Harder to measure than you think. Even if the flu vaccines and Tamiflu are only moderately effective, you would have to calculate what the cost of not vaccinating and treating would be. And would that change the mortality rate if the vaccines didn't exist? What's the cost of additional hospitalizations? Would there be any? What's the monetary cost of the potential additional lives lost? Lots of variables.
COVID-19 Pandemic: Transmissions, Deaths, Treatments, Vaccines, Interventions and More...
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Summary of key US/NY/NJ data through 4/11 and some comments from Cuomo’s 4/12 presser; several graphics are below.
- The Earth hit 1.78MM positive cases on 4/11 with 533K cases in the US, 181K in NY and 58K in NJ
- Both NY and NJ have reached the “peak plateau” in new cases, with some decline now occurring; the US has reached a peak plateau also (see graphics)
- NY now has done about 22K tests per 1MM in population, which is more than almost any other country; NJ is at 13K tests per 1MM (and Murphy said they’re still only testing symptomatic people given testing limitations) and the US is at 8K tests per 1MM, both of which are middle-of-the-pack.
- US deaths continued to climb to the 2000/day range the past few days, but appear to have finally plateaued. NY deaths per day have also plateaued around 700-800 per day, as have NJ deaths in the 200-300 per day range. Let’s hope thise all start to fall soon.
- 20.5K, 8.6K and 2.1K total deaths, respectively through 4/11 in the US, NY, and NJ. Note that these are well below the per capita deaths in Italy/Spain, but well above those in places like South Korea and Taiwan - it's all about when countries put interventions in place relative to their number of cases (and how effective those were).
- Total number of 19K hospitalized in NY has almost completely leveled off with the net new hospitalizations now being only a few hundred per day for the past several days, which is great.
- This means NY is about at its peak and the peak should be in the 20-25K range. As per my comment the other day, Cuomo showed the various model projections from mid/late March for total hospitalizations and they ranged from about 50K to 135K, which is why NY was so aggressive in increasing their bed capacity from about 50K to 90K, which was accomplished. That excess capacity won’t be needed due to the aggressive and effective testing, quarantining and social distancing that worked and continue to work and which need to continue.
- However, NY came much closer to running out of ventilators/PPE many times due to the logistical challenge of stocking and staffing so many hospitals. In fact, NY is now starting to release some ventilators (and staff) back to areas that had sent them to NY.
- While NY/NJ are doing better, plenty of states are still having cases rising much more quickly than NY/NJ now, although with social distancing in place everywhere in the US (even without formal orders in every state), currently no state appears to be having exponential growth, with only RI, and SD showing ~15% daily increases in new cases, which is still well less than exponential growth).
- Cuomo reiterated that there was a ton to do before returning slowly to “yellow” (the new normal) from our current “red” with “green” (the old normal likely being pretty far off still); he also reiterated that NY/NJ/CT plan to do this in a regionally coordinated fashion.
- The National Governors Association appealed to the Feds to put $500BB in the next relief package for the states, who all have major budget shortfalls from the pandemic costs.
- He also noted that NY/NJ will only get about $12K per coronavirus case from the stimulus bill, while several other states will get $300K per case, which is extremely unfair. There is no path to US recovery without the NYC metro area being part of that and our area cannot continue to be shortchanged, like it was during Hurricane Sandy.
- Happy Easter!!
https://www.worldometers.info/coronavirus/#countries
https://covidly.com/graph?country=United States
Summary of key US/NY/NJ data through 4/14 and some comments from Cuomo’s 4/15 presser; several graphics are below.
- The Earth hit 2.08MM positive cases on 4/14 with 644K cases in the US, 215K in NY and 71K in NJ
- Both NY and NJ have reached the “peak plateau” in new cases, with some decline possibly occurring, although there have been a few large fluctuations, likely related to testing rates; the US has reached a peak plateau also (see graphics)
- NY now has done about 27K tests per 1MM in population, which is more than almost any other country; NJ is at 16K tests per 1MM and the US is at 10K tests per 1MM, both of which are middle-of-the-pack.
