notes from expert panel on the virus & other expert views

I read that even as more test kits come in, our facilities can run only about 1,000 tests/day anyway.

But since there is nothing much that can be done for patients apart from IVs and comfort care, I’m not sure testing really makes that much difference. I don’t know what can be done except for everyone to stay away from crowds, wash hands all the time, and stop breathing.

I hope RBG is in a bubble tent.

Testing is crucial. It’s why South Korea is testing so much.

It tells medical professionals how many are actually infected. That lets planners know how based on symptom progression what the future demand will be on the system and gives real data about the infection progression.

It also can give data which could indicate viral mutation or hopefully, the end of the virus’ infection period.

As for the testing capacity, 1k per day is through the CDC which doesn’t allow automated testing.

if they allow automated testing and outsourcing to approved labs, that could easily increase 10 fold or more.

Mackeyser wrote:

Testing is crucial. It’s why South Korea is testing so much.

It tells medical professionals how many are actually infected. That lets planners know how based on symptom progression what the future demand will be on the system and gives real data about the infection progression.

It also can give data which could indicate viral mutation or hopefully, the end of the virus’ infection period.

As for the testing capacity, 1k per day is through the CDC which doesn’t allow automated testing.

if they allow automated testing and outsourcing to approved labs, that could easily increase 10 fold or more.

The way we are testing doesn’t make sense. Testing every specimen via PCR is overly time-consuming, expensive, and inefficient. Now they are running out of the reagent needed for RNA extraction. Our state lab warned us that testing might slow down as the test materials they need become backordered.

We need a quick and inexpensive EIA screening test that can be performed at every hospital lab. Only specimens that test positive with the screening test would need to be sent to the state lab for confirmatory testing with PCR. This two-tiered approach is similar to the way we test for Lyme disease. Physicians would get their results quicker as the majority of tests would be negative and they would have the results the same day. If the test is positive, the specimen can ship to the state lab the very same day so the PCR turnaround time is no longer than it is now. Actually, it would be much shorter because the state lab would be running fewer specimens.

• This reply was modified 4 years, 9 months ago by nittany ram.

This site is purty good on the basics, Invader. At least thats what I’ve been told. See the actual link. I just cut and pasted a bit of it.
Its ‘mutating’ btw. Two distinct strains as of now, from what i read from a Doc on a message board.

link:https://emcrit.org/ibcc/covid19/

basics

COVID-19 is a non-segmented, positive sense RNA virus.
COVID-19 is part of the family of coronaviruses. This contains:
(i) Four coronaviruses which are widely distributed and usually cause the common cold (but can cause viral pneumonia in patients with comorbidities).
(ii) SARS and MERS – these caused epidemics with high mortality which are somewhat similar to COVID-19. COVID-19 is most closely related to SARS.
It binds via the angiotensin-converting enzyme 2 (ACE2) receptor located on type II alveolar cells and intestinal epithelia (Hamming 2004).
This is the same receptor as used by SARS (hence the technical name for the COVID-19, “SARS-CoV-2”).
When considering possible therapies, SARS (a.k.a. “SARS-CoV-1”) is the most closely related virus to COVID-19.
COVID-19 is mutating, which may complicate matters even further (figure below). Virulence and transmission will shift over times, in ways which we cannot predict. New evidence suggests that there are roughly two different groups of COVID-19. This explains why initial reports from Wuhan described a higher mortality than some more recent case series (Tang et al. 2020; Xu et al 2020).
(Ongoing phylogenetic mapping of new strains can be found here.)
———–

stages of illness ??

