COVID-19 Pandemic: Transmissions, Deaths, Treatments, Vaccines, Interventions and More...
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Posted this in the CE board. It will be interesting to see how many actually have the antibodies, eventually.
Interesting read in the Financial Times positing that half of the UK has already been infected and that most haven't gotten extreme symptoms. Google "Financial Times COVID Oxford" to see the report. Actual link is behind paywall but you can access via google search. As most testing is done on 'sick' people and is based on nasal samples, we really won't know the full spread of the disease until we get more blood tests for antibodies. It's possible that the UK has already built up 'herd immunity' & that restrictions could be lifted sooner than expected.
Below is the extract of the actual Oxford report.
https://www.dropbox.com/s/oxmu2rwsnhi9j9c/Draft-COVID-19-Model (13).pdf?dl=0
Interesting read in the Financial Times positing that half of the UK has already been infected and that most haven't gotten extreme symptoms. Google "Financial Times COVID Oxford" to see the report. Actual link is behind paywall but you can access via google search. As most testing is done on 'sick' people and is based on nasal samples, we really won't know the full spread of the disease until we get more blood tests for antibodies. It's possible that the UK has already built up 'herd immunity' & that restrictions could be lifted sooner than expected.
Below is the extract of the actual Oxford report.
https://www.dropbox.com/s/oxmu2rwsnhi9j9c/Draft-COVID-19-Model (13).pdf?dl=0
From Cuomo's press conference today. Some better news than yesterday, but still a long way to go...
- Their model is showing 140,000 hospitalizations (at 15% hosp rate, this is 920,000 cases) vs. 53,000 beds and 40,000 ICU cases vs. 4000 beds with the apex peak in 21 days for hospitalization.
- I haven't seen their model, but I assume it's a worst case model with little social distancing and I think these numbers are high, but can't be sure without seeing the model - if NY is at 30K now and seeing 5-10K per day new cases for 21 days, that would be ~200K not ~900K
- As of Sunday, the hospitalization rate was doubling every 2 days, on Monday, the hospitalization rate was doubling every 3.4 days and yesterday the doubling was every 4.7 days. Clearly this is good news and hopefully reflects social distancing is working (and recall it takes 8-9 days to get to hospitalization, so this would reflect SD from 6-7 days ago. It also dovetails with what I said above that maybe the model projections are high.
- Plans in place to get from 53K beds to 120K beds (vs. 140K beds needed); this includes 50-100% increase in beds in hospitals by efficiencies (30K more), using dorms (29K more), FEMA (4K more)
- 103K tested so far/44K in NYC (12K on 3/23) which is 28% of US testing – hunting positives to isolate and reduce spread
- 30K positive cases in NY State now with 5K new on 3/23 and 3/24; 17K cases in NYC and about 4200 cases in Westchester where there has been a significant slowdown in new cases, again reflecting some success for social distancing (especially in the New Rochelle hotspot)
- Of those 30K positive cases, 12% (3800) are hospitalized and 3% are in ICU (888)
- More on flattening the curve: no close contact sports, closing some streets to cars to provide room outside for people without being so close, monitoring parks/playgrounds for social distancing.
- Hospital PPE: ok for now, still needs for peak
- Ventilators: need 40K total, have 4K, purchased 7K, Feds sending 4K, will look into splitting, but need more production; Feds being more helpful and praised POTUS for sending the 4K ventilators (very different tone from yesterday).
- Also said he discussed with Trump that NY is first to get hit very hard and others will likely follow and that they could address needs of rolling influx of patients with rolling deployment of 20K Fed stock of ventilators in NY first and Cuomo then promised NY will then help other areas that follow with redeploying ventilators/equip/personnel - not agreed yet, but considering
- Surge healthcare force – 40K responses so far from retirees (2300 docs/37K nurses/assistants); also mental health hotline (6K providers)
- $2T stimulus is $3.8B for NYS/$1.3B for NYC and NY needs $15B; hopes House restores some to NY (was $17B in their plan)
- Says NY is not going to relax restrictions in the middle of a major outbreak, but is working on plans on how they will reduce restrictions once this is hopefully under more control.
