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

[RU848789]

Numbers the anti-HCQ Brazil study is no more legitimate than the pro HCQ study done in France. They both dont pass mustard of a robust clinical trial. CNBC is being disingenuous blaming cardiac AEs on HCQ. Fact is nobody knows. The patients also received Z-Pack and Z-Pack is KNOWN to have cardiac AEs. Could have been Z-Pack for all we know plus they were severe patients. We already discussed ad nauseam that severe patients in cytokine storm will not be helped by an anti-viral. Let's wait for the large trials to conclude then we can judge HCQ good or bad.

Also, for altruistic reasons, cheap meds like HCQ and chlroquine will be helpful for countries with bad or non-existent healthcare systems. Do you think plasma therapy or even remdesivir would be viable in a country like Angola?

You're correct that neither is definitive, but I think the weight of evidence of the trials so far leans heavily towards lack of efficacy and several of my clinical expert colleagues agree, as does Derek Lowe and Dr. Bright, who was just sacked and the fact that HCQ is being used so much without any startlingly good results is enough for me to say that, at best, it's efficacy is marginal. Also, convalescent plasma is certainly viable in poor countries, with just a little help - hell, it was used in the 1890s and the 1918 pandemic.

Did you see Dr. Bright's comments after being sacked from his post at HHS, where he was deputy assistant secretary for preparedness and response and director of BARDA, the Biomedical Advanced Research and Development Authority (excerpted below)? Lowe and Bright are two of our best minds and I'll take their take on HCQ (as well as my friends' views).

https://blogs.sciencemag.org/pipeline/archives/2020/04/22/the-politics-of-hydroxychloroquine

“. . .To this point, I have led the government’s efforts to invest in the best science available to combat the Covid-19 pandemic. Unfortunately, this resulted in clashes with H.H.S. political leadership, including criticism for my proactive efforts to invest early into vaccines and supplies critical to saving American lives. I also resisted efforts to fund potentially dangerous drugs promoted by those with political connections.

Specifically, and contrary to misguided directives, I limited the broad use of chloroquine and hydroxychloroquine, promoted by the administration as a panacea, but which clearly lack scientific merit. While I am prepared to look at all options and to think ‘outside the box’ for effective treatments, I rightly resisted efforts to provide an unproven drug on demand to the American public. I insisted that these drugs be provided only to hospitalized patients with confirmed Covid-19 while under the supervision of a physician. . .”

 

[RU848789]

Biggest news from Cuomo's presser...

21.2% in NYC are positive for antibodies and should now be immune and not contagious (preliminary data, though). I had been guessing 15%. Here's the data...

A bit of controversy over the wide variety of antibody tests out there right now, as many are being run under EUA (Emergency Use Authorization) and a recent study showed that their accuracy is questionable.

This is a real problem for general use of these tests, as the results inform individual decisions, i.e., false positives will tell people they have antibodies and are likely immune/not contagious, when in fact they are neither, and might result in people taking risks when they shouldn't. The risk of false negatives is much lower, since that will simply result in people presumably continuing to be careful when they don't need to be. The former could get someone killed, while the latter cannot.

However, the usually small errors (except for a few which were bad) are not much of an issue for population sampling, like the NYS antibody testing that just showed ~14% of NY and 21% of NYC having antibodies, since the errors would likely only minimally affect the overall numbers and individuals shouldn't be finding out the results if the tests aren't nearly perfect. However,

https://www.nytimes.com/2020/04/24/health/coronavirus-antibody-tests.html

Dr. Krammer has developed a two-step Elisa test that he said has 100 percent specificity and delivers a measure of the quantity of IgM and IgG antibodies a person has. Scoring a rapid test’s bands might offer some data for a scientific study, he said, “but I would not make any decisions based on that.”

Dr. Krammer said false positives are less of an issue for assessing how widely the virus has spread in the population. If a test has a known false-positive rate, scientists can factor that into their calculations, he said.

But false positives become dangerous when making policy and personal decisions about who can go back to work. “You don’t want anybody back to work who has a false positive — that’s the last thing you want to do,” Dr. Krammer said.

Speaking of which, Dr. Krammer, from Mt. Sinai, who developed the very accurate 2-step ELISA antibody test, called the NY test into question, saying that the State should have shared details of the test and its accuracy before sharing the results with the public. I agree.

https://slate.com/technology/2020/04/what-do-new-yorks-antibody-tests-mean.html

 

[Proud NJ Sports Fan]

Blood sugar could be key
https://theconversation.com/amp/blo...e-protective-136592?__twitter_impression=true

 

[rutgersguy1]

I don't know if this was posted already here but came across this piece from a doctor in the NY Times with regards to the low oxygen levels and patients being "normal" for the most part. Pulse oximeter recommendation in it too.

