COVID-19 - Facts and Information Only Topic

[Hapless Bills Fan]

Homemade masks.  These ladies are legit.  They actually bought a particulate-testing machine from Grainger and went at it:
https://www.businessinsider.com.au/homemade-mask-using-hydro-knit-shop-towel-filters-better-2020-4?fbclid=IwAR35xOtPEvmleo5i7kFlGkIOrWmK_Y78e_ggPtZijkxCxuFwnmRAn8eZ0HU

 

"They bought a $US1,400 particulate-counter device from Grainger that measures filtration ability down to 0.3 microns and spent another 10 sleepless days testing all the fabrics they could find. ...They wanted a material they could buy as easily as cotton but that balanced filtration with breathability – they discovered that HEPA vacuum-cleaner bags, for instance, had great filtration but were too suffocating to wear."
 

"The ideal material turned out to be stretchy blue shop towels made from a polyester hydro knit.

Inserting two of these towels into an ordinary cotton mask brought filtration up to 93% of particles as small as 0.3 microns, the smallest their machine could test. Meanwhile, the cotton masks filtered 60% of particles at best in their tests, Schempf said."

[Justin C]

I saw this posted in a couple places. I found it here: https://www.worldometers.info/coronavirus/country/italy/

 

I somewhat feel like this might be the case when things start to settle down. Not to minimize it, but I know people in my office that were showing symptoms similar to Coronavirus back in December. So more people might have been infected than reported, especially with the lack of testing early on:

 

"Italy: the real number of COVID-19 cases in the country could be 5,000,0000 (compared to the 119,827 confirmed ones) according to a study which polled people with symptoms who have not been tested, and up to 10,000,000 or even 20,0000,000 after taking into account asymptomatic cases, according to Carlo La Vecchia, a Professor of Medical Statistics and Epidemiology at the Statale di Milano University.

 

This number would still be insufficient to reach herd immunity, which would require 2/3 of the population (about 40,000,000 people in Italy) having contracted the virus [source].

 

The number of deaths could also be underestimated by 3/4 (in Italy as well as in other countries) [source], meaning that the real number of deaths in Italy could be around 60,000.

 

If these estimates were true, the mortality rate from COVID-19  would be much lower (around 25 times less) than the case fatality rate based solely on laboratory-confirmed cases and deaths, since it would be underestimating cases (the denominator) by a factor of about 1/100 and deaths by a factor of 1/4."

[Edit: please see cross post in Covid Discussion thread to discuss/debate]

[Gray Beard]

1 minute ago, Justin C said:

I saw this posted in a couple places. I found it here: https://www.worldometers.info/coronavirus/country/italy/

 

"I somewhat feel like this might be the case when things start to settle down. Not to minimize it, but I know people in my office that were showing symptoms similar to Coronavirus back in December. So more people might have been infected than reported, especially with the lack of testing early on:

 

Italy: the real number of COVID-19 cases in the country could be 5,000,0000 (compared to the 119,827 confirmed ones) according to a study which polled people with symptoms who have not been tested, and up to 10,000,000 or even 20,0000,000 after taking into account asymptomatic cases, according to Carlo La Vecchia, a Professor of Medical Statistics and Epidemiology at the Statale di Milano University.

 

This number would still be insufficient to reach herd immunity, which would require 2/3 of the population (about 40,000,000 people in Italy) having contracted the virus [source].

 

The number of deaths could also be underestimated by 3/4 (in Italy as well as in other countries) [source], meaning that the real number of deaths in Italy could be around 60,000.

 

If these estimates were true, the mortality rate from COVID-19  would be much lower (around 25 times less) than the case fatality rate based solely on laboratory-confirmed cases and deaths, since it would be underestimating cases (the denominator) by a factor of about 1/100 and deaths by a factor of 1/4."

I check that site also. Today they posted some possible good news...

 

• 4805 new cases and 681 new deaths in Italy. The number of patients hospitalized in intensive care has declined for the first time since the beginning of the epidemic in Italy
  
  The target of bringing down the reproductive number (R0) to 1 has been reached. Now the goal is to bring it below 1. Earlier in the epidemic, it was as high as 3. This value represents the average number of people to which a single infected person will transmit the virus. An epidemic with a reproductive number below 1 will gradually disappear
  
  An estimated 30,000 lives have been saved as an effect of the lockdown measures, according to Istituto Superiore di Sanità (ISS) [source] [source]

 

 

 

[Hapless Bills Fan]

Some promising small results with monoclonal antibody treatment

 

https://www.wsbtv.com/news/trending/hiv-drug-showing-signs-successfully-treating-coronavirus-patients/4ONG76NRAREW7C2LAWBVTHK7EI/

 

https://markets.businessinsider.com/news/stocks/treatment-with-cytodyn-s-leronlimab-indicates-significant-trend-toward-immunological-restoration-in-severely-ill-covid-19-patients-1029057991

 

The drug, leronlimab, doesn't treat the covid-19 virus directly.  One complication of covid-19 is cytokine storm, where the patient's own immune system goes into berserker mode and starts attacking the lungs (this happens as a complication of some influenza cases as well).   Leronlimab "calms the storm"

 

[Hapless Bills Fan]

1 hour ago, OldTimeAFLGuy said:

..in deference to Hap and other TRD'ers with medical expertise and to help my shortsightedness, can I assume that the medical community faces two mutually exclusive conundrums as follows....

 

1. Treatment(s) to Eventuate or Promulgate Recovery-much has been made about various malaria related drugs that may assist in a COVID-19 infected person surviving.

2. A Vaccine Cure-as with the flu, I doubt there can ever be a 100% preventive cure; perhaps best case as with flu vaccines is 50%.

 

...are these the focus today in concurrence?.....

 

I'm having a bit of trouble parsing this.  I don't think vaccines and treatments are "mutually exclusive conundrums"?

 

I think the #1 priority for the medical community is assuring disease protection for health care workers and other first responders - not just medical, but police officers, social workers, personal care aides.  We don't want to render our HCW and 1st responders extinct.  There are three parts to this:

1) adequate supplies of good PPE.  We got people wearing N95 masks who should be wearing PAPRs or N95 masks + face shields, and people wearing surgical masks who should be wearing N95s.  We got people wearing gowns who should be wearing coveralls and hoods, and people wearing trash bags or rain ponchos over scrubs who should be wearing gowns.

2) serology (blood) testing and quick turn around PCR testing - if we can identify who is immune, but not contagious, then we know who can safely work most closely with infected people, assure public safety, care for elders without risking them

3) effective prophylactic treatment for people who are exposed/to clear virus from asymptomatic or presymptomatic people - if hydroxychloroquine/azythromycin work for this alone, that would be HUGE - clinical trials underway.

