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

I don't get the seasonal flu comparison. Everyone doesn't get the flu in one year. So even if the death rate (and death is not the only bad outcome) is *lower* for Covid, it still makes sense to take extreme measures to limit the spread until we have a vaccine. Because if we don't essentially everyone will be infected. That simply isn't the case with flu.

Am I missing something here?

I agree extreme measures should be universal mask-wearing and no handshakes, massive provision of free Purell, not necessarily total lockdowns indefinitely. But still the comparison to me is bogus. One has immunity and the other does not. Ask an American Indian about that, if you can find one.

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.

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The masks are good because they reduce the spread but they are not perfect. I think the initial loading is important. Most of us are able to fight off a small infection before the virus grows too much. This is the only explanation for why there are so many people walking around with virus anti-bodies. This will build up immunity the natural way.

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

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I have my own table at work. I am willing to play with a few select people but I haven't yet. The lack of exercise will kill me before the virus.

An update of my friend infected in NYC. He stayed in west coast for more than a week and finally got a chance to fly to China with two stops (very limited slot for non-stop flight). He was denied boarding from one carrier because he did not get a test result after discharge. Another carrier let him on. When he arrived in China, he got tested (everyone entering China now gets tested at least twice), positive.

He developed symptoms in mid Mar, got positive test result on 3.22 (ER took swabs on 3.21), hospitalized on 3.26, discharged on 4.5. Still tested positive on 4.25. The issue is that he thought he was non-infectious and traveled without precaution because NYC doctors believed he was fine without even testing and didn't tell him to self-isolate. There is no policy to restrict travel for these uncleared cases. My friend is lucky that he has been getting better after discharge. Some people in NYC died after discharge when doctors thought they were fine.

I can tell for those mild cases who stayed at home and waited the symptoms to disappear, many have not been followed up. They think they are recovered and cannot wait to interact with family and friends, go out and go back to work. Not all people are extremely careful and responsible, especially guidelines and experts don't tell people to do so. There are tons of news reports and published research articles from China months ago, if someone is skeptical about mainland China, then look at articles from other parts of the world even from US which discuss about the course of the COVID infection, how long on average it may take for incubation and for turning negative and what are the extreme cases ("return" to positive). Are US experts, doctors, public health staff really incompetent to understand it and make policy makers understand it? It doesn't make much sense when US is bragging about testing capacity World #1 and people don't get tested before discharge from hospital. It doesn't make much sense when US is bragging about US public health system World #1 and cannot follow up on cases. I just cannot see how US can really contain COVID. Or does US want to at all?

rainneverever said:

I don't buy the ideas that COVID will magically settle down when the summer comes in the northern hemisphere or the tropical regions get less affected by COVID. For those who work or stay indoors most of the time, hot weather outside does not make a difference and central AC may make things even worse.
For an infectious disease, old textbook says: identify and isolate the infected, cut off the transmission chain, gain immunity by infection or vaccination. SARS-CoV-2 is very challenging as it is not easy to identify the infected (mild or no symptoms), it is not ethical to get people naturally infected with such a high mortality, no vaccine will be available within months. But still we can do sth, like one can self isolate for enough time till symptoms-free even one just got a common cold at first, one can wear masks in the crowds, and more importantly, experts had better not take any chances in order to please political leaders or to save economy.
I've mentioned a friend of mine got COVID in NYC. He got discharged from hospital without RNA testing (hospitalized for 10 days, receiving oxygen and HCQ); his fever was gone but he was not fully recovered from pneumonia. He was taken off no-fly list early this week and he flew to west coast. If I were him, I would self isolate in NYC for another 2 weeks to take no chance to infect others. He was not told to do so by the doctors and I don't blame him for his choice.

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Scary.

Baal said:

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

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I will not have much faith in the current testing until we see a test developed that tests for the actual virus identified cleanly, but there may be a situation or two where someone could test positive again later and EDIT: not be sick with the virus.

