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  1. #3381
    Join Date
    Feb 2007
    Location
    Chesapeake, VA.
    Apparently in two different studies about 15% of patients who got better, were afebrile for three days or more, and had to negative tests prior to hospital discharge end up having positive tests again, at an average of 7 days after hospital discharge.

    I didn't see anything in these studies that even tried to investigate whether these people would then be able to pass on the infection at that later time point, but that is obviously the concern.

  2. #3382
    Join Date
    Feb 2007
    Location
    Washington, D.C.

    How to reopen the economy

    Ezra Klein at Vox has an interesting but discouraging article summarizing and pointing the difficulties with the various proposals that have been floated to reopen the economy. Short version: we aren't anywhere near ready to do what's needed and it's not clear when we will be. https://www.vox.com/2020/4/10/212154...n-unemployment

  3. #3383
    Quote Originally Posted by rsvman View Post
    Apparently in two different studies about 15% of patients who got better, were afebrile for three days or more, and had to negative tests prior to hospital discharge end up having positive tests again, at an average of 7 days after hospital discharge.

    I didn't see anything in these studies that even tried to investigate whether these people would then be able to pass on the infection at that later time point, but that is obviously the concern.

    Do we know why they were tested again after 2 negative tests? Are these routine follow-up tests or are patients becoming symptomatic again?

  4. #3384
    Join Date
    Feb 2007
    Location
    Steamboat Springs, CO
    Quote Originally Posted by rsvman View Post
    Apparently in two different studies about 15% of patients who got better, were afebrile for three days or more, and had to negative tests prior to hospital discharge end up having positive tests again, at an average of 7 days after hospital discharge.

    I didn't see anything in these studies that even tried to investigate whether these people would then be able to pass on the infection at that later time point, but that is obviously the concern.
    Your posts have been a valuable addition to the Board. Even educational in unintended ways. I figured, being in the Class of Mullins, I was bound to be somewhat afebrile. Only to learn that it means "not having a fever."
    Sage Grouse

    ---------------------------------------
    'When I got on the bus for my first road game at Duke, I saw that every player was carrying textbooks or laptops. I coached in the SEC for 25 years, and I had never seen that before, not even once.' - David Cutcliffe to Duke alumni in Washington, DC, June 2013

  5. #3385
    Join Date
    Feb 2007
    Location
    Raleigh
    Quote Originally Posted by JasonEvans View Post
    For folks who have not clicked on this amazing link...

    Ha! I sent that to our son in Ohio, who remains a big Panthers fan (not *quite* sure why; he did say the above distance is comparable to how much Cam Newton often overthrew his receivers), and our younger son-in-law in Chicago who has been a huge Cubs/Bears fan for most of his 3+ decades on this earth. Our son howled. SIL? (chirp-chirp)

    Our SIL does find the Tree-picksky nickname amusing.
    [redacted] them and the horses they rode in on.

  6. #3386
    Join Date
    Feb 2007
    Location
    Chesapeake, VA.
    Quote Originally Posted by scylla View Post
    Do we know why they were tested again after 2 negative tests? Are these routine follow-up tests or are patients becoming symptomatic again?
    The study was designed to learn more about viral shedding. Patients were enrolled and sent home with swabs, told to rest at different intervals even though they were clinically recovered.

    Testing was, therefore, not based on recurrence of symptoms. All subjects, including those whose tests turned positive again, started well or continued to improve despite testing positive again.

  7. #3387
    Quote Originally Posted by rsvman View Post
    The study was designed to learn more about viral shedding. Patients were enrolled and sent home with swabs, told to rest at different intervals even though they were clinically recovered.

    Testing was, therefore, not based on recurrence of symptoms. All subjects, including those whose tests turned positive again, started well or continued to improve despite testing positive again.
    So is that good or bad? Sounds bad they they’re testing positive but good they’re improving. How are we supposed to feel about this lol?

