An Over-reaction?

[Convicted One]

GERALD L MCFARLANE JR

So what you're saying is you prefer to be Anti-social rather than social?

It sure is a lot less complicated...

I prefer to think of it in another way. For decades I was under the delusion that interpersonal development was somehow beneficial.

I'm (mostly) cured now!!

[GERALD L MCFARLANE JR]

Convicted One

FWIW, I have always seen "social distancing" as somewhat of an ideal. Always to strive for, yet fleeting enough that it's worth celebrating whenever attained. 

So what you're saying is you prefer to be Anti-social rather than social?

Still waiting for them to pull anti-bodies from some that have recovered, that was one of the options for treating it as well.

It's been estimated that unemployment is up to at least 11% if not higher, that number seems a little low to me.

[Convicted One]

From today's Journal Gazette:

According to the Indiana Department of Workforce Development, for the week ending March 21

Allen County (FT Wayne) had 3,561 initial claims for unemployment, up 3,688% compared to the same period one year ago

Marion County (Indianapolis) had 10,173 initial claims, up  3,291% compared to the same period one year ago.

There is further trend analysis including some comparison to the year prior to last year....here:    https://www.journalgazette.net/news/local/20200325/thousands-rush-to-make-jobless-claims   

 

[daveklepper]

Ahead of Passover and deep into the coronavirus pandemic, Orthodox Jewish leaders and medical professionals in Florida have warned against an exodus of visitors from their homes to the Sunshine State to celebrate the Jewish holiday to visit family or stay at the all-inclusive Passover hotel and resorts.

In a letter to their communities late last week, 35 Orthodox Jewish leaders and nine medical professionals in Florida wrote, “To all those from out of state considering spending Pesach here in Florida: It’s halachically prohibited and medically irresponsible to come for Pesach.”

Passover begins at sundown on April 8 and ends at nightfall on April 16.

The letter, first reported on Thursday by COLlive, mentions that Florida’s health-care system “is currently overburdened, and an influx of new patients can lead to deaths. In addition to being a chilul Hashem, we have a halachic requirement to keep our communities safe.”

“If you choose to come anyways, jeopardizing the lives of many in Florida, you must quarantine for 14 days. This means no leaving the house, no excursions, no beach, no pool, no restaurants, etc.,” it said.

Finally, the letter notes that the Jewish institutions, including synagogues and kosher restaurants, will not be accommodating visitors this year.

[daveklepper]

A mailing from a recent MIT graduate that should interest you.  And he is thanking another "David," not me.

If this posting is not appropriate, let me know and I will delete it.  Thank you.

n Wednesday, March 25, 2020, 05:50:25 AM GMT+2, Steve Pittman <[e-mail]> wrote:

 

 

Thanks David.

 

I am going to copy the Senior House mailing list on this but I would advocate that participants not do so on subsequent replies.  Anyone not already copied who wants to continue to participate in this thread must send an email to those already on copy letting them know.  Everyone else will be dropped.

 

I have been trying to figure out how the craziness is going to end.  The Hammer & The Dance email thread was the first thing I have seen to outline a reasonable path forward.  However, I believe we need to quit talking about flattening the curve and start talking about quenching the curve.  That is, we need to drive new infections down near zero so that as testing ramps up we can begin to test all contacts of those with new infections (as was done in South Korea).  I believe that is the best way to stabilize the economy as quickly as possible.

 

Full disclosure: I am sheltering in place with my family near Boulder, Co.  When we leave the house, I believe that we are taking adequate precautions to avoid bringing infection home.  If one of us gets sick, that person is going to stay in their room and isolate themselves from the rest of us.  I am fortunate that I live in a large house with a bathroom (with at least a shower) for every member of my family.  I am well aware that not everyone is that fortunate.  Jared Polis (the new gay Democratic governor of Colorado) recently ordered residents of Denver and Boulder to shelter in place.  There are indications that his order might soon be expanded to other areas, including Longmont where I live.

 

I suspect that like me, you have been very frustrated by what you view as inadequate advice about how to avoid infection.

 

The CDC web page at https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html inexplicably fails to mention that the virus can survive on surfaces for up to three days, which seems to be true (see https://www.bbc.com/future/article/20200317-covid-19-how-long-does-the-coronavirus-last-on-surfaces), although the cited BBC web page downplays the risk to some extent.  Still, I believe that some guidance in that regard is appropriate, especially since the cited CDC web page elsewhere advises, "Clean AND disinfect frequently touched surfaces daily."  With regard to Covid-19, that advice seems silly if no one in the house is infected.  But the advice does seem very important when it comes to public places such as grocery stores.  However, such cleaning would need to occur much more frequently than daily to prevent virus transmission.  If sufficiently diligent cleaning of a grocery store is too difficult (as it seems to be), then it is up to patrons to protect themselves, but the cited CDC web page offers no advice about how to do that.

