March 12, 2020 (aka COVID-19 thread)

[Opus the Poet]

We're all gonna die.

Probably only once, though.

I wish, my customer loyalty card for Charon's Ferry Service is halfway to a free spa day at Elysian Fields Resort. Only 5 more trips...

[Dave]

Rats. A study from France reports that for patients who have been hospitalized with COVID-19 and who require oxygen, treatment with hydroxychloriquine doesn't seem to reduce the rate at which the patients get worse (requiring transfer to Intensive Care, or dying).

"These results do not support the use of HCQ in patients hospitalised for documented SARSCoV-2-positive hypoxic pneumonia."

And, there was a significant rate of complications.

"Among the 84 patients receiving HCQ within the first 48 hours, 8 (9.5%) experienced ECG modifications requiring HCQ discontinuation at a median of 4 days (3-9) after it began, according to French national guidelines. "

This study doesn't address an equally-important question: whether a chloroquine-based protocol might help patients earlier in the course of the disease (perhaps keeping them from needing to be hospitalized at all).

The fairly high rate of heart-related complications remains worrysome... this doesn't seem like a medication that would be generally seen as safe for use at these dosages without careful monitoring.

https://www.medrxiv.org/content/10.1101 ... 1.full.pdf

[jwhouk]

And, since those with heart disease and other heart issues are considered to be high risk patients for COVID, there goes that.

...and I'll keep my tongue to myself about certain people in a certain city at a certain address starting with 1600.

[Dave]

On the good-news side of things, it appears as if remdesivir may be helpful:

https://www.statnews.com/2020/04/16/ear ... treatment/

[Alkarii]

My mom's cousin's son was discharged from the hospital today. He has more physical therapy to go (as he'd been stuck in a hospital bed for three weeks), but other than that, he's fine, from what I hear.

[lake_wrangler]

I'm not trying to bring partisan politics into this thread, but since there have been a number of point/counterpoint articles linked, I figured was probably safe to bring a counterpoint to how mainstream media (as well as his political opponents) have recently been painting President Trump as being slow to respond to the crisis:

The Real Coronavirus Chronology Shows Trump Was On Top Of It While Biden Was Mocking The Danger


Hopefully, I will not need to put on my flame-proof suit, as it is currently at the cleaners...

[lake_wrangler]

Meanwhile, the Prime Minister of the province of Québec seems to be chomping at the bits to start reopening stuff and getting people working again, while the Prime Minister of the province of Alberta wants to check on its citizens via their own cell phones, to make sure people are respecting isolation directives, and the Prime Minister of Canada tried to get a law passed that would have given him the right to raise taxes as he saw fit for the next year or two, without having to have said tax raises approved by the members of parliament... (It didn't work, fortunately.)


On Easter Monday, I still saw people playing soccer in a park.

There are not quite as many people outside as there were a week ago, but that may be because the temperature dropped a bit, during the week.

Many stores now have a waiting line to get in, with stickers on the ground indicating the 2 meters distance they must keep from each other while in line (same thing at the cashiers), and people must either wash their hands (at a temporary sink installed at the entrance) or have a disinfectant spray applied to their hands, as they enter stores.

I am quite grateful to still be working and not have much of a dent in my paycheck (there is hardly any overtime available, these days, whereas I used to work anywhere between 10 to 15 hours of overtime per week, but I have been able to get a few hours each week, so far).

[Atomic]

Some good-ish news -- Virus is Following a Predictable Pattern

TL;DR: "His graphs show that all countries experienced seemingly identical coronavirus infection patterns, with the number of infected peaking in the sixth week and rapidly subsiding by the eighth week."

Also, from personal summary:

Given other reports of testing positive for antibodies vs being ill running up to 50 or 80:1 suggest the mortality rate is waaaay off overall for exposure to death ratio. It's getting big numbers due to poor information into the system and poor models overestimating the death rate.

Edit - Found the news story about above here.

Additional: Of the 397 people tested, 146 people tested positive. Not a single one had any symptoms.

[TazManiac]

Lake Wrangler, I appreciate a counter-point in any discussion, and I read that link you posted.

I am an American Citizen, and while I must assume an amount of responsibility for Donald Trump being in office, It is my opinion he is a terrible President and we are worse off with him at the wheel.

I look forward to a day when I can look back and observer we have survived his era.

This is what I think, I don't hate anyone who thinks differently.

