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

[corybroo]

This one questions if the US is testing the right people:  

 

[macaroni]

21 hours ago, mccoy said:

Last but not least, if you follow Peter Attia, I remember him saying that a very strong association [correlation] in medical studies suggests probable causation. Hazard ratios higher than 5, for example, are interpreted as very probable causation. For example, the association between cigarette smoke and lung cancer. Is it judgmental to decide that this association implies causation as well? No one ever debates that.

I am afraid that this is completely wrong. The strength of the correlation cannot diminish the importance of your causal assumptions.

 

[mccoy]

3 hours ago, macaroni said:

I am afraid that this is completely wrong. The strength of the correlation cannot diminish the importance of your causal assumptions.

Well, then we agree to disagree amicably!

[Sibiriak]

Cuomo Order That Sent Estimated 4,300 Covid-19 Patients to Nursing Homes Denounced as 'Single Dumbest Decision Anyone Could Make'

This part seems insanely wrongheaded:
 

Quote

The state health department directive (pdf), issued March 25, barred nursing homes from requiring patients deemed "medically stable" from being tested for Covid-19 prior to admission.

 

[TomBAvoider]

13 hours ago, Gordo said:

Hertz files for Chapter 11 bankruptcy protection
By the end of March, Hertz Global Holdings Inc. had racked up more than $24 billion in debt, according to the bankruptcy filing, with only $1 billion of available cash.

U.S. leveraged loan defaults at 6-year high as coronavirus hits businesses

Many people have been pinning hopes on the idea that the lockdowns will end soon (already ended in many places) and there will be a swift recovery. This is pure fantasy.  If every state opens up right now, the pain will continue and the bankruptcies are just getting started. I saw that IBM announced layoffs yesterday, I checked in with my uncle who works for them, sure enough, he was given 30 days notice this week.  White collar jobs are just starting to get hit.

Even Fauchi is getting worried:
Anthony Fauci warns of 'irreparable damage' if lockdowns are kept in place for too long

Well, I've lost hope of a V-shape recovery. At this point I'm hoping that it'll be a U shape recovery, but if they keep everything locked up beyond August, even a U shape recovery will be a fantasy. Anecdotally hearing from friends and acquintances the layoffs are getting serious. There was a wave of layoffs and new projections of budget deficits at various companies, and now they're saying that there's going to be a second wave of layoffs - so all the folks who survived the first wave, and thought "whew! I'm safe now" have to start worrying all over again. This is what I'm hearing "second wave of layoffs". 

But regardless of the recovery schedule, I keep thinking - fine, we start to recover... but what happens to all that outsize debt?? I mean the debt doesn't vanish just because we start to recover economically - it'll be a drag on growth like crazy. Unless we deal with that question, you can resign yourself to literally decades of doldrums. Look at Japan - all that debt bubble from the 80's burst in the 90's... they still have not recovered! It's been almost 30 years, and no end in sight to that overhang!

What I'm really curious about is China. They have a real chance to sprint into leadership when all the rest of the world's economies lie in devastation. They would've taken the #1 spot eventually, but this disaster really accellerated that schedule. But who knows - China is pretty opaque. I'd be more optimistic if we had a good strategy vs China, but it looks like we're led by morons, so no hope there. Every great empire eventually falls, and often it's accellerated by particularly poor leadership at crucial points. With China's rise we needed particularly adroit and smart strategists leading us - it was our bad luck to get to horrible presidents Bush Jr. and Trump, with a placeholder of a barely adequate guy Obama - no great leader in the last 20 years a crucial time in the China-US competitive matchup. Oh well.

[Gordo]

10 minutes ago, TomBAvoider said:

They have a real chance to sprint into leadership when all the rest of the world's economies lie in devastation.