 

I am very concerned that many competent people at the CDC have been fired or demoted and that the President and his cronies have influenced the advice offered on the CDC web page.

 

I don't know about you, but when I visit a store, I assume that every surface in the store is contaminated.  That includes the key pads and touch screens at checkout.  I bring my own bags to the store and use them instead of a shopping cart.  I don't allow anything to touch a surface (other than the shelf an item is on before I select it) except for some produce which must be weighed.  If I must use a checkout clerk, I hold each item out and allow the clerk to scan it without touching it, except for items which must be weighed.  I have quit using cash, which is itself a source of contamination.

 

I am fortunate to have a supply of latex gloves which I purchased several years ago.  I don latex gloves before entering the store and clean the gloves with hand sanitizer before leaving the store.  The greeters at the local Walmart are now squirting hand sanitizer into the palms of everyone leaving the store.  Brilliant!  And most stores now provide hand sanitizer at the exit.  I hope all will do so soon.  Once that happens, the only utility of latex gloves (or the gloves you use) will be to protect hands from the harsh hand sanitizer, especially when visiting multiple stores in a single outing.  And I believe hand sanitizer to be an excellent way of decontaminating your leather or fabric gloves.  Having said that, acquiring hand sanitizer is certainly a challenge lately.

 

I have not yet gone so far as to wipe all merchandise down with hand sanitizer after bringing it home.  I am relying on grocery stores to screen their stocking clerks for infection and, if uninfected, to supply them with masks and gloves for their shift.  I hope my faith is not misplaced.

 

I am sure that some would characterize what I am doing as extreme, but I believe that such measures will quench the curve and stabilize the economy as quickly as possible.  That will, of course, only happen if most people follow my example.  And to be clear, I know that if I slip up once or twice, that does not mean that I will be infected.  It means only that my risk of infection has increased by some small amount.

 

All that is preface to ask that if you know of credible information which confirms that the Covid-19 virus is not transmitted by touching a contaminated object or surface (sometimes referred to as fomite transmission), please let me know.

 

I am also concerned about advice from Sanjay Gupta who was interviewed by Stephen Colbert on Friday, March 13th (see https://www.thedailybeast.com/dr-sanjay-gupta-tells-colbert-trump-failed-americans-with-coronavirus-response).  Please ignore the headline, which I do not consider relevant.  Note that starting at 4:45 into the video, Sanjay Gupta claims that Covid-19 is not spread through the air since droplets from infected sneezes and coughs fall rapidly to the ground.  He claims that six feet of separation is sufficient to protect others from droplets expelled by infected individuals.  An acquaintance of mine repeated that advice to me a few days ago, although the acquaintance did not say where it came from.  I see advice at https://health.howstuffworks.com/diseases-conditions/infectious/infection-airborne.htm which suggests that the extent of airborne transmission depends upon a variety of factors (eg, relative humidity).  That advice seems more accurate to me.  Perhaps I should add that Sanjay Gupta's claim that droplets produced by Covid-19 victims somehow behave differently than the droplets produced by victims of (for example) smallpox seems very suspect to me.

 

If you know of credible information which confirms that Sanjay Gupta is correct, please let me know.

 

By the way, all of this is informed by reading I did perhaps a decade ago when an acquaintance asserted that flying increases the risk of getting a respiratory infection.  Research I reviewed back then said that flying does increase the risk of getting the flu (which is spread largely by droplets in the air) but not so much the risk of getting a cold (which is spread largely by touch - eg, cash passed from person to person).  Of course, there are many different families of viruses which cause colds (one of which is the coronavirus family) and the situation might vary from family to family.  In any case, politics was not influencing research back then so I believe that available information back then was at least trustworthy although certainly tentative/provisional, as is most research.

 

The bottom line is that I am feeling more comfortable after reading  The Hammer & The Dance email thread, since it does indicate a viable path forward which I am now fairly certain the United States is going to take with or without the participation of the Federal government.  It looks to me as if there are hot spots which are going to resemble Italy to some extent (Washington State and New York City come to mind).  I only hope that authorities and people in those communities are able to minimize the loss of life.

