COVID-19 Pandemic: Transmissions, Deaths, Treatments, Vaccines, Interventions and More...
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I imagine it may be too late. He has no campaign infrastructure and he will be pretty busy over the next 6 months
So yesterday we went to pick up my car from our mechanic in Hawthorne: usually we did the road that goes around the back of William Paterson College, er, University. But it was blocked off and there were a couple of confusing signs on Hamburg Tpk mentioning "Testing" with huge arrows. Now Willie P. is right beside Wayne General Hospital, now known as St. Josephs of Wayne, and that has an entrance leading out to that road. And the road was blocked off just past the entrance with signs saying "No Thru Traffic". Best guess is they are setting up some type of drive thru testing center in the outlet from Wayne General. I'll see what it looks like next time I drive past it.
Kind of surprising since we have a good relationship with Taiwan. But Taiwan has been ready for this for over a decade - they learned from the SARS issue when it was brought over to them. From what I've heard, they actually started having officials go on planes as early as the beginning of January to quarantine anyone who was showing symptoms.
Another saying I always agree with is: "Paralysis by analysis."
I've not seen the 21 days comment, but of bigger concern is that people can have it and be contagious for up to 4 days before they start showing symptoms.
I’m pretty sure that’s just a matter of people not reporting back to their doctors. Multiple recoveries already in Hoboken alone.
It often takes some time to update the data - I know of several recovered cases from on line sources, which should be accurate...
Again, I know for a fact that there are several recoveries in Hoboken already, so there you go. Put two and two together.
That being said you do understand that VAST majority recover, right? :ThumbsUp
Yes, but remember there's probabilities in there, i.e., the median time from infection to symptoms (for those who get symptoms - up to half infected people don't get symptoms, but how contagious they are has not been well established yet) is about 5 days. What this means is someone is far less likely to be contagious on Day 1 or on Day 9 than on Day 5 and there should be a classic Gaussian distribution with a tail out to 14 days after infection, where at 14 days there's an extraordinarily low probability of someone being contagious. There is some disagreement on contagiousness beyond 14 days, which is why they have not extended quarantine periods. I have linked all this before, but don't have time to find it right now.
Ok. Well I am glad they recovered. That’s good to hear . Why don’t they follow up with their doctors though ?
Right, AND asymptomatic carriers, which I am convinced the vast majority of those who come in contact are.
If you think about it, this is how I would categorize folks, just from my basic immunology class memory:
When people come in contact with the virus, I see the following scenarios happening:
1) Their immune system battles the virus and completely wins and testing shows - "negative"
2) Their immune system battles the virus and somewhat wins, enough so that symptoms don't show but would test "positive".
3) Their immune system battles the virus and it's a dog fight - symptoms showing
4) Their immune system battles the virus and is totally losing - critical and hospitalized
Majority I believe fall in category 1 & 2 - however, those in category 2 may also be the ones who are likely to spread the virus and not know it.
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Maybe they are in the doctors just don’t have time to submit everything yet who knows, but the bottom line is the vast vast majority of people will lip, a.k.a. recover, so take those numbers for what they are right now: a work in progress
Agree w Nuts here. I haven't put any faith or even monitored the recovered figures.
Yeah . But it’s important we get those numbers . Because not recovered would otherwise be dead .
Willy P. will have drive through testing starting tomorrow I believe. Bergan County Community College is up and running for drive through tests. County College of Morris and PNC Arts Center should be up and running soon (if not already). There may be some others planned but I am not aware of them.
Good summary. And finding out more about folks in category #1, in particular, is critical, especially if infected, but asymptomatic people are contagious (they can be, but the percentage is unknown from what I've read and we know that close to half of positive test responses in a "somewhat representative" population are asymptomatic from the Diamond Princess).
https://www.sciencemag.org/news/202...es-could-show-true-scale-coronavirus-pandemic
https://www.sciencemag.org/news/202...se-antibody-test-track-coronavirus-infections
Which is why moving to the next step in testing - looking for antibodies in large enough random samplings of the general population - is so important. Antibody tests reveal if someone was ever exposed to the virus, even if they never had symptoms, because once the body is exposed to the virus, the body always generated antibodies (just not enough in people who get sick).