Pure fantasy once again.  By the way, did you know China now has over 100 million people back in lockdowns?  Their economy has imploded. But on top of that, they are still run by a faltering communist party - you know, the system that's been a total disaster everywhere its ever been tried?  Good luck with that.  The struggle for survival in China is real, watch some documentaries about what is really like for everyday citizens, the median per capita income is STILL just $1,786. Defrauding foreign investors is not only legal but encouraged (watch the documentary "The China Hustle", Luckin Coffee is just one of many recent examples). They are the counterfeiting capital of the world. They constantly attack nearly all US businesses with cyber attacks (trying to guess passwords) ask any IT security person about it. They are the masters of ripping off intellectual property. They send highly addictive drugs like fentanyl all around the globe destroying countless lives for profit.  If Trump did ONE thing right, it was his stand against the cancer on the world that is China - no presidents before him (republican or democrat) have done as much in that regard. I hope he continues to tighten the screws for whatever time he has left.  I do believe eventually democracy and freedom will overtake the evil communist regime there as Taiwan and Hong Kong set an example and younger people find ways around censored internet and start to demand change:

 

[KHashmi316]

Probab. not new to many of you ...

https://www.visualcapitalist.com/the-anatomy-of-the-2-trillion-covid-19-stimulus-bill/

... but about the the current hyper-attention to our little nursing home epidemic ... hmmm.... well, that $425B "Loan" to Large Corps has, of course, very little correlation to the CONTINUED media attention and spotlighting. Hmmm .... so the Large Corps are not paying laid off workers (that comes outta that 30% "Individuals" portion) ... and they still need   $500B .... wink :; wink ;)

 

[Sibiriak]

"California Design Firm Working on Protective Suit for Concerts and Clubbing. The suit is designed for partying and safety. It includes a N95 filter as well as snap-in canisters for drinking and vaping. "

 

[Matt]

https://www.cuimc.columbia.edu/news/lowering-testosterone-may-reduce-severity-covid-19

"A study of 4532 men in the Veneto region of Italy has found that those who were being treated for prostate cancer with androgen-deprivation therapies (ADT) were less likely to develop the coronavirus COVID-19 and, if they were infected, the disease was less severe."

"Patients with prostate cancer receiving androgen-deprivation therapies had a significant four-fold reduced risk of COVID-19 infections compared to patients who did not receive ADT."

I've thought early on that sex hormones probably explain the difference between the mortality rates for men and women. Studies in animals and humans show significantly different responses to infections based on hormone levels, with men who have a lower T level displaying a high antibody response from vaccine.

https://med.stanford.edu/news/all-news/2013/12/in-men-high-testosterone-can-mean-weakened-immune-response-study-finds.html

There was a study published earlier this month showing the opposite: men with low testosterone levels have increased risk of dying. However, this could be more related to health conditions, body weight, frailty and a higher biological age -- which also happen to lower testosterone.  Lowering testosterone in an otherwise healthy person (even from CR perhaps?) may lower the risk.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119719/

[AlPater]

Remdesivir for the Treatment of Covid-19 - Preliminary Report.
Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, Hohmann E, Chu HY, Luetkemeyer A, Kline S, Lopez de Castilla D, Finberg RW, Dierberg K, Tapson V, Hsieh L, Patterson TF, Paredes R, Sweeney DA, Short WR, Touloumi G, Lye DC, Ohmagari N, Oh MD, Ruiz-Palacios GM, Benfield T, Fätkenheuer G, Kortepeter MG, Atmar RL, Creech CB, Lundgren J, Babiker AG, Pett S, Neaton JD, Burgess TH, Bonnett T, Green M, Makowski M, Osinusi A, Nayak S, Lane HC; ACTT-1 Study Group Members.
N Engl J Med. 2020 May 22. doi: 10.1056/NEJMoa2007764. Online ahead of print.
PMID: 32445440
https://www.nejm.org/doi/full/10.1056/NEJMoa2007764?query=C19&cid=DM92284_NEJM_Registered_Users_and_InActive&bid=200736552
Abstract
Background: Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (Covid-19), none have yet been shown to be efficacious.
Methods: We conducted a double-blind, randomized, placebo-controlled trial of intravenous remdesivir in adults hospitalized with Covid-19 with evidence of lower respiratory tract involvement. Patients were randomly assigned to receive either remdesivir (200 mg loading dose on day 1, followed by 100 mg daily for up to 9 additional days) or placebo for up to 10 days. The primary outcome was the time to recovery, defined by either discharge from the hospital or hospitalization for infection-control purposes only.
Results: A total of 1063 patients underwent randomization. The data and safety monitoring board recommended early unblinding of the results on the basis of findings from an analysis that showed shortened time to recovery in the remdesivir group. Preliminary results from the 1059 patients (538 assigned to remdesivir and 521 to placebo) with data available after randomization indicated that those who received remdesivir had a median recovery time of 11 days (95% confidence interval [CI], 9 to 12), as compared with 15 days (95% CI, 13 to 19) in those who received placebo (rate ratio for recovery, 1.32; 95% CI, 1.12 to 1.55; P<0.001). The Kaplan-Meier estimates of mortality by 14 days were 7.1% with remdesivir and 11.9% with placebo (hazard ratio for death, 0.70; 95% CI, 0.47 to 1.04). Serious adverse events were reported for 114 of the 541 patients in the remdesivir group who underwent randomization (21.1%) and 141 of the 522 patients in the placebo group who underwent randomization (27.0%).
Conclusions: Remdesivir was superior to placebo in shortening the time to recovery in adults hospitalized with Covid-19 and evidence of lower respiratory tract infection.