 

Here in Colorado, the ski areas are hot spots (because there were so many visitors).  Many of the infected seem to have come from Australia.  About a week ago, Jared Polis ordered the ski areas to close and told everyone to go home.  I am afraid that will mean that many infected foreigners will get on airliners.  Yikes!  Denver and Boulder are becoming hot spots, too, mostly because young adults there did not take the crisis seriously enough to begin with.  Since retiring, I have gotten involved with the Longmont Observer (an online newspaper) and Longmont Public Media (a group which took over operation of the local public access TV channel as of January 1st).  I published an editorial (at https://longmontobserver.org/opinion/opinion-steve-pittman-coronavirus-is-dangerous-for-young-people-too/) which notes that statistics from China indicate that the risk of death from Covid-19 for people in the 20-39 year old age group is 1 in 500 of those who become infected.  Not very high but certainly much higher than the flu.

 

I went out a week ago and bought the food we need to cook at home this past week.  We had to go to several stores because shelves here are already pretty bare.  Very bizarre that the first thing which sold out (after hand sanitizer) was toilet paper.  How the heck is extra toilet paper going to help anything?!??  Although people have pointed out that with everyone staying home, more of everything (toilet paper, food, snacks, etc) is needed at home.  Supply chains must pivot from supplying businesses, restaurants, and convenience stores to supplying grocery stores.  I believe that is happening reasonably quickly.  I was worried that our household might run out of toilet paper until I stopped at Walmart this past Friday and spotted people with toilet paper in their cart!!!  No need to hijack at gunpoint.     I walked to the back of the store where two gracious Walmart employees were handing out two per customer off a large pallet.

 

We have occasionally been patronizing local restaurants which Jared Polis has now restricted to take out and delivery only.  I believe take out to be safe enough, although some restaurants are better than others when it comes to avoiding contamination from other customers when picking up and paying for a meal.  My primary motivation there is to support people such as wait staff, many of whom were living paycheck to paycheck before the crisis erupted.  I know some of my girls' classmates are in families which are no doubt suffering financial hardship now.  The only good news is that local schools (which provided free or reduced cost breakfasts and lunches to students) are attempting to keep those nutrition programs in place even though schools are no longer in session.

 

I hope that by collaborating we can more quickly find credible information which helps us to quench the curve.

 

Steve Pittman

EE '71

[matthewsaggie]

NC reported 113,000 new claims over the past 7 days vs. only 33,000 claims for all of January, February and the 1st week of March last year. 

Source- Charlotte Observer 3/24/20

[Convicted One]

I believe that I read a clip that stated that jobless claims here in Indiana were 16,000 either last week or last month, compared to 3,000 for the same period one year ago.

[matthewsaggie]

blue streak 1

Has anyone else noted that the US unemployment figures for the last two weeks have not been released ?  Government censorship ?  

 

0

More likely the state labor dept. staffs are trying to work from home are not getting the data from businesses to provide to the DC staff, most of which are trying to work from home with only partial access to all the need to prepare reports. Civil service staff do their jobs no matter who is in the WH. They would rebel at the suggestion of censorship. On the other hand, dont stand in front of the door at 5:00 PM

[BaltACD]

Convicted One

 

BaltACD

Somebody can't handle the truth! 

Haven't you heard? Our masters hope to have us back at work by Easter!!

Our leader is the Easter Bunny?

[Convicted One]

BaltACD

Somebody can't handle the truth!

Haven't you heard? Our masters hope to have us back at work by Easter!!

[BaltACD]

blue streak 1

Has anyone else noted that the US unemployment figures for the last two weeks have not been released ?  Government censorship ?  

Somebody can't handle the truth!

[blue streak 1]

Has anyone else noted that the US unemployment figures for the last two weeks have not been released ?  Government censorship ?  

[daveklepper]

Two Israelis died of the novel coronavirus on Tuesday as Prime Minister Benjamin Netanyahu convened his cabinet to impose additional restrictions, bringing the Israeli death toll from the global pandemic up to three.

Some 1,930 Israelis have been diagnosed with coronavirus as of Tuesday night, according to the Health Ministry. Of those, 34 were in serious condition.

 

With the numbers growing as they are - 6% of all people tested are infected with coronavirus - the Health Ministry has been pushing for a complete lockdown throughout Israel while the Finance Ministry is  insisting that if a full state of emergency closure is implemented, the economy could not be restored.

A draft of the new restrictions - expected to be approved overnight Tuesday - was released to the media shortly before the government convened. People, according to the new rules, will only be allowed to leave their homes within 100 meters; leisure activities will only be allowed within walking distance and sporting events - even on one’s own - are forbidden.

Existing guidelines would not change with regards to traveling to and from work, but any company would be allowed to check their employees’ temperature before letting them enter the building. The ability to buy food, medicine or other essential products would not be limited even after the decision is approved, the Prime Minister's Office explained.

