Coronavirus

[Mephistopheles]

 

Yawn. Discussing drug candidates on forums, Twitter, or even by this President is not going to help anything. A lot of pharma investors have gone broke betting on trials using similar rationale. There's been a lot of misinformation about COVID and drugs that CANNOT be verified unless a randomized clinical trial is completed. Anti-HIV agents. IV Vitamin C. Ibuprofen making COVID worse. A lot of noise out there that cannot be trusted.

 

Hydroxychloroqine/Chloroquine is primarily anti parasite and immunosuppressant (why it works for RA which is an autoimmune disease). Taking an immunosuppressant when you have an infection could make things worse (compromising your defenses) or it could make them better (may reduce inflammatory damage to lungs in this case). It may also have antiviral effects but it is never used clinically for that and you have the immunosuppressive action which can make a viral infection much worse. But I'm not relying on Trump or random Tweets to draw conclusions. Good luck waiting for that trial result.

 

Azithromycin for this is just plain stupid. See image.

 

You realize Malaria is also an infection right?

 

Obviously a clinical trial would take a long time. But time is not what we have on our side in a pandemic, and we have to rely on the best data we have. Take a look at this report by French providers:

 

https://www.sciencedirect.com/science/article/pii/S0924857920300996

 

Lol at "Azithromycin is an antibiotic". So dismissive. I highly suggest you read the evidence on synergistic effects of Azithromycin+Plaquanil in malaria:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170143/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944689/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC127390/

 

I'm not relying on Trump or Twitter either

 

The mechanism of action of Chloroquine and related compound on heme in RBCs and therefore malaria is known. COVID has nothing to do with RBCs.

 

Azithromycin is a very commonly used antibiotic. Coronaviruses are not new.

 

There is very little real evidence out there that these drugs would work against COVID. Obviously if there is a patient who is very ill and nothing else is working, it may be worth a shot, but the French study showing a combination of Azithro + Hydroxychloro is very very flawed and you can read what's out there from physicians & scientists on how poorly constructed that study was.

 

I am not here to discuss pharmacology anyway.

 

I think probabilistically and I my estimates for Azithro working is not zero, but close. Hydroxychloro is higher, but it's not significant and nowhere close to 50%. Remdesivir sounds more promising, but we'll have to wait.

 

This thread has taken up much of my time the past month or so I've been sounding the alarms on this. Glad to see some people out in the real world finally taking this seriously. Hope many patients can be spared from the worst of this, and glad to have a real leader in Gov Cuomo.

 

Again not the point. But your whole argument that you cannot use immunosuppressants in infections is totally flawed. Malaria is an infection and immunocompromised people are at a higher risk YET it is still recommended to treat with hydroxychloroquine.

 

Also saying "azithromycin for this is plain stupid (because it's an antibiotic)" is just dismissive and again a flawed point which contradicts the real medical evidence that is established.

 

Perhaps the antiinflammatory affects of the drug reduce odds of ARDS. We'll find out eventually.

 

And nobody is saying that there is substantial evidence to treat COVID. University of Minnesota started a double blind study recently, we'll see what comes about. I'm just trying to correct misinformation.

[Guest cherzeca]

"Hydroxychloroqine/Chloroquine is primarily anti parasite and immunosuppressant (why it works for RA which is an autoimmune disease)."

 

it has been prescribed for RA.  but it doesn't work effectively for RA.  with the development of biologics, only a fool would continue to prescribe for RA.

[LongHaul]

I appreciate people putting a lot of info and great articles on here.

 

Is anyone else frustrated with the current US situation?

 

I think the most effective way to kill the virus would be to:

 

1.  Shelter in place the entire US population.  Stay in your homes except for supermarkets and essentials.  Essentially copy China strict policy and enforce it.

Perhaps a 3 week shelter in place would be good to start.

This would:

1. Allow more testing to ramp up

2. Kill the R0 to <.5 (my guess) if implemented correctly and thus bring the virus transmission down.

3.  By the end of the 3 weeks (or more) we can hopefully test almost everyone and then quarantine those testing postiive.

 

Essentially I am trying to come up with a solution that kills the virus as soon as possible and results in the least amount of people getting Covid and the most lives saved.

The Goal should be a RO of ZERO.

 

Our leadership at the national level is dragging their feet as a result millions more will likely get Covid 19 and the economy will be shit for far longer. 

 

I feel like making a petition to petition the US GOVT to enact a nation shelter in place.  Thoughts?

Better to be proactive than reactive.

