Coronavirus

[cubsfan]

Kim Strassel on not having an impartial functioning press using Coronavirus timeline (4/14/2020)

 

 

Warning label: You Fake News lovers are going to hate this interview.

 

 

[Liberty]

https://www.lesswrong.com/posts/3yCcdg7DQQnfqZoax/far-ultraviolet-light-in-public-spaces-to-fight-pandemic-is

 

Also: https://www.cnbc.com/2020/04/15/bill-gates-calls-trumps-decision-to-halt-funding-for-who-dangerous.html

[rb]

 

The interesting aspect of this is that the homeless population is not a very healthy group.  Most of them have some sort of existing condition, are smokers, drinkers, or have poor nutrition.  I am very surprised that Covid was not harsher with such a group.

 

SJ

Maybe it's because they have stronger immune systems due to living in squalor and unsanitary conditions?

[Guest Schwab711]

 

"Whoa!  29/210 (13.7%) of asymptomatic women admitted for delivery tested positive for the #coronavirus in NYC  (3/29 developed fever later) https://nejm.org/doi/full/10.1056/NEJMc2009316"

 

And now this:

 

"Whoa, 147 (36%) out of 408 people tested positive for the #coronavirus at a large homeless shelter in Boston

https://medrxiv.org/content/10.1101/2020.04.12.20059618v1. More interestingly, only ~1/6 showed symptoms among those tested positive, i.e.  1:5 for symptomatic vs asymptomatic.  #COVID19"

 

No way, I don't believe it. So we have germany, pregnant woman, homeless people. Critics will note, not a totally representative study but very interesting. Need to see what the Stanford study says. Mortality rate will likely trend down still. Will be interesting to watch.

 

You said testing was pointless. You said everyone already had the virus 5-6 weeks ago. There would not be 36% of a sample actively infected if that was true unless we didn't have immunity to the virus after recovering.

 

You were wrong about the random things you made up without support. We do need testing. Not everyone was infected 5-6 weeks ago. It doesn't matter, but it does seem necessary to remind you.

 

This is a dumb disagreement though because I don't want it to look like I'm cheerleading for bad outcomes or that I'm taking credit for anything I've written. I personally didn't come up with any idea. I just read ideas and pieced them together. You didn't personally come up with anything. You described them as a gut feel. Guesses by another phrase. They were wrong. It's not that they were wrong that is important. It's that you passionately held opinions about guesses on a topic that can be studied. It's that you didn't see the importance of testing so that experts didn't have to make educated guesses (and countries throughout the world didn't have to shutdown due to the unknown).

 

 

I'd also note that 36% infected simultaneously in a population like homeless is similar to the cruise ship samples. Asymptomatic rate is high because many were infected just before the testing (thus <5 days infected and asymptomatic). Hopefully they follow up with this population. High asymptomatic rate is consistent with everything we know in high infection growth rate situations since all infected <5 days are asymptomatic + some % of the infected at 5 - X days (the % that remain asymptomatic). Again, we don't have enough data to know so I'm not married to this explanation. Only pointing out that both pregnant woman in NYC and homeless in Boston studies are consistent with everything experts have said about the virus thus far (and not your guesses).

[Dalal.Holdings]

 

"Whoa!  29/210 (13.7%) of asymptomatic women admitted for delivery tested positive for the #coronavirus in NYC  (3/29 developed fever later) https://nejm.org/doi/full/10.1056/NEJMc2009316"

 

And now this:

 

"Whoa, 147 (36%) out of 408 people tested positive for the #coronavirus at a large homeless shelter in Boston

https://medrxiv.org/content/10.1101/2020.04.12.20059618v1. More interestingly, only ~1/6 showed symptoms among those tested positive, i.e.  1:5 for symptomatic vs asymptomatic.  #COVID19"

 

So...um...from the BMJ study:

 

Upon observing a cluster of COVID-19 cases from a single large homeless shelter in Boston, Boston Health Care for the Homeless Program conducted symptom assessments and polymerase chain reaction (PCR) testing for SARS-CoV-2

 

Does this sound like a random sample? If I tested residents of a nursing home with a large cluster of covid cases, is that result going to give me the population incidence? Or is it going to vastly overestimate it?

