outbreak! (ebola, sars, coronavirus, etc)

two terrifying articles

😦

The patient’s chart appeared unremarkable at first glance. He took no medications and had no history of chronic conditions. He had been feeling fine, hanging out at home during the lockdown like the rest of the country, when suddenly, he had trouble talking and moving the right side of his body. Imaging showed a large blockage on the left side of his head. Oxley gasped when he got to the patient’s age and covid-19 status: 44, positive.

The man was among several recent stroke patients in their 30s to 40s who were all infected with the coronavirus. The median age for that type of severe stroke is 74.

jesus

kind of wish I didn't read this article so early in the day

what the fuck

*makes note to re-up blood pressure medication*

*makes note to stop caning wine and coffee and never go outside again*

At UChicago Medicine they're opting for high-flow nasal cannulas over ventilators, and claiming 'truly remarkable' success. See also Sharon Begley's piece for STAT.

Should be noted that in the Brigham and Women's Hospital's Covid protocols, which heavily influence standard of care in the US, they recommend avoiding high-flow nasal cannulas due to the potential of increasing aerosol risk for HCWs.

“The proning and the high-flow nasal cannulas combined have brought patient oxygen levels from around 40% to 80% and 90%..."

This is exactly the sort of thing that one hoped to see at this stage, where different treatment strategies are being sorted out according to less and more effectiveness, through empiricism and communication within the medical community. But the most effective strategy by far will continue to be slowing the rate of transmission from the infected to the uninfected.

Week over week numbers dropped in Austin, TX. Stay at home order only goes to May 8 so far. Lots of rumblings about things starting to open soon. Don't know what to make of it. I think end of May seems more realistic, but people may not have the patience for that.

~2 month lockdowns were successful in places like Hubei, or where social distancing compliance was high like South Korea. But testing nationwide in the US has plateaued at ~150k tests/day through all of April, and I haven't seen mass hiring of tens of thousands for training to do test sample collection or contact tracing. And I don't think we can just lay it all in the lap of current public health and social workers: one estimate I've seen is 300k with some training in contact tracing would be required for the US to reopen.

if only there were 300k people looking for work and training!

But testing nationwide in the US has plateaued at ~150k tests/day through all of April

https://i.imgur.com/5LXVRd2.jpg

it did plateau, but seems to be picking up over the week.

xp: There should have been big grants to states explicitly for this in the first coronavirus relief bill, with CDC providing guidelines, training curriculum, and advisors. With a few exceptions, it feels like our political system has lost the ability to be proactive.

Should be noted that in the Brigham and Women's Hospital's Covid protocols, which heavily influence standard of care in the US, they recommend avoiding high-flow nasal cannulas due to the potential of increasing aerosol risk for HCWs.

Since I've been doing a lot of research on this, it's true the aerosol risk is high but it can be reduced with proper use of PPEs and negative pressure rooms. At one hospital I talked to that used this method (high flow nasal cannulas + proning), the majority of their covid patients admitted into ICU survived without intubation, with only one death and no transmission to HCWs so far.

(Most of my contributions didn't make it but it was for this story on ventilators.)

Preprint so usual caveats, but this paper has some crazy numbers. Patterns of Covid-19 Mortality and Vitamin D: An Indonesian Study. 16 out of 388 with normal D status died, only 28 out of 392 with insufficient/deficient D status survived. That could have a lot to do with socioeconomic status in Indonesia, but on the assumption it's meaningful... My immediate thought was that this could be a major factor in why African-Americans have a high fatality rate, as most have low vitamin D status (high latitude + melanin means little UVB induced 25(OH)D synthesis in skin).

I'm probably okay as I've Mediterranean skin and spend 30 mins at noon walking with bare arms/legs. But it did motivate me to find an old bottle of 5000 IU D3.

crazy numbers, like all extraordinary claims, need very close scrutiny

.... yeah

Sanpaku why is it that you think you’re smart

probably similar reasons to you

I don’t think I’m smart! I’m obviously very stupid, for instance I keep talking to you

you know, instead of taking the bait, you could have taken the hint.

I don’t have anything else going on

Some
Posts
Were
Blocked

sanpaku please just stop posting that stuff man

Aimless, I'm pretty familiar with the story (and overselling) of D over the past 2 decades (it's why a prescribed bottle languished in the freezer). Association studies of low D status found links with just about every chronic disease, but low D status is also just a marker of being too ill/old to go outside, and supplementation randomized controlled trials have been mostly disappointing, with a small effect seen when 56 RCTs were pooled looking at all-cause mortality.

Still, we're in this for the next 18 months, and so far there aren't any proven pharmaceutical interventions. Early hydroxychloroqine trials were well publicised, but there's been disappointing reports this week with remdesivir, favipiravir, and lopinavir–ritonavir. Not that the good scientists aren't throwing the spaghetti at the wall. 915 trials registered with WHO, and some are weird. But its nice to have hope that something will work. And it's fun to read papers.

Overselling the D is a rite of passage

that's what she said

He said that he believed that stricter lockdowns "only serve to flatten the curve and flattening the curve doesn't mean that cases disappear -- they are just moved in time."

"And as long as the healthcare system reasonably can cope with and give good care to the ones that need care, it's not clear that having the cases later in time is better."