  8. #3388
    Join Date
    Feb 2007
    Location
    Raleigh
    Quote Originally Posted by kshepinthehouse View Post
    So is that good or bad? Sounds bad they they’re testing positive but good they’re improving. How are we supposed to feel about this lol?
    I *think* I'd feel pretty good about this for several reasons. They've recovered and would assume they've had a normal immune response (as opposed to a "hyper" as discussed upthread or inadequate) to the disease by producing a healthy "titre" of antibodies and bodes well for the 95ish% who survive/recover with minimal/moderate/no symptoms.
    [redacted] them and the horses they rode in on.

  9. #3389
    Join Date
    Feb 2007
    Location
    Chesapeake, VA.
    Quote Originally Posted by kshepinthehouse View Post
    So is that good or bad? Sounds bad they they’re testing positive but good they’re improving. How are we supposed to feel about this lol?
    It really depends on whether they can spread the virus. Nobody really knows right now.

    They are certainly spinning it as a bad thing. Some places were using two consecutive negative tests separated by 24 hours as proof that people were definitely no longer contagious. The question is whether that assumption was wrong, given that some people subsequently test positive even when they remain well.

    Let me put it this way: it would certainly be more encouraging if nobody ever tested positive after recovering and having to negative tests.

    Having said that, testing positive doesn't necessarily equal being contagious, as contagion depends on shedding replication-competent virus in titers high enough to infect another person, but the test just looks for a portion of the viral RNA. More studies are required before we will know the answer.

  10. #3390
    Join Date
    Mar 2010
    Location
    Cincinnati
    As of April 7 there was only one antibody test that had received an Emergency Use Authorization (EUA) from the FDA: a test by Cellex (headquarters in Research Triangle Park). According to the EUA it takes fifteen to twenty minutes to get the test results but the test must be performed in an authorized lab. This test, according to testing done in China, has a specificity rate of 95.6% and a sensitivity rate of 93.8%. A highly sensitive test rarely overlooks an actual positive. A highly specific test rarely registers a positive classification for anything that is not the target of testing.

    However Dr. Marc Siegel said on the Tucker Carlson show, concerning the Cellex test, that “we are not entirely there yet.” He said that he had contacted Adm. Brett Giroir, the assistant secretary for health at the U.S. Department of Health and Human Services (HHS), who told him the current approved tests, made by Cellex Inc., have a one in three rate of not getting it right. But he apparently then went on to say that he prefers the test by Abbott Labs on their ID NOW platform which does not require a central lab and allows doctors to swab a nose and get a result in five to fifteen minutes. But that’s comparing apples and oranges, since Abbott tests for the presence of the virus and Cellex tests for antibodies. So it’s unclear to me exactly what he was talking about. Why would the FDA approve a test with a one in three chance of not getting it right?

  11. #3391
    Join Date
    Feb 2007
    Location
    Chesapeake, VA.
    Quote Originally Posted by swood1000 View Post
    As of April 7 there was only one antibody test that had received an Emergency Use Authorization (EUA) from the FDA: a test by Cellex (headquarters in Research Triangle Park). According to the EUA it takes fifteen to twenty minutes to get the test results but the test must be performed in an authorized lab. This test, according to testing done in China, has a specificity rate of 95.6% and a sensitivity rate of 93.8%. A highly sensitive test rarely overlooks an actual positive. A highly specific test rarely registers a positive classification for anything that is not the target of testing.

    However Dr. Marc Siegel said on the Tucker Carlson show, concerning the Cellex test, that “we are not entirely there yet.” He said that he had contacted Adm. Brett Giroir, the assistant secretary for health at the U.S. Department of Health and Human Services (HHS), who told him the current approved tests, made by Cellex Inc., have a one in three rate of not getting it right. But he apparently then went on to say that he prefers the test by Abbott Labs on their ID NOW platform which does not require a central lab and allows doctors to swab a nose and get a result in five to fifteen minutes. But that’s comparing apples and oranges, since Abbott tests for the presence of the virus and Cellex tests for antibodies. So it’s unclear to me exactly what he was talking about. Why would the FDA approve a test with a one in three chance of not getting it right?
    We have been using a rapid test for influenza for years that is basically a coin toss. It's helpful if positive but essentially worthless if negative. Our rapid test for mono is pretty good in teenagers and almost worthless in children under 5.

    There is a lot more to testing than just sensitivity and specificity, too. Ideally a test should have good positive predictive value or good negative predictive value, but that depends, to a large extent, on the a priori likelihood of the disease in the person being tested. So it gets complicated.