 

#2 priority is tools to control the epidemic and let people out of lockdown once the disease passes. 

1) Serology testing to know who in the general public is immune

2) Mask-wearing in public to cut off asymptomatic and presymptomatic transmission chains. 

3) a contact tracing system based on "big data" from cell phones etc - so that when someone tests positive, you can find out if you were close enough that you should be tested

 

#3 specific treatment for those unlucky enough to become critically or seriously ill.  Discussion of various options up thread

1) identifying/treating cytokine storm (autoimmune response) when it occurs

2) use of convalescent plasma donated by all those lucky souls who have had the disease (identified by serology testing) to help heal

are the two surest bets near term

 

There may be a "magic bullet" found in the 110+ clinical trials underway, and that will be great, but we need to figure out how to manage this with the tools we have to hand now

 

Vaccination  - it's not clear yet how long immunity from people who have been ill will last, or how long immunity from a vaccine will last.   People studying the genomics of this virus are saying they think it will probably take several years to mutate away from a vaccine developed against the current virus, which would be good - but the real question is for people who get the disease, how long does their immunity last?

 

Flu vaccine has a huge effect being 50-60% effective.  The cases of flu that develop are generally milder, due to partial immunity.  Flu has an effective transmission number of 1.3, due to partial immunity and vaccination.  This beast transmission number currently 2.2.  If you lower the transmission number to where it's like flu, covid-19 will still be a serious disease for some people, but it will no longer overwhelm hospitals with desperately sick people.  That, plus specific treatment to lessen the severity will make it manageable.

 

 

 

 

[ExiledInIllinois]

Anybody post the technical guide:

 

https://arstechnica.com/science/2020/04/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/

 

[Edit: This is quite good!  There are places where the information is a bit dated, as in the early belief that asymptomatic carriers were few, and that transmission from asymptomatic carriers and aerosol transmission were not occurring....it is now acknowledged at best, we don't know the extent]

[Bob in Mich]

On 4/4/2020 at 10:36 PM, Hapless Bills Fan said:

Some promising small results with monoclonal antibody treatment

 

https://www.wsbtv.com/news/trending/hiv-drug-showing-signs-successfully-treating-coronavirus-patients/4ONG76NRAREW7C2LAWBVTHK7EI/

 

https://markets.businessinsider.com/news/stocks/treatment-with-cytodyn-s-leronlimab-indicates-significant-trend-toward-immunological-restoration-in-severely-ill-covid-19-patients-1029057991

 

The drug, leronlimab, doesn't treat the covid-19 virus directly.  One complication of covid-19 is cytokine storm, where the patient's own immune system goes into berserker mode and starts attacking the lungs (this happens as a complication of some influenza cases as well).   Leronlimab "calms the storm"

 

 

Hap, feel free to move/delete this if you feel it does not belong here.  It was posted in the PPP thread 'Know Anyone with a Disease'.  That is a medical cannabis thread here. There I have posted more of my personal experience with recent respiratory problems and cannabis concentrates.

 

https://www.twobillsdrive.com/community/topic/169052-know-anyone-with-a-disease-read-this/?do=findComment&comment=6463090

 

 

I have been reading a bit more about the 'cytokine storm' that seems to overwhelm the lungs in covid-19 patients.  This is essentially an overreaction by our immune system to the virus.  It seems that this overreaction is at the heart of the fluid build up in the lungs and so to the shortness of breath issue.  With THC being a bronchodilator, there may be a treatment hidden in here somewhere I think.

 

I am no expert in this field, unfortunately.  From what I have read, many of the potential pharma treatments try to also quiet this cytokine storm.  I am curious if there is any actual current research on using cannabinoids to try to treat covid-19 patients.

 

https://www.projectcbd.org/medicine/cannabis-cbd-covid-19

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828614/

 

from the study

 

Executive summary

Cannabinoids, the active components of Cannabis sativa, and endogenous cannabinoids mediate their effects through activation of specific cannabinoid receptors known as cannabinoid receptor 1 and 2 (CB1 and CB2).

The cannabinoid system has been shown both in vivo and in vitro to be involved in regulating the immune system through its immunomodulatory properties.

Cannabinoids suppress inflammatory response and subsequently attenuate disease symptoms. This property of cannabinoids is mediated through multiple pathways such as induction of apoptosis in activated immune cells, suppression of cytokines and chemokines at inflammatory sites and upregulation of FoxP3+ regulatory T cells.

Cannabinoids have been tested in several experimental models of autoimmune disorders such as multiple sclerosis, rheumatoid arthritis, colitis and hepatitis and have been shown to protect the host from the pathogenesis through induction of multiple anti-inflammatory pathways.

Cannabinoids may also be beneficial in certain types of cancers that are triggered by chronic inflammation. In such instances, cannabinoids can either directly inhibit tumor growth or suppress inflammation and tumor angiogenesis.

Edited April 10, 2020 by Bob in Mich

[aristocrat]

 

[Hapless Bills Fan]

Really good explanation from virologist Peter Kolchinsky of why covid-19 is a harder beast to fight than SARS was.

 

https://threadreaderapp.com/thread/1246975275021348865.html?fbclid=IwAR0fbXN74tI4gmZETIgRhNSuuk5KCEh3X0lG90w0Rnf9bjNx0IdoFvqOclE

 

"Well, the ACE2 doorknob that SARS-1 & SARS-2 use is present on a variety of cells, including those in our lungs & throat. SARS-1 would enter a person via a droplet in the air (from cough) & quickly start infecting lung cells, causing severe damage person could really feel (i.e. become symptomatic). In other words, SARS-1 quickly made its presence known. In some patients, SARS-1 would go into the upper airways to replicate from where it could spread to others with a cough (or just breathing). But b/c SARS-1 patients got very sick from all the virus replicating in their lungs, they were quarantined before others got close enough to get sneezed or coughed on.

 

SARS-2, on the other hand, takes up residence in the throat cells first, which doesn’t cause significant symptoms. The person can remain asymptomatic or might not think they have anything worse than a cold. And from that person’s throat it can readily spread to others. Over the course of a week, in some patients, it will move into the lung neighborhood and replicate just as SARS-1 would, causing severe symptoms, by which point the person is quarantined, but no matter since it had successfully spread."

