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COVID-19 Pandemic: Transmissions, Deaths, Treatments, Vaccines, Interventions and More...

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China probably failed..they are just lying about their failure.
They definitely lied and covered up their failure in Hubei province. As for the rest of China - they may be lying to some degree but their response seems to have been similar to what was done in South Korea and Taiwan. Both places have so far managed to keep the outbreak largely under control with rigorous testing/tracing/quarantine along with lockdowns and movement restrictions when needed. This shows that it can be done. Will it work over the long haul, until a vaccine is available? Time will tell. It's certainly resource intensive but obviously saves lives, at least in the short term.

As for the "all countries failed except SK/Taiwan (or China)" that I've seen people using to justify the US response, that's pretty lame. The US prides itself on being a world leader, best medicine, best research, best intelligence services. Where were all those when South Korea and Taiwan were ramping up their preparedness and testing? And before anyone complains about this being a political post, I've said before and I'll say again that the failure was across all levels of government and also includes previous administrations who were supposedly planning for this very event for decades.
 
Why can't business re-open by using oximeters on every customer?If your level is 98 and above,it's not likely that you have the virus.My level was 99 today.
 
I'm really eager to know what their sample population will be.
I briefly looked for an answer to that question but found no additional details to what he provided. I guess we will learn more this week.
 
Andrew Cuomo
@NYGovCuomo


NEW: NYS will undertake the most aggressive statewide antibody testing survey in the nation in the next week. It will tell us for the first time what percentage of the population has actually had #Coronavirus. This will be the first true snapshot of what we’re dealing with.
12:29 PM · Apr 19, 2020·Twitter Web App
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Finally. We really need these data.

I would also hope somebody took blood samples from everyone on the T. Roosevelt carrier which tested everyone and had ~13% of its crew test positive for the virus (with more than half asymptomatic), which is not surprising given close quarters and no social distancing (just like the Diamond Princess had 19% test positive). That would be the perfect population to do the antibody test on to see how many more were infected, but didn't test positive (20-40% false negative rate for the virus PCR test), although we know that antibodies don't immediately appear after infection, so it's possible some would test negative, but still develop the antibodies and immunity later.
 
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That's part 2, explaining why the outbreak spread so fast in a population not taking any precautions, which is no surprise at all (been saying for over a month that high density/movement locations are at the greatest risk). Part 1 was the more important part: not having tests available until about 3/7 (<200 tests done in NY before then) leaving us flying blind in a pandemic. If we had been doing a lot of testing in late February, as originally planned, we would've likely known we had a significant outbreak in this area a couple of weeks early and could've implemented tracing, quarantining and social distancing/shutdowns earlier, potentially saving most of the lives lost in this area. Like South Korea - Seoul has 10 MM people and their metro area has 25MM, not too different from NYC/NYC Metro and they were able to control their outbreak. It's not rocket science and it was all laid out in the various pandemic planning documents/exercises the CSIS and HHS conducted last year.
 
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Finally. We really need these data.

I would also hope somebody took blood samples from everyone on the T. Roosevelt carrier which tested everyone and had ~13% of its crew test positive for the virus (with more than half asymptomatic), which is not surprising given close quarters and no social distancing (just like the Diamond Princess had 19% test positive). That would be the perfect population to do the antibody test on to see how many more were infected, but didn't test positive (20-40% false negative rate for the virus PCR test), although we know that antibodies don't immediately appear after infection, so it's possible some would test negative, but still develop the antibodies and immunity later.
They'll probably focus the testing initially in the NYC area which makes sense, but they really need to sample some less populated parts of the state to see how much spread there's been in different environments. I know testing is still very restricted up here and our case counts haven't really started to go down yet though there has been some evidence of leveling off.
 
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Andrew Cuomo
@NYGovCuomo


NEW: NYS will undertake the most aggressive statewide antibody testing survey in the nation in the next week. It will tell us for the first time what percentage of the population has actually had #Coronavirus. This will be the first true snapshot of what we’re dealing with.
12:29 PM · Apr 19, 2020·Twitter Web App
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“It will tell us for the first time what percentage of the population has actually had coronavirus,” Cuomo said. “This will be the first true snapshot of what we’re dealing with.”

