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

ITU mortality stands at 50%, 30% for non-ventilated and 80% if you require ventilation.

We are rolling out a trial currently for Hydroxychloroquine, Dexamethasone, interferon Alpha IIb, Protease inhibitor with a booster or No additional treatment. No results yet.

Remain hopeful but be aware reality doesn't always match research! HCQ has been shown time and time again to be effective at various In-vivo stages for multiple viral infections and this never panned to humans but lets hope this is the one that works!

yeah ivermectin is commonly used against parasites and particularly worms!

Yep. Also a very safe drug, used effectively by people in parts of the world where there are almost no doctors to treat similar parasitic infections that occur in humans.

But at the moment no evidence at all of in vivo (in a person or animal, not a test tube) activity against any virus. Which to be honest is where we are still at with chloroquine and hydroxychloroquine, although that will hopefully change soon when results of current trials are known. Note that the journal that published the original French report has retracted it, saying the evidence was not up to an acceptable standard.

passifid said:

ITU mortality stands at 50%, 30% for non-ventilated and 80% if you require ventilation.

We are rolling out a trial currently for Hydroxychloroquine, Dexamethasone, interferon Alpha IIb, Protease inhibitor with a booster or No additional treatment. No results yet.

Remain hopeful but be aware reality doesn't always match research! HCQ has been shown time and time again to be effective at various In-vivo stages for multiple viral infections and this never panned to humans but lets hope this is the one that works!

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Disturbing evidence is emerging of sudden cardiac deaths in Covid-19 patients, so chloroquine, which can induce arrythmias will need to be used very carefully.

Regarding ventilators, a colleague of mine told me that in ARDS caused by influenza survival rate on a ventilator is somewhere around 50%. It may be lower in Covid-19. Without it, though, it approaches 0. The thing is that in a country like the US we ought to be able to do multiple things at once, like make masks and PPE, and ventilators too.

Baal said:

Yes, that was my thought too, so I did a little more digging into the literature. Apparently the main effect in the case of coronavirus is that inhibition of nuclear import helps it evade human immune responses. The pathways are fairly complex but include multiple transcription factors that cant get into the nucleus.

Good search terms are coronavirus, importin A, importin B, interferon, if you're interested.

Ivermectin effects on SARS-CoV-2 in cultured cells were very large.

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Yeah I read that hypothesis too. But since that test was done in cultured cells where there is no immune system effect to speak of, the hypothesis can’t be used to explain the test result.

passifid said:

ITU mortality stands at 50%, 30% for non-ventilated and 80% if you require ventilation.

We are rolling out a trial currently for Hydroxychloroquine, Dexamethasone, interferon Alpha IIb, Protease inhibitor with a booster or No additional treatment. No results yet.

Remain hopeful but be aware reality doesn't always match research! HCQ has been shown time and time again to be effective at various In-vivo stages for multiple viral infections and this never panned to humans but lets hope this is the one that works!

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How is your PM BJ doing? I heard he’s getting better with reduced fever.

Thanks guys for valuable discussions.

It isn't as bad as people think, this will likely be used mostly in hospital setting where we will do an ECG no problem. The arrythmias come from the class action that prolongs the QT so you can just make sure it's below 500 and stop any other drugs that prolong it to stop any real risk of dangerous arrythmias.
ITU survival rates once you're ventilated are low no matter what, once you're critial care level 3 not only are you unbeleviebly sick you typically see multi organ system failure. It's not surprising to see cardiac deaths in ITU as the respiratory and Cardiac systems are clearly linked.

Also it seems typical in COVID Itu to treat with the full compliment of drugs especially in the first few days to stop people fighting the ventilator so it isn't uncommon to see: Noradrenliline, Propofol, Remifentanyl, Actacurium, O2, PPI/H2 for stress ulceration, Clarithromycin (although likely this will need to be carefully watched if on HCQ due to its effects on HERG) and Pipperacillin Tazobactam. And this is ignoring any medication needed for other conditions.
ITU treatment is very demanding physioligically and as such combined with Resps failure and chest sepsis its a bad prognosis!

I am hearing second hand that the treatment protocols have improved and that doctors are feeling more confident that after this first wave is over, they will be able to handle the second wave much better.

Reading up on local hospitalisation stats, a correllation between high BMI and covid-19 hospitalisation is noted.

One in three covid-19 patients in hospital is obese (bmi over 25). That is over double the ratio of obesity across the entire population.

This surprised me somewhat. I have not seen this coincidentation mentioned (suspected) before. If this coincidence is substantial, or even a proper relation, I shudder for these parts where obesity is the norm and morbid obesity no exception.

