Covid-19 #17: Covid Is For Ever

[The Anti-Targ]

8 minutes ago, LongRider said:

JFC, this type of bullshit is everywhere.   Hope that idea fails. 

If there was ever any doubt that the right-wing despises workers...

 

People here are concerned we may be in the back of the queue with the vaccine. Out govt is contributing hundreds of millions of dollars to vaccine development, so that we are not in the back of the queue. But if we are fortunate to be virus free when the vaccine is widely available there really is no rush to start mass vaccination in New Zealand. We would have the luxury of being able to be patient, and stay healthy, while the rest of the world takes higher priority. I would rather our govt commit that money because we are conscientious members of a global community, and not to buy our way closer to the front of the queue than a more needy country who can't afford to stump up the cash.

We would of course require anyone entering the country to have been vaccinated at least 14 days, and be symptom free before coming in to the country, but otherwise there would be no restriction on entry. And ideally we would have some stocks of vaccine to vaccinate people before leaving so that they can return safely. Otherwise you would need to vaccinate while overseas and stay overseas for at least 14 days post-vaccination.

[Guest]

4 hours ago, Free Northman Reborn said:

Take New Zealand - the poster child of the lockdown movement. If Covid is going to be with us forever like the flu, are they going to continue going into lockdown each time a handful of cases pop up?

Do you think that because you're willing to be a spendthrift with the lives of your fellow Americans to obtain a dubious, at best, economic advantage, every other country on Earth should follow your lead?

[Fragile Bird]

54 minutes ago, The Anti-Targ said:

Just noticing that the USA has ticked over to 6 million confirmed cases, and it got me wondering, so I did some quick maths. If the USA continues to confirm about 40,000 cases per day, on average, there is a reasonable probability of the confirmed cases hitting 6.66 million on 11 Sept.

I wonder what message people who believe in these kinds of signs might take from that, if it happens? Perhaps best to hope that this coincidence (or is it?) doesn't happen.

They are cutting back testing in the US now. The numbers will drop and drop as you get closer to the election.

[The Anti-Targ]

1 minute ago, The Great Unwashed said:

Do you think that because you're willing to be a spendthrift with the lives of your fellow Americans to obtain a dubious, at best, economic advantage, every other country on Earth should follow your lead?

Everyone likes to think they have the right idea about how to deal with this once in a lifetime crisis. The "measure of a (wo)man" is whether they can admit their idea turned out to be wrong.

We're too early in this thing to really be able to confidently say that any particular approach is definitely wrong, aside from approaches that completely ignore all scientific advice and go with pure ideological solutions. But even then, shit could get so bad that really no solution was a good one, and how much science you put into your COVID policy won't matter a bit. In someways it might be comforting to eventually discover that no matter how unscientific a govt was in handling this thing the suffering and deaths were inevitable, that people you know didn't suffer and die unnecessarily because the idiots in charge couldn't organise a piss up in a brewery. Sadly, I think many people have suffered and died unnecessarily, and bad decisions go right back to the start with China trying to cover up until it couldn't.

I'm open to the possibility of New Zealand's approach being shown to have been the wrong one. But right now it has the appearance of being a rational and sensible approach for the situation we found ourselves in mid-March and also now. Who knows what the gift of hindsight will give us this time next year, or in two years, or whenever it is we can sit comfortably and second guess every decision every govt and international institution made.

[The Anti-Targ]

6 minutes ago, Fragile Bird said:

They are cutting back testing in the US now. The numbers will drop and drop as you get closer to the election.

The consequence of which is a probable increase in transmission, which might have the unintended effect of seeing higher confirmed cases as the proportion of tests confirming positive increases. Of course the lag effect might man this consequence is not seen before November. Though with over 2 months before the election day, increased transmission from reduced testing, tracking and isolating should show up in the data, if nothing else it would cause an increase in hospitalisations.

One interpretation of the CDC advice is that the CDC doesn't want people going for tests too soon after a possible exposure event. If you get an alert that you were in the infection zone 24 to 48 hrs ago of someone who has tested positive, if you run out and get a test immediately chances are you will get a negative result. Then you will breathe a sigh of relief and carry on as if you are not infected, only to find out too late, or even not at all if you happen to be an asymptomatic case, that you actually did pick up the infection. Though in that case the recommendation should really be that you get tested ASAP, and if negative you get tested a second time a week later. But that bumps up against test kit availability and lab capacity. latest science on asymptomatic cases is that it's about 15-20% of people get no symptoms. So if you are totally symptom-less 10 days after an exposure event there is an 80-85% chance you did not get infected. I am not a big fan of playing those odds, but if there are resource constraints around sampling and testing playing those odds may be justified. It would be good for that advice to also tell people to take precautions (self-isolating if possible, judicious use of PPE and hygienic practices otherwise) for at least a week.