Secretary to the governor, Melissa DeRosa tweeted Sunday the antibody test will sample 3,000 people for a population of 19.5 million people.

“For context, Germany just did 3K person sample with a population of 83M,” DeRosa tweeted.

She also says the sample will be representative of the state by region, race, gender, and age.

https://www.wivb.com/health/coronavirus/new-york-state-antibody-test-will-sample-3000/
 
“It will tell us for the first time what percentage of the population has actually had coronavirus,” Cuomo said. “This will be the first true snapshot of what we’re dealing with.”

Secretary to the governor, Melissa DeRosa tweeted Sunday the antibody test will sample 3,000 people for a population of 19.5 million people.

“For context, Germany just did 3K person sample with a population of 83M,” DeRosa tweeted.

She also says the sample will be representative of the state by region, race, gender, and age.

https://www.wivb.com/health/coronavirus/new-york-state-antibody-test-will-sample-3000/

Anyone know the timing around this? Hoping for a big number.
 
That's part 2, explaining why the outbreak spread so fast in a population not taking any precautions, which is no surprise at all (been saying for over a month that high density/movement locations are at the greatest risk). Part 1 was the more important part: not having tests available until about 3/7 (<200 tests done in NY before then) leaving us flying blind in a pandemic. If we had been doing a lot of testing in late February, as originally planned, we would've likely known we had a significant outbreak in this area a couple of weeks early and could've implemented tracing, quarantining and social distancing/shutdowns earlier, potentially saving most of the lives lost in this area. Like South Korea - Seoul has 10 MM people and their metro area has 25MM, not too different from NYC/NYC Metro and they were able to control their outbreak. It's not rocket science and it was all laid out in the various pandemic planning documents/exercises the CSIS and HHS conducted last year.
If the question is why it was hit harder then the rest of the country, then the part 1 is not relevant, as every state was flying blind.
 
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If the question is why it was hit harder then the rest of the country, then the part 1 is not relevant, as every state was flying blind.
Disagree completely. NY/NJ were hit earlier, likely due to much more international travel and regional commuting, when there was no testing and it spread a lot faster for the density/contact reasons discussed above. Earlier testing would have revealed the earlier outbreak, just like it did in SK, who was earlier than anyone but China. Testing was on line to at least some degree in most states by the time the outbreak hit them.
 
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The other factor is that the limited testing was initially focused on those who traveled to Asia, per CDC requirements. Since it appears that initial cases of the virus in the NY area were imported from Europe, those who exhibited symptoms were not tested, since they did not travel to Asia or have contact with someone who traveled to Asia. This allowed widespread infection in the NY metro area before testing capacity was ramped up and the "Asia" requirement was removed from the testing protocol.
 
“It will tell us for the first time what percentage of the population has actually had coronavirus,” Cuomo said. “This will be the first true snapshot of what we’re dealing with.”

Secretary to the governor, Melissa DeRosa tweeted Sunday the antibody test will sample 3,000 people for a population of 19.5 million people.

“For context, Germany just did 3K person sample with a population of 83M,” DeRosa tweeted.

She also says the sample will be representative of the state by region, race, gender, and age.

https://www.wivb.com/health/coronavirus/new-york-state-antibody-test-will-sample-3000/
Looks like they have capacity to take a larger sample.

From CNN:

On antibody testing: Cuomo said said the FDA has approved the state's antibody tests.

“Now that we have the approved test we’re going to be rolling it out to do the largest survey of any state population that has been done,” he said.

Cuomo said the state can conduct 2,000 antibody tests per day, or about 14,000 per week. He mentioned that while this sounds like a large number, it is only a small percentage of New York's population of more than 19 million people.

Cuomo said this is the first real statistical number on exactly “where we are as a population,” and will provide a true “baseline.”

“We have not had hard data on where we are," Cuomo said.
 
I'm really eager to know what their sample population will be.
All of us are.If they include only obese,two pack a day smokers,the tally will be very high.If distance runners are the ones sampled,the total should be microscopic.They need to break it down into as many categories as we see on Election Night.
 
All of us are.If they include only obese,two pack a day smokers,the tally will be very high.If distance runners are the ones sampled,the total should be microscopic.They need to break it down into as many categories as we see on Election Night.

