SARS-CoV-2 and COVID-19 (3)
This is a continuation of the topic SARS-CoV-2 and COVID-19 (2).
This topic was continued by SARS-CoV-2 and COVID-19 (4).
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Mass. General (Hopital) ‘Desperately’ Needs Supplies, Even 3D-Printed Ones, President Says
Perry Russom • Published March 19, 2020
MGH President Peter Slavin said he is worried about respirators, masks, gowns and gloves, all in short supply as the coronavirus outbreak intensifies.
...Slavin said a company in Italy has figured out a way to make masks using 3D printers.
"We have vast numbers of 3D printers in this country," he said. "The formula for producing these masks is available online for free. I would hope companies across the country would, who would have that capability, would start making masks later this afternoon."
Vice President Mike Pence said after changes in law Wednesday night, industrial masks can now be sold directly to hospitals.
"Those companies have now greatly increased, by the tens of millions, their production of so-called N95 masks that will give our health care workers the protection that they need," Pence said.
On Wednesday, boxes of masks were dropped off at Boston Medical Center. Trade unions are clearing out training facilities.
"To see the country rallying around to create those tools to provide the supplies is one of the most important things the country can do right now to make the front line provider know they are seen and supported through this," said Dr. Katrina Armstrong, chief of medicine at MGH...
More on hydroxychloroquine:
Jia Liu et al. 18 March 2020. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discovery volume 6, Article number: 16 (2020). https://www.nature.com/articles/s41421-020-0156-0
Mylan Ramps Up Production of Hydroxychloroquine as a Potential COVID-19 Treatment
The decades-old malaria drug could help fight the new coronavirus.
Brian Orelli | Mar 19, 2020
What Coronavirus Symptoms Look Like, Day By Day (5:18)
Science Insider • Mar 18, 2020
After being exposed to the virus that causes COVID-19, it can take as few as two and as many as 14 days for symptoms to develop. Cases range from mild to critical. The average timeline from the first symptom to recovery is about 17 days, but some cases are fatal. Here's what it looks like to develop COVID-19, day by day.
For engineers and tinkerers--from the better-than-nothing file next to homemade masks. :)
Be sure to read his "notes from chatting with pulmonologist".
Low-Cost Open Source Ventilator-ish Device (8:48)
•Mar 18, 2020
In the event that COVID-19 hospitalizations exhaust the availability of FDA approved ventilators. This project attempts to convert a low-cost CPAP (Continuous Positive Airway Pressure) blower into a rudimentary ventilator-ish device that could help with breathing during an acute respiratory distress.
WARNING/DISCLAIMER: Whenever possible, please seek professional medical care with proper equipment setup by trained individuals. Do not use random information you found on the internet. I am not a medical professional, just a random person on the internet.
For more details, build information, provide feedback/help, and on-going updates: visit the Github project below: https://github.com/jcl5m1/ventilator
I've also added some notes after speaking with a pulmanologist about understanding critical functions of ventilators:
You can help AI to predict the spread of coronavirus. No expertise needed - they are looking for the "wisdom of crowds". They want people who are willing to update their estimates at least weekly.
Oregon: I think it's important to note what you went through and report it wherever the right place is and whenever the right time is. On the other hand, if it's true that you had a very early case of covid-19, there is nothing you could or should have done other than what you did.
Right now, it probably does not matter, but eventually a history of the virus will need to be compiled. And if you actually had it, that puts it in three places at one time long before Senators were selling stocks. And if you did have it, your doctor probably treated other cases.
That said, it's hard to control what you feel when you're connected to something like this. I probably have written of this before on this site, but my wife was in Bergamo from Feb. 11-18 (a bizarre situation, as it is 5 hours from here, we've been in Slovenia for 18 years, and neither of us have ever visited Milan or Bergamo--a friend had an apartment there for a month, doing an academic project, and invited my wife to spend a week). On her return doctors rejected the notion that she might need a test, or that the neighbors might benefit from her getting a test, and a consulted epidemiologist agreed... I would have given her the test. Right about when she returned people started turning up with the virus all over the world after visits specifically to Milan, some to 'northern Italy', Bergamo being one of the worst of the places.
So naturally we wonder if our family went through it--she had a brief cold upon her return and the two kids followed suit--whether we had the virus, what that would mean if it were so, etcetera.
Calling All People Who Sew And Make: You Can Help Solve 2020 N95-Type Mask Shortage
TJ McCue | Mar 20, 2020
...Joost De Cock (Old Dutch for “The Cook”) started the FreeSewing Open Source Project from his home in the Netherlands to provide free sewing patterns. Recently, his wife who is a surgeon started seeing potential shortages in personal protective equipment (PPE). Joost knew what to do, so he posted it to FreeSewing in late February. People thought he was being silly as a handmade mask would never be used by professionals. (I love the brand for FreeSewing.org, by the way.)
But he was onto something when he posted: Calling all makers: Here's a 1-page PDF facemask pattern ( https://freesewing.org/blog/facemask-frenzy/ ); Now go make some and help beat this thing.
...Additional Resources for Open Source or Volunteer COVID-19 Projects:
One of my favorite how-to sites is Instructables ( https://www.instructables.com/id/DIY-Cloth-Face-Mask/ ). The DIY Cloth Face Mask has almost 100,000 views. It is a step-by-step instruction for those who need it. Kudos to ashevillejm ( https://www.instructables.com/member/ashevillejm/ ).
In 2006, CDC released a Simple Respiratory Mask design ( https://wwwnc.cdc.gov/eid/article/12/6/05-1468_article ) using heavyweight t-shirts ( https://wwwnc.cdc.gov/eid/article/12/6/05-1468-f1 ) in its Emerging Infectious Diseases journal. More of an academic post, but some ideas in it.
A Facebook group was formed last week: Open Source COVID19 Medical Supplies ( https://www.facebook.com/groups/opensourcecovid19medicalsupplies ). It is worth a visit — in just a few short days there are 20,000-plus members and volunteers.
If you are looking for some research and street-level testing of various materials for DIY mask-making, this post from Smart Air Filters is exceptional: What Are The Best Materials for Making DIY Masks? ( https://smartairfilters.com/en/blog/best-materials-make-diy-face-mask-virus/ ) It also includes a few great links at the end of it.
Forbes’ editor Amy Feldman just expanded on the developing story of a team in Italy that is 3D printing respirator parts. Read it here: Meet The Italian Engineers 3D-Printing Respirator Parts For Free To Help Keep Coronavirus Patients Alive ( https://www.forbes.com/sites/amyfeldman/2020/03/19/talking-with-the-italian-engi... ).
Bloomberg confirms that the workers and communities around them are rising up to meet this challenge: Hospital Workers Make Masks From Office Supplies Amid U.S. Shortage.
If you have a 3D Printer and have been trying out different N95 designs, then you will want to read this one from 3D Printing Media Network by Davide Sher: Copper3D organizing global campaign to 3D print antimicrobial masks on a global scale ( https://www.3dprintingmedia.network/copper3d-organizing-global-campaign-to-3d-pr... ). After you read it, you will probably want to order some PLA filament from the folks at Copper3D ( https://copper3d.com/ ) who are making their patent-pending idea and design open source to help fight COVID-19.
Goldman (Sachs) deck shows US (dashed red line) now has more cases than any country
-- including China (blue) --
relative to when both countries had 100.
Our trajectory is bleak.
Image ( https://twitter.com/jciv/status/1241098800393064457/photo/1 )
- John Coates @jciv | 4:26 PM · Mar 20, 2020
Answer to immunity question is "unclear"--but article is interesting read:
Do You Get Immunity After Recovering From A Case Of Coronavirus?
Nell Greenfieldboyce | March 20, 2020
CNN Town Hall Q&A: In first A, Dr. Fauci states that they are looking at using serum from recovered patients to confer antibodies on others.
(Remember that similar procedure was used in 2014 with Ebola. Sounds like little success in 2014 (7% improvement), but a French study was planned to tweak the process to improve Ebola survival rate: https://www.sciencemag.org/news/2016/01/plasma-transfusions-cant-combat-ebola )
Is delivery dangerous? Can I go outside? Your Qs answered
At CNN's coronavirus town hall, doctors answered your questions about testing, a possible antidote and social distancing.
Interesting thread on vaccination prospects, from Pharma investor/virologist perspective:
Peter Kolchinsky @PeterKolchinsky
Mar 19th 2020, 28 tweets, 5 min read
I’m a virologist & investor... & I’m hearing people say it’s impossible to make covid vaccine b/c we haven’t been able to make one to any coronaviruses. Not true. We have veterinary vaccines for dog & cow strains. Human one’s not been investment worthy, until now. here’s why...
There are 4 coronavirus strains that circulate amongst humans causing nothing more than mild colds in most people. They stimulate a modest immune response- enough to get over an infection and leave you protected for about a year, maybe more. But eventually antibodies wane...
And that’s when you become susceptible to reinfection by same virus. So why haven’t we developed a vaccine against these 4 coronavirus strains? We could take it every year and protect ourselves against colds, right? That’s a nice idea but most colds are caused by other viruses...
Our four standard human coronaviruses only cause 20% of colds. Colds are mostly caused by rhinoviruses, RSV, parainfluenza virus (not same as influenza), and other viruses we haven’t even identified yet. They are all so different that each would require a different vaccine.
So while we could have made a coronavirus vaccine (which really would have had to be four vaccines, one for each strain), the trouble is that it would have only helped protect you against 20% of the viruses that cause colds.
It would be difficult and expensive to run a clinical trial that showed that the coronavirus vaccine worked because even if it reduced your risk of suffering a coronavirus-mediated cold by 75%, that would cut the risk of any cold by only 15% (75% of 20%).
It would be a large trial so that this 15% reduction would be statistically significant. But it’s doable. Bigger problem is the marketing message of 15%. Adults get 2-4 colds a year, so a 15% reduction doesn’t even add up to 1 fewer cold per year. Not very compelling, right?
The commercial product people want is not a coronavirus common cold vaccine. They want a COMMON COLD vaccine that protects them against most of their risk. For that, vaccine would have to protect against most cold viruses (and we don’t even know what causes 30% of colds).
And some viruses require vaccines to have multiple components (antigens) to be effective. All these components would require their own development and optimization. We’re not talking about inventing one product...
we’re talking about inventing over a dozen, each of which would be useless along but all of which would be needed just to get what may be a commercially viable product people would MAYBE want to take. Why do I say maybe?
Because 1) it’s just a cold, 2) your insurance would probably make you pay a copay to nudge you into not taking it, 3) people have needles, and here’s the clincher...
Anti-vaxxers would tell you that it causes horrors. Some people would get diagnosed with, let’s say, MS or cancer a few days after they got the vaccine simply because that happens to some people by chance at random... it’s a coincidence but anti-vaxxers would blame the vaccine.
It won’t be true and data will show its not true, but that won’t matter, because many people will think “why risk it, I’ll get over a cold”. Investors look at all this and see a multi-billion dollar sinkhole of risk that will probably be as unrewarding as...
as the Lyme vaccine GSK developed, launched, & pulled off the market after a few years for same reasons I just listed. (And we really need a Lyme vaccine b/c ticks are spreading & carry a host of horrors. But that’s a slower, quieter pandemic we can talk about another time.)
But Covid is different. It’s serious, more so than the flu. So we’ll develop a vaccine for it just as we have for the flu and dog/cow coronaviruses. It might cost a few billion dollars across a dozen different programs, but there will be a market.
Just as Sanofi, GSK, & several others companies compete on price & still make billions each year supplying the world with a constantly evolving yet affordable flu vaccine (usually $10-20), similarly industry can develop & supply world w/ a covid vaccine.
Maybe even mix it w/ annual flu shot for convenience. — By the way, I’ve heard people say that industry doesn’t even care to make a universal flu vaccine. That’s also not true. There have long been efforts and investors willing to fund credible projects, but this is really hard.
Despite decades of failure, there are still biotech companies toiling on a universal flu vaccine (would protect us against most strains w/ one shot every 5-10 years). It’s hard, yet I think doable. By comparison, covid is simple. It definitely ain’t herpes (simplex is misnomer).
Covid is so technically doable we already have vaccines for dog & cow coronaviruses. We’ll definitely make one for covid, trials will be simple since we’ll be specifically trying to prevent Covid, which is only caused by SARS-CoV-2 (not by dozen different viruses), and...
insurance will pay for it just as it pays for the flu vaccine, in many cases without a copay. For those without insurance (shame on us, America!), there are free flu shot clinics. Google “free flu shot near me”. Similarly, there will be affordable covid vaccines for everyone...
because this is a serious public health problem. America can be heartless in its poor coverage of many medicines, eg insulin (I wrote a book about drug affordability and how to fix our system) but America is pretty good about making vaccines affordable.
Btw, if you’re interested in learning more about the drug industry, why medicines aren’t affordable for some, & what we need to change to make innovation work for all, then do read my book. You’ll never see healthcare the same.
The Great American Drug Deal
I’ll leave you with following insight from flu & what it means for covid vaccine development. Vaccine is like a mugshot of criminal you show to police so they know who to look out for. As we get older, our immune systems become weaker & vaccines don’t work as well.
You show our immune systems the mugshot, &’it doesn’t react very strongly. Biotech industry is working on vaccines that compensate, essentially illuminating better mugshots so more immune cells notice them. We’ll need that advanced technology for covid since it’s hell on elderly.
Until then, we’ll need younger people to get vaccinated to provide herd immunity for older folks. It’s a travesty that 10k-60k/year die of flu (mostly old folks) & more hospitalized b/c the young don’t think they need vaccine for themselves. Vaccinate for others if not yourself!
I should add that when I say “investors” have been hesitant to invest in common cold vaccine, I don’t mean just billionaires. I mean people who manage money on behalf of pension funds, endowments; eg ordinary Americans rely on mutual funds not to make unprofitable investments.
It would be wrong for fund managers to fund development of drug they know will be a commercial flop b/c America isn’t willing to pay for it. You can donate to such a cause, & gov can fund it w/taxes (eg Barda) but investment professionals can’t waste people’s savings on it.
That’s key reason we don’t have more antibiotics. Current ones work so well there is only a small (terrifying though) need for new ones, & hospitals resist paying high price for the few patients who need them. Small market, small incentive, little investment, few new antibiotics.
Coronavirus Could Overwhelm U.S. Without Urgent Action, Estimates Say
James Glanz, Lauren Leatherby, Matthew Bloch, Mitch Smith, Larry Buchanan, Jin Wu and Nicholas Bogel-BurroughsMarch 20, 2020
The coronavirus has infected far more people in the United States than testing has shown so far, and stringent measures to limit social contact in parts of the country not yet seeing many cases are needed to significantly stem the tide of illness and death in the coming months.
Those are the conclusions of Columbia University researchers who used a New York Times database of known cases and Census Bureau transportation data to model how the outbreak could evolve based on what is known about the virus. The estimates are inherently uncertain, and they could change as America adopts unprecedented measures to control the outbreak.
But they offer a stark warning: Even if the country cut its rate of transmission in half — a tall order — some 650,000 people might become infected in the next two months... (see maps)
Coronavirus in N.Y.: ‘Deluge’ of Cases Begins Hitting Hospitals
Brian M. Rosenthal, Joseph Goldstein and Michael Rothfeld | March 20, 2020. Updated March 21, 2020, 7:52 a.m. ET
New York State’s long-feared surge of coronavirus cases has begun, thrusting the medical system toward a crisis point.
In a startlingly quick ascent, officials reported on Friday that the state was closing in on 8,000 positive tests, about half the cases in the country. The number was 10 times higher than what was reported earlier in the week.
In the Bronx, doctors at Lincoln Medical and Mental Health Center say they have only a few remaining ventilators for patients who need them to breathe. In Brooklyn, doctors at Kings County Hospital Center say they are so low on supplies that they are reusing masks for up to a week, slathering them with hand sanitizer between shifts.
Some of the jump in New York’s cases can be traced to significantly increased testing, which the state began this week. But the escalation, and the response, could offer other states a glimpse of what might be in store if the virus continues to spread...
Temp hospital at Salem fairgrounds for COVID-19 patients
Dan Tilkin | Mar 18, 2020. Updated: Mar 20, 2020 / 03:30 PM PDT
PORTLAND, Ore. (KOIN) — Governor Kate Brown announced on Wednesday that health officials are setting up a temporary hospital in Salem and later ordered all non-emergency procedures to stop in an effort to preserve supplies for front-line health care providers.
The hospital will have 250 beds and is being set up on Wednesday. It’s unclear exactly when the beds will become available. The hospital is being set up by the Emergency Coordination Center. (Oregon State Fairgrounds inside the Jackman-Long building)
To preserve masks, gowns and gloves for health care workers on the front lines dealing with COVID-19, Oregon orders all hospitals, clinics and health care providers — including veterinarians and dentists — to stop all procedures that are not an emergency...
You lost me at "investor". Business interests need to fuck off out of healthcare from basic research up in the US (and not only the US). How many Sackler opioid crises and now this will it take to see the evil of profiting off sick people?
It's ruinous for society in every way--and science too.
#12--our health care system is the worst in the western world and it's not even close. It's all set up for profit and our politicians still defend it tooth and nail. Create false positions to foment fears about a M4A system to protect the large donors who want to keep health about profit and not about what actually would be good for the population. The Democratic nominee Biden defends our for profit system---do we hear anything from Joe these days about how he would deal with this pandemic? I hear from Andrew Cuomo all the time how New York state is dealing with this pandemic almost on a daily basis---I don't hear anything at all from Biden or his campaign about it on what he actually plans to do if he becomes POTUS. He and his campaign have pretty much gone silent and people are dying right now---about 40-50 a day and that's almost certainly going to start climbing.
Yeah, it's simply disgusting how the fatcats have reacted to all this--Democracy Now did a good report on the plan to exploit the vaccine in the US.
