***NON-POLITICAL COVID-19 Discussion Thread***

[JakeF]

A couple of reminders...

Originally Posted by Bwana

Once again, don't come in this thread with some kind of political agenda, or you will be shown the door. If you want to go that route, there is a thread about this in DC.

Originally Posted by Dartgod

People, there is a lot of good information in this thread, let's try to keep the petty bickering to a minimum.

We all have varying opinions about the impact of this, the numbers, etc. We will all never agree with each other. But we can all keep it civil.

Thanks!

Click here for the original OP:

Spoiler!

Apparently the CoronaVirus can survive on a inanimate objects, such as door knobs, for 9 days.

California coronavirus case could be first spread within U.S. community, CDC says
By SOUMYA KARLAMANGLA, JACLYN COSGROVE
FEB. 26, 2020 8:04 PM

The Centers for Disease Control and Prevention is investigating what could be the first case of novel coronavirus in the United States involving a patient in California who neither recently traveled out of the country nor was in contact with someone who did.

“At this time, the patient’s exposure is unknown. It’s possible this could be an instance of community spread of COVID-19, which would be the first time this has happened in the United States,” the CDC said in a statement. “Community spread means spread of an illness for which the source of infection is unknown. It’s also possible, however, that the patient may have been exposed to a returned traveler who was infected.”

The individual is a resident of Solano County and is receiving medical care in Sacramento County, according to the state Department of Public Health.

The CDC said the “case was detected through the U.S. public health system — picked up by astute clinicians.”

Officials at UC Davis Medical Center expanded on what the federal agency might have meant by that in an email sent Wednesday, as reported by the Davis Enterprise newspaper.

The patient arrived at UC Davis Medical Center from another hospital Feb. 19 and “had already been intubated, was on a ventilator, and given droplet protection orders because of an undiagnosed and suspected viral condition,” according to an email sent by UC Davis officials that was obtained by the Davis Enterprise.

The staff at UC Davis requested COVID-19 testing by the CDC, but because the patient didn’t fit the CDC’s existing criteria for the virus, a test wasn’t immediately administered, according to the email. The CDC then ordered the test Sunday, and results were announced Wednesday. Hospital administrators reportedly said in the email that despite these issues, there has been minimal exposure at the hospital because of safety protocols they have in place.

A UC Davis Health spokesperson declined Wednesday evening to share the email with The Times.

Since Feb. 2, more than 8,400 returning travelers from China have entered California, according to the state health department. They have been advised to self-quarantine for 14 days and limit interactions with others as much as possible, officials said.

“This is a new virus, and while we are still learning about it, there is a lot we already know,” Dr. Sonia Angell, director of the California Department of Public Health, said in a statement. “We have been anticipating the potential for such a case in the U.S., and given our close familial, social and business relationships with China, it is not unexpected that the first case in the U.S. would be in California.”

It is not clear how the person became infected, but public health workers could not identify any contacts with people who had traveled to China or other areas where the virus is widespread. That raises concern that the virus is spreading in the United States, creating a challenge for public health officials, experts say.

“It’s the first signal that we could be having silent transmission in the community,” said Lawrence Gostin, director of the World Health Organization Collaborating Center on National and Global Health Law. “It probably means there are many more cases out there, and it probably means this individual has infected others, and now it’s a race to try to find out who that person has infected.”

On Tuesday, the CDC offered its most serious warning to date that the United States should expect and prepare for the coronavirus to become a more widespread health issue.

“Ultimately, we expect we will see coronavirus spread in this country,” said Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases. “It’s not so much a question of if, but a question of when.”

According to the CDC’s latest count Wednesday morning, 59 U.S. residents have tested positive for the new strain of coronavirus — 42 of whom are repatriated citizens from a Diamond Princess cruise. That number has grown by two since Messonnier’s last count Tuesday, although the CDC was not immediately available to offer details on the additional cases.

More than 82,000 cases of coronavirus have been reported globally, and more than 2,700 people have died, with the majority in mainland China, the epicenter of the outbreak.

But public health leaders have repeatedly reminded residents that the health risk from the novel coronavirus to the general public remains low.

