Just curious, anyone have a plan, or preps for global pandemic?

[Ron Put]

1 hour ago, Gordo said:

Not saying that’s the wrong strategy, but can you really call it containment if the majority of the population gets it?

I don't know how anyone can really talk realistically about containment, since there is a long incubation period with high infection rate, the currently available test kits have 30% false negative rate and we live in a mobile world, with the virus already present in the majority of world's countries.

Mitigation seems much more realistic strategy, with a containment focus on those who are vulnerable and their caregivers, while striving to reach herd immunity at the least cost to society.

Vaccines will hopefully emerge, but these are unlikely to be available for at least a few more months, possibly a year. And those who clamor to shortcut testing procedures will be the first to blame the party in power and the manufacturers if there are adverse consequences to a rushed mass vaccine. We have enough problems with the anti-vaxers as it.

Edited March 15, 2020 by Ron Put

[BrianA]

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.

[BrianA]

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."

Edited March 15, 2020 by BrianA

[Sibiriak]

45 minutes ago, BrianA said:

French health minister: Anti-inflammatory medicine such as Ibuprofen and cortison may worsen the condition

Thanks Brian for a lot of interesting posts in this thread.    (Btw, the comments at the link  get into some more details and caveats.)

Cf. https://www.theguardian.com/world/2020/mar/14/anti-inflammatory-drugs-may-aggravate-coronavirus-infection

Edited March 15, 2020 by Sibiriak

[BrianA]

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

[BrianA]

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

 

Edited March 15, 2020 by BrianA

[Sibiriak]

5 hours ago, Ron Put said:

containment focus on those who are vulnerable and their caregivers,

One issue:   how do you define "those who vulnerable" and how many are there?

How Many Adults Are at Risk of Serious Illness If Infected with Coronavirus?

Quote

Based on information currently available, our definition of high risk includes older adults (ages 60 or older) and younger adults between the ages of 18 and 59 with heart disease, cancer, chronic obstructive pulmonary disease (COPD) or diabetes. We were unable to include hypertension as a risk factor because it is not tracked by the survey .  [what about asthma?]

 

Quote

Key Findings

• About four in ten adults (41%) ages 18 and older in the U.S. (105.5 million people) have a higher risk of developing serious illness if they are infected with coronavirus, due to their older age (60 and older) or health condition (Figure 1; Table 1).
• Most of those at higher risk of developing a serious illness are older (72.4% or 76.3 million adults); however, the remaining 29.2 million adults ages 18-59 are at risk due to an underlying medical condition.
• The share of adults ages 18 and older who have a higher risk of developing a more serious illness varies across the country, ranging from 31 percent (Washington, D.C.) to 51 percent (West Virginia). In Washington State, California and New York, some of the states hardest hit by COVID-19 thus far, the share of adults at high risk is 40 percent, 37 percent and 40 percent respectively.
• An estimated 5.7 million adults who are at higher risk of getting a serious illness if they become infected with coronavirus are uninsured, including 3.9 million adults under age 60 and 1.8 million who are ages 60-64.

Figure 1: More Than 100 Million of 258 million U.S. Adults Are At Higher Risk For Serious Illness If Infected With Coronavirus

Obviously the definitions and methodology used in this study are subject to debate,  but the issue remains.   Where do you draw the line on who is vulnerable enough to qualify for special containment protections,  and who must simply run with the herd?

If you make the definition of vulnerability too narrow, you run the risk that a good number who qualify for the herd will need hospitalization, and if the virus spreads to fast,  hospitals will be overwhelmed.

If you make the definition wider,  many more containment measures will be necessary.

I tend to agree with Brian-- each country/locality needs to find  some feasible and effective point between total lockdown, and the "we give up" herd immunity strategy.   It's not really an either/or choice.

 

Edited March 15, 2020 by Sibiriak

[Ron Put]

40 minutes ago, Sibiriak said:

One issue:   how do you define "those who vulnerable" and how many are there?....

I guess the same way pneumonia vaccines and extra-strength flu vaccines are doled out, based on determination of need. Obesity is a risk factor, so yeah, a lot of Americans are in that group. But it's not a bright dividing line, as you note, so I guess isolation efforts can range from "Wash your hands and avoid large groups" to "Stay home and food must be delivered to you and your helper, and we'll test you as soon as you sneeze."

The uninsured in the US usually end up being seen an the emergency room, for the flu too. The US needs to get some sort of universal basic coverage, no question.