[corybroo]

I just read  https://www.economist.com/united-states/2020/05/23/how-the-worlds-premier-public-health-agency-was-handcuffed  

which provides a nice comparison of CDC actions in 2014 (Ebola crisis) and now and then tries to explain what happened. 

In the last pandemic to affect the US before coronavirus, the head of CDC appeared almost daily to provide information for the public.  Now, the CDC has not had a public briefing since mid March.  The article reports that the director of trad policy, a senior White House official, said the CDC “really let the country down”.  Meanwhile, the Center for Global Development, a think-tank, said the CDC had been muzzled, citing the administration’s gutting of the CDC guidelines for reopening.

“How was the agency brought so low? On February 5th, the cdc sent to state laboratories a testing kit for covid-19 that it had been working on at headquarters. Something was wrong with one of the reagents and state labs could not get the test to work. The Food and Drug Administration (fda), which regulates medical devices, including tests, then dithered for three weeks before allowing private and university laboratories to work on the problem, which they soon fixed. But when tests did become available, the cdc restricted them to a handful of Americans. By the time the rules were relaxed, the cdc had missed the vital first stages of the epidemic; community transmission was rife.”

“Public health is chronically under-funded. In 2018 America spent less than $300 per person on it, compared with over $10,000 on all health care, according to the Trust for America’s Health (tfah), a not-for-profit group. In the decade to 2017, jobs in public health fell by 50,000.

Mr Trump has proposed cutting the cdc’s budget each year by between 10% and 20%, but Congress has protected the agency. The cdc’s budget has been flat since 2016, and this year emergency-spending bills will provide an extra $6bn over the next five years. However, the two main programmes for helping state and local health-care systems prepare for emergencies, Public Health Emergency Preparedness and the Hospital Preparedness Programme, have been cut by over 50% in real terms since 2003. This has forced states to scale back emergency preparation and left the cdc bearing more of that burden.”

The article gives me a strong feeling that in six years we’ve gone from having a world leading medical facility to buying (https://www.thesun.co.uk/news/11532113/russia-putin-bills-trump-coronavirus-aid-faulty-ventilators/) fire-prone (https://www.themoscowtimes.com/2020/05/13/our-equipment-is-dangerous-russian-doctors-expected-ventilators-tragedy-a70253) Russian ventilators.

[mccoy]

I became aware that the full epidemiological study on the Vò Euganeo town, 3300 citizens, has been published. Vò has been the first town to be drastically locked down, after the inception of the epidemic in Italy, February 21st. 70%to 80% of all citizens has been tested, on Feb 24th and on March 7th. Interesting because that's the large part of a close community meaning it is a representative sample of the whole population with most people exposed to the virus.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

 Advanced issues found

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45

Quote

On  the  first  survey,  which  was  conducted  around  the  time  the 
town  lockdown started, we  found a prevalence of infection of 2.6% (95% confidence  interval (CI)  2.1-
3.3%).    On  the  second  survey,  which  was  conducted  at  the  end  of  the  lockdown,  we  found  a 
prevalence  of  1.2%  (95%  CI  0.8-1.8%).  Notably,  43.2%  (95%  CI  32.2-54.7%)  of  the  confirmed  SARS-
CoV-2 infections  detected across the two surveys were asymptomatic. The mean serial interval was 
6.9  days  (95%  CI  2.6-13.4)...