“While COVID-19 has a high transmission rate, it has a low mortality rate,” the state Department of Public Health said in a statement Wednesday. “From the international data we have, of those who have tested positive for COVID-19, approximately 80% do not exhibit symptoms that would require hospitalization. There have been no confirmed deaths related to COVID-19 in the United States to date.”

CDC officials have also warned that although the virus is likely to spread in U.S. communities, the flu still poses a greater risk.

Gostin said the news of potential silent transmission does not eliminate the possibility of containing the virus in the U.S. and preventing an outbreak.

“There are few enough cases that we should at least try,” he said. “Most of us are not optimistic that that will be successful, but we’re still in the position to try.”

[Bugeater]

Originally Posted by RINGLEADER

Some interesting data from the CDC is leading some to report that we may have been visited by this and mis-attributed cases to the flu that were really Corona. Combined with how it is spreading this person (quoting some gov sources) seems to think a lot of people have already had the Corona virus. Not sure if the increases are more due to having fewer tests early on the positively ID Corona but the spike in cases attributed to the flu in Dec and Jan are interesting.

Heck, I know a guy who was extremely sick for a couple weeks just before last Christmas and looking back now what he described to me sure sounds familiar. Respiratory issues, nasty persistent cough, can't recall if he mentioned fever though. He had been working in a house that was being renovated pulling old rotten dusty carper prior, and apparently the Drs attributed it to that, which I thought was odd, but not improbable. Sure makes one think though...

[SPchief]

Originally Posted by BigRedChief

I know Tommy’s friend too. He’s young, strong, healthy. And this thing has really knocked him down. Please take it seriously. https://t.co/MrIEwUec0a

— Jake Tapper (@jaketapper) March 15, 2020

stop

[jjjayb]

Originally Posted by SPchief

stop

Hey, I know Tommy's friend too! I do!

Why don't we see many news reports of the people who have had it and recovered? Of the majority of the people who have had it and had mild symptoms? Guess that doesn't sell eh?

[suzzer99]

Originally Posted by Bugeater

Heck, I know a guy who was extremely sick for a couple weeks just before last Christmas and looking back now what he described to me sure sounds familiar. Respiratory issues, nasty persistent cough, can't recall if he mentioned fever though. He had been working in a house that was being renovated pulling old rotten dusty carper prior, and apparently the Drs attributed it to that, which I thought was odd, but not improbable. Sure makes one think though...

You know it's really weird because almost everyone I work with and a bunch of my friends and family got a 3-4 week cough in late December. I got it in Vegas. Started out mild, then the second and 3rd week really sucked, coughing myself to sleep at night, some coughing fits in the day. I have a really strong immune system too. Feels like the longest cold I've ever had.

I heard a DJ in KC (Chuck Nasty I think) describe the same thing and say his Dr. told him he had the croup. So I assumed that's what it was.

I don't really remember a fever at the onset but maybe there was one.

Maybe what we all got was the milder strain, and then it mutated in China and they and Italy got the brutal strain. Maybe we have some herd immunity or something. Also a population of smokers could be the big problem.

Some official in China is convinced some US athletes brought it over there in November. But obviously that doesn't mean much.

[Titty Meat]

Dave really is on some bullshit

['Hamas' Jenkins]

Originally Posted by dlphg9

So he had TB and lung problems? Doesn't sound like a guy that is too healthy to me. Also what's the anti malaria medicine for? That literally doesn't make sense. Also half the shit on social media is a lie.

The antimalarial is chloroquine or hydroxychloroquine (brand name Plaquenil). Plaquenil is also used for rheumatoid arthritis because it reduces the inflammatory autoimmune response, which leads to joint destruction. While our immune responses are normally helpful, there are examples where pathogens can cause inflammatory responses that are detrimental--one of the best examples is the cytokine storm invoked by the 1918 H1N1 strain, which is why young adults with the healthiest immune systems suffered the highest rates of death.

It is likely that severe cases of COVID-19 initiate a harmful inflammatory response, which is why agents like chloroquine and tocilizumab are being investigated for efficacy. However, that does not mean that all immunosuppressants are created equal. In almost all cases you want robust immune function.