Related but broader in focus:
“Coronavirus Capitalism”: Naomi Klein’s Case for Transformative Change Amid Coronavirus Pandemic (Democracy Now)
#14--it's like Mitt Romney and maybe Josh Hawley are running to the left of the Democratic Party on economic policy to deal with this crisis. It's like Pelosi and Schumer are thinking about austerity right now and that is an opening for at least some republicans to get on the right side of all this. It's like the center of the Democratic Party is braindead on ideas and policy. The only thing they're thinking is 'when we get back to normal'. If and when we get out of this there is going to be a new normal. I think this is going to be bigger than 9-11 and 2008 combined and maybe times over and if you're going to have any impact on the future you have to get your deadheads out of power. People in the United States used to laugh at the old fogies in the Politburo. Pretty much that's what we have now---incompetents and lackeys.
Andrew Cuomo at least seems concerned Nancy and Chuck. I'll go watch Naomi.
Trump is a lost man-child who appears to be losing a lot of sleep
because he can't use his go-to rally lines to quell the fear and
misery the C-Virus situation is visiting upon us. And, it appears
he ignored the warnings our intel people were passing on to him
and his administration in January and February.
Oh boy, all the snow birds--'er canaries--heading north.
(Students coming back from Spring Break maybe shouldn't visit Gran for a couple weeks?)
Millions of smart thermometers are picking up higher than expected rates of fever readings in #Florida. How many more canaries in the coal mine do we need?
Image ( https://twitter.com/kit_delgadoMD/status/1241363808263823360 )
Kinsa and 9 others
- Kit Delgado (ER doc, prof) @kit_delgadoMD9:59 AM · Mar 21, 2020
FEMA Declares New York a ‘Major Disaster’: Live Updates
...New Jersey’s governor, Philip D. Murphy, directed all residents to stay home
as he announced a statewide shutdown of all nonessential businesses, effective Saturday at 9 p.m...
Why does Russia, population 146 million, have fewer coronavirus cases than Luxembourg?
Mary Ilyushina | March 21, 2020
...According to information released by Russian officials, Putin's strategy seems to have worked. The number of confirmed Russian coronavirus cases is surprisingly low, despite Russia sharing a lengthy border with China and recording its first case back in January.
The numbers are picking up, but Russia -- a country of 146 million people -- has fewer confirmed cases than Luxembourg, with just 253 people infected.
...Russia's early response measures -- such as shutting down its 2,600-mile border with China as early as January 30, and setting up quarantine zones -- may have contributed to the delay of a full-blown outbreak...
...A strong record on testing
...Still, Russia contends with widespread public skepticism
....Cover-up allegations rebutted by Kremlin and the WHO
...Putin..."Here is the thing: the authorities may not possess the full information, because people a) sometimes do not report it, b) they themselves don't know that they are sick, and the latent period is very long," he said in a televised meeting. "But everything that is issued ... by the Ministry of Health is all objective information."
...This week the numbers have surged, with Russia adding 30 to 50 cases every day, and the count will most likely continue its upward trajectory as Russia expands its testing.
...Meanwhile, the government moved to impose more sweeping measures, canceling public events and closing Russia's borders to foreigners, with some exceptions.
...(Authorities have not changed the April 22 date for) a nationwide referendum on constitutional amendments that could see (Putin) stay in power till 2036...
Italy coronavirus deaths surge by 793 in a day, lifting total death toll to 4,825
March 21, 2020
ROME (Reuters) - The death toll from an outbreak of coronavirus in Italy has leapt by 793 to 4,825, officials said on Saturday, an increase of 19.6% — by far the largest daily rise in absolute terms since the contagion emerged a month ago.
On Thursday, Italy overtook China as the country to register most deaths from the highly contagious virus....
The coronavirus did not escape from a lab.
Here's how we know.
Jeanna Bryner | 3/21/2020
The persistent myth can be put to bed...
Kristian G. Andersen et al. 2020. The proximal origin of SARS-CoV-2 (Correspondence). Nature Medicine (17 March 2020). https://www.nature.com/articles/s41591-020-0820-9
Remember human rights during pandemic: OHRC (Canadian HRReporter)
Employers must keep human rights principles at the centre of decision-making during the coronavirus pandemic, says the Ontario Human Rights Commission (OHRC)...
UNAIDS calls for a human rights approach to the COVID-19 outbreak that puts communities at the centre (UNAIDS)
UNAIDS is calling on countries to adopt a human rights-based approach in responding to the global outbreak of COVID-19 that puts communities at the centre and respects the rights and dignity of all... The new guidance from UNAIDS is grounded in international human rights law and obligations and makes it clear that responding to an epidemic is not a question of balancing public health and human rights but rather that a successful and effective response requires us to adhere to human rights principles... “Successful responses to global epidemics are always grounded in a respect for human rights and community leadership”...
US draws up plans to use military against 'civil disturbances' amid virus outbreak (Daily Sabah)
As the United States ramps up measures to fight the ongoing coronavirus pandemic, the country's military is preparing its armed forces to take on a larger role in response to the outbreak, including suppressing potential "civil disturbances" and administering law and order...
Coronavirus pandemic and the overlooked homeless (7:38)
Al Jazeera's Victoria Gatenby • Mar 21, 2020
Much of the focus during the coronavirus outbreak has been on the most vulnerable, such as the elderly and anyone with underlying health conditions.
But the homeless are equally vulnerable and continuously overlooked.
If infected, they will not only have difficulty getting medical treatment but could also find it impossible to isolate themselves.
World's most vulnerable in 'third wave' for Covid-19 support, experts warn (Guardian)
The world’s most vulnerable people could be last in line for support to deal with the coronavirus outbreak, experts have warned. Countries already dealing with humanitarian and refugee crises face a struggle to find the resources to deal with the pandemic by the time it reaches them...
Man shops at Tesco amidst panic buying. For some reason, I watched.
(The guy's also a master of improvisation, demonstrating it's possible with some finagling to feed oneself three square meals in the UK for £1. Frankly a non-starter in the U.S.)
Cuban doctors head to Italy battle coronavirus
Nelson Acosta | March 22, 2020
...Cuba said it dispatched a brigade of doctors and nurses (52) to Italy for the first time this weekend to help in the fight against the novel coronavirus at the request of the worst-affected region Lombardy....
The Caribbean island has sent its “armies of white robes” to disaster sites around the world largely in poor countries since its 1959 revolution. Its doctors were in the front lines in the fight against cholera in Haiti and against ebola in West Africa in the 2010s.
...This is the sixth medical brigade Cuba has sent in recent days to combat the spread of the new disease abroad. It has sent contingents to socialist allies Venezuela and Nicaragua as well as Jamaica, Suriname and Grenada.
...“In a time of crisis, the Cuban government, the Cuban people ... have risen to the occasion, they have heard our appeal and they have responded,” Jamaican Health Minister Christopher Tufton said on Saturday upon greeting 140 Cuban medical professionals at Kingston international airport.
Britain also thanked Cuba last week for allowing a British cruise ship that had been turned away by several Caribbean ports to dock on the island and for enabling the evacuation of the more than 600 passengers onboard.
Meanwhile Cuba, which is known for its disaster preparedness, is stepping up measures at home too to stem the coronavirus contagion. Twenty-five cases have been confirmed so far...closing its borders to foreign non-residents from Tuesday in a major blow to one of the motors of its cash-strapped economy, tourism.
Thousands of doctors and medicine students are also going door-to-door monitoring their local communities.
In 2019, Cuba's population is 11,333,483 with a median age of 41.1.
US population is currently estimated at 330,467,650, with median age of 38.3.
FDA authorizes new test that could detect coronavirus in about 45 minutes
Wesley Bruer and Kelly Mena | March 21, 2020
Washington, DC (CNN)The US Food and Drug Administration announced it has authorized the use of the first rapid diagnostic test that could detect the novel coronavirus in approximately 45 minutes.
The authorization was made Friday and tests will begin shipping next week, according to a statement from California-based Cepheid, the company manufacturing the tests.
"During this time of increased demand for hospital services, Clinicians urgently need an on-demand diagnostic test for real-time management of patients being evaluated for admission to health-care facilities," said Dr. David Persing, MD, Ph.D., chief medical and technology officer at Cepheid.
"An accurate test delivered close to the patient can be transformative -- and help alleviate the pressure that the emergence of the 2019-nCoV outbreak has put on healthcare facilities that need to properly allocate their respiratory isolation resources," Persing added.
...If cases of the disease are not identified quickly and community spread continues unchecked, it could soon overwhelm the nation's medical system, just as it did in Wuhan, China, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine...
Lots of local info posted by neighborhood associations if you care to join, e.g.,
I learned that while one of our hospitals doesn't want homemade masks, the other is providing patterns.
Also, according to my neighborhood network, 1/4" elastic in short supply on amazon and in local fabric shops.
p.s. I was able to join my nextdoor neighbor group without giving access to my FB friends. I think I just left that box blank.
Coronavirus: The Hammer and the Dance
A very interesting epidemiological analysis, which jibes with but elaborates upon the Imperian College report. Bottom line: the harsher the measures that are introduced in the short term, the greater leeway there will be in the future. Some won't like the war analogies, but the bottom line is that IF countries with community transmission are willing to crack down in draconian fashion for several weeks, then commit to applying intensive epidemiological measures to keep transmission rates under control, social and economic life might be able to return to near normal for the subsequent months until there is a vaccine.
Brazil’s densely packed favelas brace for coronavirus: ‘It will kill a lot of people.’
Terrence McCoy and Heloísa Traiano | March 21, 2020
...It’s a challenge now confronting governments across the developing world, as the coronavirus moves into densely populated, poorer countries, where expansive urban slums with limited sanitation and medical care could accelerate disease transmission.
In Liberia, the 2014 outbreak of Ebola was fueled by conditions in the slums of Monrovia. In India, influenza propagates more rapidly in the poorest neighborhoods, which then feed back into the city at large. And in Brazil, even the mosquito-borne disease of Zika was far more concentrated in the favelas of the north, around the city of Recife.
Now in the global war against the coronavirus, analysts believe some of the most important battles will be fought in the poorest parts of the developing world, with far fewer tools and far less capacity for isolation than higher-income countries.
“The strategy being pushed in the United States and China and Korea, there is no strategy for that there,” said Madhav Marathe, a division director of the University of Virginia’s Biocomplexity Institute. “Once a disease enters a slum, it’s very hard to do social distancing. Once it’s in a slum, it’s very hard to protect them.”
It will also make it much harder to protect everywhere else, Marathe said. Studying influenza in New Delhi, he found that slums have a multiplying effect during an outbreak. It will be much more difficult for countries with extreme urban poverty to overcome the epidemic: There will be a feedback loop.
“The point is that they matter a lot,” he said. “They play a big role in concentrating and speeding up the disease.”
In a country such as Brazil, which has more than 1,000 confirmed cases as of Saturday — by far the most in Latin America — public health professionals say it won’t be long before the disease reaches the favelas, if it hasn’t already. The first confirmed cases were wealthy Brazilians who contracted the disease while traveling abroad. But the classes here mix so regularly — the poor work in wealthy households as doormen, laborers and domestic employees — that it’s soon expected to be everywhere. Rio state’s first reported coronavirus death was that of a 63-year-old maid who apparently caught it from her boss after the woman’s return from Italy.
Trump had photo taken with infected Brazilian official but does not plan to get tested for coronavirus
“The people who brought this were the rich coming from vacations to Europe, but the people who will suffer much more will be the poor,” said Paulo Buss, one of Brazil’s leading public health doctors. “Unfortunately, I think it’s going to be there soon, and we will have big numbers.”...
I think this speaks volumes of how important social distancing is right now
GIF ( https://twitter.com/QueensPrincipal/status/1241785621422768128 )
- Patrick Deane @QueensPrincipal | 1:55 PM · Mar 22, 2020
Everyone In Iceland Can Get Tested For The Coronavirus. Here's How The Results Could Help All Of Us.
Alberto Nardelli, Emily Ashton | March 18, 2020
The small island nation’s large-scale testing strategy includes people who don’t have any symptoms.
...voluntary tests on people with no symptoms, which started last Friday. The first batch of 1,800 tests produced 19 positive cases, or about 1% of the sample.
"Early results from deCode Genetics indicate that a low proportion of the general population has contracted the virus and that about half of those who tested positive are non-symptomatic,” said (Thorolfur Guðnason, Iceland’s chief epidemiologist). “The other half displays very moderate cold-like symptoms."
“This data can also become a valuable resource for scientific studies of the virus in the future,” he added...
...In the small northern Italian town of Vo, one of the communities where the outbreak first emerged, the entire population of 3,300 people was tested — 3% of residents tested positive, and of these, the majority had no symptoms, researchers said.
The population was tested again after a two-week lockdown and isolation. Researchers found that transmission was reduced by 90% and all those still positive were without symptoms and could remain quarantined.
Luca Zaia, the governor of the Veneto region told Italian media this week: "We tested everyone, even if the 'experts' told us this was a mistake: 3,000 tests. We found 66 positives, who we isolated for 14 days, and after that 6 of them were still positive. And that is how we ended it."
Zaia wants to now extend mass testing, which started as a contingency measure in Vo, to the whole region. The Veneto governor told newspaper Corriere della Sera that the region has the ability to carry out 20-25,000 swabs a day.
The initial data from Iceland and Veneto appears to be in line with authoritative studies that have attempted to model the novel coronavirus....
A Medical Worker Describes Terrifying Lung Failure From COVID-19 — Even in His Young Patients
*puffs corticosteroid inhaler thoughtfully*
In Africa, social distancing is a privilege few can afford (Al Jazeera)
If you live in a township, make a living in the informal sector, or travel on a crowded bus, how do you self-quarantine?...
In Africa, the crisis has not yet reached epic proportions. But the cracks caused by existing inequalities are already showing...
Recovering Kenyan Covid-19 patient shares her story (Star)
the worry of infecting her two children — aged two-and-a-half and five — drains her more than the disease itself...
Germany's low coronavirus mortality rate intrigues experts (Guardian)
Germany’s relatively low mortality rate continues to intrigue experts as Covid-19 spreads across Europe, with some questioning the methodology behind its data gathering while others argue the country’s high testing rates allow a more accurate approximation of the threat posed by the novel coronavirus.
While the pandemic has hit Germany with full force, with Johns Hopkins University noting 22,364 confirmed infections by Sunday morning, only 84 people are so far reported to have died.
This means Germany currently has the lowest mortality rate of the 10 countries most severely hit by the pandemic: 0.3% compared with 9% in Italy and 4.6% in the UK.
The contrast with Italy is especially surprising because the two countries have the highest percentage of citizens aged 65 or over in Europe. If anything, the Bloomberg Global Health Index would suggest Italians have a healthier lifestyle than Germans...
And in deference to LT being a book website...
Waterstones closes stores in U-turn over staff's Covid-19 fears (Guardian)
Waterstones has said it will close its 280 UK branches from Monday, hours after its chief executive said the bookstore chain was “no different to a supermarket or a pharmacy” and would stay open during the coronavirus shutdown.
James Daunt said the decision had been taken after some staff complained that they felt at risk in the stores and had not been given any protective equipment such as hand sanitiser or gloves...
There are now more confirmed cases of coronavirus in New York City (10,764)
than there are in all of South Korea (8,897).
- Alexander Nazaryan (yahoo News) @alexnazaryan | 9:14 PM · Mar 22, 2020
Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection
Roni Caryn Rabin | March 22, 2020
Doctor groups are recommending testing and isolation for people who lose their ability to smell and taste, even if they have no other symptoms.
A mother who was infected with the coronavirus couldn’t smell her baby’s full diaper. Cooks who can usually name every spice in a restaurant dish can’t smell curry or garlic, and food tastes bland. Others say they can’t pick up the sweet scent of shampoo or the foul odor of kitty litter.
Anosmia, the loss of sense of smell, and ageusia, an accompanying diminished sense of taste, have emerged as peculiar telltale signs of Covid-19, the disease caused by the coronavirus, and possible markers of infection.
On Friday, British ear, nose and throat doctors, citing reports from colleagues around the world, called on adults who lose their senses of smell to isolate themselves for seven days, even if they have no other symptoms, to slow the disease’s spread. The published data is limited, but doctors are concerned enough to raise warnings...
Doctor's Note: Coronavirus and 'underlying health conditions'
Dr Amir Khanby | 17 Mar 2020
It is becoming a bit of a mantra; we hear it whenever anyone is talking about the coronavirus: "The elderly and those with underlying health conditions are most at risk."
...does that mean that anyone with a long-term health issue is doomed to fall victim to the complications of Covid-19?...not necessarily.
There is a good chance that even those who have underlying health conditions will make a full recovery from the virus, but they are at increased risk of complications such as shortness of breath, pneumonia, and in some cases, needing a machine and intensive hospital treatment to help them breathe.
...people who have diabetes (of any kind) are most at risk of developing complications and needing intensive hospital care, followed by those with underlying heart conditions, then lung conditions such as asthma and chronic obstructive pulmonary disease (COPD).
...there are a few...things you can do to minimise your risk...
...high levels of sugars in your blood can dampen your immune system...now is a really good time to get on top of your sugars.
...over time, high blood pressure and high cholesterol will put considerable pressure on your heart and its ability to pump blood around your body, making you prone to infections.
...Most people who have significant asthma or COPD are prescribed two groups of inhalers...If you are using your reliever inhaler more than two to three times per week, it would suggest your background lung health is not under control and you should speak with the clinician who manages your condition to see whether or not you need stepping up your treatment...
Providence network in Seattle was begging for masks. They were sending out kits with patterns and materials. By the time I contacted them, a Seattle business had stepped up to make them in quantity. But a representative of a Portland hospital was on the radio asking for masks, so I will make some for them.
Our neighborhood association keeps sending out notices for a nextdoor group, but I have not joined. I have seen too many complaints about racism on that platform. (They didn't build it as a racist platform, but it seems that is how it is being used.)