[Warrl]

I am an American Citizen, and while I must assume an amount of responsibility for Donald Trump being in office, It is my opinion he is a terrible President and we are worse off with him at the wheel.

The sad thing is, I think he's perhaps the second-best President we've had in my lifetime - and I agree that he's a terrible President.

We seem to have a system well-designed to identify the good candidates and eliminate them quickly.

[Atomic]

Rate vs Quantity vs Region

New York City area is skewing USA numbers

TL;DR: NYC Region by itself is world leader in COVID infections / deaths per million. USA as whole is #7/8 by comparison to other countries.

Opinion: One size does not fit all.

[jwhouk]

There is a reason for the sign at Sky Harbor telling people from NY-NJ-CN area to self-isolate for 14 days upon arrival.

[lake_wrangler]

This is what I think, I don't hate anyone who thinks differently.

See? We're already agreeing on something...


Meanwhile, back at the ranch... (i.e. the province of Québec, in Canada)

They are speaking of (or has it already been done? I don't know, I don't listen to the news, much...) letting construction workers go back to work IF they work on new housing projects whose original delivery date was before the end of July.

Measures are to be taken (which ones, I forget...) to keep people safe from each other and the risk of infection, including someone being hired to daily disinfect the work site... How they will do that, I have no idea...

[Dave]

Heck and darnation: another study on hydroxychloroquine has been released, with disappointing results. This one is a U.S. study in VA hospitals. Summary: no significant benefit observed, and there was a significantly higher death rate among patients given hydroxychloroquine without azithromycin.

RESULTS: A total of 368 patients were evaluated (HC, n=97; HC+AZ, n=113; no HC, n=158). Rates of death in the HC, HC+AZ, and no HC groups were 27.8%, 22.1%, 11.4%, respectively. Rates of ventilation in the HC, HC+AZ, and no HC groups were 13.3%, 6.9%, 14.1%, respectively. Compared to the no HC group, the risk of death from any cause was higher in the HC group (adjusted hazard ratio, 2.61; 95% CI, 1.10 to 6.17; P=0.03) but not in the HC+AZ group (adjusted hazard ratio, 1.14; 95% CI, 0.56 to 2.32; P=0.72). The risk of ventilation was similar in the HC group (adjusted hazard ratio, 1.43; 95% CI, 0.53 to 3.79; P=0.48) and in the HC+AZ group (adjusted hazard ratio, 0.43; 95% CI, 0.16 to 1.12; P=0.09), compared to the no HC group. CONCLUSIONS: In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with hydroxychloroquine alone.

https://www.medrxiv.org/content/10.1101 ... 20065920v1

[TazManiac]

This is what I think, I don't hate anyone who thinks differently.

See? We're already agreeing on something...

Well done Sir, well done.

We too, here in and around San Francisco, have been given to believe that if the Construction Project met certain criteria (% of Affordable Units*, etc) the construction could continue.

*What amounts to the economical ceiling that constitutes 'Affordable' around here should be a crime.

[AnotherFairportfan]

Small sample, but at least as valid as the French one that gets quoted - which removed people from the study who went to Intensive Care ... or died, i believe:

No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection

we wished to assess in a prospective study virologic and clinical outcomes of 11 consecutive patients hospitalised in our department who received hydroxychloroquine (600 mg/d for 10 days) and azithromycin (500 mg day 1 and 250 mg days 2 to 5) using the same dosing regimen reported by Gautret et al. [3].

There were 7 men and 4 women with a mean age of 58.7 years (range: 20–77), 8 had significant comorbidities associated with poor outcomes (obesity: 2; solid cancer: 3; hematological cancer: 2; HIV-infection: 1).

At the time of treatment initiation, 10/11 had fever and received nasal oxygen therapy. Within 5 days, one patient died, two were transferred to the ICU. In one patient, hydroxychloroquine and azithromycin were discontinued after 4 days because of a prolongation of the QT interval from 405 ms before treatment to 460 and 470 ms under the combination. Mean through blood concentration of hydroxychloroquine was 678 ng/mL (range: 381–891) at days 3–7 after treatment initiation.

Repeated nasopharyngeal swabs in 10 patients (not done in the patient who died) using a qualitative PCR assay (nucleic acid extraction using Nuclisens Easy Mag®, Biomerieux and amplification with RealStar SARS CoV-2®, Altona), were still positive for SARS-CoV2 RNA in 8/10 patients (80%, 95% confidence interval: 49–94) at days 5 to 6 after treatment initiation.

