SARS-CoV-2; CoVID-19; Coronavirus; Updates and Information

More less than good news for chloroquine in JAMA. A randomized clinical trial had to be stopped early because of adverse effects.. We still don't know how it will fare in patients with less severe disease.

Results Out of a predefined sample size of 440 patients, 81 were enrolled (41 [50.6%] to high-dosage group and 40 [49.4%] to low-dosage group). Enrolled patients had a mean (SD) age of 51.1 (13.9) years, and most (60 [75.3%]) were men. Older age (mean [SD] age, 54.7 [13.7] years vs 47.4 [13.3] years) and more heart disease (5 of 28 [17.9%] vs 0) were seen in the high-dose group. Viral RNA was detected in 31 of 40 (77.5%) and 31 of 41 (75.6%) patients in the low-dosage and high-dosage groups, respectively. Lethality until day 13 was 39.0% in the high-dosage group (16 of 41) and 15.0% in the low-dosage group (6 of 40). The high-dosage group presented more instance of QTc interval greater than 500 milliseconds (7 of 37 [18.9%]) compared with the low-dosage group (4 of 36 [11.1%]). Respiratory secretion at day 4 was negative in only 6 of 27 patients (22.2%).


Conclusions and Relevance The preliminary findings of this study suggest that the higher CQ dosage should not be recommended for critically ill patients with COVID-19 because of its potential safety hazards, especially when taken concurrently with azithromycin and oseltamivir. These findings cannot be extrapolated to patients with nonsevere COVID-19.

Further down.......

In this study, a high-dosage of CQ (12 g) given for 10 days concurrently with azithromycin and oseltamivir was not sufficiently safe to warrant continuation of that study group. Age was an important confounder and might be associated with the unfavorable outcomes. We recommend that similar dosages no longer be used for the treatment of severe COVID-19, especially because treatment based on older patients with previous cardiac diseases who are receiving concomitant cardiotoxic drugs should be the rule. No apparent benefit of CQ was seen regarding lethality in our patients so far. To better understand the role of CQ or HCQ in the treatment of COVID-19, we recommend the following next steps: (1) randomized clinical trials evaluating its role as a prophylactic drug and (2) randomized clinical trials evaluating its efficacy against the progression of COVID-19 when administered to patients with mild or moderate disease. Even if we fail to generate good evidence in time to control the current pandemic, the information will affect how we deal with coronavirus outbreaks in the future.

NextLevel said:

Watch the video I just posted that is all I have to say. We can revisit in a year's time since you don't seem to grasp that there is a difference between mitigating strategies and locking down the economy especially when the population at risk is largely identifiable and protectable.

No one is arguing for zero intervention.

https://youtu.be/qtrv-mCCOD8

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Largely identifiable and protectable? Laughable. That video is redundant as it just rehashes what Tegnell said from the outset - the vulnerable is to be protected, which is exactly why Sweden keeps getting grilled because he has failed to "protect" them.

https://www.theguardian.com/world/2...as-elderly-pay-price-for-coronavirus-strategy

“They have to admit that it’s a huge failure, since they have said the whole time that their main aim has been to protect the elderly,” she said. “But what is really strange is that they still do not acknowledge the likely route. They say it’s very unfortunate, that they are investigating, and that it’s a matter of the training personnel, but they will not acknowledge that presymptomatic or asymptomatic spread is a factor.”

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Whatever you feel about the lockdown, especially when among the vulnerable, the US was at the stage that called for it.

https://www3.nhk.or.jp/nhkworld/en/news/backstories/1039/

Ebara: What do you think of the effectiveness of lockdown or stringent stay-at-home measures?

Leung: There are three pillar strategies that we deploy in public health. One is border restrictions and just about every country has imposed these border restrictions, both with the outside world but also, in some larger countries, within their countries, between metropolitan areas. Border controls are really for stopping importation and exportation of cases.
Then you have the quarantine and isolation. And then the third, which is the most destructive socially and economically, is the so-called physical distancing lockdown where basically everything stops. Schools are suspended, work and all economic activities basically grind to a halt and therefore it is something that affects everybody in that particular society.
And so, for each of these strategies, there are appropriate stages during the epidemic when we might apply them but there are also other stages of the outbreak when these measures may not work as well as they are sometimes thought to.