[Old Zog]

23 minutes ago, The Anti-Targ said:

[...] about 15-20% of people get no symptoms. So if you are totally symptom-less 10 days after an exposure event there is an 80-85% chance you did not get infected.

No, that's not how probability works.

[rotting sea cow]

9 hours ago, Clueless Northman said:

There's also been some serious clues for months that there is a degree of cross-resistance with the other coronaviruses. And we still don't have very effective drugs against Covid, not to mention a months-away if not year-away vaccine.

So, considering that a few of the human coronaviruses are mild - not as in "coronavirus mild", which is in many cases bullshit because it can cause harm and lasting damages to many of the people who don't require a hospital stay, but as in "just a common cold" -, wouldn't it be easier for now, while we're waiting for a vaccine, to develop some kind of inoculation of that far less harmful coronavirus, not in the hope of causing absolute immunity, but at least to bring solid resistance against Covid and only a truly mild case (genuinely like the typical cold) instead of the life-threatening bastard? Heck, if doing it like vaccination-light is complicated, I'd actually even personally go for infection the normal way by that old well-known coronavirus; I'd consider worth it to suffer now a common cold to avoid a far higher risk later (considering the amount of colds I've gone through in my life, I'm 100% sure I already got hit by one of those older milder coronaviruses at some point in my life).

The problem is we don't know. The crossreactivity with other coronavirus is speculation, but in its scientific meaning of the term. That's there are good reasons to believe that is actually happening. I think I've seen some studies trying to address the issue in a more formal way. The question is whether all other four endemic coronavirus offer similar protection or it's just one of them. On the other hand there are studies in particular setting where SARS-COV-2 has an awful high second attack rate, that's most of the people get infected which would contradict that hypothesis. It's possible that the prevalence of the other viruses is not well studied.

There is also a wilder speculation that an ancestral and less virulent form of SARS-COV-2 was circulating for months or years before November and some people got infected with it.

[The Anti-Targ]

I feel obligated to put this here, because of my past comments on the subject of HCQ

I haven't read the Belgian study myself. The main take aways for me are: There is life in this dog yet, and more study is required; This study is not definitive as it is not randomised, double blind but it is indicative and justifies demand for a more robust trial; WhyTF were previous studies virtually overdosing patients and not using the recommended dose?

After watching many hours of his videos since January, I am satisfied that John tries to follow where the legitimate science leads him and not where politics and partisanship tells him to go. Not that he hasn't been guilty of dipping his toe into political waters from time to time, which is hard to completely avoid with COVID-19. But he is pretty good at separating his punditry from the science.

There may indeed be something to the HCQ thing, but I am not yet convinced that the null hypothesis has been disproved. And this study does nothing to support the more wildly optimistic claims that HCQ is the great cure that will stop this plague in its tracks. In fact it suggests the opposite. It is possibly helpful in reducing deaths but a lot of people are still going to die.

[rotting sea cow]

5 hours ago, The Anti-Targ said:

I feel obligated to put this here, because of my past comments on the subject of HCQ

I haven't read the Belgian study myself. The main take aways for me are: There is life in this dog yet, and more study is required; This study is not definitive as it is not randomised, double blind but it is indicative and justifies demand for a more robust trial; WhyTF were previous studies virtually overdosing patients and not using the recommended dose?

After watching many hours of his videos since January, I am satisfied that John tries to follow where the legitimate science leads him and not where politics and partisanship tells him to go. Not that he hasn't been guilty of dipping his toe into political waters from time to time, which is hard to completely avoid with COVID-19. But he is pretty good at separating his punditry from the science.

There may indeed be something to the HCQ thing, but I am not yet convinced that the null hypothesis has been disproved. And this study does nothing to support the more wildly optimistic claims that HCQ is the great cure that will stop this plague in its tracks. In fact it suggests the opposite. It is possibly helpful in reducing deaths but a lot of people are still going to die.

I think I said like two or three threads ago that a lot of the science behind HCQ, etc is not good. In both directions. Trump (and Bolsonaro) only clouded the waters and people, specially in the US, took their seats and didn't attempt to paid attention anymore.