From the article:

We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath.

Patients compensate for the low oxygen in their blood by breathing faster and deeper — and this happens without their realizing it. This silent hypoxia, and the patient’s physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until oxygen levels plummet. In effect, patients are injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure.

By the time patients have noticeable trouble breathing and present to the hospital with dangerously low oxygen levels, many will ultimately require a ventilator.

Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath. (It appears that most Covid-19 patients experience relatively mild symptoms and get over the illness in a week or two without treatment.)

https://www.nytimes.com/2020/04/20/...xa1BUVRijuWZtr-q3AtJ3xdvPlSu9rgDW1Z2IGapn3MLc

 

[RU848789]

I don't know if this was posted already here but came across this piece from a doctor in the NY Times with regards to the low oxygen levels and patients being "normal" for the most part. Pulse oximeter recommendation in it too.

From the article:

We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath.

Patients compensate for the low oxygen in their blood by breathing faster and deeper — and this happens without their realizing it. This silent hypoxia, and the patient’s physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until oxygen levels plummet. In effect, patients are injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure.

By the time patients have noticeable trouble breathing and present to the hospital with dangerously low oxygen levels, many will ultimately require a ventilator.

Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath. (It appears that most Covid-19 patients experience relatively mild symptoms and get over the illness in a week or two without treatment.)

https://www.nytimes.com/2020/04/20/...xa1BUVRijuWZtr-q3AtJ3xdvPlSu9rgDW1Z2IGapn3MLc

Yes, there was a pretty good discussion about this a couple of days ago. There are also some docs who think we should be treating this like altitude sickness. Then throw in the coagulation issues and unusual strokes and it's pretty clear that this thing isn't very well understood still.

 

[RU848789]

Interesting critique of the U Washington/IHME Model, which has increasingly become a low outlier among the models forecasting the evolution of the pandemic. Personally, I like the model a lot, which is why I've been sharing their regular updates. I also like that they show fairly wide ranges of outcomes for things like deaths and hospitalizations (and supplies), given the wide range of effectiveness of interventions, like social distancing.

But it is a purely statistical model, not taking into account the usual epidemiological factors like transmission rates and time to infection, so it has limitations. It's why NY was always talking about the several models they used, since the outcomes of those were often quite different. Because of its reliance on past rates/stats, it's likely to underestimate US deaths a bit; currently it's projecting 67K deaths, but there are many indications we're going to hit 70-80K before hopefully dropping to very low rates, assuming we continue with aggressive interventions until then (i.e., through May at least; my original guess was 85-170K over a month ago, assuming little social distancing before I dropped to 40-50K a few weeks ago with heavy social distancing - was too optimistic, sorry).

Yet the administration’s reliance on its projections has nevertheless frustrated much of the public health community, which cautions that IHME has not hewed to traditional disease modeling procedures or incorporated crucial variables. The result is a rosier picture of the crisis than the one portrayed by much of the rest of the modeling world.

“The IHME model is an odd duck in the pool of mathematical models,” said Gregg Gonsalves, an epidemiologist at the Yale School of Medicine. “I fear the White House is looking for data that tells them a story they want to hear, and so they look to the model with the lowest projection of death.”

At the center of those concerns is a key element, the IHME model’s critics say. The projection makes no attempt to account for the virus’ defining characteristics, such as how easily it spreads or how long someone can be infected before they show symptoms.

Instead, it relies on data from cities already hit by the coronavirus, including in Italy and China, and matches the U.S. to a similar curve.

https://www.politico.com/news/2020/04/24/trump-coronavirus-model-207582

 

[Proud NJ Sports Fan]

 

[Proud NJ Sports Fan]

Learn from history

There won't be a sloping curve, but instead many waves of carnage

 

[RU#1fan]

View embedded media

Stunning . Depressing as well.

 

[RU848789]

Breakthrough on the hypoxia/ventilator front from U of Chicago Medicine? I know many of us have been batting this topic around with regard to the horrible death rates (80-90%) on ventilators - sounds pretty cool...

https://www.uchicagomedicine.org/fo...1aoYs1pjWMu7sS9CmeHKcRmLF08F35fVvtOkJMiEeeinE

Doctors at the University of Chicago Medicine are seeing “truly remarkable” results using high-flow nasal cannulas rather than ventilators and intubation to treat some COVID-19 patients.

High-flow nasal cannulas, or HFNCs, are non-invasive nasal prongs that sit below the nostrils and blow large volumes of warm, humidified oxygen into the nose and lungs.