I remembered seeing your report that your wife had been in Bergamo. I heard that a case has been found in China from early November, but don't remember the source.
Whatever I had in November, it was so bad that I stayed home for several days after I felt OK, to make sure I did not pass it on. I do think I should eventually get tested for antibodies, if only to provide a data point around the early cases in WA and OR. But right now, there are others who need those tests. I am just staying home and out of the way.
As of 03/22/20, Washington state has performed 30,875 tests, with 6% positive. NY has performed more tests, but WA has tested a higher % of a much smaller population.
Persons under age 40 account for 25% of cases, but no deaths. The 80+ group has 15% of cases and 50% of deaths. Age 70-79 has 15% of cases and 30% of deaths. Contrary to results in Italy, WA is finding that 51% of cases and 54% of deaths are in females.
>38 oregonobsessionz: Racists everywhere--damn! I did find this though in one of nextdoor's discussions:
Last updated March 19, this seems to be a central site organized by state with individual hospital requests, e.g. design preferences for masks:
Million Mask Challenge
We have free tools, supplies & guidance in our Creator’s Studios for making supplies to donate to America’s hospitals.
>39 oregonobsessionz: Red Cross didn't want my stinkin' blood on Friday. Though it had been 33 days since my fever broke, I still have a bit of a cough in evening and morning, clearing stuff from throat and upper chest. According to MD lungs were clear when she listened nine days after fever broke.
Digestive Symptoms Tied to Worse COVID-19 Outcomes
Ricki Lewis, PhD | March 19, 2020
...For the overall study population, (Lei Pan, MD, PhD, of Binzhou Medical University Hospital in Binzhou, China) and colleagues found that the average time from symptom onset to hospital admission was 8.1 days. However, it was 9.0 days for patients with GI symptoms, including those with anorexia, compared with 7.3 days for those who did not have digestive symptoms. Seven patients had digestive symptoms but no respiratory symptoms at admission.
...symptoms included anorexia (83.8%), diarrhea (29.3%), vomiting (0.8%), and abdominal pain (0.4%)...
Digestive symptoms appeared to be tied to worse outcomes. Whereas 60% of patients without digestive symptoms recovered and were discharged, only 34.3% of the patients with digestive symptoms recovered.
(Brennan M. R. Spiegel, MD, MSHS, co–editor-in-chief of the American Journal of Gastroenterology) explained how the digestive symptoms arise. "The virus enters human cells through the ACE2 receptor in the lungs but also in other body parts, including the GI tract. We think the virus gets into saliva and we swallow it, and then it passes through the acid layer in some patients and uses the ACE2 receptors to enter epithelial cells that line the intestine."
The virus replicates rapidly in the cells of the GI lining, enters the intestinal tract, and is shed, Spiegel said. "There is clear evidence from endoscopy that it can damage the stomach and the intestines. The fact that these patients do worse may be that more of the body is involved."
An explanation for the longer time between symptom onset and COVID-19 diagnosis might be that patients with only GI symptoms or mild respiratory complaints did not think that they could have the coronavirus...
Lei Pan et al. 2020. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study
American Journal of Gastroenterology. https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf (This version will undergo additional copy editing, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content)
...Abstract Conclusion: We found that digestive symptoms are common in patients with COVID-19. Moreover, these patients have a longer time from onset to admission and their prognosis is worse than patients without digestive symptoms. Clinicians should recognize that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge. However, further large sample studies are needed to confirm these findings...
>34 davidgn: got me thinking. If we're essentially seeing patients drowning in their own blood, and it's difficult to oxygenate using gases, mightn't it make sense to oxygenate using liquids (specifically, perfluorocarbons)?
The technology exists, and it's been tried before, but never on a widespread basis -- mostly just as a niche technique for premature babies. (https://www.realclearscience.com/blog/2019/08/15/can_humans_breathe_liquid.html)
Looks like there have been a few recent developments in the technique as well.
Have to wonder whether it might prove effective in this COVID-19 pneumonia. If so, it ultimately comes down developing and producing the hardware.
Maybe I'm just trying to give myself hope in the event immunity turns out to be short-lived and this becomes a perennial pestilence. But I hope SOMEONE is working on the idea.
Speaking of hope, not sure whether anyone has mentioned the Chinese results for Avigan/favipirivir.
>44 davidgn: I saw that. I am by nature coursing with hope, which is where I get my sardonicism. That said, I have already seen the positive side of the globally intimate nature of these days. Positive action? Vitamin D. How do I know? The doctor you, dgn, introduced me to this guy: https://www.youtube.com/watch?v=s6JrkLvsKtw, and his clarity has been important. And if he says taking vitamin D helps, I'm taking vitamin D.
South Sudan closes airports and borders over coronavirus fears (Radio Tamazuj)
>45 RickHarsch: D is good, especially in winter, dark-skinned, etc.
DO look into zinc supplements, which are pretty darn safe (always check with pharmacist if on any Rx).
(My opthalmologist has me on 80 mg per day.)
White spots on one's nails can signify Zn deficiency.
Zn lozenges may reduce the duration of colds, perhaps by a day or so, and may reduce the number of upper respiratory infections in children (webmd).
20% of colds are caused by Corona viruses related to COVID-19.
From previous thread:
In video below, California pulmonologist & critical care specialist Roger Seheult, MD, explains how the virus SARS-CoV-2 invades a cell in the disease COVID-19 (~2:40 minutes in).
Also excerpted below, Te Velthuis (2010) showed that zinc impairs the replication of closely related RNA virus, SARS-CoV (which causes SARS).
Coronavirus Epidemic Update 32: Important Data from South Korea, Can Zinc Help Prevent COVID-19? (~20 minutes)
•Mar 6, 2020
MedCram - Medical Lectures Explained CLEARLY
Coronavirus (COVID-19) Update 32 with pulmonologist & critical care specialist Roger Seheult, MD of https://www.MedCram.com
South Korea has tested over 140,000 people for COVID-19 and their data may give the best insight into a more accurate fatality rate, and how quickly the new coronavirus can spread. Dr. Seheult illustrates how this coronavirus actually replicates within human cells - which is key to understanding how potential treatments and supplements such as zinc may aid in prevention.
Aartjan J. W. te Velthuis et al. 2010. Zn2+ Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture. PLOS. Published: November 4, 2010. https://doi.org/10.1371/journal.ppat.1001176 https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001176
Increasing the intracellular Zn2+ concentration with zinc-ionophores like pyrithione (PT) can efficiently impair the replication of a variety of RNA viruses, including poliovirus and influenza virus. For some viruses this effect has been attributed to interference with viral polyprotein processing. In this study we demonstrate that the combination of Zn2+ and PT at low concentrations (2 µM Zn2+ and 2 µM PT) inhibits the replication of SARS-coronavirus (SARS-CoV) and equine arteritis virus (EAV) in cell culture. The RNA synthesis of these two distantly related nidoviruses is catalyzed by an RNA-dependent RNA polymerase (RdRp), which is the core enzyme of their multiprotein replication and transcription complex (RTC). Using an activity assay for RTCs isolated from cells infected with SARS-CoV or EAV—thus eliminating the need for PT to transport Zn2+ across the plasma membrane—we show that Zn2+ efficiently inhibits the RNA-synthesizing activity of the RTCs of both viruses. Enzymatic studies using recombinant RdRps (SARS-CoV nsp12 and EAV nsp9) purified from E. coli subsequently revealed that Zn2+ directly inhibited the in vitro activity of both nidovirus polymerases. More specifically, Zn2+ was found to block the initiation step of EAV RNA synthesis, whereas in the case of the SARS-CoV RdRp elongation was inhibited and template binding reduced. By chelating Zn2+ with MgEDTA, the inhibitory effect of the divalent cation could be reversed, which provides a novel experimental tool for in vitro studies of the molecular details of nidovirus replication and transcription.
...In summary, the combination of zinc ions and the zinc-ionophore PT efficiently inhibits nidovirus replication in cell culture. This provides an interesting basis for further studies into the use of zinc-ionophores as antiviral compounds, although systemic effects have to be considered and a water-soluble zinc-ionophore may be better suited, given the apparent lack of systemic toxicity of such a compound at concentrations that were effective against tumors in a mouse xenograft model. In vitro, the reversible inhibition of the RdRp by Zn2+ has also provided us with a convenient research tool to gain more insight into the molecular details of (nido)viral RNA synthesis, and revealed novel mechanistic differences between the RdRps of SARS-CoV and EAV.or.
India, the world’s second-most populous country, will order its 1.3 billion people to stay inside their homes for three weeks to try to curb the spread of the coronavirus, Prime Minister Narendra Modi declared on Tuesday...a day after the authorities there grounded all domestic flights...“There will be a total ban of coming out of your homes...Every district, every lane, every village will be under lockdown,...If you can’t handle these 21 days, this country will go back 21 years.”...Left unclear was how Indians would be able to get food and other needed supplies...reported coronavirus cases remains relatively low, around 500, the fear is that if the virus hits as it has in the United States, Europe or China, it could be a disaster far bigger than anywhere else.
New York (City)
...Gov. Andrew M. Cuomo, who last week adopted a friendly tone toward President Trump, got as close as he has to chastising the federal government
“You want a pat on the back for sending 400 ventilators (to NYC)...What are we going to do with 400 ventilators when we need 30,000 ventilators? You’re missing the magnitude of the problem, and the problem is defined by the magnitude...We haven’t flattened the curve. And the curve is actually increasing...The apex is higher than we thought and the apex is sooner than we thought...That is a bad combination of facts.”
..the rate of new coronavirus infections in New York is doubling about every three days...The peak of infection in New York could come as soon as two to three weeks, far earlier than previously anticipated,...which would put even bigger strain on the health care system than officials had feared.
The governor said the state now projects that it may need as many as 140,000 hospital beds to house virus patients, up from the 110,000 projected a few days ago. As of now, only 53,000 are available. Up to 40,000 intensive-care beds could be needed. “Those are troubling and astronomical numbers,” he said.
As of Tuesday morning, New York State had 25,665 cases, with at least 157 deaths. The state now accounts for nearly 7 percent of global cases tallied by The New York Times...In New York City alone, there have been around 15,000 cases.
“Look at us today,” he warned the rest of the country. “Where we are today, you will be in four weeks or five weeks or six weeks. We are your future.”
Michigan had similar 0 to 800 trajectory of confirmed cases, largely in Detroit Metro Area (incl nearby richer counties), but only 8 deaths c.f. with LA's 20.
More hospitals here?
Coronavirus cases grew faster in Louisiana than anywhere else in the world: UL study
ADAM DAIGLE | Mar 23, 2020. Updated Mar 24, 2020
The number of confirmed coronavirus cases in Louisiana grew faster in the first 14 days than anywhere else in the world, data shows.
The state’s number of COVID-19 cases grew 67.8% in the first two weeks after the initial diagnosis and the growth rate continues to track paths of Italy and Spain, according to data compiled by Gary Wagner, Acadiana Business Economist at the University of Louisiana at Lafayette.
The growth rate in Louisiana is also similar to Italy and Spain in number of cases after 100 positive tests.
Gov. John Bel Edwards issued a statewide stay-at-home order until April 12 in an attempt to slow the spread of the virus.
“I would say that Louisiana was not on and still is not on a very good trajectory compared to other countries in the world who have been exposed to the virus longer than we have,” Wagner said. “What a lot of people are worried about — and you can see this happening in Italy — you have this huge growth in cases and you have a huge percentage of people diagnosed that require hospitalization. You can quickly overwhelm the ability to provide health care services.”
In two weeks, Louisiana has gone from zero to 837 confirmed cases and 20 deaths in 36 of its 64 parishes. While most of the cases were reported in the New Orleans area, more parishes are starting to report their first cases as testing is become more widespread.
As of Monday evening, 41 parishes have reported at least one confirmed case...
New Orleans, LA hospitals low on PPE, staff: https://www.nola.com/news/coronavirus/article_fea0282a-6dff-11ea-946b-b78e9c4531...
A percentage of their EMS personnel are off on quarantine.
COVID-19 and Conflict: Seven Trends to Watch (International Crisis Group)
I. The Vulnerability of Conflict-affected Populations...
II. Damage to International Crisis Management and Conflict Resolution Mechanisms...
III. Risks to Social Order...
IV. Political Exploitation of the Crisis...
V. A Turning Point in Major Power Relations?...
VI. Opportunities to Be Seized...
VII. Potential Crisis Mitigation Measures...
Interesting that FL Guv doesn't order people to stay at home with 1,400+ cases, tending to be a bit younger than national average. At risk is tourism, elderly Rs--in an election year! In tourism, PR is EVERYTHING, even if he doesn't care about individual Floridians and hospitals...
De Santis is calling for mandatory quarantine of arrivals from NY & NJ, but in Ontario, border towns are discouraging returning snowbirds from stopping to grocery shop. Kids returning from Spring Break are called on to self-quarantine. In FL development where we stayed, there were license plates from eastern half of North America--FL could receive AND seed all over!
Florida coronavirus cases rise above 1,400, state remains open amid calls for lock down
Emilee Speck | March 24, 2020
This sounds about right!
I probably have a ‘mild to moderate’ case of covid-19. I don’t think I could survive worse.
David Von Drehle | March 24, 2020
Trump would like U.S. citizens to die for Wall Street and/or die for the Dow.
Cuba's sending not just doctors, but their own Cuban-Chinese developed therapeutic drug.
CUBA USES 'WONDER DRUG' TO FIGHT CORONAVIRUS AROUND WORLD DESPITE U.S. SANCTIONS
Arizona man dies after attempting to take Trump coronavirus 'cure' (Guardian)
Wife survives after couple in their 60s ingested chloroquine phosphate, which Trump falsely claimed was approved to treat coronavirus...
MIT tech review has roundup on some clinical trial results. They put a damper on various hopes and hypes.
Some folks at MIT are also dusting off a decade-old prototype for a low-cost, simple-to-manufacture ventilator.
Louisiana is not at all surprising after Mardi Gras.
Start with the local population, which generally rates at or near the bottom for most measures of health and wellness. Add 1 million people from all over the world, many arriving by air. Pack together firmly, and apply copious amounts of alcohol. Mix well, as people wander from one event to another. Load all of the tourists back onto airplanes, and disperse them back to their homes. What could go wrong?
The same applies to all those people who packed the beaches over spring break, except that the average participants there might be younger and healthier.
Unfortunately, emergent viruses with logarithmic rates of propagation do not believe in wishful thinking.
Oracle to partner with Trump administration to collect data on unproven drugs to treat covid-19
Yasmeen Abutaleb, Laurie McGinley and and Josh Dawsey | March 24, 2020
...Ellison — who recently held a high-profile fundraiser for Trump — has helped arrange a partnership between Oracle, the software company he co-founded, and the federal government to crowdsource that idea by collecting data in real time from doctors trying out (chloroquine and hydroxychloroquine) and other unproven drugs on covid-19 patients.
...While the anti-malarial drugs are also being tested in clinical trials, the primary purpose of Oracle’s new website and mobile app is to help gather information on patients prescribed the medications outside of trials and more quickly assess whether the drugs — or any others that may emerge as possible treatments — are effective against covid-19, for which there is no proven treatment. The company plans to donate the site to the government.
Chloroquine and hydroxychloroquine are approved for malaria, so doctors can prescribe them for other illnesses. Some are trying them on patients with covid-19 based on anecdotal reports that they are sometimes helpful. The Oracle technology is meant to help the government collect data “in real time” and faster than in traditional Food and Drug Administration clinical trials
...The administration is also exploring whether it will offer bonus payments to doctors who use the technology. This raises ethical concerns among some health officials, who fear that will further promote the use of unproven drugs
...The president’s recent statements underscore his desire for a quick fix to the rapidly escalating pandemic that has infected more than 53,000 Americans and killed upward of 600. They have also resulted in shortages of chloroquine and hydroxychloroquine for patients who need them for other uses
...FDA Commissioner Stephen Hahn, Centers for Disease Control and Prevention Director Robert Redfield and Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases...pushed back on the idea (that the government could expedite approval of chloroquine, hydroxychloroquine and remdesivir, an antiviral that has not been approved for any use but is currently being scrutinized in several late-stage trials), urging the president to wait for the results of randomized clinical trials that meet the FDA’s standards.
But Health and Human Services Secretary Alex Azar, who had been asked by Trump earlier that day to find legal authority to immediately approve the drugs, told the president he had conferred with his lawyers and had options for immediate approval if Trump wanted them, including emergency authorities granted to the health secretary.
...other officials in the room were stunned at the suggestion and urged Trump to rely on the clinical trials.
Trump ultimately stood down
...On Tuesday, the state of New York was scheduled to begin testing chloroquine and hydroxychloroquine as treatments for covid-19....
Coronavirus Treatment Developed by Gilead Sciences Granted “Rare Disease” Status, Potentially Limiting Affordability
Sharon Lerner, Lee Fang
March 23 2020, 10:03 p.m.
On Monday afternoon, the Food and Drug Administration granted Gilead Sciences “orphan” drug status for its antiviral drug, remdesivir. The designation allows the pharmaceutical company to profit exclusively for seven years from the product, which is one of dozens being tested as a possible treatment for Covid-19, the disease caused by the new coronavirus.
Experts warn that the designation, reserved for treating “rare diseases,” could block supplies of the antiviral medication from generic drug manufacturers and provide a lucrative windfall for Gilead Sciences, which maintains close ties with President Donald Trump’s task force for controlling the coronavirus crisis. Joe Grogan, who serves on the White House coronavirus task force, lobbied for Gilead from 2011 to 2017 on issues including the pricing of pharmaceuticals.