 The time  to viral clearance (time from  the  earliest posi tive  sample  for the  subjects with 
more  than  one  sample  in  the  first  survey  and  a  negative  sample  in  the  second  survey)  ranged  from  8 
to  13  days  and  was  on  average  9.3  days,...

SARS-CoV-2  positivity  overall  (i.e.  first  and 
second  survey combined) and  at  the  first survey  was more  frequently  associated  with those  aged  71-
80 years  (compared  to 21-30 year olds,  p-value = 0.01) ...

 

 

[Mike41]

15 hours ago, Gordo said:

Pure fantasy once again.  By the way, did you know China now has over 100 million people back in lockdowns?  Their economy has imploded. But on top of that, they are still run by a faltering communist party - you know, the system that's been a total disaster everywhere its ever been tried?  Good luck with that.  The struggle for survival in China is real, watch some documentaries about what is really like for everyday citizens, the median per capita income is STILL just $1,786. Defrauding foreign investors is not only legal but encouraged (watch the documentary "The China Hustle", Luckin Coffee is just one of many recent examples). They are the counterfeiting capital of the world. They constantly attack nearly all US businesses with cyber attacks (trying to guess passwords) ask any IT security person about it. They are the masters of ripping off intellectual property. They send highly addictive drugs like fentanyl all around the globe destroying countless lives for profit.  If Trump did ONE thing right, it was his stand against the cancer on the world that is China - no presidents before him (republican or democrat) have done as much in that regard. I hope he continues to tighten the screws for whatever time he has left.  I do believe eventually democracy and freedom will overtake the evil communist regime there as Taiwan and Hong Kong set an example and younger people find ways around censored internet and start to demand change:

 

Gordo, I tend to agree that the one thing right about Trump was his antagonism with China. Not so sure he’s accomplished anything there, but on another point I’m not so sure they are doomed to fail. State run Capitalism is an experiment mostly being played out by China. Time will tell.

[TomBAvoider]

I have no issue with Trumps enmity toward China - or rather I'd like to say "competitive attitude" rather than enmity. I would like for the U.S. to outcompete China. But the problem I have with Trump is with his tactics and lack of well-thought out longer term strategy. I mean, I can give him credit for at least recognizing the direction in which he ought to shoot, but I given him zero credit with the accuracy of his fire. However, that's too long a discussion for this thread (or indeed boards). 

[Gordo]

Artificial Intelligence System May Unlock COVID-19 Vaccine Far Faster Than Humans

Not sure about putting much hope in the actual headline but I do like the idea of AI sifting through research papers. I’ve actually thought before it would be nice to have a better (automated) way of sifting through the mountain of research out there related to health, longevity and anti-aging to find things that show the most promise.

[Gordo]

Some more good commentary from medcram including more info on COVID-19 as endothelial disease:

 

He also seems concerned about the “reopening” of America. I think there are an awful lot of stupid people that can’t seem to tell the difference between reopening with caution/protection and just a free for all “coast is clear”.

[macaroni]

On 5/23/2020 at 12:54 PM, mccoy said:

Well, then we agree to disagree amicably!

YOU THINK I WILL AGREE THAT EASILY!

Basically, all I am saying is this. You can use sample data to make statistical inferences about the original population from which you sampled the data, but you cannot make such inferences about a different population.

In your example of smoking and lung cancer, you could say that someone who smokes likely has lung cancer. But if you consider only those individuals whose astrological sign is Aries or only those whose blood type is A then your previous observations alone dont give you any reason to say how likely it is that one of those individuals who smokes also has lung cancer. To do that you also need judgement.

 

[Ron Put]

On 5/20/2020 at 1:17 PM, Todd Allen said:

April 6th was only 6 weeks ago.

 

On 5/20/2020 at 1:31 PM, Mike41 said:

Ron it ain’t over yet!

No, it ain't over, but luckily the Covid-19 worldwide death toll (less than 350,000 as of today) is still at a fraction of the 1,200,000 estimated dead from the 2017-2018 flu season. 

And compared to a really bad flu season, like the 1969 or 1957 flu pandemics, each of which killed well over 2,000,000 people worldwide adjusted for population, Covid-19 is more of a blip, as far as deadly viruses go.  But Covid-19 is the event of the century in terms of political opportunism, fearmongering and spin, which all came together to crash the Western economies.  It will have a lasting impact on Western societies and will likely result in a major geopolitical realignment over the next decade or so.