A team from UChicago Medicine’s emergency room took dozens of COVID-19 patients who were in respiratory distress and gave them HFNCs instead of putting them on ventilators. The patients all fared extremely well, and only one of them required intubation after 10 days.

 

[cohwx]

Breakthrough on the hypoxia/ventilator front from U of Chicago Medicine? I know many of us have been batting this topic around with regard to the horrible death rates (80-90%) on ventilators - sounds pretty cool...

https://www.uchicagomedicine.org/fo...1aoYs1pjWMu7sS9CmeHKcRmLF08F35fVvtOkJMiEeeinE

Doctors at the University of Chicago Medicine are seeing “truly remarkable” results using high-flow nasal cannulas rather than ventilators and intubation to treat some COVID-19 patients.

High-flow nasal cannulas, or HFNCs, are non-invasive nasal prongs that sit below the nostrils and blow large volumes of warm, humidified oxygen into the nose and lungs.

A team from UChicago Medicine’s emergency room took dozens of COVID-19 patients who were in respiratory distress and gave them HFNCs instead of putting them on ventilators. The patients all fared extremely well, and only one of them required intubation after 10 days.

I don't know if you're interested, but the link I posted yesterday (webinar with a number of ER/ICU doctors) covered the ventilator issue in great detail. Probably more detail than most would want but it was interesting to me.

 

[RU4Real]

Breakthrough on the hypoxia/ventilator front from U of Chicago Medicine? I know many of us have been batting this topic around with regard to the horrible death rates (80-90%) on ventilators - sounds pretty cool...

https://www.uchicagomedicine.org/fo...1aoYs1pjWMu7sS9CmeHKcRmLF08F35fVvtOkJMiEeeinE

Doctors at the University of Chicago Medicine are seeing “truly remarkable” results using high-flow nasal cannulas rather than ventilators and intubation to treat some COVID-19 patients.

High-flow nasal cannulas, or HFNCs, are non-invasive nasal prongs that sit below the nostrils and blow large volumes of warm, humidified oxygen into the nose and lungs.

A team from UChicago Medicine’s emergency room took dozens of COVID-19 patients who were in respiratory distress and gave them HFNCs instead of putting them on ventilators. The patients all fared extremely well, and only one of them required intubation after 10 days.

This doesn't indicate what "high flow" is. In the field, the rule of thumb is nothing more than 6 lpm via canula; anything more requires a mask because the nasal passages, alone, are flow-limited.

 

[RU848789]

I don't know if you're interested, but the link I posted yesterday (webinar with a number of ER/ICU doctors) covered the ventilator issue in great detail. Probably more detail than most would want but it was interesting to me.

Saw it, but didn't get around to watching - thanks for the reminder...

 

[RUBOB72]

Please stop the non sense and stupidity on covid19. We are nowhere near a vaccine and as for therapeutics that still needs to play out. All the conjecture by the Rutgers board experts is admirable but now on top of all the daily negative news items we still have conflicting reports . We have the US science nerds parroting media news reports which are worthless. Then we have the reports out of where else ? ...China... trust this regime with their past atrocities and human rights abuses. Now we have a possible bigger problem. If Kim Jong Un is dead , as the most recent reports claim , all bets are off the table. Within weeks China will either insert their puppet leader head or will place troops inside North Korea to make sure an insurgency amongst competing groups does not take place. It s not an ideal situation for bordering nations as China’s hope for global military expansion just became quite feasible. You do not have to have an advanced degree in diplomacy to figure what is coming next , especially since the US is under extreme duress with covid19 and China ‘s plan becomes more visible. If we get involved in a conflict with China we would be at a distinct disadvantage . Follow this just as carefully as you do with covid19 . Funny how some people don’t think Armageddon is possible. “ Eve Of Destruction” by Barry Maguire appropriate way back when and still fits what may soon be taking place... Ahh...to be back in the 60’s and 70’s... all we need is a good Hot Hot Hot summer .

 

[bethlehemfan]

Please stop the non sense and stupidity on covid19. We are nowhere near a vaccine and as for therapeutics that still needs to play out. All the conjecture by the Rutgers board experts is admirable but now on top of all the daily negative news items we still have conflicting reports . We have the US science nerds parroting media news reports which are worthless. Then we have the reports out of where else ? ...China... trust this regime with their past atrocities and human rights abuses. Now we have a possible bigger problem. If Kim Jong Un is dead , as the most recent reports claim , all bets are off the table. Within weeks China will either insert their puppet leader head or will place troops inside North Korea to make sure an insurgency amongst competing groups does not take place. It s not an ideal situation for bordering nations as China’s hope for global military expansion just became quite feasible. You do not have to have an advanced degree in diplomacy to figure what is coming next , especially since the US is under extreme duress with covid19 and China ‘s plan becomes more visible. If we get involved in a conflict with China we would be at a distinct disadvantage . Follow this just as carefully as you do with covid19 . Funny how some people don’t think Armageddon is possible. “ Eve Of Destruction” by Barry Maguire appropriate way back when and still fits what may soon be taking place... Ahh...to be back in the 60’s and 70’s... all we need is a good Hot Hot Hot summer .