Ebara: What should governments be mindful of when carrying out these measures?

Leung: Health protection is task number one. But if the economy completely tanks there are consequences, and these consequences must be made explicit and the trade-offs must be also made transparent. There's (another) dimension, and that is social consent and the mental and emotional wellbeing of the population. I suppose you could call it social acceptance. If you impose very strict draconian measures such as a complete lockdown, it affects everybody. You cannot do this forever. There is a tolerance limit to any and all such measures. And that's why health protection, economic protection and social consent and social acceptance… it's a perennial tug of war, three ways, as we go forward until we have sufficient immunity, either preferably by vaccination, but possibly by natural infection and recovery, because this is not going to settle down until (there is) sufficient immunity in the population.

Ebara: In Hong Kong, there has been a period when civil servants on work-from-home orders have been allowed to return to the office. How many rounds of constraints will be necessary?

Leung: Well actually we have, as you put it, actually asked civil servants, as well a lot of employers, to allow employees to go back home and adopt flexible working arrangements. But then during the month of February, for part of it, there was some relaxation because our epidemic was actually heading in the right direction. And then as of mid-March, we have re-instituted these flexible work arrangements. And so civil servants as well as most actual workers, especially those who can work from home, are now working from home.

Ever since then we've seen reassuring signs, i.e. the real time, instantaneous reproductive number, that that has now come back down below one. In fact the latest estimate is somewhere around 0.7 to 0.8, which is quite reassuring, although we're not at all letting up our guard against a possible recrudescence. So that is why we are still keeping with very stringent and drastic social distancing measures at the moment.

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A Doctor from a California medical outfit gives a long vid on the public stats of Covid and the associated statistics. He asks some questions of our responses. The website with this vid is heavily hyping the conspiracy aspect, but the doctor speaking is very calm and sticking to the reported stats. The doc looks like he is part of a medical group with medical facilities across California,

zeio said:

Largely identifiable and protectable? Laughable. That video is redundant as it just rehashes what Tegnell said from the outset - the vulnerable is to be protected, which is exactly why Sweden keeps getting grilled because he has failed to "protect" them.

https://www.theguardian.com/world/2...as-elderly-pay-price-for-coronavirus-strategy

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So which country which had a lockdown succeeded in protecting them? The point is that if the virus hits a nursing home, then that is what drives the problem. A lockdown doesn't address that problem directly.

Whatever you feel about the lockdown, especially when among the vulnerable. The US was at the stage that called for it.

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We will see in retrospect. The lockdown when discussed in terms exclusively of its benefits completely misses the point. THe one thing I will admit is that the US is a very sick population in general so the disease will impact it more heavily. But the disease was already in the general population. What the lockdown will achieve in terms of benefit to cost and what will happen in the second or third wave is still an open question.

A lockdown is not the same as slowing the spread - everyone is trying to slow the spread, even Sweden.

Unless people are getting outside, getting exposed to the mild bacteria and virus needed to maintain immune system and taking care of the other things helping immune system... when majorirty of population now has even weaker immune system than before and starts to get around... you can know there will be more susceptibility to illness with an overall weaker immume system than before "lockdown" which really wasn't a lockdown.

Anyone wanting a LOCKDOWN can join the military and REAL lockdowns for FREE. Think Basic Training and deployments to remote parts of Iraq and Afghanistan restricted to staying on the camp.

Recent interview of Ian Lipkin, the virus hunter. I guess he will upset a lot of people here when talking about not to expect a normal life (massive gathering, sporting events, etc) until broad vaccination. He has a good point that people can do something (change behaviors) even after reopening to save lives.
He is quite honest and funny when asked to comment on Trump handling COVID and criticisms against China.

Scripps has some good webinars
Outsmarting Emerging Pathogens in an Interconnected World: Kristian Andersen, PhD, Scripps Research
Addressing the Coronavirus Challenge: Front Row Lecture with Michael Farzan, PhD

Good scientists too.