[Titty Meat]

Originally Posted by 'Hamas' Jenkins

The antimalarial is chloroquine or hydroxychloroquine (brand name Plaquenil). Plaquenil is also used for rheumatoid arthritis because it reduces the inflammatory autoimmune response, which leads to joint destruction. While our immune responses are normally helpful, there are examples where pathogens can cause inflammatory responses that are detrimental--one of the best examples is the cytokine storm invoked by the 1918 H1N1 strain, which is why young adults with the healthiest immune systems suffered the highest rates of death.

It is likely that severe cases of COVID-19 initiate a harmful inflammatory response, which is why agents like chloroquine and tocilizumab are being investigated for efficacy. However, that does not mean that all immunosuppressants are created equal. In almost all cases you want robust immune function.

How many people in a study have to show success in order for the drug to move forward? I've read Favilavir has shown to be successful with about 70 in a clinical study in China. Also read that APN01 was developed in the early 2000s during the SARS outbreak and helped prevent damage to lungs. Could a cocktail of these drugs work the same way HIV patients take a number of medications in combination to combat the virus?

[IUsedToBeATightEnd]

Originally Posted by SupDock

Graphs are useful but to really get what that rising curve is, have a look at the obituaries page of this Bergamo daily newspaper, comparing one from February with one from now pic.twitter.com/78mgZseyVt

— Ben Phillips (@benphillips76) March 14, 2020

Powerful

Scary.
Bergamo has a population of 120.000. What if it spreads to Milan with a population of 2+ Millions, and not far from Bergamo.
Guess they took the right decision locking up the whole country.

['Hamas' Jenkins]

Originally Posted by Titty Meat

How many people in a study have to show success in order for the drug to move forward? I've read Favilavir has shown to be successful with about 70 in a clinical study in China. Also read that APN01 was developed in the early 2000s during the SARS outbreak and helped prevent damage to lungs. Could a cocktail of these drugs work the same way HIV patients take a number of medications in combination to combat the virus?

The short answer is that it's complicated. The long answer will follow:

1) The evidence is only as good as the trial design. In a situation like this, you aren't going to have good trial design, because people deteriorate quickly, there are no known beneficial treatments, and the need is so great that you aren't going to be able to blind patients and/or investigators as there is no standard of care to compare against. Ideally, you would want a large, multicenter trial with thousands of patients from a variety of demographics. They would need a random distribution between the intervention and the control group that is also consistent within subgroups. The trial should also be forward-looking (prospective) rather than collecting data from old cases and compiling it together (retrospective). The more patients you have, the greater your predictive power of the trial can be. Blinding helps prevent the placebo effect and reporter bias, but that really can't be done at this stage either.

2) In order to pass muster, most operators have agreed that a p-value of greater than two standard deviations is necessary to reduce the chances of it being a statistical anomaly. What that means is that there has to be less than a five percent chance the effects are random for it to be statistically significant. However, this is also complicated--what is the difference between clinical and statistical significance? Let's say I have a blood pressure drug I'm bringing to market and it lowers BP by an average of 2mmHg compared to a popular ACE-inhibitor, like lisinopril. Is that statistically significant? Yes. Is it clinically significant? Not likely. So the other thing I have to do is consider how much of a clinical impact this drug may have. That's why Tamiflu is overused in my opinion. Unless you are very young or old/immunocompromised, Tamiflu only shortens the duration of flu symptoms by about 8 hours, and that's only if you begin treatment within the first 40 hours of symptom onset.

3) Trials normally progress through three distinct phases (ignoring the preclinical trials with animal and computer models). The first is a dose escalation study--what can the body handle. Usually this is done in healthy volunteers depending upon the drug, but in more emergent cases, it is applied to individuals with the illness. The second phase is generally a placebo comparison--is this better than nothing at all? The third phase is comparison against an active comparator. Is this better than the current standard of care? As you can see, a trial for a COVID-19 agent isn't going to be able to meet these standards very well, either.

So, let's apply this to COVID-19:

What am I looking for first: a mortality benefit. What am I looking for next: morbidity benefits: decreased hospitalization length, reduced clinical sequelae, etc.

So, what are these studies like: the favipravir study you mention is just a dose escalation study of about 60 people. You can get enough data with a sample size that small to meet statistical significance, but the confidence intervals will be broad and uncertainty high due to the small sample size.

Also, what are the impacts of polypharmacy? Generally, multiple agents are needed in the case of antivirals, whether it's Hep C or HIV. However, one must be careful in choosing those agents due to drug interactions.