There seem to be different stages of illness that patients may move through.
(#1) Replicative stage – Viral replication occurs over a period of several days. An innate immune response occurs, but this response fails to contain the virus. Relatively mild symptoms may occur due to direct viral cytopathic effect and innate immune responses.
(#2) Adaptive immunity stage – An adaptive immune response eventually kicks into gear. This leads to falling titers of virus. However, it may also increase levels of inflammatory cytokines and lead to tissue damage – causing clinical deterioration. There is a suggestion that this could lead to virus-induced hemophagocytic lymphohistiocytosis (HLH)(Mehta et al.). More discussion about this entity and possible therapy here.
This progression may explain the clinical phenomenon wherein patients are relatively OK for several days, but then suddenly deteriorate when they enter the adaptive immunity stage (e.g. Young et al. 3/3/2020).
This has potentially important clinical implications:
Initial clinical symptoms aren’t necessarily predictive of future deterioration. Sophisticated strategies may be required to guide risk-stratification and disposition (see below section on prognosis).
Anti-viral therapies might need to be deployed early to work optimally (during the replicative stage).
Immunosuppressive therapy (e.g. low-dose steroid) might be best initiated during the adaptive immune stage (with a goal of blunting this immunopathologic response slightly, in the sickest patients). But this is purely speculative.

transmission

(back to contents)
large droplet transmission

COVID-19 transmission can occur via large droplet transmission (with a risk limited to ~6 feet from the patient)(Carlos del Rio 2/28).
This is typical for respiratory viruses such as influenza.
Transmission via large droplet transmission can be prevented by using a standard surgical-style mask.

airborne transmission ??

It’s controversial whether COVID19 can be transmitted via an airborne route (small particles which remain aloft in the air for longer periods of time). Airborne transmission would imply the need for N95 masks (“FFP2” in Europe), rather than surgical masks. This controversy is explored further in Shiu et al 2019.
Airborne precautions started being used with MERS and SARS out of an abundance of caution (rather than any clear evidence that coronaviruses are transmitted via an airborne route). This practice has often been carried down to COVID19.
Guidelines disagree about whether to use airborne precautions:
The Canadian Guidelines and World Health Organization guidelines both recommend using only droplet precautions for routine care of COVID19 patients. However, both of these guidelines recommend airborne precautions for procedures which generate aerosols (e.g. intubation, noninvasive ventilation, CPR, bag-mask ventilation, and bronchoscopy).
The United States CDC recommends using airborne precautions all the time when managing COVID19 patients.
Using airborne precautions for all patients who are definitely or potentially infected with COVID19 will likely result in rapid depletion of N95 masks. This will leave healthcare providers unprotected when they actually need these masks for aerosol-generating procedures.
In the context of a pandemic, the Canadian and WHO guidelines may be more sensible in countries with finite resources (i.e. most locales). However, infection control is ultimately local, so be sure to follow your hospital’s guidance regarding this.

contact transmission (“fomite-to-face”)

This mode of transmission has a tendency to get overlooked, but it may be incredibly important. This is how it works:
(i) Someone with coronavirus coughs, emitting large droplets containing the virus. Droplets settle on surfaces in the room, creating a thin film of coronavirus. The virus may be shed in nasal secretions as well, which could be transmitted to the environment.
(ii) The virus persists on fomites in the environment. Human coronaviruses can survive on surfaces for up to about a week (Kampf et al 2020). It’s unknown how long COVID-19 can survive in the environment, but it might be even longer (some animal coronaviruses can survive for weeks!).
(iii) Someone else touches the contaminated the surface hours or days later, transferring the virus to their hands.
(iv) If the hands touch a mucous membrane (eyes, nose, or mouth), this may transmit the infection.
Any effort to limit spread of the virus must block contact transmission. The above chain of events can be disrupted in a variety of ways:
(a) Regular cleaning of environmental surfaces (e.g. using 70% ethanol or 0.5% sodium hypochlorite solutions; for details see Kampf et al 2020 and CDC guidelines).
(b) Hand hygiene (high concentration ethanol neutralizes the virus and is easy to perform, so this might be preferable if hands aren’t visibly soiled)(Kampf 2017).
(c) Avoidance of touching your face. This is nearly impossible, as we unconsciously touch our faces constantly. The main benefit of wearing a surgical mask could be that the mask acts as a physical barrier to prevent touching the mouth or nose.
Any medical equipment could become contaminated with COVID-19 and potentially transfer virus to providers (e.g. stethoscope earpieces and shoes). A recent study found widespread deposition of COVID-19 in one patient’s room, but fortunately this seems to be removable by cleaning with sodium dichloroisocyanurate (Ong et al 2020).

when can transmission occur?