 

What about if I find 15% in a region dubbed “German Wuhan” had antibodies. Do you think the number for the rest of the population is a) much higher, b) equal to, or c) much lower? Hint: there is only one answer here with nearly 100% confidence.

[minten]

 

"Whoa!  29/210 (13.7%) of asymptomatic women admitted for delivery tested positive for the #coronavirus in NYC  (3/29 developed fever later) https://nejm.org/doi/full/10.1056/NEJMc2009316"

 

And now this:

 

"Whoa, 147 (36%) out of 408 people tested positive for the #coronavirus at a large homeless shelter in Boston

https://medrxiv.org/content/10.1101/2020.04.12.20059618v1. More interestingly, only ~1/6 showed symptoms among those tested positive, i.e.  1:5 for symptomatic vs asymptomatic.  #COVID19"

 

So...um...from the BMJ study:

 

Upon observing a cluster of COVID-19 cases from a single large homeless shelter in Boston, Boston Health Care for the Homeless Program conducted symptom assessments and polymerase chain reaction (PCR) testing for SARS-CoV-2

 

Does this sound like a random sample? If I tested residents of a nursing home with a large cluster of covid cases, is that result going to give me the population incidence? Or is it going to vastly overestimate it?

 

Uhm, absolutely nobody said this was a random sample. Even the tweet (which, for clarity, isn't mine) implictly says this by saying "More interestingly ...". 

[Dalal.Holdings]

C. The answer is c.

[Viking]

More dominoes will start to fall with each passing week. Lots of weak companies, like JC Penney, will declare bankruptcy. They all have a great reason: coronavirus. Management is not to blame :-)

 

J.C. Penney Might File for Bankruptcy. What That Says About Macy’s and Other Retailers.

- https://www.barrons.com/articles/jc-penney-stock-bankruptcy-department-store-retailers-covid-19-e-commerce-51586970318?mod=hp_DAY_1

 

After years of dwindling foot traffic and sales, J.C. Penney is reportedly considering a bankruptcy filing among its options to deal with the coronavirus shutdown.

 

It is also considering pursuing an out-of-court debt restructuring or rescue financing, according to Reuters. The department store doesn’t necessarily need to take action soon; the company has enough cash to cover its $105 million bond maturing in June, ratings firms say. Fitch Ratings said earlier this month that J.C. Penney  (ticker: JCP) should have enough liquidity to get through the 2020 holiday season, and the analysts don’t expect a debt restructuring until next year.

 

Across the industry, however, coronavirus-related shutdowns and widespread store closures have piled extra financial stress on top of the existing pressure of changing shopper tastes and the rise of e-commerce. March brought the steepest monthly decline in retail sales on record, with a nearly 9% slide from the month before, according to the Census Bureau.

 

That means J.C. Penney certainly isn’t the only retailer feeling the pinch. Fitch Ratings downgraded at least eight retailers earlier this month because of the coronavirus shutdown. Among them were Macy’s (M), Dillard’s (DDS), Capri Holdings (CPRI) and Tapestry (TPR), all of which the firm downgraded to junk from investment grade.

[Dalal.Holdings]

https://www.bloomberg.com/news/articles/2020-04-15/germany-likely-to-extend-national-lockdown-measures-until-may-3-k913n3v2

 

German Chancellor Angela Merkel announced tentative steps to slowly start returning the country to normal, allowing some smaller shops to reopen next week and schools to gradually restart in early May.

 

The benefits of acting early and aggressively (like aggressive testing, lockdowns) are enormous. There is a clear outlier among countries with the largest number of confirmed cases—see attachment.

[arcube]

https://www.bloomberg.com/news/articles/2020-04-15/germany-likely-to-extend-national-lockdown-measures-until-may-3-k913n3v2

 

German Chancellor Angela Merkel announced tentative steps to slowly start returning the country to normal, allowing some smaller shops to reopen next week and schools to gradually restart in early May.

 

The benefits of acting early and aggressively (like aggressive testing, lockdowns) are enormous. There is a clear outlier among countries with the largest number of confirmed cases—see attachment.

 

+1. They went about it very methodically unlike in U.S. All bravado talk and no real on the ground plan.

[RichardGibbons]

This is unfortunate.

