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Txzen

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Posts posted by Txzen

  1. 5 minutes ago, Skipper said:

    I don't think you necessarily need a 'cure'.  You just need something that significantly limits the severity.   If you could reduce hospital admissions/ICU admissions to a point that it would be extremely unlikely to overrun the increased infrastructure and reduce death rates to something that looks like a really bad flu season, that would drastically change policy and may be a risk most could live with then you continue to isolate those (elderly) that would continue to be most as risk.   I don't know how likely we are to find that, determine it's safe, and mass produce it before a vaccine, but that's probably our best bet.

    Perhaps, but it's also the scale of production for whatever that treatment is. We know already that there are shortages of hydroxycholoroquine (and that's due to some minor hoarding and its expanded used in trials), and while Gilead is spooling up production of rendemisvir, right now the supply is only 1.5 million doses. It's possible that the production and rollout of a vaccine may be the only way to really 'control' this. I'm not sure there's enough supply of drugs worldwide for everyone to be prescribed these meds, and certainly not for prophylactic use. 

  2. Study to test if COVID was in California earlier than previously thought

    Will be interesting to see the data from this.

    Quote

    Researchers at Stanford Medicine are working to find out what proportion of Californians have already had COVID-19. The new study could help policymakers make more informed decisions during the coronavirus pandemic.

    The team tested 3,200 people at three Bay Area locations on Saturday using an antibody test for COVID-19 and expect to release results in the coming weeks. The data could help to prove COVID-19 arrived undetected in California much earlier than previously thought.

    The hypothesis that COVID-19 first started spreading in California in the fall of 2019 is one explanation for the state's lower than expected case numbers.

    [snip]

    Hanson said he thinks it is possible COVID-19 has been spreading among Californians since the fall when doctors reported an early flu season in the state. During that same time, California was welcoming as many as 8,000 Chinese nationals daily into our airports. Some of those visitors even arriving on direct flights from Wuhan, the epicenter of the coronavirus outbreak in China.

    "When you add it all up it would be naïve to think that California did not have some exposure," said Hanson.

    For years California has been the No. 1 travel destination for Chinese tourists in the United States. Even after the U.S. halted flights from China this winter Chinese travelers were still able to come to California on flights from Europe and Canada.

    Hanson said through all of this the Chinese have been disingenuous about the timing of the initial outbreak of COVID-19.

    "They originally said it was in early January, then it got backdated to December and then early December and now they are saying as early as November 17," said Hanson.

    If Californians were exposed earlier than the rest of the country to COVID-19 we may have had a chance to build up some herd immunity to the disease. We won't know if that is the case until results from the Stanford Medicine study come back.

     

    • Like 2
  3. 1 hour ago, Captainant said:

     

    Haven't seen much discussion here yet on some early challenges with HCQ treatments. Medical professionals, have y'all seen or heard much on this yet?

    Yes, cardiac issues are a potential side effect of both hydroxychloroquine and azithromycin for a population of patientis even when given individually, which is why co-administration is potentially tricky. 

    American College of Cardiology

    Quote

    - Hydroxychloroquine or chloroquine therapy should occur in the context of a clinical trial or registry, until sufficient evidence is available for use in clinical practice.

    - Hydroxychloroquine or chloroquine use outside of a clinical trial should occur at the direction of an infectious disease or COVID-19 expert, with cardiology input regarding QT monitoring.

    - The intensity of QT and arrhythmia monitoring should be considered in the context of potential drug benefit, drug safety, resource availability and quarantine considerations.

     

    • Like 1
  4. On 4/3/2020 at 9:03 PM, strangulation! said:

    Would tests on people be the next stage? Or would they need to test on certain animals and then progress to humans?

    Full disclosure, I'm a cancer research guy, not infectious disease. But certainly many of the animal models for human infectious diseases are fraught with limitations just like those in oncology. 

    The Gilead drug remdesivir, for instance, looked good in vitro for Ebola, and pretty good in primate disease models models - but perhaps has not shown as much promise in the field. The primate models are so-called semi-permissive for Ebola (and also some respiratory viruses), meaning that the disease often doesn't quite take hold as well in monkeys or is not as sustained as it is in humans. So, testing of the drugs in these models often is early on after exposure to the infectious agent to show if it has an impact. 

    Compare that to treating people in the field where Ebola has sprung up - people in all the various stages of disease, long after being infected with various levels of disease burden and the resulting complications of other systems involved. It's not so simple to make the leap from preclinical to clinical. 

    It all highlights the need for the continued clinical trials of all of these agents alone or in combination, as is ongoing now. Sporadic reports of a few patients treated here or there is not conclusive evidence of efficacy. 