- US deaths were at the ~2000/day range much of last week, but then dropped to ~1500/day over the weekend and then shot up to ~2500/day the past 2 days – it’s probable that the rates are really flatter, but we’re seeing weekend reporting issues, as has happened in other locations. On a moving average, deaths have likely plateaued. NY deaths per day have also plateaued around 700-800 per day, as have NJ deaths in the 200-300 per day range (again with the weekend effect counted).
- The big surprise was that NYC announced 3800 “additional” deaths on Monday, which were deaths that were never confirmed by a positive viral test, but presumed to be due to COVID, as most occurred in hospitals in patients clearly suffering from COVID (where a test seemed superfluous); these have not been added into any graphics/tallies yet. Other states will likely have the same issue and it’s not clear how this will be handled yet, statistically.
- 28.5K, 11.6K and 3.1K total deaths, respectively, through 4/14 in the US, NY, and NJ.
- Total number of 19K hospitalized in NY has completely leveled off with the net new hospitalizations now being essentially zero for the past few days, which is great.
- As promised, NY is now sending ventilators to other needy states, like Michigan and Maryland
- Currently the only state showing greater than a 10% increase on 4/14 vs. 4/13 is South Dakota, which has a major outbreak going on in a pork processing plant.
- On Monday it was announced that NY/NJ/CT/RI/PA/MD/DE and CA/WA/OR woud plan to manage the process of staged “reopenings” for their areas in a regionally coordinated fashion. Much debate over federal vs. state authority here – time to go re-read the Federalist Papers, lol.
- Reiterated the keys to the phased reopening (prior to having a vaccine or treatment) being massive, instant viral testing to see who is infected, massive antibody testing to see who has been infected and is likely immune (neither in place yet and need federal help on these), a system for contact tracing/quarantining (not in place yet), and a system for determining which businesses should reopen and when/how – this will be a function of how essential that business is and how big the public health risk from that business is. Obviously the greater risk/lower importance quadrant will be the lowest priority and will have the highest social distancing requirements. See the graphic.
- Lastly all people in public that can’t easily achieve SD, must wear masks.
It sounds like you're making assumptions. The only way this could be true is if we've run out of tests and people with symptoms aren't being tested.
1)I wouldn't think it was that hard or expensive to just keep count.
2)Do the model runners not get paid?
3)How do we count for deaths for other causes? Such as cancer, or car accidents, or gun deaths?
I've definitely heard of people with mild symptoms not being tested but being told to quarantine.
There have been news reports within the past few days of public testing sites in NJ running out of tests (and labs running out of processing capacity). For example: https://www.nytimes.com/2020/04/13/nyregion/coronavirus-testing.html
Does this work to help prevent, like a vaccine? Or is this only a therapy once you’re infected?
By no means am I a professional in any way, but certain things I've learned and studied have stuck in my brain like Science and Math. Remembering back to what I've learned about genetics many years ago, they should be studying families that have got covid-19 where the husband or wife got it and died, and their spouse was asymptomatic, and children, of said parents, have died/recovered carrying that same DNA sequencing. There have been a few stories I've read that fit that scenario covered in the media to study. Yes, other people that are immunocompromised are dying as well, but Covid-19 is attacking a certain DNA sequencing that some people carry to make it deadly and the majority of others asymptomatic. Those are the cases that should be focal points to figuring Covid-19 out. It just takes time comparing data of millions of DNA sequences we all carry.
Covid-19 is much worse than the Flu. Anybody who doubts this just needs to go to any North Bergen or Essex county hospital.
That said, I agree with your colleagues 100% - people who die from the Flu are real. My brother who was 29 at the time, died from the Flu. Came home one day not feeling well, collapsed on the floor and was dead before he reached the hospital. Autopsy confirmed it was Influenza. So the Flu kills and it serves no purpose on why anybody would doubt the killing power of the Flu.