(#1) Asymptomatic transmission (in people with no or minimal symptoms) appears to be possible (Carlos del Rio 2/28).
(#2) Transmission appears to occur over roughly ~8 days following the initiation of illness.
Patients may continue to have positive pharyngeal PCR for weeks after convalescence (Lan 2/27). However, virus culture methods are unable to recover viable virus after ~8 days of clinical illness (Wolfel 2020). This implies that prolonged PCR positivity probably doesn’t correlate with clinical virus transmission. However, all subjects in Wolfel et al. had mild illness, so it remains possible that prolonged transmission could occur in more severe cases.
CDC guidance is vague on how long patients with known COVID-19 should be isolated. It may be advisable to obtain two paired RT-PCR tests (one of the nasopharynx and one of the pharynx), with each pair collected >24 hours apart, prior to discontinuing precautions.

R⌀

R⌀ is the average number of people that an infected person transmits the virus to.
If R⌀ is <1, the epidemic will burn out.
If R⌀ = 1, then epidemic will continue at a steady pace.
If R⌀ >1, the epidemic will increase exponentially.
Current estimates put R⌀ at ~2.5-2.9 (Peng PWH et al, 2/28). This is a bit higher than seasonal influenza.
R⌀ is a reflection of both the virus and also human behavior. Interventions such as social distancing and improved hygiene will decrease R⌀.
Control of spread of COVID-19 in China proves that R⌀ is a modifiable number that can be reduced by effective public health interventions.
The R⌀ on board the Diamond Princess cruise ship was 15 – illustrating that cramped quarters with inadequate hygiene will increase R⌀ (Rocklov 2/28).

Invader,

I’ve heard experts say it’s anywhere between 10 times and 40 times worse than regular influenza. The latter kills tens of thousands of Americans per year, and we have vaccines and decades of immunity build-up for that. We have nothing whatsoever on either front for Covid-19.

Seems to me officials and the media would be criminally negligent if they didn’t make a huge deal about this.

Experts have also said we might reach 50% infected rate, or worse. Which means, even at under 1% mortality, more than a million Americans would die.

This is serious, especially for us old fogies with underlying health issues.

and call me crazy if you want.

cuz i probably am.

but i predicted a long time ago when kroenke bought that piece of land out in inglewood that the rams were moving back to la….

so. there.

How Serious is the Coronavirus? Infectious Disease Expert Michael Osterholm Explains | Joe Rogan

Michael Osterholm is an internationally recognized expert in infectious disease epidemiology. He is Regents Professor, McKnight Presidential Endowed Chair in Public Health, the director of the Center for Infectious Disease Research and Policy (CIDRAP), Distinguished Teaching Professor in the Division of Environmental Health Sciences, School of Public Health, a professor in the Technological Leadership Institute, College of Science and Engineering, and an adjunct professor in the Medical School, all at the University of Minnesota. Look for his book “Deadliest Enemy: Our War Against Deadly Germs” for more info. https://amzn.to/2IAzeLe

The first video is a beginning of the whole interview. This seemed as good as anything, so watch it and decide it you agree,

Invader, it is important when comparing numbers to study not just the pathology, but the external factors.

China was initially in denial and engaged in half measures. By the time they really understood, they had to brutally lockdown 60M people and were literally spraying the streets down every night with tanker trucks and literally rounding up symptomatic people (ignoring for now the speculation about what happened to those people, the rumors are pretty out there and may be true, we just don’t know).

But think about this… China, for the first time, shared actual data in real time. The infectious disease community was first surprised and then very, very concerned.

South Korea was VERY proactive, started MASSIVE testing and that has lead to significantly better results.

Italy was at first very lax and ran into the same issues as China, had to quarantine a whole section of the country and they have ERs where they are literally performing battle field triage. In this case, old people who present are simply not treated and allowed to die. These reports have been confirmed by multiple accounts. When ERs get overrun, it’s all they can do.

Iran has such a high rate because they cannot even get masks due to the economic sanctions.