Whereas the RNA PCR tests being used in current testing will only detect the virus above a certain titer (concentration), meaning someone exposed to the virus, but very early in the infection progression or after recovery from the infection (whether mild or serious symptoms) will test negative for the virus. That's why some people who have mild or no symptoms test negative at first, but positive as the virus rapidly multiplies in the body.
A quick antibody test that was cheap and easy enough could be used by the whole population, in theory, to know if they were ever exposed, since people who now have antibodies will almost certainly be immune from reinfection with the virus for at least some decent period of time, as is the case with every virus, except influenza, since influenza changes markedly every year - whereas measles and chicken pox antibodies last for most of one's life. So far, German researchers have seen high levels of antibodies a month after infection which is a good sign. I'm sure people would love to know if they had antibodies, because if they did, they could go out in public and not fear getting the virus or giving it to someone, at least for awhile.
Unfortunately, while several countries have developed antibody tests, they're fairly complex and lengthy to run, so they've only been used for critical applications (see 2nd link on use of these tests to confirm contact tracing histories in Singapore). However, progress is being made and some researchers say the tests are ready for use in "thousands" of tests per day.
If this was done for a small representative population somewhere it would answer a ton of questions, like whether children aren't impacted much by the virus because they get exposed and quickly make enough antibodies to keep viral levels low (such that they test negative for the virus. It might also reveal what percentage of the general population have already been exposed/infected, but without symptoms, but with "protection."
One other thing I'd love to see done is to do the antibody test on the 83% of the population of the Diamond Princess that tested negative for the coronavirus. If some or more of them have the antibodies, but tested negative, that would be fantastic, as it would show that the worst case scenarios of 50-70% infections world wide (if we do nothing) could actually be "true," but somewhat meaningless if the vast majority get "infected" but only enough to generate antibodies. Right now it's not clear if only 17% tested positive because the rest weren't exposed or if they were exposed, infected and developed antibodies, but didn't test positive via the virus test. I haven't seen any discussion on line of testing these passengers for antibodies. Anyone? We should be milking that great "experiment" for all its worth...
I've said a few times that there are some experts who believe the "cap" for total infections is ~20%, based on the 17% of the Diamond Princes testing positive, since that was a fantastic "experiment" in infecting a whole population, with close quarters and communal eating/activities for about 12 days before they realized the virus was spreading and the ship quarantined. But even if "only" 20% get infected and the mortality rate stayed around 1%, then, for example, without aggressive interventions, 60MM would get this in the US, similar to the swine flu outbreak in 2009, but 600K would die and 5-10X more would require hospitalization (vs. 35,000 annual flu deaths and 12,000 swine flu deaths, given 0.05-0.1% mortatlity rates). The problem is we've only seen 0.1% at most of any population get infected in real life. Also, the Diamond Princess was heavily skewed towards older people so the mortality rate of 1% (all over 70 I believe) on that ship could easily have only been 0.2% or so when projected across the whole population. It's all a long way of saying we need better data to generate better forecast models (sounds like meteorology, no?).
Another potential application is to collect serum from people with antibodies and once enough is collected, separate out the antibodies and use them to help seriously infected patients. I haven't seen examples of this being done yet, but I imagine it might be going on in some advanced hospitals even now. This is a laborious approach and hopefully the approach Regeneron is pursuing (and others) will result in unlimited supplies of effective antibodies for either prevention (a quasi vaccine) or treatment.
The scientific horsepower around the world being focused on every element of this situation, including diagnostics, treatment and prevention, is why it's so important to "flatten the curve" so we don't overwhelm the health care system, which will then buy us some time to hopefully make the medical breakthroughs we need to deal with this (and I'm hopeful we'll see some of these before a vaccine in ~12 months).
https://rutgers.forums.rivals.com/t...social-distancing.191275/page-13#post-4449948
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Well said. It simply takes time to close out cases and sometimes to report them. If one looks at the latest data from around the world, it's easy to see that, as very few countries list more than 25% of cases being recovered; only China has a very high %, since they started over a month before anyone else. And their numbers, overall, are a fiction, I believe, but I think the relative numbers in each category are probably correct vs. the total number of infections reported - I just think they probably have 10X as many cases as the 82K reported (and 10X every other number in every column.
Also, the progression from infection to symptoms to hospitalization to death (or to recovered from any of those points) can take 3-5 weeks, so for countries that didn't start their exponential increase phase until 3-4 weeks ago, like Europe, or 1-2 weeks ago like the US, most of the cases simply haven't reached the recovery stage, even though the vast majority (~99% eventually, assuming the true mortality rate is 1%) of cases will be eventually classified as recovered.
