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Everything posted by BrianA

  1. Looks like some good results for chloroquine in this small new French study. Even better results when combined with azithromycin. First results from french open-label trial of Chloroquine for COVID19 https://www.reddit.com/r/medicine/comments/fkh526/first_results_from_french_openlabel_trial_of/
  2. Starting to see more US efforts towards cloning the successes from Asia. Masks... not sure if they will become a widespread thing here or not. Currently still being discouraged by officials due to their completely bungled (at all levels, fed/state/private) preparation levels, now scrambling to try and hoover up all mask supplies. Perhaps 2 or 3 months from now, after that crisis is over and all the ramped up China and US production is flowing well, then you could see mask prices drop back close to normal and availability be enough that the officials and/or public might change their stance during a potential virus rebound this fall/winter. Surveillance Company Says It's Deploying 'Coronavirus-Detecting' Cameras In US https://science.slashdot.org/story/20/03/17/211228/surveillance-company-says-its-deploying-coronavirus-detecting-cameras-in-us US Government, Tech Industry Discussing Ways To Use Smartphone Location Data To Combat Coronavirus https://yro.slashdot.org/story/20/03/17/1911201/us-government-tech-industry-discussing-ways-to-use-smartphone-location-data-to-combat-coronavirus More from that UK study, predicting a virus rebound later in the year after this initial lockdown period ends. Inside the model that may be making US, UK rethink coronavirus control https://arstechnica.com/science/2020/03/new-model-examines-impact-of-different-methods-of-coronavirus-control/#p3
  3. Here's another potential stopgap treatment that might be experimented with, camostat mesylate, a generic drug from Japan: SARS-CoV-2 Cell Entry Depends on ACE2 andTMPRSS2 and Is Blocked by a Clinically ProvenProtease Inhibitor https://www.cell.com/action/showPdf?pii=S0092-8674(20)30229-4 https://business.nikkei.com/atcl/gen/19/00110/031600009/
  4. I'm finding the realtime Tomtom traffic data charts interesting to check in various parts of the world, to see an unbiased view of economic activity. For example in China, Shenzhen was pretty much back to normal traffic levels yesterday for the first time since the outbreak. https://www.tomtom.com/en_gb/traffic-index/shenzhen-traffic So it is possible to get the virus under control within around a six week period, given the correct measures (which the US is failing at currently). As I mentioned here yesterday, China now has ongoing measures in place to try to prevent/control further outbreaks, including now quarantining all foreign travelers for 14 days so places like the USA don't reinfect their cities. Their industrial production/GDP/etc definitely took a major hit to accomplish this, but from what I've read this is expected to quickly rebound and by the 2nd half of the year it's expected they would be essentially back to normal. I think the issue in the US and Europe is that if/when the virus is left essentially unchecked to spread, the speed of it is such that it results in vastly exceeding the hospital capacity, as seen in Italy (parts of Seattle are close to this point from what I read). And it's that kind of very public (no real censorship in these places) result that politicians are driven to avoid. And most everyday people too. They don't want to see tons of grandparents and great grandparents just essentially left to die in the hallways of hospitals because the limited resources are triaged towards younger patients. Due to that potential horror show the UK did a 180 today and is no longer embracing their "take it on the chin"/"herd immunity" policy. They realized their NHS was about to get hit with a tsunami of ICU patients like in Italy, and are now moving more towards the Euro/USA approach... try to slow down the overall infection rate to avoid those kinds of news reports from hospitals happening. I see the US trying in fits and starts to try and copy some bits of the Asian approaches, for example I'm reading more about doing drive through testing like from South Korea. Testing volume is going to keep ramping up over the next 2 months to the point that everyone who wants a free test will eventually be able to get one. Unfortunately though at the moment my guess is the US just isn't going to be strict enough to really eliminate the virus completely in large geographic areas like China may be able to achieve (remains to be seen though, even for them). So my expectation is eventually after experimenting with regionally-driven lockdowns for varying lengths of time (long enough to keep the spread slow enough to avoid hospitals being crushed too badly), eventually yes things will sort of go back to a kind of normal, with the virus still around here in varying intensities well into