OT: Corona virus

[Lowpe]

ORIGINAL: obvert
His prediction for US mortality is quite far off now.

For the time the article was printed it was far far closer than any of the models.

but to flatten the initial curve they (economic lockdown) have been essential

I don't think that has been proven at all other than simplistic headlines.

[obvert]

This a look at testing in the UK. There has been a lot of criticism of methods for ramping up measures, testing and getting PPE here in the UK. The mortality rate is higher than many other European countries. The health system has had some bumps, but hasn't been overwhelmed except in specific locations for shorts periods, and while the PPE problem is big, other problems like medications running out are also beginning to emerge.

Testing here is increasing, but may not reach the target of 100k/day by the end of April.

The UK is now 9th in the world though in total tests performed. It is much lower (off this chart low at number 37 in test/million population).

The UK is now 2nd highest in % of tests that come back positive at 23.2%

The UK is now 9th in positive test/million population at 2,197/million.

The high % positive rate is indicative of the tests being mostly available to people already in hospital with symptoms. This would indicate though a much higher rate of infection across the population as well. The WHO advocates for a 10% positive % to begin reopening after lockdowns.

So as testing increases it'll be interesting to see if the % positive number goes down, or stays the same. The curve has flattened, new case numbers are dropping, as are mortalities per day. I hope that by mid-to-late May some things will begin opening again. Pubs, hopefully, and nurseries.

[obvert]

ORIGINAL: Lowpe

ORIGINAL: obvert
His prediction for US mortality is quite far off now.

For the time the article was printed it was far far closer than any of the models.

Not really. He said 10k without a lockdown. We've gone over that in the US in a month with a lockdown. Right?

In addition, because mortality is a lagging statistic, sometimes by 2-4 weeks, the cases that were actually being transmitted during the time he was publishing were still adding to the mortality rates a month later as well. Most probably the number of cases existing by that time of publication would have resulted in much higher than that 10k number (or cases that led to 10k+ deaths) well before lockdowns were implemented.

but to flatten the initial curve they (economic lockdown) have been essential

I don't think that has been proven at all other than simplistic headlines.

[/quote]

Actually, its been quite demonstrably proven by a number of countries having flattened the curve through lockdowns. Without lockdowns you'd see what happened in the initial stages in Italy, with hospitals being overwhelmed. That was due to the lockdown starting well after the infection had taken hold and transmitted extensively in the community. We've heard here both from Italians and experts that without those closures the entire country would have been as bad as Lombardy and areas of the North. Not good.

If you need more info we can dredge some up, but it's in the thread and in many of the graphs showing how the curve responds to lockdown dates. It's very easy to see if you look at two very similar countries, France and the UK. France is faring better now as they locked down earlier in their curve.

This is from the FT. It shows the lockdown dates as little stars to the left for each country. I've posted these throughout the thread and earlier it was quite apparent how the curve responded to the lockdown date more or less after two weeks of measures being in place.

[Chickenboy]

ORIGINAL: Chickenboy

Just read the Belgian report guys:

https://www.bloomberg.com/news/articles ... -s-capital

It's all about the nursing homes. It's all about the nursing homes. Everything about the mortality is about the nursing homes. Everywhere.

Yeesh. This is what happens when you're reading about the impact of COVID-19 globally and you've had too many glasses of wine.

But I was struck with just how much of the mortality globally is in nursing homes and how disproportionate the effect seems to have been. Sweden, Canada, Belgium, etc.-if you you can account for / control exposure in your nursing home populations you go a long ways towards reducing the impact of this disease. And maybe we can all figure out a way to get back on with life for everyone else that's not in a nursing home.

The article I linked also expounded on why Belgium has the highest rate of deaths in Europe and globally. As we've talked about here numerous times, it's all in how you record 'deaths'. Belgians are casting a broad net and calling everything about 'excess mortality' 'presumptive COVID-19 deaths'. The German methodology caught some flak here-they apparently are still only calling confirmed virus positive deaths as 'COVID-19' deaths.

IMO, both lead to distorted pictures of the impact-the Belgians are probably overcounting and the Germans undercounting. The article discussed a pan-European effort to standardize how mortality will be counted or restated. But it is unclear when or if this will be adopted.

[Chickenboy]

ORIGINAL: Lowpe

A New York Times Opinion piece about the virus, lockdown, and New York.