A quick find did not yield much usable data about partitionings of the covid-19 affected, except for the glaringly obvious socio-economic relation: the (historically) underprivileged are hit hardest and suffer more.

yoass said:

Reading up on local hospitalisation stats, a correllation between high BMI and covid-19 hospitalisation is noted.

One in three covid-19 patients in hospital is obese (bmi over 25). That is over double the ratio of obesity across the entire population.

This surprised me somewhat. I have not seen this coincidentation mentioned (suspected) before. If this coincidence is substantial, or even a proper relation, I shudder for these parts where obesity is the norm and morbid obesity no exception.

A quick find did not yield much usable data about partitionings of the covid-19 affected, except for the glaringly obvious socio-economic relation: the (historically) underpriviliged are hit hardest and suffer more.

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This is a weird post. When I have been writing for a while about comorbidities and diabetics and preexisting conditions and glucose metabolism, you think all these things aren't highly correlated with BMI?

Hopefully you will get accused of blaming the victim just like o was or talking about things that I have no understanding of.

I am not as optimistic as Dr Fauci.
https://www.youtube.com/watch?v=eTX3xoLdDlw&t=10s
The reason why is that there are still approximately 2 deaths for every recovery. If this is extrapolated to the 450,000 now infected in the US then 150,000 people will die not 60,000. The US death toll is at over 16,000. For Dr Fauchi be be right only 44,000 or less than 10% can die of the 450,000 infected. What is going to change that ratio? This ratio has been about the same for weeks now. Initially it was lower using the Chinese data which is now suspect.

I still see videos of people acting irresponsibly on YouTube. I would use a different term. Some people would say they are trying to get their Darwin awards.

I live in Washington State where the virus took its first victims. At first Washington State was the CCP virus hot spot. However, the measures taken here have 'flattened the curve ' but deaths are still increasing slowly. There hasn't been a CCP virus death in my county for several days now. Other states have zoomed ahead because they haven't taken social isolation seriously. Social isolation makes a difference in spreading the virus which is import because it seems that once one is infected there is only a 2 in 3 chance of surviving now. Perhaps some of the treatments mention above will help.

What is really necessary is a vaccine. I am 66 and I don't want to go around in a mask for the rest of my life. I do have a very good 3M mask that even has charcoal filters for VOCs but it is heavy and cumbersome.

"If liberty means anything at all, it means the right to tell people what they do not want to hear."
George Orwell

I don't think it is right to call this the Chinese virus. I have distributors in China. They are good people. I have two Chinese people working for me now. When China was having problems with their powdered milk we sent some to China for their kids. We sent masks to China in January when we thought they needed them. Last week we were sent masks because some of our guys are still doing tech support.

Can we leave the politics out of science. We have plenty of geographic names. Derbyshire Neck, MERS, Spanish Flu, African Sleeping Sickness Japanese encephalitis etc. China virus might be a colloquium which would be fine. Pro tip: Spanish Flu wasn't even from Spain! Thy were just neutral and therefore reported it first so they didn't look weak

NextLevel said:

This is a weird post. When I have been writing for a while about comorbidities and diabetics and preexisting conditions and glucose metabolism, you think all these things aren't highly correlated with BMI?

Hopefully you will get accused of blaming the victim just like o was or talking about things that I have no understanding of.

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Not sure what population is meant in yoass post. ~40% of american adults are obese by BMI. If only one in three hospitalized Covid patients is obese that is lower than overall population. Or were you talking about another country?

My musings were about Dutch statistics. Probably less obesity, and certainly less morbid obesity, than across the pond(s).

As for blaming the victim, I merely stated my mild surprise at a reported correllation — for the Dutch situation only, since I’ve found nothing of the sort mentioned elsewhere. I did not mean to suggest a strong relation - a causal one, for example.

And yes, I am aware of the strong relation between obesity and type 2 diabetes (and related). And yes, I do know about comorbidities; but I had not seen BMI isolated in a statistical correlation this directly.

Brs said:

Not sure what population is meant in yoass post. ~40% of american adults are obese by BMI. If only one in three hospitalized Covid patients is obese that is lower than overall population. Or were you talking about another country?

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He is Dutch. His flag is in his profile.

yoass said:

My musings were about Dutch statistics. Probably less obesity, and certainly less morbid obesity, than across the pond(s).

As for blaming the victim, I merely stated my mild surprise at a reported correllation — for the Dutch situation only, since I’ve found nothing of the sort mentioned elsewhere. I did not mean to suggest a strong relation - a causal one, for example.