"So SARS-1 was a comparatively dumb virus. It went straight for the lungs, announced itself before it could spread to others, and so got social distanced into extinction. "

 

"But SAR-2, the one plaguing us now, is stealthier, spreading first before revealing itself (and causing harm).  What’s the take-away for all of us? It’s that beating this virus means social distancing & wearing masks even if we think we aren’t infected. Because we might be. The virus might be replicating in our throats without us knowing (that’s its evil plan!), so put up a roadblock. "
 

Nature publication about study this info is based upon: https://www.nature.com/articles/s41586-020-2196-x

 

[Hapless Bills Fan]

3 hours ago, OldTimeAFLGuy said:

...Hap...any validity to this?....

Indoor humidity may slow coronavirus spread, Yale scientists say

By James Rogers | Fox News

 

Researchers at Yale say that we may get some respite from the coronavirus pandemic as we move into spring, although this depends on how indoor environments adapt.

While the effectiveness of social distancing measures obviously plays a crucial role in battling the spread of COVID-19, the scientists are also eyeing changes in relative humidity indoors from winter to spring to summer.

 

Relative humidity measures water vapor relative to the temperature of the air.

 

“In other words, it is a measure of the actual amount of water vapor in the air compared to the total amount of vapor that can exist in the air at its current temperature,” explains the National Weather Service on its website. This differs from absolute humidity, which is a measure of the actual amount of water vapor in the air, regardless of its temperature.

 

https://www.foxnews.com/science/indoor-humidity-may-slow-coronavirus-spread-yale-scientists-say

 

Eh, here's the paper:

https://www.annualreviews.org/doi/pdf/10.1146/annurev-virology-012420-022445

 

Basically the operative word is "MAY".  Their argument seems to be that other human coronaviruses that cause common cold are seasonal and tail off at the end of April, so this one will too.  But there is no new evidence offered on that point.

 

They make a case for relative humidity - the amount of water vapor in the air, vs the amount the air can hold at that temperature - which is low in heated environments in winter - as a factor impacting virus viability and ability to spread - and they review a bunch of research on that point, but none of that research is on covid-19

[Hapless Bills Fan]

University of Texas group takes a look at the chances that even 1 positive case in a county indicates community spread is underway:

 

https://cid.utexas.edu/sites/default/files/cid/files/covid-risk-maps_counties_4.3.2020.pdf?m=1585958755&fbclid=IwAR3xoK7HG6WvIrdYMfC0zwswIf7ePb-qGo9FXR8JbXDWdOfaPSlZi-rAwlQ

 

Without a coordinated state or federal response to COVID-19 across the United States,counties are left to weigh the potentially large yet unseen threat of COVID-19 with theeconomic and societal costs of enacting strict social distancing measures. Theimmediate and long-term risk of the virus can be difficult to grasp, given the lack ofhistorical precedent and that many cases go undetected. We calculated the risk thatthere already is sustained community transmission that has not yet been detected.Given the low testing rates throughout the country, we assume that one in ten cases aretested and reported. If a county has detected only one case of COVID-19, there is a 51%chance that there is already a growing outbreak underway. COVID-19 is likely spreadingin 72% of all counties in the US, containing 94% of the national population. Proactivesocial distancing, even before two cases are confirmed, is prudent

 

[SlimShady'sSpaceForce]

hospitalizations drop for second day in a row in NYC - local DC TV news  no link sorry 

[Edit: graphic on positive cases and deaths.  positive cases closely linked to hospitalizations since they are only testing people sick enough for admission and HCW/1st responders]

 

Edited April 7, 2020 by Hapless Bills Fan

[SlimShady'sSpaceForce]

New York virus deaths hit new daily high, but hospitalizations slow  

 

https://www.msn.com/en-us/news/us/ny-virus-deaths-hit-new-high-but-hospitalizations-slow-live-updates/ar-BB12gExd?OCID=ansmsnnews11

[OldTimeAFLGuy]

18 hours ago, Hapless Bills Fan said:

 

Eh, here's the paper:

https://www.annualreviews.org/doi/pdf/10.1146/annurev-virology-012420-022445

 

Basically the operative word is "MAY".  Their argument seems to be that other human coronaviruses that cause common cold are seasonal and tail off at the end of April, so this one will too.  But there is no new evidence offered on that point.

 

They make a case for relative humidity - the amount of water vapor in the air, vs the amount the air can hold at that temperature - which is low in heated environments in winter - as a factor impacting virus viability and ability to spread - and they review a bunch of research on that point, but none of that research is on covid-19

 

...if I understand correctly, it should NOT be flourishing in Brazil which is in their summer season..........

 

from The Guardian:

Brazil is bracing for a surge in coronavirus cases as doctors and researchers warn that underreporting and a lack of testing mean nobody knows the real scale of Covid-19’s spread.

 

“What’s happening is enormous underreporting,” said Isabella Rêllo, a doctor working in emergency and intensive care in Rio de Janeiro hospitals, in a widely shared Facebook post challenging official numbers. “There are MANY more,” she wrote.

 

As Latin America’s worst hit country, Brazil officially has 9,056 coronavirus cases – including actors, singers, government ministers and Fabio Wajngarten, press secretary of the president, Jair Bolsonaro.

[dave mcbride]

3 hours ago, SlimShady'sSpaceForce said:

New York virus deaths hit new daily high, but hospitalizations slow  

 

https://www.msn.com/en-us/news/us/ny-virus-deaths-hit-new-high-but-hospitalizations-slow-live-updates/ar-BB12gExd?OCID=ansmsnnews11

Also NYC related: https://gothamist.com/news/surge-number-new-yorkers-dying-home-officials-suspect-undercount-covid-19-related-deaths

 

[Thanks for posting - seemed inappropriate for me to "like" tho. ? This is pretty common in an epidemic situation.  Very likely happened in China and is happening in Italy/Spain and elsewhere too.  When the dust settles, statisticians look at seasonal deaths from previous years and calculate an "excess death rate" which may be attributed to the disease]

[Hapless Bills Fan]

 

This is a good visualization with lasers as to how microdroplet transmission occurs, and a model of how it would linger and move about a closed room with relatively poor air circulation.  My bottom line: Indoors, Mask up!

 

 

 

Edit: and here is a Belgian study about the effects of exercising close to others:

https://medium.com/@jurgenthoelen/belgian-dutch-study-why-in-times-of-covid-19-you-can-not-walk-run-bike-close-to-each-other-a5df19c77d08

 

 

Edited April 10, 2020 by Hapless Bills Fan
add second visualization video

[aristocrat]

https://www.npr.org/sections/health-shots/2020/04/02/826105278/ventilators-are-no-panacea-for-critically-ill-covid-19-patients

 

Hapless what are your thoughts on this? 

What are my thoughts on this?  I saw this a couple days ago and it took me a bit to unsnarl my thoughts to give a more-or-less reasoned response. 