    • Like 1
  5. 2 hours ago, PittsburghTiger said:

    https://abc7.com/coronavirus-drug-covid-19-malaria-hydroxychloroquine/6079864/

     

    LOS ANGELES (KABC) -- A Los Angeles doctor said he is seeing significant success in prescribing the malaria drug hydroxychloroquine in combination with zinc to treat patients with severe symptoms of COVID-19.
    [snip]
    Hydroxychloroquine has been touted as a possible treatment for COVID-19 by President Trump among others, but it remains controversial as some experts believe it is unproven and may not be effective.

    He said he has found it only works if combined with zinc. The drug, he said, opens a channel for the zinc to enter the cell and block virus replication.
     

    One never knows if this is just lazy science ignorant journalism, or if he actually said this. Among all the mechanisms of action described for hydroxycholorquine from it's use in rheumatology, autoimmunity and infectious disease, 'opening a channel' ain't one of them. The fact that he thinks this illuminates the need for the (current ongoing) world-wide clinical trials. 

  6. 6 hours ago, cam4mav said:

    Cheers from Seattle,

    I don't know how or where to look at graphs like that on a state level. At this point, I feel like it would be useful to be able to show the curves of the major international places and compare them to each state in the US as each state is on it's own curve, with unique exposure, length of time, testing access, stay at home measures in place, etc etc.... Have all states with X min cases on the graph along with S. Korea, Italy, China, Spain, UK, etc.

     

    Best source of graphs, per capita at state/regional level, as percent of population (super helpful way to look at the data, frankly) https://twitter.com/isfBob

    Case density as percent of population, worldwide:

    Spoiler

    EUZjSQZUUAEweRH?format=jpg&name=4096x409

    Mid-West

    Spoiler

    EUZlxjDUUAAX3k9?format=jpg&name=4096x409

    South: 

    Spoiler

    EUZlq4PU8AAihYJ?format=jpg&name=4096x409

    Northeast:

    Spoiler

    EUZlkkdUcAAH2qw?format=jpg&name=4096x409

     

    West:

    Spoiler

    EUZld9NVAAA1_PF?format=jpg&name=4096x409

     

    • Like 8
  7. 3 hours ago, G650 said:

    A friend who is a chemist for a pharma co said that it [chloroquine] had been approved, fwiw.

    No. Not approved - authorized for emergency use, there's a difference. 

    Along those lines, Gilead pulled back remdesivir from compassionate use - which is a process that allows a new, unapproved drug to be used for people who have no other treatment available. The issue is that those are often done as one-off, small group studies as was done for Ebola. It's not the best way to understand the efficacy of a drug during a pandemic. 

    This was done to enable larger, world-wide clinical studies like the SOLIDARITY Study by the WHO, as a part of a process called 'Expanded Access' which allows the testing of larger groups of people simultaneously under a single blanked designation. The study will test thousands across the globe in a randomized adaptive trial looking at multiple single-agents and combinations : 

    Quote

    The drugs to be tested are the antiviral drug remdesivir; a combination of two HIV drugs, lopinavir and ritonavir; lopinavir and ritonavir plus interferon beta; and the antimalarial drug chloroquine. All show some evidence of effectiveness against the SARS-CoV 2 virus, which causes Covid-19, either in vitro and/or animal studies.

     

  8. Amid frenzy over potential COVID-19 drug, patients see shortages and states fight reckless scripts

    Quote

    Enthusiasm around the drug stems partly from early learnings from a French study conducted by professor Didier Raoult and his team. In that study, 70% of patients who were given hydroxychloroquine tested negative for the virus after six days. In the control arm, only two out of 16 patients were negative after six days. Some of the hydroxychloroquine patients also received the antibiotic azithromycin; all six of them tested negative.

    Despite the "small sample size," the evidence showed that "hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin," Raoult wrote.

    Weighing the findings, two experts told investigative journalist Mary Beth Pfeiffer the results are enough for them to recommend the treatment regimen of hydroxychloroquine and azithromycin for patients who are hospitalized with COVID-19 considering the graveness of the global pandemic and lack of available treatments.

    Separately, one early study from China had been characterized as a “positive” result, but Evercore ISI analyst Umer Raffat saw things differently after looking into the data for himself. Hydroxychloroquine failed to beat placebo at virological clearance rate and temperature normalization at day 7, the analyst wrote in a Monday note to clients. The drug did beat placebo at radiological progression, but the data are tough to interpret because of the size of the study, Raffat added.

     

  9. Sorry if already posted Party Zero : How a Soiree in Connecticut Became a 'Super Spreader'

    Quote

    About 50 guests gathered on March 5 at a home in the stately suburb of Westport, Connecticut, to toast the hostess on her 40th birthday and greet old friends, including one visiting from South Africa. They shared reminiscences, a lavish buffet and, unknown to anyone, the coronavirus.

    Then they scattered.