Phew... I think I will buy some more Ammo and whiskey...

 

[RU4Real]

Not saying it's going to happen, but putting China in the DPRK doesn't really change anything.

I've been saying for years that our best political gambit (assuming a DPRK under Kim Jong Un's leadership) would have been to tell China to just go take it. It's a low-risk move for us and brings North Korea into a more stable environment.

There's not a great deal of concern about having a Chinese possession on the north side of the DMZ. None of the defensive strategy changes. Maybe you add a few more THAAD batteries, but that's about it.

 

[RU-05]

Please stop the non sense and stupidity on covid19. We are nowhere near a vaccine and as for therapeutics that still needs to play out. All the conjecture by the Rutgers board experts is admirable but now on top of all the daily negative news items we still have conflicting reports . We have the US science nerds parroting media news reports which are worthless. Then we have the reports out of where else ? ...China... trust this regime with their past atrocities and human rights abuses. Now we have a possible bigger problem. If Kim Jong Un is dead , as the most recent reports claim , all bets are off the table. Within weeks China will either insert their puppet leader head or will place troops inside North Korea to make sure an insurgency amongst competing groups does not take place. It s not an ideal situation for bordering nations as China’s hope for global military expansion just became quite feasible. You do not have to have an advanced degree in diplomacy to figure what is coming next , especially since the US is under extreme duress with covid19 and China ‘s plan becomes more visible. If we get involved in a conflict with China we would be at a distinct disadvantage . Follow this just as carefully as you do with covid19 . Funny how some people don’t think Armageddon is possible. “ Eve Of Destruction” by Barry Maguire appropriate way back when and still fits what may soon be taking place... Ahh...to be back in the 60’s and 70’s... all we need is a good Hot Hot Hot summer .

I see the talk about possible treatments and vacinne's as akin to potential recruits putting Rutgers in their top 11.

Let me know when they commit.

 

[RU848789]

This doesn't indicate what "high flow" is. In the field, the rule of thumb is nothing more than 6 lpm via canula; anything more requires a mask because the nasal passages, alone, are flow-limited.

Hopefully they add more details in a paper, but the comment below probably means it's above that rate...

This approach is not without risk, however. HFNCs blow air out, and convert the COVID-19 virus into a fine spray in the air. To protect themselves from the virus, staff must have proper personal protective equipment (PPE), negative pressure patient rooms, and anterooms, which are rooms in front of the patient rooms where staff can change in and out of their safety gear to avoid contaminating others.

 

[T2Kplus10]

Blood sugar could be key
https://theconversation.com/amp/blo...e-protective-136592?__twitter_impression=true

Seems pretty clear that the 3 biggest risk factors are:
Age
Obesity
Diabetes
(obviously, the last 2 are closely linked)

 

[cohwx]

This doesn't indicate what "high flow" is. In the field, the rule of thumb is nothing more than 6 lpm via canula; anything more requires a mask because the nasal passages, alone, are flow-limited.

40 lpm was the number they were throwing around on that webinar/panel discussion I posted, maybe even higher.

 

[RU848789]

This paper in the New England Journal of Medicine confirms in spades what many others have shown in part - that presymptomatic/asymptomatic spread of the infection is at the core of why this is so much more difficult to control than SARS or almost any other virus. SARS had low viral loads until symptoms and had it's highest viral loads well after symptom onset (and they were mostly lower respiratory, in nature, meaning much less coughing/sneezing), when patients were usually quite ill (SARS had a 10% case fatality rate, so it was much more deadly) meaning it was easy to "contain" those folks when they were most contagious.

COVID shows viral load peaks from just before symptoms to a few days after (with much higher loads in the upper respiratory system, leading to more coughing/sneezing), meaning people are contagious before symptoms and when mildly symptomatic. The paper is focused on nursing homes and talks about the need for massive asymptomatic testing of everyone associated with such facilities (and places like jails, homeless centers and any very crowded location really) to prevent spread and high levels of death.

https://www.nejm.org/doi/full/10.1056/NEJMe2009758

What explains these differences in transmission and spread? A key factor in the transmissibility of Covid-19 is the high level of SARS-CoV-2 shedding in the upper respiratory tract,1 even among presymptomatic patients, which distinguishes it from SARS-CoV-1, where replication occurs mainly in the lower respiratory tract.2 Viral loads with SARS-CoV-1, which are associated with symptom onset, peak a median of 5 days later than viral loads with SARS-CoV-2, which makes symptom-based detection of infection more effective in the case of SARS CoV-1.3 With influenza, persons with asymptomatic disease generally have lower quantitative viral loads in secretions from the upper respiratory tract than from the lower respiratory tract and a shorter duration of viral shedding than persons with symptoms,4 which decreases the risk of transmission from paucisymptomatic persons (i.e., those with few symptoms).