  12. #3392
    Join Date
    Feb 2007
    Location
    Steamboat Springs, CO

    What Will It Take to Re-Open the Duke Campus for Students?

    Presumably in August 2020.

    Low rates of COVID-19 infections? Availability of testing for all?

    An unacceptable answer is -- "a miracle." But heck, as the Pope said, who am I to judge?
    Sage Grouse

    ---------------------------------------
    'When I got on the bus for my first road game at Duke, I saw that every player was carrying textbooks or laptops. I coached in the SEC for 25 years, and I had never seen that before, not even once.' - David Cutcliffe to Duke alumni in Washington, DC, June 2013

  13. #3393
    Join Date
    Feb 2007
    Location
    Skinker-DeBaliviere, Saint Louis
    Duke will be fine. It has an endowment of like $9B.

    There's going to be massive financial failure and consolidation of universities if F2020 doesn't go more or less as planned. The few dozen prestige cartel schools will weather the storm OK. Everyone else is in for a world of hurt. So Duke is almost the very last place I'm worried about. (I suppose Harvard is the very last).

  14. #3394
    Being an RN doesn’t make me a pulmonologist, duh, but I continue to be confused by the cdc recommendation of facial converings. When out today to get some essentials, about half of the people wearing masks would frequently be touching their faces which is a big no no. It seems the recommendation was based on a few studies, one not being peer reviewed and the other utilizing a nebulizer. The consensus just isn’t even close to be there from what I am seeing in regards to airborne precautions vs droplet in public places. I fear that if this IS just droplet, people are doing way more harm then good by wearing those masks they aren’t trained to use.

  15. #3395
    Join Date
    Nov 2007
    Location
    Vermont
    Quote Originally Posted by LasVegas View Post
    Being an RN doesn’t make me a pulmonologist, duh, but I continue to be confused by the cdc recommendation of facial converings. When out today to get some essentials, about half of the people wearing masks would frequently be touching their faces which is a big no no. It seems the recommendation was based on a few studies, one not being peer reviewed and the other utilizing a nebulizer. The consensus just isn’t even close to be there from what I am seeing in regards to airborne precautions vs droplet in public places. I fear that if this IS just droplet, people are doing way more harm then good by wearing those masks they aren’t trained to use.
    If I understand things correctly, the point of the mask isn't so much to protect the wearer as it is to protect others from the wearer's airborne particles. Keeps your coughs and sneezes to yourself.

  16. #3396
    Join Date
    Feb 2018
    Location
    Dur'm
    Quote Originally Posted by throatybeard View Post
    Duke will be fine. It has an endowment of like $9B.
    Fine in the sense of "won't collapse", yes, but Duke has something like a $1.3B operating budget, as well, much of which is federal grant money. If this follows along with the Great Recession, sponsored projects are going to dry up with the economic tightening. It won't be business as usual.

    But yes, Duke will come through this and make it to the other side, while many other institutions and businesses will not.

    As for when campus will re-open, that's going to depend on what the virus does. A big summer drop-off coupled with either a viable antibody or drug therapy and/or nearly universal testing and contact tracking could make it happen. I'm not sure much short of that will do the trick. The likelihood is that a vaccine can't possibly be ready any time before the end of the year, so there has to be some way to ensure that a crowded campus won't lead to a rash of dangerous infections. I mean, how would you feel about being a professor holding office hours with a bunch of college-age kids who all traveled across the country to be here and now have new roommates?

  17. #3397
    Join Date
    Feb 2007
    Location
    Skinker-DeBaliviere, Saint Louis
    Quote Originally Posted by Phredd3 View Post
    Fine in the sense of "won't collapse", yes, but Duke has something like a $1.3B operating budget, as well, much of which is federal grant money. If this follows along with the Great Recession, sponsored projects are going to dry up with the economic tightening. It won't be business as usual.

    But yes, Duke will come through this and make it to the other side, while many other institutions and businesses will not.

