Coronavirus

[Bicycle Bill]

A graphic illustration of the spread of the virus and why social distancing matters, from the Ohio Department of Health.



-"BB"-

[ex-khobar Andy]

It (BSG's note) is an interesting study - not peer reviewed because I suppose they wanted to get the info out ASAP.

The eventual sample size was 40 or 41 in each of two groups receiving either a high dose (12g) or low dose (2.7 g) over ten days. There was no placebo group because of ethics. Double blind and randomized so that neither the patients nor those administering the dose and assessing its efficacy knew who got what. The low dose patients had some placebo pills which contained no active ingredient so they were on exactly the same daily pill regimen. So the control group was essentially expectations based on experience.

All subjects got identical doses of ceftriazone and azithromycin in addition to the chloroquine and, if pneumonia was suspected, a dose of oseltamvir which is a routine treatment for the condition.

The overall death rate of 13.5% was similar to that of the 'controls' - i.e., as expected. The numbers of deaths in the high dose group was higher - there are not enough to say it's significant statistically to any normal level but it was enough to convince them to abandon the effort to compare the two dose levels and put them all on the low dose from Day 6 onward.

Assessing the overall results is yet to be completed.

Retraction Watch has reported that the original journal which published the French study by Didier Raoult has issued a statement of concern. This is often a preliminary to retraction.

[MajGenl.Meade]

Sweden just took a giant bad leap forward

114 deaths today taking them up to 1033 which is 102 per million of population

US still lower at 74 per million. With 887 deaths the trend may be lower but still very grim indeed

Plucky little Belgium is taking it in the shorts at 359 per million and as for San Marino... well.

Discussion here as to why Africa is experiencing such low rates of infection. Perhaps it's something to do with fewer affluent travelers jetting around the world? It's not insignificant that the wealthiest "real" African country (South Africa) has the largest number of cases and deaths. Even the Mediterranean countries (that pretend to be African when it suits them but otherwise look down on the southern neighbors) are lower. It's a puzzle but nobody is complaining; instead we wait for the other shoe to drop

Help! We are down to only five bottles of wine and another 16 days to go!!!! Oh, the humanity

[BoSoxGal]

I just tried to give blood and was turned away by American Red Cross; my temperature was 99.8 and they won’t take anybody over 99.5.

The battery in our thermometer conked out a few days ago and so I haven’t been able to monitor but have been feeling alright. I dunno if I’m an asymptomatic carrier or what the heck. My normal temperature has generally been around 97+ but always fluctuates and sometimes as high as 99+, so who the heck knows. I just looked back in my prior donation entries and also my vitals for 3 years of doctors visits and it’s always somewhere in that range.

I looked at several medical websites and they all say that 100.4 is the threshold for fever associated with illness. I guess I understand they are being cautious, but they’re also pleading for blood donors because donations have dropped off massively and blood only keeps for so long. So I made the appointment (they don’t take walk-ins anymore for social distancing purposes) which took it away from someone else and then I got rejected and couldn’t give blood. It sucks, I wanted to be a helper. And so it seems for the indefinite future I am not going to be able to give blood which is stupid because I’ve got a couple of gallon pins in my past.

Maybe I’ll just suck on ice before I walk in next time?

[RayThom]

... the indefinite future..."

What's the time frame between donation attempts?

Why not make an appointment before the end of the week?

[BoSoxGal]

... the indefinite future..."

What's the time frame between donation attempts?

Why not make an appointment before the end of the week?

They are booked solid the remainder of the month. I found a drive at Gillette Stadium on the 28th and signed up for the last remaining slot - there’s a Trader Joe’s there and I haven’t shopped there in more than 3 years, so at least I’ll get to do something cool even if I get turned away again.

I’m probably gonna suck on ice just before I walk in, for good measure.

I found this online; I can only assume that they are turning away donors over 99.5 on theory that they pose risk of infecting others - even though they are providing medical masks for donors to wear during donation and requiring all donors be masked. You already have to attest that you are feeling well at time of donation and presumably they’re capable of wiping down with disinfectant any surfaces a donor might touch in the 45 minutes they have to be there to donate a pint.