----

On 5/21/2020 at 11:53 AM, Todd Allen said:

My guess is most governments would prefer to under recognize the pandemic....

Nope.  Those who pushed for the lockdowns have a lot to lose if mortality rates don't justify their actions.  So, we have a lot of "presumed" Covid-19 deaths, often more than the actually confirmed ones.

Then there are also financial incentives to count deaths as Covid-19, which are likely to further inflate the number deaths designated as Covid-19.  We won't know for a year or two.

----

8 hours ago, macaroni said:

YOU THINK I WILL AGREE THAT EASILY!

Basically, all I am saying is this. You can use sample data to make statistical inferences about the original population from which you sampled the data, but you cannot make such inferences about a different population.

In your example of smoking and lung cancer, you could say that someone who smokes likely has lung cancer. But if you consider only those individuals whose astrological sign is Aries or only those whose blood type is A then your previous observations alone dont give you any reason to say how likely it is that one of those individuals who smokes also has lung cancer. To do that you also need judgement.

 

Yep.  A few issues here, which will take at least a year, possibly two to sort out. 

First, some numbers, like those coming out of New York, simply do not make sense, so they should be viewed with caution until more is known.  Aside from the normal political jockeying and opportunism, now there are major political careers at stake.

We also have major regulatory screw-ups in NY IL and CA, such as requiring that nursing homes to accept Covid-19 patients, which is likely to have increased the death toll among the most vulnerable. 

And then there is the dramatic drop in heart attack and stroke emergency room visits, at least some of which likely resulted in deaths, which may have been lumped as Covid-19 by administrators.  And while this was a relatively mild flu season, tens of thousands still died from it, probably overlapping to an extent with the Covid-19 deaths.

As I've pointed out, comparing deaths for May is misleading, as normally the peak of excess deaths in the Northern hemisphere is between December and February, when the average flu kills roughly half a million worldwide.  By March deaths start dropping and by May they are way down. 

So, in the case of a Spring pandemic like Covid-19, the excess deaths are measured against corresponding weeks which have relatively few fatalities, which makes the graph spikes look scarier (@mccoy, this was what I was trying to illustrate earlier with the Singapore graph spikes).

We need to wait and look where we are at the end of the year, and then sort out what people actually died from, which will take another year or two.  For instance, for the 2017-208 flu season, the CDC first put out a number of deaths as high as 95,000, then reduced it to an "official" number of 80,000, until a few months ago it published the definitive final number of 61,000 dead Americans.  Plus, for those who like random models, there are predictions for all sorts of excess deaths because of the locdown and the financial and job losses many are experiencing.

For what it's worth, more than half of all the states report lower excess deaths than usual, with some like NY's neighbor Connecticut reporting 48% of expected deaths.  

 

Edited May 26, 2020 by Ron Put

[Sibiriak]

41 minutes ago, Ron Put said:

the Covid-19 worldwide death toll (less than 350,000 as of today) is still at a fraction of the 1,200,000 estimated dead from the 2017-2018 flu season. 

Still comparing apples and oranges.  Not very scientific.     Carry on. 

[Ron Put]

10 minutes ago, Sibiriak said:

Still comparing apples and oranges.  Not very scientific.     Carry on. 

Can you please elaborate?

What exactly is the difference?  If you have issues with the facts or the argument, explain why it's wrong.  Fruits don't really cut it.

Edited May 26, 2020 by Ron Put

[Sibiriak]

1 hour ago, Ron Put said:

Can you please elaborate?

Ron, it's has already been elaborated multiple times in this thread.  Multiple links to methodological explanations, analyses and studies addressing that exact issue have been posted.  The disparate methodologies used to produce  the  historical statistics by the CDC etc.  vs the current tallies posted at the Worldometer etc. have been made abundantly clear.   "Directly comparing data for 2 different diseases when mortality statistics are obtained by different methods provides inaccurate information. "

If you are not aware of those fundamental disparities (do you really believe you are comparing  apples to apples?  i.e. comparing the  results of  similar statistical methodologies?),   I suggest you go back  through this thread and find those posts you've missed or ignored,  or research the issue yourself.   Or just carry on as you have been.