The thing is, as different as the Flu is from cov2 in terms of species, they are just as different in the way they inflict their damage. Cov2 is much more dramatic while the Flu is more subdued and keeps a low profile. But the Flu kill numbers are real. Thousands die from it worldwide every year. Especially in third world countries where healthcare is not only bad, in some cases simply non-existent.
As for cov2, there is still a lot we don't know. Lots of info from "scientific professionals" but IMHO, many are still very much unproven. I'm not even sure they've pinned down the basics such as incubation period, ability to infect, etc - just based on my own personal experience. For the record, I am on day 11 recovering from being cov2 positive. I don't want to jinx myself but once I recover completely, I will provide details of my experiences, what to look out for, etc for anyone who might think they have it. For now all I can say is cov2 is no joke. I wouldn't want to wish this on my worse enemy.
I really hope this works but the biggest obstacle to allogeneic therapies are adverse events.
Plenty of folks out there would like to help. But if they aren't offering tests to determine those who might have had it without their full knowledge, then you're only left with those relatively "few" who absolutely knew. The market for antibody-rich plasma could go up dramatically IF the government approved and created enough tests for the population at large to get tested.
Lots of obstacles, unfortunately (see the article a few pages back on "Who Is Immune..." if you haven't seen it yet), but, so far, the promise seen in China and here, both in very limited cases, is at least tantalizing and much more than we've seen from any other treatment yet.
It's still not clear to me if they're allowing people who recovered without having had a positive test to participate (I think they are if one's doctor confirms likely COVID), as that would definitely enlarge the pool of donors. But to me the biggest problem is lack of "advertising" that donors are needed, although at home antibody tests or even readily available ones at a lab would clearly make this much easier.
Great post, thanks. And good luck with the recovery - sounds like an ordeal nobody wants to go through, even for those who don't become serious enough for hospitalization.
My condolences regarding your brother. The flu is no joke and it seems to hit others NOT in the high risk category without any rhyme or reason. And yes about some of the NNJ hospitals. Many are at capacity and have created ICUs within the hospitals where none have ever existed ..and have tripled (or more) their ICU beds...These beds are all now full. It's a compressed tidal wave of critically ill patients. I wish you a continued recovery from your Covid-19 diagnosis. Deep breathing and proning are basic treatments which are beneficial if your lungs have been compromised.
Could be both and is being looked at, clinically, as a treatment and a preventative, although scaling this up to more than the 10-20K in ICU (guessing on that) or the ~100K in hospitals (if it works as a treatment) would be a monumental challenge, meaning the prevention approach might be impossible to apply to 240 million to achieve herd immunity in ~80% of the population if the R0 of 5.7 (measure of contagiousness) is correct. My guess is that if the antibody approach works, scaling up to millions would require one of the genetically engineered antibody technologies to work (should know by mid-summer) and even that would take months to reach millions.
Great question and it's being looked at. Seems almost obvious that there must be some genetic marker or condition that is linked to susceptibility, but it may take quite some time to figure out...
https://singularityhub.com/2020/04/...-sickens-some-and-spares-others-in-our-genes/
The really scary thing about covid is how differently it behaves in different people. Many seem to get no or minor symptoms, others have a couple of weeks of fever and feeling crappy but never develop breathing problems, and of course others wind up on ventilators or dead. And on top of that, some people have kidney or liver damage, others cardiac issues. Low white blood counts, blood clotting issues...it's really an amazingly diverse presentation across the population. And then there's the question of reactivation or reinfection. I still think those cases are probably reflecting testing issues but we don't know for certain.
I wish you a complete recovery and look forward to hearing about your experience.
Thanks for taking the time to explain this.
People I know at a major midwest hospital say this approach is working as a treatment (studies are still small). There are still many challenges with this approach, however.
To answer your question, in theory, it could protect, as well as treat. There is no way to know for sure until tested. One obvious danger is that you could infect healthy people if you accidentally transfer the virus.
found an interesting hypothesis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136957/
is BCG vaccine, for TB, the reason for low rate of infection in developing countries?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136957/
is BCG vaccine, for TB, the reason for low rate of infection in developing countries?
fantastic news. REMDESIVIR is working !!
https://www.statnews.com/2020/04/16...uggests-patients-are-responding-to-treatment/
"The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir. “The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital."
https://www.statnews.com/2020/04/16...uggests-patients-are-responding-to-treatment/
"The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir. “The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital."