According to the US Food and Drugs Administration, “respiratory viruses are not known to be transmitted by blood transfusion, and there have been no reported cases of transfusion-transmitted coronavirus.”

The Red Cross says that “there is no data or evidence that this coronavirus can be transmissible by blood transfusion,” adding that it “only collects blood from individuals who are healthy and feeling well at the time of donation.” The Red Cross, and other blood collection centers, like the Memorial Blood Center do not specifically test for Covid-19.

Binding sites:

“There is absolutely no evidence of transfusion transmission for COVID-19, or any other coronavirus,” says Dr. Steven Drews, associate director of microbiology at Canadian Blood Services (CBS).

“This family of respiratory viruses just doesn’t appear to be transfusion-transmitted.”

According to Canadian Blood Services, “viruses rely on 'binding sites' on their host cells, proteins which allow them to attach and invade. The binding sites for COVID-19 are located in the lungs and the intestines. “There is no evidence this new coronavirus targets blood cells, or even uses plasma to move around and invade other organs,” according to CBS.

[rubato]

We were in Antwerp Belgium in 2011 on Belgium independence day. Naturally I asked our waiter for lunch who they were celebrating independence from. He was a little surly but he said "everyone". Gave me a laugh.

Best beer in the world, after the U.S..

yrs,
rubato

[BoSoxGal]

This is a good article worth reading and I also recommend the video included - it’s just under 7 minutes.

What Doctors on the Front Lines Wish They’d Known a Month Ago


I recall seeing photos and reading about doctors proning covid19 patients in Italy a few weeks back before it hit hard here; it seems to be a strategy that works very well for some patients who are then able to recover without a ventilator - just supplemental oxygen and other supporting measures and following a proning regimen which I’ve read elsewhere can be from 8-16 hours per day, whatever the patient can tolerate. I’d be curious to know if Boris Johnson was proned by NHS doctors during his time in ICU on oxygen.

It certainly makes me hope that if I’m going to get really sick with coronavirus, I will have that experience as far down the road as possible - because clearly gods bless them, our doctors are flying blind and it may turn out that some of the treatment strategies used early on will have been more detrimental than necessary.

[BoSoxGal]

Here’s an interesting article from LA Times - I’m cutting/pasting because I’m not sure if they’re providing pandemic coverage free or not. I’ve read multiple pieces in which scientists and doctors theorize it’s the cytokine storm killing younger folks with healthy immune systems, so hopefully a treatment like this will soon be standardized for younger patients - maybe introducing immunosuppressive medications before they become so critically ill that they need ECMO, which is not widely available.

Emergency room doctor, near death with coronavirus, saved with experimental treatment

Dr. Ryan Padgett, a Seattle emergency room physician, contracted COVID-19 and was saved by doctors who used an experimental treatment.
By RICHARD READ
SEATTLE BUREAU CHIEF

SEATTLE — As critically ill, elderly patients streamed into his emergency room outside Seattle, Dr. Ryan Padgett quickly came to understand how deadly COVID-19 could be.
Of the first two dozen or so he saw, not a single one survived.

It took longer for Padgett and his colleagues at EvergreenHealth Medical Center — the first hospital in the country to treat multiple coronavirus patients — to learn how easily the disease could spread.

At first, the medical workers wore only surgical masks and gloves. Later, they were told to wear respirators and other gear, but the equipment was unfamiliar and Padgett couldn’t be certain he put it on and took it off correctly each time.

A 6-foot-3, 250-pound former football star who played for Northwestern in the 1996 Rose Bowl, he wasn’t fazed by much.

“To worry about myself, as a 44-year-old healthy man, didn’t even cross my mind,” he said in an interview Monday.

But on March 12, with his wedding day two months away, Padgett became the patient.

Soon after being admitted to his own hospital with a fever, cough and difficulty breathing, he was placed on a ventilator. Five days after that, his lungs and kidneys were failing, his heart was in trouble, and doctors figured he had a day or so to live.

He owes his survival to an elite team of doctors who tried an experimental treatment pioneered in China and used on the sickest of all COVID-19 patients.

Lessons from his dramatic recovery could help doctors worldwide treat other extremely ill COVID-19 patients.

