Coronavirus (COVID-19)

[mission27]

15 minutes ago, WizeGuy said:

40 minutes ago, mission27 said:

Yeah .5-.7 CFR from NYC data, I'm guessing the reason that is higher than what we are seeing other places is a combination of... 

1. demographics

2. health care system overload

3. the way they are counting in home deaths

4. possibility that the Italy / NYC strain is deadlier than China / west coast strain

Also, they didnt test minors, so that likely skewed the death rate a bit since minors dont get hit nearly as severely.

Ah thats a very good point.  So it could be quite a bit lower.  25% of NYC is under 18 and the death rate in that population is very close to 0.  If you adjust for that its maybe 0.3% to 0.5% which is in line with what we've seen elsewhere, albeit on the high end of the range, but could definitely be explained by the hospitals being overwhelmed. 

[TVScout]

6 hours ago, WizeGuy said:

Damn, Cuomo just said 20% of NYC and 13.9% of the entire state of NY have tested positive for antibodies thus far. That's a crazy #. Hopefully immunity last- it'll slow the spread tremendously in the densely populated areas. 

 

Edit: Estimates the mortality rate to be .55-.66. The higher end includes in-home deaths. Also, some participants had the virus 6 weeks ago and still have antibodies. As most of us expected, immunity should last at least a few months then...hopefully longer.

https://www.cnn.com/2020/04/23/health/us-coronavirus-thursday/index.html

[Shanedorf]

from buzzfeed, the diary of an ER doc in NYC -  I posted a few snippets below

https://www.buzzfeednews.com/article/jasonhill/coronavirus-covid-19-er-doctor-diary-new-york-hospital

The eyes stay with you

"...For those I intubate, those who choose intubation, I often find myself having a final stare. After all the words are spoken, the decisions made, the medications drawn, the bed positioned, and the tubes and drips and ventilators readied, there is a final stare. It is a stare of intention. It is a moment of humanity. It is a shared space, a hallowed space, the final moment of someone’s awareness, possibly forever. It is a space where fear and hope mingle, where autonomy fades into trust, uncertainty into acceptance, and all the patient has left is placed firmly in your gloved hands. It’s brief, and you’re busy, and time is essential, but you find a few seconds to share this breath. That stare lasts a moment. That stare lasts a lifetime. And the eyes stay with you
 

Today I’m a palliative care doc. This man is not doing well. This man needs intubation to survive. He’s 67 and only speaks Spanish. He’s healthy. He’s dying. His oxygen is very low. His respiratory rate is very high. He’s getting tired. He’s suffocating in his own body. He needs to be intubated. He doesn’t want to be intubated. He doesn’t want to be on a machine. We ask if we can help call his family to say goodbye. He looks at us, puzzled, somehow still not fully understanding. “Se está muriendo, señor. Es el fin.”  This is the end.

He gets it. He’s stoic despite the tears. He’s strong. If this disease attacked character instead of lungs, he would have a fighting chance. We set up a video call with his family. He says goodbye. They say they love him in a dozen different ways. He touches the screen. A digital handhold in a pandemic age. We make him comfortable. He’s still drowning, but he can’t feel it. He says thank you before his eyes close..."

 

This is why WE have to make some sacrifices in our lives. Beyond all the charts, graphs and models. Beyond all the hype and hysteria and politics and fighting over death rate decimals - this is the humanity of what's going on.

Edited April 23, 2020 by Shanedorf

[mission27]

3 hours ago, Shanedorf said:

from buzzfeed, the diary of an ER doc in NYC -  I posted a few snippets below

https://www.buzzfeednews.com/article/jasonhill/coronavirus-covid-19-er-doctor-diary-new-york-hospital

The eyes stay with you

"...For those I intubate, those who choose intubation, I often find myself having a final stare. After all the words are spoken, the decisions made, the medications drawn, the bed positioned, and the tubes and drips and ventilators readied, there is a final stare. It is a stare of intention. It is a moment of humanity. It is a shared space, a hallowed space, the final moment of someone’s awareness, possibly forever. It is a space where fear and hope mingle, where autonomy fades into trust, uncertainty into acceptance, and all the patient has left is placed firmly in your gloved hands. It’s brief, and you’re busy, and time is essential, but you find a few seconds to share this breath. That stare lasts a moment. That stare lasts a lifetime. And the eyes stay with you
 

Today I’m a palliative care doc. This man is not doing well. This man needs intubation to survive. He’s 67 and only speaks Spanish. He’s healthy. He’s dying. His oxygen is very low. His respiratory rate is very high. He’s getting tired. He’s suffocating in his own body. He needs to be intubated. He doesn’t want to be intubated. He doesn’t want to be on a machine. We ask if we can help call his family to say goodbye. He looks at us, puzzled, somehow still not fully understanding. “Se está muriendo, señor. Es el fin.”  This is the end.