- Commented again on really needing antibody tests to send people back to work with confidence they won't get infected and won't infect people (since a sizable % of people who get the virus have mild to no symptoms, but don't even know they had it and are now immune for awhile.
Been talking about this for awhile in this thread, but remember, that article is using a model with assumptions without any "proof" since we simply don't know how many have been infected but aren't symptomatic and/or wouldn't test + for the virus. Many are thinking the same thing is possible, given that half of the positives on the Diamond Princess were asymptomatic, but only 17% of the passengers were positive, despite very high density and close contact over 14 days before the quarantine (one would've expected far more to test positive).
What we don't know is how many more were infected, but at too low of a level to test positive by the RNA-PCR virus test (which is much less sensitive than an antibody test). It's why having the antibody test ASAP for millions is really the best way out of this mess, IMO and why I think the first group who should be tested is the 83% of the people on that floating virus transmission "laboratory" who tested negative for the virus, but could have antibodies to the virus.
Not as much, I get post nasal drip which leads to a dry cough at times. I actually had that last night when I went to the store, just kept it under control.
why werent Cuomo and De Blasio pro active when anyone could figure out NYC was likely to be the worst hit, just saying
and actually I dont blame them or Trump or anyone..sometimes once in a lifetime pandemics happen, as late as January 14 the WHO was poo pooing Coronavirus...wrap your head around that one.
(sorry, gave you a like because i feel your pain not because I was glad you were suffering lol)
I agree with you. The government at all levels squandered precious time. They should be criticized. This is worse than it needed to be on everyone in the U.S.
With that said, of course they were. About the only thing the government excels at in reacting quickly is fighting the last war. Unfortunately, the next crisis is usually different than the last one.
However, what has been severely lacking in this whole thing from all sides is thoughtful perspective. Without it, we get little thoughtful response, only extremes (do nothing / do everything) supported by hyperbole (it's the flu / we are about to become Italy) that in my view make things worse.
watched the whole thing . Very impressive job again. Yes, he provided positive news while maintaining the need for more prep and planning. Some really creative ideas and its also impressive the response by folks to the call to create a reserve med force.
Very corp. like...please...a NON political comment folks. Just really appreciated the update , data, use of charts, and the level of detailed info.
I've never said we were going to Italy's death rate - I said it was looking like we were headed towards Italy's high infection rate and we do now have about double the new cases per day they do (but not 5-6X as would happen if we had the same new case rate per capita - and hopefully one big difference is we did go to social distancing earlier in our outbreak than they did) and was concerned that that could lead to overwhelming our hospitals in densely populated areas, which could increase death rates (but not to Italy's very high ones, which we know is somewhat due to a higher average age in Italy).
And as I said last night and before, we're also much earlier in our outbreak than most of Europe, so our death rates will go up some, since it takes 3+ weeks from testing positive to death in most cases, but as long as we don't overwhelm our hospitals we should likely stay at <2% mortality rate (1.3% now). I know I post a lot and some are long, but I don't think you're reading my posts well enough to say what you said.
https://rutgers.forums.rivals.com/t...social-distancing.191275/page-32#post-4469114
My biggest problem all along has been on testing, as aggressive early testing is the one common denominator for the countries who have largely controlled the outbreak (SK, Taiwan, Singapore, Hong Kong and eventually China) - along with aggressive tracing of contacts of positives and quarantining of positives and contacts. Also, everyone wears masks in public in these countries. In addition, countries like Germany and Iceland have kept death rates low (<0.5% of cases), despite having a lot of cases, and they've had very aggressive testing/tracing/quarantining.