Der_Echte said:

A Doctor from a California medical outfit gives a long vid on the public stats of Covid and the associated statistics. He asks some questions of our responses. The website with this vid is heavily hyping the conspiracy aspect, but the doctor speaking is very calm and sticking to the reported stats. The doc looks like he is part of a medical group with medical facilities across California,

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I listened to this. I agree with most of it. However, I would have asked some harder questions. I didn't see where they were talking about conspiracy but they were challenging policy. They admitted that their opinions have changed.

1. The point of isolating only the sick is good but this is a case where the apparently healthy are spreading the virus. NYC did nothing about social distancing until it was too late and had paid dearly. If the virus has spread so to much then isolating the apparently healthy doesn't make much sense.

2. The comment about the immune system degrading if isolated. Where is the proof? How quickly does the immune system degrade. There should be plenty of data. Astronauts are now in space for over 2 months at a time and they are isolated before going up. Also, the crews on submarines are often below the water for two months at a time if they are on a SSBN.

Does every one know the rule of 72? Basically it is used in investing to compute when your investments will double assuming a constant growth rate, but in this case it can be applied to predicting when the number of deaths will double assuming a constant death rate increase. In the US the current death increase is a little less than 2% for today. If the rate stays at 2% the number of deaths will double in 72/2=36 days. That is assuming the death rate increase stays at 2%. It shouldn't, but there is a lot of 'momentum' in the numbers. There are over 750,000 active cases. There many be 50 times more that have been infected without knowing but of the confirmed cases, more than a third are still dying.

Other things that I have seen that aren't right. I have seen graphs of infected or deaths and the cumulative total drops. This is nuts and not the say to adjust the numbers. If numbers need to be subtracted they should be done for the date where the error occurs. This will lower all the numbers to the right after that date. This will make predictions better, lower.

I would absolutely NOT want submarine duty of my own volition. I already chose 30 yrs in a very unsavory, uncomfortable position in the military and endured it, but that kind of continuous duty is for the birds. Not only is there little to zero fresh air and sunlight, but it is real cooped up and you need a totally different temporary warrior perspective to cope with that environment for months on end. You have others to cope with and you can only hope they have coping skills and only hope no one who out ranks you or works closely with you or lives with you is in a bad tooth bear kind of mood. It is too closely confined for any of that kind of action.

When asked if Fauci was wrong, they both agreed that early on, with no data and a duty to be cautious, they would have supported the same decision to isolate in mass, but now, with enough time and data, they see how it is going with different approaches. They both stated that it is not about who is right or wrong, but what the data is showing and some obvious conclusions to make. They emphasized that early on, like in Feb, there wasn't the amount of data there is now.

It isn't a coincidence that when CDC put out new guidelines on listing causes of death on death certificate, that the number of deaths attributed to Corona went way up quickly.

USA has a larger issues with our nutrition, our lack of awareness of how our bodies work, our personal choices, and several industries hell-bent on wrecking us to make money. The average USA person can do way better at maintaining and improving their immune systems.

Whenever we have any semblance of getting back to normal unrestricted by govt activities, those with weakened immune systems, prolly had them get weaker during isolation, and now they are gunna more easily get viruses, corona vaccine available or not, which is gunna be another load down soon enough. Even with a "Lockdown" it really isn't a lockdown. There is a lot of people and exposure going on, that is good and bad.

Those with strong enough immune systems will acquire a natural (and better than vaccine acquired) immunity to this version of Corona. Those with poor immune systems will not cope as well and possibly die. This happens every year with flu in the same ballpark of numbers or 1/2 depending on the year, and much higher numbers with Sepsis and Septic Shock.

Poor or incomplete nutrition is a large part of our national problem with illness and disease, but it is a lot more complicated with a lot of industries contributing. Big sugar pushing people to consume huge amounts of added sugar, which destroys the natural microbiome of our gut, which is very important to our immune response. Chems all over out crops and embedded in seeds and sprayed on wheat which has residue and affect microbiome, livestock industry giving antibiotics to cattle who eat un-natural diet to get fat quick... the antibiotics help bacteria evolve to be resistant to antibiotics, so infections persist more... Tons of added processed carbs in fast food and store bought prepared frozen food -same drill - they wreck microbiome.

So, the deck is stacked against many if they are not aware and find other sources for their ingredients and make their own food... not so many do that and there is a huge cost in health - not just the immune system, but develop inflammatory conditions and many kinds of disorders from that with time.