America Shouldn’t Have to Play by New York Rules

https://www.nytimes.com/2020/04/24/opin ... kdown.html

Exactly so. We've been on to this here for some time, but nice to hear it dawning on the New York Times.

[Canoerebel]

From what I've seen of the raw data here in Georgia, plus similar reports elsewhere, I think the wine-sensitive Chickenboy is right.

The Georgia mortalities have overwhelmingly been the elderly. The most deadly breakouts here occurred in nursing homes, assisted living, and choir- and funeral-related functions. Protect the elderly and prohibit dense gatherings where people are singing (or otherwise exhaling strongly, as in sporting matches) and that seemingly would address nearly all situations here.

I recall an early study that said you had a 10% chance of catching the virus if another member of your household had it. The odds dropped dramatically if there was a person in your workplace. And outdoors in a spread out environment? Basically no chance.

[Canoerebel]

Here's a segment of the Georgia Department of Health mortality chart for Dougherty County. Look at the ages.

Dougherty is the southwest Georgia county that suffered a big per-capita outbreak when the virus spread through two big funerals.

The link: https://dph.georgia.gov/covid-19-daily-status-report

[Chickenboy]

ORIGINAL: Canoerebel

Here's a segment of the Georgia Department of Health mortality chart for Dougherty County. Look at the ages.

Dougherty is the southwest Georgia county that suffered a big per-capita outbreak when the virus spread through two big funerals.

The link: https://dph.georgia.gov/covid-19-daily-status-report

What's the Yes/Unk column on the right?

[Lowpe]

ORIGINAL: obvert


Actually, its been quite demonstrably proven by a number of countries having flattened the curve through lockdowns. Without lockdowns you'd see what happened in the initial stages in Italy, with hospitals being overwhelmed.

There are plenty of places that didn't lockdown and aren't overwhelmed. How do you explain that?

To ascribe lockdowns as the culpable factor in flattening the curve, which is not a scientific proven fact but rather a hypothesis, at this stage is wrong. Sure, we have all gone thru extensive pain from the disease and lockdown and want to believe it is working as advertised.

[Canoerebel]

To Chickenboy: The "Yes/UNK" column is whether there was a known underlying cause of death - presumably a contributing factor like diabetes or hypertension.

[mind_messing]

ORIGINAL: Chickenboy

ORIGINAL: Chickenboy

Just read the Belgian report guys:

https://www.bloomberg.com/news/articles ... -s-capital

It's all about the nursing homes. It's all about the nursing homes. Everything about the mortality is about the nursing homes. Everywhere.

Yeesh. This is what happens when you're reading about the impact of COVID-19 globally and you've had too many glasses of wine.

But I was struck with just how much of the mortality globally is in nursing homes and how disproportionate the effect seems to have been. Sweden, Canada, Belgium, etc.-if you you can account for / control exposure in your nursing home populations you go a long ways towards reducing the impact of this disease. And maybe we can all figure out a way to get back on with life for everyone else that's not in a nursing home.

The article I linked also expounded on why Belgium has the highest rate of deaths in Europe and globally. As we've talked about here numerous times, it's all in how you record 'deaths'. Belgians are casting a broad net and calling everything about 'excess mortality' 'presumptive COVID-19 deaths'. The German methodology caught some flak here-they apparently are still only calling confirmed virus positive deaths as 'COVID-19' deaths.

IMO, both lead to distorted pictures of the impact-the Belgians are probably overcounting and the Germans undercounting. The article discussed a pan-European effort to standardize how mortality will be counted or restated. But it is unclear when or if this will be adopted.

Which is why I'm banging on about the international comparisons being largely worthless. Cases and deaths are not by default directly comparable.

Even within the UK, Scotland is counting the deaths markedly different (mentions on death certificate, even if not confirmed) from England (died in hospital, tested positive).

Of course, that was handwaved way.

[mind_messing]

ORIGINAL: Lowpe

ORIGINAL: obvert


Actually, its been quite demonstrably proven by a number of countries having flattened the curve through lockdowns. Without lockdowns you'd see what happened in the initial stages in Italy, with hospitals being overwhelmed.

There are plenty of places that didn't lockdown and aren't overwhelmed. How do you explain that?

Examples, please?