The criticality of aggressive early/often testing/tracking/quarantining was well known by mid/late February for this virus and is a general foundation of preventing/limiting outbreaks and we had plenty of time to implement such a program, but we simply didn't do it until it was too late to prevent a major outbreak, largely due to the testing kit debacle. However, as per my other post last night and as per Cuomo's presser today (above), NY, at least has taken aggressive testing to heart, along with social distancing, and it's starting to look as though that might be paying off in a slowing of the new case acceleration (too early for victory yet, though).
https://www.theguardian.com/world/2...301nhZ-24lZbJXdYXlywuyN9kczMxAevhx1zGBIUoLzeE
https://www.washingtonpost.com/worl...ce18e4-6d05-11ea-a156-0048b62cdb51_story.html
https://www.buzzfeed.com/albertonar...nvBLmw51FEQJJFc4SGb36zWEtaj0UiJGO6gJIiPVJ8cN0
I posted an article from the times on the differences between Germany and Italy and the death rates. Some interesting info.
https://www.bloomberg.com/news/arti...eadly-in-germany-because-of-youthful-patients
Health authorities still don’t know exactly how the virus entered Italy, but once there it easily infiltrated the high-risk older generation. To a degree uncommon in most other parts of Europe, Italian adults are in frequent contact with their parents. The “nonna” and “nonno” provide childcare and standing Sunday lunch dates, and they often live in the same city -- or even closer....
In Italy, 74% of those who’ve tested positive are over 50. In Germany, 82% of cases are people under 60. The prospect that the outbreak may shift to older people has German health officials worried, too.
....
More than 20% of Italians between the ages of 30 and 49 live with their parents, according to Bonn University economists Christian Bayer and Moritz Kuhn. That’s more than double the rate for Germans in that age bracket. Bayer and Moritz have found a correlation between generations living under one roof and case fatality for coronavirus.
Italy is just one gigantic outlier. Hopefully, they remain just that, an outlier.
Yep and China showed that nearly 80% of transmissions occurred within the household, which is why identifying positives early and aggressively and quarantining them outside the house is so important. We're still telling mildly symptomatic people to self-quarantine at home, which could mean infecting others if they aren't very careful - the Asian countries all set up locations for quarantining positives (which they tested if any symptoms and even without any if in contact with infected people).
One "plus" in the US is that most seniors live in nursing homes, communities or on their own, which should make isolation/protection of them easier (as long as the virus doesn't get into that community, like in Kirkland or in Woodbridge NJ's ongoing mess) than in Italy and I'm sure is a large reason for our 1.3% mortality rate vs. Italy's 10% (not just them being older).
It won't be for long - taking "snapshots" of data without thinking about how an outbreak evolves will lead to bad analysis and planning. Our death rate is climbing very fast (225 yesterday and will likely be over 1000/day soon) and SK's is basically nil (<10/day). As I said last night, the best case for this in the US is likely being similar to the flu with regard to deaths, but worse for hospitalizations (~35K deaths/year from flu), whereas 5-10X flu death rates are likely if we don't continue our control measures or relax them too soon (and ratchet them up in some places, especially cities), but I don't think those 2-3MM deaths are realistic scenarios.
We all know you've been harping on testing and nobody disagrees with you. However, countries like SK and Taiwan already went through testing debacle when MERs/SARs hit them in early/mid 2000. For that reason they are of course more naturally prepared.
The constant blame game doesn't help anyone. Politicizing the issue doesn't help anyone. One thing I do know, once this country puts aside it's differences and focuses on solutioning, it is the most innovative and most well resourced country in the world. Nobody is better. None.
We were the ones who were making the test kits that were being sent to these countries. Now that we've removed the FDA bureaucracy in getting these kits approved, look how quickly testing ramped up. And when the smoke clears, it will be our own scientists and doctors that will find a cure and vaccines for this virus. Of course the world won't thank us for it.
hopefully the use of the malaria drug with z-packs and zinc that are being tried actually do help and weaken the virus.
As I said last night the latest data point was a positive. It increases the likelihood the next data point would show a decrease in the rate of change. Let’s hope data isn’t flaw or another variable doesn’t get entered in the equation that changes things.
Forget about April 12
We need to squash CV now
June/July seems more realistic, flatten the curve , buy time for better treatments, hospital beds, equipment, etc
We need to squash CV now
June/July seems more realistic, flatten the curve , buy time for better treatments, hospital beds, equipment, etc
I haven't seen much about N.J.s
Covid-19 cases in our major cities.
Can we consider that good news?
Covid-19 cases in our major cities.
Can we consider that good news?