Right now, Sweden's hospitals aren't overrun like the US's, but not sure what it would take for that to happen either

https://edition.cnn.com/2020/04/28/europe/sweden-coronavirus-lockdown-strategy-intl/index.html

it's not clear that having the cases later in time is better

This is the weak point in his reasoning. Even if no cure or vaccine become available, the cumulative experience of treating covid-19 patients will over time lead to a convergence upon the best possible treatment options for the best possible outcomes.

Seems we're about 2 weeks away from a major med journal publishing a large randomized trial on convalescent plasma. That could have saved tens of thousands worldwide, and I have confidence it will as SOP. Avoiding mechanical ventilation as long as possible with high flow nasal canulas and proning may have similar benefits.

If some pandemic lumbers towards becoming endemic, its better to be among the second and later waves.

It feels very strange to post this on the day of the USA's 4th highest death toll, but it appears that we are post-peak of the first wave here in the states.

So much for the Sunshine Law: #Florida medical examiners were releasing #coronavirus death data, which showed a higher number than the official state tally. The state made them stop. https://t.co/XsvyTM1xcO via @kmcgrory & @rwoolington

— Craig Pittman (@craigtimes) April 29, 2020

deaths per day def seem to be on the decline particularly in NY

ten times (or more) the reported cases

The new serological data, which is provisional, suggests that coronavirus infections greatly outnumber confirmed covid-19 cases, potentially by a factor of 10 or more. Many people experience mild symptoms or none at all, and never get the standard diagnostic test with a swab up the nose, so they’re missed in the official covid-19 case counts.

https://www.washingtonpost.com/health/antibody-tests-support-whats-been-obvious-covid-19-is-much-more-lethal-than-flu/2020/04/28/2fc215d8-87f7-11ea-ac8a-fe9b8088e101_story.html

The new serological data, which is provisional, suggests that coronavirus infections greatly outnumber confirmed covid-19 cases, potentially by a factor of 10 or more. Many people experience mild symptoms or none at all, and but even if they're ill for a month, they're told to stay home until they're at death's door so they never get the standard diagnostic test with a swab up the nose, so they’re missed in the official covid-19 case counts.

probably just a coincidence that the lab is in wuhan

https://www.newsweek.com/dr-fauci-backed-controversial-wuhan-lab-millions-us-dollars-risky-coronavirus-research-1500741

btw i'm not sure if this has been discussed itt but it's a new article so there it is

newsweek has become a conspiracy website, and this is essentially a conspiracy story that has been pushed by the usual right-wing sewer afaict

^^^

yeah newsweek turned into some dumb shit at some point. I stopped paying attention to them years ago. when did this happen?

alright

so the whole thing is bullshit?

https://slate.com/technology/2018/02/what-went-wrong-at-newsweek-according-to-current-and-former-staffers.html

so the whole thing is bullshit?

― davey, Wednesday, April 29, 2020 9:45 AM (five minutes ago) bookmarkflaglink

a lot of it frankly reads like bullshit

I hope this is true:
https://m-en.yna.co.kr/view/AEN20200429007051320

SEOUL, April 29 (Yonhap) -- South Korean health experts said Wednesday that recovered coronavirus patients may have tested positive again due to traces of virus fragments that have been inactivated.

As of Tuesday, a total of 277 people who recovered from COVID-19 have retested positive here, according to the Korea Centers for Disease Control and Prevention (KCDC).

The country's central clinical committee for emerging disease control said there was no live virus present in such cases, positively refuting theories like the virus being reactivated or reinfection.

They said that apparent reinfection cases came because fragments of the virus remained in their bodies and showed up in test kits.
The country currently uses a reverse transcription polymerase chain reaction (PCR) test for the COVID-19 virus that works by finding the virus's genetic information, or RNA, in a sample taken from a patient.

The experts said this PCR test is so sensitive that it can still pick up parts of the small amount of RNA from a cell even after the person has recovered from COVID-19.

"RNA fragments still can exist in a cell even if the virus is inactivated," they said in a press release. "It is more likely that those who tested positive again picked up virus RNA that has already been inactivated."

Oh Myoung-don, head of the committee, said the cases in which people retested positive were due to technical limits of the PCR tests.

The committee further said it is virtually impossible for the virus to be reactivated unless the COVID-19 virus causes chronic infections.

"The COVID-19 virus does not invade inside of the cell nucleus and combine with a patient's DNA," Oh said. "It means that the virus does not create chronic infections."

Oh further said the COVID-19 virus is different from diseases such as HIV and hepatitis B in which the virus stays dormant inside of a cell nucleus and later causes chronic infection.

Concerns have risen over chronic infections after several COVID-19 patients stayed in hospitals over two months before being cured.

The country reported nine more cases of the new coronavirus Wednesday, bringing the nation's total infections to 10,761, the KCDC said. It marked the 11th day in a row that the number of new infections stayed at 15 or below.

✧✧✧@y✧✧.c✧.k✧

i think it definitely does stay in the body for while though. a month at least for me.

Yeah it was the whole reinfection thing that was freaking me out. If you can't get reinfected, then maybe issuing immunity passports could work after all.

NY Times really jazzed about Cuomo saying it’s “disgusting” what’s going on, that homeless people are sleeping in subways. Are they insinuating that he is saying homeless people themselves are disgusting? It kind of seems like that, and it also seems clear that’s not what he meant.

Fragments of inactivated RNA would explain the positive test results, but many recovering patients report periodic recurrence of mild symptoms, like low fever or pains, which are not explained by inactive RNA. There's still a lot to learn about this virus.