[RangerJoe]

ORIGINAL: Chickenboy

ORIGINAL: Chickenboy

Just read the Belgian report guys:

https://www.bloomberg.com/news/articles ... -s-capital

It's all about the nursing homes. It's all about the nursing homes. Everything about the mortality is about the nursing homes. Everywhere.

Yeesh. This is what happens when you're reading about the impact of COVID-19 globally and you've had too many glasses of wine.

But I was struck with just how much of the mortality globally is in nursing homes and how disproportionate the effect seems to have been. Sweden, Canada, Belgium, etc.-if you you can account for / control exposure in your nursing home populations you go a long ways towards reducing the impact of this disease. And maybe we can all figure out a way to get back on with life for everyone else that's not in a nursing home.

The article I linked also expounded on why Belgium has the highest rate of deaths in Europe and globally. As we've talked about here numerous times, it's all in how you record 'deaths'. Belgians are casting a broad net and calling everything about 'excess mortality' 'presumptive COVID-19 deaths'. The German methodology caught some flak here-they apparently are still only calling confirmed virus positive deaths as 'COVID-19' deaths.

IMO, both lead to distorted pictures of the impact-the Belgians are probably overcounting and the Germans undercounting. The article discussed a pan-European effort to standardize how mortality will be counted or restated. But it is unclear when or if this will be adopted.

How about getting every worker tested to see if they have had and for those who have not, give them plasma therapy for protection. If I remember correctly, one donation of plasma will treat one person who is seriously ill but for those who get it as a precaution, they need one twentieth of the dose. It can also be used for the people who are first responders as well as medical staff.

[Chickenboy]

Yesterday hit a new high on cases nationally @>35,000.

*However*, we've quadrupled national testing in the last couple of weeks. That's why I've been keeping an eye on granular 'attack rates' of different states: % positive tests / tests performed.

In Texas, the attack rate for testing had been 8%-10%. Now it's 5%. In New York, the attack rate had been >50%. Now it's 22.4%. California's testing is more difficult to interpret as they publish raw testing data in fits and spurts. It ranges between 1.2% and 15.8% depending on the day.

Because we are testing much more, we are finding many more cases. It's to be expected. So the raw number of cases counted begins to mean less for interpretational value. Expect this to go on as states cast a broader net, change their definitions for who should be tested and do more testing of mildly symptomatic people.

https://covidtracking.com/data

[Chickenboy]

ORIGINAL: RangerJoe

ORIGINAL: Chickenboy

ORIGINAL: Chickenboy

Just read the Belgian report guys:

https://www.bloomberg.com/news/articles ... -s-capital

It's all about the nursing homes. It's all about the nursing homes. Everything about the mortality is about the nursing homes. Everywhere.

Yeesh. This is what happens when you're reading about the impact of COVID-19 globally and you've had too many glasses of wine.

But I was struck with just how much of the mortality globally is in nursing homes and how disproportionate the effect seems to have been. Sweden, Canada, Belgium, etc.-if you you can account for / control exposure in your nursing home populations you go a long ways towards reducing the impact of this disease. And maybe we can all figure out a way to get back on with life for everyone else that's not in a nursing home.

The article I linked also expounded on why Belgium has the highest rate of deaths in Europe and globally. As we've talked about here numerous times, it's all in how you record 'deaths'. Belgians are casting a broad net and calling everything about 'excess mortality' 'presumptive COVID-19 deaths'. The German methodology caught some flak here-they apparently are still only calling confirmed virus positive deaths as 'COVID-19' deaths.

IMO, both lead to distorted pictures of the impact-the Belgians are probably overcounting and the Germans undercounting. The article discussed a pan-European effort to standardize how mortality will be counted or restated. But it is unclear when or if this will be adopted.

How about getting every worker tested to see if they have had and for those who have not, give them plasma therapy for protection. If I remember correctly, one donation of plasma will treat one person who is seriously ill but for those who get it as a precaution, they need one twentieth of the dose. It can also be used for the people who are first responders as well as medical staff.

I really don't know enough about the protective prophylactic efficacy of plasma therapy to opine, RangerJoe. Do you have a source on the value of such therapy, either for therapeutic or prophylactic purposes?

[RangerJoe]

Published by PNAS. Proceedings of the National Academy of Sciences of the United States of America.
There is a lot more technical stuff in the article as well as x-rays.