I'm seeing stories of healthy 20/30 year olds in ICU in NJ and NY
Frightening stuff
Cuomo, DeBlasio and Murphy need to install much tougher travel restrictions asap
Frightening stuff
Cuomo, DeBlasio and Murphy need to install much tougher travel restrictions asap
It wasn't a "blame game" in that post. I was responding to someone stating: I "have been highly critical of the U.S. response and have stated repeatedly that the U.S. is unprepared and heading towards Italy. The facts do not back that up." I feel that was wrong and explained why.
I also mentioned testing because, despite the great progress in NY, testing is now jeopardized again, with the recent guidance that NYC/LA and others should "only be testing people sick enough to require hospitalization, saying wider testing is exhausting supplies of protective equipment." I get the importance of saving PPE, but it's very disappointing that we still don't have the PPE we require and now I fear we're not going to get the testing we need, again.
Also, not sure what you mean by we were making the test kits for other countries, as the Germans, Chinese and South Koreans manufactured the kits for themselves and many other countries (which we should've taken advantage of a month ago when the CDC test wasn't working)
https://abc7ny.com/health/nyc-healt...mdnqYb1xFDuNymZuTI3EJWoJbBHIm0JLDVMWZJcKbpxzY
I agree 100% on the US being capable of incredible medical/pharmaceutical innovation and have said so and I applaud Trump, Hahn and the FDA for temporarily suspending a bunch of regulations, allowing clinical trials for a host of treatments to start basically immediately (already underway) and I think we'll be the leaders on finding treatments, antibody diagnostics/treatments/preventatives and a vaccine.
However, we're well behind on less "sexy" innovations, like contact tracing, quarantining, medical supplies and supply chains, digital delivery systems, etc. and these are important too in enabling reduction in transmission rates and ensuring people and medical professionals are properly equipped.
Thanks for summarizing. What does this mean?
"As of Sunday, the hospitalization rate was doubling every 2 days, on Monday, the hospitalization rate was doubling every 3.4 days and yesterday the doubling was every 4.7 days."
What is the "hospitalization rate"? Rate of people hospitalized per number of cases? Overall hospitalization figures?
I don't know what the gov't could have done really. The shut downs were met with a fair amount of skepticism, as well as plain non adherence, when they first kicked in, if these measures were implemented earlier, before Italy was really rip roaring, there would have been a shit ton of push back from the public.
We do like to criticize our politicians, but it's not like the American public, as a group, is out there exhibiting exemplary behavior.
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Anecdotal evidence from MD's on the front lines (social media) is that there are no clear "breakthroughs" yet with any of the treatments being tried, but that's anecdotal and shouldn't be taken as gospel, just like Raoult's small, flawed trial of HCQ shouldn't have been taken as gospel and touted as a cure by the doctor who ran the study (Raoult) and by a famous non-scientist (our President). Let's hope the larger trial data show some success. Also, there was a similar HCQ small trial in China which showed little efficacy.
"The results in France were contradicted by those of another small study in China, which indicated that hydroxychloroquine was no more effective than other treatments for Covid-19. As AFP reported on Wednesday, the Chinese study, published in the Journal of Zhejiang University, involved treating half of a group of 30 Covid-19 patients with hydroxychloroquine for seven days. After a week of treatment, 13 of the 15 patients given the malaria drug tested negative for the coronavirus; but so did 14 of the 15 Covid-19 patients who didn’t get hydroxychloroquine."
https://theintercept.com/2020/03/24/trump-hyped-chloroquine-cure-covid-19-man-arizona-took-died/
Sorry, I don't actually know the exact data and assumptions - was just repeating what Cuomo said in the presser - getting solid data/info right now is difficult. I assume it is just looking at the rate of increase of hospitalizations over different time periods, which presumably means hospitalizations are still increasing each day, but just not as fast as they were. While that's a good sign (on limited data though), even if the rate of hospitalizations stays constant at X each day, the total number hospitalized will keep increasing until the rate has been constant for the same number of days as the average hospital stay and we're not there yet.
During the Governor's briefing today, it was reported that NJ has now conducted about 14,000 tests, which represents an increase of 2000 tests in one day. I believe that is still half the daily rate that NJ needs to achieve. The reasons that NJ is limited in testing, according to today's briefing is availability of tests and availability of PPE for those administering the tests. The availability of PPE is a major constraint, and at some point the state expects to have to decide whether to allocate PPE between testing and hospital care.