Edited May 26, 2020 by Sibiriak

[Sibiriak]

The Lancet  May 19,2020

Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City
 

Quote

Results

Between March 2 and April 1, 2020, 1150 adults were admitted to both hospitals with laboratory-confirmed COVID-19, of which 257 (22%) were critically ill (table 1; appendix p 4). The median period of observation following hospital admission was 19 days (IQR 9–30).

The median age of patients was 62 years (51–72), 171 (67%) of 257 patients were men, 159 (62%) were Hispanic or Latino, and 13 (5%) were health-care workers.

212 (82%) patients had at least one chronic illness (table 1).

119 (46%) patients had obesity (defined as body-mass index [BMI] ≥30), including 39 (71%) of 55 patients who were less than 50 years of age.

Patients presented to hospital a median of 5 days (2–7) after symptom onset; black or African American and Hispanic or Latino patients presented later in their illness course than white patients. The most common presenting symptoms were shortness of breath, fever, cough, myalgia, and diarrhoea.

 

Quote

Novel findings in this study include establishing independent associations between biomarkers for inflammation (IL-6) and thrombosis (D-dimer) and in-hospital mortality, as well as identifying a high incidence of critical illness among racial and ethnic minorities in the current epicentre of the COVID-19 pandemic.

 

[...]257 (22%) of 1150 patients admitted to hospital with COVID-19 were critically ill with acute hypoxaemic respiratory failure. This is consistent with reports from China,^3, Italy,⁵ and preliminary data released by the US Centers for Disease Control and Prevention,¹⁵ in which the incidence of ICU admission among patients admitted with COVID-19 ranged from 7–26%. This high incidence of critical illness among hospitalised patients has acute implications for US hospital systems, specifically the potential need to increase ICU surge capacity in preparation for large numbers of patients requiring IMV and other forms of organ support.

 

79% of patients received IMV during hospitalisation for median durations of 27 days among survivors and 10 days among non-survivors. This included 62% of patients who initially received less invasive methods of respiratory support. Although the proportion of patients in our cohort receiving IMV [invasive mechanical ventilation] was higher than that reported in observational studies from China and Washington state,it is similar to the rate recently reported from Italy,⁸ in which IMV was provided to 88% of critically ill patients with COVID-19. As in Italy, where the median ratio of P_aO₂ to F_iO₂ at ICU admission was 160,⁸ the higher proportion of patients requiring IMV in our cohort could be explained by the severity of hypoxaemia, as the median nadir P_aO₂ to F_iO₂ ratio in our population was 129.

 

In our cohort of patients with acute hypoxaemic respiratory failure, whose respiratory system compliance was severely reduced (median 27 mL/cm H₂O), frequency of adherence to standard-of-care lung-protective ventilation was high (median tidal volume 6·2 mL per kg predicted bodyweight, median plateau airway pressure 27 cm H₂O), as were levels of positive end-expiratory pressure (PEEP; median maximum PEEP 15 cm H₂O within the first 24 h). 25% of intubated patients received early neuromuscular blockade, 17% received prone positioning ventilation, and 3% received extracorporeal membrane oxygenation (ECMO).

 

The sudden surge of critically ill patients admitted with severe acute respiratory distress syndrome initially outpaced our capacity to provide prone-positioning ventilation, which was only performed in three of eight ICUs at our institution at the start of the outbreak. We have since expanded our capacity for prone-positioning ventilation by deploying dedicated proning teams to all ICUs, including non-traditional ICU locations. The low volume of ECMO [extracorporeal membrane oxygenation ] used during the study period is primarily a reflection of the low number of patients within our hospital system meeting criteria after initiating other therapies, such as lung-protective IMV and prone-positioning ventilation. As an ECMO referral center for regional hospitals, we received a moderate-to-high volume of ECMO referrals during that period, the majority of which were optimised with conventional management strategies and did not ultimately meet criteria for ECMO or were excluded on the basis of low probability of benefit.

 

As of April 28, 2020, 101 (39%) patients had died and 94 (37%) remained hospitalised. Similar to data reported elsewhere,^3, we identified older age, cardiopulmonary comorbidities, and higher concentrations of D-dimer as independent risk factors for poor outcomes. Higher concentrations of IL-6, which have been observed among patients with COVID-19 with more severe clinical illness,were also associated with in-hospital mortality.