Still, let's say a person got a certain mild virus, had a fever for a day or two, fought it off, and recovered. We would expect the body of that person to have developed immune response to protect again. Let's say that person is next to someone at work who passes by and sneezes on him the exact same virus dude had a month or so earlier. He breathes in the virus from that sneeze. The virus is present in his nose and throat, but it really isn't multiplying to much effect, because he has already developed immunity to that particular virus.

Now that dude gets tested for the virus and wow, we see a positive test result, because there is still enough virus there to be detected on a test, but it is not multiplying much and is about to be taken out of his body by his nice functioning immune system.

That would be a scenario where someone who had a certain virus, recovered, then a month or so later tested positive again, but is not going to be sick with the virus again.

Baal said:

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.

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I agree with Baal's observation and opinion on this to a very large degree. Baal, you will recall, I think it was somewhere near Houston, where a certain judge issued an order for everyone over 10 yrs old to wear a face covering or face $1,000 USD fine, then later, the Fraternal Order of Police made public a letter opposing that for reasons they stated.

Many Americans do not have a sense of community, cooperation or working together collectively as a nation right now. It is almost a natural evolution that those under pressure of destitution and death and hunger, work hard, work together as a family unit, and overcome mostly, but later generations not under this pressure are not so willing to work and will take handouts over working hard for it.

There may be reasons of other law enforcement priorities being more important, but if there is a communicated reason (reduce spread) for a temporary timeframe (a few weeks) and it is not a mission impossible in terms of real world difficulty or financial terms to do this (you can make a face covering out of an existing clean sock by cutting it a certain way of you do not wish to spend a few dollars on materials and use your own sewing machine or hand needle/thread)…

So it is there, reason, short timeframe, not a large infringement on rights, not a financial burden or excessive emotional/physical burden... but we basically have a lot of American cry and pout over it.

Dude, USA, be what Americans are supposed to be and work together on this in a little more united fashion than what we are doing.

Baal said:

As for lockdowns, especially in densely populated areas you need to keep the rate of new infections at a level where it doesn't overwhelm hospitals and their various resources.

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These areas present a tougher challenge as there are more chances for more people more quickly to touch the virus or it to tough them. A lockdown, USA style, doesn't really do much effect in an area like this. There are still too many people doing life business touching too many things and getting touched by virus for it to really work well.

The two realistic approaches are to

... immediately isolate away from population who is infected (you need widely available tests that can produce immediate results reliably for this and a strong enforcement system with everyone committed)

... lock EVERYTHING down except police enforcement and first responders of medical/fire. Critical services must be at work 24/7 and live where they work. (much like a fire dept - they have figured it out) Citizen must flag down an officer and speak at length to communicate need to go to emergency function, like go to emergency room. Emergency facilities would need on hand quantities of supplies and life sustainment for the prescribed duration, like 2 weeks. Citizens would need to keep enough water and sustainment handy for that. Advance preparedness is essential for that. Working together like that, then it would be possible to slow down a viral epidemic to avoid overwhelming a medical system.

Because in USA, a lockdown is not really a lockdown, there are too many ways to still spread at a high rate to the vulnerable, the USA style lockdown would not be totally effective in a dense urban area. Adherence to social distancing, common sense, and isolating if sick have an effect, but it isn't gunna wipe out a virus right away.

USA is not prepared physically or mentally for what is needed in emergencies, USA people act like they never saw emergencies... and that is true to a large degree. USA people all want to do what they want to do, so there are many competing things going on. USA society should not be like military total command authority for good reasons, but if the public were to have a couple years military experience like Korea and some other nations have, it goes a long way towards working instinctively for the common good in a coordinated and cooperative fashion. Military training forces people to figure out among themselves without being commanded how to work and live with each other in very challenging circumstances, USA could use a little or a lot more of that. A 2020 draft isn't gunna happen, but I just state the benefits of even a short time of service, even if the young gun complained the whole 2 yrs, that kind of fundamental military training stays with a person for a long time and has a positive effect. Without thinking, this type of person takes command of an accident scene and performs first responder tasks effectively for example. That counts for a lot.