Loss of sense of smell is a possible symptom in some patients even if otherwise asymptomatic.
https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html
https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html
Thought a Germany update was in order. Somehow they're still showing an incredibly low mortality rate of only 0.2% and a very low overall number of deaths (48 in 25,000 positive cases as of today). Experts have pointed to similar reasons as in the post above for this: extremely aggressive testing (more, even, than South Korea per capita with 160,000 tests per week in Germany), which identifies cases early for better outcomes, highlights earlier who needs to be quarantined, and provides a larger denominator of cases, plus they're earlier in the outbreak, meaning many of the cases wouldn't have progressed to death yet, which takes 3+ weeks (similar to the US in that regard of being early). An excerpt from the article linked below is in italics (from 2 days ago).
https://www.ft.com/content/c0755b30-69bb-11ea-800d-da70cff6e4d3
The apparent anomaly has sparked debate in Germany and beyond, though experts warn against drawing sweeping conclusions. They argue that the country’s low fatality rate most likely reflects the fact that the outbreak is still at a relatively early stage, and that the age profile of those affected has so far been younger than that in other countries. Younger patients without previous ailments have a much better chance of surviving Covid-19 than elderly patients.
The capacity in Germany is very, very significant. We can conduct more than 160,000 tests per week, and that can be increased Lothar Wieler, Koch institute Another factor that may help explain the variance is the unusually high number of tests being carried out in Germany. According to Lothar Wieler, the president of the Robert Koch Institute, German laboratories are now conducting about 160,000 coronavirus tests every week — more than some European countries have carried out in total since the crisis started.
Even South Korea, which is conducting 15,000 tests a day and has been held up by virologists as an example to follow, appears to be testing less than Germany. “This is about capacity. The capacity in Germany is very, very significant. We can conduct more than 160,000 tests per week, and that can be increased further,” Prof Wieler told journalists this week. Test capabilities would be boosted not least in part by switching laboratories that specialise in animal health towards coronavirus checks. There was no sign that test kits were running low, Prof Wieler added.
In the short term at least, mass testing feeds through into a lower fatality rate because it allows authorities to detect cases of Covid-19 even in patients who suffer few or no symptoms, and who have a much better chance of survival. It also means that Germany is likely to have a lower number of undetected cases than countries where testing is less prevalent. Indeed, one notable feature of the coronavirus outbreak in Germany so far is the high number of relatively young patients: according to data from the Robert Koch Institute, more than 80 per cent of all people infected with the coronavirus are younger than 60.
Interesting Times article about China vs. the West and ability to control the COVID-19 pandemic, with some of the difference almost certainly being China's ability to lock everything down without worrying about government popularity and the West's late response partly being the price of free societies. The article also talks a bit about how almost every country that contained this virus did very aggressive and fairly early testing, along with very thorough contact tracing/quarantines and some degree of social distancing, although nobody did anywhere near what China did in that regard, but they were first and surprised, especially after their leaders ignored the situation for weeks.
South Korea, Taiwan, Hong Kong and others have not had to shut down their economies to contain the outbreaks, since they had more time to prepare and test/trace/quarantine aggressively from the start. Apart from Germany (which is testing the hell out of things and has a very low mortality rate of 0.2%), it looks like the European countries in the worst shape and the US started aggressive testing/tracing much too late, resulting in much more need for social distancing than the Asian countries. And very few mention this, but all of those Asian countries had most people wearing masks in public and at work to reduce transmission from asymptomatic/mildly symptomatic infected carriers to others.
I'd still like to know why Eastern European countries/Russia have far lower rates of infection and cases/deaths than almost all of Western Europe (is it just testing?) and why the heck Iran's outbreak is so bad, but nobody else in the Middle East is close, as well as why India, Africa, and most of SE Asia are so low (high temp/humidity as some think, but then what about Iran?). Someone needs to feed all these rates and every socioeconomic/climate/genetic variable in these countries into a database and analyze the shit out of the data and find some correlations and maybe causations.
https://www.nytimes.com/2020/03/19/world/europe/europe-china-coronavirus.html
South Korea, Taiwan, Hong Kong and others have not had to shut down their economies to contain the outbreaks, since they had more time to prepare and test/trace/quarantine aggressively from the start. Apart from Germany (which is testing the hell out of things and has a very low mortality rate of 0.2%), it looks like the European countries in the worst shape and the US started aggressive testing/tracing much too late, resulting in much more need for social distancing than the Asian countries. And very few mention this, but all of those Asian countries had most people wearing masks in public and at work to reduce transmission from asymptomatic/mildly symptomatic infected carriers to others.