Now that sounds very promising!
Can’t wait for the results for the Gilead clinical trials. The last report that came out seemed positive, but hard to compare since no control group. This one seems even better, but again, no control. There sure does seem to be a lot of smoke here though.
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It is difficult to evaluate without any context. What does seem clear, especially from NYC data, is that once patients wind up on ventilators there is a very high death rate. However, I don't know what the death rate is for people who get sick enough to be in the hospital and be labeled "severe". What does "severe" mean? If that means they are on a vent then these results are amazing. If it means they're not on a vent yet, then we need to know what the typical outcome is for such patients who are not treated with remdesivir.
The article did say "We have seen people come off ventilators a day after starting therapy.", so at least some of them got to that point.
In the smaller, global trial that was reported the other day, there were 30 people on vents. 17 of the 30 were removed. Which seems pretty good when you hear stats being thrown around that 80% of people die when they go on a vent.
Now here's a question... A contractor came into the store today and told me he had went to donate blood... He told me he got a call back that he had covid 19 antibodies in the bloodwork...Now.. I have no way of verifying... But if you donate blood.. Are they testing for that? Reason im asking is that he told me he was down for several days in mid-January (around same time frame that I was sick also.. with most of same symptoms that I had..) Does anyone know if they are screening for that?
They said they can handle 10,000 tests a day. I don't know more than that. Anyone know how many tests were done on day 2 today in Edison? I drove past the PNC Bank Arts Center testing facility twice yesterday and it looked pretty light. We're never getting back to normal and reopening if we don't ramp up testing and we don't seem to have the wherewithal and supply to do so anytime soon.
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So, how many are infected? Tough question to answer. Here's a bulleted rundown for comparison, with some details further below on each. Long post, but this stuff is data rich and complex...
- By viral PCR testing, Spain has the highest with 0.4% of their population testing positive
- By viral PCR testing, the US has 0.2% of its population as positive
- However, by viral testing, NY state has 1.1% positive and NJ has 0.8%, as these two states are approaching the highest levels tested of any country/state (NY has tested 2.8% of its population, while most countries are below 1%) and have outbreaks as bad or worse than Italy/Spain on a case/death per capita basis.
- Note that all of the above are % based on positive tests divided by the whole country population
- Data out today from Finland and the Netherlands show that based on antibody testing of small sub-populations an estimated ~3% of their populations likely have antibodies to the virus, this is far more than any viral tests show.
- The Diamond Princess cruise ship tested every passenger (3711) and found 19% positive by the viral PCR test (half of which were asymptomatic; no antibody tests were done)
- The Theodore Roosevelt carrier tested almost every person (4800) and found 12.5% positive by the viral PCR test (60% of which were asymptomatic; no antibody tests were done)
- The quoted post above and other sources have been speculating that there could be up to 30% of the population already infected and with antibodies (and likely immunity).
- The higher the number truly infected (and with immunity), the less "targets" available to infect and the slower the virus will spread, plus, the more with immunity, the more people that should be able to go back to "normal" life without risk from the virus or risk of transmitting the virus, so the higher the number the better
- The estimated "herd immunity" (where transmission would stop) would be ~54% of the population infected, if the R0 transmission rate is 2.3, while it would be 82% at an R0 of 5.7, as recently postulated. We also still don't know that everyone with antibodies is immune, but most experts think the vast majority will be, for at least months to years.