 

Ventilators for patients in the throes of viral infection have always been a bit of a hail-Mary pass.  In an acute injury or post-surgery, they provide time for healing; with a bacterial infection they provide time for antibiotics to take hold.  For a viral infection, if there's an effective antiviral, Same, but otherwise it's a race against time.  Does the patient recover faster than they develop complications from the effects of the ventilation or secondary infections?

As I understand it, overall in China their experience was people who wound up in ICU on ventilators were 50-50 if they recovered or not.  If they did recover, it took a long time - 2 to 4 weeks.  I think the referenced initial study from Wuhan was early on, and they improved outcomes as the outbreak went on.  So I'm not sure about the statistics there.

Here is a study from UK where so far they are running 1/3 wean and leave, 2/3 fatalities for ventilated patients (but many not yet resolved, still in ICU):

https://ricochet.com/742120/covid-19-data-survival-rates-for-patients-on-ventilators/

 

Factors:

1) The saturated health care system in NYC currently.  They are only hospitalizing the most severely ill patients and sending the others home with instructions to return if they meet certain critera.  By the time those sent home meet the criteria and return, they may already be in such respiratory distress as to require immediate ventilator treatment. 

Several therapeutic windows that might keep them from needing ventilation are already lost - windows to try a clinical trial for an antiviral medication, or immune plasma, windows to see if improved oxygenation and hydration will improve outcome, and a window to test for and treat/manage cytokine storm (There is a simple, inexpensive blood test for this, ferritin, and if any of you have a seriously ill family member be sure to ask the results of this test.  But do not ask for the test before they are showing respiratory symptoms, false negative may occur). 

 

If the patient comes in with lungs already severely damaged from covid-19 or already in the throes of cytokine storm, there is little to do but support them and wait.  Either they will heal or they won't.  They can be treated to contain cytokine storm or treat sepsis, but if damage exists, it won't be reversed, it must wait to heal itself or not.

 

2) How is the ventilator being used?  The current standard of care is to treat as acute respiratory distress syndrome.   There is some evidence suggesting that covid-19 damaged lungs are sensitive and require lower pressure settings than are standard.  I do not know how clear this evidence is or how widespread use of lower pressure settings are becoming, but obviously if the ventilator is being split between patients, controlling pressure carefully (and controlling secondary infections) becomes more of an issue.

 

3) Is the patient being monitored and treated for complicating conditions such as cytokine storm or sepsis?   Are there clear clinical guidelines for these treatments?  Do the staff have time to order  the appropriate laboratory tests and keep up with the findings?  Are the medications in good supply?

 

Bottom line is this: as long as there is no cure, prevention is essential - both to avoid overstressing the health care system and to give the patients who do require it their best chance.  A metric like "I haven't heard of ventilators being unavailable" simply doesn't begin to capture the effects of health care system overload.

[SlimShady'sSpaceForce]

The United States on Tuesday reported more than 1,800 coronavirus-related fatalities, a new one-day high.

 

https://www.washingtonpost.com/world/2020/04/07/coronavirus-latest-news/

 

a Guardian report has a higher number

[thebandit27]

1 hour ago, SlimShady'sSpaceForce said:

The United States on Tuesday reported more than 1,800 coronavirus-related fatalities, a new one-day high.

 

https://www.washingtonpost.com/world/2020/04/07/coronavirus-latest-news/

 

a Guardian report has a higher number

Some good news (model accuracy or lack thereof notwithstanding):

 

https://covid19.healthdata.org/united-states-of-america

 

Estimates of death toll and max resource consumption are down significantly.

[BillsFan4]

35 minutes ago, Pilsner said:

America’s major medical society specializing in the treatment of respiratory diseases has endorsed using hydroxychloroquine for seriously ill hospitalized coronavirus patients.

The American Thoracic Society issued guidelines Monday that suggest COVID-19 patients with pneumonia get doses of the anti-malaria drug.

 

 

https://nypost.com/2020/04/06/medical-group-backs-giving-hydroxychloroquine-to-coronavirus-patients/

For context:

 

guidelines on who who qualifies for this treatment and their thinking behind issuing this advise:

Quote

“To prescribe hydroxychloroquine (or chloroquine) to hospitalized patients with COVID-19 pneumonia if all of the following apply: a) shared decision-making is possible, b) data can be collected for interim comparisons of patients who received hydroxychloroquine (or chloroquine) versus those who did not, c) the illness is sufficiently severe to warrant investigational therapy, and d) the drug is not in short supply,” the Thoracic Society said.

Quote

The medical group said evidence about the impact of hydroxychloroquine is “contradictory” but it is worth experimenting with during a public health crisis to treat very sick patients.

 

“We believe that in urgent situations like a pandemic, we can learn while treating by collecting real-world data,” said Dr. Kevin Wilson, chief of guidelines and documents at the American Thoracic Society.

 

“There are in vitro studies that suggest that hydroxychloroquine and chloroquine have activity against SARS-CoV-2019, the virus that causes COVID-19,” Wilson said.

 

But he also said several controlled trials from China and France “all have serious flaws and inconsistent findings. … Thus, the bottom line is, whether hydroxychloroquine and chloroquine confer benefits to patients with COVID-19 are unanswered questions.”

 

Like Trump, Cuomo said Monday giving sick COVID patients doses of hydroxychloroquine is a worthy experiment to try to save lives.

 

[Hapless Bills Fan]

 

 

 

https://public.flourish.studio/visualisation/1812248/?fbclid=IwAR0MeiOoCAZc1hAEOxEu3P_oiVn0PsXbCUcsTRgEA0teZrFXYmA-ooO8fJo

 

This is a very vivid presentation.  I wish I could figure out how to paste it so it would play in here. 

For anyone who thinks this is overblown, please click on the link above.  For anyone who doesn't want to watch the visualization, beginning and end below.

March 15:

 

 

April 8:

[Hapless Bills Fan]

https://www.washingtonpost.com/nation/2020/04/05/youre-basically-right-next-nuclear-reactor/?arc404=true

 

Account of an anesthesiologist intubating patients in the ICU

Our team had a meeting on March 16th to figure out a staffing plan, once it was clear where this was going. Chicago’s becoming a hot spot now. Our ICU is almost full with covid patients. The pediatric ICU has been cleared out to handle overflow. The wave is just starting, and we need to limit our exposure or we’re going to run out of staff. Everyone basically agreed we should dedicate one person to covid intubations during the day and another at night, and I started thinking: I’m 33 years old. I don’t have any kids at home. I don’t live with older relatives. About an hour after the meeting, I emailed my supervisor. “I’m happy to do this. It should be me.”

Now my pager goes off throughout the night. Nine o’clock, midnight, 2, then again at 3:30. Most of the time I do several airways in a shift. By next week or the week after that, they’re saying it could be 10.

