PlagueWatch 2020-23 - Coronavirus

[JasonEvans]

Boris Johnson's case of Covid is getting worse. He has been taken to the hospital. Whoa...

https://www.cnbc.com/2020/04/05/brit...-symptoms.html

[bundabergdevil]

Boris Johnson's case of Covid is getting worse. He has been taken to the hospital. Whoa...

https://www.cnbc.com/2020/04/05/brit...-symptoms.html

We're bound to see some deaths in the ranks of global politicians and business leaders before this is all over given it's mortality profile. It was late but they do seem to have up a bubble around US leadership now, FWIW.

[CrazyNotCrazie]

As I understand it, the way they determine the effect on society in a particular year of a disease such as the flu is by comparing the expected number of deaths without the disease with the number that actually died. This is all done by statisticians, and has the effect of excluding the people who would have died anyway that year but who also just happened to have the flu (along with all their other infirmities). So we won’t know the official effect of Covid-19 until after it’s over and they do this calculation. On the one hand the current count is too low because some were left out, as the story says, but on the other hand it’s inflated because some of those people would have died this year anyway of other causes.

Neil Ferguson, the Imperial College London scientist whose research about the enormous number of deaths there might be in Britain, told Parliament that the deaths of those who would have died anyway before the end of the year “might be as much as half or two thirds of the deaths we see, because these are people at the end of their lives or who have underlying conditions.”

That article is now almost two weeks old - a lot has changed. I'm not going to argue statistics with you because I frankly find these discussions to be really pointless (lies, damn lies, statistics). But I think at this point the contrarian argument of "it's not that bad" or "these people would have died anyway" has been debunked. People of all ages are getting sick and dying from this. And a lot of that is the second order effect of doctors, nurses, cops, etc. The whole thing might seem very imaginary for those in less hard hit areas of the country, but here in New York, it is very real and scary (I write as I hear yet another set of ambulance sirens go by my apartment and reply to a text from a fairly healthy 30-year old mother of three who is like family to me who thinks she has it and is awaiting testing).

[swood1000]

Great news. How quickly can it be mass produced for the entire U.S. population.

Mass producing a vaccine is a much bigger project because hundreds of millions of doses have to be created. It would seem that the situation with a monoclonal antibody would be different since it only gives eight to ten weeks of protection and so probably would find the greatest use with those who are already infected.

Prior to the development of a vaccine, if 86% of those who become infected have minor or no symptoms those people should probably be left to develop their own immunity naturally and it’s only the remainder who would benefit from monoclonal antibody treatment. As far as large-scale production is concerned there are a number of different methods but the time it would take would start at six weeks for a relatively small amount. More info is available at the Distributed Bio website.

[CDu]

That article is now almost two weeks old - a lot has changed. I'm not going to argue statistics with you because I frankly find these discussions to be really pointless (lies, damn lies, statistics). But I think at this point the contrarian argument of "it's not that bad" or "these people would have died anyway" has been debunked. People of all ages are getting sick and dying from this. And a lot of that is the second order effect of doctors, nurses, cops, etc. The whole thing might seem very imaginary for those in less hard hit areas of the country, but here in New York, it is very real and scary (I write as I hear yet another set of ambulance sirens go by my apartment and reply to a text from a fairly healthy 30-year old mother of three who is like family to me who thinks she has it and is awaiting testing).

Yep. Even with social distancing assumed through May, the expected COVID death toll in NY state is around 16,000 (they are already over 4,000). In other words, about half the ANNUAL death toll for the flu... for the entire US. And it will achieve that within a single month, rather than the 6-month flu season. The combination of lack of immunity and a more severe virus has made this a VERY big deal. There is a reason pretty much every country with significant number of cases has gone on lockdown.

[swood1000]

That article is now almost two weeks old - a lot has changed. I'm not going to argue statistics with you because I frankly find these discussions to be really pointless (lies, damn lies, statistics). But I think at this point the contrarian argument of "it's not that bad" or "these people would have died anyway" has been debunked. People of all ages are getting sick and dying from this. And a lot of that is the second order effect of doctors, nurses, cops, etc. The whole thing might seem very imaginary for those in less hard hit areas of the country, but here in New York, it is very real and scary (I write as I hear yet another set of ambulance sirens go by my apartment and reply to a text from a fairly healthy 30-year old mother of three who is like family to me who thinks she has it and is awaiting testing).