Protease inhibitors are a great example. Their use revolutionized treatment for HIV, but protease inhibitors are among the strongest inhibitors of an enzyme in your body called cytochrome p450 3A4, which metabolizes more drugs than any other drug type. Well, what does this mean? Let's say that I'm taking carbamazepine for seizures and I start a protease inhibitor. What happens? The inhibition of 3A4 causes carbamazepine levels in my system to build up to toxic levels because I'm not clearing the drug quickly enough.

So, what happens if one agent is a substrate and the other is an enzyme inducer? The second drug wipes out the efficacy of the first drug. In other cases, the inhibition (carbamazepine example) can actually be a benefit. Ritonavir is a potent 3A4 inhibitor, and is used to actually boost the level of other protease inhibitors (as they are also 3A4 substrates). Thus, when weighing such therapy, I must consider those effects as well.

Also, I have to think about the side effects of each drug. For years, patients coming into the hospital who may have had an infection were given broad spectrum antibiotic coverage often with vancomycin and piperacillin-tazobactam (Zosyn). This would cover gram-positive bugs, gram-negative bugs and anaerobes. However, both agents are harmful to the kidneys, and the rate of acute kidney injury from their concurrent use is high, especially in an elderly population. This is also why you should avoid the use of fluoroquinolone antibiotics in the elderly. They increase the QT interval in the heart (old people are already prone to arrhythmias) and increase the risk of tendon rupture. So, who am I giving my new therapy to? What are its side effects? How do those side effects affect that person? What are their comorbidities?

However, there's a reason why HAART works. In the case of HIV, which is prone to rapid mutation, suppression of one target (reverse transcriptase was the first and only target for almost a decade) leads to rapid development of resistance. Suppression of multiple targets (reverse transcriptase *2 plus viral protease) lead to a revolution in therapy, although not an elimination of resistance. We are still learning about SarsCoV2. Sites of attachment, entry, etc. More time will provide greater clarity on the viral life cycle, which will better elucidate treatments. Time, unfortunately, is not on our side in this case.

Key takeaways:

There is no magic number of patients, but more (hundreds to thousands) is always better and far, far more predictive than dozens.

Polypharmacy may work if the mechanisms of action are synergistic or additive, but the risk of drug interactions and drug-disease interactions also increases.

[KCUnited]

IL with 20 new cases overnight. Largest single day increase in the state since day 1. One case is a 60 yr old women in a DuPage Co nursing home.

[DaFace]

Originally Posted by srvy

Trump tests negative for the Wuhan virus.

Originally Posted by thecoffeeguy

Cant believe people actually down voted this.

I'm guessing people are downvoting it because it's "political," which I get.

As we've acknowledged, there's a ton of grey area here. My personal opinion is that factual news about Trump and the administration's response is welcome in this thread. It would be very difficult to avoid it entirely. Posts that second-guess said response or try to get into the blame game are not.

[dirk digler]

just do it

Dr. Fauci would prefer a 14-day national shutdown of some sort to slow down coronavirus, and has made this point of view known in admin, he says on "Meet the Press."

"I think we should really be overly aggressive and get criticized for over-reacting," Fauci told @chucktodd.

— Jennifer Jacobs (@JenniferJJacobs) March 15, 2020

[displacedinMN]

good morning all. Hoping for a healthy day.

[DaFace]

Originally Posted by TLO

Health anxiety (GAD and Panic DIsorder) combined with OCD is a bitch.

I wish I could turn it off and unplug, I just can't bring myself to do it.

Can you force yourself to only check in in doses? The constant stream of information and knowing every little detail are the things that drive anxiety. If you can just check in in the morning and evening or something, it might help.

Nothing about this is changing so fast that not knowing the latest for 12 hours is gonna make any difference.

[Chief Roundup]

Originally Posted by dirk digler

just do it

Dr. Fauci would prefer a 14-day national shutdown of some sort to slow down coronavirus, and has made this point of view known in admin, he says on "Meet the Press."

"I think we should really be overly aggressive and get criticized for over-reacting," Fauci told @chucktodd.

— Jennifer Jacobs (@JenniferJJacobs) March 15, 2020

There would still be masses meeting up and spreading it.

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