- The US is starting similar antibody testing programs in small populations, but we really need to be ready to do massive antibody testing of millions of people per week to truly know where we are - even at 10MM/week, it would take 8 months to test 330MM Americans.
https://thl.fi/en/web/thlfi-en/-/nu...mes-higher-than-the-number-of-confirmed-cases
https://nltimes.nl/2020/04/16/3-dutch-blood-donors-covid-19-antibodies
The post quoted above talked about 5-10% or even 30% infected being possible. And today's data from the Theodore Roosevelt US aircraft carrier showed that about 600 of 4800 people tested (12.5%; and 94% of the crew have been tested so it's almost complete) positive for the actual virus, with over 60% of the positives not having shown symptoms yet. Also, the vast majority of positives have not been very sick with only 5 sailors hospitalized and 1 death, which is a case fatality rate of about 0.2% (1/600), which is quite low.
This is not a representative population, of course, with most of the crew being young and healthy, so a low CFR would be expected. However, I hope they are also testing the crew for antibodies, to see how many truly were infected with the virus, but tested negative with the far less sensitive viral test by PCR. We really need to know how many people in a closed, high contact environment (without social distancing) become infected - and how many of those have antibodies and are likely now immune.
https://www.reuters.com/article/us-...-d4J2-dS4Mgg6cTq5BQBks-LWxRwYSbVE5NWS9d-3yY38
What's also interesting to me, though, is that the TR data are not that far off what we saw from the Diamond Princess cruise ship back in February, at least with respect to positive cases. The DP, like the TR, was a perfect "floating virus transmission laboratory" with 3711 people, who were exposed to the virus for 14 days (before the quarantine) in a location as densely populated as Manhattan with conditions ripe for transmission, given communal activities and meals and close quarters.
About 712 people tested positive by the viral test (19%) and of those about half had symptoms and half did not and we have no idea how many of the rest were infected but tested negative, due to low virus levels not detectable by the test. We'd need to test all of them via the serological antibody assay to know for sure (wasn't done and now likely too late to do). And of those 705, 9 died for a case fatality rate of 1.3%, while 37 (5.2%) required intensive care. It's not surprising that the CFR was about 8X higher than on the TR, given that the DP population skewed heavily towards the elderly.
https://www.nature.com/articles/d41586-020-00885-w
https://rutgers.forums.rivals.com/t...social-distancing.191275/page-36#post-4471448
We need antibody testing to happen ASAP. Having something like 30% of the population being “immune” would be such good news.
While this is certainly encouraging, there is still a long way to go before concluding that remdesivir is effective. This is not a placebo/standard-treatment controlled trial and it's data being leaked without authorization, which is highly irregular (Stat obtained a copy of an internal U of Chicago video discussing the results). To their credit, Gilead is not claiming anything definitive yet either.
In addition, given that remdesivir hasn't shown compelling data, so far, in earlier COVID trials, I'd say let's wait for the full trial data to become available in the next week or two, as well as results from some other ongoing trials. We just went through weeks of churn over HCQ, which is not panning out, despite some promising early results. Proving a drug works isn't easy, although I've always been more optimistic that anti-virals, like remdesivir and others would have at least some efficacy (since they have some anti-viral activity).
https://blogs.sciencemag.org/pipeli...clinical-data-against-covid-19-as-of-april-16
Gilead, in an emailed statement, said "the totality of the data need to be analyzed in order to draw any conclusions from the trial."
UChicago Medicine, also in an email, said "partial data from an ongoing clinical trial is by definition incomplete and should never be used to draw conclusions."
The university said information from an internal forum for research colleagues concerning work in progress was released without authorization.
Gilead expects results from its Phase 3 study in patients with severe COVID-19 at the end of this month, and additional data from other studies to become available in May.
https://www.nytimes.com/reuters/2020/04/16/us/16reuters-health-coronavirus-gilead-sciences.html
At 1:24 AM,there are 4 cops in Times Square and no one else.I'm waiting for Orson Welles to appear any minute now.
Only 6 states have higher death totals from this virus than are the totals from the 10 year average of flu deaths in their respective states:NY,NJ,CT,MI,MA,and LA.
So why are the other 44 states on lockdown?Furthermore,within those 6 states are the hot spots where most of the deaths are concentrated.
Dean Wormer would likely have had something to say for the way this situation has been handled.