 

https://www.scmp.com/news/china/science/article/3080055/anti-malarial-treatment-hailed-trump-has-no-benefit-coronavirus

[Dalal.Holdings]

This is unfortunate.

 

https://www.scmp.com/news/china/science/article/3080055/anti-malarial-treatment-hailed-trump-has-no-benefit-coronavirus

 

And don’t forget the downside of these drugs:

 

As well as measuring drug efficacy, researchers found abnormal heartbeat among side effects

 

Prolonged QT interval is not a benign thing

[RichardGibbons]

Yeah, kudos to you for saying early on that you thought it was unlikely to work.

[Liberty]

 

The interesting aspect of this is that the homeless population is not a very healthy group.  Most of them have some sort of existing condition, are smokers, drinkers, or have poor nutrition.  I am very surprised that Covid was not harsher with such a group.

 

SJ

Maybe it's because they have stronger immune systems due to living in squalor and unsanitary conditions?

 

More likely that they aren't getting tested, don't get medical care, or their deaths/illnesses don't get reported as COVID deaths than some super-immune system.

[DocSnowball]

Randomized trial for hydroxychloroquine being run in the US is still to finish. While the above data gives one pause, here is the larger issue if HCQ is not effective:

 

The only other anti-viral being studied seriously is Remdesivir from Gilead. It is an intravenous drug, so using it at scale for treating everyone with mild or moderate symptoms, or for protection of healthy exposed individuals is a non-starter. So if there is no oral drug, we'd continue to wait for people to get admitted/ seriously ill before giving them effective therapy.

 

The second class of drugs being studied is IL-6 receptor blockers Tocilizumab or Sarilumab, for which trials are being run for patients in intensive care, most on the ventilator. So drugs to use in reducing death rate in the very late stage.

 

Only HCQ or an oral drug has the game changer potential. Not anchoring as a scientist, but hoping as an imperfect human we get something to work with on HCQ treatment and prophylaxis trials.

 

Finally, HCQ, Remdesivir, and IL-6 receptor blockers are ALREADY being widely used across the US. So the mortality rate is what it is despite widespread use. Unless the drugs were causing the deaths,  we won't get very dramatically different results even if a trial shows efficacy (although we will see some improvement).

 

On the whole, I remain pessimistic on the healthcare and therapeutics front...

[orthopa]

 

"Whoa!  29/210 (13.7%) of asymptomatic women admitted for delivery tested positive for the #coronavirus in NYC  (3/29 developed fever later) https://nejm.org/doi/full/10.1056/NEJMc2009316"

 

And now this:

 

"Whoa, 147 (36%) out of 408 people tested positive for the #coronavirus at a large homeless shelter in Boston

https://medrxiv.org/content/10.1101/2020.04.12.20059618v1. More interestingly, only ~1/6 showed symptoms among those tested positive, i.e.  1:5 for symptomatic vs asymptomatic.  #COVID19"

 

No way, I don't believe it. So we have germany, pregnant woman, homeless people. Critics will note, not a totally representative study but very interesting. Need to see what the Stanford study says. Mortality rate will likely trend down still. Will be interesting to watch.

 

You said testing was pointless. You said everyone already had the virus 5-6 weeks ago. There would not be 36% of a sample actively infected if that was true unless we didn't have immunity to the virus after recovering.

 

You were wrong about the random things you made up without support. We do need testing. Not everyone was infected 5-6 weeks ago. It doesn't matter, but it does seem necessary to remind you.

 

This is a dumb disagreement though because I don't want it to look like I'm cheerleading for bad outcomes or that I'm taking credit for anything I've written. I personally didn't come up with any idea. I just read ideas and pieced them together. You didn't personally come up with anything. You described them as a gut feel. Guesses by another phrase. They were wrong. It's not that they were wrong that is important. It's that you passionately held opinions about guesses on a topic that can be studied. It's that you didn't see the importance of testing so that experts didn't have to make educated guesses (and countries throughout the world didn't have to shutdown due to the unknown).

 

 

I'd also note that 36% infected simultaneously in a population like homeless is similar to the cruise ship samples. Asymptomatic rate is high because many were infected just before the testing (thus <5 days infected and asymptomatic). Hopefully they follow up with this population. High asymptomatic rate is consistent with everything we know in high infection growth rate situations since all infected <5 days are asymptomatic + some % of the infected at 5 - X days (the % that remain asymptomatic). Again, we don't have enough data to know so I'm not married to this explanation. Only pointing out that both pregnant woman in NYC and homeless in Boston studies are consistent with everything experts have said about the virus thus far (and not your guesses).