Anyway, what is the alternative? Lock everyone up and then have this repeat as soon as people start moving about again? Or test everyone, a few times, to make up for the false negative tests? All I am suggesting is that the UK and California are right to take the course where limited resources are expended first on the most vulnerable, then the next, and the next, until you get to the healthy population which is gaining immunity with relatively minor consequences.

BrianA is right on Korea, they are handling this much better than China and better than Italy.

Edited March 15, 2020 by Ron Put

[mccoy]

9 hours ago, Ron Put said:

You protect the vulnerable by isolating them and testing only those who assist them, to prevent infection of the vulnerable.

Everyone else can go about their business and those who get exposed will build immunity. Once you have enough people with immunity (about 60%), transmission is reduced significantly and this has the effect of "cocooning" the vulnerable.

What better solutions are there, until a vaccine (or cure) is available? Wishful thinking, or just a desire for draconian measures for the sake of the populace feeling that some strong Great Leader is doing something "strong?"

I am not sure that China or Italy are the best models to follow.

Ron, the fact is that the protection of the vulnerable is not at all realistic. First, as Sibiriak rightly points out, you should be able to define this group which is not easy given the present knowledge. Then you should isolate them and those who assist them because even if they are not infected they cannot go out and risk a likely infection. But this virus survives on fomites (surfaces of materials) for a long time, so you should isolate all of the material you bring to the isolated vulnerable and the isolated caregivers for 2-3 days before that material is touched by them. I see it as an impossible proposal. I myself am wearing a mask when going out but I'm perfectly aware that it is futile. I should wear total body protection and dispose of it before entering the home. Or I should wear at least mask and protective glasses and gloves, then come back home, wash all my garments, wash under the shower, especially the hair...

So, the UK proposal is like saying: we know that the vulnerable cannot be efficiently protected or isolated, so we accept the large peak which will result in the death of tens/hundreds of thousands of the vulnerable because there will be no intensive care for them. After that, the young and the strong will thrive and the nation will be rejuvenated. And we'll have an economic edge on the other nations. 

The option you cite, multiple tests, tracing and so on is pretty hard to follow. Italy started to do so, then gave up. Anyhow, I'm curious to see how the situation unfolds in the UK if such a strategy is strictly implemented. Boris Johnson might think it back though.

Edited March 15, 2020 by mccoy

[mccoy]

Spain and France are starting to enforce exceptional restrictive measures, very similar to those enforced in Italy.

In the UK victims doubled in 24 hours.

 

[Sibiriak]

UK over-70s to be asked to self isolate for up to four months

Quote

 

Experts on the UK’s Scientific Advisory Group for Emergencies have set out the need for extra action to slow the spread of the disease. The panel advised that the next interventions “will need to be instituted soon”.

Those measures will include steps to shield the vulnerable from the virus, including the elderly and those with existing health problems, by telling them to stay in their houses or care homes. There could also be a shift to household isolation rather than individual self-isolation.

 

 

[Sibiriak]

I just went to get some supplies at a discount depot.  I saw only two people wearing masks out of hundreds, in other words, practically nobody.  No sign of people stocking up for a long haul,  let alone panic buying.   Life continues just as usual.  

This of course  could change at any minute.  I'm making preparations for an outbreak.

[mccoy]

59 minutes ago, Sibiriak said:

I just went to get some supplies at a discount depot.  I saw only two people wearing masks out of hundreds, in other words, practically nobody.  No sign of people stocking up for a long haul,  let alone panic buying.   Life continues just as usual.  

Sibiriak, 59 confirmed cases in all Russia seem to be very low, any hints of under reporting?

 

[Sibiriak]

Mccoy,  surely everyone thinks there are many more cases than the official total (as elsewhere).  Could be deliberate under-reporting, but even more  likely, under-testing.   I would be quite surprised if the totals in Moscow in particular  don't start rising rapidly very soon.

There's pretty much free social media and free internet access here,  unlike China,  and there isn't the intrusive social control and surveillance as in China,   nor a similar deference to authority, so if lots of elderly/vulnerable people were dying from the virus, and/or hospitals were getting overwhelmed,  it would be hard to suppress that information for any length of time.

Edited March 15, 2020 by Sibiriak

[Sibiriak]

On 3/13/2020 at 3:26 PM, mccoy said:

I've started wearing an FPP1 mask with tissue paper on it when going to public places like shops and supermarkets. I'll then dispose of the tissue paper.