...The 1983 Orphan Drug Act gives special inducements to pharmaceutical companies to make products that treat rare diseases. In addition to the seven-year period of market exclusivity, “orphan” status can give companies grants and tax credits of 25 percent of the clinical drug testing cost. The law is reserved for drugs that treat illnesses that affect fewer than 200,000 people in the U.S. But a loophole allows drugs that treat more common illnesses to be classified as orphans if the designation is given before the disease reaches that threshold. As of press time, there were more than 40,000 confirmed cases of Covid-19 in the U.S, and some 366,000 worldwide.
The distinction could severely limit supply of remdesivir by granting Gilead Sciences exclusive protection over the drug and complete control of its price. Other pharmaceutical firms, including India-based pharmaceutical firm Cipla, are reportedly working toward a generic form of remdesivir, but patients in the U.S. could be prevented from buying generics with lower prices now that Gilead Sciences’s drug has been designated an orphan.
Today, Gilead abruptly announced that it would no longer provide emergency access to remdesivir, telling the New York Times that “overwhelming demand” left it unable to process requests for the drug through its compassionate use program. Hours later, the FDA gave the drug orphan status. Almost immediately, Gilead’s stock price shot up....
The special orphan designation, which can also be granted to drugs when there is little reasonable expectation that a company will recoup its research costs, was given to remdesivir despite hefty support by the government for the development of the drug.
Gilead Sciences’ remdesivir was developed with at least $79 million in U.S. government funding...The U.S. National Institute Allergies and Infectious Diseases continued providing significant taxpayer funding to subsidize the development of remdesivir. NIAID grants to Columbia University, Vanderbilt University, University of North Carolina-Chapel Hill, and the University of Alabama subsequently found that remdesivir prevents virus replication in a range of coronaviruses in human lung cells.
...Grogan, who in 2016 earned over $800,000 in salary and bonuses at Gilead, came under scrutiny in 2018 for his work, also at Gilead, on a Medicare payment model for a cancer treatment.
The company has also come under fire for its pricing schemes. In 2014, Gilead sparked a controversy over listing its hepatitis C drug, Sovaldi, for $84,000 for a 12-week course therapy. The company had purchased the patent from another firm and proceeded to nearly triple the price. Gilead also sells Truvada, a drug to help prevent the transmission of HIV, for almost $2,000 a month despite the fact that it costs only $6 to manufacture.
...Johanna Mercier, executive vice president of Gilead, noted that the company is focused on increasing capacity to meet demands for patients and government access. “Commercial opportunity,” Mercier added, “might come if this becomes a seasonal disease or stockpiling comes into play, but that’s much later down the line.”
“Gilead probably feels like now’s the time to cash in before somebody comes up with a better drug or a vaccine is done,” said (James Love, director of Knowledge Ecology International, a watchdog on pharmaceutical patent abuse). “They’re going to be very aggressive in how they go after this.”...
>49 margd: >57 oregonobsessionz: LA, contd.
Mardi Gras, coronavirus make 'perfect storm' crisis in Louisiana (5:59)
March 24, 2020
Dr. Rebekah Gee, CEO of LSU Healthcare Services, talks with Rachel Maddow about
how the skyrocketing spread of the coronavirus in Louisiana threatens to overwhelm hospital resources there,
not just the bed capacity but the staffing resources as well.
Mayor of New Orleans told me tonight that OVER HALF of EMS personnel in her city are under quarantine.
In NYC, sick callouts of NYPD are 2700-2800. Getting closer to 10% of force.
To state the obvious, these numbers matter...
- Erin Burnett @ErinBurnett11:00 PM · Mar 24, 2020
For those of you wondering why all these California companies* have mask stockpiles:
the answer is wildfires. new regulation went into effect last year requiring N95s
California just became the first state to set safety regulation for workers exposed to wildfire...
California's worker safety standards board now requires workers to be protected from wildfire smoke — the first regulation of its kind.
- Elizabeth Lopatto @mslopatto | 8:00 PM · Mar 24, 2020
* Apple, Facebook
Slow Response to the Coronavirus Measured in Lost Opportunity
David E. Sanger, Zolan Kanno-Youngs and Ana Swanson | March 24, 2020
...For the first time, it is now possible to quantify the cost of the lost weeks, as President Trump was claiming as recently as February that in a “couple of days” the number of cases in the United States “is going to be down to close to zero.”
Ford’s timeline suggested that if the administration had reacted to the acute shortage of ventilators in February, the joint effort between Ford and General Electric might have produced lifesaving equipment sometime in mid- to late April.
....The gap between the production timelines and the need for immediate supplies led to a scathing assessment from Gov. Andrew M. Cuomo of New York. New York accounts for more than 25,000 cases, more than half the total in the country, he said, but it has received only 400 ventilators from the federal government..."we need 30,000 ventilators...I don’t need ventilators in six months...And I don’t need ventilators in five months, four months or three months.”
The reality is that timing is impossible, producers of the equipment say. For example, Medtronic, one of the leading manufacturers of ventilators, now makes about 225 of its high-end machines each week, up from 100 in more normal times. But it is a daunting task because there are 1,500 unique parts supplied from 14 countries. The company is aiming for 500 a week...Even that would not satisfy current demand.
Last week, Mr. Trump urged states to fend for themselves, looking for whatever they could find on the open market...Gov. J.B. Pritzker of Illinois, a Democrat, argued that in sending each of the states off to find their own equipment, “we’re competing against each other, we’re competing against other countries.” The result, he said, was “we’re overpaying.”
...the federal government will not be able to back up the states, at least at the scale needed, for the first wave of patients. And by letting companies voluntarily produce the necessary equipment, rather than under orders in the Defense Production Act, the administration is not responsible for whether the quotas are met, or if the output reaches hospitals.
Ford’s new partnership with GE Healthcare and 3M aims to produce about 1,000 respirators a month, using fans from F-150 trucks, the most widely sold in the United States, and parts made on 3-D printers. But Mr. Hackett noted that those parts would have to be merged with electronics produced by other suppliers.
...Representative Elissa Slotkin, Democrat of Michigan, a former C.I.A. officer who is on the House Homeland Security Committee...said she was introducing legislation to require the administration to enforce the Defense Production Act. But that may well be for a future crisis, not this one.
Federal handling of COVID-19 seems destined to be Exhibit A of how-not-to respond-to-pandemic in a future public health textbook.
Not just "politics", people are dying as result of this latest eruption of incompetence and ignorance...
Testing Blunders Crippled US Response as Coronavirus Spread
Associated Press | 23 March 2020
A series of missteps at the nation’s top public health agency caused a critical shortage of reliable laboratory tests for the coronavirus, hobbling the federal response as the pandemic spread across the country like wildfire.
...outside observers and federal health officials have pointed to four primary issues that together hampered the national response —
the early decision not to use the test adopted by the World Health Organization,
flaws with the more complex test developed by the CDC,
government guidelines restricting who could be tested and
delays in engaging the private sector to ramp up testing capacity...
...Only in the last few days has the United States finally begun testing more people each day than far smaller South Korea, according to data complied by Johns Hopkins University.
(Dr. Ashish K. Jha, the director of the Global Health Institute at Harvard) estimates the U.S. should be testing 100,000 to 150,000 people per day — figures he said should be obtainable given the number of high-quality diagnostic labs in the country.
“We certainly have the capacity. It’s just we’re not doing it,” Jha said Thursday. “We are up to about 40,000 tests per day now — and so we are moving in the right direction. Still far from where we need to be, but moving.”
>62 davidgn: We shouldn't be surprised, but I think it reflects well on those of us who retain capacity for outrage...
Would that the MAGA folk would get it--they've been had.
Coronavirus tracked: the latest figures as the pandemic spreads (charts and maps)
Steven Bernard, Cale Tilford, John Burn-Murdoch and Keith Fray | March 24, 2020
...death tolls growing more quickly in Italy and Spain than they did in China at the same stage of the outbreak
...Lombardia has eclipsed Wuhan as the most badly affected region in the world, and in Spain Madrid could soon surpass even that.
...In most western countries case numbers have been increasing by about 33 per cent a day, a sign that other countries may soon be facing the same challenge as Italy. The Asian city-state of Singapore and the territory of Hong Kong are on a different trajectory in terms of the growth in case numbers. The rate of increase has so far been relatively contained through rapid and strict measures.
...There have now been at least 100 confirmed cases recorded in 78 countries around the world.
...mapping the coronavirus outbreak...
Death toll the last two days in NYS---81 and 114. Those numbers are beginning to take off.
211 NYPD officers or employees have tested positive or 7.6% of NYPD's work force. One wonders what the %'s are of doctors and medical staff or other first responders who are being exposed all the time. Shortages of ventilators, masks, gowns and other essentials and 4 to 5000 new cases regularly every day.
Again Trump wants to open up for business?
Watching the US climb the tracker lists in cases and deaths is a little how I imagine staring into the oncoming train feels.
We are living in a modern-day Twilight Zone ~ a poll indicates that
60% of the people polled approve of Trump's virus-era actions ~
the bar is soooo low now, an ant can mosey its way over it.
Terrible news! :
RE: "Trump's response to the novel coronavirus pandemic"
(Gallup poll) "Americans give the president generally positive reviews for his handling of the situation, with 60% approving and 38% disapproving. Ninety-four percent of Republicans, 60% of independents and 27% of Democrats approve of his response."
Your “ants” get their chance in November.
Meanwhile, you'd better pray and pray real hard for Trump's failure in his efforts to shepherd the nation and its people through a time of rare hardship and compounded miseries for so many millions of people.
You, who have, like other Trump-haters, leapt at the chance to instrumentalize a world-wide health crisis for the better advancement of your petty partisan desires, should have no trouble earnestly calling on divine intervention to foil Trump's efforts to bring relief to millions now in or at risk of soon being in the grip of a deadly viral pestilence and what it brings with it: financial ruin, social chaos, lives cut short and, for grieving survivors, lives and careers blighted. Surely God would not fail to see the wickedness you impute to Trump's every word and deed. Surely, once your prayers are launched, God will see to Trump's meeting with the failure and disgrace which you so hope shall be his.
Do your best; with every bankruptcy, every death, your hopes to see the Trump approval-meter move down a point can seem, by your logic, to find encouragement.
‘It would not take large numbers’ to overwhelm Alabama hospitals; officials look at adding beds
Anna Claire Vollers | 3/25/2020
About 75% of Alabama’s 14,790 hospital beds are full on a regular day.
...Alabama had 283 confirmed cases of COVID-19 as of Wednesday afternoon, a dramatic increase from the 36 confirmed cases one week ago. Around 7 or 8 percent of those cases have required hospitalization, said State Health Officer Dr. Scott Harris on Tuesday, but he said actual hospitalization numbers could be higher because of data reporting issues.
...Nowhere in the state is a hospital bed shortage more immediate than in Birmingham. Patients already fill 90 percent of available hospital beds in Birmingham on an average, non-COVID-19 day....
NYC morgues near capacity, DHS briefing warns
BETSY WOODRUFF SWAN, DANIEL LIPPMAN and AMANDA EISENBERG | 03/25/2020
...DHS officials were told that morgues in NYC are expected to reach capacity next week...some of the city’s hospital morgues hit capacity over the last seven days. And a FEMA spokesperson told POLITICO that New York has asked for emergency mortuary assistance. Hawaii and North Carolina have asked for mortuary help as well...
FDA will allow doctors to treat critically ill coronavirus patients with blood from survivors
Mike Hixenbaugh | March 24, 2020
The Food and Drug Administration will allow doctors across the country to begin using plasma donated by coronavirus survivors to treat patients who are critically ill with the virus under new emergency protocols approved Tuesday.
The FDA's decision comes a day after New York Gov. Andrew Cuomo announced that the state's health department planned to begin treating the sickest coronavirus patients with antibody-rich plasma extracted from the blood of those who've recovered.
The treatment, known as convalescent plasma, dates back centuries and was used during the flu pandemic of 1918, in an era before modern vaccines and antiviral drugs. Some experts have argued that it might be the best hope for combating the coronavirus until more sophisticated therapies can be developed, which could take several months.
"The approach definitely has merit, and what's remarkable about it is it's not a new idea; it's been with us for a good hundred years or longer," said Dr. Jeffrey Henderson, an associate professor of medicine and molecular microbiology at the Washington University School of Medicine in St. Louis. "I think we don't know until we have experience and case reports with this particular disease whether it will be effective, but just based on its track record with a number of other viruses, I think it has a very good chance of working."
Henderson is part of a nationwide network of doctors and researchers, led by a team at Johns Hopkins University in Baltimore, who have been working to establish protocols for use of plasma to treat those suffering from COVID-19, the disease caused by the coronavirus.
The method — essentially harvesting virus-fighting antibodies from the blood of previously infected patients — was associated with milder symptoms and shorter hospital stays for some patients during the 2002 SARS outbreak. And initial reports from China suggest convalescent plasma might also be effective in dulling the effects of COVID-19.
Under the emergency protocols approved by the FDA, doctors can request permission to treat critically ill COVID-19 patients on a case-by-case basis. For now, the experimental treatment will be reserved for patients who are in dire condition and at risk of death. The FDA will respond to most requests within four to eight hours, the agency said. For patients who require treatment faster, doctors can call the FDA's Office of Emergency Operations to get approval over the phone.
If the treatment is proven safe and effective, experts said it would likely work best if given to patients before symptoms become too severe. And past studies indicate that proactive infusions of convalescent plasma might also be effective in protecting front line health care workers from becoming seriously ill.
#70--I was looking at a Democracy Now clip on what's happening in Madrid Spain. They set up their overflow morgue in an ice skating rink. There are several rinks in NYC.
A speculative and circumstantial look at China's experience -- the mystery of the sudden cancellation of 21 million net cell phone subscriptions.
The Kenyan president has just announced a 7 pm to 5 am curfew, as many people are apparently not obeying instructions about social distancing. Mind you, it will probably be impossible to enforce in the shanty towns.
Reminds me of Sudan after the military coup d'etat in 1989, when we were under a night-time curfew for years. Mind you, we didn't really obey that one, even though you could get shot. But that one was just a tool of the oppressive military regime, not a liifesaver, so there was no incentive to obey it and every incentive to oppose it. The current curfew in Kenya has the opposite dynamic - there is plenty of incentive to support it.
I had to go shopping for groceries and prescription medications during the day yesterday, and every shop I went into had either hand sanitiser or soap and water, with a staff member there to make sure you used it.
And next door, in Uganda...
'Sensitise to sanitise': Bobi Wine uses song to fight coronavirus across Africa (Guardian)
Bobi Wine, a Ugandan musician and rising political force, has joined the likes of footballer-turned-president George Weah in resorting to song to help stem the spread of coronavirus in Africa.
Wine, whose real name is Robert Kyagulanyi, worked with fellow artist Nubian Li to release a song on Wednesday laced with east Africa’s signature rhumba melodies about the importance of personal hygiene.
“The bad news is that everyone is a potential victim,” Wine sings. “But the good news is that everyone is a potential solution.”
The pair exhort people to regularly wash hands, keep a distance and look out for symptoms such as a fever and cough...
Uganda suspends refugee arrivals as coronavirus cases rise (The New Humanitarian)
‘This will greatly affect those seeking asylum, which goes against the policy and practice of Uganda’...
South Sudan also closed borders and airports this week.
In general, the basic idea behind the guy's reasoning is valid. It can sometimes be revealing--if reasoned correctly--to take such data and attempt to use them to "read between the lines." But it' foolish to forget about the dangers of "garbage in, garbage out."
China has well more than a billion people. Even supposing that one-tenth of those cancellations are due to virus-related deaths, how many routinely explicable cell-phone service cancellations do you think there are on an ordinary day? and, why, in these circumstances, wouldn't this many Chinese--who may have multiple cell phones--decide that, for the sake of saving when things are especially dire, one or more of the phones contracts is dispensible? Secondly, where China is concerned, I'd expect cell-phone companies to inflate, exaggerate, their subscriber-lists for any number of reasons that this could help make them look more prosperous--and natural human tendencies for mimickery and envy are no small part of this. Cell-phones can easily be made a fashion-fad and sellers of fashion want, above all, people to regard with envy and a desire to imitate them those who have their products.
Q. : 21m cell phones are what fraction of the usual total of cell phones in daily use in China?
From your guy's video's own data, one provider showed a drop of 7.254m users from a supposed subscriber base of 942.16m. That's a drop of 0.77%.--over a month. Or, over a month, for that provider, an average of 241,800 people per day dropped or changed their service provider. Why is this a "sudden" drop.
Hockey equipment manufacturer Bauer (a Canadian company) can turn out 10,000 faceshields a week like in the link below for medical staff and first responders. I got the 10,000 from another article:
>76 lriley: My hockey-playing relatives are liking this on Facebook:
Social Distancing For Canadians.....
If I Can Hit You With A
Hockey Stick...(And I Will)
You're Too Close...lol
Waffle House closes 365 locations across the U.S.
Josh Carter | March 24, 2020
JACKSON, Miss. (WLBT) - Waffle House has now closed 365 locations across the U.S. due to the coronavirus pandemic...1,627 remain open...
(FEMA's Waffle House Index) is based on the reputation of Waffle House for having good disaster preparedness and staying open during extreme weather, or reopening quickly afterwards.
If you get there and the Waffle House is closed? That's really bad...
— Craig Fugate, Former Head of the Federal Emergency Management Agency
The index has three levels, based on the extent of operations and service at the restaurant following a storm:23
GREEN: full menu – restaurant has power and damage is limited or no damage at all.
YELLOW: limited menu – no power or only power from a generator, or food supplies may be low.
RED: the restaurant is closed – indicating severe damage or severe flooding.
This is the highest number of new cases reported by a single country in one day since the coronavirus pandemic began
Over the past 24 hours, the U.S. reported 14,024 new cases of coronavirus and 265 new deaths, raising the total to 68,347 cases and 1,037 dead
Tracking coronavirus: Map, data and timeline - BNO News
- BNO Newsroom @BNODesk | 11:23 PM · Mar 25, 2020
Gov. Ron DeSantis won’t shut down Florida. Here’s who he’s talking to about that.