[orthopa]

 

Yawn. Discussing drug candidates on forums, Twitter, or even by this President is not going to help anything. A lot of pharma investors have gone broke betting on trials using similar rationale. There's been a lot of misinformation about COVID and drugs that CANNOT be verified unless a randomized clinical trial is completed. Anti-HIV agents. IV Vitamin C. Ibuprofen making COVID worse. A lot of noise out there that cannot be trusted.

 

Hydroxychloroqine/Chloroquine is primarily anti parasite and immunosuppressant (why it works for RA which is an autoimmune disease). Taking an immunosuppressant when you have an infection could make things worse (compromising your defenses) or it could make them better (may reduce inflammatory damage to lungs in this case). It may also have antiviral effects but it is never used clinically for that and you have the immunosuppressive action which can make a viral infection much worse. But I'm not relying on Trump or random Tweets to draw conclusions. Good luck waiting for that trial result.

 

Azithromycin for this is just plain stupid. See image.

 

You realize Malaria is also an infection right?

 

Obviously a clinical trial would take a long time. But time is not what we have on our side in a pandemic, and we have to rely on the best data we have. Take a look at this report by French providers:

 

https://www.sciencedirect.com/science/article/pii/S0924857920300996

 

Lol at "Azithromycin is an antibiotic". So dismissive. I highly suggest you read the evidence on synergistic effects of Azithromycin+Plaquanil in malaria:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170143/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944689/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC127390/

 

I'm not relying on Trump or Twitter either

 

The mechanism of action of Chloroquine and related compound on heme in RBCs and therefore malaria is known. COVID has nothing to do with RBCs.

 

Azithromycin is a very commonly used antibiotic with some antimalarial properties. Malaria is not a virus. The evidence that Azithro could work against viruses is not really out there. Coronaviruses are not new either.

 

There is very little real evidence out there that these drugs would work against COVID. Obviously if there is a patient who is very ill and nothing else is working, it may be worth a shot, but the French study showing a combination of Azithro + Hydroxychloro is very very flawed and you can read what's out there from physicians & scientists on how poorly constructed that study was.

 

I am not here to discuss pharmacology anyway.

 

I think probabilistically and I my estimates for Azithro working is not zero, but close. Hydroxychloro is higher, but it's not significant and nowhere close to 50%. Remdesivir sounds more promising (and unlike any other drug that's being discussed something that targets single stranded RNA viruses), but we'll have to wait.

 

This thread has taken up much of my time the past month or so I've been sounding the alarms on this whole COVID thing. Glad to see some people out in the real world finally taking this seriously. Hope many patients can be spared from the worst of this, and glad to have a real leader in Gov Cuomo.

 

I'm out.

 

Your not "out". Your locked down in NYC for the next 4-6 weeks who are you kidding. What else do you have to do in your 300 sq ft apartment besides argue with guys you have never met.  ;D

[Liberty]

Bad title but interesting article: https://www.haaretz.com/israel-news/.premium.MAGAZINE-israeli-expert-trump-is-right-about-covid-19-who-is-wrong-1.8691031

[tede02]

 

Our leadership at the national level is dragging their feet as a result millions more will likely get Covid 19 and the economy will be shit for far longer. 

 

I feel like making a petition to petition the US GOVT to enact a nation shelter in place.  Thoughts?

Better to be proactive than reactive.

 

It seems like many states and the federal government are taking a wait and see approach as the number of confirmed cases grows. Based on everything I've read, a national shutdown should have started last week if there was going to be any chance of significantly slowing the spread down. It looks like we're too late. By the time the president announces a national shelter in place, the numbers are going to be off the charts. My personal expectation is the US is a week or two behind Europe. The only upside is it might be over faster. My wife works in healthcare and they are preparing for an onslaught. One large hospital in the Minneapolis area has apparently been working to convert an entire floor to ICU beds.

[Liberty]

https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

 

Another good read: The Hammer and the Dance

[Spekulatius]

 

Our leadership at the national level is dragging their feet as a result millions more will likely get Covid 19 and the economy will be shit for far longer. 

 

I feel like making a petition to petition the US GOVT to enact a nation shelter in place.  Thoughts?

Better to be proactive than reactive.

 

It seems like many states and the federal government are taking a wait and see approach as the number of confirmed cases grows. Based on everything I've read, a national shutdown should have started last week if there was going to be any chance of significantly slowing the spread down. It looks like we're too late. By the time the president announces a national shelter in place, the numbers are going to be off the charts. My personal expectation is the US is a week or two behind Europe. The only upside is it might be over faster. My wife works in healthcare and they are preparing for an onslaught. One large hospital in the Minneapolis area has apparently been working to convert an entire floor to ICU beds.