Asymptomatic transmission of SARS-CoV-2 is the Achilles’ heel of Covid-19 pandemic control through the public health strategies we have currently deployed. Symptom-based screening has utility, but epidemiologic evaluations of Covid-19 outbreaks within skilled nursing facilities such as the one described by Arons et al. strongly demonstrate that our current approaches are inadequate. This recommendation for SARS-CoV-2 testing of asymptomatic persons in skilled nursing facilities should most likely be expanded to other congregate living situations, such as prisons and jails (where outbreaks in the United States, whose incarceration rate is much higher than rates in other countries, are increasing), enclosed mental health facilities, and homeless shelters, and to hospitalized inpatients. Current U.S. testing capability must increase immediately for this strategy to be implemented.

 

[RU4Real]

Hopefully they add more details in a paper, but the comment below probably means it's above that rate...

This approach is not without risk, however. HFNCs blow air out, and convert the COVID-19 virus into a fine spray in the air. To protect themselves from the virus, staff must have proper personal protective equipment (PPE), negative pressure patient rooms, and anterooms, which are rooms in front of the patient rooms where staff can change in and out of their safety gear to avoid contaminating others.

Mmmmmmnnot really...

It's just pointing out that O2 via canula isn't a closed system. Some amount of the flow - really, at any level over 2 lpm - is going to "backwash" out of the nasal passages.

I'm trying to figure out what the advantage of the canula vs. a mask would be, other than it's more convenient to the patient. If all they're trying to do is oxygenate the patient with high-flow O2 then a standard non-rebreather would work just ducky..

 

[RUBOB72]

Not saying it's going to happen, but putting China in the DPRK doesn't really change anything.

I've been saying for years that our best political gambit (assuming a DPRK under Kim Jong Un's leadership) would have been to tell China to just go take it. It's a low-risk move for us and brings North Korea into a more stable environment.

There's not a great deal of concern about having a Chinese possession on the north side of the DMZ. None of the defensive strategy changes. Maybe you add a few more THAAD batteries, but that's about it.

You are incorrect grasshopper. If China does not place a figure head leader in charge and decides to otherwise place troops within North Korea’s borders that is a troubling thing . It not only re- enforces everything the Chinese are attempting to accomplish , a dominance of the pacific theatre but it threatens our current allies if South Korea and Japan. It also puts US troops in harms way.There is much old history here especially the mutual dislike of Japan. China would command a military force of overwhelming proportions. The Russians would not and are NOT happy with China as we post this. This will play out eventually. So , you would be ok with them possessing that capability ? I find it hard to believe how naive people with some supposed brains literally think this possible scenario would not impact their lives. There are many who have accepted this theory that world globalization will work. I hope China doesn’t push the issue it will not end well. Prediction still stands : Russia will get into conflict with China... will ask for US help and you know the rest will be ugly mess.

 

[RU848789]

Not saying it's going to happen, but putting China in the DPRK doesn't really change anything.

I've been saying for years that our best political gambit (assuming a DPRK under Kim Jong Un's leadership) would have been to tell China to just go take it. It's a low-risk move for us and brings North Korea into a more stable environment.

There's not a great deal of concern about having a Chinese possession on the north side of the DMZ. None of the defensive strategy changes. Maybe you add a few more THAAD batteries, but that's about it.

Agree. The Cold War was so "stable" because we at least mostly understood each other, even if we liked having proxy wars to try out weapons and tactics. Would way rather have the devil we know than an absolute loose cannon, like NK has been for a long time...

 

[RU848789]

Please stop the non sense and stupidity on covid19. We are nowhere near a vaccine and as for therapeutics that still needs to play out. All the conjecture by the Rutgers board experts is admirable but now on top of all the daily negative news items we still have conflicting reports . We have the US science nerds parroting media news reports which are worthless. Then we have the reports out of where else ? ...China... trust this regime with their past atrocities and human rights abuses. Now we have a possible bigger problem. If Kim Jong Un is dead , as the most recent reports claim , all bets are off the table. Within weeks China will either insert their puppet leader head or will place troops inside North Korea to make sure an insurgency amongst competing groups does not take place. It s not an ideal situation for bordering nations as China’s hope for global military expansion just became quite feasible. You do not have to have an advanced degree in diplomacy to figure what is coming next , especially since the US is under extreme duress with covid19 and China ‘s plan becomes more visible. If we get involved in a conflict with China we would be at a distinct disadvantage . Follow this just as carefully as you do with covid19 . Funny how some people don’t think Armageddon is possible. “ Eve Of Destruction” by Barry Maguire appropriate way back when and still fits what may soon be taking place... Ahh...to be back in the 60’s and 70’s... all we need is a good Hot Hot Hot summer .