That doesn't make sense. They're testing to see what percentage of the population has been infected. The criteria you cite aren't relevant to the infection rate.
 
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That doesn't make sense. They're testing to see what percentage of the population has been infected. The criteria you cite aren't relevant to the infection rate.
Yep. They have a couple of top notch epidemiologists they've been collaborating with at Weill Cornell Medical including Dr. Hupert, who has been very good throughout this. Presumably they know how to take the appropriate random, yet representative sample population from NY (including county level representative samples, too, to capture NYC).

https://news.weill.cornell.edu/news...rucial-in-the-fight-against-covid-19-pandemic

I'll be surprised if we're below 15% with antibodies in the NYC metro area (which has been hit the hardest and is most likely to have very high infection levels approaching an isolated ship, given density and contact levels), based on the carrier and the Diamond Princess having 13%/19% positive for the virus, respectively (they tested everyone on each ship), which only showed those positive with the virus, which almost certainly is less than those with antibodies, since the virus test is not nearly as sensitive as the antibody test and will miss some infected people (20-40% by some estimates).
 
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Yep. They have a couple of top notch epidemiologists they've been collaborating with at Weill Cornell Medical including Dr. Hupert, who has been very good throughout this. Presumably they know how to take the appropriate random, yet representative sample population from NY (including county level representative samples, too, to capture NYC).

https://news.weill.cornell.edu/news...rucial-in-the-fight-against-covid-19-pandemic

I'll be surprised if we're below 15% with antibodies in the NYC metro area (which has been hit the hardest and is most likely to have very high infection levels approaching an isolated ship, given density and contact levels), based on the carrier and the Diamond Princess having 13%/19% positive for the virus, respectively (they tested everyone on each ship), which only showed those positive with the virus, which almost certainly is less than those with antibodies, since the virus test is not nearly as sensitive as the antibody test and will miss some infected people (20-40% by some estimates).

I dunno, I’d be pretty shocked if it’s above 15%. Would be great news, but NYC is much bigger than a ship.
 
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Yep. They have a couple of top notch epidemiologists they've been collaborating with at Weill Cornell Medical including Dr. Hupert, who has been very good throughout this. Presumably they know how to take the appropriate random, yet representative sample population from NY (including county level representative samples, too, to capture NYC).

https://news.weill.cornell.edu/news...rucial-in-the-fight-against-covid-19-pandemic

I'll be surprised if we're below 15% with antibodies in the NYC metro area (which has been hit the hardest and is most likely to have very high infection levels approaching an isolated ship, given density and contact levels), based on the carrier and the Diamond Princess having 13%/19% positive for the virus, respectively (they tested everyone on each ship), which only showed those positive with the virus, which almost certainly is less than those with antibodies, since the virus test is not nearly as sensitive as the antibody test and will miss some infected people (20-40% by some estimates).

Hopefully these tests are accurate - there have been so many poor quality tests released.

In the end, it likely will be epidemiologists like Hupert who make the decision on when we go back to work and play.
 
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I dunno, I’d be pretty shocked if it’s above 15%. Would be great news, but NYC is much bigger than a ship.
Edited: Wuhan population density is 15,000 per square mile (not 3000, as originally in this post - that's for the larger Wuhan metro area; the paper below was referencing the 15,000 per sq mi number), NYC is 26,000 per sq mi with Manhattan at 67,000 per sq mi and the Diamond Princess was estimated to have 4 the density of Wuhan or 60,000 per sq mi.

So, NYC is a bit more densely populated than Wuhan, but a fair amount less than the estimated DP density, except for Manhattan which is similar, except for the NYC subways, trains and buses which are even more densely populated (especially the subways). So, I think my 15% is certainly plausible for NYC, especially since the DP went 14 days before quarantines/social distancing, while the NYC area probably went 20-30 days before that. But that's just my somewhat educated guess - could be wrong...