On Monday night, Netanyahu told cabinet members that 10,000 Israelis could die from the coronavirus and one million could be infected. “We could reach a million infected within a month,” the prime minister said according to a report on N12. “There could also be 10,000 dead Israelis.”

The prime minister also instructed Mossad Chief Yosi Cohen to lead a new National Emergency Team that will orchestrate Israel’s efforts to purchase medical equipment, especially ventilators, that will be needed to treat these patients.  In addition, he instructed the Israeli Defense Industries to examine options to manufacture such medical equipment in the country.

'1 mil. Israelis with coronavirus is conservative,' disease expert says

 Penalties being considered for breaking these orders would be up to six months in prison or fines of as much as NIS 3,000.

The Health Ministry's guidelines have harshly stung the economy, pushing Israel's unemployment rate to 19% as of Tuesday at 4:30 p.m.

So far, the Israeli Employment Service said that some 633,939 people applied for unemployment benefits in March, including 18,105 people between 7 a.m. and 4:30 p.m. Tuesday.

 According to Bank of Israel estimates published on Tuesday, current measures to contain the novel coronavirus are likely to result in an unemployment rate of approximately 7% - an increase of 150,000 people - by the end of 2020.

"We must help individuals whose company or turnover has been impacted, and they must continue to meet their ongoing expenses," said Bank of  Israel Governor Prof. Amir Yaron. "We also need to help those who have been made redundant, or have been placed on unpaid leave and their  income has been affected dramatically. This is what governments around the world are doing, and on a huge scale."

Back to the sick, the Health Ministry reported that the majority still have mild cases of the virus – 1,795 – and another 45 people are in moderate condition.

The man who died on Monday had been brought to Hadassah from the Nofim  Geriatric Center, where he lived. Shortly before news of his death,  the second coronavirus patient who died was identified as Malka Kever, 67, from Bat Yam. She died at Wolfson Hospital. She, too, had  pre-existing conditions.

"Our intensive care team fought for her life with great dedication,  the hospital said, "but her condition deteriorated."

Kever was patient number 445. She had previously volunteered at the hospital where she died, according to N12, until she was diagnosed with cancer in the last year.

Her family members, who are in isolation, called on the public to "stay home."

"Don't go out, you risk yourself, your children, your relatives and people you don't know," Kever's daughter, Dorit, told N12. "My mother gave her life, gave her soul to the Creator because of this illness. We are hurting, we are sad."

 The man in his 60s who died Monday at Sourasky Medical Center (Ichilov Hospital) in Tel Aviv and was suspected of having coronavirus had not contracted the disease, the hospital reported. Test results revealed that the man had respiratory symptoms and his death, as determined by the hospital, was probably from a different viral disease.

 In a related development, a premature baby at the prenatal ward of Shaare Tzedek Medical Center in Jerusalem was reported on Tuesday as not having had the novel coronavirus after it was earlier reported that a worker of the ward was infected with the virus and might have infected him. All the premature babies in the ward were found to not have the virus, and the hospital is working alongside the Health Ministry to proceed with removing the workers of the ward out of quarantine per the regulations.

Some 53 people have recovered from the virus.

So far, more than 135,000 Israelis have spent time in quarantine. The Health Ministry said that 71,029 are in isolation now, including another member of Israel's government. Diaspora Affairs Minister Tzipi > Hotovely became the latest MK to enter home quarantine on Tuesday, bringing the number up to eight. Hotovely came in contact with a deputy director-general of her ministry who was later diagnosed with the virus. She will need to be quarantined until April 1.

Hotovely is the sixth MK from Prime Minister Benjamin Netanyahu's right-center bloc in quarantine, joining ministers Tzachi Hanegbi (Likud), Arye Deri (Shas), Bezalel Smotrich (Yamina) and Shas MKs Itzik Cohen and Moshe Abutbul. The only quarantined MKs from the left-center bloc are Alon Shuster and Ran Ben-Barak.

The number of infected people is expected to climb as Israel conducts more coronavirus tests. In the last 24 hours, more than 3,700 people were screened. On Monday, Magen David Adom opened up three more drive-through testing complexes: in Jerusalem, Beersheba and Haifa.

In total, according to the ministry, 27,054 tests had been taken by Tuesday morning.

Gil Hoffman and Eytan Halon contributed to this report.

[daveklepper]

An Israeli rabbinical organization has created what it claims is a unique volunteer system for the distribution of food and basic necessities to the elderly and other homebound Israelis amid the ongoing coronavirus lockdown.