    The Westport soirée — Party Zero in southwestern Connecticut and beyond — is a story of how, in the Gilded Age of money, social connectedness and air travel, a pandemic has spread at lightning speed. The partygoers — more than half of whom are now infected — left that evening for Johannesburg, New York City, and other parts of Connecticut and the United States, all seeding infections on the way.

    Westport, a town of 28,000 on the Long Island Sound, did not have a single known case of the coronavirus on the day of the party. It had 85 on Monday, up more than 40-fold in 11 days. At a news conference Monday afternoon, Gov. Ned Lamont of Connecticut said that 415 people in the state were infected, up from 327 on Sunday night. Ten people have died. Westport, with less than 1% of the state’s population, now makes up more than one-fifth of its COVID-19 infections with its 85 cases. Fairfield County, where Westport is, has 270 cases, 65% of the total.

     

    • Like 4
  10. 3 hours ago, Hagbard Celine said:

    I think Vail and the Italian ski resort in Lombardy were the nexus which reached in to the NBA, Kaylee Hartung, heads of state, etc.  There was a disproportionate number of rich and famous in the first batch of positives.   Skiing did this.

    Was there right before New Years. Wife ripped up her knee - went to the Vail hospital at the base. Couldn’t get a room as the place was overrun with flu patients. Too early for COVID I think, but certainly there’s been a few hot spots worldwide at resorts. 

  11. 1 hour ago, PhillyD said:

    Thanks!  I'm going to give this the same weight as Junior Miller with the three cases in the Arlington Hospital and Greenspoint saying it's in the Houston jail according to his DA buddy.

    How about published research then The proximal origin of SARS-CoV-2, Nature Medicine

    In-depth molecular analysis, with the final conclusion: 

    Spoiler

    In the midst of the global COVID-19 public-health emergency, it is reasonable to wonder why the origins of the pandemic matter. Detailed understanding of how an animal virus jumped species boundaries to infect humans so productively will help in the prevention of future zoonotic events. For example, if SARS-CoV-2 pre-adapted in another animal species, then there is the risk of future re-emergence events. In contrast, if the adaptive process occurred in humans, then even if repeated zoonotic transfers occur, they are unlikely to take off without the same series of mutations. In addition, identifying the closest viral relatives of SARS-CoV-2 circulating in animals will greatly assist studies of viral function. Indeed, the availability of the RaTG13 bat sequence helped reveal key RBD mutations and the polybasic cleavage site.

    The genomic features described here may explain in part the infectiousness and transmissibility of SARS-CoV-2 in humans. Although the evidence shows that SARS-CoV-2 is not a purposefully manipulated virus, it is currently impossible to prove or disprove the other theories of its origin described here. However, since we observed all notable SARS-CoV-2 features, including the optimized RBD and polybasic cleavage site, in related coronaviruses in nature, we do not believe that any type of laboratory-based scenario is plausible.

    More scientific data could swing the balance of evidence to favor one hypothesis over another. Obtaining related viral sequences from animal sources would be the most definitive way of revealing viral origins. For example, a future observation of an intermediate or fully formed polybasic cleavage site in a SARS-CoV-2-like virus from animals would lend even further support to the natural-selection hypotheses. It would also be helpful to obtain more genetic and functional data about SARS-CoV-2, including animal studies. The identification of a potential intermediate host of SARS-CoV-2, as well as sequencing of the virus from very early cases, would similarly be highly informative. Irrespective of the exact mechanisms by which SARS-CoV-2 originated via natural selection, the ongoing surveillance of pneumonia in humans and other animals is clearly of utmost importance.

     

    • Like 1
  12. 46 minutes ago, Pato del Muerto said:

    Ok so is fortnite ok for preteens then?  I’ve said no to online community gaming so far, but they turn 11 this week. Fortnite might be a decent distraction. They are already getting a Switch and Mario odyssey as new content. 
    i do not have any gaming headsets if that impacts the playability of fortnite. 

    Perfectly fine for pre-teen. No blood, very cartoon-like. Creative mode where you build your own world, is fun. My 12yo has been playing since he was ~10. 

  13. 2 hours ago, Iconoclast Texan said:

    Christians around the world withstood torture and death to celebrate mass. THERE HAS NEVER BEEN A DOCUMENTED CASE OF INFECTIOUS DISEASE SPREAD FROM THE COMMUNION CUP. I have cited the peer reviewed research in an earlier and I will do it again:

    Bishop Doyle from the Diocese of Texas has banned the practice of intincting the host (which is less sanitary than drinking from the communion cup because people's fingers sometimes end up touching the wine) for the time being and has ordered holy water stoups to be drained. Still there has never been a documented case of an infectious disease being transmitted from the communion cup. Every Episcopal church I have been to take the appropriate safeguards--that is, wiping the interior and exterior rim between communicants, use of care to rotate the cloth during use, and use of a clean cloth for each service - to diminish this risk