Link to article on Diamond Princess
 
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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.
https://www.governor.ny.gov/news/am...sues-executive-order-requiring-all-people-new

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Summary/commentary for some key World/US data through 4/18.
  • The most important number in comparing outbreak severity, IMO, is deaths per 1MM people (cases and hospitalizations are important too, but are subject to much more error). Italy, Spain and Belgium are the highest in the world, in the neighborhood of 400-500 deaths/1MM. The US is in the middle of the pack with ~120 deaths/1MM, although the US is earlier in its outbreak and will likely catch up somewhat.
  • While the US, overall, looks better by comparison, if NY were a country it would have the worst outbreak in the world at 900 deaths/1MM, while NJ is in the range of those European countries at ~460 deaths/1MM. Have talked about why this is in other posts and will revisit shortly...
  • Excluding NY/NJ, the rest of the US is “only” at 53 deaths per 1MM, which is similar to Germany, the “best” of the populous European countries with 55 deaths/1MM. But that needs to be put in context of what is considered “good” control of the epidemic: South Korea, China, Taiwan, Japan, Singapore and more all have <10 deaths/1MM and were all hit with their first waves before the US and Europe. Most experts believe the differences are primarily due to how much better these countries did with early/aggressive testing, aggressive contact tracing and quarantining, moderate to aggressive social distancing, and establishing a mask culture.
  • Of course, there are also many other countries in South/Central America, Africa, and Asia with <10 deaths/1MM, but it’s possible some of that is due to some combo of low population density and much less travel to these locations and perhaps some of it is due to “seasonality” (like flu) where the virus is less virulent in warm/humid climates – will be interesting to see if these locations (especially in the southern hemisphere) start to see increases soon.
  • It’s worth noting that Iran is the only country outside of Europe and the US which has >50 deaths/1MM (62) US deaths have roughly plateaued in the 1500-2500/day range for about the past 12 days (with some fluctuations, including a huge fluctuation when NY added 3800 deaths on 4/14 that were presumed due to COVID, but never had a viral test done (most were in hospitals and it was obvious they had COVID, so the tests were skipped); hopefully we’ll see this start to decline in a week or so, as deaths lag cases. NY deaths per day plateaued around 700-800 per day for over a week, but have slowly dropped to about 500/day over the last 4 days. NJ deaths look like they are starting to decline.
  • 39.0K, 17.7K and 4.0K 28.5K total deaths, respectively, through 4/18 in the US, NY, and NJ. It’s now looking like my 4/5 guesstimate of 40-50K US deaths in this first wave will be a little low; the U of Washington latest projection is for 60K deaths (they were at 82K on 4/5).
  • The Earth hit 2.33MM positive cases on 4/18 with 739K cases in the US, 241K in NY and 81K in NJ.
Some comments on NY/NJ/US and from Cuomo’s 4/19 presser
  • Both NY and NJ have reached the “peak plateau” in new cases, with some decline starting to occur, especially in NY, which saw its lowest new case number (6K) since 3/25although there have been a few large fluctuations, likely related to testing rates; the US has reached a peak plateau also and has stayed there for about 2 weeks, although it looks like a decline might be starting.
  • NY now has done about 30K tests per 1MM in population, which is more than almost any other country; NJ is at 18K tests per 1MM and the US is at 11K tests per 1MM, both of which are middle-of-the-pack (vs. countries with major outbreaks)
  • Some very good news: total number of hospitalized in NY has steadily declined from about 19K to 16K over the last 4-5 days.
  • As promised, NY is now sending ventilators to other needy states, like Massachusetts, Michigan and Maryland
  • Currently three states are showing close to a 10% increase on 4/18 vs. 4/17: Nebraska (13%), Ohio (12.2% and South Dakota 9.3%).
  • Cuomo thanked the 1.1MM front line health care workers in NY, as well as the 95K medical staff who voluntarily came to NY simply to help.
  • He talked at length on the path back to the “new normal” with the major focus on the need for fast, massive testing for the virus, to know who is sick or getting sick, so they can be quarantined and their contacts traced, as well as massive antibody testing to know who already has had the virus and now likely has immunity, at least for months to maybe years.
  • He then announced NY’s ambitious program, starting tomorrow, to test thousands of people from a random, representative sample of the population, to estimate the percentage of people in NY who have had the virus: 1.2% of NY has tested positive by the virus test and there are estimates of 5-15-30% of the general population having been infected (and having antibodies) with most not knowing it. That number greatly impacts how many can go back to work without risks of getting or giving the virus and how much more transmission will occur (with less targets).
  • He reiterated the plan for NY/NJ/CT/RI/PA/MA/DE to manage the process of staged “reopenings” for their areas in a regionally coordinated fashion – doesn’t mean “identical” but it will at least be “coordinated.” Also talked about how we should be thinking of how this is an opportunity to improve health care, transportation and education, especially with technology.
  • He also reiterated the bipartisan NGA’s (Nat’l Gov’s Assoc) call for $500BB to help state/local budget shortfalls which were not addressed in CARES.