So, where are we? We’ve performed by far the least testing per capita among major countries and among industrialized nations in the entire world. We have 50+ depts of health for states and territories, all governed in part by political appointees, so the reactions have ranged as you would expect. However, there are NO places where one can just go to get tested even if you have confirmed symptoms and can trace the infection to a direct cause (travel abroad) or contact with that person. If anything, testing has almost ground to a halt based on the CDC’s numbers.

Moreover, unlike everywhere else in the world except maybe the UK, a large number of young people are gathering I guess to spite the situation. The problem is that the numbers from South Korea show that 30% of those mass tested were in that 18-29 age bracket. The reason Italy’s numbers skew so much older is that they ONLY test those who are already symptomatic suggesting that young people may be able to spread this prior to them becoming noticeably symptomatic.

This is yet another vector for community spread which could make this so much worse.

Listen, I’m in that highest bracket as I’ve got a compromised immune system (Crohn’s in remission), I have asthma AND I’ve had multiple bouts of pneumonia including two that were nearly fatal, one of which it was divine providence that it didn’t as I should have been dead by rights.

I would really love if this was all hype and media bullshit, but the science doesn’t bear that out.

even best case scenario of 40% spread and 0.7% morbidity rate, that’s 329M x .4 x 0.007 = 921k

Think about that. The BEST case scenario which ignores how badly we’re fucking this up mean nearly a MILLION dead.

That’s nearly as many soldiers that have died in every US war…EVER. All within a period of a few months. And if it mutates like the Spanish Flu did (there is already an S and L variant…the S being the ancestor and the L being a newer, more damaging strain), then we’re looking at multiple rounds of this.

I still think that most people just can’t wrap their heads around this, but once they do… it seems we need to see hospitals overwhelmed to believe how bad it is gonna be.

I mean think about it. China basically shut down their manufacturing exports for MONTHS for this. Think how serious it would need to be for them to do that…

Mackeyser wrote:

I would really love if this was all hype and media bullshit, but the science doesn’t bear that out.

i’m just willing to wait it out until we know more.

that’s not to say the approach has been all wrong.

i agree with the cancellation of mass gatherings.

and we do need to do more testing.

and i’m keeping an eye on how the new vaccination trial is going.

but the science is changing every week.

i do still worry about the negative impacts this pandemic could cause beyond just the disease itself.

zn wrote:

We know a lot.

i’ve read it. we know a lot about other cases.

and we can project. we don’t know about this particular strain. again we can project. and make very educated guesses. there’s a range that we can work within. that’s it.

and thanks ag for that video. that was informative.

we’ll just have to see.

Coronaviruses have a variety of animal reseviours. The first SARS was hosted in civits and racoon dogs. For MERS it was camels. The novel coronavirus is found in bats and pangolins. Practically all birds and mammals will host some variety of coronavirus.

Coronaviruses are RNA viruses. Unlike DNA viruses (ex. Herpes) RNA viruses are prone to mutations because they lack the biochemical machinery necessary to fix replication errors. Most of the errors are lethal or have a negative or neutral impact on the virus. However, every so often, a mutation confers some advantage on the virus, such as the ability to infect a new host. As the COVID-19 virus spreads around the globe, it’s very possible a mutation will allow it to acquire new animal hosts.

Viruses that have only a single host can be eradicated because they have no place to hide. Small pox is an example. Develop a vaccine and you’re good to go. However, it’s nearly impossible to eradicate a virus that can jump back and forth between humans and other animals because it can re-emerge later on as a new and improved version of itself. Herd immunity and vaccines might still effectively control the virus but they will never eliminate it completely, and the potential for new outbreaks will always exist. It will be interesting to see if the novel coronavirus can acquire some new animal hosts as it moves around the world. There might be some species of bats in the US that it could infect right now without mutating at all.

this is a cnn interview with the same guy rogan interviewed above.

https://www.cnn.com/2020/03/10/opinions/osterholm-coronavirus-interview-bergen/index.html

wv wrote:

Do we have any logic-based-guesses on when the Virus is really gonna get going in the USA ? How soon before it gets rolling? Do we know?

my understanding is that it’s about… now.