    As for when campus will re-open, that's going to depend on what the virus does. A big summer drop-off coupled with either a viable antibody or drug therapy and/or nearly universal testing and contact tracking could make it happen. I'm not sure much short of that will do the trick. The likelihood is that a vaccine can't possibly be ready any time before the end of the year, so there has to be some way to ensure that a crowded campus won't lead to a rash of dangerous infections. I mean, how would you feel about being a professor holding office hours with a bunch of college-age kids who all traveled across the country to be here and now have new roommates?
    Are you actually asking? Uh, let's go with glumly resigned.

    I suppose I'm lucky most of my students are from within 90 minutes of campus, although I'm sure we can all infect each other just as well as if people were from Maine and Singapore.

    A movie is not about what it's about; it's about how it's about it.
    ---Roger Ebert


    Some questions cannot be answered
    Who’s gonna bury who
    We need a love like Johnny, Johnny and June
    ---Over the Rhine

  18. #3398
    Join Date
    Feb 2007
    Location
    Steamboat Springs, CO
    Quote Originally Posted by Phredd3 View Post
    Fine in the sense of "won't collapse", yes, but Duke has something like a $1.3B operating budget, as well, much of which is federal grant money. If this follows along with the Great Recession, sponsored projects are going to dry up with the economic tightening. It won't be business as usual.

    But yes, Duke will come through this and make it to the other side, while many other institutions and businesses will not.

    As for when campus will re-open, that's going to depend on what the virus does. A big summer drop-off coupled with either a viable antibody or drug therapy and/or nearly universal testing and contact tracking could make it happen. I'm not sure much short of that will do the trick. The likelihood is that a vaccine can't possibly be ready any time before the end of the year, so there has to be some way to ensure that a crowded campus won't lead to a rash of dangerous infections. I mean, how would you feel about being a professor holding office hours with a bunch of college-age kids who all traveled across the country to be here and now have new roommates?
    Quote Originally Posted by throatybeard View Post
    Are you actually asking? Uh, let's go with glumly resigned.

    I suppose I'm lucky most of my students are from within 90 minutes of campus, although I'm sure we can all infect each other just as well as if people were from Maine and Singapore.
    Answering my own question from a page or so back.

    For Duke to open, it will require a very low rate of infections nationally and in Durham County. And, I would say, everyone at Duke gets a coronavirus test -- that's about 30,000 people (lots of folk work at Duke Health). I wouldn't be surprised if Duke had its own proprietary tests by then -- or at least a partnership with a test company. Those students testing positive get to go to the fabulous Duke quarantine facility for 14 days.

    Would you professors be comfortable if these conditions were met?
    Sage Grouse

    ---------------------------------------
    'When I got on the bus for my first road game at Duke, I saw that every player was carrying textbooks or laptops. I coached in the SEC for 25 years, and I had never seen that before, not even once.' - David Cutcliffe to Duke alumni in Washington, DC, June 2013

  19. #3399
    Join Date
    Feb 2007
    Location
    Washington, D.C.

    Okay

    Quote Originally Posted by sagegrouse View Post
    Answering my own question from a page or so back.

    For Duke to open, it will require a very low rate of infections nationally and in Durham County. And, I would say, everyone at Duke gets a coronavirus test -- that's about 30,000 people (lots of folk work at Duke Health). I wouldn't be surprised if Duke had its own proprietary tests by then -- or at least a partnership with a test company. Those students testing positive get to go to the fabulous Duke quarantine facility for 14 days.

    Would you professors be comfortable if these conditions were met?
    Not a professor, but this suggests to me no football. Do you agree, sage?

  20. #3400
    Join Date
    Feb 2007
    Location
    Steamboat Springs, CO
    Quote Originally Posted by MChambers View Post
    Not a professor, but this suggests to me no football. Do you agree, sage?
    (Well, Doc, I am making all this stuff up.) Football starts August 1 and coaches activities before that. I assume there will be some ACC group-think and Duke will have a very strong voice in how it comes out -- because of our medical experts, not the power of our football team.
    Sage Grouse

    ---------------------------------------
    'When I got on the bus for my first road game at Duke, I saw that every player was carrying textbooks or laptops. I coached in the SEC for 25 years, and I had never seen that before, not even once.' - David Cutcliffe to Duke alumni in Washington, DC, June 2013

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