Lawrence Mower | March 25, 2020
“We’re recommending that the governor continue to do what he’s doing,” said Florida Chamber President and CEO Mark Wilson. “I don’t think the data says we need to do a statewide shutdown.”...
Governor Orders Limited Gatherings, Declares Most Businesses 'Essential,' Supersedes Local Safety Efforts
Nick Judin | March 24, 2020
Gov. Tate Reeves signed an executive order early this evening superseding a patchwork of local bans on public gatherings in Mississippi and other heightened restrictions that several municipalities across the state have ordered or considered in the wake of COVID-19’s spread inside Mississippi. The state reached 320 official cases today, up 300 percent since 80 known cases on Friday.
The order seems to declare that most types of businesses in Mississippi are "essential" and thus exempt from social-distancing requirements suggested in the order. "The uninterrupted delivery of essential services and functions is vital to infrastructure viability, critical to maintain continuity of functions critical to public health and safety, as well as economic and national security, and is crucial to community resilience, continuity of essential functions and to promote the security and safety of Mississippi residents even as the nation limits human interaction and engages in social distancing," the order stated.
Notably, Reeves' executive order supersedes any orders by local mayors or other governing body in Mississippi that conflict with the businesses and organizations he deems exempt as "essential" businesses.
...Department Stores, Offices, Factories Among Exempt Businesses...
The LameStream Media is the dominant force in trying to get me to keep our Country closed as long as possible
in the hope that it will be detrimental to my election success.
The real people want to get back to work ASAP. We will be stronger than ever before!
- Donald J. Trump @realDonaldTrump | 4:04 PM · Mar 25, 2020
#77--it keeps the Bauer plant going too. But that's pretty funny. I haven't played in about 15 years now but I still have sticks and skates around the house. Never wore a shield or a cage though--so I don't have any of those. I should bring a stick with me next time I go to the grocery store.
An epidemiological model suggests that opening the country up at Easter, as President Trump wants to,
rather than two weeks later would kill an additional 450,000 Americans
- Ana Swanson (NYT) @AnaSwanson | 10:26 PM · Mar 25, 202
Opinion | Trump Wants to ‘Reopen America.’ Here’s What Happens if We Do.
Many could die if we ease up too soon.
10:26 PM · Mar 25, 2020
Trump Wants to ‘Reopen America.’ Here’s What Happens if We Do.
Nicholas Kristof and Stuart A. Thompson
Model created with Gabriel Goh, Steven De Keninck, Ashleigh Tuite and David N. Fisman
March 25, 2020
Scramble for medical equipment descends into chaos as U.S. states and hospitals compete for rare supplies
With prices rising and supplies uncertain, governors and health-care officials are urging the Trump administration to use the Defense Production Act to bring order
Jeanne Whalen, Tony Romm, Aaron Gregg and Tom Hamburger | March 24, 2020
A mad scramble for masks, gowns and ventilators is pitting states against each other and driving up prices. Some hard-hit parts of the country are receiving fresh supplies of N95 masks, but others are still out of stock. Hospitals are requesting donations of masks and gloves from construction companies, nail salons and tattoo parlors, and considering using ventilators designed for large animals because they cannot find the kind made for people.
The market for medical supplies has descended into chaos, according to state officials and health-care leaders. They are begging the federal government to use a wartime law to bring order and ensure the United States has the gear it needs to battle the coronavirus. So far, the Trump administration has declined...
The big question looming over Trump’s coronavirus disaster
Greg Sargent | March 25, 2020
...Trump has invoked this 1950 wartime production measure (Defense Production Act, or DPA) but has not deployed it. Numerous states and health officials are pleading with him to do so, warning of severe equipment shortages crippling their own responses.
...Trump’s explanations for refusing to deploy the DPA don’t add up. He and other officials have claimed the private sector is filling the void on its own. Trump insists companies understand that the threat of deploying the DPA gives him “leverage," forcing them to step up.
But as a recent New York Times report documented, many of these executives themselves are locked in “widespread confusion” about who should be producing what for whom, resulting in a “bewildering” lack of coordination. Trump himself recently tweeted that it’s “not easy” to get states equipment they need, because the world market is “crazy.”
Some private-sector groups have lobbied the administration against deploying the DPA, arguing it would be counterproductive when they need flexibility to ramp up.* Trump reportedly finds this persuasive...
* "The U.S. Chamber of Commerce and the heads of major corporations have lobbied the administration against using the act. They say the move could prove counterproductive, imposing red tape on companies precisely when they need flexibility to deal with closed borders and shuttered factories." https://www.nytimes.com/2020/03/22/us/politics/coronavirus-trump-defense-product...
Compare your community's social distancing activity to its activity prior to COVID-19
Coronavirus: Hydroxychloroquine for a dog? Questionable prescriptions poured into Ohio pharmacies
Lucas Sullivan | Mar 25, 2020
Jennifer Tackett walked into her Meijer pharmacy in Hilliard on Monday to refill the same prescription of hydroxychloroquine she’s received since 2012 to relieve the crushing arthritis in her hands, only to be told the pharmacy had none.
Just days before, an Ohio veterinarian filed a prescription order of the drug for a dog. And an emergency room doctor near Akron requested 1,000 pills for himself.
Pharmacists across Ohio this week provided details to The Dispatch of questionable prescriptions for hydroxychloroquine, or chloroquine, that have poured in from doctors in the past week. The prescriptions were filed as soon as an hour after President Donald Trump promoted them last Thursday as a possible treatment for coronavirus...
#81--Donald's detachment from reality is continually on display. He's talking about filling church pews on Easter Sunday. What he'll end up doing more than anything is murdering off a good % of his evangelical/catholic base.
So business be fucked and religious attendance be fucked. Right now this has been killing about 100 people a day in NYC. I'm expecting that number to go up and if we're looking at Italy and Spain their numbers of cases are not only staying up the daily death toll is getting higher and higher. This fucking dipshit of a numbskull in the White House among other things he can't read he can't read graphs or statistics either.
I'm not going out in public except for groceries. The last time I was out was Saturday and that was an in and out trip. I don't see reason enough to go anywhere for another several days and that will be for the same purpose. Donald Shithead can make all the pronouncements he wants but he's the last one in the universe that I'd pay any attention to. When I think it's safe then I'll mingle again. It ain't safe now and it ain't going to be for a while. Donald can go fuck himself--better if he jumped off a cliff. Fuck you Donald---go visit some of the people who are sick because of you.
>85 lriley: The models I sent you basically say one comforting thing: there is an end in sight. That is absolutely true from what is known now. But the model comports to data that makes sense comparatively. So, for instance, is the US behaves in a bizarre manner, the model will be as bad as Iran's. Even the worst hit countries conform to the model because the behaviour is predictable enough. When you factor in something insane, you've discombobulated the model.
So, the good news is that even with Trump and a degraded oligarchy running things, the epidemic will come to an end in the US. The bad news is that because of Trump being at the head of a degraded oligarchy, the epidemic will be worse than it should have been.
(Imagine, or dwell on the fact: US senators selling stocks for fear of catastrophe, and at the same time refusing to take on Trump and his murderous behavior. Such a country surely is in its death throes.)
Age alone is of course, as a factor here, very likely to be purely coincidental. There are too many people of all ages getting sick—in degrees of severity which are too varied among these cohorts—for this to be “explained” in any important way by age.
We should ask—as undoubtedly researchers are asking—“What are the physiological commonalities between elderly and young victims of the virus which have little or no relation to age per se?" Thus, how are both environmental and behaviorial characteristics markedly similar across age groups in those who do contract the virus as well as show seriously debilitating symptoms and, conversely, "What sorts of the same things distinguish across age groups, those who haven't so far shown symptoms (despite their having been almost certainly exposed to the virus in ways and to degrees which were ample to infect and cause seriously debilitating symptoms in others) from those who have presented severe symptoms with their exposure to the virus?"
The virus is in certain respects like a voyaging “space-traveller” : no matter how similar human beings are, every individual represents, for the virus, what amounts to a “new and alien planet.” Thus, the environmental conditions encountered on some “planets” greatly lend themselves to the propagation of the virus interius corpus. Notice, too, that, despite its being rampant in Wuhan and beyond in Hubei province, this strain, unlike other strains of Corona virus, has not both infected and killed mass numbers of other species eventhough many have certainly been exposed to this virus. Why doesn't it sicken and kill any other species exposed to it?
Coronavirus: Could Germany become Europe’s first country to flatten the curve? (Independent)
High levels of testing, age of patients and a strong healthcare system may explain country’s low coronavirus mortality rate...
Thursday ~ 5-ish p.m. Eastern time
The U.S. just jumped to the top of the world-wide confirmed cases list.
WE'RE #1! :(
We had dramatically more warning, more time, and better health care infrastructure than China.
Our total failure to get this under control despite that is a matter of our leadership and its management of the crisis.
Image ( https://twitter.com/benjaminwittes/status/1243298231431376898 )
- Benjamin Wittes @benjaminwittes | 6:06 PM · Mar 26, 2020
This shows the location data of phones that were on a Florida beach during Spring Break. It then shows where those phones traveled.
First thing you should note is the importance of social distancing. The second is how much data your phone gives off.
1:11 ( https://twitter.com/MikaelThalen/status/1243281598037913600 )
From Tectonix GEO
- Mikael Thalen @MikaelThalen | 5:00 PM · Mar 26, 2020
Front-line report from SE Michigan. Last ventilator at the Ascension hospital in Southfield, MI went to one of this nurse's patients. And that was yesterday.
News coverage https://www.fox2detroit.com/news/emergency-room-nurse-begs-michiganders-to-stay-...
ETA: We need more of this.
And from Ars Technica, we have triage guidelines. Will read in full when I have a chance.
A lot of Americans like Trump's handling of crisis (CNN)
As the coronavirus crisis unfolds and media and Democratic bashing of President Donald Trump continues, a curious thing is happening -- his numbers are going up.
The Gallup poll this week recorded its highest ever job approval for the President (49% approve, versus 45% who don't). Likewise, Trump is generally getting decent marks on his handling of the pandemic, with Gallup showing 60% approval on the subject.
The question is -- why?...
Trump (the life-long con man) uses his jovial personality and
pleasant façade to spread fear and hate. Capturing peoples
hearts, minds and souls appears to be his innate ability (it's sad
that he uses this ability for evil rather than good). Having
Murdoch's FOX News channel on-air personalities (who are rich
and getting richer each day) singing his praises 24/7 is a plus,
>92 davidgn: Thanks for posting video of ICU nurse from se Michigan (Southfield)--powerful testimony. Southfield is just east of here...between our home and our youngest son's.
The horror will get worse...Here is photo of letter on triage policy of Henry Ford Health system:
Henry Ford Health officials confirm letter outlining life and death protocols for COVID-19
Phoebe Wall Howard | March 27, 2020
...Henry Ford Health System..."With a pandemic, we must be prepared for worst case...With collective wisdom from our industry, we crafted a policy to provide guidance for making difficult patient care decisions. We hope never to have to apply them. We will always utilize every resource to care for our patients."
The original Henry Ford Health System letter that triggered discussion said:
"To our patients, families and community:
Please know that we care deeply about you and your family's health and are doing our best to protect and serve you and our community. We currently have a public health emergency that is making our supply of some medical resources hard to find. Because of shortages, we will need to be careful with resources. Patients who have the best chance of getting better are our first priority. Patients will be evaluated for the best plan of care and dying patients will be provided comfort care.
What this means for you and your family:
1. Alert staff during triage of any current medical conditions or if you have a Do Not Resuscitate (DNR)/Do Not Attempt Resuscitation (DNAR) or other important medical information.
2. If you (or a family member) becomes ill and your medical doctor believes that you need extra care in an Intensive Care Unit (ICU) or Mechanical Ventilation (breathing machine) you will be assessed for eligibility based only on your specific condition.
3. Some patients will be extremely sick and very unlikely to survive their illness even with critical treatment. Treating these patients would take away resources for patients who might survive.
4. Patients who are not eligible for ICU or ventilator care will receive treatment for pain control and comfort measures. Some conditions that are likely to may make you not eligible include:
severe heart, lung, kidney or liver failure
Severe trauma or burns
Like governors of WA, CA, and especially NY, MI's governor is fighting for her people. She tends to focus on discrete problems, and as Dem minority leader she had a reputation of taking a lot from Rs in even-tempered pursuit of her goals. Hope her approach serves her well as she fights for Michiganders' lives. I thought Trump was writing off D states, but here he also attacks a swing state that narrowly voted for him in 2016. Take note! This is not politics--it's life and death for too many:
Michigan’s Gretchen Whitmer Fires Back After Trump Slams ‘Young Woman Governor’
Ed Mazza | 03/27/2020 01:11 am ET
President Donald Trump...the nation’s governors should be “doing more” to combat the COVID-19 coronavirus pandemic and not rely so heavily on the federal government for help...most governors “have been fantastic,” but then took a few potshots at Washington’s Jay Inslee (D) and Michigan’s Gretchen Whitmer (D), whose name he either forgot or simply didn’t want to mention...“We’ve had a big problem with the young, a woman governor, you know who I’m talking about from Michigan...We don’t like to see the complaints.”
Michigan has one of fastest rates of growth in coronavirus, now approaching 3,000 confirmed cases and 60 deaths. However, the state has struggled to get essential supplies including protective gear for hospital workers, and Whitmer is calling on Trump to issue a major disaster declaration for the state and the emergency support that comes with it.
Trump...said this week that federal aid will only flow to states that “treat us well....It’s a two-way street”...Whitmer has “not been pleasant...all she does is sit there and blame the federal government.”
Gretchen Whitmer @GovWhitmer | 10:19 PM - Mar 26, 2020:
Hi, my name is Gretchen Whitmer, and that governor is me 👋
I've asked repeatedly and respectfully for help. We need it.
No more political attacks, just PPEs, ventilators, N95 masks, test kits.
You said you stand with Michigan — prove it.
PS: I’m happy to work with the VP! We get along well.
Correia, Sergio and Luck, Stephan and Verner, Emil, Pandemics Depress the Economy, Public Health Interventions Do Not: Evidence from the 1918 Flu (March 26, 2020). Available at SSRN: https://ssrn.com/abstract=3561560 https://papers.ssrn.com/sol3/papers.cfm
What are the economic consequences of an influenza pandemic? And given the pandemic, what are the economic costs and benefits of non-pharmaceutical interventions (NPI)? Using geographic variation in mortality during the 1918 Flu Pandemic in the U.S., we find that more exposed areas experience a sharp and persistent decline in economic activity. The estimates imply that the pandemic reduced manufacturing output by 18%. The downturn is driven by both supply and demand-side channels. Further, building on findings from the epidemiology literature establishing that NPIs decrease influenza mortality, we use variation in the timing and intensity of NPIs across U.S. cities to study their economic effects. We find that cities that intervened earlier and more aggressively do not perform worse and, if anything, grow faster after the pandemic is over. Our findings thus indicate that NPIs not only lower mortality; they also mitigate the adverse economic consequences of a pandemic.
(Authors are from Federal Reserve, MIT.)
"The effects are economically sizable. Reacting 10 days earlier to the arrival of the pandemic in a given city increases manufacturing employment by around 5% in the post period. ... an additional 50 days increases manufacturing employment by 6.5% after the pandemic."
#94--most of the states really effected are democratic states. I think a lot of people think this is going to die out in NYC and be pretty much containable everywhere else. That Trump is going to open up the country for business in a month or so and everything is going to go back to normal. There is going to be a baseball season, a football season and they might even have NBA playoffs. In the meantime they'll get a nice $1200 check. A lot of Americans think it's going away and they're not seeing dead bodies yet. They're not taking this all that seriously.
As well Joe Biden has almost completely disappeared. He's nowhere to be found and offering nothing.
Marc Lipsitch (Harvard epidemiologist) @mlipsitch | 9:21 PM · Mar 26, 2020:
Tonight #DeborahBirx* stated that models anticipating large-scale transmission of COVID-19 do not match reality on the ground. Our modeling (done by @StephenKissler based on work with @ctedijanto and @yhgrad and me) is one of the models she is talking about.
We received a request to model dozens of scenarios from the US government at 5pm on Tuesday. We responded to many of these on Wednesday evening, thanks to fast and careful work by @StephenKissler. This was done in good faith in order to help support the USG response.
Modeling the scenario of intense social distancing for a temporary period, followed by a letup, produces predictions of resurgent transmission and large epidemics, with the exact consequences depending on the degree and duration of reduced transmission during social distancing.
Dr. Birx's statements today indicated that "when people start talking about 20% of a population getting infected, it's very scary, but we don't have data that matches that based on our experience." https://realclearpolitics.com/video/2020/03/26/dr_birx_coronavirus_data_doesnt_m...
True. We are near the beginning of the epidemic, with most people still susceptible. China and Korea have suppressed transmission by massive testing, combined in China with far more intense distancing than here and in Korea with significant distancing
South Korea Tries ‘Social Distancing’ to Prevent Coronavirus Spread
If our social distancing works it is possible we will not just flatten the curve, but get a decline in cases. Under a best-case scenario, we will keep that policy in place long enough to get down to very, very few cases domestically.
If at the same time we ramp up testing capacity and the ability to trace contacts, in a very best-case scenario, we might conceivably be able to turn to a Korea- or Singapore-style mix of less intense distancing combined with super-intense contact tracing, isolation, quarantine
That will not be easy with this virus as our @CCDD_HSPH analysis has shown but as some (mainly island) countries have shown, it may be just possible. We should do everything we can to reach for this goal, even if it is unattainable.
Modeling the Comparative Impact of Individual Quarantine vs. Active Monitoring of Contacts for the Mitigation of COVID-19
But here's why it is a best-case, likely unattainable scenario.