And yes, I am aware of the strong relation between obesity and type 2 diabetes (and related). And yes, I do know about comorbidities; but I had not seen BMI isolated in a statistical correlation this directly.

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BMI is just an imperfect reflection of underlying conditions when looking at this issue. It is all relative. Maybe Asians don't gain weight in quite the same way when diabetic or insulin resistant.

But you would find the higher BMI in just about every seriously ill coronavirus population. Because BMI has a high correlation with underlying conditions. Just as in the US today, more AFRICAN Americans are being seriously affected by this disease than average. Because they tend to have worse statistics for preexisting conditions and work more jobs that require them to be out there. And because lower income drives crappier diets forced upon you by commercial interests, they would end up sicker with higher BMI as well.

Yes, the socio-economic effect is real.

There do exist people exhorting that the sickness does not discriminate, and hurts the rich equally. I wish that were the case; it would certainly improve the response.

Interesting study from Germany:

Preliminary results and conclusions of the COVID-19 case cluster study (Gangelt municipality)

9 April 2020

Background: The community of Gangelt is one of the hardest hit in Germany. It's believed the epidemic started due to a carnival on February 15.... A representative sample from the community (population 12,529) was obtained...


Goal: to determine the percentage of all infected, and the status of current SARS-CoV2 immunity in the community...


Procedure: A form letter was sent to approximately 600 households. Overall, ~1000 inhabitants from ~400 households took part. Questionnaires were collected, throat swabs taken and blood tested for the presence of antibodies (IgG, IgA)...


Preliminary result: An existing immunity of ~14% (antiSARS-CoV2 IgG positive, specificity of the method > 99%) was determined. About 2% of the individuals had a current SARS-CoV-2 determined using the PCR method. The infection rate (current infection or recently recovered) was about 15%. The case fatality rate in Gangelt is about 0.37%. This figure is 5 times lower than the current estimate for Germany (1.98%, according to Johns Hopkins)...


Preliminary conclusion: The overall German mortality rate (5 times higher than Gangelt, as estimated at Johns Hopkins) is explained by incomplete counting of infected people. This study captures all infected people in the sample, including asymptomatic infections and those with mild symptoms...


In Gangelt, 15% of the population may be immune to subsequent infection by SARS-CoV-2. This should reduce the speed of further spread...


By adhering to stringent hygiene measures, lower virus concentration at the time of infection may result in less severe illness. Favorable conditions for low level exposure are not present in a superspreading event (e.g. carnival session, apres ski bar Ischgl)...

Some data on an anti-viral. Not a controlled trial but promising. Just came out in New England Journal of Medicine. These were very very sick patients. The paper includes a lot of detail on the outcomes.

Compassionate Use of Remdesivir for Patients with Severe Covid-19


Jonathan Grein, M.D., Norio Ohmagari, M.D., Ph.D., Daniel Shin, M.D., George Diaz, M.D., et al.
April 10, 2020


Abstract
BACKGROUND
Remdesivir, a nucleotide analogue prodrug that inhibits viral RNA polymerases, has shown in vitro activity against SARS-CoV-2.


METHODS
We provided remdesivir on a compassionate-use basis to patients hospitalized with Covid-19, the illness caused by infection with SARS-CoV-2. Patients were those with confirmed SARS-CoV-2 infection who had an oxygen saturation of 94% or less while they were breathing ambient air or who were receiving oxygen support. Patients received a 10-day course of remdesivir, consisting of 200 mg administered intravenously on day 1, followed by 100 mg daily for the remaining 9 days of treatment. This report is based on data from patients who received remdesivir during the period from January 25, 2020, through March 7, 2020, and have clinical data for at least 1 subsequent day.


RESULTS
Of the 61 patients who received at least one dose of remdesivir, data from 8 could not be analyzed (including 7 patients with no post-treatment data and 1 with a dosing error). Of the 53 patients whose data were analyzed, 22 were in the United States, 22 in Europe or Canada, and 9 in Japan. At baseline, 30 patients (57%) were receiving mechanical ventilation and 4 (8%) were receiving extracorporeal membrane oxygenation. During a median follow-up of 18 days, 36 patients (68%) had an improvement in oxygen-support class, including 17 of 30 patients (57%) receiving mechanical ventilation who were extubated. A total of 25 patients (47%) were discharged, and 7 patients (13%) died; mortality was 18% (6 of 34) among patients receiving invasive ventilation and 5% (1 of 19) among those not receiving invasive ventilation.


CONCLUSIONS
In this cohort of patients hospitalized for severe Covid-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 patients (68%). Measurement of efficacy will require ongoing randomized, placebo-controlled trials of remdesivir therapy. (Funded by Gilead Sciences.)