My only point is that when people look back in the history books at the number of deaths attributable to Covid-19 the number they see there will be calculated the same way flu deaths are calculated. If the death rate is fairly constant at X per year and the year of Covid-19 the number of deaths is X+Y, then Y is the number that will be attributed to Covid-19. Granted, it’s a little more complicated than that but I think that’s basically how they do it. The result is to exclude from the Covid-19 total the number who would have died that year anyway.

[sagegrouse]

Best wishes to Boris Johnson. The 55-YO prime minister tested positive for coronavirus ten days ago. Today (April 5) he was admitted to the hospital for "tests." I hope so, but the progression of the disease seems to be that the second week brings the lung and respiratory problems and potentially grave consequences. We'll doubtless hear more on this subject from the ever-watchful UK media.

[CDu]

My only point is that when people look back in the history books at the number of deaths attributable to Covid-19 the number they see there will be calculated the same way flu deaths are calculated. If the death rate is fairly constant at X per year and the year of Covid-19 the number of deaths is X+Y, then Y is the number that will be attributed to Covid-19. Granted, it’s a little more complicated than that but I think that’s basically how they do it. The result is to exclude from the Covid-19 total the number who would have died that year anyway.

This definitely isn’t how they do it in the US. The CDC website lays out how they do it for flu. It is a series of calculations based off of flu hospitalizations (to estimate hospitalized deaths due to the flu) and death certificates (to estimate nonhospitalized flu deaths). So the death counts you are seeing now for the US are almost certainly underestimates (because we probably don’t have all the nonhospitalized deaths) and not overestimates.

It also isn’t how the WHO does it. The approach you have outlined may be true for the UK, but I don’t think it is how most places do it. Especially not for the flu, which happens every year. So if they used this approach to estimate annual flu deaths, there would be by definition years in which the flu kills a negative number of people.

[Dr. Rosenrosen]

Lions and tigers and... oh my! Even the big cats at the Bronx zoo caught the virus.

https://amp.cnn.com/cnn/2020/04/05/u...rnd/index.html

[bundabergdevil]

Lions and tigers and... oh my! Even the big cats at the Bronx zoo caught the virus.

https://amp.cnn.com/cnn/2020/04/05/u...rnd/index.html

Who you got? Sharks with laser beams attached to their heads or coronavirus tigers?

[kshepinthehouse]

Who you got? Sharks with laser beams attached to their heads or coronavirus tigers?

Both should watch out for Carol Baskin!

[bedeviled]

Small randomized trial of hydroxchloroquine shows potential. Published to non-peer reviewed site. Hopefully we get additional corroboration or confirmation via additional controlled trials that are underway and referenced in this piece. https://www.contagionlive.com/news/r...ne-for-covid19

Perhaps HC is effective primarily if taken before or in the very first stages of infection, as with these lupus patients. Apparently, there is a study being conducted in which they are giving HC prophylactically to volunteer health care workers and first responders. The results should be interesting.

Duke is also initiating a clinical trial (HERO-HCQ) to assess hydroxychloroquine for prophylaxis in healthcare workers.

Yes, the timeline for initiating HCQ tx has been a prominent feature from the start. Personally, I view it as unconscionable and inexcusable that some powers-that-be have now limited its use to only hospitalized cases and that some parties have revoked clinician's ability to prescribe it off-label...this one medicine, not even other potential COVID treatments, just this. [smh]

If anyone, including non-healthcare workers, is exposed to a COVID+ contact and wants to take HCQ, there is a chance. Univ of Minnesota has an HCQ prophylaxis trial (COVID-PEP) in which anyone in the US can volunteer to participate. But, you need to enroll within the first 4 days of COVID-19 exposure or positive test result. Progress updates will be found here.

It's hard to guess how HCQ is going to end up faring; the new bounty of experiential reports & unpublished data from around the world have mixed findings. A couple more notable examples:

• A glowing report of clinical experience w/ early initiation of HCQ, with particular relevance to the elderly population, will be added from São Paulo probably by the end of this week.
• On the other hand, a potentially trustworthy source, Univ of Mich, states,

  We haven’t seen any clear evidence of benefit so we aren’t going to use hydroxychloroquine routinely anymore,” Chopra says. “We were initially recommending it to both inpatients and outpatients, but we’re no longer doing that routinely. That’s based upon the fact that we’ve been prescribing hydroxychloroquine for a few weeks, did not see therapeutic benefit, but did see adverse effects

  I say "potentially trustworthy source" because there's also this interesting addendum

  Chopra notes that use of chloroquine or hydroxychloroquine could also exclude a patient from being allowed to join other COVID-19-related clinical trials, so it’s important to consider all of these factors before prescribing the drug

Another story interesting to me is that Michel Chrétien, a scientist brother to former Canadian PM Jean Chrétien, believes the supplement quercetin can be used for prophylaxis or treatment, and he has initial funding and infrastructure to start a small trial in China.