The Barkai Center for Practical Rabbinics and Community Development, an organization dedicated to building Israeli society by bringing Diaspora models of community-building to the Jewish state, created the system in conjunction with the Modi’in Municipality.

Barkai rabbis and other members appointed neighborhood “captains” who set up WhatsApp groups to mobilize volunteers and to be in direct contact with those in need in each of Modi’in’s neighborhoods to ensure the necessary food distribution packages.

“Our community-building model has meant that we were ready to step in and create networks to ensure those in need receive the food and other necessities they so badly need during the coronavirus crisis,” said founder and dean of Barkai Rabbi David Fine. “We see that this model can be replicated in cities and towns across Israel in a speedy and smooth manner, so the elderly and other homebound Israelis receive what they so desperately require during this difficult time.”

The project involves more than 250 volunteers who deliver cooked meals to the elderly and other homebound residents in each of Modi’in’s 13 neighborhoods three times a week. Each package contains sufficient prepared food, including meat, carbohydrates and vegetables, for two days.

 

In addition, the volunteers deliver food from supermarkets to hundreds of elderly and homebound Modi’in residents. When the volunteers deliver the packages, they ask the recipients how they are and if they have any further needs, and alert both the Modi’in Municipality and Israel’s Ministry of Social Affairs and Social Services to update their national database, which tracks the condition of elderly and infirm citizens across the country.

“We deeply appreciate the networks and food distribution model created by the Barkai team, and we recommend and encourage other municipalities to copy them,” said Deputy Modi’in Mayor Amiad Taub, who holds the social-services portfolio in the municipality.

[Overmod]

daveklepper

Results are in from the first organized trials of drugs to treat Covid-19...

Remember I predicted they wouldn't be able to figure out how and when to use 3CLpro inhibitors in prompt reduction of viral load of specifically analogous coronaviruses?  How cute it is of them to start trials of protease inhibitors specific to HIV ... perhaps on the assumption that the 'deadlier' the virus the more likely a protease inhibitor that 'stops' viruses in general ought to be?

Here we go.  (Or don't go, as the case may be.)

Somebody figure out for me why anti-inflammatory agents (to reduce, for example, some of the responses that may be involved in ARDS) don't make the protocol, even though the actual research I've read on hydroxychloroquine treatment involved it, but Zithromax (which has little I can see to do with this at all, but might be useful in the four documented cases so far of co-infection) does.  Perhaps the conventional wisdom of "antiviral" action against influenza, where coinfections are more a historical concern, is as active here as it was when people presenting with COVID-19 symptoms were administered things like Tamiflu and prednisone and became dangerously affected as a proximate result.

I have seen a couple of comments that 3CLpro inhibitors have been thought about, but not adopted 'as they do not lead to a cure'.  Any reasons for prompt reduction of viral titer -- for example, to reduce the kinetics of viral transfer to uninfected emergency workers or hospital personnel who may find themselves performing heroic intervention on large numbers of patients -- seems not to be considered important.

Were it not for the high conservation of 3CLpro inhibition across a range of coronavirus, almost certainly involving this one (since it was sequenced early and the work on 3CLpro inhibition was well advanced in other areas of study) I wouldn't be quite as irritated at this.  It's not only a logical starting place for designed analysis, the stuff has been in industrial production over a year...

 

[daveklepper]

Coronavirus prompts acts of kindness in

Central Florida

 

 

ORLANDO SENTINEL |

MAR 24, 2020 | 12:16 PM

 

A few Central Floridians are a shining light during these unpredictable times, performing acts of kindness.

 

Organized by residents of Lake Nona’s Laureate Park neighborhood, this colorful community activity encourages families to decorate their portion of the sidewalk with doodles, designs, obstacle courses, and encouraging messages for their fellow neighbors.(Courtesy Karlee Kunkle)

 

Trinity Church in Deltona is hosting a drive-through event on March 26, where those in need can get free rolls of toilet paper.(Courtesy James Jones)

Trinity Church has acquired about 2,000 rolls of toilet paper, which they will distribute to families in need at 2 p.m. on March 26 at a drive-through event at the church (875 Elkcam Blvd. in Deltona).

 

“As the church, we must help people not only spiritually, but even their basic needs like toilet paper,” said James Jones, the church’s pastor, in an email.

 

Service dog Cloud was supposed to go to training classes with her disabled human, but the coronavirus caused a delay. Linda Rutherford stepped up to foster Cloud at her home in Longwood until classes resume, and in the meantime, Rutherford is reinforcing training by asking Cloud to perform tasks on command (from opening the refrigerator to fetching the remote) so that the pooch doesn’t get rusty.