How does that work, btw?   You attach tissue paper to the mask,  then remove it.  Is that easy?  I presume you have to be very careful disposing of the tissue paper.    How long do you keep using a single mask?

Right now I just have a bunch of the soft three-layer type masks.  Had to check a few places before I could find them, but it wasn't too difficult.

I've got some more FPPI/N95 - type masks coming... someone else ordered them for me... not exactly sure what I'm getting, lol.   😬😷

Edited March 15, 2020 by Sibiriak

[mccoy]

6 hours ago, Sibiriak said:

How does that work, btw?   You attach tissue paper to the mask,  then remove it.  Is that easy?  I presume you have to be very careful disposing of the tissue paper.    How long do you keep using a single mask?

That's a pretty rough business, I'll just roll the edges of a paper handkerchief unto the edges of the mask to keep it there. It works though, the higher breathing effort means a higher degree of filtration. Usage time depends on exposure, at the hospitals they are supposed to dispose of it after one day, but until there is a shortage they tend to save them. If you have many, and use them, I'd suggest to discard it after one day. I just burn the used handkerchiefs. One colleague of mine also gave me a useful tip for eyes protection, although it's drastic, I don't know if I'm going to use it: facial protection, the one in the picture also provides hair protection:

 

 

Of course, the more drastic, but effective way is this,  it's necessary to verify the filters/protection (organic aerosols).

 

Last, they say that China's next production of masks, due to the extreme demand, may not be as reliable as the certified masks before the virus upsurge.

 

 

 

Edited March 15, 2020 by mccoy

[Gordo]

(source)

Just thought it was interesting in light of people in this thread talking about "how much zinc should I take".  Note, I checked my order history, the last time I bought this zinc picolinate it was $12.95 now its $19.99, yikes, corona inflation?  

Same product is on eBay, no price gouging there.

Edited March 15, 2020 by Gordo

[mccoy]

new Peter attia podcast on SARS-COV2

 

 

Edited March 15, 2020 by mccoy

[Ron Put]

15 hours ago, mccoy said:

Ron, the fact is that the protection of the vulnerable is not at all realistic....

You may have misunderstood my post, what I was pointing out was that the Chinese vaccine which many are clamouring for has at least 25% false negative results, which necessitates additional testing, or a CT scan if one is to get to a 90% certainty. This is why South Korea, the US CDC and others are developing their own tests.

So, if it's "unrealistic" to focus our limited resources and efforts on a vulnerable subgroup, how is it more realistic to spread the same limited resources across the general population, including those who are unlikely to be at risk of significant adverse consequences?

Basically, Italy, Spain and others are acting from political pressure and expediency, because healthy people are panicking and demanding that "the government does something." And the more dramatic the action, the better such people will feel. The virus is the "enemy" which will unite the flag-waving and patriotically singing populace behind the loudest voices (in your neck of the woods, it's "Il Capitano" Salvini).

China is using this as propaganda to show the "efficiency" of its political system compared to the Western-style democracies and for some  bizarre reason WHO is acting as a mouthpiece for Xi (at first I thought it was a strategy to encourage China to be more open, but now it makes me think that there is pressure on the current leadership).

 

14 hours ago, mccoy said:

Spain and France are starting to enforce exceptional restrictive measures, very similar to those enforced in Italy.

In the UK victims doubled in 24 hours.

 

Now, this is scaremongering, intentional or unintentional, amplified by the media which competes with social media, and politicians who energize their supporters by creating a sense of urgency.

Can you imagine if we read an hour-by hour account of all the deaths from the flu, 24 hours a day? People will be just as panicked, except that in this case it's a devil they don't know, so it's even worse.

Stuff like this is the reason why people are stocking up on toilet paper for a year and having fights in stores. Do you think it helps the "vulnerable" who can't get supplies, because the panicked healthy are swarming in and hoarding everything?

Edited March 15, 2020 by Ron Put

[TomBAvoider]

I'm unenthusiastic about recommendations by Dr. Oz. Be that as it may, 80 mg zinc - what if Chris Masterjohn is right and you only absorb about 7 mg at a time? Are you popping bits of zinc all day? As to Vit. C, I think 500mg is about as much as your tissues can absorb in a day, and you top out very soon after a couple of days, so to keep taking such big amounts might be pointless at best. Your immune system is probably impacted more strongly by other factors than these micronutrients, such as adequate sleep, stress modulation, sun exposure etc. 