 

Many countries have effectively shelter in place . Germany has is for a couple days and they have escalated compliance today. It’s too early as there seems to be some weekend reporting effect (with lower numbers on weekends) but the numbers of new infections have begun to show promising trends and so far, the Heath care system is holding up. I think people have come to realize the seriousness last week and compliance has improved, which wasn’t the case in Italy at all.

 

US is still in the exponential growth phase so who knows how it ends.

[tede02]

 

Our leadership at the national level is dragging their feet as a result millions more will likely get Covid 19 and the economy will be shit for far longer. 

 

I feel like making a petition to petition the US GOVT to enact a nation shelter in place.  Thoughts?

Better to be proactive than reactive.

 

It seems like many states and the federal government are taking a wait and see approach as the number of confirmed cases grows. Based on everything I've read, a national shutdown should have started last week if there was going to be any chance of significantly slowing the spread down. It looks like we're too late. By the time the president announces a national shelter in place, the numbers are going to be off the charts. My personal expectation is the US is a week or two behind Europe. The only upside is it might be over faster. My wife works in healthcare and they are preparing for an onslaught. One large hospital in the Minneapolis area has apparently been working to convert an entire floor to ICU beds.

 

Many countries have effectively shelter in place . Germany has is for a couple days and they have escalated compliance today. It’s too early as there seems to be some weekend reporting effect (with lower numbers on weekends) but the numbers of new infections have begun to show promising trends and so far, the Heath care system is holding up. I think people have come to realize the seriousness last week and compliance has improved, which wasn’t the case in Italy at all.

 

US is still in the exponential growth phase so who knows how it ends.

 

This is purely based on the narrow observations in my own life and social circle, but I don't think enough people in the US are taking it seriously which means it's probably going to get ugly before people do take it seriously. The next 4-6 weeks are going to be nerve wracking.

[arcube]

 

Our leadership at the national level is dragging their feet as a result millions more will likely get Covid 19 and the economy will be shit for far longer. 

 

I feel like making a petition to petition the US GOVT to enact a nation shelter in place.  Thoughts?

Better to be proactive than reactive.

 

It seems like many states and the federal government are taking a wait and see approach as the number of confirmed cases grows. Based on everything I've read, a national shutdown should have started last week if there was going to be any chance of significantly slowing the spread down. It looks like we're too late. By the time the president announces a national shelter in place, the numbers are going to be off the charts. My personal expectation is the US is a week or two behind Europe. The only upside is it might be over faster. My wife works in healthcare and they are preparing for an onslaught. One large hospital in the Minneapolis area has apparently been working to convert an entire floor to ICU beds.

 

Many countries have effectively shelter in place . Germany has is for a couple days and they have escalated compliance today. It’s too early as there seems to be some weekend reporting effect (with lower numbers on weekends) but the numbers of new infections have begun to show promising trends and so far, the Heath care system is holding up. I think people have come to realize the seriousness last week and compliance has improved, which wasn’t the case in Italy at all.

 

US is still in the exponential growth phase so who knows how it ends.

 

This is purely based on the narrow observations in my own life and social circle, but I don't think enough people in the US are taking it seriously which means it's probably going to get ugly before people do take it seriously. The next 4-6 weeks are going to be nerve wracking.

 

Spot on. There are still a bunch of morons that do not understand what is going on. It is a shame, a lot of literate but uneducated dummies. Next 4-6 weeks is really going to test everything.

[LongHaul]

I signed it.  Thx for posting LIberty.

 

I agree - people are not taking this seriously.  I just yelled at my parents for being at a social event (>6ft apart) but C'mon.

 

I think that is why this will spread - overconfident people putting themselves at risk and Covid 19 is super contagious.  They are like children and need to have the hammer brought down.

Going to get a lot worse.

 

Funny story - Walks in nature away from everything help me sort things out and destress.  I decided to go for a walk in some big woods near me and while in thought, up ahead are some feral hogs  and piglets.  They were too close so I went up a tree, made loud noises with the piglets squealing the alerts.  So much for a calm nature walk....

[ERICOPOLY]

With Rand Paul out and more Republicans in quarantine because of it, the've lot 5 votes in the Senate and the Democrats haven't lost any. 

 

What's it going to look like in a few weeks?  Rand Paul is asymptomatic, I wonder how long he's had this.