 

Whoa!! who put sand in your panties!!

 

So let me get this right. You hammer on my guesses but in hindsight when you chose not to stick your neck out. You prefer to read everyone else then opine in hindsight. Ok bud! :) Not to mention I said they were opinions right?

 

...And from what I gather from your posts you seem to think you have a reasonable understanding of things medical but honestly based on what you have posted/discussed, you don't to be frank.  You seem to have a bone to pick with me which is fine I don't give a fuck, but to return the favor Ill follow your posts and hammer you going forward. Fine with me, please make sure ANYTHING remotely close to dealing with medicine you research, talk to some friends, and google the fuck out it because I will hammer you. 

 

That being said I dont think my guesses were too bad.

 

Contact tracing will obviously no longer work in the US. That is an opportunity the US has missed. 

 

We must start social distancing immediately, including cancelling public events, and reducing exposures to large groups.

 

Marc Lipsitch, the Harvard Epidemiologist has a thread here:

 

 

Weren't we just arguing about this in my example of extended contact at airport ? Now because he says it, its true? LOL

 

Orthopa, do you think you can slow down a bit and try to communicate a little more clearly? I think you are making some good points, but it seems your points may not be getting across clearly or that you may even be misunderstood. This post in particular makes me think that is the case.

 

I also thought your earlier point about testing the role of testing in a diagnosis is likely a good point, but was probably too hasty to get your point across. Maybe some other medical professionals could weigh in on that, especially if you're to busy to respond.

 

I dont know how much more I can slow down. I have probably posted 50 times? Trying to get some points across. Am I completely right?, of course not but I have experience FWIW. Others have graphs,  twitter links, and or political angles which are underwhelming at best sometimes.

 

Again points that I have made that I believe are true FWIW (we are allowed an opinion right?)

 

1. The virus has been here for months, likely early January and has been seen/dealt with in the health system under other diagnoses for months.

2. The first test confirmed, was not the first test here.

3. There was nothing the government or any nation in the world could do to stop the initial spread

4. Older people and those most at risk will die. There is no cure, and viruses kill people. Elderly people should take appropriate precautions.

5. Because the virus has been here for months testing is borderline useless and your going to chase your tail the entire time. This is due to numerous contacts and the extended incubation period.

6. If you don't test everyone the virus will continue to spread quickly, again via asymptomatic people and kids. Best policy is to test everyone, but its impossible and too late.

7. Best way to prevent spread is standard precautions! This includes isolation, hand washing, yada, yada. NOT TESTING.

8. If a patient test positive and there has been minimal definite contacts say someone who is home bound with a handful of contacts testing may make sense but these are limited cases.

9. The the spring/summer will bring a reprieve in new cases and hopefully that was well as the fact that nearly everyone will have been exposed or infected this will limit virgin hosts.

10. A vaccine is useless if the virus mutates significantly.

11. The number of cases are vastly under reported, probably numbering in the millions by now in the US.

12. If someone you know or yourself had a cold/URI/flu symptoms that tested negative, and was "way worse" then the common cold there was very high chance it is/was the corona virus.

13. Every case of the virus is not severe, so don't model it as such. Corona virus dx does not = ICU and ventilator.

14. I believe eventually those in charge medically will come to the conclusion that its inevitable that this becomes a pandemic with everyone getting infected in time.

15. If your human, you will get the virus in your lifetime. Nothing you can do.

16. Flattening the curve makes sense but I question when the curve will bump as the virus again likely has been here for months.

 

Time here and number of cases up for debate and apparently others are wondering too as studies continue to come out regarding antibody testing. Does that bother you? Others are posting these not me and apparently others are thinking its a possibility too.  Did you see who I said we had to test above? Did you see how I said we should stop the spread? Stick your neck out or sit in the peanut gallery and shut the fuck up please. 

 

Are you aware of a resource I should have accessed on March 11th?

 

 

 

 

Did I misinterpret or misrepresent anything here?