He gets it. He’s stoic despite the tears. He’s strong. If this disease attacked character instead of lungs, he would have a fighting chance. We set up a video call with his family. He says goodbye. They say they love him in a dozen different ways. He touches the screen. A digital handhold in a pandemic age. We make him comfortable. He’s still drowning, but he can’t feel it. He says thank you before his eyes close..."

 

This is why WE have to make some sacrifices in our lives. Beyond all the charts, graphs and models. Beyond all the hype and hysteria and politics and fighting over death rate decimals - this is the humanity of what's going on.

I completely agree with you but lets not lose sight of the fact that people struggling to feed their families or separated from their loved ones and socially isolated is an equal human tragedy.  This lockdown is likely to lead to hundreds of millions of people going hungry.  Even in developed country which will likely fair much better, life is short and there is no guarantee the economic hardship, emotional trauma, opportunities lost, families broken apart, etc. from this will be fixed on the other side... or even any sense whatsoever when the other side will be.  For many death is not the greatest fear.  Its the damage, long term damage, of the lockdown on their lives.  There is going to be lasting damage from this beyond the health impacts on those infected by the virus.  We need to able to have an adult conversation about the parameters for going back to our lives look like and what cost we are willing to pay.  While its helpful to remind people that this is a dangerous disease that is causing a lot of pain and suffering we can't have that conversation purely from a position of fear and emotion, on either side.

[mission27]

4/23/2020 MoL Scores:

Methodology and disclaimer: MoL score is a simple metric for measuring rate of spread of the novel coronavirus within communities.  The metric was developed by mission and TLO and has not been subjected to academic peer review.  The MoL looks at a trailing average of daily new cases and compares this to trailing active cases within the community.  These rankings do not represent the opinion of anyone other than mission and TLO and should not be taken as advice of any kind.  Please note while the numbers themselves are objective calculations, smugness and Taylor Swift lyrics may factor into our commentary and decisions on tiers.  The MoL reserves the right to make changes to this methodology at any time.  Please follow all relevant governmental and/or WHO/CDC guidance.  We will defeat this virus.

"I knew you were trouble when you walked in
So, shame on me now
Flew me to places I'd never been
Now I'm lyin' on the cold hard ground"

- Taylor Swift

Today the MoL is smug as Singapore nearly breaks into a new tier and the USA reaches a key milestone

Tier 1: Outbreak under control, safe to begin relaxing social distancing measures

South Korea: 0.4 (South Korea back at #1 with an all-time low score, its frustrating to the MoL that other countries are not laser focused on pursuing South Korea's highly effective test and trace strategy to allow for lockdowns to be lifted)

Hong Kong: 0.5 (now 9 of 10 days at 0.5)

Australia: 0.8 (and the Shady's did it, breaking below 1! great job)

China: 1.5 (China's numbers continue to get better and better)

Austria: 1.6 

Czech Republic: 2.2 (a smug country, land of beer) 

Switzerland: 2.4 (somehow Swiss disappeared from our rankings, wonder how)

Tier 2: New case growth is minimal suggesting social distancing is working, likely a few weeks away from breaking into tier 1

France: 2.5 (give it until the weekend and then we will let them into Tier 1)

Italy: 2.6 (same as France)

Portugal: 2.9 (a slight tick up, but new cases have been pretty stable the last week or so)

Netherlands: 3.0

Israel: 3.2

Philippines: 3.5 (#seasonality)

Germany: 3.5

Spain: 3.7 (slight tick up, but important to recognize how far Spain has come in the past two weeks, these numbers are still very good in the grand scheme of things)

USA: 4.5 (new all-time low for USA, for the sixth straight day, and now no states or territories in Tier 4!)