[ExiledInIllinois]

Just don't inhale your food... Very informative on how coronavirus is spread:

 

https://www.npr.org/sections/health-shots/2020/04/08/822903487/how-safe-is-it-to-eat-take-out

 

"Infectious disease and food safety experts we spoke to say they base their determination that takeout food is safe on decades of research on other coronaviruses, which were first identified in humans in the 1960s."

 

"While COVID-19 is new to us, coronaviruses are not, and with all the studies done on these viruses, there has never been any information to implicate food-borne transmission," says Dr. William Schaffner, a professor of medicine in the department of infectious diseases at the Vanderbilt University School of Medicine in Nashville, Tenn. ..."

[Sundancer]

Hapless has been quoting a geneticist (Bedford, also quoted often in this piece)  early in this thread. Turns out that most of the CV-19 cases we have here came from European travelers, according to two separate studies. 
 

https://www.nytimes.com/2020/04/08/science/new-york-coronavirus-cases-europe-genomes.html

 

A travel ban for Europe in Jan would have made a big difference but we didn’t know Europe was ahead of us by a few weeks. Amazing science here. 

Edited April 9, 2020 by Sundancer

[thebandit27]

Seems that Fauci is agreeing with the lower estimate from WSU’s model:

 

 

 

Which would be relatively excellent news

Edit: it would be good news, but note several caveats

1) The model ASSUMES CURRENT STAY AT HOME AND OTHER SOCIAL DISTANCING MEASURES REMAIN IN PLACE THROUGH MAY
2) Here is a figure from the website with the model.  Click to embiggen.   The shaded area represents the 95% confidence intervals in the model.  Note the substantial uncertainty.

Edited April 10, 2020 by Hapless Bills Fan
edited to add more info about model

[Hapless Bills Fan]

5 hours ago, ExiledInIllinois said:

Just don't inhale your food... Very informative on how coronavirus is spread:

 

https://www.npr.org/sections/health-shots/2020/04/08/822903487/how-safe-is-it-to-eat-take-out

 

"Infectious disease and food safety experts we spoke to say they base their determination that takeout food is safe on decades of research on other coronaviruses, which were first identified in humans in the 1960s."

 

"While COVID-19 is new to us, coronaviruses are not, and with all the studies done on these viruses, there has never been any information to implicate food-borne transmission," says Dr. William Schaffner, a professor of medicine in the department of infectious diseases at the Vanderbilt University School of Medicine in Nashville, Tenn. ..."

 

So one question to ask is: with all those other coronaviruses, do they enter cells through the same mechanism?  My understanding is no except for....

.....SARS-CoV, the virus that caused SARS, was thought to have spread in part through fecal-oral transmission...and it binds to ACE2.

 

-They are finding SARS-CoV-2 RNA in fecal samples.  Whether it is live virus capable of causing covid-19, is another question.

-Coronaviruses are typically acid-stable, which is why it is advised not to use vinegar as a disinfectant

-Sars-CoV2 is thought to bind to ACE2 as well

-There are a lot of ACE2 receptors in intestines

 

Yes, food workers should be safe, practice good hygiene, and not come to work when ill.  But they don't, always.

This sort of piece just bothers me.  The restaurant industry is getting killed, and I understand wanting to help it, but while there isn't evidence of food-borne transmission, there are a buttload of cases where the source of the disease is listed as "under investigation" or "unknown".

3 hours ago, Sundancer said:

Hapless has been quoting a geneticist (Bedford, also quoted often in this piece)  early in this thread. Turns out that most of the CV-19 cases we have here came from European travelers, according to two separate studies. 
 

https://www.nytimes.com/2020/04/08/science/new-york-coronavirus-cases-europe-genomes.html

 

A travel ban for Europe in Jan would have made a big difference but we didn’t know Europe was ahead of us by a few weeks. Amazing science here. 

 

It's linked in the article, but go here

https://www.gisaid.org/epiflu-applications/next-hcov-19-app/

scroll down, and hit "play"

[Hapless Bills Fan]

PSA: here is a link to a national project, asking people to self- report symptoms from various locations.  They are trying to get a handle on how many people staying at home have had symptoms that might be covid-19.   They send you daily reminders to report in, but you can opt out.

 

https://med.stanford.edu/covid19/covid-counter.html

If you have recovered from covid-19, consider becoming a plasma donor to help others fight the disease.  Here is a website:

https://ccpp19.org/donors/index.html

 

Here is an article about this:

https://www.usatoday.com/story/news/health/2020/04/01/coronavirus-plasma-therapy-5-us-patients-covid-19-donors/5090946002/

 

If you believe you have had covid-19 symptoms after mid- January, contact your doctor or your local covid-19 information phone number and ask if it would be possible for you to get a serology or antibody test to see if you've had covid-19, so that you may donate plasma if you qualify.

 

[Hapless Bills Fan]

Covid-19 and your heart

 

https://www.livescience.com/how-coronavirus-affects-heart.html

[K-9]

This Ohio PSA is one of the best depictions of the importance of social distancing I’ve seen. Very clever. 
 

 

 

 

 

 

[Hapless Bills Fan]

More on chloroquine.  If you wish to discuss, I ask that you copy the link to this post and discuss in the discussion thread, Please.

If you ask questions here, I'll quote your post and paste in the best answer I can find for you into this post.

 

I've followed this blogger, Derek Lowe, for years.  He knows his drug discovery/development stuff. 

Here's his assessment of two small, controlled studies on chloroquine out of China.

 

https://blogs.sciencemag.org/pipeline/archives/2020/03/31/comparing-chloroquine-trials

 

 

Bottom line: one study showed no effect.  One showed what appears to be a real effect. 

Neither showed the amazing miracle cure French doctor stuff. 

The best effect was 1 day difference in fever,  a nice effect on pneumonia assessed by CT scan.   PCR testing was not repeated in the study that showed an effect.

 

He notes:

(Both studies) excluded patients with any sort of cardiac arrhythmias, a wise precaution since one of the most acute worries with high doses of hydroxychloroquine is QT-interval prolongation, and you don’t want to do that to anyone with any underlying problems. So as long as such patients are excluded, for now hydroxychloroquine is in the “might do nothing, might do some good” category, which under the current conditions seems sufficient for treating patients, pending further data. You will notice that we are not exactly in the “total cure” category that the Marseilles group has been putting itself in, but frankly, these results from China are more like what I expect from the clinic (at best!) when using a repurposed drug against such a pathogen.