 

I think you have an excellent understanding of this at this point, and apparently able to put it down on paper better then me.

 

Thanks.  Just trying to make sure I fully understand the various perspectives.  Again, apologies again for the comment before re: the profession you've chosen.  It meant no disrepect.

 

I do want to ask you - if you were to take a step back and think about your position, where could you be wrong?

 

I could be wrong by how much of a hit this will be to the ICU/need for respirator, ie breakdown of health system. I can only think back to working during the H1N1 outbreak and the 17-18 flu season and that volume load which was ~15 million cases if I recall correctly. The system was stretched, but did not collapse, My opinion is the virus has been here for 6 weeks/months and cases are vastly under reported. So in my mind we are currently in an environment of where many think we will be from documented patient 1 say 4-6 weeks from now, already!  Its in this mind frame I have a hard time rectifying a wickedly high death rate and medical system collapse if we are operating in this environment currently.

 

I certainly could be wrong on this, I hope I'm right of course. We will see. The fact of the matter is if the cases are severely under estimated and we are handling it now maybe we are further along on the curve then we think, and handling it fine.

 

Here is another prediction I made and now in hindsight we know the models were estimating 5-6 times the need for beds and ICU's ventilators and outside of NYC we have not seen nearly the worst case scenario envisioned. Sorry if I dont have the time to sit down, run a small study, spend endless hours citing papers, articles, etc to your satisfaction. Ill try harder next time I promise.

 

Finally I haven't seen you piss all over Dalal, alwaysdrawing etc who foresaw exponential deaths and complete collapse of the healthcare system in WA and NYC. Those two cities were supposed to be a sign of things to come for the rest of the US which as of right now, is completely wrong. Please get a hard on for them too as I dont feel its necessary to run back and rub their nose in it. Be fair and do it for me.

[arcube]

New York Gov. Andrew Cuomo orders all people to wear face coverings in public

 

https://www.cnbc.com/2020/04/15/new-york-gov-cuomo-to-order-all-people-to-wear-masks-or-face-coverings-in-public.html

[Jurgis]

I'm trying to ask this uncontroversially mostly medical professionals here: assuming a gradual relaxation of the lockdown with no vaccine, no treatment, and no (or minimal) testing/tracking. Would you say going out is acceptable or too risky? Let's assume a medium-high risk state like MA. Let's assume not super vulnerable person.

 

If we want to talk concrete "going out" categories, let's say going to parks, general shopping, meeting friends/family, going to office/work, going to a restaurant (I tried to order this from least risk to most risk).

 

Outcome of "severe" infection sounds very scary. That has to be balanced with infection risks though.

 

I know this is a bit theoretical and uncertain, but since there's a talk of "relaxation" even in NY state, maybe this could be useful.

 

I could open a new topic... but probably not worth it.

 

Thanks

[Dalal.Holdings]

Randomized trial for hydroxychloroquine being run in the US is still to finish. While the above data gives one pause, here is the larger issue if HCQ is not effective:

 

The only other anti-viral being studied seriously is Remdesivir from Gilead. It is an intravenous drug, so using it at scale for treating everyone with mild or moderate symptoms, or for protection of healthy exposed individuals is a non-starter. So if there is no oral drug, we'd continue to wait for people to get admitted/ seriously ill before giving them effective therapy.

 

The second class of drugs being studied is IL-6 receptor blockers Tocilizumab or Sarilumab, for which trials are being run for patients in intensive care, most on the ventilator. So drugs to use in reducing death rate in the very late stage.

 

Only HCQ or an oral drug has the game changer potential. Not anchoring as a scientist, but hoping as an imperfect human we get something to work with on HCQ treatment and prophylaxis trials.

 

Finally, HCQ, Remdesivir, and IL-6 receptor blockers are ALREADY being widely used across the US. So the mortality rate is what it is despite widespread use. Unless the drugs were causing the deaths,  we won't get very dramatically different results even if a trial shows efficacy (although we will see some improvement).

 

On the whole, I remain pessimistic on the healthcare and therapeutics front...

 

The bolded part of your quote is key. Furthermore...