Also, it was indicated that only 90% of reports indicate both positive and negative tests, explaining the math issue I previously noted. The Health Department indicated that today, positive tests represent 29% of tests performed where both positive and negative results are provided. The criteria for receiving a test in NJ continues to require showing of symptoms.
Today's total positives are 736, bringing NJ's total to 4402 positive. There were 18 deaths, bringing that toal to 62.
Yep, it would've been much harder here than in SK and Taiwan, for example (and India now), where selected shutdowns, aggressive testing and social distancing were instituted far earlier in the outbreak. Those countries have more trust in their governments and a populace that is generally more "obedient." It's part of why I've been so focused on testing for so long, as I had always assumed we'd struggle with shutdowns/social distancing, just like we've struggled with using masks in public, which definitely work to reduce transmission but are socially unacceptable here.
https://www.theguardian.com/world/2...301nhZ-24lZbJXdYXlywuyN9kczMxAevhx1zGBIUoLzeE
They should have very publicly started stocking/ordering/manufacturing appropriate supplies and preparing for increased medical capacity. It would have changed the public perception of preparedness greatly.
IIRC I think the percent of positives that need to be hospitalized in NY was 12%. Percent that needed ICU was 3% IIRC an that number was like 880+ cases out of 30K+ cases.
Yes, that was what I posted in my presser post; however, we'd need to know the numbers every day for the past several days to know about hospitalization rate increases and doubling times and their assumptions/calcs (are they doing it on single day numbers, moving averages, etc.). My guess is we won't get that info and should just be happy that there is some calculation showing a modest, but significant decrease in the rate of increase of hospitalizations.
@bac2therac @Wolv RU @Salvi's Headband Please let's keep the politics out of this. If you want to discuss whether Cuomo, Pol Pot, Trump, De Blasio, Mother Theresa, Murphy, RU#'s, My Left Foot should have done what at where sometime before when, take it to the CE Board.
the NY data is promising, but it also needs additional data points. If the hospitalization growth rate is slowing, that's great. However, would need to know what the average length of a hospital stay is. if they are diagnosing and hospitalizing 250 people a day, that's 1750 a week. if they need to stay two weeks or more and new hospitalizations keep coming in, the hospitals will still be overwhelmed. Also would want to know what the rate of denial for testing is...how many people who show symptoms AREN'T being tested, despite showing up to a facility to be tested. That would change the math on potential cases.
People shouldn't get too excited yet, but this could be at least a short term gamechanger until other treatments and/or vaccines come along. NY now has FDA permission to permit emergency use of blood plasma rich in antibodies to the virus, collected from recovered patients, in current coronavirus patients in need, via infusion.
This kind of therapy is low tech but has been shown to work in the past and should work here, in theory. It's not clear to me how many patients can be treated with this approach (not sure what level of antibodies would be needed for either treatment or prevention), but I think it might be all seriously ill patients (since there are far more people who get infected and recover than are seriously ill).
In theory, it could also be used as a preventative for health care workers and other at-risk people, until more scalable antibody treatments, like the Regeneron approach I've posted about before (where antibodies are developed from mouse models, tested and successful ones manufactured in cell bioreactors for injection in patients to provide virus protection) and/or a vaccine are available...or if one of the ongoing trials with repurposed old drugs works.
How blood from coronavirus survivors might save lives
New York City researchers hope antibody-rich plasma can keep people out of intensive care.
"On 23 March, New York governor Andrew Cuomo announced the plan to use convalescent plasma to aid the response in the state, which has more than 25,000 infections, with 210 deaths. “We think it shows promise,” he said. Thanks to the researchers’ efforts, the US Food and Drug Administration (FDA) today announced that it will permit the emergency use of plasma for patients in need. As early as next week, at least two hospitals in New York City — Mount Sinai and Albert Einstein College of Medicine — hope to start using coronavirus-survivor plasma to treat people with the disease, Joyner says.