Finally, let's go even cheaper and more fun (but w/ minimal hope from me). Misr Univ in Egypt is conducting a trial of honey to treat COVID-19. For those of you coming out of hibernation, the dose appears to be 1 gram of honey per kilogram of weight per day, in divided doses.

[MChambers]

[URL="https://dcri.org/hero-pcori-funding-coronavirus/"]Personally, I view it as unconscionable and inexcusable that some powers-that-be have now limited its use to only hospitalized cases and that some parties have revoked clinician's ability to prescribe it off-label...this one medicine, not even other potential COVID treatments, just this. [smh]

What about the concern that the people who have been prescribed hydroxychloroquine for uses where it has been found effective, such as lupus, have had trouble getting it? Surely they should get priority over unproven uses? Perhaps that's why its use has been limited?

[camion]

What about the concern that the people who have been prescribed hydroxychloroquine for uses where it has been found effective, such as lupus, have had trouble getting it? Surely they should get priority over unproven uses? Perhaps that's why its use has been limited?

I have such a friend dealing with lupus and he has already had a great deal of trouble getting a supply. Is it conscionable to take his supply away? This is one of those cases we are repeatedly running into during the pandemic, how to allocate limited resources.

[bundabergdevil]

Got an email from a second of our healthcare providers saying someone on staff got the thing. We hadn’t been in any time to be exposed but it’s been enough that we’ve started requesting teledoc for all our appointments next few months.

[acdevil]

I have such a friend dealing with lupus and he has already had a great deal of trouble getting a supply. Is it conscionable to take his supply away? This is one of those cases we are repeatedly running into during the pandemic, how to allocate limited resources.

Same (aunt on my wife’s side).

[Truth&Justise]

West Virginia has stopped selling booze to Pennsylvanians crossing the border. West Virginia.

That's not some shot at West Virginia, I have great respect for their drinking culture. I'm just utterly shocked that they would stop serving anyone ever.

This could be unconstitutional, as the Privileges and Immunities Clause bars many forms of state government discrimination against non-residents. The Courts have typically looked unfavorably at economic discrimination against non-residents, but have sometimes allowed it where no fundamental rights are at issue--for instance, they held in 1978 that elk hunting is a privilege, not a right, so non-residents could be charged more for a license.

In other words, the key question for whether this is constitutional: do we have a fundamental right to buy alcohol?

[MChambers]

This could be unconstitutional, as the Privileges and Immunities Clause bars many forms of state government discrimination against non-residents. The Courts have typically looked unfavorably at economic discrimination against non-residents, but have sometimes allowed it where no fundamental rights are at issue--for instance, they held in 1978 that elk hunting is a privilege, not a right, so non-residents could be charged more for a license.

In other words, the key question for whether this is constitutional: do we have a fundamental right to buy alcohol?

One of my law professors told a story about arguing to a state judge that some state law was unconstitutional under US Supreme Court precedent. The judge responded: "The Supreme Court does what it has to do and we do what we have to do."

[bundabergdevil]

This could be unconstitutional, as the Privileges and Immunities Clause bars many forms of state government discrimination against non-residents. The Courts have typically looked unfavorably at economic discrimination against non-residents, but have sometimes allowed it where no fundamental rights are at issue--for instance, they held in 1978 that elk hunting is a privilege, not a right, so non-residents could be charged more for a license.

In other words, the key question for whether this is constitutional: do we have a fundamental right to buy alcohol?

Don’t know about a fundamental legal right. All I know is when my kousa dogwood tree goes to fruit and that fruit rots everything from the wasps to the possums gets drunk off it.

As Ian Malcolm said: Life finds a way to get lit.

[OldPhiKap]

One of my law professors told a story about arguing to a state judge that some state law was unconstitutional under US Supreme Court precedent. The judge responded: "The Supreme Court does what it has to do and we do what we have to do."

I was waiting in court for my hearing to be called a few years ago, and this hotshot lawyer from out of town came in to argue a motion before mine was reached. He was going on and on about all of the support for his position from United States Supreme Court decisions (it was a criminal motion). Our senior judge finally leaned forward and said "Son, you got any Georgia law?"

We are having our own inter-state squabble here, with the Governor opening all beaches and the mayor of Tybee Island trying to ignore the order.