I'd still like to know why Eastern European countries/Russia have far lower rates of infection and cases/deaths than almost all of Western Europe (is it just testing?) and why the heck Iran's outbreak is so bad, but nobody else in the Middle East is close, as well as why India, Africa, and most of SE Asia are so low (high temp/humidity as some think, but then what about Iran?). Someone needs to feed all these rates and every socioeconomic/climate/genetic variable in these countries into a database and analyze the shit out of the data and find some correlations and maybe causations.
https://www.nytimes.com/2020/03/19/world/europe/europe-china-coronavirus.html
been thinking about warm climes....my son's baseball instructor has just gotten back from visiting home in the DR when the outbreak closed the training facility. Poor guy shoulda stayed on the island with mami's home cooking. I have a feeling the speed won't be nearly as bad in the tropics. Then again who knows.
Some more color on the test kits ..........
Spoke to an uncle who works for Roche Diagnostics in Branchburg. He said he's been working 10-12 hour shifts, 6-7 days a week for three months now. That's crazy. Anyhow, he said they've been shipping covid test kits all over the world except the US. He said they only received the "temporary approval" recently, so they have now focused on supplying the US hospitals. He said something like 400,000 units was the first shipment.
Spoke to an uncle who works for Roche Diagnostics in Branchburg. He said he's been working 10-12 hour shifts, 6-7 days a week for three months now. That's crazy. Anyhow, he said they've been shipping covid test kits all over the world except the US. He said they only received the "temporary approval" recently, so they have now focused on supplying the US hospitals. He said something like 400,000 units was the first shipment.
Seems like cases are rapidly increasing in Thailand, Malaysia, Philippines. Those are all warm humid areas which is not a good sign, though one can hope that there will be some mitigating effect.
Interesting commentary in the WSJ yesterday from Scott Gottlieb, former FDA commissioner: https://www.wsj.com/articles/how-long-will-the-coronavirus-lockdowns-go-on-11584899513
To summarize, he talks about the priorities over the next few weeks, other than continuing social distance restrictions and expanding hospital capacity. He says the U.S. will need widespread testing to know where and to what extent the virus is spreading. He suggests that the US needs to reach the per capita testing rate of South Korea along with contact tracking. (He does not talk about availability of PPE, but that is obviously a critical need now, along with testing and hospital capacity.)
Beyond today's critical needs, he identifies some actions that the US needs to start taking now, to prepare for the next steps.
He says the US needs serological surveillance to determine which individuals have been previously exposed and have antibodies. "If a sizable portion of a local community has some protection, authorities can be more confident in relying on less invasive measures. Once deployed, serological tests are cheap, straightforward, and easy to scale."
And he talks about development of treatments and prophylaxis. He indicates that the FDA and other regulators need to be innovative and flexible in clinical trials and approvals (and he gives some specific examples). And he indicates that companies should have protections so they can scale up manufacturing for promising drugs, so that we can distribute doses on a massive scale as soon as it is proved safe and effective.
To summarize, he talks about the priorities over the next few weeks, other than continuing social distance restrictions and expanding hospital capacity. He says the U.S. will need widespread testing to know where and to what extent the virus is spreading. He suggests that the US needs to reach the per capita testing rate of South Korea along with contact tracking. (He does not talk about availability of PPE, but that is obviously a critical need now, along with testing and hospital capacity.)
Beyond today's critical needs, he identifies some actions that the US needs to start taking now, to prepare for the next steps.
He says the US needs serological surveillance to determine which individuals have been previously exposed and have antibodies. "If a sizable portion of a local community has some protection, authorities can be more confident in relying on less invasive measures. Once deployed, serological tests are cheap, straightforward, and easy to scale."
And he talks about development of treatments and prophylaxis. He indicates that the FDA and other regulators need to be innovative and flexible in clinical trials and approvals (and he gives some specific examples). And he indicates that companies should have protections so they can scale up manufacturing for promising drugs, so that we can distribute doses on a massive scale as soon as it is proved safe and effective.