Effectiveness of convalescent plasma therapy in severe COVID-19 patients
March 18, 2020

Significance

COVID-19 is currently a big threat to global health. However, no specific antiviral agents are available for its treatment. In this work, we explore the feasibility of convalescent plasma (CP) transfusion to rescue severe patients. The results from 10 severe adult cases showed that one dose (200 mL) of CP was well tolerated and could significantly increase or maintain the neutralizing antibodies at a high level, leading to disappearance of viremia in 7 d. Meanwhile, clinical symptoms and paraclinical criteria rapidly improved within 3 d. Radiological examination showed varying degrees of absorption of lung lesions within 7 d. These results indicate that CP can serve as a promising rescue option for severe COVID-19, while the randomized trial is warranted.

Abstract

Currently, there are no approved specific antiviral agents for novel coronavirus disease 2019 (COVID-19). In this study, 10 severe patients confirmed by real-time viral RNA test were enrolled prospectively. One dose of 200 mL of convalescent plasma (CP) derived from recently recovered donors with the neutralizing antibody titers above 1:640 was transfused to the patients as an addition to maximal supportive care and antiviral agents. The primary endpoint was the safety of CP transfusion. The second endpoints were the improvement of clinical symptoms and laboratory parameters within 3 d after CP transfusion. The median time from onset of illness to CP transfusion was 16.5 d. After CP transfusion, the level of neutralizing antibody increased rapidly up to 1:640 in five cases, while that of the other four cases maintained at a high level (1:640). The clinical symptoms were significantly improved along with increase of oxyhemoglobin saturation within 3 d. Several parameters tended to improve as compared to pretransfusion, including increased lymphocyte counts (0.65 × 109/L vs. 0.76 × 109/L) and decreased C-reactive protein (55.98 mg/L vs. 18.13 mg/L). Radiological examinations showed varying degrees of absorption of lung lesions within 7 d. The viral load was undetectable after transfusion in seven patients who had previous viremia. No severe adverse effects were observed. This study showed CP therapy was well tolerated and could potentially improve the clinical outcomes through neutralizing viremia in severe COVID-19 cases. The optimal dose and time point, as well as the clinical benefit of CP therapy, needs further investigation in
larger well-controlled trials.
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Convalescent plasma (CP) therapy, a classic adaptive immunotherapy, has been applied to the prevention and treatment of many infectious diseases for more than one century. Over the past two decades, CP therapy was successfully used in the treatment of SARS, MERS, and 2009 H1N1 pandemic with satisfactory efficacy and safety (9⇓⇓–12). A meta-analysis from 32 studies of SARS coronavirus infection and severe influenza showed a statistically significant reduction in the pooled odds of mortality following CP therapy, compared with placebo or no therapy (odds ratio, 0.25; 95% confidence interval, 0.14–0.45) (13). However, the CP therapy was unable to significantly improve the survival in the Ebola virus disease, probably due to the absence of data of neutralizing antibody titration for stratified analysis (14). Since the virological and clinical characteristics share similarity among SARS, Middle East Respiratory Syndrome (MERS), and COVID-19 (15), CP therapy might be a promising treatment option for COVID-19 rescue (16). Patients who have recovered from COVID-19 with a high neutralizing antibody titer may be a valuable donor source of CP. Nevertheless, the potential clinical benefit and risk of convalescent blood products in COVID-19 remains uncertain. Hence, we performed this pilot study in three participating hospitals to explore the feasibility of CP treatment in 10 severe COVID-19 patients.
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Results
Neutralizing Activity of CP against SARS-CoV-2.

The neutralizing activity against SARS-CoV-2 was evaluated by classical plaque reduction test using a recently isolated viral strain (1). Among the first batch of CP samples from 40 recovered COVID-19 patients, 39 showed high antibody titers of at least 1:160, whereas only one had an antibody titer of 1:32. This result laid the basis for our pilot clinical trial using CP in severe patients.
General Characteristics of Patients in the Trial.