Some of us actually understand science at a very deep level and can read the actual medical literature instead of the often slanted media reports, and make some sense of it (not all of it, as there is some crap out there). I called BS on day one with HCQ and will be correct on that one (if anyone wants to bet and give me their $$ let me know) and still don't think remdesivir will show more than modest benefit. Would put most of my chips on convalescent plasma, as I said at the first report of it being used, since it should just work, even if not perfectly and am confident some of the engineered antibody "cocktails" will work even better and be available by late summer. I also think we'll have a commercial vaccine before the end of the year as I see us and others taking the human challenge approach to cut 3-5 months off the development timeline. Could be wrong on some or all of that (except HCQ), though, as drug development is really, really hard having been deeply involved in it for over 30 years. You're not going to get perfection anywhere, so why complain about it on a message board?

 

[retired711]

This BBC news report -- and there are plenty of other reports like this today -- says that WHO thinks there is no evidence that suffering Covid-19 immunizes against a future infection. If that's true, and if the subsequent case can be worse than the first case, we're not going to be able to open the economy for a long while.

https://www.bbc.com/news/world-52425825

 

[RU848789]

This BBC news report -- and there are plenty of other reports like this today -- says that WHO thinks there is no evidence that suffering Covid-19 immunizes against a future infection. If that's true, and if the subsequent case can be worse than the first case, we're not going to be able to open the economy for a long while.

https://www.bbc.com/news/world-52425825

They're being cautious and rightly so, especially with substandard antibody tests out there, which could have more than trivial levels of false positives, the worst result for anyone, as that would leave someone thinking they're likely immune and not contagious, when, in fact, they have no antibodies. So the last thing we want is to give someone an "immunity passport" when they either don't actually have antibodies or the antibodies aren't enough for immunity.

https://www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19

And we also don't know, for sure, yet, whether antibodies, post-infection in recovered patients confer immunity or if they do, what level and what kinds of antibodies are needed (and we also don't know how long any immunity would last). Most experts think recovered patients will be immune for months to years based on similarities to immune responses with the closely related SARS virus (immunity has been shown in macaques and a vaccine has also been shown to be protective in rhesus monkeys in a very small trial), but it's going to take some time to prove that in humans. The Scientific American review article is really well done, as is the Vox article (surprisingly).

Having said all that, though, I think some are "overdoing it" with regard to what the WHO said. They're not saying there will never be immunity, which is almost what some of the headlines sound like - they're just saying that currently is "not enough evidence about the effectiveness of antibody mediated immunity to guarantee the accuracy of an "immunity passport," just because one has antibodies. Their last paragraph should be the message. And it will be a huge surprise (and catastrophe) if antibodies don't lead to immunity in most people.

At this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an “immunity passport” or “risk-free certificate.” People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice. The use of such certificates may therefore increase the risks of continued transmission. As new evidence becomes available, WHO will update this scientific brief.

https://www.scientificamerican.com/article/what-immunity-to-covid-19-really-means/

https://www.vox.com/authors/umair-irfan

 

[MulletCork]

You are incorrect grasshopper. If China does not place a figure head leader in charge and decides to otherwise place troops within North Korea’s borders that is a troubling thing . It not only re- enforces everything the Chinese are attempting to accomplish , a dominance of the pacific theatre but it threatens our current allies if South Korea and Japan. It also puts US troops in harms way.There is much old history here especially the mutual dislike of Japan. China would command a military force of overwhelming proportions. The Russians would not and are NOT happy with China as we post this. This will play out eventually. So , you would be ok with them possessing that capability ? I find it hard to believe how naive people with some supposed brains literally think this possible scenario would not impact their lives. There are many who have accepted this theory that world globalization will work. I hope China doesn’t push the issue it will not end well. Prediction still stands : Russia will get into conflict with China... will ask for US help and you know the rest will be ugly mess.

 

[LETSGORU91]

This doesn't indicate what "high flow" is. In the field, the rule of thumb is nothing more than 6 lpm via canula; anything more requires a mask because the nasal passages, alone, are flow-limited.