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Wuhan population density is 3200 per square mile, NYC is 26,000 per sq mi (with Manhattan at 67,000 per sq mi) and the Diamond Princess was estimated to have 4 the density of Wuhan or 12,800 per sq mi. Also, much of the immediate NYC Metro area (NE NJ/SW CT/Westchester/Rockland/LI areas) has a density in the 5000-15,000 people per sq mi.

Wuhan has 11 MM people in 3300 sq miles (which is roughly 1.5 times the area of Delaware).

But the urban core of Wuhan has 8.9 MM people in an area of 590 sq miles for an urban density of 15,000 people per sq mile. And the central Jiangan and Wuchang districts have a combined 2MM people with densities of over 35,000 people per sq mile.
 
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Ok, @LETSGORU91 and @RUfubar and this preprint is for you. Not sure if this qualifies as groundbreaking or just intriguing (since I'm not an MD/clinician), but if verified, it's one of the first papers I've seen that seems to have found some markers (IgG response time and NLR - neutrophil to lymphocyte ratio) that correlate reasonably well with COVID-19 severity and outcomes. The obvious next step might be to tailor treatments relative to these markers, where the markers might suggest certain types of treatment.

Findings A total of 222 patients were included in this study. IgG was first detected on day 4 of illness, and its peak levels occurred in the fourth week. Severe cases were more frequently found in patients with high IgG levels, compared to those who with low IgG levels (51.8% versus 32.3%; p=0.008). Severity rates for patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype was 72.3%, 48.5%, 33.3%, and 15.6%, respectively (p<0.0001). Furthermore, severe patients with NLRhiIgGhi, NLRhiIgGlo had higher proinflammatory cytokines levels including IL-2, IL-6 and IL-10, and decreased CD4+ T cell count compared to those with NLRloIgGlo phenotype (p<0.05). Recovery rate for severe patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype was 58.8% (20/34), 68.8% (11/16), 80.0% (4/5), and 100% (12/12), respectively (p=0.0592). Dead cases only occurred in NLRhiIgGhi and NLRhiIgGlo phenotypes.


Interpretation COVID-19 severity is associated with increased IgG response, and an immune response phenotyping based on late IgG response and NLR could act as a simple complementary tool to discriminate between severe and nonsevere COVID-19 patients, and further predict their clinical outcome.

https://www.medrxiv.org/content/10.1101/2020.03.12.20035048v1.full.pdf
Ok, @LETSGORU91 and @RUfubar and this preprint is for you. Not sure if this qualifies as groundbreaking or just intriguing (since I'm not an MD/clinician), but if verified, it's one of the first papers I've seen that seems to have found some markers (IgG response time and NLR - neutrophil to lymphocyte ratio) that correlate reasonably well with COVID-19 severity and outcomes. The obvious next step might be to tailor treatments relative to these markers, where the markers might suggest certain types of treatment.

Findings A total of 222 patients were included in this study. IgG was first detected on day 4 of illness, and its peak levels occurred in the fourth week. Severe cases were more frequently found in patients with high IgG levels, compared to those who with low IgG levels (51.8% versus 32.3%; p=0.008). Severity rates for patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype was 72.3%, 48.5%, 33.3%, and 15.6%, respectively (p<0.0001). Furthermore, severe patients with NLRhiIgGhi, NLRhiIgGlo had higher proinflammatory cytokines levels including IL-2, IL-6 and IL-10, and decreased CD4+ T cell count compared to those with NLRloIgGlo phenotype (p<0.05). Recovery rate for severe patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype was 58.8% (20/34), 68.8% (11/16), 80.0% (4/5), and 100% (12/12), respectively (p=0.0592). Dead cases only occurred in NLRhiIgGhi and NLRhiIgGlo phenotypes.