And people need to stay the hell home when they are sick.

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A very common sense approach that USA does not consistently do. This is a foundation of say Korea's approach that has helped out the situation a lot over there.

As for wearing facemasks long term, I doubt that will catch on in USA, many will not see or accept a longer term reason for this. MAYBE, if BURBERRY or LOUIS VITTON or GUCCI figure out how to captivate Americans and make them think it is distinctive and fashionable, then maybe. Still, that is the wrong reason. A face covering provides good protection vs dust, which is a threat in many places, ESPECIALLY right where I live. It provides some, not much protection vs airbourne virus, and helps reduce by a degree the airbourne spread from someone with virus.

Getting into the habit of using a face covering while walking outside or around people will take some reason and time for it to permeate in USA.

Say A got infected before and recovered (mild symptoms or no symptom) and tested positive again later. It is not concerning whether A will get sick again, A most likely has neutralization antibodies and if not, A may have strong immune system because he/she went through for the first time. It is concerning that A contacted B, C and B, C contacted D, E, F, G during the time when A felt or was told that he/she was recovered and when A was tested positive again. D may be most vulnerable, get infected through A-B and die; G may do essential work and can contact hundreds or thousands of people during incubation time if infected.

There are arguments when A tested positive again, is it because new infection or some false negative test result (or no test at all like in US) of the first infection? Do specimens (i.e., swabs) contain viable viruses or just debris of viruses? It is not difficult for research lab to examine whether viable viruses can be isolated from A's specimens by infecting culture cells. But specimens need to treated differently from PCR tests and BSL3 lab is required and of course more PPE is required. When there are many similar cases like A, it is just cost ineffective.
On the other hand, it does not cost much to test and identify A as positive early and isolate A from contacting B, C, etc (assure A got covered during "sick leave" being positive). It saves D's life and secure G's job. It does not overwhelm hospitals, or hurt economy, or bother to contact tracing hundreds or thousands of people.

I see that Sweden is being referred to quite a bit. I'm not a doctor/healthcare expert/statistician but here's some facts that are important:
- Our government can't step in and make any kind of decisions just to please the public opinion. I prefer that scientists are running the show. Rather an educated mistake as opposed to a politicians just trying to please the opinion. Our ministers are not allowed to control government agencies (https://en.wikipedia.org/wiki/Ministerstyre)
- Sweden includes people that have died outside of the healthcare system in the death rate. I know that several countries like the UK and the Netherlands don't. It's hard to compare numbers when you're comparing apples and oranges.
- Sweden's statistics lags as deaths that happened days/weeks ago are still being added (after autopsies, checks against other government agencies databases etc). The graphs on Worldometers.info are not correct. The proper graphs can be seen here: https://experience.arcgis.com/experience/09f821667ce64bf7be6f9f87457ed9aa
(Avlidna per dag = deaths per day)

Just my 0.02€.

Shouldnt it be ore?

The RT-PCR test quantifies the RNA that makes up the genome of the virus in a swab sample. BUT, it is an amplification procedure. First the RNA is converted into DNA and then the DNA is AMPLIFIED 2-fold each thermal cycle, 20+ cycles, hence super sensitive in theory. (multiply by 2 to the 20th power after 20 cycles, although in practice efficiency is below that). I've used it to amplify RNA from a single cell. There are lots of ways to screw it up. RNA is inherently unstable and of course it depends a lot on whether the swab happens to hit an infected area. Hence false negatives. False positives are really common in a place where the SAME assay is being done over and over again. Before you know it, someone managed to get that DNA all over the place and then even the negative controls sometimes show signal. (That was the problem with the original CDC tests, which had contamination in one reagent in EVERY kit they sent out).

If someone cuts corners in a clinical lab somewhere, or is not technically skillful, you could easily see false positives happening. Considering how many times this is being done around the world there HAVE to be some false positives.

So can we directly measure viral proteins directly from nose or saliva? No. I don't see that happening, at least not while the patient is alive. It would be almost impossible to get the necessary sensitivity.