So why are the other 44 states on lockdown?Furthermore,within those 6 states are the hot spots where most of the deaths are concentrated.
Dean Wormer would likely have had something to say for the way this situation has been handled.
Are you comparing annual flu deaths against 1 month of Covid-19 deaths?
To answer your question, gonna go out on a limb here and say they are probably locked down so they don’t turn into a New Jersey....
It’s almost like the mitigation efforts you are complaining about are actually helping those 44 states stay safe.
BINGO!!!! If they didnt learn from those hit hardest, they should have gotten a good knock in the head. Kinda like the knock Georgia's and Florida's governors should have gotten.
Really good commentary by Derek Lowe (In the Pipeline, the best blog out there on new pharmaceuticals currently in R&D usually; he's a PhD organic chemist who has spent 30+ years in drug discovery and development) this morning. He also said releasing this info was a serious breach of protocol:
And let’s be honest about this part: this was a severe breach of the trial protocol, the sort of thing that under other circumstances could lead to the whole thing being invalidated and not accepted by the FDA as evidence. That’s not going to happen here; everyone is just going to roll their eyes, kick their desks, and find a way to deal.
He also had similar commentary about the weakness of the study, given no control arm and the overstating of what "severe" patients meant - these were not people on ventilators (those folks were formally excluded from the trial). Again, we need to see the results from randomized, standard-of-care-controlled, double-blind clinical trials (ongoing) to determine safety and efficacy of this drug.
But now that it’s out there, let’s talk about what’s in the leak. Gilead stock jumped like a spawning salmon in after-market trading on this, and one of the reasons was that that 113 of the 125 patients were classed as having “severe disease”. People ran with the idea that these must have been people on ventilators who were walking out of the hospital, but that is not the case. As AndyBiotech pointed out on Twitter, all you had to do was read the trial’s exclusion criteria: patients were not even admitted into the trial if they were on mechanical ventilation. Some will have moved on to ventilation during the trial, but we don’t know how many (the trial protocol has these in a separate group).
Note also that this trial is open-label; both doctors and patients know who is getting what, and note the really key point: there is no control arm. This is one of the trials mentioned in this post on small-molecule therapies as being the most likely to read out first, but it’s always been clear that the tradeoff for that speed is rigor. The observational paper that was published on remdesivir in the NEJM had no controls either, of course, and that made it hard to interpret. Scratch that, it made it impossible to interpret. It will likely be the same with this trial – the comparison is between a five-day course of remdesivir and a ten-day course, and the primary endpoint is the odds ratio for improvement between the two groups.
So we will have the choice to like remdesivir or to love it; there will be no direct standard of comparison for how these patients will have done without it. Everyone will be trying to synthesize such a comparator from other clinical trials and reports, but that’s a dangerous business. I hope that we can learn something from the subgroup analyses, but there’s a limit.
Bottom line: I’m sounding like a defective parrot here because I say this so often, but we have to wait for controlled trials in order to say anything definite. Such trials are underway, with actual comparisons to standard of care, but they take longer. Fast trials are generally not very interpretable, interpretable trials are generally not fast. I will be glad to see these numbers when they appear, but don’t believe anyone who runs with a “Cure for Covid!” headline, because it’s extremely unlikely that remdesivir (a single agent with a broad mechanisms that’s not optimized for this virus) is any such thing. My hope for the drug is that it is effective enough to get people out of the hospitals more quickly and to keep more of them off ventilators than if they were not taking it. For that hope to be realized, we need that comparison to the people who are not taking it. This trial doesn’t have it.
https://blogs.sciencemag.org/pipeli...hats-happening-with-remdesivir#comment-316789
Only time will tell here.
In any event,there's a link at the top of Drudge today telling of a study claiming that regular,vigorous cardiovascular exercise prevents this virus from attacking the lungs.You don't see distance runners dying from this.
In any event,there's a link at the top of Drudge today telling of a study claiming that regular,vigorous cardiovascular exercise prevents this virus from attacking the lungs.You don't see distance runners dying from this.
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