Given this continued situation, a lot of people are going to be susceptible to infection - our year after year problem with Sepsis is a big indicator and we have continued death rates of 40% (and much higher yearly death numbers) from Septic Shock that the same factors contribute.

It would be much more of a benefit for USA to stop doing what is largely contributing to our underlying causes, but it is unlikely as a number of these pushing the problems are very entrenched. Is it likely that an executive order or law passed by congress is going to end sugar beverages and added sugar to prepared foods? Not likely. Will there be an executive order to stop GMO corn and soy from all our prepared foods? Not likely. Will that happen this year with pouring Glyphosate all over crops? Prolly not.

Addressing the underlying issues will have a much better effect, but don't expect that soon from govt, there is a long history of support for there, regardless of who or which party is in power.

Northern California Govt said:

April 20
Older Californians can call Friendship Line California to connect with a friendly listening ear when they feel lonely and isolated.

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The above quote is a cut and paste from a timeline of No. California Corona summary.

I usually do not give any praise to any govt org of California... but I would say in this case, it is an obvious risk assessment mitigating action with some semblance of possible effectiveness to combat secondary effects of a prolonged situation like the isolation.

Some member here are young and have not seen a lot in life yet, some members are macho-man and say screw those who are too weak to fight for their lives... but facts are facts, in such a situation of prolonged fear of death and isolation, humans have an increased chance of wishing to kill themselves. Often, it starts with feelings of loneliness, or feelings that no one cares about them.

It doesn't cost a whole ton of funds to operate a phone line (California has existing bandwidth for this) with people who care, if played right, could have many volunteers willing to help as a community effort to contribute. We see such cooperation in the US military community and in other areas of USA, it is supposed to be part of community and being an American.

The younger generation and the scoffer macho-man crowd will not ever give enough credit to the effectiveness of someone there who cares to prevent a suicide - you would be surprised at who commits suicide. Old people like to talk... to anyone. Old people who know of this resource may be inclined to use it. I can tell you firsthand what a difference it makes for someone down in mood ready to do bad stuff to themselves... what a difference it makes if they believe someone cares and is willing to listen and talk. That concept has saved lives, difficult to quantify exact numbers, but it is a huge factor in prevention.

The US military has been particularly concerned with this aspect as so many active duty and former duty vets kill themselves each year, which is something that can be greatly mitigated with caring people, and the individual at risk believing someone cares and is willing to listen and talk. There has been an exponential increase of awareness and effort to combat this in the military for many years now. Thoughts of suicide are a secondary effect of the profession sometimes, in the lengthy isolation orders, there is a risk of this too.

I do not know how many people would use this resource, have used it, or how well marketed this resource has been done, but I can tell you it is a no-brainer cost effective and on the ground effective approach as one of the ways of awareness and care in prevention. So many, regardless of age kill themselves each year, but the older crowd, they are more willing to reach out and talk first, or are better effected by those who care and listen.

This is a good move, California.

NextLevel said:

So which country which had a lockdown succeeded in protecting them? The point is that if the virus hits a nursing home, then that is what drives the problem. A lockdown doesn't address that problem directly.



We will see in retrospect. The lockdown when discussed in terms exclusively of its benefits completely misses the point. THe one thing I will admit is that the US is a very sick population in general so the disease will impact it more heavily. But the disease was already in the general population. What the lockdown will achieve in terms of benefit to cost and what will happen in the second or third wave is still an open question.

A lockdown is not the same as slowing the spread - everyone is trying to slow the spread, even Sweden.

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As pointed out earlier, these lockdowns are a desperate, last-ditch effort necessary "to reduce the death counts after the fact." It's called mitigation because the damage has been done. The ultimate goal is not to slow down the spread, which would require containment and not possible at this point given how widespread it is, but forcefully "reset/halt" this wave ASAP so that you can prepare properly for the next wave. For containment, you need mass testing, contact tracing, quarantine, isolation, social distancing etc. The US and Europe missed the window for that.

https://www.otandp.com/blog/covid-19-to-contain-or-delay-and-mitigate-which-is-the-best-strategy

This is the playbook typically described by the WHO1 for the management of epidemics of infectious disease:

Containment: Effective and rapid containment of emerging diseases is just as vital as early detection in order to avoid a large scale epidemic. Rapid containment should start as soon as the first case is detected regardless of the cause, which is most likely to be unknown. It requires skilled professionals to safely implement the necessary countermeasures. Pre-training of these professionals is essential to guarantee the safety and efficiency of the operations.