 

Faith Assembly of God in Orlando is paying up to $100,000 in essential bills for their congregation to help those currently unemployed or working reduced hours because of COVID-19, according to a press release. In the Facebook video (tune in at 2:23), the church’s senior pastor Carl Stephens announces the church’s initiative and how others can contribute.

 

“We are sending out teams into neighborhoods — if you need help, if you’re a senior citizen, you’re someone that’s a single mom, you need help as far as someone to pick up groceries or take you to the doctor or go pick up medicine ... we’re trying, at this point, to be the church,” said Stephens in the video.

[Convicted One]

I found this comparison of "over responders" vs "under responders" to be interesting.

I hadn't previously thought of the denialists AS BEING FEAR MOTIVATED,  but I think they may have a point

https://www.cnn.com/2020/03/24/health/social-distancing-wellness-trnd/index.html

[Convicted One]

FWIW, I have always seen "social distancing" as somewhat of an ideal. Always to strive for, yet fleeting enough that it's worth celebrating whenever attained.

[GERALD L MCFARLANE JR]

charlie hebdo

Social refers to living in various forms of contact with other humans.  Physical space refers to the three dimensional volume around us.  Since the virus is transmitted only between humans (assuming you don't have access to the fruit bats from Hubei that are the theorized source)  keeping a 2 meter physical space around one would include all objects, which would thus be an unnecessary precaution.  Social distancing refers to keeping a 2 meter space around you in relation to other humans only. 

 

 

Do you believe you can be social(per the Cambridge Dictionary; relating to activities in which you meet and spend time with other people and that happen during the time when you are not working) and be 6 feet away from the other person?   If you do then we have a difference of opinion on being social and will never agree that "social distancing" is not the proper term.  However, on the other hand, if we agree that you can't be social with other people and be 6 feet away from them, then we have common ground to admit that calling it "social distancing" is not the proper term.  What they really want people to do is be Anti-social social.

[charlie hebdo]

Convicted One

 

 

charlie hebdo

lift the social restrictions soon, against all medical advice.

 

 

I thought that the calls for senior americans to shoulder the risk so that the world left for their grandchildren would be worth inheiriting were  particularly callous and opportunistic.

 

Not an example of a Profile in Courage. 

[CSSHEGEWISCH]

It's fairly well known that the current inhabitant views himself as the smartest guy in the room on any topic and doesn't need advice from mere mortals.  That being said, it was quite revealing to watch him squirm a few days ago when Dr. Fauci said in so many words that the statement he just made was medically unsound.

[Convicted One]

charlie hebdo

lift the social restrictions soon, against all medical advice.

I thought that the calls for senior americans to shoulder the risk so that the world left for their grandchildren would be worth inheiriting were  particularly callous and opportunistic.

[charlie hebdo]

David K: Thank you.  Unfortunately the impatient, impulsive cuurrent occupant wants to lift the social restrictions soon, against all medical advice.

[daveklepper]

From Technology Review, the MIT Alumni Magazine

The first medical reports are in, but there’s no silver bullet for coronavirus infection yet.

by Antonio Regalado

Mar 23, 2020

Results are in from the first organized trials of drugs to treat Covid-19, but so far, there’s no cure.

As the new respiratory disease spread widely starting in January, doctors—first in China and then in the US, Italy, and France—all moved to test readily available drugs that are used for other purposes and are fairly safe. Now, just three months into the pandemic, the first medical results from organized trials—studies structured to measure whether a drug actually helps—are becoming public. We count three so far, all involving drugs with antiviral properties.

Patients who end up in the ICU are begging for whatever treatment they can get, and demand for drugs will skyrocket in the US. Not only is the number of confirmed cases now over 35,000, but this week twice that many or more will likely feel the onset of typical symptoms like cough, fever, and shortness of breath.

So far, there is no approved medicines for Covid-19, so the main treatment for severe cases isn’t drugs at all—it’s oxygen therapy, ventilators that help people breathe, and supportive care. Some patients get standard antibiotics.

Overall, scores of drug studies are under way, checking the benefits of everything from vitamin C to Chinese traditional medicine. A list of trials compiled by CellTrials.org, a consultancy, found that doctors had registered over 250 Covid-19 studies, mostly in China, and were seeking to recruit 26,000 patients. It may be another month before some other large, important studies, like several involving the experimental antiviral remdesivir, made by the US company Gilead, are ready to report any findings.

Here are the facts about the drug studies published so far.

Chloroquine or hydroxychloroquine

The hype: President Donald Trump praised the malaria drug, saying it had shown “tremendous promise” against Covid-19. “I think it’s going to be very exciting,” he said. “I think it could be a game-changer, and maybe not.”

HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains - Thank You! Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents).....

 

The report: Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an openlabel non-randomized clinical trial

The data: During early March, French doctors at IHU-Méditerranée Infection in Marseille, France, treated Covid-19 patients with hydroxychloroquine, a version of the 90-year-old malaria drug chloroquine. They tried giving 200 milligrams of hydroxychloroquine three times per day, over 10 days, to 26 patients, and some got the antibiotic azithromycin, too. In their report, treated patients had less virus in their system after six days than other patients at a different center, who didn’t get the treatment. The study’s conclusions aren’t firm because so few patients were involved and the study was not rigorously designed, although chloroquine has also been tried in China with rumors of success.

So does the drug work? Scientists say there’s not enough evidence to say. “Anecdotal reports may be true, but they are anecdotal,” Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said during a briefing at the White House. “It was not done in a controlled clinical trial. So you really can’t make any definitive statement about it.”

In the absence of other options, Governor Andrew Cuomo of New York said his state, now a global epicenter of Covid-19, had obtained 70,000 doses of hydroxychloroquine and 750,000 doses of chloroquine, as well as azithromycin (also called Zithromax). “The trial will start this Tuesday,” said Cuomo over the weekend. “There is a good basis to believe they could work. The president ordered the FDA to move and the FDA moved.”

Chloroquine has risks, because it can affect heart rhythm. No one should take it without a prescription.

Favipiravir

The hype: News reports last week claimed Chinese officials had touted this antiviral medicine made in Japan as “clearly effective.”

 

The report: Favipiravir versus Arbidol for COVID-19: A Randomized Clinical
Trial

The data: While favipiravir, an antiviral made by Toyama Chemical (part of Fuji Film), generated hopeful headlines, the report from doctors at China’s Wuhan University makes more modest claims. They organized a study of 240 “ordinary” patients (meaning they had pneumonia but were not the worst cases) around Hubei province. Half got favipiravir and half got umifenovir (or Arbidol), an antiviral used in Russia, and they were watched to see which group recovered faster. The doctors found that patients’ fevers and coughs went away faster on favipiravir, but similar numbers in each group ended up needing oxygen or a ventilator. On the basis of these findings, they concluded that favipiravir is the “preferred” of the two drugs.

Favipiravir, which is known by the trade name Avigan in Japan, inhibits viruses from copying their genetic material. It was originally discovered while searching for drugs to treat influenza.

Lopinavir and ritonavir

The hype: Doctors reached into the cabinet of advanced anti-HIV medications, hoping for a quick success. 

 

The report: A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19

The data: This is the largest, best-organized study of a treatment for Covid-19 so far, but it didn’t find a benefit. In January, doctors in China randomly assigned 199 patients with pneumonia either to get the HIV medicines lopinavir and ritonavir twice a day for two weeks, or to receive only standard care. Then they watched to see who improved or got discharged from the hospital. Unfortunately, no benefit was seen from the treatment. Nearly 20% of the patients died. The team wonders if the drug combo, sold in the US by AbbVie to treat HIV infection under the trade name Kaletra, could still prove beneficial for less sick patients.

The key drug here is lopinavir, a protease inhibitor, which has been shown in lab and animal tests to have effects against Middle East respiratory syndrome coronavirus, or MERS. Ritonavir acts to increase the first drug’s availability in the body.  (DLK: But Lopinavir by itself, is ineffective by the study quoted.)

Different article:  Few health institutions around the world are as renowned as the US Centers for Disease Control and Prevention. Which makes it all the more baffling that the CDC could have fumbled the rollout of coronavirus diagnostic tests throughout the country so badly. While other countries have been able to run millions of tests, the CDC has tested only 1,235 patients. Speed is of the essence when dealing with an epidemic early, and the CDC’s mistakes are already proving costly to tracking the outbreak in the US.

On February 5 the CDC began to send out coronavirus test kits, but many of the kits were soon found to have faulty negative controls (what shows up when coronavirus is absent), caused by contaminated reagents. This was probably a side effect of a rushed job to put the kits together. Labs with failed negative controls had to ship their samples to the CDC itself for testing.

The CDC’s kits are based on PCR testing, which makes millions or billions of copies of a DNA sample so that clinicians can easily identify and study it. PCR is a well established technology that’s been around for 35 years. We’ve improved the process with upgrades such as higher-quality enzymes and reagents, allowing for more precise testing and making it possible to detect targets in real time even while the assay is still running.

So how exactly does the CDC, of all places, goof up something so tried and true?