High flow oxygen is delivered via a special machine that compresses air, humidifies it, and delivers it at rates up to 30 times a traditional nasal cannula. Its larger, diameter tubing. Oxygen can be titrated from 21% (the amount of oxygen in the atmosphere) to 100%. Flow rates vary from 20 liters/min to 60 L/m. Kinda like a humidied air hose forcing oxygen deep into the lungs...much like an enema, but we dont want anything in return with high flow O2.

Mmmmmmnnot really...

It's just pointing out that O2 via canula isn't a closed system. Some amount of the flow - really, at any level over 2 lpm - is going to "backwash" out of the nasal passages.

I'm trying to figure out what the advantage of the canula vs. a mask would be, other than it's more convenient to the patient. If all they're trying to do is oxygenate the patient with high-flow O2 then a standard non-rebreather would work just ducky..

100% non-rebreather masks are being used as well. However, with a mask, the patient is required to inhale the delivered oxygen in order to get to the alveolar level for O2/CO2 exchange. Patients with shallow respiratory efforts will not get adequate perfusion of O2. Also, the percentage of oxygen cannot be titrated (unless using another type of mask). High flow O2, forces air down into the respiratory tree up to 60 liters/min and the percentage of oxygen can be titrated.

 

[RU848789]

High flow oxygen is delivered via a special machine that compresses air, humidifies it, and delivers it at rates up to 30 times a traditional nasal cannula. Its larger, diameter tubing. Oxygen can be titrated from 21% (the amount of oxygen in the atmosphere) to 100%. Flow rates vary from 20 liters/min to 60 L/m. Kinda like a humidied air hose forcing oxygen deep into the lungs...much like an enema, but we dont want anything in return with high flow O2.

100% non-rebreather masks are being used as well. However, with a mask, the patient is required to inhale the delivered oxygen in order to get to the alveolar level for O2/CO2 exchange. Patients with shallow respiratory efforts will not get adequate perfusion of O2. Also, the percentage of oxygen cannot be titrated (unless using another type of mask). High flow O2, forces air down into the respiratory tree up to 60 liters/min and the percentage of oxygen can be titrated.

You obviously know a lot more about all this than I do, although I had an exchange with an MD friend by email and he thought this comment of mine was interesting...

You'll forgive me if I don't think I have much to add with regard to what to do medically for hypoxia, but the one thing I can comment on is the step-by-step process involved in transferring air from the lungs to the alveoli and then diffusing across to the blood and the red blood cells (gases are in both) rich in CO2/deficient in O2, which is supposed to be happening in parallel with that CO2 diffusing the other direction from the blood/red blood cells in the capillaries into the alveoli, so the CO2 can be exhaled.

From a mass balance perspective (that's what we chem E's do, lol) it tells me that somewhere the diffusion process seems most likely to be the issue, if "breathing" appears to be close to normal, i.e., the volume of air to and from the alveoli is close to normal, but the gases simply aren't being diffused/exchanged into and out of the blood in the capillaries properly for some reason. Diffusion is a pretty simple process, though, so unless the paper thin walls of the alveoli or the capillaries are affected in some way, perhaps the hemoglobin in the red blood cells is being impacted somehow, not allowing the oxygen to be properly captured by the hemoglobin (like what happens to some extent in carbon monoxide poisoning, where CO binds so tightly to hemoglobin that O2 is displaced and not delivered to the tissues).

The problem with that theory is the oximeter is presumably reading the O2 in solution in the blood at the fingertip (unless it'srreading total O2 in the blood and the hemoglobin somehow), not what's held by the hemoglobin for delivery to the tissues (and most of the O2 is supposedly sequestered by the hemoglobin vs. the much smaller amount in solution in the blood - so if the hemoglobin in the red blood cell isn't working "properly" to take up O2, then one would expect the O2 levels in the free blood to be high and they're not. That would argue for the first point, that somehow the O2 is not crossing into the blood very well at all in the alveoli, resulting in the hemoglobin taking what comes to the blood up, leaving very low levels of O2 in solution in the blood. No idea why the virus could cause gas diffusion issues though.

Is there any chance some pH imbalance caused by the virus/inflammation could be impacting the CO2 side of the equation, not allowing the dissolved carbonic acid to be transported from the blood fluid and and into the alveoli where it converts to CO2 and is expelled by breathing. If the O2 in the blood is low, does this mean the CO2/carbonic acid in the blood are high (if they're high, the competing ion effect might not allow O2 into the blood)?

His response was hmmmmm, respiratory acidosis? Any thoughts?