From January 23, 2020, to February 19, 2020, 10 severe COVID-19 patients (six males and four females) were enrolled and received CP transfusion. The median age was 52.5 y (interquartile range [IQR], 45.0 y to 59.5 y) (Table 1). None of the patients had direct exposure to Huanan Seafood Wholesale Market. The median time from onset of symptoms to hospital admission and CP transfusion was 6 d (IQR, 2.5 d to 8.5 d) and 16.5 d (IQR, 11.0 d to 19.3 d), respectively. Three patients were affected by clustering infection. The most common symptoms at disease onset were fever (7 of 10 patients), cough (eight cases), and shortness of breath (eight cases), while less common symptoms included sputum production (five cases), chest pain (two cases), diarrhea (two cases), nausea and vomiting (two cases), headache (one case), and sore throat (one case). Four patients had underlying chronic diseases, including cardiovascular and/or cerebrovascular diseases and essential hypertension. Nine patients received arbidol monotherapy or combination therapy with remdesivir (in one case not included in the current clinical trial), or ribavirin, or peramivir, while one patient received ribavirin monotherapy (Table 2). Antibacterial or antifungal treatment was used when patients had coinfection. Six patients received intravenous (i.v.) methylprednisolone (20 mg every 24 h).
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Effects of CP Transfusion.
Improvement of clinical symptoms.

All symptoms in the 10 patients, especially fever, cough, shortness of breath, and chest pain, disappeared or largely improved within 1 d to 3 d upon CP transfusion. Prior to CP treatment, three patients received mechanical ventilation, three received high-flow nasal cannula oxygenation, and two received conventional low-flow nasal cannula oxygenation. After treatment with CP, two patients were weaned from mechanical ventilation to high-flow nasal cannula, and one patient discontinued high-flow nasal cannula. Besides, in one patient treated with conventional nasal cannula oxygenation, continuous oxygenation was shifted to intermittent oxygenation (Table 2).
Reduction of pulmonary lesions on chest CT examinations.

According to chest CTs, all patients showed different degrees of absorption of pulmonary lesions after CP transfusion. Representative chest CT images of patient 9 and patient 10 are shown on Fig. 1. Patient 9, a 49-y-old female admitted 1 day postonset of illness (dpoi), showed the most obvious pulmonary image improvement. At 10 dpoi, one dose of 200-mL transfusion of CP was given. The SARS-CoV-2 RNA converted to negative at 12 dpoi. Compared with the result at 7 dpoi, massive infiltration and ground-glass attenuation disappeared on CT image performed at 13 dpoi, accompanied by a much better pulmonary function. Patient 10, a 50-y-old male, was admitted 3 dpoi and was given a 200-mL transfusion of CP at 20 dpoi. His chest CT presented massive infiltration and widespread ground-glass attenuation on admission and started to show a gradual absorption of lung lesions 5 d after CP transfusion. The SARS-CoV-2 RNA became negative at 25 dpoi.
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Outcome of patients treated with CP as compared to a recent historic control group.

A historic control group was formed by random selection of 10 patients from the cohort treated in the same hospitals and matched by age, gender, and severity of the diseases to the 10 cases in our trial. Baseline characteristics of patients between CP treatment group and control group showed no significant differences, while clinical outcomes of these two groups were different: three cases discharged while seven cases in much improved status and ready for discharge in CP group, as compared to three deaths, six cases in stabilized status, and one case in improvement in the control group (P < 0.001; SI Appendix, Table S1).
Adverse Effects of CP Transfusions.

Patient 2 showed an evanescent facial red spot. No serious adverse reactions or safety events were recorded after CP transfusion.

https://www.pnas.org/content/early/2020 ... 2004168117

There are tests in the US on going, I think they just started recently.

[RangerJoe]

Another article, much shorter and not as technical:

Convalescent plasma as a potential therapy for COVID-19
published February 2, 2020

https://www.thelancet.com/journals/lani ... 9/fulltext

[Lowpe]

ORIGINAL: mind_messing

ORIGINAL: Lowpe

ORIGINAL: obvert


Actually, its been quite demonstrably proven by a number of countries having flattened the curve through lockdowns. Without lockdowns you'd see what happened in the initial stages in Italy, with hospitals being overwhelmed.

There are plenty of places that didn't lockdown and aren't overwhelmed. How do you explain that?

Examples, please?

There are 8 states in the US that performed no economic lockdown, and none of them are overwhelmed.

The reporting numbers is inconsistent across the board and to be taken with a huge grain of salt especially in states that report presumptive cases, and there is also seemingly a move to count excess deaths as covid deaths because the excess deaths were caused by a breakdown of healthcare caused by covid.