I am not convinced by the imperative to wear masks outdoors. Is there any real evidence that the corona virus is transmitted by people breathing it in. Droplets from coughing and sneezing will quickly fall to the floor and any that are so small as to remain airborne would surely be so diffuse as to make any risk minimal. I appreciate that this changes in close contact with people and in confined spaces and that medical grade masks then become important. I am personally very uncomfortable with The idea that we put socks over our mouths to out for a walk. Unless backed by some proper evidence I don’ t think this kind of advice helps anyone

Joepole said:

I am not convinced by the imperative to wear masks outdoors. Is there any real evidence that the corona virus is transmitted by people breathing it in. Droplets from coughing and sneezing will quickly fall to the floor and any that are so small as to remain airborne would surely be so diffuse as to make any risk minimal. I appreciate that this changes in close contact with people and in confined spaces and that medical grade masks then become important. I am personally very uncomfortable with The idea that we put socks over our mouths to out for a walk. Unless backed by some proper evidence I don’ t think this kind of advice helps anyone

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Coronaviruses have been shown to form aerosols and do not just sink to the ground. They have a very low Reynolds number so they mostly stay in the air and are buffeted around by any turbulence. Simply breathing expels virus. They primarily infect people through the upper repiratory tract. They can be inhaled. Probably too they can adhere to the surface of your eye and then get washed into your nose through the lacrimal ducts, and in that area there are lots of cells that express the receptor for the virus.

Will a mask outdoors protect you and is it needed? To be honest I'm not convinced either. But it depends a bit on how big a crowd and how close people are. Normally the viruses should get "diluted" much faster outdoors. Whether your immune system holds the virus in check is dependent at least in part on how much your are exposed and how many of your cells get infected.

So wearing a mask while going out for a walk us arguably unecessary especially if you maintain a distance. In my city where we are being asked now to wear masks there are still exemptions for exercising outdoors. It is more strict in some other places.

Nevertheless, I still wear one while biking. I just think it's not that big a deal and it cant hurt, and in part I prefer not to make suppositions.. If you want to be more safe, add some sort of eye protection, like wrap around sunglasses.

I would DEFINITELY wear one if I was standing in a line outdoors.

Bear in mind a big part of wearing masks is to protect other people in case you are infected and dont know it.

Brs said:

I don't get the seasonal flu comparison. Everyone doesn't get the flu in one year. So even if the death rate (and death is not the only bad outcome) is *lower* for Covid, it still makes sense to take extreme measures to limit the spread until we have a vaccine. Because if we don't essentially everyone will be infected. That simply isn't the case with flu.

Am I missing something here?

I agree extreme measures should be universal mask-wearing and no handshakes, massive provision of free Purell, not necessarily total lockdowns indefinitely. But still the comparison to me is bogus. One has immunity and the other does not. Ask an American Indian about that, if you can find one.

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If most of the people who get infected recover without issues ( and this is the general wisdom surrounding this disease at the moment ), why would you prefer that people get prevented from going to work at all coat and 28 million people filing for unemployment to letting the disease spread while protecting the people who are most likely at risk?

With the flu as well,almost every bad outcome attributed to Covid is also attributed to the flu. The difference other than herd immunity and vaccines is that no one reports on the flu anymore. It is considered part of the seasonal variation of the world. But the herd immunity prevents it from spreading.

When I argue these things, a part of me clearly says that in the USA, given all the sick people out there, you really can't protect them and you do need to lockdown the economy. But there is a part of me that also says that it is easy to be okay with a lockdown when you aren't the one suffering during it. I sit in an industry where I can see the effect this stuff is having on people and it isn't trivial. Lots of companies are just not paying people because they can't make money. Business owners are wondering how to pay the rent. Maybe it is a black mark for the American welfare system but it isn't as straightforward as refusing to consider alternative viewpoints just because your particular status or work is not affected by what is currently happening.