 

[RU4Real]

High flow oxygen is delivered via a special machine that compresses air, humidifies it, and delivers it at rates up to 30 times a traditional nasal cannula. Its larger, diameter tubing. Oxygen can be titrated from 21% (the amount of oxygen in the atmosphere) to 100%. Flow rates vary from 20 liters/min to 60 L/m. Kinda like a humidied air hose forcing oxygen deep into the lungs...much like an enema, but we dont want anything in return with high flow O2.

So similar to CPAP, then. Not the "I snore really loud" kind, but the kind that was introduced to the rigs about 15 years ago We could connect them to the House O2 on the bus and they'd basically blow people up with oxygen.

 

[RU4Real]

You are incorrect grasshopper. If China does not place a figure head leader in charge and decides to otherwise place troops within North Korea’s borders that is a troubling thing . It not only re- enforces everything the Chinese are attempting to accomplish , a dominance of the pacific theatre but it threatens our current allies if South Korea and Japan. It also puts US troops in harms way.There is much old history here especially the mutual dislike of Japan. China would command a military force of overwhelming proportions. The Russians would not and are NOT happy with China as we post this. This will play out eventually. So , you would be ok with them possessing that capability ? I find it hard to believe how naive people with some supposed brains literally think this possible scenario would not impact their lives. There are many who have accepted this theory that world globalization will work. I hope China doesn’t push the issue it will not end well. Prediction still stands : Russia will get into conflict with China... will ask for US help and you know the rest will be ugly mess.

I spent my share of time on the DMZ. I lost two friends out there. Don't lecture me on the topic, I have no interest in your illogic.

 

[Upstream]

This BBC news report -- and there are plenty of other reports like this today -- says that WHO thinks there is no evidence that suffering Covid-19 immunizes against a future infection. If that's true, and if the subsequent case can be worse than the first case, we're not going to be able to open the economy for a long while.

https://www.bbc.com/news/world-52425825

"There is no evidence that a previous Covid infection provides immunity" is not the same as "There is evidence that a previous infection DOES NOT provide immunity."

All the expert expectations point to immunity. But the evidence needs to be gathered to validate that, and to show what level of antibodies and other factors are needed, and how long the immunity lasts.

 

[RU85inFla]

respiratory acidosis?

isn’t that what Santiago died of?

 

[goru7]

Most underrated post in 80+ pages of thread.

If I am correct, you are a doctor either on the front line or in the medical field. You questioned in my mention in my earliest post that Leronlimab is showing promising early treatment results in a small sample size and fast tracked for 2 trials for treatment of Covid in mild/ moderate and a severe cases, and it has little to no side effects. You said every drug has side effects which is probably true but this one seems to have minimal serious side effects and is safe. It actually is a drug for AIDS and breast cancer and was already in Phase 3 and Phase 2 trials for those now, with no major side effects in early AIDS trials, and was used experientially for Covid. What is your medical opinion on this drug Leronlimab ?

 

[ArminRU]

Should be hearing some trial news this week on both Leronlimab and Remdesivir

 

[RU848789]

SIAP (hard to keep up, lol), but seeing lots of chatter on this and trials on this stem cell therapy are underway in the US also. The data, to date, are anecdotal and not from controlled trials (remember HCQ's "success" started out like this), so skepticism is warranted for now, but let's hope that larger, controlled trials show that this treatment can be successful, as it would be fantastic to have a treatment for the most critically ill patients. Here's a fairly in-depth article on it....

https://www.the-scientist.com/.../are-mesenchymal-stem...

 

[e5fdny]

You are incorrect grasshopper. If China does not place a figure head leader in charge and decides to otherwise place troops within North Korea’s borders that is a troubling thing . It not only re- enforces everything the Chinese are attempting to accomplish , a dominance of the pacific theatre but it threatens our current allies if South Korea and Japan. It also puts US troops in harms way.There is much old history here especially the mutual dislike of Japan. China would command a military force of overwhelming proportions. The Russians would not and are NOT happy with China as we post this. This will play out eventually. So , you would be ok with them possessing that capability ? I find it hard to believe how naive people with some supposed brains literally think this possible scenario would not impact their lives. There are many who have accepted this theory that world globalization will work. I hope China doesn’t push the issue it will not end well. Prediction still stands : Russia will get into conflict with China... will ask for US help and you know the rest will be ugly mess.

That last part was the first draft for “Red Dawn” but the studio told the screenwriters to go back and tweak it to what we saw in the theater.

 

[goru7]

Should be hearing some trial news this week on both Leronlimab and Remdesivir

New England Journal of Medicine will be releasing a statement on Leronlimab tomorrow .

 

[RU4Real]

New England Journal of Medicine will be releasing a statement on Leronlimab tomorrow .

I'll be interested to see how its efficacy compares to that of bleach.

But seriously, here's hoping for some positive news.