Chloriquine and HCQ is being used in a big chunk of the world reportedly with some success. I seriously doubt that Indian, Turkish, Cuban, Egyptians, etc doctors care about what these two sorry excuses of presidents say about this or that drug. 

Regarding the study. Is this one?

https://www.sciencedirect.com/science/article/pii/S0924857920303423?via%3Dihub

There is also an Italian study

https://www.ejinme.com/article/S0953-6205(20)30335-6/fulltext

 

 

 

[DireWolfSpirit]

On 8/26/2020 at 11:10 PM, Fragile Bird said:

They are cutting back testing in the US now. The numbers will drop and drop as you get closer to the election.

Not only that but there is also some chicanery with the reporting I'm betting. Recall a few weeks back the protocal with reporting was massaged and the information now passes through different officials.

In other words the testing and reporting has been politicized, the administration has conveniently figured a way to make the news sound less shitty than the reality in the short term.

If the administration would channel as much energy into governing well as they put into being deceptive, we would be so much better off.

[The Anti-Targ]

6 hours ago, rotting sea cow said:

I think I said like two or three threads ago that a lot of the science behind HCQ, etc is not good. In both directions. Trump (and Bolsonaro) only clouded the waters and people, specially in the US, took their seats and didn't attempt to paid attention anymore.

Chloriquine and HCQ is being used in a big chunk of the world reportedly with some success. I seriously doubt that Indian, Turkish, Cuban, Egyptians, etc doctors care about what these two sorry excuses of presidents say about this or that drug. 

Regarding the study. Is this one?

https://www.sciencedirect.com/science/article/pii/S0924857920303423?via%3Dihub

There is also an Italian study

https://www.ejinme.com/article/S0953-6205(20)30335-6/fulltext

 

 

 

From the Italian study:

Quote

Within the limits of an observational study and awaiting results from randomized controlled trials, these data do not discourage the use of HCQ in inpatients with COVID-19.

That is about how I would characterise it. It doesn't discourage use, but it doesn't clearly commend its use either. It's cheap, at the right doses it should not do a much harm by way of side effects, and it may help. These observational studies are a step up from anecdata, but they are far from the gold standard required for unqualified recommendation for treatment. And it seems dex may be better, has somewhat more robust studies supporting it, and is just as cheap.

[Raja]

On 8/28/2020 at 1:22 AM, The Anti-Targ said:

WhyTF were previous studies virtually overdosing patients and not using the recommended dose?

After watching many hours of his videos since January, I am satisfied that John tries to follow where the legitimate science leads him

Don't want to spend too much time on HCQ because I think the science is pretty clear at this point but thought I'd answer your question. I skimmed a little bit of the video that you linked and whilst the dude is bemused at the Recovery trial using a higher dose than the one used in Rheumatoid and SLE/ Malaria, he could have easily found out the answer to his question if he had 1. Read the recovery trial protocol or 2. Read the Preprint publication or the NEJM paper

Imo, these are absolute basics to be done but I don't think this guy did that, if he did, he would have the answer to his questions.

From the pre-print ( There is more explanation in the protocol before HCQ was discontinued back in June)

Quote

The exact mechanism of antiviral action is uncertain but these 65 drugs increase the pH of endosomes that the virus uses for cell entry and also interfere with the 66 glycosylation of the cellular receptor of SARS-CoV, angiotensin-converting enzyme 2 (ACE2), 67 and associated gangliosides. The 4-aminoquinoline concentrations required to inhibit SARS-68 CoV-2 replication in vitro are relatively high by comparison with the free plasma concentrations  observed in the prevention and treatment of malaria. These drugs are generally well tolerated,  inexpensive and widely available. Following oral administration they are rapidly absorbed, even  in severely ill patients. If active, therapeutic hydroxychloroquine concentrations could be expected in the human lung shortly after an initial loading dose.

Hydroxychloroquine has been proposed as a treatment for COVID-19 based largely on its in  vitro SARS-CoV-2 antiviral activity and on data from observational studies reporting effective  reduction in viral loads. However, the 4-aminoquinoline drugs are relatively weak antivirals. Demonstration of therapeutic efficacy of hydroxychloroquine in severe COVID-19 would require  rapid attainment of efficacious levels of free drug in the blood and respiratory epithelium. Thus,  to provide the greatest chance of providing benefit in life threatening COVID-19, the dose  regimen was designed to result in rapid attainment and maintenance of plasma concentrations  that were as high as safely possible. These concentrations were predicted to be at the upper  end of those observed during steady state treatment of rheumatoid arthritis with 266 hydroxychloroquine. Our dosing schedule was based on hydroxychloroquine pharmacokinetic  modelling referencing a SARS-CoV-2 half maximal effective concentration (EC50)of 0.72 μM 268 scaled to whole blood concentrations and an assumption that cytosolic concentrations in the  respiratory epithelium are in dynamic equilibrium with blood concentrations.