The daily death count toll is also very misleading...in Pennsylvania for example they are attributing deaths that occurred in the past but that they feel they can assign to the virus the current day's reporting.

You could as easily quantify your flattening of the curve theory to better handwashing as to the lockdown or it could simply be the life cycle of the virus and herd immunity developing or warmer temperatures arriving or playing with statistics.

[RangerJoe]

Two South Koreans recover from COVID-19 after plasma therapy
07 Apr 2020

SEOUL: Two elderly South Korean coronavirus patients recovered from severe pneumonia after being treated with plasma from survivors, researchers said Tuesday (Apr 7), offering hope in the face of the global pandemic.

Scientists have pointed to the potential benefits of plasma - a blood fluid - from recovered individuals who have developed antibodies to the virus enabling the body's defences to attack it.
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Plasma therapy could become "an alternative treatment for patients in critical condition who do not respond to antiviral drugs", said Choi Jun-yong, a doctor and researcher at Severance Hospital in Seoul, where both patients were treated.

But large-scale clinical trials were needed to prove its effectiveness, he added.

One of the two patients was a 71-year-old man with no underlying conditions who only improved when treated with plasma from a recovered patient in his 20s, along with steroids.

He was initially given malaria drugs and a respirator for severe pneumonia.

The other patient, a 67-year-old female, also did not respond to initial treatments including malaria, HIV drugs, and oxygen therapy. She began to recover after receiving plasma therapy and steroids at the same time, researchers said.

Their findings were published in the peer-reviewed Journal of Korean Medicine.

Kwon Jun-wook, an official at Seoul's Central Disease Control Headquarters, said plasma therapy was "important" when there was "currently no vaccine or treatment available" for the virus.

https://www.channelnewsasia.com/news/as ... y-12618422

And on youtube (the news caster is easy on the eyes):

https://www.youtube.com/watch?v=47IOaG2oUQQ

[RangerJoe]

Updated:
Apr 1, 2020
Original:
Mar 30, 2020

Before Vaccines, Doctors ‘Borrowed’ Antibodies from Recovered Patients to Save Lives
Doctors first tried injecting patients with blood plasma in the early 1900s. The method has been used against diphtheria, the 1918 flu pandemic, measles and Ebola.

n 1934, a doctor at a private boy’s school in Pennsylvania tried a unique method to stave off a potentially deadly measles outbreak. Dr. J. Roswell Gallagher extracted blood serum from a student who had recently recovered from a serious measles infection and began injecting the plasma into 62 other boys who were at high risk of catching the disease.

Only three students ended up contracting measles and all were mild cases.
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During the pandemic influenza outbreak of 1918 known as the “Spanish flu,” fatality rates were cut in half for patients who were treated with blood plasma compared to those who weren’t. The method seemed particularly effective when patients received the antibodies in the early days of their infection, before their own immune systems had a chance to overreact and damage vital organs. In the 1930s, doctors like Gallagher used convalescent plasma effectively against measles.
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By the 1940s and 1950s, antibiotics and vaccines began to replace the use of convalescent plasma for treating many infectious disease outbreaks, but the old-fashioned method came in handy yet again during the Korean War when thousands of United Nations troops were stricken with something called Korean hemorrhagic fever, also known as Hantavirus. With no other treatment available, field doctors transfused convalescent plasma to sickened patients and saved untold numbers of lives.
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One of the best-known modern uses of convalescent plasma is for the production of antivenom to treat deadly snake bites. Antivenom is made by injecting small amounts of snake venom into horses and allowing the horse’s immune system to produce antibodies that neutralize the poison. Those equine antibodies are isolated, purified and distributed to hospitals as antivenom.

In March 2020, doctors at Johns Hopkins University began testing convalescent plasma as a promising stop-gap treatment for COVID-19 while the search continued for a permanent vaccine. The advantage of convalescent plasma is that it can be drawn from recovered patients using the same plasma separation technology used at blood banks.

"It's all doable,” says immunologist Arturo Casadevall, lead researcher on the COVID-19 study, “but to get it done it requires effort, organization, resources… and people who have recovered from the disease who can donate the blood."

https://www.history.com/news/blood-plas ... panish-flu