[tede02]

 

Funny story - Walks in nature away from everything help me sort things out and destress.  I decided to go for a walk in some big woods near me and while in thought, up ahead are some feral hogs  and piglets.  They were too close so I went up a tree, made loud noises with the piglets squealing the alerts.  So much for a calm nature walk....

 

My wife in I live about 30 miles outside Minneapolis where it the landscape really transitions into rural communities. What's kind of surreal about this event is you read the news and it feels like a frantic crisis, almost like war-time. Then I go for a walk at home, see the migrating ducks and geese, other wildelife, etc. and it's as if nothing is happening. Just another peaceful spring day. It's just a strange contrast.

[cubsfan]

 

I think the most effective way to kill the virus would be to:

 

1.  Shelter in place the entire US population.  Stay in your homes except for supermarkets and essentials.  Essentially copy China strict policy and enforce it.

Perhaps a 3 week shelter in place would be good to start.

 

 

https://www.mitre.org/sites/default/files/publications/COVID-19_MITRE_Action_Paper_March-2020.pdf

 

These guys would agree with you:

 

• We believe that we need to reduce the human-to-human contact rate of Americans by 90 percent to stop this epidemic.

 

Specific recommendations:

1. Immediately close all schools and institutions of learning in the United States regardless of location (move to remote learning where possible).

2. Incentivize private enterprises to implement remote work policies and ensure social distancing is maximized in operating facilities.

3. Support and encourage commercial food, medical, and basic supply distribution businesses to remain in operation as well as related transport and logistics operations.

Have the government ensure a sanitary environment for the production and delivery of materials and protect employees of these entities with testing and protective gear.

4. Shut down places of social gathering, including restaurants, bars, movie theaters, concerts, sporting events, etc.

5. Extend the Centers for Disease Control and Prevention recommendation to build home food supplies to everyone, not just the elderly. Provide financial support and food to those who cannot afford or are otherwise unable to do so.

6. Seal or restrict all U.S. borders to all forms of traffic/transport, after allowing a week for Americans to return home if they desire.

7. Depending upon the number of cases in a country from which an American is returning, quarantine returning citizens in hotels or other facilities, one to a room, with skeleton staff (also protected). Ensure these facilities are supplied with food, water, and communication capabilities, compensating the facility providers with federal monies.

8. Incentivize Americans not to leave their home for anything other than medically necessary movement or to work in support of other NPIs and U.S. critical infrastructure.

9. Provide compensation (net-out payments to employees) to business owners for temporarily closing non-essential businesses that require major physical presence at their facilities to operate.

10. Ensure that food, water, and medically necessary products and services delivery capabilities remain in place, or are extended as needed throughout the country, compensating providers appropriately.

11. When the observed reproduction number drops sufficiently, until all new cases are under contact tracing (depends on existing level of infections, which have to be measured carefully and continuously), begin to gradually lift implemented NPIs (epidemics die off quickly when observed reproduction rates drop well below 1). Once there are no new cases for at least one week, we can begin to lift NPIs. We must be extremely vigilant and thorough with our testing in order not to stop social distancing actions too early, or we may face a resurgence of the epidemic. We anticipate the NPIs will have to remain in place for at least three months.

12. Diligently monitor for residual infections and aggressively quarantine families of new patients for three weeks, providing basic services as needed. Provide consistent supports for those families during the quarantine period.

13. Do not unseal borders until the global pandemic is under control.

14. Prepare for resurgence and watch case counts for signals that a second wave of actions is needed. Make sure there is a widespread surveillance and testing capability in place to detect and monitor infections.

CONCLUSION

[Liberty]

Iceland: https://www.buzzfeed.com/albertonardelli/coronavirus-testing-iceland

 

Doctor op-ed on hydroxychloroquine: https://www.wsj.com/articles/these-drugs-are-helping-our-coronavirus-patients-11584899438

[Liberty]

This guy is great. Explains what the army corps of engineers will do to create temporary ICU-like spaces:

 

[Guest cherzeca]

risk vs uncertainty and covid-19...or an economist walks into a pandemic:  https://www.wsj.com/articles/risk-uncertainty-and-coronavirus-11584975787?mod=hp_opin_pos_1

[Pelagic]

Apropos of nothing...

 

2007 paper about SARS virus by Hong Kong researchers

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2176051/

 

Quote from the last paragraph in the paper:

 

The presence of a large reservoir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb.