We did not observe excess mortality in the first 2 days of treatment with hydroxychloroquine, the time when early effects of dose-dependent toxicity might be expected.  Furthermore, the preliminary data presented here did not show any excess in ventricular  tachycardia (including torsade de pointes) or ventricular fibrillation in the hydroxychloroquine  arm.

The above is why a higher dosage was used than the one used for Malaria/ SLE/ RA.

As stated before, there is more detail in the protocol should you be curious. They used a safe dose, which did not show any dose dependent toxicity despite the higher dose, and the study showed no difference in mortality.

Secondly, in medicine, medications don't have just one ''recommended dose'  - and there isn't a 'recommended dose' for COVID 19 - Of course, some medications have one dose, but dosages for medications are usually based on indication. And the same medication can have completely different doses depending on the indication. Take Quinine for example, to treat muscle cramps the dose is 300mg once daily at night. However, if we are using Quinine to treat Malaria ( more rare now with the advent of other antimalarials) then the dose is 1800mg once daily. And this is VERY common, this is just one example but there are lots of similar examples.

To me, it's clear that it does not work to reduce mortality either in Hospitalized patients as shown by RECOVERY*, WHO* and ORCHID* or symptom severity in non-hospitalized patients as shown here ( HCQ given earlier here)

Happy to read further RCTs if and when they come out but for now the evidence is quite strong against the use of HCQ.

*All RCTs, btw

( Edit - no links to this belgian study so I can't read that)

[Fragile Bird]

I am used to having CNN on, and they use Johns Hopkins numbers to paste on their screen image. Their numbers and Worldometer's numbers keep getting further and further apart. I see according to Worldometer the US crossed into 6 M cases yesterday, while Johns Hopkins is showing 5,900,000 or so, and Worldometer is showing more than 185,000 deaths while JH is showing 181,000. Those are fairly large differences.

[rotting sea cow]

4 hours ago, The Anti-Targ said:

From the Italian study:

That is about how I would characterise it. It doesn't discourage use, but it doesn't clearly commend its use either. It's cheap, at the right doses it should not do a much harm by way of side effects, and it may help. These observational studies are a step up from anecdata, but they are far from the gold standard required for unqualified recommendation for treatment. And it seems dex may be better, has somewhat more robust studies supporting it, and is just as cheap.

From my limited understanding of the things, HCQ, etc should be used as an antiviral early in the infection (which may also be the reason why remdesivir shows very limited success) while dexamethasone and similars are used against the cytokine storm.

[DireWolfSpirit]

S.Dakota just doubled its highest previous daily new cases number. 

[Fragile Bird]

18 minutes ago, DireWolfSpirit said:

S.Dakota just doubled its highest previous daily new cases number. 

Almost tripled, actually. 623 cases reported yesterday, previous high was 251 just on August 22, previous high was 249 all the way back on May 9. These cases are being attributed to the Sturgis motorcycle event.

[Mr. Chatywin et al.]

22 minutes ago, Fragile Bird said:

Almost tripled, actually. 623 cases reported yesterday, previous high was 251 just on August 22, previous high was 249 all the way back on May 9. These cases are being attributed to the Sturgis motorcycle event.

Think about the people who attend from out of state.....

[rotting sea cow]

The Wall Street Journal account of the events leading to the pandemic. It's particularly damming with China and absolving with the WHO, but otherwise very informative. Paywalled link, archive link.

 

[DireWolfSpirit]

India is in the midst of a raging outbreak. 76000 cases yesterday alone.

[rotting sea cow]

4 hours ago, DireWolfSpirit said:

India is in the midst of a raging outbreak. 76000 cases yesterday alone.

India has a huge population with many of them living in poverty in densely populated cities. The ideal environment for an infectious disease to spread like wildfire.

If we believe the serological studies, the total fraction of infected is far larger than the reported. For example, in Delhi alone there have been nearly 5 millions of infected

https://www.bbc.com/news/world-asia-india-53485039

and half of population of the Mumbai slums already got COVID-19

https://www.bbc.com/news/world-asia-india-53576653