And also sounds a note of caution:

As Leonid Schneider has commented on PubPeer, the original trial as registered in China looks quite different from what we see here. Update: see this comment as well. The design was for 100 control patients, another 100 patients to receive one dose of hydroxychloroquine, and 100 more to receive a higher dose. What we have, though, are only two groups of 31 patients each, which suggests that there were problems with the inclusion criteria for the trial and/or with patient recruitment. The trial design also called for endpoints of negative results for viral RNA, and for “T cell recovery time”, to be collected by sputum and throat swabs and by blood samples, respectively, and none of this shows up in the preprint at all.
 

Now, it may be that the 100-patient size numbers were in there as a placeholder and meant “Up to this many depending on how many people we can enroll”. But the endpoints and sample collections seem to have changed pretty thoroughly, and it would be good to know more about that, why these decisions were made, whether any of these data were collected and what they were like. So my opinion of this latest study is “cautious approval”, and that probably sums up my feelings about hydroxychloroquine as a therapy in the Covid-19 epidemic in general. It’s a long way from “This is the cure and it’s unethical to disagree”, that’s for sure. More data will be coming, and we’ll revisit the topic then.

 

 

[Hapless Bills Fan]

OK, from the same source, blogger Derek Lowe, on hydroxychloroquine/azythromycin.  He does a nice job assessing a new French study and discussing clinical trials, effect size, and so forth.

 

First up, the study itself.  The title is "No  Evidence  of  Rapid  Antiviral  Clearance  or  Clinical  Benefit  with  the  Combination  of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection" and that pretty well sums it up.  "we  wished  to  assess  in  a prospective  study  virologic  and  clinical  outcomes  of  11  consecutive  patients  hospitalized  in our department who received hydroxychloroquine (600 mg/d for 10 days) and azithromycin (500 mg Day 1 and 250 mg days 2 to 5) using the same dosing regimen reported by Gautret et al. (3). ......At the time of treatment initiation, 10/11 had fever and received nasal oxygen therapy. Within 5 days, one patient died, two were transferred to the ICU. In one patient, hydroxychloroquine and azithromycin were discontinued after 4 days because of a prolongation of the QT interval from  405  ms  before  treatment  to  460  and  470  ms  under  the  combination.

 

Repeated  nasopharyngeal  swabs  in  10  patients  (not  done  in the  patient  who  died)  using  a qualitative  PCR  assay  (nucleic  acid  extraction  using  Nuclisens  Easy  Mag®,  Biomerieux  and amplification  with  RealStar  SARS  CoV-2®,  Altona),  were  still  positive  for  SARS-CoV2  RNA  in 8/10 patients (80%, 95% confidence interval: 49-94) at days 5 to 6 after treatment initiation.  These virologic results stand in contrast with those reported by Gautret et al. and cast doubts about the strong antiviral efficacy of this combination.

Furthermore, in their report Gautret et al also reported one death and three transfers to the ICU among the 26 patients who received hydroxychloroquine, also underlining the poor clinical outcome with this combination.

For the layperson, prolongation of QT interval is bad - it can signal fatal cardiac arrhythmias.  Occurring in 1 out of 11 patients is bad.

 

Lowe has this to say: "while this is a small study and not a perfect match, it provides no evidence to show that the HCQ/AZ combination had any benefit at all."

He goes on to point to an upcoming publication from a NYU team treating covid-19 patients with hydroxycholorquine/azithromycin: "While we’re on the subject of QT prolongation, there’s this preprint from a medical team at NYU that was also treating patients with the same combination of drugs. In 84 patients, they found notable QT prolongation in about 30% of them, and another 11% were to a level (>500 milliseconds) that put them at a high risk for arrhythmia. This group’s mean age was 63, 74% male. No cancer patients in this group, but 65% did have hypertension and 20% were diabetic (which from many reports is actually a reasonable look at the patients most likely to progress to severe disease). The strongest predictor of dangerous QT numbers was the development of renal trouble while on the drug combination.

 

In the discussion thread, @Nervous Guy correctly cited the incidence of cardiac-related adverse events in patients taking chloroquine or hydroxychloroquine for other conditions, and it's quite low.  I sounded a note of caution, that cardiac arrhythmias are apparently seen in covid-19 patients with a pretty high incidence in general, so one could not assume the same low incidence of side effects in a population of sick people.  At the time, I didn't know of the NYU preprint, but unfortunately the NYU study suggests this may be a concern.

An important point Lowe makes about the Gautret ("French physician") studies is that even taking the reduction in viral titer at face value, that's what could be considered a "surrogate endpoint" for what one really cares about when treating patients - how many treated patients got better,did the treated group recover more quickly than other patients by some patient-centered measure such as CT scan of lungs, fever, # of patients discharged vs ICU etc.

 

Anyway, Derek Lowe really understands the whole process of developing a drug and deciding whether or not it has a sufficient clinical effect to justify any risk, and his blog is well worth reading - give it a look.

 

He deconstructs the Gautret et al study as well and points to another publication that deconstructs it, but I already had a go at that myself up thread so I'll just link it. His conclusion: these new results are still not from randomized patients and still do not have any sort of control group for comparison. The sample is larger, but it’s still not possible to judge what’s going on. And on further reading, I have doubts about Dr. Raoult’s general approach to science and doubts about Dr. Raoult himself. Despite this second publication, I am actually less hopeful than I was before. Now the details. 

 

On 4/11/2020 at 5:02 AM, Nervous Guy said:

What I cited was the incidence of HCQ alone, not in combination with any other drug...whose to say the drug combination exacerbated a rare side effect and actually it looks like this is very likely.   Here is the warning for azithromycin, have to admit I did not know this:

QT prolongation

• Prolonged cardiac repolarization and QT interval, imparting a risk of developing cardiac arrhythmia and torsades de pointes, have been reported with macrolides, including azithromycin
• Elderly patients may be more susceptible to drug-associated effects on the QT interval

• Consider the risk of QT prolongation for at-risk groups including:

  • Patients with known prolongation of the QT interval, a history of torsades de pointes, congenital long QT syndrome, bradyarrhythmias or uncompensated heart failure
  • Patients on drugs known to prolong the QT interval
  • Patients with ongoing proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia, and in patients receiving Class IA (quinidine, procainamide) or Class III (dofetilide, amiodarone, sotalol) antiarrhythmic agents

 

https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-azithromycin-zithromax-or-zmax-and-risk-potentially-fatal-heart

 

I did know that, but I don't think it's just the combo of drugs... just treating with chloroquine (which China has done extensively, it became their standard of care) they have seen cardiac side effects at incidents higher than one would expect given the drug's history....because it became the standard of care without blinded studies or controls, of course, it could be they are seeing the effects of the disease as well and there is some data on that.  That's the problem with uncontrolled studies. ?