Japan: 4.6 (Japan's measures appear to be working as the MoL drops below the maintenance threshold) 

Belgium: 4.8

UK: 4.8 (a word of caution - UK's number is messed up because they do not report recoveries, which makes it look like there are more folks still sick than is actually the case and skews the numbers)

Global: 4.8 (global score ticks down, though just barely)

Sweden: 5.0 (what a tremendous level of consistency tbh)

Denmark: 5.5

Turkey: 5.6

Iran: 6.2* (consistently bs numbers, tbh)

Canada: 8.4 (Canad has really hit a plateau the past week, our hope is cases will not continue to rise and this is the beginning of a rapid fall and quick return to hockey, etc.)

Ireland: 9.4 

Tier 3: Countries in this group that are showing increased MoLs have the potential to go deep into the danger zones, but countries with falling MoLs may only be a couple of days from tier 2 status and may have already peaked in gross # of new cases

India: 10.0

Brazil: 12.6

Russia: 15.5 (Russia outbreak showing some good signs here the last few days, new cases essentially flat at around 5k / day for the past week, lets see if this is for real, low population density could help here)

Mexico: 17.5

Tier 4: Aggressive growth, still likely have not peaked in single day cases, and likely a week or two minimum from peak in deaths (however many of these countries are still slowing down)

Singapore: 19.8 (Singapore showing some slow down, could justify Tier 3 status soon, which would make the MoL smug)

USA State Level MoLs

For the first time, there is NO state or territory in the USA in Tier 4.  That doesn't mean states couldn't slip back down, but its encouraging.  On the flip side, South Carolina's very promising numbers over Monday - Wednesday appear to be as temporary as the MoL suggested at the time. 

The MoL would like to thank everyone for their contributions to this important work including @ET80 @acowboys62 @dtait93 @Dome @naptownskinsfan @kingseanjohn @Malfatron @Shady Slim @malagabears @daboyle250 @vikesfan89 @ramssuperbowl99 @sdrawkcab321 @Nazgul @kingseanjohn @mistakey @TwoUpTwoDown @Xenos @Nex_Gen @FinneasGage and the others who love us so much

We'd even like to thank @pwny @Glen and others for their critical attitude because of the attention it brings to the great work MoL is doing 

@TLO

Edited April 24, 2020 by mission27

[malagabears]

Promising vaccine candidate:

https://www.mymcmedia.org/gaithersburg-lab-one-step-closer-to-potential-covid-19-vaccine/

A local bio-technology company has found a coronavirus vaccine candidate, and the first in-human trial is expected to begin in May. Novavax, which is located in Gaithersburg, develops next-generation vaccines for serious infectious diseases.

Officials say they will be using NVX-CoV2373, which is described as a stable, prefusion protein made using Novavax’s proprietary nanoparticle technology.

“Our scientists identified an ideal vaccine candidate selected from a number of constructs and, in partnership with Dr. Matthew Frieman, demonstrated that NVX-CoV2373 produced high levels of neutralizing antibodies against SARS-CoV-2 in animal studies,” said Gregory Glenn, M.D., President of Research and Development at Novavax. “In addition, we have worked closely with our colleagues at Emergent BioSolutions to transfer our production technology that allows the manufacture of GMP vaccine for clinical trials. With preliminary CEPI funding, these heroic efforts, combined with the candidate’s excellent early results, put us in position to have preliminary human data in July.”

According to a press release, the clinical development plan combines a two phase approach to allow rapid advancement during the current coronavirus health crisis. The phase one clinical trial is a placebo-controlled study of 130 healthy adults and includes assessment of dosage amount and number of vaccinations. The trial is expected to begin in mid-May, and preliminary results are expected in July.

“We validated that NVX-CoV2373 generates high titer neutralizing antibodies against live SARS-CoV-2 virus,” said Matthew Frieman, Ph.D., Associate Professor at the University of Maryland School of Medicine. “This is strong evidence that the vaccine created by Novavax has the potential to be highly immunogenic in humans which could lead to protection from COVID-19 and helping to control the spread of this disease.”

[Xmad]

35 minutes ago, malagabears said:

Promising vaccine candidate:

https://www.mymcmedia.org/gaithersburg-lab-one-step-closer-to-potential-covid-19-vaccine/

A local bio-technology company has found a coronavirus vaccine candidate, and the first in-human trial is expected to begin in May. Novavax, which is located in Gaithersburg, develops next-generation vaccines for serious infectious diseases.