next year. Hopefully by later 2021 there would be a proven out vaccine to finally end it. Between now and then, things will gradually return to normal, a decent amount of older people will die (but not as many as if we do nothing to slow the virus spread), there may be lingering loss of jobs through a good chunk of this year at least in hospitality areas (New York state unemployment website apparently was crashing today). So I guess I'm leaning towards the recovery in the US potentially taking a bit longer than parts of Asia, just due to how bad of a containment job we're doing, perhaps by the 4th quarter this year or maybe into 2021 before GDP recovers, maybe until into 2nd half 2021 for most job losses to recover (although we are seeing plenty of hiring now in online-centric businesses, Amazon announced hiring 100k people due to massive online demand right now). If the feds pump in a very large amount of fiscal stimulus (well over $1 trillion might be needed by the end of this), then things might be cushioned to a decent degree. Unfortunately due to this being an election year, it's hard to come to agreement on some of this, we'll see. Investments-wise, I would say investing in various kinds of tech (incl biotech) should still be a good investment for the long term. People will want even more online and remote services after this outbreak. And the health system will be revamped to better handle an outbreak like this in the future, plenty of spending on that I expect. I can't say if the current stock market value is a good place to invest in the short term, there are still a lot of unknowns regarding fiscal policy, the virus itself (will it mutate? how soon to a treatment or vaccine? etc) that make the short term almost impossible to predict. This is why there are 5 to 10% overnight and daily market swings still going on. But my guess is that as clarity comes to these issues, the market will go back up.
  5. Here's an interesting read of the current lifestyle in China. Their virus control system seems to consist of: a) mandatory mask wearing b) mandatory temperature checks in various places c) enforced crowd control in parks or other places by requiring reservation via app d) geographical movement restrictions remain. edit: I want to point out that in the countries so far that have a handle on the virus, they all are heavy on mask wearing: China, Taiwan, Hong Kong, Singapore, South Korea. Whereas the countries in Europe that have exploding virus numbers are highly anti-mask (though the worst hit parts of Italy are now finally shifting in past week towards mask wearing in public). My impressions from Shanghai: Back to business, but NOT as usual (Mar 16) https://www.reddit.com/r/China_Flu/comments/fjesyl/my_impressions_from_shanghai_back_to_business_but/
  6. Highly speculative preprint paper that the virus can mutate in some people (particularly older folks who may make "less perfect" antibodies), allowing it to attack immune cells. Leading to the by now often-noticed factor in ICU patients that have leukopenia and/or lymphocytopenia. Apparently this problem was observed in attempts to make a SARS vaccine previously. Vaccines targeting the "spike" protein part of the virus can accidentally lead to this effect. This would explain why most people seem to get the mild symptoms, but other people suddenly progress to a more severe stage of symptoms later on. Also might explain how a small number of people seem to initially recover, but then relapse with a more intense version. Medical Countermeasures Analysis of 2019-nCoV and Vaccine Risks for Antibody-Dependent Enhancement (ADE) https://www.preprints.org/manuscript/202003.0138/v1 Antibody-dependent enhancement https://en.wikipedia.org/wiki/Antibody-dependent_enhancement Does SARS-CoV-2 utilize antibody-dependent enhancement? https://www.lesswrong.com/posts/e5cKbs2etGiFrXxGd/does-sars-cov-2-utilize-antibody-dependent-enhancement Dysregulation of immune response in patients with COVID-19 in Wuhan, China https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa248/5803306
  7. Tweets from David Sinclair speculating why chloroquine might help - the virus may attack red blood cells. Lower blood sugar / less glycated heme helps. I haven't seen the China research he's mentioning. https://threadreaderapp.com/thread/1238972082756648960.html
  8. Regarding things that increase ACE2 receptor expression (such as ACE inhibitors), and therefore bad for this virus, I'm reading that perhaps NSAIDs (aspirin/ibuprofen) may also do this. The French health minister is suggesting to avoid these for fever control, use some alternative. French health minister: Anti-inflammatory medicine such as Ibuprofen and cortison may worsen the condition https://www.reddit.com/r/Coronavirus/comments/figvrn/french_health_minister_antiinflammatory_medicine/ Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext "ACE2 can also be increased by thiazolidinediones and ibuprofen."