    • Letter to the Editor from CDC Scientists,
      "Risk of Infectious Disease Transmission from a Common Communion Cup"
      American Journal of Infection Control (Vol. 26, pgs. 538-539). 
      • Key quotes: "no documented transmission of any infectious disease has ever been traced to the use of a common communion cup" and "the risk for infectious disease transmission by a common communion cup is very low"
    • Peer-Reviewed Article,
      "The hazard of infection from the shared communion cup"
      Journal of Infection (1988) (Vol 16, pgs. 3-23).
      • Key quote: "No episode of disease attributable to the shared communion cup has ever been reported. Currently available data do not provide any support for suggesting that the practice of sharing a common communion cup should be abandoned because it might spread infection."

     

    A cloth. To clean. Between people sharing a highly communicable disease. That's some real turn-of-the-century logic here. 

    Bet you didn't pull the paper. I did. Interesting first that simply putting this text in google pulls up mentions on dozens of Christian websites, so this clearly this argument makes the rounds in the religious circles. 

    And I quote

    link

    Quote

    There is substantial evidence that neither infection with hepatitis B virus nor HIV can be transmitted directly via saliva so that indirect transmission via inanimate objects is even less likely. No episode of disease attributable to the shared communion cup has ever been reported.

    In 1988 - which is why they were looking at HIV transmission. 

    Do you know how different COVID-19 is from HIV and hepatitis B? Just curious. 

     

     

    • Like 4
    • Haha 1
  14. More from the same Harvard epidemiologist

    Link

    Quote

    GAZETTE: Has it become apparent that the virus is either easier to transmit or more deadly than previously thought? Or are these increasing case and fatality numbers in line with what our thinking was a week ago?

    LIPSITCH: The ease of transmission is still being confirmed. In terms of the so-called “R-nought,” or how many secondary cases a single case infects, experts’ assessment is getting tighter around a level of transmissibility that’s perhaps lower than SARS, which was about 3 and higher than pandemic flu, which can be up to about 2. But what makes this one perhaps harder to control than SARS is that it may be possible to transmit before you are sick, or before you are very sick — so it’s hard to block transmission by just isolating confirmed cases.

    GAZETTE: Is that the most concerning new information, that it might be transmissible before symptoms are apparent? That would seem to make this a lot trickier.

    LIPSITCH: Yes. I think that’s the most concerning piece, but the evidence for that so far in the public domain is pretty limited. I’ve seen hints that aren’t published yet, but the evidence for that that’s been peer reviewed is quite limited. On severity, estimates are that it’s worse than seasonal flu, where about one in 1,000 infected cases die, and it’s not as bad as SARS, where 8 or 9 percent of infected cases died. I’ve been working with some colleagues on estimates. They’re preliminary still but bounded by those two. That’s a large range, however, so the important question is where the final figure ends up, because 3 or 4 percent of cases dying would be much more worrisome than 0.4 percent.

     

  15. 1 hour ago, SquishMitten said:


    I interpreted that as him saying it’s going to be endemic. So, between now and the end of their life, pretty much everybody will get it at some point. Just like the flu or a cold, everybody doesn’t get it every year, but everybody eventually gets it.

    From Marc Lipsitch, a professor of epidemiology at Harvard T.H. Chan School of Public Health in Boston: link

    Quote

    KH: Are children spared from the virus?

    Lipsitch: Children do not get detectable infection at the same rate as adults, especially severe infection, but they may get infection and may transmit -- we just don’t know.  

    KH: Is it true that for the vast majority of people, the virus will pass like a common cold and they will never know they’ve had it?

    Lipsitch: I don’t think we yet know that. There are many people, especially young people, for whom this infection is mild. I don’t think there are any published data yet on the full spectrum of cases. But good news is even in the Chinese first 44,000 cases published by the China CDC, more than 80 percent were defined as mild. That may be more than a common cold, but not severe.

    Quote

    KH: Are we looking at the worst pandemic of this century? What are the estimated infection and death tolls?

    Lipsitch: It looks like this will be worse than 2009 influenza, the only other true pandemic of the century. I estimate that 20-60 percent of adults will get infected, though not all will be symptomatic. Estimates I trust are that between 1-2 percent of symptomatic people die. That may come down a little as we define symptoms more broadly (milder symptoms). The problem with giving an overall number is that to calculate a number, we need to multiply the proportion of these two estimates times the proportion of infected who are symptomatic (unknown) times the population size.

    KH: When do you predict the epidemic will peak -- here in Korea and globally?

    Lipsitch: This is very hard to predict for many reasons -- not knowing the true number infected, which affects the peak time, and also not knowing what kinds of control measures will be applied, which will reduce the number of people and delay the peak.

     

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