These virologic results stand in contrast with those reported by Gautret et al. and cast doubts about the strong antiviral efficacy of this combination. Furthermore, in their report Gautret et al. also reported one death and three transfers to the ICU among the 26 patients who received hydroxychloroquine, also underlining the poor clinical outcome with this combination.

In addition, a recent study from China in individuals with COVID-19 found no difference in the rate of virologic clearance at 7 days with or without 5 days of hydroxychloroquine, and no difference in clinical outcomes (duration of hospitalisation, temperature normalisation, radiological progression) [4]. These results are consistent with the lack of virologic or clinical benefit of chloroquine in a number of viral infections where it was assessed for treatment or prophylaxis with sometimes a deleterious effect on viral replication [5], [6], [7], [8].

In summary, despite a reported antiviral activity of chloroquine against COVID-19 in vitro, we found no evidence of a strong antiviral activity or clinical benefit of the combination of hydroxychloroquine and azithromycin for the treatment of our hospitalised patients with severe COVID-19.

https://www.sciencedirect.com/science/a ... via%3Dihub

This one is about the same size asa the French one:

Hydroxychloroquine, a medicine for malaria that President Donald Trump has touted as a treatment for coronavirus, was no more effective than conventional care, a small study found.

The report published by the Journal of Zhejiang University in China showed that patients who got the medicine didn’t fight off the new coronavirus more often than those who did not get the medicine.

The study involved just 30 patients. Of the 15 patients given the malaria drug, 13 tested negative for the coronavirus after a week of treatment. Of the 15 patients who didn’t get hydroxychloroquine, 14 tested negative for the virus.

{SNIP}

Hydroxychloroquine, particularly when given with the antibiotic azithromycin, has received widespread attention following a controversial, small study of about 40 patients hospitalized with Covid-19 in France. In that study, the drug appeared to help clear the virus from the bodies of 26 patients who were given the medication, based on samples taken from nasal swabs. Experts have criticized the design of the study, calling it interesting but far from definitive.

{SNIP}

In the Chinese study, which was conducted by researchers from the department of infection and immunity at the Shanghai Public Health Clinical Center, the 15 patients who didn’t get hydroxychloroquine were treated with conventional care.

This includes bed rest, oxygen inhalation, and the use of anti-viral drugs recommended in China’s treatment guidelines like lopinavir and ritonavir, and antibiotics when necessary.

One patient treated with hydroxychloroquine progressed to severe disease during the study. Four patients given the medicine developed diarrhea and signs of potential liver damage, compared with three getting conventional treatment.

https://www.bloomberg.com/news/articles ... e-in-study

I had been going to include the same study Dave did, upthread.

[Atomic]

As always, Garbage In, Garbage Out.

Counterpoint to the CQ Doesn't Work study.

You don't get good science from small samples and manipulating the population, much less valid results. Small sample oddities can point the way to further research, but don't overextend the presumed results.

Obligatory XKCD "Jelly Beans Cause Acne"

[Warrl]

As always, Garbage In, Garbage Out.

Counterpoint to the CQ Doesn't Work study.

Summary: the media have been pooh-poohing a number of previous reports because they weren't proper controlled clinical studies of a representative population, and they did agree with President Trump. The same media are loudly touting this study because at first glance it disagrees with President Trump - even though it has ALL the same flaws as the previous reports, and even though the study's actual conclusion is "we need a proper controlled clinical study of a representative population".

[TazManiac]

San Francisco, CA (which is both a City AND a County btw...) has stepped up testing for 'Essential Workers'.

Depending on who is reporting the story you either _do_ need to be showing some sort of symptom OR you do not.

I am almost sure I could finagle an appointment, lack of symptoms notwithstanding, but rather than find out if I have it, I'd rather get an anti-body test to see if I've ever been exposed to it....

[Atomic]

Some good news, in the sense that tiger fur is much more common than tiger attacks:

Antibody Testing: Proves We've Been Had!

Political opinions included, but hard numbers as well.

TL:DR: New York State

• Population -19,540,500
  Test Postive for Antibodies - 2,500,000 (Recovered), a 13% exposure rate
  Currently Ill - 263,000
  Died - 19,543
  
  Death Rate: 19,542 / 2,500,000 = 0.78%