“This is a movie-like save, it doesn’t happen in the real world often,” Padgett said. “I was just a fortunate recipient of people who said, ‘We are not done. We are going to go into an experimental realm to try and save your life.’"

Once his colleagues at EvergreenHealth realized they had run out of options, they called Swedish Medical Center, one of two Seattle hospitals that has a machine known as an ECMO, which replaces the functions of the heart and lungs.

But even after the hospital admitted him, doctors there had to figure out why he was so profoundly sick.

Based on the astronomical level of inflammation in his body and reports written by Chinese and Italian physicians who had treated the sickest COVID-19 patients, the doctors came to believe that it was not the disease itself killing him but his own immune system.

It had gone haywire and began to attack itself — a syndrome known as a “cytokine storm.”

The immune system normally uses proteins called cytokines as weapons in fighting a disease. For unknown reasons in some COVID-19 patients, the immune system first fails to respond quickly enough and then floods the body with cytokines, destroying blood vessels and filling the lungs with fluid.

The doctors tried a drug called Actemra, which was designed to treat rheumatoid arthritis but also approved in 2017 to treat cytokine storms in cancer patients.

“Our role was to quiet the storm,” said Dr. Samuel Youssef, a cardiac surgeon. “Dr. Padgett was able to clear the virus” once his immune system was back in balance.

Dr. Matt Hartman, a cardiologist, said that after four days on the immunosuppressive drug, supplemented by high-dose vitamin C and other therapies, the level of oxygen in Padgett’s blood improved dramatically. On March 23, doctors were able to take him off life support.

Four days later, they removed his breathing tube. He slowly came out of his sedated coma, at first imagining that he was in the top floor of the Space Needle converted to a COVID ward.

He soon became more conscious of his surroundings and had a FaceTime conversation with family members, who hadn’t been able to visit because of the hospital’s coronavirus lockdown.

“It’s an incredible thing to survive a brush with death and not be able to see and be with your most loved people,” Padgett said. “And when everyone on staff who comes to see you has to be in a spacesuit, you just feel like this pariah. The isolation was pretty devastating at times.”

On March 31, balloons, gifts and letters came in the door. It was his 45th birthday. “My birthday cake was an ice chip,” he said, recalling how grateful he was for his first sustenance by mouth.

As Padgett got to know Youssef, Hartman and other team members, they told him about a 33-year-old woman — a mother of three — who was in the hospital as well, also having experienced a cytokine storm. He saw the team’s excitement when they tried the approach on her, and she too recovered.

Padgett went home on April 5. He said Monday that he faced a long, slow recovery, physically and cognitively. He expects to be a better doctor, reminded how devastating an illness can be to a patient and a family.

Returning to the ER won’t be easy, he said. “But that’s my home, that’s what I do,” he said. “I enjoy that everyone-in-the-foxhole mentality.”

And one day before then, Padgett and his fiancee, Connie Kinsley, plan to have a small wedding ceremony with a few friends on their boat moored on a Seattle lake.

[MajGenl.Meade]

Here’s an interesting article from LA Times - I’m cutting/pasting

Thanks for that and for the story

[BoSoxGal]

Troubling piece from the WashPo; I found out that if I visit WashPo from my incognito browser it lets me into the articles, though I’m not sure how long that lasts as this was the first I’d tried to access this way. But FYI for news junkies, if you sign up for an email list of pandemic coverage by WashPo, they’ll let you read all the included articles in the list for free. Here’s where to go to subscribe: https://subscribe.washingtonpost.com/ne ... oronavirus

State Department cables warned of safety issues at Wuhan lab studying bat coronaviruses
By
Josh Rogin
Columnist
April 14, 2020 at 6:00 a.m. EDT

Two years before the novel coronavirus pandemic upended the world, U.S. Embassy officials visited a Chinese research facility in the city of Wuhan several times and sent two official warnings back to Washington about inadequate safety at the lab, which was conducting risky studies on coronaviruses from bats. The cables have fueled discussions inside the U.S. government about whether this or another Wuhan lab was the source of the virus — even though conclusive proof has yet to emerge.