Control and mitigation: Once the infectious disease threat reaches an epidemic or pandemic level, the goal of the response is to mitigate its impact and reduce its incidence, morbidity and mortality as well as disruptions to economic, political, and social systems.

Elimination or eradication: Control of a disease may lead to its elimination, which means that it is sufficiently controlled to prevent an epidemic from occurring in a defined geographical area. Elimination means that the disease is no longer considered as a major public health issue. However, intervention measures (surveillance and control) should continue to prevent its re-emergence.

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The first wave had been allowed to spread unabated for months. By the time they realized they had to act, it was already too late. The US didn't didn't ban nursing home visits until Mar 13, 2 days after the WHO declared it a pandemic. France didn't ban visits until Mar 11. Care homes in northern Italy went into lockdown on Feb 21, but the country-wide ban didn't happen until Mar 5.

In a sense, all these countries practiced herd immunity for 2 months and failed miserably. One would've thought Sweden would be able to take the precautions early on after these tragic lessons.

How coronavirus has torn through France's elderly nursing homes
https://www.thelocal.fr/20200410/an...as-torn-through-frances-elderly-nursing-homes

They also knew that their presence, now more than ever, was key to the residents' wellbeing. The government had banned all visits into the country’s long term care homes on March 11th and the carers were now the only social contact the residents had access to.
...
“We have known about the coronavirus since January. No one cared about the Ehpad until late March. That’s a problem, don’t you think?”
...
By time the lockdown measures entered into effect in nursing homes in areas harder hit by the virus, it was already too late.

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For Hong Kong, visits to nursing homes were strongly discouraged, cut down by 90% in late January and virtually banned since February. Essential visits must take place with extra precautions. As of Apr 3, none of the some 600 nursing homes had any outbreaks.

http://www.lionrockdaily.com/2020/03/04/03.pdf

……個別情況亦可安排雙方每周一次於院舍內某指定地點見面，而每次只限一人探望，並限時約20分鐘 ，「 見面時要戴口罩，家人要穿保護衣，雙方不可以有身體接觸 ，長者於見面後會即時洗澡」。

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In individual cases, the two parties can be arranged to meet at a designated place in the institution once a week, and only one person can visit each time and the time limit is about 20 minutes. "Face masks are required when meeting, family members must wear protective clothing, and elders get a shower afterwards."

zeio said:

As pointed out earlier, these lockdowns are a desperate, last-ditch effort necessary "to reduce the death counts after the fact." It's called mitigation because the damage has been done. The ultimate goal is not to slow down the spread, which would require containment and not possible at this point given how widespread it is, but forcefully "reset/halt" this wave ASAP so that you can prepare properly for the next wave. For containment, you need mass testing, contact tracing, quarantine, isolation, social distancing etc. The US and Europe missed the window for that.

https://www.otandp.com/blog/covid-19-to-contain-or-delay-and-mitigate-which-is-the-best-strategy


The first wave had been allowed to spread unabated for months. By the time they realized they had to act, it was already too late. The US didn't didn't ban nursing home visits until Mar 13, 2 days after the WHO declared it a pandemic. France didn't ban visits until Mar 11. Care homes in northern Italy went into lockdown on Feb 21, but the country-wide ban didn't happen until Mar 5.

In a sense, all these countries practiced herd immunity for 2 months and failed miserably. One would've thought Sweden would be able to take the precautions early on after these tragic lessons.

How coronavirus has torn through France's elderly nursing homes
https://www.thelocal.fr/20200410/an...as-torn-through-frances-elderly-nursing-homes


For Hong Kong, visits to nursing homes were strongly discouraged, cut down by 90% in late January and virtually banned since February. Essential visits must take place with extra precautions. As of Apr 3, none of the some 600 nursing homes had any outbreaks.

http://www.lionrockdaily.com/2020/03/04/03.pdf

In individual cases, the two parties can be arranged to meet at a designated place in the institution once a week, and only one person can visit each time and the time limit is about 20 minutes. "Face masks are required when meeting, family members must wear protective clothing, and elders get a shower afterwards."