EDIT: this just in.  https://www.medrxiv.org/content/10.1101/2020.04.08.20054551v1.full.pdf

Group reviewed medical record data from 6 countries looking for concurrent administration of hydroxychloroquine and azithromycin OR  hydroxychloroquine and ampicillin.
They found that while hydroxychloroquine alone (when compared to another rhumatoid arthritis drug) showed no excess adverse events, when combined with azithromycin they saw increased cardiac events and heart failure:
Conclusions  Short-term hydroxychloroquine treatment is safe, but addition of azithromycin may induce heart failure and cardiovascular mortality, potentially due to synergistic effects on QT length. We call for caution if such combination is to be used in the management of Covid-19

 

[Hapless Bills Fan]

More about serology testing, and a note of caution.  I will admit I did not "get" this myself initially, and had to consult a friend who is an expert in antibody-based testing to get my head straight but I "get it" now.

 

So we are hearing this:

https://currently.att.yahoo.com/news/antibody-test-allow-us-back-191110496.html

 

A major answer to the question of when — and how — Americans can return to public places like work and school could depend on something called an antibody test, a blood test that determines whether someone has ever been infected with the coronavirus.
 

People who are believed to be immune may be able to safely return to work. It would be especially important to know which health care workers are protected from getting infected and could continue to care for sick people.
 

The Centers for Disease Control and Prevention recently announced that it would begin using antibody tests to see what proportion of the population has already been infected.

“Within a period of a week or so, we are going to have a relatively large number of tests available,” Dr. Anthony Fauci, the leading infectious disease expert in the U.S., said Friday morning on CNN.
 

He said the White House coronavirus task force was discussing the idea of “certificates of immunity,” which could be issued to people who had previously been infected.

WHOA NELLIE! 

 

Let's work through whether or not that's a good idea for a second.  Bottom line: for people who have reason to believe they were infected (relevant symptoms, close contact with someone who tested positive for covid-19, someone who's symptoms are recent enough to be tested for SARS-Cov2 by RT-PCR and tests positive), sure.

 

For the general population?  Whether or not that means anything, depends entirely on how many people are actually infected.  If it's 50% of the population, or even 30%, yeah, it means something.  If it's 3 or 4% of the population, or less - BAD idea.  Very very BAD idea.  (Fauci is a smart dude and almost certainly know that - it is probably what he means when he says “As we get to the point of considering opening the country, it is very important to understand how much that virus has penetrated society.” Immunity certificates, he said, had “some merit under certain circumstances.”

 

The linked article gives a very good explanation of what the tests look for and their role - recommend as a read.  But there's an entire Mare's Nest, well-known to people who develop these tests (Where's @BillsFanNC?  This your lane, right? Weigh in here!) - the influence of population prevalance of false positives.

 

All tests have false positives, and false negatives.

Bottom line again: if the incidence of immunity is only 3 or 4% in the population, and the test is good - say, 95% specificity - IF YOU TEST POSITIVE, MEANING YOU'RE IMMUNE, there is a 50/50 chance that result is correct.  Read that again.  Wrap your mind around it.

https://twitter.com/zbinney_NFLinj/status/1245789672833417217?s=20

 

 

Again, my first reaction to this was "WTF?" and I rang up a friend whose "lane" this is and said "walk me through this, speak slowly, use small words".  Then we did the calculations independently and came up with the same answer.  Whether or not this is a good idea, depends entirely on how prevalant in a population covid-19 turns out to be.  If some people who posted here are correct and 50% or even 30% of the population have had the disease, Genius.
If it's actually only 2-4%, and you test broadly - BAD MOVE.  Millions of people would be incorrectly identified as immune, when they're not, even with a test that is 95% accurate.

Picture worth 1000 words so here are some pictures explaining this from the same guy, using a theoretical test for Diabetes as an example.  Click to embiggen.  Questions?  Ask.  If someone with a better lane here doesn't answer and I'm not sure, I will grab my friend (in a socially distant way) and shake more answers out of him.

 

 

20 minutes ago, OldTimeAFLGuy said:

 

....how is this affected in layman terms by those who have recovered, but have contracted the virus again?.........would this type of test subsequently show them as immune and NOT a candidate for re-infection?...thanks.............

 

People who are believed to be immune may be able to safely return to work. I

 

I would have to know what cases you're talking about "recovered then contracted the virus again"?

 

I know there are some cases especially in China and S. Korea, where patients have tested negative, then tested positive again some time later, but there is some question as to whether the negative result was essentially a "false negative" - the patient was actually still shedding virus when they tested negative, but not enough for the test to pick up.  The Chinese test may be ~30-40% false negatives, and the S. Korea test 10%-25%, for various reasons not all having to do with the test itself (eg swabbing procedure, whether or not the person has enough virus to test in their nasopharynx at that time)

 

If you know of documented cases where someone was 100% recovered, tested negative, then developed symptoms of the disease again, please link.  Thanks!!!

As far as a serology blood test is concerned, if you have a good antibody response on a blood test, you should be immune - but the problem is if testing broadly, even a small false positive rate will result in MANY MANY PEOPLE showing as immune on the blood test but actually NOT being immune - see pictures for explanation, visual is very good.

 

[Hapless Bills Fan]

The statement was made that patients  being treated with hydroxychloroquine do not get covid-19.

That statement would appear to be untrue.

 

We have a database: patients prescribed hydroxychloroquine for their rheumatoid arthritis, who generously participated

Early results from the patient experience survey (over 6000 responses):

• Primary rheumatic disease: 24% with rheumatoid arthritis, 15% with systemic lupus erythematosus, 6% with axial spondyloarthritis, 3% with psoriatic arthritis
• 309 (5%) reported COVID–19 infections.
• 142 (46%) were taking hydroxychloroquine at the time they were diagnosed with COVID–19.

[Hapless Bills Fan]

Another viral epidemiologist weighs in

 

 

I don't have a "threader" version, sorry - perhaps someone with a Twitter account could make one?

 

Key points of the thread:

 

 

 

 

[Hapless Bills Fan]

Pretty good Vox article, which points out that a right-leaning/conservative think tank, a left-leaning think tank, and two other sources have pretty much reached similar conclusions about what the "reopening" alternatives look like

 

https://www.vox.com/2020/4/10/21215494/coronavirus-plans-social-distancing-economy-recession-depression-unemployment
 

When scientists of vastly different political and socioeconomic perspectives reach pretty much the same conclusion, it's probably real.