[Gordo]

I've completely warmed to the idea that its just not tenable for people to "hole up" like so many are doing (and many experts are recommending).   It will cause an epic depression and cascade of debt defaults, unemployment, and plummeting GDP the likes of which we've never seen.  Hopefully just by people staying home when sick, wiping down commonly touched surfaces, obsessive hand washing, and no touching other people, we can slow the spread enough that hospitals are not overwhelmed, but we need to return to "mostly normal behavior" and get our kids back to school pretty much immediately.  Expect that millions will get the virus and most will be fine.  It's only a matter of time before politicians wake up and realize this has to be done.  The fear and panic cannot go on like this, nor can we allow the total destruction of the global economy which is happening before our eyes (the Fed just cut interest rates to zero and announced a new quantitative easing scheme and futures are limit down).  Sorry old folks, but hey, at least if you are retired you can personally hole up for the next year if you want while researchers work on those vaccines (maybe get your groceries delivered, sanitize everything, avoid people, do what you can). 

Edited March 16, 2020 by Gordo

[BrianA]

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/

 

Edited March 16, 2020 by BrianA

[TomBAvoider]

Yes, that's my concern too. More than a few weeks of these closures and it's going to cascade to the point where almost everyone is affected. Because even if you have "wealth" like you own rental buildings, unless they're paid off completely, when people can't pay rent because they have no jobs, you too are going to be affected, and when loans can't be paid back, banks will start to get wobbly... and Republicans - who always and forever hate all regulation no matter how rational - have sufficiently diluted everything so that financial institutions are yet again leveraged way too much... it won't take too much for those dominoes to fall too. I wonder how happy the average guy out there is going to be, when he's starving, but banksters are bailed out yet again with public money after they've greedily prospered with flimsy regulations not enforced by bought politicians (of both parties). 

All in all, I hope these various measures being floated right now, prevent a total economic collapse, because the revolution if it comes to that, will spare no one, the guilty or innocent. 

I'm an optimist by nature so I figure we'll muddle through somehow, and hopefully will never have to test the limits of what the economy can take. Here's hoping to all of this being controlled over the next few months. Maybe the hit to the economy will be like a mild cold instead of double pneumonia. I'm a bit concerned, but not massively worried as yet.

[Sibiriak]

CHINA

Quote

China has suffered even deeper economic damage from the coronavirus pandemic than predicted, with figures released by the National Bureau of Statistics on Monday showing factory production inside the country dropped at the fastest pace seen in three decades.

Financial analysts have said the economic impact of the pandemic may have cut China’s growth in half during the first quarter [but it's still growing! ].

Industrial output fell 13.5% in January-February, compared with 2019, which ING economist Iris Pang told AFP was the first contraction since January 1990, when industrial production shrank 21.1%.

Year-on-year, fixed asset investment fell 24.5%, private sector investment fell 26.4%, and retail sales shrank 20.5%.

“Judging by the data, the shock to China’s economic activity from the coronavirus epidemic is greater than the global financial crisis,” Zhang Yi, chief economist at Zhonghai Shengrong Capital Management told Reuters.

 

On the bright  side,  carbon emissions are way down,  traffic is way down, and air quality  is drastically improved.

Quote

Marshall Burke, a researcher at Stanford University, calculated that the improvements in air quality recorded in China may have saved the lives of 4,000 children under 5 years old and 73,000 adults over 70.  Better air is saving more people than coronavirus is killing.

COVID-19 reduces economic activity, which reduces pollution, which saves lives

Quote

Below I calculate that the reductions in air pollution in China caused by this economic disruption likely saved twenty times more lives in China than have currently been lost due to infection with the virus in that country.

A few weeks ago, NASA published striking satellite images of the massive reduction in air pollution (specifically, NO2) over China resulting from the economic slow-down in that country following it's aggressive response to COVID-1

 

 

Edited March 16, 2020 by Sibiriak

[Shezian]

20 hours ago, Sibiriak said:

I just went to get some supplies at a discount depot.  I saw only two people wearing masks out of hundreds, in other words, practically nobody.  No sign of people stocking up for a long haul,  let alone panic buying.   Life continues just as usual.  

This of course  could change at any minute.  I'm making preparations for an outbreak.

Not here in Australia, nothing left on the shelves at the supermarket. No one wearing masks as yet.