Interpretation COVID-19 severity is associated with increased IgG response, and an immune response phenotyping based on late IgG response and NLR could act as a simple complementary tool to discriminate between severe and nonsevere COVID-19 patients, and further predict their clinical outcome.

https://www.medrxiv.org/content/10.1101/2020.03.12.20035048v1.full.pdf

Even though it's China reporting, their theory of the high IGG phenotype may be, in fact , a contraindication to using plasma donor during severe cytokine storm. Now that's interesting in that we may be making things worse in that particular phenotype - but we are at the "what do we got to lose "stage anyway andwedon't know what the f*** we're doing. The only common sense method of dealing with this is to identify people at the earliest possible stage of infection or pre-infectionand block the damn receptor. BLocking receptor would also deal with mutations since they all behave the same way at the receptor site. I'll leave that for the people who are a lot smarter than me.
I must say though that I've seen a similar phenomena before with some healthy people who go on the bypass machine and have over reactive hyperimmune responses to the filters and tubing and have a rough post-op time as opposed to some frail elderly who are just able to walk out of the hospital like nothing happened.
 
Even though it's China reporting, their theory of the high IGG phenotype may be, in fact , a contraindication to using plasma donor during severe cytokine storm. Now that's interesting in that we may be making things worse in that particular phenotype - but we are at the "what do we got to lose "stage anyway andwedon't know what the f*** we're doing. The only common sense method of dealing with this is to identify people at the earliest possible stage of infection or pre-infectionand block the damn receptor. BLocking receptor would also deal with mutations since they all behave the same way at the receptor site. I'll leave that for the people who are a lot smarter than me.
I must say though that I've seen a similar phenomena before with some healthy people who go on the bypass machine and have over reactive hyperimmune responses to the filters and tubing and have a rough post-op time as opposed to some frail elderly who are just able to walk out of the hospital like nothing happened.
I've been saying all along we need to treat people earlier, but that's hard to do in an overwhelmed hospital system. Maybe once we beat back the crisis we can start getting people into hospitals and treated before they become severe/critical cases.

Has anyone been using the "cytosorb" or whatever it is called - to remove cytokines from the blood? I don't know if that is something that is widely available or even if it's been widely tested but remember reading about it a while ago.
 
I've been saying all along we need to treat people earlier, but that's hard to do in an overwhelmed hospital system. Maybe once we beat back the crisis we can start getting people into hospitals and treated before they become severe/critical cases.

Has anyone been using the "cytosorb" or whatever it is called - to remove cytokines from the blood? I don't know if that is something that is widely available or even if it's been widely tested but remember reading about it a while ago.

So here's where I disagree and here comes some dirty little secrets. The hospitals are breeding grounds and virus factories. One hospital system where I am on staff is letting the docs back after a week as long as they're
asymptomatic for 72 hours and nobody knows or cares if they're blowing virus in the air or out their ass.
Yet at other systems you are required to be out for two weeks and show two negative PCR tests separated by a week apart. And we all know that there r sampling problems and don't know if people are getting reinfected or if it's just a sampling problem. So those negative people, are they truly negative and do they have a neutralizing antibodies present?
And this is a an infection that people get sick coincident with a high viral load as well and there's lots of high viral loads circulating around hospitals. It's a problem with the US system being so hospital-based. In Germany they have more docs doing a more concierge type of practice with the covid patients and doing house calls I believe with what they called covid mobiles, so they areable to keep people out of the hospital and they're doing a lot better.this virus loves the dysfunctional US healthcare system which is hospital-based and eats it alive. One administrator tried to pull a fast one on me a couple weeks ago to get me to go to a high viral load hospital on Sunday afternoon and only told me the "bait and switch hospital"at the end of the conversation. The whole time I thought he was talking about the hospital that my own patients were stationed at. The dude was just looking for a body and when I said I'd like to help but I wasn't familiar with the EMR at that particular hospital he said who cares " just jotdown a note and we'll scan it." I told the dude to get one of the young bucks from the hospital I'm familiar with to go over there and I'll do the young bucks shift.
 