1) We have not proven that US-style social distancing can produce R_effective
BBC News - Coronavirus: Prime Minister Boris Johnson tests positive
I wonder if this will affect UK government policies?
From what I read, possibly the strongest effect would come if he's incapacitated, putting Dominic Raab in charge instead--an even worse customer than Johnson...
Coronavirus: Raab accused of 'reckless insanity' for claiming pandemic strengthens case for speedy Brexit
Full speed ahead and damn the torpedoes!
Michigan’s migrant workers especially vulnerable to virus
Kurt Williams | 3/27/2020
...Nearly 95,000 migrant and seasonal workers come to Michigan to work in agriculture, according to the most recent analysis produced by the Michigan Interagency Migrant Services Committee.
There are 46 Michigan crops that are harvested by hand. The growing season runs from April, with asparagus, until October’s apples, said Teresa Hendricks, executive director of Migrant Legal Aid.
“H-2A workers are always together,” Hendricks said. They ride together in buses to and from the fields, they work the rows side-by-side, transfer produce together, travel to town together and live in very close quarters together...
"Convalescent plasma" is a technique for sharing antibodies that predates antibiotics apparently. Made me wonder about pre-vaccine technique variolation. Smallpox is also respiratory virus. Scratched into skin, the virus results in (usually mild) case--and immunity. More dangerous than the vaccine, but smallpox used to kill (30 percent?). Mentioned in John Adams' biography.
Convalescent plasma treats COVID, hopefully--500 people volunteered to donate plasma in NY!
Variolation confers immunity--in smallpox at least.
As cases rise in Alabama, Governor Ivey is *also* not issuing a stay at home order.
But at least her announcement makes clear that Alabama counties doing more to save lives will not have their local rules superseded by her lax statewide order.
PDF link: https://governor.alabama.gov/assets/2020/03/Amended-Statewide-Social-Distancing-...
- Rachel Maddow MSNBC @maddow | 3:12 PM · Mar 27, 2020
Three stories from Africa:
'We fear, but have to work': isolation not an option for the poor of Nairobi (Guardian)
As coronavirus arrives in Kenya, retreat behind closed doors is only an alternative for those who can afford it...
WHO: Half of Africa’s countries can still avoid a serious outbreak (Mail & Guardian)
There is still a chance for up to half of all African countries to avoid a serious outbreak of Covid-19, said the World Health Organisation on Thursday... “We still have a window. It’s true that it is narrowing every day, as the data about the geographic spread is telling us, but in just over half of the region we still only have imported cases. We have not yet identified that local spread is occurring … we still could contain this virus in many countries”...
Coronavirus: 150 Tunisians self-isolate in factory to make masks (BBC)
Employees at a Tunisian factory are churning out 50,000 face masks a day and other protective medical gear after opting to go into lockdown at work. The 150 workers, mainly women, have isolated themselves at the Consomed factory for a month. They were spurred on by patriotism as the country battles coronavirus...
Fact or fiction? Warmer weather slows down the coronavirus
Shannon Osaka | Mar 23, 2020
...there is some (very) early evidence that the current pandemic could be alleviated by rising temperatures and local climates. A preprint of a study* by researchers in China — which has yet to be peer reviewed — examined 100 Chinese cities that had more than 400 cases. They found that the coronavirus was transmitted more rapidly in cities with cooler and drier weather conditions. Wuhan, the epicenter of the virus, typically has temperatures in the 40s Fahrenheit during December and January. Last week, it was in the low 70s.
Similarly, two other draft papers posted in recent weeks suggest that the current global spread of the coronavirus shows that it prefers cool and dry climates.
...Warmer, more humid conditions have slowed the spread of other viruses...flu...SARS...MERS...Four types of mild coronaviruses that cause the common cold, also follow the same pattern....But that doesn’t necessarily mean that this coronavirus will behave the same way. Researchers just aren’t sure yet.
Ebi pointed out that several countries increasingly gripped by the virus, including Brazil and Singapore, have generally high temperatures. The fact that there have been more COVID-19 cases in temperate regions might be tied to patterns of travel and trade, not warmer, humid weather. “In many of the countries that are warmer, there’s only been a fairly recent introduction” of the virus, she said.
According to Glass, the biggest question is whether the virus is transmitted more in the environment — by touching a contaminated object, for example — or through person-to-person contact. If the virus is mostly passed through objects and the environment, warmer temperatures and more humid conditions could slow its spread. “But to my mind, we don’t have anywhere near that kind of information” on how the virus spreads, he said.
* Jingyuan Wang et al. March 9, 2020. High Temperature and High Humidity Reduce the Transmission of COVID-19 (pre-print). 19 pages. https://arxiv.org/ftp/arxiv/papers/2003/2003.05003.pdf
This paper investigates how air temperature and humidity influence the transmission of COVID-19. After estimating the serial interval of COVID-19 from 105 pairs of the virus carrier and the infected, we calculate the daily effective reproductive number, R, for each of all 100 Chinese cities with more than 40 cases. Using the daily Rvalues from January 21 to 23, 2020 as proxies of non-intervened transmission intensity, we find, under a linear regression framework for 100 Chinese cities, high temperature and high relative humidity significantly reduce the transmission of COVID-19, respectively, even after controlling for population density and GDP per capita of cities. One degree Celsius increase in temperature and one percent increase in relative humidity lower Rby 0.0383 and 0.0224, respectively. This result is consistent with the fact that the high temperature and high humidity significantly reduce the transmission of influenza. It indicates that the arrival of summer and rainy season in the northern hemisphere can effectively reduce the transmission of the COVID-19.
>96 margd: Frankly, Marge, if it were me, and if anyone close to me deteriorated enough to need hospitalization, all other things equal, I'd try to get them driven to Lansing or
The state is already working on this. (https://wwmt.com/news/state/state-announces-plan-to-help-balance-covid-19-patien...) Might as well help them along.
Of course, that creates a lot more problems with isolation (given they're not likely to be up to driving themselves alone). Several possible solutions, the simplest (and most heart-wrenching) of which would be a dump-and-run.
>108 davidgn: (And it looks like they need the helping along). https://www.michiganradio.org/post/relief-plan-overwhelmed-hospitals-begins-requ...
>108 davidgn: Apparently some people in se Michigan headed north to their cabins, which is problematic because they could seed the virus up north, plus rural hospitals are even less equipped than urban ones to deal with a surge.
There are two hospitals in Ann Arbor and they are both scouring the town for PPE--one even asks for homemade masks. (I assume for less exposed healthcare and EMS workers or incoming (coughing) patients.)
ETA: "157 Washtenaw County residents have tested positive for COVID-19 as of 12 p.m. today. Yesterday, that number was 92. A week ago it was 16. The majority of these new cases were not related to travel, meaning these individuals were exposed to the virus locally." https://www.washtenaw.org/3095/COVID-19
I hope Michigan, like NY, can offer convalescent plasma/antibodies.
(Snowbirds called home early to Canada--they're supposed to self-isolate for two weeks--are causing local concern when they stop for groceries as they enter Canada or pick up their mail on the way home. Those flying in are supposed to avoid public transportation (like shuttles), even if it means spending the two weeks in designated hotels near the airport.)
Trump's newest policy advisor "White House coronavirus task force member Dr. Deborah Birx warned the public not to panic when they hear about models and projections of the pandemic's spread."
Trump approves Michigan disaster declaration; more masks arrive
Craig Mauger | March 28, 2020 |
Lansing — President Donald Trump has declared a major disaster exists in Michigan amid the COVID-19 outbreak and ordered federal assistance to aid recovery efforts here, his administration announced Saturday.
...Gov. Gretchen Whitmer also announced Saturday that Michigan had received 112,800 N95 masks from the federal government's strategic national stockpile with another shipment of "8,000 masks on the way." The masks have been in short supply but are needed to protect health care workers in the state.
...(disaster) funding was approved for the crisis counseling program and for emergency protective measures from the public assistance category...
"This is a good start, and it will help us protect Michiganders and slow the spread of COVID-19,” Whitmer said Saturday. "I’m hopeful that the president will review my request for individual assistance programs that would provide meals to families who need them and rental assistance and temporary housing for families."...
Wonder where these masks are supposed to come from?
(I gave mine to local hospital. Was about to fire up Mom's old Bernina to make some replacements...)
Would everyone wearing face masks help us slow the pandemic?
Kelly Servick | Mar. 28, 2020
...Even experts who favor masking the masses say their impact on the spread of disease is likely to be modest. Many are also afraid to promote mask buying amid dire shortages at hospitals. But as the pandemic wears on, some public health experts think government messages discouraging mask wearing should shift.
“It’s really a perfectly good public health intervention that’s not used,” argues KK Cheng, a public health expert at the University of Birmingham. “It’s not to protect yourself. It’s to protect people against the droplets coming out of your respiratory tract.”
Cheng and others stress that however masks are used, people must practice social distancing and stay at home as much as possible to prevent the spread of the novel coronavirus. When people do venture out and interact, they’re likely to spew some saliva. “I don’t want to frighten you, but when people speak and breathe and sing—you don’t have to sneeze or cough—these droplets are coming out,” he says...
More Americans Should Probably Wear Masks for Protection
Experts have started to question whether masks may offer at least some protection to healthy individuals and essential workers.
Knvul Sheikh | March 27, 2020. Updated March 28, 2020, 9:28 a.m. ET
As the coronavirus pandemic rages on, experts have started to question official guidance about whether ordinary, healthy people should protect themselves with a regular surgical mask, or even a scarf.
The World Health Organization and the Centers for Disease Control and Prevention continue to state that masks don’t necessarily protect healthy individuals from getting infected as they go about their daily lives.
The official guidance continues to recommend that masks should be reserved for people who are already sick, as well as for the health workers and caregivers who must interact with infected individuals on a regular basis. Everyone else, they say, should stick to frequent hand-washing and maintaining a distance of at least 6 feet from other people to protect themselves.
But the recent surge in infections in the United States, which has put the country at the center of the epidemic, with more confirmed cases than China, Italy or any other country, means that more Americans are now at risk of getting sick. And healthy individuals, especially those with essential jobs who cannot avoid public transportation or close interaction with others, may need to start wearing masks more regularly...
NEW: CDC guidance on masks expected to change in next 10 days.
Americans will be advised to wear masks in everyday life.
Current recommendation is for high-risk groups only.
- Matt McCarthy @DrMattMcCarthy | 9:24 AM · Mar 28, 2020
'A game changer': FDA authorizes Abbott Labs' portable, 5-minute coronavirus test the size of a toaster
Grace Hauck | 3/28/2020
CHICAGO – A five-minute, point-of-care coronavirus test could be coming to urgent care clinics next week, and experts say it could be "game-changing."
The U.S. Food and Drug Administration issued Emergency Use Authorization to Illinois-based medical device maker Abbott Labs on Friday for a coronavirus test that delivers positive results in as little as five minutes and negative results in 13 minutes, the company said.
The company expects the tests to be available next week and expects to ramp up manufacturing to deliver 50,000 tests per day...
Uncertainty whether Trump has authority to do this. Sounds like pandering to R Florida at expense of D NY. D NY is doing much more to contain COVID19 than R FL...
Trump considering ‘enforceable’ quarantine in New York, New Jersey and parts of Connecticut
Published Sat, Mar 28 202012:40 PM EDT
This picture is from 3pm today.
You can see exactly where Duval County ends and St. John’s County begins.
All beaches in Duval are closed, while St. John’s only blocked parking at the beach.
Gov. DeSantis needs to order a state-wide closure of all Florida beaches.
Image ( https://twitter.com/travisakers/status/1243990179557359616/photo/1 )
- Travis Akers @travisakers | 3:55 PM · Mar 28, 2020
Federal statutory authority to quarantine is limited to “any individual reasonably believed to be infected with a communicable disease.”
No such authority empowers executive officials to quarantine on a statewide basis.
Nor does POTUS have any such power under Article II.
- Laurence Tribe tribelaw | 4:11 PM · Mar 28, 2020
Announcing that you’re “considering” a quarantine without actually being prepared to do it immediately (if he CAN even do it)
sounds like a pretty good way to get people to panic and leave the city, which is kind of the opposite of the goal of a quarantine.
- Julian Sanchez @normative | 3:40 PM · Mar 28, 2020
The Lost Month: How a Failure to Test Blinded the U.S. to Covid-19
Michael D. Shear, Abby Goodnough, Sheila Kaplan, Sheri Fink, Katie Thomas and Noah Weiland | March 28, 2020
Aggressive screening might have helped contain the coronavirus in the United States. But technical flaws, regulatory hurdles and lapses in leadership let it spread undetected for weeks.
WASHINGTON — Early on, the dozen federal officials charged with defending America against the coronavirus gathered day after day in the White House Situation Room, consumed by crises. They grappled with how to evacuate the United States consulate in Wuhan, China, ban Chinese travelers and extract Americans from the Diamond Princess and other cruise ships.
The members of the coronavirus task force typically devoted only five or 10 minutes, often at the end of contentious meetings, to talk about testing, several participants recalled. The Centers for Disease Control and Prevention, its leaders assured the others, had developed a diagnostic model that would be rolled out quickly as a first step.
But as the deadly virus from China spread with ferocity across the United States between late January and early March, large-scale testing of people who might have been infected did not happen — because of technical flaws, regulatory hurdles, business-as-usual bureaucracies and lack of leadership at multiple levels, according to interviews with more than 50 current and former public health officials, administration officials, senior scientists and company executives.
The result was a lost month, when the world’s richest country — armed with some of the most highly trained scientists and infectious disease specialists — squandered its best chance of containing the virus’s spread. Instead, Americans were left largely blind to the scale of a looming public health catastrophe...
See graph at website!
THREAD: This week tragic reality on ground will overtake events.
There are multiple epicenters of U.S. spread. We'll grapple with national epidemic.
April will be hard. We'll get through it.
Focus must be on slowing spread nationally, support healthcare system, build back in May.
Image ( https://twitter.com/ScottGottliebMD/status/1243990554700103680/photo/1 )
- Scott Gottlieb, MD @ScottGottliebMD | 3:57 PM · Mar 28, 2020
#115--I just posted a comment to this on another Covid-19 thread but we pretty much reached the same conclusion. DeSantis who has done as little as possible to contain the virus pandering to Trump and blaming New Yorkers for the cases he has.
#117--March has seemed almost unbelievably long and April will probably be harder. Over 200 people died in New York today--Gov. Cuomo thinks the apex is two/three weeks away. We may have 600--700--800 a day perhaps even hit 1000 on occasion. I hope not but it wouldn't shock me. Doctors and Nurses are going to be under a lot of strain and some of them are almost certainly going to be victims too. I know we could have done a lot more to contain this if we had acted earlier--even a couple weeks earlier would have made a huge difference.
I think some people around this country still don't take this seriously enough. I think they look at it as a New York, Michigan, New Jersey, California, Washington, Louisiana problem and it will go away and they'll be relatively untouched and if summer knocks it down maybe they'll do alright but if it doesn't they're going to get hurt too--so those states not preparing should think twice.
We need warm weather as soon as possible though. We need to find out.
I'll reiterate the need for medicare for all. It's necessarily to streamline our health system and control costs. This pandemic has rocked the nation--people were chuckling a couple months ago how we couldn't afford a trillion $'s for Sanders system. Now instead we're paying $2 trillion for a stimulus which probably isn't going to be enough to get us back to close to where we were though some huge corporations will do alright.
Coronavirus Florida: Town of Palm Beach issues ‘shelter-in-place’ order
Carol Rose | Mar 28, 2020 at 12:48 PM
...State health officials identified 98 new Palm Beach County cases in the last 24 hours, a 148 percent jump since Wednesday and a 50 percent increase since Friday morning. The number of county deaths remained unchanged from Friday at five...
Statewide, 3,763 people have been diagnosed with COVID-19, a 30 percent one-day increase, the figures released Saturday by the state Department of Health show.
The number of deaths statewide rose to 54, an increase of 19 over 24 hours.
Palm Beach joins Boca Raton as the only cities in Palm Beach County to issue “shelter-in-place” orders...Boca officials said they had to be more aggressive because counties to the south, Broward and Miami-Dade, are the counties in Florida hardest hit by the virus...
Homemade HEPA filter-base mask manufacturing best practices:
Mask reuse best practices:
Don’t panic about shopping, getting delivery or accepting packages
Joseph G. Allen | March 26, 2020
...In the epidemiological world, we have a helpful way to think about it: the “Sufficient-Component Cause model.” Think of this model as pieces of a pie. For disease to happen, all of the pieces of the pie have to be there: sick driver, sneezing/coughing, viral particles transferred to the package, a very short time lapse before delivery, you touching the exact same spot on the package as the sneeze, you then touching your face or mouth before hand-washing.
In this model, the virus on the package is a necessary component, but it alone is not sufficient to get you sick. Many other pieces of the pie would have to be in place.
So this is what you can do to disassemble the pie — to cut the chain.
You can leave that cardboard package at your door for a few hours — or bring it inside and leave it right inside your door, then wash your hands again. If you’re still concerned there was any virus on the package, you could wipe down the exterior with a disinfectant, or open it outdoors and put the packaging in the recycling can. (Then wash your hands again.)
What about going to the grocery store? The same approach applies.
Shop when you need to (keeping six feet from other customers) and load items into your cart or basket. Keep your hands away from your face while shopping, and wash them as soon as you’re home. Put away your groceries, and then wash your hands again. If you wait even a few hours before using anything you just purchased, most of the virus that was on any package will be significantly reduced. If you need to use something immediately, and want to take extra precautions, wipe the package down with a disinfectant. Last, wash all fruits and vegetables as you normally would.
...if you take basic precautions, including washing your hands frequently, the danger from accepting a package from a delivery driver or from takeout from a local restaurant or from buying groceries is de minimis. That’s a scientific way of saying, “The risks are small, and manageable.”