Right now, Nigeria is in lockdown. Unlike the US, Nigeria has mostly poor people who need to work to get their income. The oil prices are hitting the government hard since oil determines the exchange rates. The funny thing is that the lockdown is going on without really good evidence that the disease is overwhelming the hospital capacity.

Americans do need to realize that some of the things they are doing have a broader impact that they might think they do. Of course America should think about itself first when making decisions. But people shouldn't assume that even stopping the spread for many months won't have impacts on the whole world. Starvation kills people too.

BTW, I agree 100% that the American approach to public behavior when contagious diseases are around has to change. Hopefully, masks, handwashing and social distancing will be a staple of flu season and the police will figure out how to do their jobs with the new normal.

The unemployment stats lag, takes a little time. Also difficult to calculate with real accuracy the real number un-employed as the number of jobs is a moving target and some un-employed get a job and some people might work independently...


You can try to add the numbers of new claims and subtract what you think are new jobs and incomes, but it is all a big guess.

Right now, in California, more than half of people who had jobs are not working. Some may be receiving pay, but majority were let go. I believe it is mostly like that in states that "shutdown". Overall, by the end of April, there has got to be a number approaching or crossing 75 million not working if we had 160 million working making a blind estimate of number of people working before all this. IRS tax income numbers would prolly be more insightful.

I just spent 3 hours HAND SEWING a new face cover from some excellent towels I got and some women's hair pony tail elastic ties, then a nose bridge from brass paper holder bendyclips (covered those with cloth and sewed them inside in right place)... I ended up with a good result, very comfy and breathes well, fits well... did by hand 'cause my sewing machine was kaput.

I finished the face cover, opened my door, and WOW, replacement sewing machine was there, prolly the whole time.

I learned two things.

- I really suck at hand sewing, but I fought through it and got the job done.

- I should be more aware of the delivery status of something critical like a sewing machine.

Baal said:

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

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This is the official position from the WHO - they don't know enough to say that reinfection is not a real possibility.

https://www.cnn.com/2020/04/25/us/who-immunity-antibodies-covid-19/index.html

NextLevel said:

This is the official position from the WHO - they don't know enough to say that reinfection is not a real possibility.

https://www.cnn.com/2020/04/25/us/who-immunity-antibodies-covid-19/index.html

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When the same PCR test is repeated a large number of times in the same place it is not unusual to start to get false positives if someone is slightly careless. It depends a bit on assay design, instruments, and how much hand pipetting needs to be done, also how the lab is physically set up..

The test works like this: A swab is used to sample the nose. If the virus is in the nose trace amounts of RNA from its genome are present. RNA is hard to work with so the sample ought to be processed immediately. It is converted to DNA using a reverse transcriptase (RT). The DNA is then amplified in a series of reactions (cycles). In theory with, say, 20 cycles, you should get amplification of 2 raised to the 20th power (a big number), in practice you get less, in fact efficiency decreases a bit with each cycle. So in the first 10-15 cycles the rate of product growth is related to how much RNA you started with. With more cycles, (say 25-30) quantification is less reliable but can still give a yes-no answer. The product growth is compared to growth of a standard so you can quantify how much viral RNA you started with (from the swab), and also with a buffer with no RNA in it as a negative control.

The original CDC kits were contaminated so even the empty tubes, the negative controls, gave strong signal. This apparently happened because one of the buffers in the kit was manufactured at the same CDC facility where they were processing lots of assays, which was an appalling violation of the standards they enforce on all other manufacturers, and an illustration of how easy it is to get contamination-induced false positives with PCR testing. This very badly hurt initial efforts in the US to figure out what was going on. The WHO kits designed in Germany worked fine. So did other assays prople developed in the US, but CDC refused to allow their use for several crucial weeks, even though their own kits were worthless. So when you hear American government officials trash the WHO, keep this bit of history in mind, along with all the other things NOT done in Jan and Feb. But I digress.

It is actually impressive the various kits work as well as they do, but when you consider the many hundreds of thousands, if not millions of tests being done, well it is simply impossible to not have some false positives. So I'm not convinced people can be reinfected. I very much doubt it, actually.