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So in other words, none of the countries practicing lockdown managed to do better than Sweden. I know we love to write but the answer is simple - reducing the spread after the disease enters your country is unlikely to have good results unless you can eradicate the infection. What really works is protecting the population at risk. And if you fail there, you fail there. Lockdowns are going to create as many problems as they solve if they affect employment and social health to a high degree so the balance needs to be found.

This just in. 8 patients in HK have tested positive again after being discharged.

https://www.scmp.com/news/hong-kong...onavirus-hong-kong-records-two-new-cases-both

Chuang said eight patients had tested positive for the virus after being discharged from hospital.

“We have consulted experts who believe the virus could have been left over in the body after treatment and the risk of infection to others is low,” she said.

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https://www.scmp.com/week-asia/heal...mmunity-or-mutations-south-korea-investigates

Poor immunity or mutations? South Korea investigates ‘shrewd’ coronavirus as reinfections creep up

141 South Koreans have retested positive for Covid-19. While it’s a small fraction of recovered patients, it raises doubts about developing a vaccine
Health experts say this could be from reinfection, reactivation after being dormant, or simply mass testing picking up remnants of the virus in patients

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zeio said:

This just in. 8 patients in HK have tested positive again after being discharged.

https://www.scmp.com/news/hong-kong...onavirus-hong-kong-records-two-new-cases-both


https://www.scmp.com/week-asia/heal...mmunity-or-mutations-south-korea-investigates

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So how will a lockdown solve for that?

NextLevel said:

So how will a lockdown solve for that?

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Hmm, how does herd immunity work again?

These are people who have been infected AND recovered. Are they really immunized? Have they generated enough antibodies to prevent reinfection? How long do they last? Can they infect others if they test positive again? Not to mention the potential sequelae.

zeio said:

Hmm, how does herd immunity work again?

These are people who have been infected AND recovered. Are they really immunized? Have they generated enough antibodies to prevent reinfection? How long do they last? Can they infect others if they test positive again? Not to mention the potential sequelae.

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Herd immunity is one aspect of everything - even without heard immunity people survive the disease. Another aspect is that you can't control how the disease spreads forever in a lockdown other than to delay the inevitable. The funny thing is that we aren't even implementing serious lockdowns in the US. You can still go to grocery stores but not to coffee shops. So if someone can still reinfect people after he has recovered, what is the new solution? Lockdown people who have been sick forever?

The thing that these death rates are comparable to some of the silently communicated flu death rates. Obviously the lack of herd immunity makes things worse but the order of magnitude of danger is not different.

Lockdowns may even have made perfect sense when we had no idea what the true disease profile was. We still have gaps but we have a much better idea. Definitely American customs from handshaking to how we behave during times of contagion need some revision. But what I don't get is why you continually act like there is no alternative to lockdown and that Sweden must be idiots for doing what they are doing.

I suspect errors in testing accounts for some of the reports of re-infection.

Even without complete lockdowns too many people chafe at the slightest measures that could reduce the impact of this, like being asked to wear face coverings.

As for lockdowns, especially in densely populated areas you need to keep the rate of new infections at a level where it doesnt overwhelm hospitals and their various resources. The resources include PPE, other supplies, and provider's time. Hospitals need to also be able to care for all the other diseases people have (which will include influenza in the fall). You dont want doctors and nurses getting sick. If hospitals can only take care of Covid-19 they will quickly go bankrupt (in rural areas of the US most hospitals are barely functioning as it is). That is the nature of the stupidly inefficient healthcare economic system we have in the US where we pay vastly more than any other country as % of GDP for embarrassingly bad outcomes.

That is the thing more than anything else that determines when lockdowns can end. It is reasonable to end lockdowns once hospitals can resume close to normal operations. Some places are there now, some are not. This also depends on how quickly hospitals can obtain materials they need. Right now that is a $hit$how.

Even once that happens and people are working, life cant go back to the way things were before. For some time we need to not stand so close, and get used to seeing others in masks (like Japan or Hong Kong). And people need to stay the hell home when they are sick.

Speaking for myself, TT is out of the question for months.