It's important in analysing the virus in the US to note that the first case in the US on January 20. Despite that, despite all the warnings in meetings in January, despite demonstrably successful models to choose from among, despite tremendous wealth, the US will have double the cases of China within 3 days and very soon will have had more deaths than those in China.
>122 RickHarsch: Assuming one trusts the China numbers.
My working assumption is that the curves bear a reasonable resemblance to reality. The quantities, on the other hand... https://www.bloomberg.com/news/articles/2020-03-27/stacks-of-urns-in-wuhan-promp...
Further: does that also mean the rest of the world has likely been making bad assumptions of magnitude based on garbage Chinese data? Yes. Yes, it does.
>123 davidgn: Several sources confirm that the Chinese numbers are more or less accurate.
For each country that doesn't conform to expectations there are numerous variables involved. It appears that in Italy the virus was present and spreading widely long before the knowledge of what it was or that it was anything was out.
However, the response in Italy was not nearly as late as that in the US. The horror of it seems in part that there were several adjacent 'epicenters' and thus the medical system was overwhelmed.
Belgium is not conforming to expectations. No one I've spoken with seems to know why.
I've wondered about the high Swiss numbers. They may conform to expectations, but with high numbers of infections and deaths. THe reason may well turn out to be that as a wealthy nation of travelers they brought back the virus from all over the world and it spread throughout the country before any effective measures could be undertaken.
In Slovenia, the problem is the low number of people. Expectations may be that by now about 45 new cases per day are to be expected, but what is the significance of a day of 74? And if tomorrow it's 41 and the next day 81? So it's easy for short term data to skew the look of a model-based graph. I know that Slovenia is not testing the way it has been suggested countries do, but otherwise they did a fair job of going into lockdown (a week late, maybe), and people are being careful. And it does look like the peak is past or if not, very near: Yet as of midnight tonight police will have expanded powers, be able to enter homes at will to check whether people are conforming to dictates.
Josh Marshall @joshtpm | 12:28 AM · Mar 29, 2020
Good lord this video. Like a thoroughbred making a late break in a horse race
1:44 ( https://twitter.com/joshtpm/status/1244119212701990913 )
From Interviewer Aashutosh Kumar
Monty Boa @MontyBoa99 · 14h
Here's the version where China's stats are shown, too.
Since their pop'n is 4 times ours, when we have the same number of cases, it means we have 4 times as many cases per 1,000 people than they do.
Abject failure of leadership.
0:30 ( https://twitter.com/MontyBoa99/status/1244129537199349768 )
Estimates Show Wuhan Death Toll Far Higher Than Official Figure
As authorities lifted a two-month coronavirus lockdown in the central Chinese city of Wuhan, residents said they were growing increasingly skeptical that the figure of some 2,500 deaths in the city to date was accurate...42,000(?)...40,000(?)...
California governor: 170 ventilators sent from Trump administration were 'not working'
Justin Wise - 03/29/20
...Newsom said that the stockpile of ventilators had been sent to Los Angeles County by the Department of Health and Human Services (HHS). He noted that a company called Bloom Energy was fixing the equipment.
“Rather than lamenting about it, rather than complaining about it, rather than pointing fingers, rather than generating headlines in order to generate more stress and anxiety, we got a car and a truck,” Newsom said after touring Bloom Energy's ventilator refurbishing site in Sunnyvale, Calif.
“We had those 170 brought here to this facility at 8 a.m. this morning, and they are quite literally working on those ventilators right now.”..
Looks like Europe is getting faulty equipment from China.
But after Spain on Friday withdrew 58,000 Chinese-made coronavirus testing kits on discovering that they had an accuracy rate of just 30%, the Netherlands – which has recorded 771 deaths, with more than 10,000 confirmed cases – on Sunday recalled 600,000 Chinese face masks that were also found to be defective.
From this article: https://www.theguardian.com/world/2020/mar/29/spain-poised-to-tighten-coronaviru...
As annoying as he is on so many levels, Chris Martenson's review today is essential.
Ranging widely across the scientific literature, he pulls a LOT of details together. Not least, he hints as to why Germany's numbers look the way they do and helps illuminate the effectiveness and social dynamics of masks and mask recommendations from multiple directions. A must watch.
South Sudan’s Juba Archdiocese Suspends Public Mass over COVID-19 in Neighboring Nations (ACI Africa)
This is the Catholic church. The Anglican church has done the same. These are the two biggest churches in South Sudan.
MIT Will Post Free Plans Online for an Emergency Ventilator That Can Be Built for $100
David L. Chandler, Massachusetts Institute of Technology March 28, 2020
...The team is particularly concerned about the potential for well-meaning but inexperienced do-it-yourselfers to try to reproduce such a system without the necessary clinical knowledge or expertise with hardware that can operate for days; around 1 million cycles would be required to support a ventilated patient over a two-week period. Furthermore, it requires code that is fault-tolerant, since ventilators are precision devices that perform a life-critical function. To help curtail the spread of misinformation or poorly-thought-out advice, the team has added to their website verified information resources on the clinical use of ventilators and the requirements for training and monitoring in using such systems. All of this information is freely available at e-vent.mit.edu*...
* MIT Emergency Ventilator (E-Vent) Project
...Almost every bed in a hospital has a manual resuscitator (Ambu-Bag) nearby, available in the event of a rapid response or code where healthcare workers maintain oxygenation by squeezing the bag. Automating this appears to be the simplest strategy that satisfies the need for low-cost mechanical ventilation, with the ability to be rapidly manufactured in large quantities. However, doing this safely is not trivial...
>129 davidgn: At 23:59 Martenson cites a couple papers on how to sterilize N95 masks with heat and UV, e.g.,
SM Duan et al. 2003. Stability of SARS Coronavirus in Human Specimens and Environment and Its Sensitivity to Heating and UV Irradiation.
Biomedical and Environmental Sciences 16(3):246-55 · October 2003. https://www.researchgate.net/publication/8995908_Stability_of_SARS_Coronavirus_i...
The causal agent for SARS is considered as a novel coronavirus that has never been described both in human and animals previously. The stability of SARS coronavirus in human specimens and in environments was studied. Using a SARS coronavirus strain CoV-P9, which was isolated from pharyngeal swab of a probable SARS case in Beijing, its stability in mimic human specimens and in mimic environment including surfaces of commonly used materials or in household conditions, as well as its resistance to temperature and UV irradiation were analyzed. A total of 10(6) TCID50 viruses were placed in each tested condition, and changes of the viral infectivity in samples after treatments were measured by evaluating cytopathic effect (CPE) in cell line Vero-E6 at 48 h after infection. The results showed that SARS coronavirus in the testing condition could survive in serum, 1:20 diluted sputum and feces for at least 96 h, whereas it could remain alive in urine for at least 72 h with a low level of infectivity. The survival abilities on the surfaces of eight different materials and in water were quite comparable, revealing reduction of infectivity after 72 to 96 h exposure. Viruses stayed stable at 4 degrees C, at room temperature (20 degrees C) and at 37 degrees C for at least 2 h without remarkable change in the infectious ability in cells, but were converted to be non-infectious after 90-, 60- and 30-min exposure at 56 degrees C, at 67 degrees C and at 75 degrees C, respectively. Irradiation of UV for 60 min on the virus in culture medium resulted in the destruction of viral infectivity at an undetectable level. The survival ability of SARS coronavirus in human specimens and in environments seems to be relatively strong. Heating and UV irradiation can efficiently eliminate the viral infectivity.
If hand washing works, I suspect combination of hot water, detergent, agitation (and maybe bleach of some kind), dryer(?), and time would clean up homemade masks.
Made my first mask yesterday (deaconess pattern). From my late dad's old flannel bathrobe, so extra protection. ;) Mom's old Bernina machine was NOT happy with the layers of material and knotted round elastic... Hope next one goes easier! I considered leaving a pocket for non-woven insert, but challenge enough to breathe through (flannel) mask. Maybe I'm just not used to it. I suspect we'd only use on sick family member, God forbid.
FDA issues emergency authorization of anti-malaria drug for coronavirus care
DAN DIAMOND | 03/29/2020
The Food and Drug Administration on Sunday issued an emergency use authorization for hydroxychloroquine and chloroquine, decades-old malaria drugs championed by President Donald Trump for coronavirus treatment despite scant evidence.
The agency allowed for the drugs to be "donated to the Strategic National Stockpile to be distributed and prescribed by doctors to hospitalized teen and adult patients with COVID-19, as appropriate, when a clinical trial is not available or feasible," HHS said in a statement,* announcing that Sandoz donated 30 million doses of hydroxychloroquine to the stockpile and Bayer donated 1 million doses of chloroquine....
...Career scientists...not(ed) the lack of data on the drugs' efficacy for coronavirus care and worried that it would siphon medication away from patients who need it for other conditions, calling instead for the agency to pursue its usual clinical trials. FDA's move is expected to facilitate more access to the drugs by allowing more donations, and a second EUA is under consideration that would allow more manufacturers to produce it, said three officials.
Hydroxychloroquine, which is already available commercially in the United States, is commonly used to treat malaria, lupus and rheumatoid arthritis. The drug also has been touted as a therapy for coronavirus by an unusual assortment of investors, TV correspondents and even some advisers to the White House — including some advocates who overstated their claims and credentials — and been championed by guests on Fox News.
However, a growing number of lupus and arthritis patients have complained that they've been unable to full their prescriptions amid ongoing shortages, and reports have emerged that some physicians are hoarding the drug for themselves. Federal officials also have privately complained that Trump's focus on anti-malaria drugs has distracted from efforts to investigate more promising therapies...
this shows Britain's health-'care' incompetence as well as why where you are bears importantly on your statistical chances of surviving the Wuhan virus, not contracting it, surviving it once you've contracted it
Germany : Confirmed cases (total) 63 221
................Total deaths : ............. 546
..........(deaths ÷ confirmed cases): 0.0086363
U.K. : ...... Confirmed cases (total) 19 522
................Total deaths : ............. 1 228
..........(deaths ÷ confirmed cases): 0.0629033
Gee! Uhm, maybe very different demographics account for this enormous difference. Could that be it?
>127 margd: >128 clamairy: Hoarding, stealing, favouritism, inside trading, defective equipment--there are some real lovelies out there.
Way outnumbered by good guys and helpers, though.
Just knew something like this would happen:
Shocking Video: Man Filmed Licking Shopping Cart at Stop & Shop (Nanuet) Amid COVID-19 Pandemic
Rockland Report Editor | March 30, 2020
Here in Michigan, an anti-social not only licked a shopping cart in Genessee County, he kissed the back window of police car.
That last one got him arrested for vandalizing police equipment.
(If no alcohol wipes and not wearing gloves, one could use produce bag to avoid touching a potentially contaminated shopping-cart handle?)
#135--the best in most people will come out during a crisis but there are always some you'll get their worst.
Unfortunately we see in our POTUS we see the worst. He expects to have his ass kissed--for governors to tell him what a great job he's done before sending any federal help so certain states are getting fucked over royally while Florida gets the golden boy treatment. He's playing politics with people's lives and when you have the guy at the top doing that it encourages all the cheats and scam artists.
With my halting take on how SARS-COV-2 first establishes itself in nasal passage and throat (Roman Woelfel et al. 2020., below), I'm becoming more convinced that zinc might be a good prophylactic for anyone likely to be exposed to COVID-19.
Te Velthuis et al. (2010) reported that zinc inhibits viral replication of closely related SARS virus (SARS-CoV). https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001176
Little downside? Warning on pkge of ZICAM RAPIDMELTS (a lozenge for sore throat that "shortens colds", 20% of which are caused by Corona viruses): "ask a doctor before use if you have a sensitivity to zinc or are allergic to zinc." (Maybe also consult a pharmacists for possible interaction with any drug you might be on.)
As is our practice, DH and I took these lozenges when sore throat briefly preceded our (COVID-19?) fevers. We were already consuming a regular hefty dose of zinc via an OTC vitamin preparation (Preservision AREDS2).
Roman Woelfel et al. 2020 may also be argument for all but immune folks to wear masks--to protect others?.
People ‘shed’ high levels of coronavirus, study finds, but most are likely not infectious after recovery begins
Helen Branswell | March 9, 2020
People who contract the novel coronavirus emit high amounts of virus very early on in their infection, according to a new study from Germany that helps to explain the rapid and efficient way in which the virus has spread around the world.
At the same time, the study suggests that while people with mild infections can still test positive by throat swabs for days and even weeks after their illness, those who are only mildly sick are likely not still infectious by about 10 days after they start to experience symptoms.
The study,* by scientists in Berlin and Munich, is one of the first outside China to look at clinical data from patients who have been diagnosed with Covid-19, the disease caused by the coronavirus, and one of the first to try to map when people infected with the virus can infect others...
* Roman Woelfel et al. 2020. Clinical presentation and virological assessment of hospitalized cases of coronavirus disease 2019 in a travel-associated transmission cluster. doi: https://doi.org/10.1101/2020.03.05.20030502 https://www.medrxiv.org/content/10.1101/2020.03.05.20030502v1 https://www.medrxiv.org/content/10.1101/2020.03.05.20030502v1.full.pdf+html
(This article is a preprint and has not been peer-reviewed. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.)
Background: In coronavirus disease 2019 (COVID-19), current case definitions presume mainly lower respiratory tract infection. However, cases seen outside the epicenter of the epidemic may differ in their overall clinical appearance due to more sensitive case finding.
Methods: We studied viral load courses by RT-PCR in oro- and nasopharyngeal swabs, sputum, stool, blood, and urine in nine hospitalized cases. Infectious virus was detected by cell culture. Active replication was demonstrated by analysis of viral subgenomic replicative intermediates. Serology including neutralization testing was done to characterize immune response.
Results: Seven cases had upper respiratory tract disease. Lower respiratory tract symptoms seen in two cases were limited. Clinical sensitivity of RT-PCR on swabs taken on days 1-5 of symptoms was 100%, with no differences comparing swab and sputum samples taken simultaneously. Average viral load was 6.76x10E5 copies per swab during the first 5 days. Live virus isolates were obtained from swabs during the first week of illness. Proof of active viral replication in upper respiratory tract tissues was obtained by detection of subgenomic viral RNA. Shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after about one week.
Conclusions: The present study shows that COVID-19 can often present as a common cold-like illness. SARS-CoV-2 can actively replicate in the upper respiratory tract, and is shed for a prolonged time after symptoms end, including in stool. These findings suggest adjustments of current case definitions and re-evaluation of the prospects of outbreak containment.
(paragraph breaks are margd's and may not be the same as in article)
The clinical courses in subjects under study were mild, all being young- to middle-aged professionals without significant underlying disease. Apart from one patient, all cases were first tested when symptoms were still mild or in the prodromal stage,* a period in which most patients would present once there is general awareness of a circulating pandemic disease
Diagnostic testing suggests that simple throat swabs will provide sufficient sensitivity at this stage of infection. This is in stark contrast to SARS. For instance, only 38 of 98 nasal or nasopharyngeal swab samples tested positive by RT-PCR* in SARS patients in Hong Kong.
Also, viral load differed considerably. In SARS, it took 7 to 10 days after onset until peak RNA concentrations (of up to 5x10 to the 5th power) copies per swab) were reached. In the present study, peak concentrations were reached before day 5, and were more than 1000 times higher. Successful live virus isolation from throat swabs is another striking difference from SARS, for which such isolation was rarely successful. Altogether, this suggests active virus
replication in upper respiratory tract tissues, where only minimal ACE-2* expression is found and SARS-CoV* is therefore not thought to replicate.
At the same time, the concurrent use of ACE-2 as a receptor by SARS-CoV and SARS-CoV-2* corresponds to a highly similar excretion kinetic in sputum, with active replication in the lung. SARS-CoV was found in sputum at mean concentrations of 1.2-2.8x10 to the 6th power copies per mL, which corresponds to observations made here.
Whereas proof of replication by histopathology* is awaited, extended tissue tropism* of SARS-CoV-2 with replication in the throat is strongly supported by our studies of sgRNA-transcribing* cells in throat swab samples, particularly during the first 5 days of symptoms.
Striking additional evidence for independent replication in the throat is provided by sequence findings in one patient who consistently showed a distinct virus in her throat as opposed to the lung. Critically, the majority of patients in the present study seemed to be already beyond their shedding peak in upper respiratory tract samples when first tested, while shedding of infectious virus in sputum continued through the first week of symptoms. Together, these findings suggest a more efficient transmission of SARS-CoV-2 than SARS-CoV through active pharyngeal viral shedding at a time when symptoms are still mild and typical of upper respiratory tract infection. Later in the disease, COVID-19 then resembles SARS in terms of replication in the lower respiratory tract. Of note, the two patients who showed some symptoms of lung affection showed a prolonged viral load in sputum. Studies should look at
the prognostic value of an increase of viral load beyond the end of week 1, potentially indicating aggravation of symptoms.
One of the most interesting hypotheses to explain a potential extension of tropism to the throat is the presence of a polybasic* furin-type* cleavage site at the S1-S2 junction in the SARS-CoV-2 spike protein* that is not present in SARS-CoV. Insertion of a polybasic cleavage site in the S1-S2 region in SARS-CoV was shown to lead to a moderate but discernible gain of fusion activity that might result in increased viral entry in tissues with low density of ACE2 expression.
The combination of very high virus RNA concentrations and occasional detection of sgRNA-containing cells in stool indicate active replication in the gastrointestinal tract. Active replication is also suggested by a much higher detection rate as compared to MERS-coronavirus, for which we found stool-associated RNA in only 14.6% samples in 37 patients hospitalized in Riyadh, Saudi Arabia.
If virus was only passively present in stool, such as after swallowing respiratory secretions, similar detection rates as for MERS-CoV would be expected. Replication in the gastrointestinal tract is also supported by analogy with SARS-CoV, which was regularly excreted in stool, from which it could be isolated in cell culture.