Nuts - I applaud your positive outlook but watching and reading all of the stuff out there, it appears the information is all over the place. Today, I read about a teenager who went into the hospital with symptoms and died the next day. Conversely, it appears some people seem to be sick for a day and then feel fine the next day.
Maybe #'s and the doctors on this board can address if it is possible that there are two different strains out there or if the virus is evolving. It just seems to a lay person that the information is all over the place.
Yes I agree it seems all over the place . Another thing is when should someone absolutely go to the hospital ? At a 103 degree fever ?
https://www.biospace.com/article/gi...mand-for-the-experimental-covid-19-treatment/
This suggests it's working and doctors are asking for it from word of mouth. Data April 3 - fingers crossed.
This suggests it's working and doctors are asking for it from word of mouth. Data April 3 - fingers crossed.
I think it's good it's all over the place. It means our immune system is putting up a fight.
A more concise summary of today's press conference by Cuomo...
- Ventilators/masks/gloves etc: need federal defense production act to oversee production/pricing as it’s a national emergency where states are bidding against states and being ripped off; for example, they have about 5000 ventilators, but will need 30,000 if projections are correct. Thinks NYC, in particular, will be running out of key supplies in about a week if nothing done.
- Working with FDA, starting HCQ + azithromycin use on compassionate use basis and starting antibody-plasma therapy trial for serious patients this week - this is huge news.
- Starting testing of antibodies in blood in some people to see who had it and is ok from getting it (hopefully on a decent size random population sample to gauge exposure)
- 78000 tests so far in NY, which is 25% of US testing; On 3/13, NY got authority to test from FDA and have gone from 1000 tests/day to 16,000/day now (more than SK’s 20,000 day per capita)
- 20,000 total positive/5000 new cases in NY (12,000/3200 in NYC); 39,000 total cases in US, 1900 in NJ, 1800 in CA
- 13% of cases hospitalized (2600) in NY, inluding 621 ICU patients (24% of hospitalized)
- NY has 53K hospital beds, but need 110K, so he ordered all hospitals to increase capacity by 50% with goal of 100% (reorganizing space, reusing equipment, etc.)
- ICU beds – have 3K and might need 18-37K; looking at doubling up on ventilators, but truly need Federal help here.
- FEMA now helping with 1000 new beds hospital at the Javits Center
- Need more licensed medical staff – bringing back retired staff on voluntary basis/repurpose insurance medical staff
- Talked about the future a bit: "NY Forward" (on NY Pause now), i.e., how to restart economy? Not much on specifics, but good to see them thinking about it.
https://www.governor.ny.gov/keywords/media
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Scott's reading my posts again, lol. Seriously, he's been great and agree with every point, which is why I'm disappointed to hear that we're not testing people without significant symptoms - we need that intel to quarantine those people (although people with mild symptoms should quarantine) and their contacts, but we're also not doing anywhere near enough contact tracing.
100% agree on serological testing for antibodies, as per last night's post - see my Cuomo presser summary just now, where NY is starting to do both serological-antibody testing of a small subset of the public and is starting a clinical trial using antibodies from plasma from exposed people to try to treat the virus in seriously ill patients. And we definitely need to be ready to quickly scale up and approve any drugs that show promise - NY is also starting a trial with HCQ/azithromycin, which is great to see.
Not a doctor but everything I've seen says don't bother trying to go to a hospital unless you are having trouble breathing, low pulse ox, that kind of thing. Fever alone (or even with cough), you'll probably be told to go home. I've had temps over 102 from flu in the past, 103 would start to scare me but doesn't seem to be uncommon with this virus.
You'd have to think there were some underlying circumstances with that teen going into the hospital then dying the very next day. That seems almost impossible otherwise. Certainly frightening though.
He might be reading your posts. He's originally from East Brunswick, so he might read this board.
Or maybe you're reading his columns.
Or maybe these are just common sense suggestions.
As far as testing volumes, after squandering almost 2 months, it is hard to ramp up testing capabilities. It requires adequate test kits, but also adequate PPE for those conducting the tests. Unfortunately with the case curve growing exponentially, it may be too late to get testing ahead of that curve. But we have to keep moving toward that goal.
I’m not denying other things may be happening but bottom line is people ARE recovering. That “zero” just isn’t/wasn’t correct.
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