In January 2018, the U.S. Embassy in Beijing took the unusual step of repeatedly sending U.S. science diplomats to the Wuhan Institute of Virology (WIV), which had in 2015 become China’s first laboratory to achieve the highest level of international bioresearch safety (known as BSL-4). WIV issued a news release in English about the last of these visits, which occurred on March 27, 2018. The U.S. delegation was led by Jamison Fouss, the consul general in Wuhan, and Rick Switzer, the embassy’s counselor of environment, science, technology and health. Last week, WIV erased that statement from its website, though it remains archived on the Internet.

What the U.S. officials learned during their visits concerned them so much that they dispatched two diplomatic cables categorized as Sensitive But Unclassified back to Washington. The cables warned about safety and management weaknesses at the WIV lab and proposed more attention and help. The first cable, which I obtained, also warns that the lab’s work on bat coronaviruses and their potential human transmission represented a risk of a new SARS-like pandemic.

“During interactions with scientists at the WIV laboratory, they noted the new lab has a serious shortage of appropriately trained technicians and investigators needed to safely operate this high-containment laboratory,” states the Jan. 19, 2018, cable, which was drafted by two officials from the embassy’s environment, science and health sections who met with the WIV scientists. (The State Department declined to comment on this and other details of the story.)

The Chinese researchers at WIV were receiving assistance from the Galveston National Laboratory at the University of Texas Medical Branch and other U.S. organizations, but the Chinese requested additional help. The cables argued that the United States should give the Wuhan lab further support, mainly because its research on bat coronaviruses was important but also dangerous.

As the cable noted, the U.S. visitors met with Shi Zhengli, the head of the research project, who had been publishing studies related to bat coronaviruses for many years. In November 2017, just before the U.S. officials’ visit, Shi’s team had published research showing that horseshoe bats they had collected from a cave in Yunnan province were very likely from the same bat population that spawned the SARS coronavirus in 2003.

“Most importantly,” the cable states, “the researchers also showed that various SARS-like coronaviruses can interact with ACE2, the human receptor identified for SARS-coronavirus. This finding strongly suggests that SARS-like coronaviruses from bats can be transmitted to humans to cause SARS-like diseases. From a public health perspective, this makes the continued surveillance of SARS-like coronaviruses in bats and study of the animal-human interface critical to future emerging coronavirus outbreak prediction and prevention.”

The research was designed to prevent the next SARS-like pandemic by anticipating how it might emerge. But even in 2015, other scientists questioned whether Shi’s team was taking unnecessary risks. In October 2014, the U.S. government had imposed a moratorium on funding of any research that makes a virus more deadly or contagious, known as “gain-of-function” experiments.

As many have pointed out, there is no evidence that the virus now plaguing the world was engineered; scientists largely agree it came from animals. But that is not the same as saying it didn’t come from the lab, which spent years testing bat coronaviruses in animals, said Xiao Qiang, a research scientist at the School of Information at the University of California at Berkeley.

“The cable tells us that there have long been concerns about the possibility of the threat to public health that came from this lab’s research, if it was not being adequately conducted and protected,” he said.

There are similar concerns about the nearby Wuhan Center for Disease Control and Prevention lab, which operates at biosecurity level 2, a level significantly less secure than the level-4 standard claimed by the Wuhan Insititute of Virology lab, Xiao said. That’s important because the Chinese government still refuses to answer basic questions about the origin of the novel coronavirus while suppressing any attempts to examine whether either lab was involved.
Sources familiar with the cables said they were meant to sound an alarm about the grave safety concerns at the WIV lab, especially regarding its work with bat coronaviruses. The embassy officials were calling for more U.S. attention to this lab and more support for it, to help it fix its problems.

“The cable was a warning shot,” one U.S. official said. “They were begging people to pay attention to what was going on.”

No extra assistance to the labs was provided by the U.S. government in response to these cables. The cables began to circulate again inside the administration over the past two months as officials debated whether the lab could be the origin of the pandemic and what the implications would be for the U.S. pandemic response and relations with China.

Inside the Trump administration, many national security officials have long suspected either the WIV or the Wuhan Center for Disease Control and Prevention lab was the source of the novel coronavirus outbreak. According to the New York Times, the intelligence community has provided no evidence to confirm this. But one senior administration official told me that the cables provide one more piece of evidence to support the possibility that the pandemic is the result of a lab accident in Wuhan.