 

Thanks for sharing this. I had dug out one of my epidemiology textbooks from college and read the chapter on corona viruses the other day. It too talked about their prevalence in horseshoe bats and how SARS was something of a warning to the world about the possibility of other coronaviruses making the jump to humans but this goes into a lot more depth.

 

The real issue isn't the bats themselves, or even humans eating them per se, it's keeping bats and a host of other animals like civets, raccoon dogs, pangolins, etc. in so called wet markets where viruses endemic to bats have a chance to jump species and eventually make the jump to humans. Most of these viruses would never be a threat to humans if they weren't placed in crowded conditions with a number of species where they can rapidly mutate and become infectious to multiple species.

 

SARS was a warning we never took seriously. Hopefully post-Covid19 we'll see these type of markets have much stricter requirements when it comes to separating different types of animals, if not shut down entirely.

[Liberty]

US cumulative tests: 228,216

 

Canada cumulative tests: 92,015

[Liberty]

Short video (3 mins) on the exponential decline after a lockdown, and why it shouldn't have to last for months if you have good contact tracing:

 

[EliG]

The real issue isn't the bats themselves, or even humans eating them per se, it's keeping bats and a host of other animals like civets, raccoon dogs, pangolins, etc. in so called wet markets where viruses endemic to bats have a chance to jump species and eventually make the jump to humans. Most of these viruses would never be a threat to humans if they weren't placed in crowded conditions with a number of species where they can rapidly mutate and become infectious to multiple species.

 

SARS was a warning we never took seriously. Hopefully post-Covid19 we'll see these type of markets have much stricter requirements when it comes to separating different types of animals, if not shut down entirely.

 

SARS was a warning that Chinese Communist Party never took seriously.

 

I know you mean "we" as a humankind, but that absolves CCP of any responsibility. No one else was in position to shut down these wet markets.

 

Once this ordeal is over, the world should unite and hold CCP accountable.

 

[Pelagic]

The real issue isn't the bats themselves, or even humans eating them per se, it's keeping bats and a host of other animals like civets, raccoon dogs, pangolins, etc. in so called wet markets where viruses endemic to bats have a chance to jump species and eventually make the jump to humans. Most of these viruses would never be a threat to humans if they weren't placed in crowded conditions with a number of species where they can rapidly mutate and become infectious to multiple species.

 

SARS was a warning we never took seriously. Hopefully post-Covid19 we'll see these type of markets have much stricter requirements when it comes to separating different types of animals, if not shut down entirely.

 

SARS was a warning that Chinese Communist Party never took seriously.

 

I know you mean "we" as a humankind, but that absolves CCP of any responsibility. No one else was in position to shut down these wet markets.

 

Once this ordeal is over, the world should unite and hold CCP accountable.

 

100% agreed. This really ties in with animal rights activists who have long advocated for an end to the exotic animal trade (pangolins for instance) and by extension an end to exotic animal markets where those same animals end up. I think once the facts come out once this is over we're going to see a lot of pressure globally and more locally by the younger generation of Chinese to end these practices.

 

Are there other potential vectors of novel viruses in humans? Absolutely, laboratories for testing are mentioned in the original article for instance, and consuming wild animals directly certainly presents risks as well, but few present the same kind of risk to humans that these markets do. When you go back and read literature on SARS and how clear the link was between these markets and a novel coronavirus that presented a major global threat, it's somewhat amazing how unexpected COVID19 has been made out to be.

[cubsfan]

 

SARS was a warning we never took seriously. Hopefully post-Covid19 we'll see these type of markets have much stricter requirements when it comes to separating different types of animals, if not shut down entirely.

 

So true - undercover video on the Wet Markets:

 

 

 

[Liberty]

https://www.cnbc.com/2020/03/23/roche-ceo-widespread-coronavirus-testing-in-us-is-weeks-if-not-months-out.html

[Liberty]

https://www.washingtonpost.com/politics/trump-signals-growing-weariness-with-social-distancing-and-other-steps-advocated-by-health-officials/2020/03/23/0920ea0a-6cfc-11ea-a3ec-70d7479d83f0_story.html

 

Trump has begun canvassing his advisers, GOP Senators and other allies about what his course of action should be, according to a senior administration official. He is worried about the impact of soaring unemployment and severe economic contraction on his 2020 presidential reelection bid, and fielded phone calls for much of the weekend from alarmed business leaders. He remains fixated on the plummeting stock market, is chafing at the idea of the country remaining closed until the summer and growing tired of talking only about coronavirus, one person said.