After this first rollout, researchers hope the use will be extended to people at a high risk of developing COVID-19, such as nurses and physicians. For them, it could prevent illness so that they can remain in the hospital workforce, which can’t afford depletion.
The US tests of convalescent plasma aren’t the first. Since early February, researchers in China — where the coronavirus emerged late last year — have launched several studies using the plasma. Researchers have yet to report on the status and results of these studies. But Liang Yu, an infectious-disease specialist at Zhejiang University School of Medicine in China, told Nature that in one preliminary study, doctors treated 13 people who were critically ill with COVID-19 with convalescent plasma. Within several days, he says the virus no longer seemed to be circulating in the patients, indicating that antibodies had fought it off. But he says that their conditions continued to deteriorate, suggesting that the disease might have been too far along for this therapy to be effective. Most had been sick for more than two weeks.
In one of three proposed US trials, Liise-anne Pirofski, an infectious-disease specialist at Albert Einstein College of Medicine, says researchers plan to infuse patients at an early stage of the disease and see how often they advance to critical care. Another trial would enroll severe cases. The third would explore plasma’s use as a preventative measure for people in close contact with those confirmed to have COVID-19, and would evaluate how often such people fall ill after an infusion compared with others who were similarly exposed but not treated. These outcomes are measurable within a month, she says. “Efficacy data could be obtained very, very quickly.”
And academic hospitals across the United States are now planning to launch a placebo-controlled clinical trial to collect hard evidence on how well the treatment works. The world will be watching because, unlike drugs, blood from survivors is relatively cheap and available to any country hit hard by an outbreak.
https://www.nature.com/articles/d41...6tll_d4rjI0v9tRBTtsMcAKMomkbl1Gb6zJ9DoaQaX6Ag
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Story doesn't say it, but he lives in Metuchen now. Heard about it from John Otterstedt who was his teacher in Ridgewood and said he's just a great kid and the whole town is pulling for him. Lousy situation...
https://dailyvoice.com/new-jersey/m...t-experimental-covid-19-drug-mom-says/785436/
how about making it easier to go give blood or plasma someplace?
redcross site wants you to schedule an appointment maybe 3 weeks out... when they are having media tell us they need blood now.
redcross site wants you to schedule an appointment maybe 3 weeks out... when they are having media tell us they need blood now.
Number one, the minimal amount of tests available were controlled by the government and were flawed from the outset. It was realized when an outside person (physician I believe) was touring the plant and happened to notice an issue..and he wasn't even there as an inspector. Second, once the error was corrected, the number of tests available was still paltry. The testing was controlled by the government who provided very few tests to facilities throughout the country and the turnaround time was 5-7 days to report positive cases. Third, once they knew they didn't have a sufficient number of tests, they still disallowed facilities to do their own testing and consider them valid. Hospitals started doing their own testing and if positive, the patients were "presumed positive". Guess what? They still had to send a sample for government testing to be considered positive for Covid-19 which took 5-7 days. During all this time when the floodgates should have been opened up with testing, people circulated about their daily lives and transmitted this virus. The new hosts then transmitted it to multiple other hosts. Remember the TV commercial "They told two friends, and they told to friends, and they told two friends, and so on...and so on...and so on. That's how we arrived at this juncture. Spanky, mentioning the government is relevant in discussing how and why we got here, which I why I did it. I will fully disclose I have no party lines, but I won't shy away to place blame on a person or entity if I see fit...no matter who they are.
I'd be careful using the hospitalization rate to define progression or regression. Annual hospitalization rates are defined as the number of hospitalizations divided by the person-years. First, there is a good amount of public education imploring people to stay away from the hospitals unless they have an indication for being seen at a hospital. Low grade fevers, cough, aches are not an indication. The more people are educated, the more they realize they should not be there as they are taking time away from those who really need it. Second, people know the really sick are going to the hospital to get treated. Would you consider going to an emergency room if you knew multiple Covid-19 suspected patients are near you? Third, as hospitals near capacity, they don't have room to take in new patients. Look at it this way, if the hospitals were 100% full, the only way people could be hospitalized is if someone is discharged or passes away. One in one out. Fourth, looking at the definition, I don't even know what that means.
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