Our failure to isolate live SARS-CoV-2 from stool may be due to the mild courses of cases, with only one case showing intermittent diarrhea. In China, diarrhea has been seen in only 2 of 99 cases.
Further studies should therefore address whether SARS-CoV-2 shed in stool is rendered non-infectious though contact with the gut environment. Our initial results suggest that measures to contain viral spread should aim at droplet-, rather than fomite-based* transmission.
The prolonged viral shedding in sputum is relevant not only for hospital infection control, but also for discharge management. In a situation characterized by limited capacity of hospital beds in infectious diseases wards, there is pressure for early discharge following treatment.
Based on the present findings, early discharge with ensuing home isolation could be chosen for patients who are beyond day 10 of symptoms with less than 100,000 viral RNA copies per ml of sputum. Both criteria predict that there is little residual risk of infectivity, based on cell culture.
The serological courses of all patients suggest a timing of seroconversion* similar to or slightly earlier than in SARS-CoV infection. Seroconversion in most cases of SARS occurred during the second week of symptoms. As in SARS and MERS, IgM* was not detected significantly earlier than IgG* in immunofluorescence, which might in part be due to technical reasons as the higher avidity of IgG antibodies outcompetes IgM for viral epitopes in the assay. IgG depletion can only partially alleviate this effect. Because IFA* is a labor-intensive method, ELISA tests should be developed as a screening test.
Neutralization testing* is necessary to rule out cross-reactive antibodies directed against endemic human coronaviruses. Based on frequently low neutralizing antibody titers observed in coronavirus infection, we have here developed a particularly sensitive plaque reduction neutralization*
assay. Considering the titers observed, a simpler microneutralization test format is likely to provide sufficient sensitivity in routine application and population studies.
When aligned to viral load courses, it seems there is no abrupt virus elimination at the time of seroconversion. Rather, seroconversion early in week 2 coincides with a slow but steady decline of sputum viral load. Whether certain properties such as glycosylation* pattern at critical sites of the glycoprotein play a role in the attenuation of neutralizing antibody response needs further clarification. In any case, vaccine approaches targeting mainly the induction of antibody responses should aim to induce particularly strong antibody responses in order to be effective.
prodermal -- relating to or denoting the period between the appearance of initial symptoms and the full development of a rash or fever. (Oxford)
Reverse transcription polymerase chain reaction -- a laboratory technique combining reverse transcription of RNA into DNA and amplification of specific DNA targets using polymerase chain reaction. It is primarily used to measure the amount of a specific RNA. Wikipedia
ACE-2 -- the host cell receptor responsible for mediating infection by SARS-CoV-2, the novel coronavirus responsible for coronavirus disease 2019 (COVID-19). Treatment with anti-ACE-2 antibodies disrupts the interaction between virus and receptor. Fig. 1 https://www.rndsystems.com/resources/articles/ace-2-sars-receptor-identified
SARS-CoV -- virus responsible for SARS ( Severe Acute Respiratory Syndrome )
SARS-CoV-2 -- virus responsible for COVID-19
Tissue tropism -- cells and tissues of a host that support growth of a particular virus or bacterium. Some bacteria and viruses have a broad tissue tropism and can infect many types of cells and tissues. Other viruses may infect primarily a single tissue. Wikipedia
Histopathology-- the microscopic examination of tissue (e.g., on a slide) in order to study the manifestations of disease. Wikipedia
sgRNA -- “single guide RNA ((ribonucleic acid))”, a single RNA molecule that contains both the custom-designed short crRNA sequence fused to the scaffold tracrRNA sequence. sgRNA can be synthetically generated or made in vitro or in vivo (transcribed) from a DNA template. https://www.synthego.com/guide/how-to-use-crispr/sgrna
polybasic -- having more than one hydrogen atom replaceable by basic atoms or radicals —used of acids (Merriam-Webster)
furin -- one of the proteases (enzyme that breaks down proteins) responsible for the...cleavage...prior to viral assembly. (Wikipedia)
S1-S2 junction in the SARS-CoV-2 spike protein -- see pulmonologist's video of howCOVID19 virus invades cell, replicating there: ~2:50 of https://www.youtube.com/watch?v=Eeh054-Hx1U
fomite or fomes -- any inanimate object that, when contaminated with or exposed to infectious agents can transfer disease to a new host (Wikipedia)
seroconversion -- the time period during which a specific antibody develops and becomes detectable in the blood. After seroconversion has occurred, the disease can be detected in blood tests for the antibody. Wikipedia
IgM -- Immunoglobulin M is one of several isotypes of antibody (also known as immunoglobulin) that are produced by vertebrates. IgM is the largest antibody, and it is the first antibody to appear in the response to initial exposure to an antigen. Wikipedia
IgG -- mmunoglobulin G is a type of antibody. Representing approximately 75% of serum antibodies in humans, IgG is the most common type of antibody found in blood circulation. IgG molecules are created and released by plasma B cells. Each IgG has two antigen binding sites. Wikipedia
IFA -- Immunofluorescent assay or test, in which HIV antigen is mixed with a fluorescent compound and then with a sample of the patient's blood. medical-dictionary.thefreedictionary.com
antigen -- any substance that causes your immune system to produce antibodies against it. MedlinePlus Medical Encyclopedia.
epitope -- is the part of an antigen that is recognized by the immune system, specifically by antibodies, B cells, or T cells. For example, the epitope is the specific piece of the antigen to which an antibody binds. (Wikipedia)
ELISA -- enzyme-linked immunosorbent assay is a commonly used analytical biochemistry assay, which uses a solid-phase enzyme immunoassay to detect the presence of a ligand in a liquid sample using antibodies directed against the protein to be measured. Wikipedia
plaque reduction neutralization test -- measures the ability of the patient's antibody to neutralize infectivity and protect cells from infection, so it is considered a gold standard for the assessment of protective antibody. www.sciencedirect.com . Wikipedia
glycosylation -- important and highly regulated mechanism of secondary protein processing within cells. It plays a critical role in determining protein structure, function and stability. ... Changes in these complexes result in alterations in how they recruit, interact and activate signaling proteins (e.g. G proteins). The Role of Glycosylation in Receptor Signaling | IntechOpen
#111 Unfortunately, Dr. Birx appears to have drunk the Kool-Aid...
I wonder, however, if she isn't shovelling the compliments (Trump has mind for numbers??) and spin in order to keep orange ear for real numbers.*
As long as public health isn't hurt with spin, she might be sacrificing her reputation for nation's sake?
Birx Spins ‘Extraordinarily Low Numbers’ of Coronavirus Cases
Eugene Kiely and Lori Robertson | March 27, 2020
Dr. Deborah Birx, the coordinator of the White House coronavirus task force, misleadingly claimed that 19 states — “almost 40% of the country” — “have less than 200 cases” of COVID-19, the disease caused by the virus. In fact, 17 states with 7.2% of the U.S. population have fewer than 200 confirmed cases each.
Birx made her remarks at a task force press briefing at the White House on March 26 on a day when the United States passed China and became the country with the most confirmed coronavirus cases in the world...
At the same briefing, President Donald Trump spoke about wanting to soon open “large sections of our country that aren’t so seriously affected.” The president has said he would “love to have the country opened up and just raring to go by Easter
...while Birx boasts about “almost 40% of the country with extraordinarily low numbers,” the fact is that only 7.2% of the population lives in those states.
* “Deborah Birx, the White House’s coronavirus response coordinator, and Anthony S. Fauci, an infectious-disease expert, repeatedly presented the president with worst-case scenarios to underscore just how cataclysmic the crisis could get.”
Johnson & Johnson Identifies Lead Coronavirus Vaccine Candidate
Martin Baccardax | Mar 30, 2020
..Johnson & Johnson said the vaccine was developed in partnership with Jansen Pharmaceuticals and the U.S Biomedical Advanced Research and Development Authority and that it hopes to initiate human trials for the lead vaccine candidate by September at the latest. The company also said it expects the first batch could be available for emergency use in early 2021.
Johnson & Johnson said it will expand it global manufacturing capabilities in order to meet its ambition of providing a billion doses, including the building of new sites in the United States.
"The additional capacity will assist in the rapid production of a vaccine and will enable the supply of more than one billion doses of a safe and effective vaccine globally," Johnson & Johnson said. "The Company plans to begin production at risk imminently and is committed to bringing an affordable vaccine to the public on a not-for-profit basis for emergency pandemic use."...
Germany has got testing spot on.
They plan to test hundreds of thousands for the presence of the antibodies and issue 'Immunity Certificates' to those who test positive-allowing their work to be exempt from the lockdown.
This information will be a huge weapon against the virus.
-Professor Karol Sikora @ProfKarolSikora | 6:06 AM · Mar 30, 2020
NBC News: FEMA is sending 60 ambulances today to New York City to help with the heavy 911 medical call volume
which has reached had a record-breaking 5 day run (soon to be six days?), a FEMA official familiar with the matter says.
In other FDNY news, the department has 266 members who have now tested positive for COVID-19, a senior FDNY official says.
This includes firefighters, EMTs, and civilians.
Reported w/ @jonathan4ny
- Tom Winter (NBC) @Tom_Winter | 2:12 PM · Mar 30, 2020
I am asking healthcare workers across the country:
If things are not urgent in your own community, please come to New York.
We need relief for nurses. We need relief for doctors.
If you can, help us: http://health.ny.gov/assistance
We will return the favor in your hour of need.
- Andrew Cuomo @NYGovCuomo | 1:38 PM · Mar 30, 2020
This morning in Central Park. A fully operational field hospital being set up along Fifth Avenue.
- Mark Elliott @markmobility | 9:06 AM · Mar 30, 2020
Florida coronavirus cases are growing fast. Here’s what that means.
Experts say the epidemic in Florida is already past the point of easy containment.
Kathleen McGrory and Adam Playford | 3/30/2020
...experts say the math is simple. The number of cases is already past the point of easy containment and infections are growing faster and faster, at what statisticians call an exponential rate.
Without dramatic steps, they worry that the epidemic will balloon across Florida and place an unprecedented strain on hospitals and health clinics.
Thomas Hladish, a University of Florida research scientist who specializes in disease modeling and has been advising the state on the outbreak, said that while epidemiologists might disagree on the nuances of their projections, they all agree on the main point.
“We do understand the math and the models well enough to say with great confidence that Florida is going to have a huge public health crisis,” Hladish said. “And we are just at the beginning of it right now.”...
.@IHME_UW Covid-19 projections for Florida peaks at 174 deaths per day May 3
They project New Jersey deaths to peak at 104 per day on April 10
and giant California to peak at 100 per day on April 25.
Image ( https://twitter.com/davidfrum/status/1244678394081611782/photo/1 )
- David Frum @davidfrum | 1:30 PM · Mar 30, 2020
And there's other good news as well out of #Italy.
The country's infection rate has increased by only 2.2% - the lowest it's been so far.
That bookends several days of slowing infection rates.
That means that Italy's curve may finally be beginning to "flatten."
- Matt Bradley @MattMcBradley | 12:18 PM · Mar 30, 2020
The case for some mild optimism for Italy in one table.
Here's the average daily increase in the number of admissions into hospitals/ICUs in the various regions.
The numbers are clearly improving.
PS: Most regions are not (yet) at/near full capacity #Covid_19 (h/t @Teo_Beilin)
Image ( https://twitter.com/FerdiGiugliano/status/1244668589946404877/photo/1 )
- Ferdinando Giugliano (Bloomberg) @FerdiGiugliano | 12:51 PM · Mar 30, 2020
Florida is going to pay the price I'm afraid for lagging behind the rest of the country (which was already weeks behind) in taking measures to stop this disease. The republican governor DeSantis for one thing wanted to squeeze the last $ he could out of the spring breakers. Their two Senators Marco Rubio and Rick Scott are two complete assholes as well.
Deaths in New York were 253 from yesterday to today. There will probably be an even higher number tomorrow. A total of over 1200 dead NY residents in this pandemic at noon time. Doctors and nurses and other first responders getting it. Trump insinuating that some of them are stealing masks. If this were a war there would be a huge outcry if we sent our soldiers into battle without guns or body armor--here it's okay to send nurses and doctors into this battle without what they need and to accuse them now of thieving. Some of these people are going to die trying to save others and this is our president throwing vague accusations at them. It's disgraceful but par for the course of his presidency and he's got still a very large segment of the population cheering him on. They are a disgrace too.
Replicating global responses to COVID-19 may not work for Africa (Institute for Security Studies)
Containing the virus in Africa requires focusing on vulnerable communities and context-specific responses...
>144 lriley: There is some chance New York is near to its peak of new cases. But the federal system surely makes the US hard to model. As I'm sure does the income gap--the ghettoization of ALL cities.
>145 johnthefireman: Sounds like earliest vaccine arrives March 2021, so if COVID-19 proves to be a seasonal illness, the Southern Hemisphere may only have to go through one cycle? Looks like Northern Hemisphere would have two? Community transmission might be less in hot and humid areas?
Maybe Africans having been exposed to a different array of diseases than Europeans--may have been exposed to one that confers just an itsy bit more resistance to this one? Hope so.
Perhaps Africa should jump right to the antibody tests, so that they can detect the immune, and allow only them to move freely between communities?
In mean time, rely on young healthy healthcare workers, suit up any necessary older ones in full PPE, protect AMAP the old and the vulnerable?
Long term, might be a teachable moment about wildlife? China reported to now be enforcing its laws. https://www.cnn.com/2020/03/27/opinions/pangolin-coronavirus-pandemic-breiman/in...
I think one of the key differences is that social isolation just doesn't work in a continent where so much of the population lives in crowded informal "shanty town" settlements, refugee camps, displaced persons camps, etc with no provate or personal space, and depends on the informal economy to survive, ie they can't stop working in the sort of jobs which involve contact with other people. They also have to go out and buy food every day, and don't have any spare cash to stock up on things. Many don't have clean water for washing, or they have to buy it at a price they can't afford.
>141 margd: NYC's health system strained to breaking point, contd.
Nurses Die, Doctors Fall Sick and Panic Rises on Virus Front Lines
Michael Schwirtz | March 30, 2020
Imagine risking your life to save others from Covid-19 in NYC hospitals
and having your president accuse you of stealing masks.
- Morgan J. Freeman ("not the actor") | @mjfree11:19 PM · Mar 30, 2020
This week's cover artist for The NewYorker asked his daughter what his drawing should be about.
“Make sure it’s about how most doctors have children and families of their own,” she said.
Image ( https://twitter.com/crtrud/status/1244598338126741504/photo/1 )
- Craig Trudell @crtrud | 8:12 AM · Mar 30, 2020
Most US coronavirus cases per 100,000 via CNN:
New York 342
New Jersey 187
District of Columbia 70
Rhode Island 39
Reported US coronavirus cases via CNN:
Four weeks ago: 102
Three weeks ago: 678
Two weeks ago: 4,459
One week ago: 42,663
Right now: 160,377
Reported US coronavirus cases:
- Ryan Struyk @ryanstruyk | 9:04 PM · Mar 30, 2020
The University of Minnesota and Mayo Clinic are close to unveiling antibody tests that can determine if people have already been infected by the coronavirus that caused COVID-19 and are no longer threats to get or spread the infection.
- Star Tribune @StarTribune | 8:41 PM · Mar 30, 2020
University of Minnesota, Mayo Clinic ready COVID-19 antibody tests in state
Jeremy Olson | March 31, 2020
The University of Minnesota and Mayo Clinic are close to unveiling antibody tests that can determine if people have already been infected by the coronavirus that causes COVID-19 and are no longer threats to get or spread the infection.
State health officials see these tests as a key part of Minnesota’s pandemic response, because they could define the breadth of the outbreak and maybe identify previously infected individuals who could move about in public freely and volunteer in response efforts...
>150 margd: Important to note that those are death totals, not per day deaths.
#149--the effects of this for those nurses and doctors who survive this will probably last a large number of them a lifetime. Long grueling days of treating sick and dying people--sometimes their own colleagues will take a lot of them into PTSD territory. It is a nightmare.
Trump's irresponsible inaction--his baseless accusations that some of them are thieving as he holds back and/or doesn't provide them the support or equipment/supplies that they need.
This week, Missouri saw a 600% jump in coronavirus cases — the largest increase in the country
Bryce Gray , Janelle O'Dea | 3/30/2020
...The region’s caseload is rocketing upward, with the state seeing a more than 600% increase in total cases over the past week — the largest percentage increase in the country as of Thursday, according to data collected by Johns Hopkins University.
And a lack of widespread testing largely means that experts aren’t sure when the region will reach the peak of its curve...
...In Illinois, where the state is under lockdown, the number of confirmed cases grew by 237% in the same period.
As of Thursday, Missouri’s per-capita rate for confirmed COVID-19 cases was 8.5 per 100,000 people. In Illinois, it was 20 per 100,000....
>127 margd: US sent California faulty ventilators, contd.
Sounds like HHS, Kushner, FEMA, DHS have a penny-smart / pound-foolish, short-sighted approach to negotiating contracts... The Art of the Deal?
A Ventilator Stockpile, With One Hitch: Thousands Do Not Work
David E. SangerZolan Kanno-YoungsNicholas Kulish
David E. Sanger, Zolan Kanno-Youngs and Nicholas Kulish | April 1, 2020
WASHINGTON — President Trump has repeatedly assured Americans that the federal government is holding 10,000 ventilators in reserve to ship to the hardest-hit hospitals around the nation as they struggle to keep the most critically ill patients alive.
But what federal officials have neglected to mention is that an additional 2,109 lifesaving devices are unavailable after the contract to maintain the government’s stockpile lapsed late last summer, and a contracting dispute meant that a new firm did not begin its work until late January. By then, the coronavirus crisis was already underway...
This topic was continued by SARS-CoV-2 and COVID-19 (4).
This topic is not marked as primarily about any work, author or other topic.