. [The Danish Doctors Pledge does not mention potential patients, only "patients" [, which I understand as "actual patients"].

 

- - - o 0 o - - -

 

So based on my limited understanding of World Wide ethics among health care professionals I dare ask for some comments and considerations from you - and certainly comments and considerations from the other doctors who have been active in the discussions in this topic are most welcome - on the ethical dimensions of the Swedish Corona strategy.

 

Perhaps needless to post it, but as a layman, I consider it problematic, ref. "Do not do any harm." I sincerely hope this post does not appear as rubbish among the doctors here on CoBF.

As likely inferred already, i’ve taken that Pledge and often failed miserably. One of the revelations was how much people understand when you do your best and how, especially when suffering, ordinary people spontaneously recognize the difference between human and humane.

 

The Oath itself (and its interpretations) is not so clear. You may be interested in the fact that the origin of the “first do no harm” principle is relatively disputed. Hippocrates did write about ethics of the practice and most of the substance related to the principle can be found in Of The Epidemics (!). Specifically: "The physician must be able to tell the antecedents, know the present, and foretell the future — must mediate these things, and have two special objects in view with regard to disease, namely, to do good or to do no harm." The risk? obviously is to do nothing and somehow the process is very similar to investing. Didn't Mr. Buffett suggest that the first rule was not to lose?

 

Think about that when somebody offers potentially lethal chemotherapy or mutilating surgery. It’s not so easy to reconcile in real life.

 

I like the way you are engaging this discussion and i’m in no way defending Sweden’s strategy but people involved in devising and applying policy in my area often use the analogy that it’s like building a plane while it’s flying. I’d say that’s beyond what even the Musks of this world could achieve gracefully.

 

In addition to the beneficience and non-maleficience potential conflicts inherent to individual patient encounters, public health policy needs to integrate concepts such as efficiency, population health maximization (‘social’ beneficience), justice and proportionality. So it depends on values which are subjective. Think of the general who may need to lose a few battles (sacrifice) in order to win the war. For example, concerning the issue of proportionality (balance or tension between individual rights and collective good, an obvious point of contention in the numerous above posts), i understand that Denmark (just used as an illustration) has the legislative balance tilted most towards the collective side of the argument which brings the topic of the last item: respect of autonomy at the individual and collective level. The first duty is to inform and, ideally, individuals should usually be able to take decisions that minimize failures and collective interventions have to be initiated with care (first, do no harm?). A way to mitigate this at the society’s level is to provide a unified and educated message to gather essential elements of society and reach a critical mass in order to move in the right (civilized) direction. Do i need to say more?

 

That was pretty much useless verbal inflation so to compensate, here’s a link that provides interesting data and analysis as well as some economic correlation. The whole thing has been very humbling.

https://lipperalpha.refinitiv.com/2020/05/fathom-recovery-watch-29-05-2020/?utm_source=Eloqua&utm_medium=email&utm_campaign=00008DL_NewsletterLipperAlphaInsightWeekly&utm_content=Newsletter_InvestmentWeekly_02June2020&elqTrackId=c6126a5396e1467887c07718c78c1120&elq=398d29cf74ab456f97e170b788f4a4c5&elqaid=67000&elqat=1&elqCampaignId=165

 

[jamesmadison]

https://www.washingtonexaminer.com/news/influential-hydroxychloroquine-study-used-suspect-data-from-company-run-by-pornographic-model-and-sci-fi-author

 

A study showing that the anti-malaria drug touted by President Trump, hydroxychloroquine, harmed COVID-19 patients is likely based on fabricated data.

 

An investigation by the Guardian found that the study, published in the Lancet (a prestigious medical journal), relied on data from a company called Surgisphere that appears to be highly suspect. The Lancet released an "expression of concern" about the study during the investigation.

 

All true, except for describing the Lancet as a Prestigious Medical Journal.  They haven't been for a very long time - say going back to publishing that absolute crap about Vaccines causing Autism, which they needed to retract and which caused untold negative consequences.

 

https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine

Governments and WHO changed Covid-19 policy based on suspect data from tiny US company

 

Surgisphere, whose employees appear to include a sci-fi writer and adult content model, provided database behind Lancet and New England Journal of Medicine hydroxychloroquine studies

 

.........................................

 

While proper studies by NYU Grossman using HCQ, Zinc and Azithromycin showing 44% less deaths in certain Covid patient population and Indian ICMR studies of prophylactic use of HCQ have been ignored.

 

 

All true except the comment about Lancet being a prestigious medical journal.  They lost that title many years ago when they published that garbage about Vaccines causing Autism, which they had to retract and which caused untold misery

[jamesmadison]

The cognitive dissonance occurring now that millions have decided to say "screw the lockdowns" but for the politically correct reasons is mind blowing.