 

IL-6 blockers & hydroxychloroquine--if they work is likely due to immune suppression (which is how these work in Rheumatoid arthritis). However I would argue then that these are not drugs to use in every covid patient, but rather exclusively in covid patients with ARDS. Right now you have a bunch of PCPs instructing people to take hydroxychloroquine while recovering at home--who knows if immune suppression is actually a good thing in the early stages of covid? It may actually make things worse.

 

With ARDS--which is an inflammatory condition where your immune system goes into overdrive (neutrophil mediated) and damages lung tissue--immunosuppressants may help reduce severity, but to use it in COVID infections without ARDS may not help and may actually instead make the course of infection worse by ramping down immune protection....

 

A lot of uncertainty, but then you can just look at your bolded statement and that's enough to draw conclusions about these treatments. (Inverting the problem)

[Dalal.Holdings]

Finally I haven't seen you piss all over Dalal, alwaysdrawing etc who foresaw exponential deaths and complete collapse of the healthcare system in WA and NYC. Those two cities were supposed to be a sign of things to come for the rest of the US which as of right now, is completely wrong. Please get a hard on for them too as I dont feel its necessary to run back and rub their nose in it. Be fair and do it for me.

 

I made it policy to no longer respond to you (Schwab711 does a good job anyway), but you attempt to call me out here and grossly mischaracterize my statements--"fearing a collapse in the healthcare system" does not equal "predicting complete collapse of healthcare system":

 

No, collapse did not happen thanks to

- NYC lockdown,

- every single hospital in NYC turning itself inside out,

- Cuomo,

- cancelling all elective cases,

- A military ship,

- Javit's center,

- A tent in central park,

- And more unprecedented, never before done actions taken

 

Saying I should be criticized for fearing healthcare collapse in early March (before any of these things were put in place) is laughable.

 

And btw, the deaths were exponential until the curve flattened thanks to all of these unprecedented, never-before-done measures.

 

Finally,

You are and have been consistently wrong and refuse to eat your bowl of crow.

 

So, your bowl is going cold--can I just have it instead? Groceries are hard to come by these days. Thanks.

[Guest cherzeca]

the best tell that we are flattening the curve on covid-19 is that posting on the thread has slowed down...though unfortunately not by Dalal

[RichardGibbons]

That being said I dont think my guesses were too bad.

 

No, they were appallingly bad, to the extent that I'd lose a some degree of respect for all doctors if it weren't for Dalal's sensible posts on this thread to pull me back off that ledge.

 

Frankly, it terrifies me that doctors exist who ignore evidence for gut feel, make wild speculations not even supported by common sense let alone facts, and then when the evidence proves them wrong, continue to insist that they were right. (What the heck is one to do if one seriously needs a doctor, and this is the doctor one gets? Just roll over and die?)

[Guest cherzeca]

https://www.timesofisrael.com/top-israeli-prof-claims-simple-stats-show-virus-plays-itself-out-after-70-days/

[John Hjorth]

I think the facts are, that major mistakes were made in the early innings in just about every country around the world. The mistakes may vary from country to country.

 

I just hope that when we are finally done with SARS-CoV-2, that there will be a World-Wide conclusion, to avoid that this - to the best of all nations - won't happen again.

[minten]

That being said I dont think my guesses were too bad.

 

No, they were appallingly bad, to the extent that I'd lose a some degree of respect for all doctors if it weren't for Dalal's sensible posts on this thread to pull me back off that ledge.

 

Frankly, it terrifies me that doctors exist who ignore evidence for gut feel, make wild speculations not even supported by common sense let alone facts, and then when the evidence proves them wrong, continue to insist that they were right. (What the heck is one to do if one seriously needs a doctor, and this is the doctor one gets? Just roll over and die?)

 

That seems a bit harsh to me. I've been in this thread a while now and I know for sure who I'd like my doctor to be (if anyone here is a doctor at all; or maybe we all are, who knows); anyway, I'm pretty sure we all have a conscious or subconscious preference to whatever or whomever fits our pre-existing bias best, so let's not get too personal.

 

https://www.bloomberg.com/news/articles/2020-04-15/china-s-data-on-symptom-free-cases-reveals-most-never-get-sick.  Coincedentally this source reports a similar percentage of asymptomatic patients as Boston's homeless study did (you know, the study nobody said was random). Some of you think it's all China's fault and all China does is lie, bla bla bla, but still.