 

Although the pathogenesis of severe COVID-19 remains to be completely understood, emerging data suggest that organ dysfunction and poor outcomes could be mediated by high concentrations of proinflammatory cytokines, including IL-6 and dysregulated coagulation and thrombosis.^12, Continued investigation of these pathological processes and the utility of their biomarkers is needed, given increasing reports of corticosteroid use and ongoing clinical trials of IL-6 receptor antagonists among critically ill patients with COVID-19 (eg, NCT04315298 registered with ClinicalTrials.gov) as well as rapidly evolving guidelines¹⁹ for anticoagulant use in this population.

 

Consistent with data from China,³ and Italy,⁸  hypertension was associated with poor in-hospital survival. Given the globally high burden of hypertension and emerging understanding of interactions between SARS-CoV-2 and angiotensin-converting-enzyme-2,²⁰ further investigations are needed to better define a relation—if any—between hypertension, exposure to renin angiotensin aldosterone system antagonists, and severe COVID-19.

 

31% of patients in our cohort developed severe acute kidney injury requiring RRT [ renal replacement therapy ] during hospitalisation.  Consistent with emerging data from China,¹a high proportion of patients (87%) had proteinuria. The high frequency of RRT in our patient population has considerable implications for resource allocation, given the limited available supplies of RRT machines and consumables, and staffing requirements necessary to provide continuous or intermittent RRT to critically ill patients. As the general incidence and underlying mechanisms of severe COVID-19-related kidney injury remain poorly understood,²¹ epidemiological, clinical, and biological investigations are necessary to inform hospital preparedness strategies and development of targeted preventive and treatment interventions.

 

46% of critically ill patients had obesity. This observation is consistent with trends seen in hospitalised patients with COVID-19 in the UK, where obesity has been associated with increased incidence of ICU admission and mortality.²²

 

However, although obesity was more common in our adult patient population than in the general New York City adult population (where prevalence of obesity is 22%),²³ we did not identify severe obesity (BMI ≥40) as an independent risk factor for mortality. Similar to other cardiometabolic comorbidities, further studies are needed to identify the mechanisms that mediate the association of obesity with susceptibility to or severity of COVID-19.

 

Edited May 26, 2020 by Sibiriak

[Sibiriak]

OT perhaps,  but I have to say that the new liberal democratic censorship regime  is  getting really outrageous:

Quote

YouTube has taken down the controversial Michael Moore-produced documentary Planet of the Humans in response to a copyright infringement claim by a British environmental photographer.

The movie, which has been condemned as inaccurate and misleading by climate scientists and activists, allegedly includes a clip used without the permission of the owner Toby Smith, who does not approve of the context in which his material is being used.

In response, the filmmakers denied violating fair usage rules and accused their critics of politically motivated censorship.

[...] “This attempt to take down our film and prevent the public from seeing it is a blatant act of censorship by political critics of Planet of the Humans. It is a misuse of copyright law to shut down a film that has opened a serious conversation about how parts of the environmental movement have gotten into bed with Wall Street and so-called “green capitalists.” There is absolutely no copyright violation in my film. This is just another attempt by the film’s opponents to subvert the right to free speech.”

 

 

Edited May 26, 2020 by Sibiriak

[AlPater]

13 hours ago, Ron Put said:

For what it's worth, more than half of all the states report lower excess deaths than usual , with some like NY's neighbor Connecticut reporting 48% of expected deaths.

Did you look at the data, Ron?  What was the COVID-19/flu ratio in the US?  75,283/6,259 deaths.  And, all the physical distancing, hand washing, business shutdowns, and so on would have a drastic effect on flu and other similarly infectious disease deaths, as well as fewer traffic deaths, deaths from stress at work, etc.

Edited May 26, 2020 by AlPater

[Matt]

This talk about the flu having more deaths than COVID-19.

I'm still not sure I get it. There's been almost 3 billion people under various levels of lock down since this thing really started to take off in March.

What do you expect? As shown in many antibody studies, the cases leveled off and dropped as expected. And as a result of that, the percentage of the population exposed to this novel virus which nobody has immunity to has only reached a small fraction of the population.