“The idea that it was just a totally natural occurrence is circumstantial. The evidence it leaked from the lab is circumstantial. Right now, the ledger on the side of it leaking from the lab is packed with bullet points and there’s almost nothing on the other side,” the official said.
As my colleague David Ignatius noted, the Chinese government’s original story — that the virus emerged from a seafood market in Wuhan — is shaky. Research by Chinese experts published in the Lancet in January showed the first known patient, identified on Dec. 1, had no connection to the market, nor did more than one-third of the cases in the first large cluster. Also, the market didn’t sell bats.

Shi and other WIV researchers have categorically denied this lab was the origin for the novel coronavirus. On Feb. 3, her team was the first to publicly report the virus known as 2019-nCoV was a bat-derived coronavirus.

The Chinese government, meanwhile, has put a total lockdown on information related to the virus origins. Beijing has yet to provide U.S. experts with samples of the novel coronavirus collected from the earliest cases. The Shanghai lab that published the novel coronavirus genome on Jan. 11 was quickly shut down by authorities for “rectification.” Several of the doctors and journalists who reported on the spread early on have disappeared.
On Feb. 14, Chinese President Xi Jinping called for a new biosecurity law to be accelerated. On Wednesday, CNN reported the Chinese government has placed severe restrictions requiring approval before any research institution publishes anything on the origin of the novel coronavirus.

The origin story is not just about blame. It’s crucial to understanding how the novel coronavirus pandemic started because that informs how to prevent the next one. The Chinese government must be transparent and answer the questions about the Wuhan labs because they are vital to our scientific understanding of the virus, said Xiao.

We don’t know whether the novel coronavirus originated in the Wuhan lab, but the cable pointed to the danger there and increases the impetus to find out, he said.
“I don’t think it’s a conspiracy theory. I think it’s a legitimate question that needs to be investigated and answered,” he said. “To understand exactly how this originated is critical knowledge for preventing this from happening in the future.”

So it seems like while not engineered, this virus might have been accidentally released into the human population. But note that it also appears that while this would be the fault of a research facility in China - that was doing important research that the USA supported - it also appears that some significant responsibility lies with an ineffectual State Department under the Trump administration that did nothing whatsoever to respond to the local US embassy’s warnings that the Chinese needed more help at this lab.

There have been stories for 3 years about how Trump was drowning the State Department in a bathtub under his guidance; it seems more and more certain that Trump will bear significant responsibility for how this pandemic has played out not just here at home, but globally.

[Gob]

Best beer in the world, after the U.S..

Have to disagree, although the US is now up there with some of the best, both Belgium and the Czech republic, (and of course the UK,) are above it.

But, de gustibus.

[BoSoxGal]

https://slate.com/technology/2020/04/ny ... virus.html

[Bicycle Bill]

-"BB"-

[Econoline]

[Gob]

[BoSoxGal]

French study finds hydroxychloroquine doesn't help patients with coronavirus

[Darren]

Here’s an interesting article from LA Times - I’m cutting/pasting because I’m not sure if they’re providing pandemic coverage free or not. I’ve read multiple pieces in which scientists and doctors theorize it’s the cytokine storm killing younger folks with healthy immune systems, so hopefully a treatment like this will soon be standardized for younger patients - maybe introducing immunosuppressive medications before they become so critically ill that they need ECMO, which is not widely available.

Someone in the area was saved with the ECMO equipment. I'm wondering if bypassing the lungs allows the bone marrow enough time to produce enough red blood cells to end the hypoxia. Otherwise your organs shut down and you die from the lack of oxygen.

[Bicycle Bill]

D  O  N  A  L  D     A  N  D     J  O  H  N

( T H E   C O N T I N U I N G   A D V E N T U R E S   O F   A   B O Y   P R E S I D E N T
A N D   H I S   I M A G I N A R Y   P U B L I C I S T )

... in which the mischievous imp Little Donald is warned of a coming alien virus invasion
and leaps into inaction!

-"BB"-

[Econoline]