Officials say they will be using NVX-CoV2373, which is described as a stable, prefusion protein made using Novavax’s proprietary nanoparticle technology.

“Our scientists identified an ideal vaccine candidate selected from a number of constructs and, in partnership with Dr. Matthew Frieman, demonstrated that NVX-CoV2373 produced high levels of neutralizing antibodies against SARS-CoV-2 in animal studies,” said Gregory Glenn, M.D., President of Research and Development at Novavax. “In addition, we have worked closely with our colleagues at Emergent BioSolutions to transfer our production technology that allows the manufacture of GMP vaccine for clinical trials. With preliminary CEPI funding, these heroic efforts, combined with the candidate’s excellent early results, put us in position to have preliminary human data in July.”

According to a press release, the clinical development plan combines a two phase approach to allow rapid advancement during the current coronavirus health crisis. The phase one clinical trial is a placebo-controlled study of 130 healthy adults and includes assessment of dosage amount and number of vaccinations. The trial is expected to begin in mid-May, and preliminary results are expected in July.

“We validated that NVX-CoV2373 generates high titer neutralizing antibodies against live SARS-CoV-2 virus,” said Matthew Frieman, Ph.D., Associate Professor at the University of Maryland School of Medicine. “This is strong evidence that the vaccine created by Novavax has the potential to be highly immunogenic in humans which could lead to protection from COVID-19 and helping to control the spread of this disease.”

Cool.

Whoever gets the first Vaccine to market is gonna be dripping in money. 

[diehardlionfan]

11 minutes ago, SwoleXmad said:

Cool.

Whoever gets the first Vaccine to market is gonna be dripping in money. 

It would be awesome to see a company that develops a vaccine recoup expenses and donate the vaccine. 

[rob_shadows]

https://www.yahoo.com/lifestyle/coronavirus-is-likely-not-sexually-transmitted-study-finds-180317908.html

I mean... That's cool and all but even without being transmitted directly through sex I have to imagine it'd still be pretty hard to have sex with someone infected and not get the virus.

[diehardlionfan]

7 hours ago, mission27 said:

I completely agree with you but lets not lose sight of the fact that people struggling to feed their families or separated from their loved ones and socially isolated is an equal human tragedy.  This lockdown is likely to lead to hundreds of millions of people going hungry.  Even in developed country which will likely fair much better, life is short and there is no guarantee the economic hardship, emotional trauma, opportunities lost, families broken apart, etc. from this will be fixed on the other side... or even any sense whatsoever when the other side will be.  For many death is not the greatest fear.  Its the damage, long term damage, of the lockdown on their lives.  There is going to be lasting damage from this beyond the health impacts on those infected by the virus.  We need to able to have an adult conversation about the parameters for going back to our lives look like and what cost we are willing to pay.  While its helpful to remind people that this is a dangerous disease that is causing a lot of pain and suffering we can't have that conversation purely from a position of fear and emotion, on either side.

You make some excellent points. I don’t like assuming what others may or may not feel but I’ve personally been thinking about this for awhile.

Im in the high risk category so I’m going to share my thoughts.

My biggest loss is contact with my grandchildren. We are extremely close, especially my oldest grandson. Since they were born they spend every other weekend with my wife and I. My fears are for their future and selfishly my heartbreaks a bit more everyday. I cant even think about them without tearing up.

I am not afraid of death. It happens to everyone. What I am afraid of is being restrained due to the panic that happens when you can’t get oxygen. I am terrified of flopping around like a fish on the dock, eyes bugged out gasping. I will not be on a ventilator. The odds aren’t good to begin with. For me it’s a waste of resources offering minimal hope while risking permanent debilitating lung damage. The resources are much better used on someone with a better chance.

We have right to die legislation in Canada. From my perspective I would need to ensure that right to die wouldn’t be blocked during this crisis. If I get this disease it’s important Doctors know at a certain point to simply give me the needle. 

I’m not at all concerned about the economic impact. My father served in WW2 and grew up during the Great Depression. I’ve seen far harder economic times (that will change if this lasts longer) and one thing is consistent. People adapt and get through difficult times. 