[Hapless Bills Fan]

https://threadreaderapp.com/thread/1247609734896607232.html

 

Discussion by "my boi" virologist Trevor Bedford on estimating population prevalence of covid-19.  (I quote him a lot, because he kind of knows his stuff, and he puts it out there so that others can weigh in and correct if need be).

 

The "dream state" would be 50% of the population has actually had covid-19, in which case Jackpot! that's herd immunity.  Bottom line, Bedford doesn't think we're there, and here's why

 

Here's a report by the MRC estimating prevalence in Europe:

https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-13-europe-npi-impact/ (summary)
https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020-03-30-COVID19-Report-13.pdf (full thing)

 

Table from the above (note the error estimates):

 

Currently, the US has 560,891 cases of covid-19.

Bedford estimates

(note he uses the words "I guess", but the guess of a trained epidemiologist on his topic of expertise is not the same as my guess or your guess.  It would be more like the trained eye of a football scout estimating the foot speed of a prospect by eye vs. me doing it)

 

So Bedford's estimate would mean between 5.6M and 11.2M people in the US are actually infected: 1.7 - 3.4% of the population.

 

That's way short of what's needed for herd immunity.

 

 

 

[Hapless Bills Fan]

55 minutes ago, OldTimeAFLGuy said:

...just a layperson's question.......would an in depth study of asymptomatic folks help to pinpoint the susceptibility and as to why they had it with no symptoms yet were fine?.....would or could that help in treating the more vulnerable versus evaluating 330 + mil people in the US?....I've done a lousy job of phrasing my question.... 

 

That's absolutely one of the things medical people would love to know......

 

...first a caveat, people mean different things by "asymptomatic".  Sometimes it means asymptomatic at the time of the test, in countries that are doing extensive contact tracing, but later develop symptoms.   Sometimes it depends upon the questions asked about symptoms.   Sometimes a follow-up interview indicates symptoms that weren't considered worth mentioning or relevant (eg GI symptoms, pink eye, etc).  That's why you see "asymptomatic" rates flying all over the place.

 

Be that as it may, it would be hella helpful to all if we understood why some people get no symptoms or mild symptoms, some people get a severe flu-like disease but recover (both considered "mild" cases) while ~20% need some form of significant, prolonged hospital care. 

Unfortunately, that's probably the sort of information that's going to take a while to sort out.

[Hapless Bills Fan]

7 hours ago, plenzmd1 said:

Not sure if this is the correct thread, but some anecdotaol evidence thet look like almost 20% could be asympatmatic

https://nypost.com/2020/04/14/pregnant-women-without-symptoms-are-getting-coronavirus-study/

 

Good place for it.  When you test a bunch of people, it's no longer anecdotal.

At this point, the preponderance of evidence seems to indicate that at least 20-25% of people infected with covid-19 are truly asymptomatic throughout the course of the disease, and that presymptomatic people are infectious for 24-48 hrs before they develop symptoms .  Some data say as many as 40-50% of people may be asymptomatically infected.

 

It's one of the most crucial questions for public health officials trying to make good decisions about the epidemic to have good information about: how many people are asymptomatic, how long are they infectious?  How long are presymptomatic people infectious?  The initial assumptions here were "not many" and "not very", and increasing evidence says that both those assumptions were wrong. 

 

https://www.newsday.com/news/health/coronavirus/asymptomatic-coronavirus-1.43629598

"As many as 25% of people with the virus are asymptomatic and will remain so, Dr. Robert Redfield, the director of the U.S. Centers for Disease Control and Prevention, said in an interview broadcast Tuesday on National Public Radio. Those who get sick from COVID-19 may be capable of transmitting the virus for up to 48 hours before they have symptoms, he said. Both groups help explain why the virus has spread so quickly, he added."

Data from different countries:
China now seems to be saying 18-19%, with variation by age (highest % in children and >70 years old) [initial estimates were <1%]
https://www.medrxiv.org/content/10.1101/2020.03.16.20037259v1

 

S. Korea, which has done extensive testing and also monitoring of positive-test cases to detect any symptoms, is saying 20% asymptomatic
 

Iceland, which has done very high per-capita testing, is saying 50% asymptomatic

https://www.bloomberg.com/news/articles/2020-03-22/one-third-of-coronavirus-cases-may-show-no-symptom-scmp-reports
 

Italy
Tests of the entire town of Vo, 3000 people, showed 90 infected people, 6 asymptomatic:
https://www.theguardian.com/world/2020/mar/18/scientists-say-mass-tests-in-italian-town-have-halted-covid-19
Per this report on Vo, even higher (50-76%) but I have heard that as "asymptomatic at time of testing" and some later developed symptoms:
https://www.bmj.com/content/368/bmj.m1165

If anyone else has good sourced data on this, put it up - I'll quote it and fold it in here.
 

6 hours ago, snafu said:

From the quoted part of you post, are they saying that if someone has asymptomatic Covid-19, then they’re not infectious?

Only people who eventually develop symptoms are infections before they exhibit symptoms?

Thats strange to me, unless I’m mis-reading.

 

I think you're misreading.  From the same quote: "Both groups help explain why the virus has spread so quickly, he added", eg the current thinking is that asymptomatic infected people are indeed infectious, at the point where they have enough virus to be tested positive.

This is one of the things that makes covid-19 such a grizzly bear to fight from the epidemiological viewpoint.  Many other viruses, you're not infectious until you have symptoms, and almost everyone has symptoms, so telling people "stay home if you feel symptoms" is a reasonably good way to contain and control.

 

[Scraps]

This is a somewhat useful fact checker.  Its a bit annoying that it doesn't give you the newest information first, by default.  Also, it seems limited on topics.  I was able to find information on PPE and chloroquine but when I looked for remdesivir, it returned nothing.

 

https://www.poynter.org/ifcn-covid-19-misinformation/page/2/?search_terms=chloroquine

Edited April 14, 2020 by Scraps

[Punching Bag]

Wyoming reports first death, last of the 50 states.

https://www.usatoday.com/story/news/nation/2020/04/13/coronavirus-wyoming-first-death-last-state-mark-gordon/2987542001/

Quote

 The Cowboy State had been the only in the U.S. without a death since Hawaii reported the first of its now nine fatalities March 31.. Coronavirus has killed at least one person in all 50 states.

 

Quote

 

While Wyoming is one of just eight states that hasn’t issued a stay-at-home or shelter-in-place order, Gordon has prohibited gatherings of 10 or more people and closed schools and many businesses until April 30. He has often used the hashtag #StaySafeStayHome on Twitter.

The other states that haven’t mandated their residents to stay home: Arkansas, Iowa, Nebraska, North Dakota, Oklahoma, South Dakota and Utah.

 

Edited April 14, 2020 by Limeaid
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