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So here's where I disagree and here comes some dirty little secrets. The hospitals are breeding grounds and virus factories. One hospital system where I am on staff is letting the docs back after a week as long as they're
asymptomatic for 72 hours and nobody knows or cares if they're blowing virus in the air or out their ass.
Yet at other systems you are required to be out for two weeks and show two negative PCR tests separated by a week apart. And we all know that there r sampling problems and don't know if people are getting reinfected or if it's just a sampling problem. So those negative people, are they truly negative and do they have a neutralizing antibodies present?
And this is a an infection that people get sick coincident with a high viral load as well and there's lots of high viral loads circulating around hospitals. It's a problem with the US system being so hospital-based. In Germany they have more docs doing a more concierge type of practice with the covid patients and doing house calls I believe with what they called covid mobiles, so they areable to keep people out of the hospital and they're doing a lot better.this virus loves the dysfunctional US healthcare system which is hospital-based and eats it alive. One administrator tried to pull a fast one on me a couple weeks ago to get me to go to a high viral load hospital on Sunday afternoon and only told me the "bait and switch hospital"at the end of the conversation. The whole time I thought he was talking about the hospital that my own patients were stationed at. The dude was just looking for a body and when I said I'd like to help but I wasn't familiar with the EMR at that particular hospital he said who cares " just jotdown a note and we'll scan it." I told the dude to get one of the young bucks from the hospital I'm familiar with to go over there and I'll do the young bucks shift.
Yeah, I hear you on hospitals...not only virus but also bacterial breeding grounds. What's the adage, the worst place for a sick person is the hospital? Scary to hear that the "regs" are so different for various places. Still, I think it is imperative that we treat people with covid earlier in the disease process. If there is a way to do that outside of a hospital, I'm all for that. Outpatient clinic, doctors office, whatever...though I think some of the treatments might require a hospital type setting. Doesn't remdesivir, for example, have to be given as an IV?

Anyway, stay safe!
 
Wuhan has 11 MM people in 3300 sq miles (which is roughly 1.5 times the area of Delaware).

But the urban core of Wuhan has 8.9 MM people in an area of 590 sq miles for an urban density of 15,000 people per sq mile. And the central Jiangan and Wuchang districts have a combined 2MM people with densities of over 35,000 people per sq mile.
Thanks - just took the 3K number off the internet, without realizing the paper had more details elsewhere. Edited original post since I didn't want to leave incorrect info out there. Didn't change my thinking much, especially considering the very densely populated mass transit systems, so I'd still say 15% with antibodies in the NYC area is plausible.

Here's the relevant section from the paper...

"Assuming that only 50% of decks are being used, approximately 62,400 persons are confined per mi2 on a ship compared to approximately 15,300 persons per mi2 in urban Wuhan. This means that the population density was about 4 times higher on the cruise ship."

https://watermark.silverchair.com/t...fWdR-iffe8pWpJkvx_xMjFLLUWdbFv5NtLzXHNI_411zQ
 
Another data point (as if we needed more) on the value of early, aggressive testing, with tracking, quarantining and early treatment on controlling the outbreak and reducing death rates in this comparison of Germany and France. Both have very good health care systems and are wealthy countries, but Germany has simply done way better, so far, with only 55 deaths per 1MM vs. 302 per 1MM in France, despite them having about the same number of cases - Germany, however has tested 3X as many per 1MM.

“Testing and tracking is the strategy that was successful in South Korea and we have tried to learn from that,” Hendrik Streeck, who leads the University of Bonn’s virology institute, told the New York Times.

It appears Germany plans to keep up intense tracking for the foreseeable future. “Once ... we are down to, let’s say, a couple of hundred cases per day or even better, less than a hundred cases, we will try to follow up on every case and get in touch with everyone who has been in touch with those new cases, quarantine and test them,” Karl Lauterbach, an epidemiologist at the University of Cologne, told CNBC on April 3.


https://www.vox.com/2020/4/17/21223915/coronavirus-germany-france-cases-death-rate
 
Unfortunately they are vulnerable places for the virus.
There are coronavirus cases at more than 20% of California's skilled nursing homes

From CNN's Stella Chan

More than 20% of the California’s skilled nursing facilities have reported at least one coronavirus case, according to data released by the California Department of Public Health.

Brier Oak on Sunset in Los Angeles reports 80 patient cases and 62 staff cases. The Redwood Springs Healthcare center in Tulare County has 91 cases among patients and 46 among staff. And the Gateway Care & Rehabilitation Center in Alameda County reports 69 patient cases and 33 staff cases.