  9. I think South Korea is doing a good job of piloting a course midway between total lockdown, and the "we give up" herd immunity strategy. Using a huge number of rapid tests, advanced and extensive case tracing, and localized cluster lockdowns they have now slowed the percentage increase of new cases to the smallest (except China) of countries that have the virus. And yet most of their industry is able to keep operating.
  10. On the Japan-docked cruise ship it's looking like around a 1% CFR in that population, the researchers estimate in the overall general population the CFR may end up being 0.5% (assuming everyone can get needed ideal medical care). Interesting that around half of people that had it didn't have any symptoms. So you can see how that allows it to spread so much, tons of people walking around spreading it with no idea. It's just highly variable in symptom severity, unfortunately older people and a small fraction of younger people have a really bad reaction to it. My concern is in places like the UK and California which are now taking the approach of just letting it essentially naturally spread, and only asking the obviously sick people to stay home, this could lead to it getting too far out of control due to the symptomless spreaders. We're going to find out real soon. Cruise ship data helps reveal coronavirus death rate: researchers https://www.foxnews.com/us/cruise-ship-data-helps-reveal-coronavirus-death-rate-researchers
  11. The Sudden Economic Stop https://www.calculatedriskblog.com/2020/03/the-sudden-economic-stop.html Coronavirus: some recovered patients may have reduced lung function and are left gasping for air while walking briskly, Hong Kong doctors find https://www.scmp.com/news/hong-kong/health-environment/article/3074988/coronavirus-some-recovered-patients-may-have South Korea’s coronavirus response is the opposite of China and Italy – and it’s working https://www.scmp.com/week-asia/health-environment/article/3075164/south-koreas-coronavirus-response-opposite-china-and
  12. Thank you FDA for speeding things up on the approvals: Roche coronavirus test gets emergency FDA approval https://www.marketwatch.com/story/roche-coronavirus-test-gets-emergency-fda-approval-2020-03-13
  13. Some good news is mask production is ramping up a lot in China in the past couple weeks. The availability of them around the world should eventually catch up and stabilize, going to take at least a further 4 to 6 weeks I'd guess just due to transport times and other factors. China’s mask-making juggernaut cranks into gear, sparking fears of over-reliance on world’s workshop https://www.scmp.com/economy/global-economy/article/3074821/coronavirus-chinas-mask-making-juggernaut-cranks-gear also, Alibaba's Jack Ma is donating some masks and other supplies to the US and other countries: Alibaba billionaire Jack Ma just pledged to donate 500,000 coronavirus tests and 1 million face masks to the US as shortages mount https://www.businessinsider.com/jack-ma-pledges-to-ship-coronavirus-tests-masks-to-us-2020-3
  14. I often feel the FDA holds things back waaaay too much. Seems to be the case here again, also they seem to have been involved in slowing down the CDC's initial testing effort. Both of these agencies seem to be creating huge roadblocks to what we need right now: speed. How this South Korean company created coronavirus test kits in three weeks https://www.cnn.com/2020/03/12/asia/coronavirus-south-korea-testing-intl-hnk/index.html
  15. What It Means To Wear A Face Mask In America If you wear one here, you are gullible, selfish, foreign, sick, and asking for attention. But in Asia, face masks mean something else altogether. https://www.refinery29.com/en-us/2020/03/9497452/asian-face-mask-coronavirus-racism
  16. ACE inhibitors and angiotensin II type-I receptor blockers (ARBs) may cause worsened Covid severity due to increase in ACE2 receptor expression. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext
  17. I think the answer is simply some countries are doing an incredibly better job at dealing with this than others. The badly failing countries have a lot to learn. The countries that do well can get it under control. The ones that can't, well we're going to see, I remain unsure myself how bad it could get. I read an article today on the contact tracing "technology" used in my state, they are simply phone calling people and trying to get them to recall where they were in past two weeks.. tracing all the contacts for a single Covid case can easily eat up an entire day for one tracing worker. Compare to South Korea's tech. Also: masks. Masks ubiquitous now in the countries that seem to have a handle on it, whereas in Europe and the US people still get made fun of for wearing one in public... that attitude has to change. Here's an article: Special Report: Italy and South Korea virus outbreaks reveal disparity in deaths and tactics https://www.reuters.com/article/us-health-coronavirus-response-specialre/italy-and-south-korea-virus-outbreaks-reveal-disparity-in-deaths-and-tactics-idUSKBN20Z27P
  18. Doctors in Italy reported to be experimenting with chloroquine treatment
  19. Regarding getting the bacterial pneumonia vaccine, I did recommend to my parents to get it a couple weeks back. The reasoning is that even though it won't help directly against this viral type pneumonia directly, many cases of fatal pneumonia end in part due to secondary opportunistic infections. So that vaccine might perhaps help slightly with that. Maybe. Secondary infections mentioned in fatal covid-19 case studies: First study identifies risk factors associated with death in adults hospitalized with new coronavirus disease in Wuhan https://www.sciencedaily.com/releases/2020/03/200309130109.htm Some dual viral & bacterial infections noted in this study of mask effectiveness in health care workers: Study shows superiority of N95 respirators in protecting health workers against bacterial respiratory infections. http://www.isg.org.au/index.php/news-items/study-shows-superiority-of-n95-respirators-in-protecting-health-workers-against-bacterial-respiratory-infections./
  20. Report from 24+ hours ago is some areas of Italy are so overwhelmed they aren't even assessing/treating patients 65+ years old if they have any other comorbitities. Health resources are being reserved for younger individuals. This would be why the case fatality rate seems to now be worse than China. In more positive news, China announced plans to send 1000 ventilators and other medical supplies to Italy. taken from twitter thread: https://threadreaderapp.com/thread/1237142891077697538.html
  21. China researchers found via bus surveillance video and case tracing that the virus can spread airborne for around 15 feet in confined areas like a bus. Also can linger in the air for at least 30 minutes. 1 infected passenger infected 8 other people on the bus. Passengers wearing masks weren't infected. Coronavirus can travel twice as far as official ‘safe distance’ and stay in air for 30 minutes, Chinese study finds https://www.scmp.com/news/china/science/article/3074351/coronavirus-can-travel-twice-far-official-safe-distance-and-stay
  22. According to this note supposedly from a Milan doctor, there roughly 10% of all positive patients are ending up in the ICU. Perhaps due to older typical average age of Italians? https://mailchi.mp/esicm/the-future-of-haemodynamic-monitoring-first-webinar-of-the-year-1009715?e=[UNIQID]
  23. Possible evidence emerging from China research that the virus fairly often involves some level of nervous system infection: Chinese doctor discovers novel coronavirus in patient's cerebrospinal fluid https://www.globaltimes.cn/content/1181630.shtml "It said that 30 percent of the 214 patients the team studied showed symptoms in their nervous systems and the rate is even higher in critical patients at 45.5 percent."
  24. The fatality rate in US is simply a statistical error due to how few people continue to be tested here compared to some other countries like South Korea. Here's another study on how curcumin can prevent lung damage in severe lung infections in mice. Dose used was 50 mg/kg, not sure how to translate that to humans. The most severe cases of this virus in China are showing lung fibrosis on autopsy: https://www.globaltimes.cn/content/1181121.shtml Curcumin Modulates the Inflammatory Response and Inhibits Subsequent Fibrosis in a Mouse Model of Viral-induced Acute Respiratory Distress Syndrome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577717/
  25. WHO now estimates average death rate is 3.4%. For folks in the 75+ years range, it goes up to maybe 10% or higher (saw this charted elsewhere). https://www.cnbc.com/2020/03/03/who-says-coronavirus-death-rate-is-3point4percent-globally-higher-than-previously-thought.html