Our countries, U.S.A. and Canada have sufficient resources to withstand the economic impact unfortunately we still see far to much selfish motivation and not nearly enough community caring. We don’t need more luxuries, vacation homes, big screen T.V.’s etc. We need well supplied food banks, shelter for the homeless and medical care for the poor. We don’t need more large homes and multiple cars in driveways, boats, trailers, etc. 

Our societies need to grow up and recognize what’s important and not fall victim to the B.S. being touted by those whose only interest is their wealth. They push to open prematurely to protect their interests. Everyone talks about the demographics of this virus but the focus, in my opinion, should be the excessive price being paid by the disadvantaged in the world. In every hot spot the poor pay an excessive price. Summer is coming and that spells torture for those living in modest accommodation. Millions without air conditioning, stuck inside, possibly short of food. The emotional response to living in those conditions, trapped inside will be negative.

The lives most of us posting here live are far more comfortable than over 95% of the planet. 

 

 

[mistakey]

Surpassed 50k deaths, had 3k in last 24 hrs.  Thats very slightly more than 9/11 and we will surpass the 60k mark very shortly unfortunately.  This will be more than the vietnam war. 

[theJ]

11 minutes ago, mistakey said:

Surpassed 50k deaths, had 3k in last 24 hrs.  Thats very slightly more than 9/11 and we will surpass the 60k mark very shortly unfortunately.  This will be more than the vietnam war. 

Yep.  While the growth is no longer exponential, it's still almost perfectly linear.  We've been seeing roughly the same amount of cases and deaths every day for the last 2-3 weeks.  Probably due in part to regional outbreaks.  This doesn't appear like it will be over anytime soon.

[malagabears]

@mission27 Spain finally has numbers indicating the curve may be on it's way down. 3105 cured, 2796 new infections, & 367 fatalities yesterday.

Edited April 24, 2020 by malagabears

[LETSGOBROWNIES]

everything is stable now, only thing to do is wait and see what happens when people are let out of their homes.

[WizeGuy]

Are other states doing what NY is going to do and start opening by region? Seems like a great idea. Dense cities shouldn't dictate what goes on for the rest of the state. Here in Rochester, NY we're doing a great job at flattening the curve. I could see us starting to open things up by late May. NYC, however, is going to take longer to open up, so it only makes sense to have the smaller cities begin opening in phases first.

Also, if immunity is gained long term + the virus doesn't mutate to negate current immunity, then the spread is going to slow down quite a bit in the the coming months, at least in the very dense areas of the states. 22% of the population testing positive for antibodies in NYC + *possible* seasonal effects + more accurate testing and tracing= Much less stress on our hospitals here in NY. 

As for the antibody study in NY, there's a lot of chatter that the type of people that go to grocery stores are less likely to practice social distancing, so it may skew the results. I think it's important to note 3 things:

1) We were made aware here in NY that these tests were taking place in grocery stores. Me personally, someone who hasn't been to a grocery store in over month, I was strongly considering going to Wegmans to get tested. Not because I thought I had the virus in the past, but because I genuinely wanted to know if I had it at some point. I believe a lot of people felt the way I did, so there was probably a surge of people who don't normally go out that wanted to get tested out of curiosity.

2) Minors were not involved in the testing. This would have an impact on the mortality rate. Of course unreported deaths will also impact the death rate, but from what I've read, and i'm not 100% certain on this, the higher side of the death rate being tossed around by Cuomo included in-home deaths as well. It seems likely that at the moment we can assume the death rate is close to .5%. Of course further testing may change that number. 

3) It can take up to 20 some odd days for antibodies to show up in the body. Also, in theory -people who experience incredibly mild symptoms may not produce antibodies (up to 5% of people with mild symptoms don't show a detectable level of antibodies according to a study I read that isn't peer reviewed). This doesn't mean they aren't immune since antibodies aren't the only way our body builds immunity (I assume, but correct me if I'm wrong), only that they won't show up on the antibody tests. So it seems reasonable to me that the amount of people who may have immunity may actually be higher than 22%. 

This is an optimistic view, of course. Herd immunity seems damn near impossible with how contagious this bastard is, but slowing the spread to give our healthcare workers a fighting chance seems to be coming sooner rather than later. Fingers crossed!