 

https://www.nationalreview.com/news/not-the-same-question-de-blasio-says-businesses-churches-to-remain-closed-even-as-demonstrators-flout-lockdowns/?utm_source=recirc-desktop&utm_medium=homepage&utm_campaign=river&utm_content=featured-content-trending&utm_term=first

 

And of course, they don't even realize their own massive hypocrisy.  The lockdowns are either needed to prevent a massive pandemic or not.  In what insane alternate universe is there an exception for massive gatherings for just causes???

[jamesmadison]

Surgisphere, whose employees appear to include a sci-fi writer and adult content model, provided database behind Lancet and New England Journal of Medicine hydroxychloroquine studies

 

 

Some more details:

 

 

Make sure to turn volume up to hear the appropriate sound effects.

 

Lancet and NEJM covering themselves in glory.  It's almost like they wanted the results to be true so much that they didn't want to actually check the source out too carefully.

[clutch]

^^^

All these things show you just how everything in the US is political and the truth/good simply depends on whether it fits your political narrative or not.

 

Many people, even those highly educated, cannot think on their own and simply fall along the lines of left or right. Bipartisan democracy at its finest.

[jamesmadison]

^^^

 

Yup.  Covid (and the riots) have really brought this to the fore.

[widenthemoat]

I've found this whole experience to be incredibly eye-opening. Some of these politicians make me sick. Every time I read the news, all I can think of is Atlas Shrugged and how spot on Ayn Rand was with some of this stuff. It's honestly quite depressing.

[clutch]

I wonder if any health official would risk their career to criticize the protests?

 

In some sense I am glad that this shows you that so called "public health" is not the absolute priority and human rights (and freedom) can be more important...

 

Someone should ask Cuomo: "are these protests better than death?"

[jamesmadison]

It's worse (or perhaps simply more ironic) than that.  If you take these feckless politicians at their word, they are (a) encouraging the protests, which according to their own logic will result in additional deaths from Covid but (b) decrying the rioting which has resulted in massive property damage primarily. Think about it.  What they are saying is that the cause (social justice, ending racism, etc.) trumps lives but not property!!  These morons couldn't logic their way out of a paper bag.  They are human mobius strips.

[LongHaul]

DHS testing presentation leak with a few summary findings  (Note this is from April but I thought it was interesting.)

 

https://www.scribd.com/document/456897616/DHSST#download&from_embed

[*]

Virus is most stable in cool/dry conditions.

[*]Virus decays/inactivates faster in warmer and more humid environments.

• 
  Aerosol Stability - Virus is very stable in No Solar conditions.  Opening windows may help reduce indoor exposure.
  
• Sunlight rapidly inactivates Virus Half Life:  Full Intensity: 2 Min, Half: 3 Min, Quarter: 4 Min
   
  
• 
  

[jamesmadison]

That's why enforcing a lockdown and keeping as many people inside as possible was so important and such a great idea!

[cwericb]

It is rather ironic that if you intend to break the law, its a great time to wear a mask.

 

Over the next couple of weeks should we expect to see a spike in Covid due to the mass protests?

Or will the warmer weather offset the effects of the large gatherings.

 

Predictions?

[Cigarbutt]

https://www.washingtonexaminer.com/news/influential-hydroxychloroquine-study-used-suspect-data-from-company-run-by-pornographic-model-and-sci-fi-author

 

A study showing that the anti-malaria drug touted by President Trump, hydroxychloroquine, harmed COVID-19 patients is likely based on fabricated data.

 

An investigation by the Guardian found that the study, published in the Lancet (a prestigious medical journal), relied on data from a company called Surgisphere that appears to be highly suspect. The Lancet released an "expression of concern" about the study during the investigation.

 

https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine

Governments and WHO changed Covid-19 policy based on suspect data from tiny US company

 

Surgisphere, whose employees appear to include a sci-fi writer and adult content model, provided database behind Lancet and New England Journal of Medicine hydroxychloroquine studies

 

.........................................

 

While proper studies by NYU Grossman using HCQ, Zinc and Azithromycin showing 44% less deaths in certain Covid patient population and Indian ICMR studies of prophylactic use of HCQ have been ignored.

You seem to have high conviction about hydroxychloroquine.

Just released, is a multi-center trial that appears to be very solid evidence in relation to the role as prevention post-exposure. Conclusion: it seems hydroxychloroquine, in that context, is neutral: no significant side effects and no benefit.

https://www.nejm.org/doi/pdf/10.1056/NEJMoa2016638?articleTools=true

The main investigator is based in Minneapolis. Not everything that comes out of that place is questionable.