The point-in-time data of 86% of reporting facilities in the last 24 hours as of Friday. California has a total of 1,224 nursing homes
 
Another treatment approach. My buddy (who used to be in my group at Merck and is now a VP at Regeneron!) sent me this link to an NBC piece on their elegant approach to treating and or preventing COVID-19 and they're hopeful they'll have a product in the not too distant future. It's essentially antibody therapy, where a "pseudo" coronavirus is used to elicit antibodies in mice genetically altered to mimic the human immune system and the antibodies that work best to deactivate the coronavirus are then selected and cultured in large bioreactors featuring cell lines which make enough product for the market.

The product can either be a treatment for infected patients (at higher doses) or a preventative for uninfected patients, kind of like a vaccine, except with vaccines, usually some weakened or killed virus is injected so the human body makes the antibodies to it, so that when the actual virus is encountered, the body is ready to destroy it. Since no virus is being injected (just antibodies), it should make clinical trials far simpler to run (and much easier to evaluate for safety/efficacy), although it likely would only work for several months as a preventative, which would still be great, especially for health care workers. Let's hope this approach works - it has worked for other diseases like Ebola, especially as a treatment. Other companies, obviously, are pursuing similar approaches.

https://www.nbcnews.com/…/new-york-biotech-company-working-…

Update on the "engineered antibody" approach being pursued by Regeneron and other companies - they don't all do it the same way, but they all produce some sort of antibody "cocktail" to boost the ability of the body to neutralize the cell invasion/replication of the virus. This antibody cocktail can be infused into humans as a treatment for those ill with the virus or as a somewhat short term prophylactic for healthy people until a longer acting vaccine is available.

As per the quoted post, Regeneron used this approach with significant success in treating patients sick with the Ebola virus, so the approach should work. How well and for how long are the big questions. Regeneron has seen success in the lab and has selected their cocktail of antibodies to test in monkeys shortly, with potential human clinical trials to start in late June.

If successful, commercial launch would come in August with the potential to treat 20K sick patients per month or 200K healthy at-risk patients (more is needed for sick patients) - ramping up to millions should only take a few months. There are several other companies working in this area, too, with similar timelines. Crossing fingers, especially since if this or the convalescent plasma-antibody treatment in ongoing trials now is highly effective for seriously ill patients, it's a gamechanger, as it would give most people confidence to return to "somewhat normal" life (especially young/healthy people).

“The odds are very high this will work, especially when you have multiple programs and multiple manufacturers,” says James Crowe, a veteran immunologist at Vanderbilt University Medical Center who’s working with AstraZeneca Plc and others on Covid-19 treatments. Scott Gottlieb, former head of the U.S. Food and Drug Administration, also sounded optimistic in a recent interview with Bloomberg News, saying, “If I had to place one bet on a drug that could be available by the summer and could have activity and could have a profile that I think could change the contours of the infection, it would be the antibody approaches.”

https://www.bloomberg.com/news/feat...JqQM4w5jnsXJpRhOUKFQlLBQMbRF5kX3TztXuDw09IloU
 
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Old, old news? The 17 bodies crammed into a room story broke just after Easter. Representatives claimed the Easter/Passover time resulted in slow processing of the bodies out and to the funeral home. This story I linked came out 13 hours ago. NBC reported the total was up to 75 this morning. Maybe you are confusing Andover with this following nursing home in Woodbridge, but the Andover facility is far from old news:

From 3/29/20
https://www.newjerseyhills.com/hano...cle_2e01ba5d-e1cb-5010-8c9d-e0c0bb4d6391.html
 
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Thought this graphic was pretty cool. Shows the R0 (they're calling it Rt) which is a measure of current viral transmission rates, where 1 is the point at which the infection stops spreading (without interventions the R0 is somewhere between 2.3 and 5.7, from different papers - most are now thinking it's on the high side, i.e., if it's 5.7 that means every infected person will infect 5.7 other people - that's much higher than influenza). NY/NJ are right around 1 (would've thought it was lower), due to social distancing and CT is below 0.5 (I thought NJ would be closer to that). Not exactly sure how calculated...

6wxAFZm.png


https://rt.live/#learn-more
 
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