The first thing to know is that PCR is a very sensitive test. You need extremely clean reagents, and the smallest contaminants can ruin it completely (as happened in this instance). A negative control that detects the wrong viral genome and raises a false positive is practically a worst-case scenario, because it calls into question all the other results in the run—you don’t know if samples are truly positive or if they are positive because of the contamination. “You basically can’t even judge if anything worked,” says Nigel McMillan, the director of infectious diseases and immunology at Griffith University in Australia.

The amplification of DNA in PCR has to be initiated using short strands that are complementary to the target DNA, called primers. Keith Jerome, the head of virology at the University of Washington, points out that “primer design is still somewhat of an art, and not fully predictable.” Even when you have a good database of viral sequences, not all primer sets that look good on a computer will perform well in real life.

These are common problems that can afflict not just PCR, but testing for any virus or any new infectious disease. “For the CDC, however, I’m sure it is unheard of,” says McMillan. “They’re normally very careful about these things.”

Don’t blame PCR itself for the lack of reliable tests, though. According to Duane Newton, the director of clinical microbiology at the University of Michigan, the biggest limitation in diagnostics is not the technology, but rather the regulatory approval process for new tests and platforms. While this process is critical for ensuring safety and efficacy, the necessary delays often “hamper the willingness and ability of manufacturers and laboratories to invest resources into developing and implementing new tests,” he says.

Case in point: FDA rules initially prevented state and commercial labs from developing their own coronavirus diagnostic tests, even if they could develop coronavirus PCR primers on their own. So when the only available test suddenly turned out to be bunk, no one could actually say what primer sets worked.

The CDC and FDA reversed course and lifted this rule on February 29, and commercial and academic labs are now allowed to participate. “Lots of people are working on this, and we’re on the phone all the time with each other comparing notes,” says Jerome. “At least in our hands, it seems that some of the CDC primers work better than others, some of the WHO primer sets look really good, and some from academic groups look great also.”

There’s no particular technical difficulty in designing a PCR test, so most laboratories should be able to do so with confidence. This week, state and commercial labs began testing on their own. We’re already seeing major steps forward; the University of Washington, for instance, has a new diagnostic that will allow it to test 1,500 samples a day. A group in Japan claims to have a test that can detect the virus in just 10 to 30 minutes.

“The great strength the US has always had, not just in virology, is that we’ve always had a wide variety of people and groups working on any given problem,” says Jerome. “When we decided all coronavirus testing had to be done by a single entity, even one as outstanding as CDC, we basically gave away our greatest strength.”

The reagents are now fixed, and the CDC looks ready to move forward. By the end of the week, it expects labs around the country to be able test about 400,000 patients. Other groups around the world are already looking at the crisis as an opportunity to make PCR faster and even develop other viral diagnostics like antibody testing. Local and commercial institutions should be given similar mandates to act decisively, without bizarre constraints. “You’ve got a fantastic resource in the CDC,” says McMillan. “But if they’re not proactive enough or timely enough, then things down the road will start to fall.”

[daveklepper]

[quote user="charlie hebdo"]

David: The IDF has blockaded Gaza for years. Are they allowing medical supplies to enter now?

[/quote above]

Israel never blocked medical supplies except when terrorists attacked the people delivering them to the checkpoints.

I have not yet been tested, but Israel has supplied 100 testing kits to Hamas in Gaza.

To alliviate Gaza's shortage of water, Israel (the manufacturer itself) has supplied an electronic water-from-air device, which had been used by the California Fire Department to assist in putting out the massive fire there.

There were and are trucks with essential supplies daily going through the checkpoint.  The ohly interruptions were caused by Hamas itself.

[Deggesty]

As to doctors' handwriting, a doctor sent a frinedly note to one of his patients; the patient could not read it, so he took it to a pharmacist. A few minutes afterwards, the phsrmacist gave him a bottle of medicine, and told him the cost of the medicine.

[Convicted One]

I used to use a "weatherfax" program where I could plug a shortwave radio receiving SSB into the soundcard on my PC, and produce weather maps being broadcast from NOAA depicting information from their weather satellite. Took a long time for a full page to appear

 

[Flintlock76]

One thing's for certain, you can't hack paper!  

You can only pick it up and run with it and hope you don't get caught!

[BaltACD]

54light15

Interesting about medical record keeping practises, I was in the hospital five and a half years ago for an operation and I was surprised how everything was on paper. There didn't seem to be a lot of computerised record keeping. And the did talk about faxing documents to other doctors and such. Funny, that. 

I think some doctors resistance to computerized record keeping is that things like instructions are typed and anyone and everyone can read what the doctor wrote.  In the 'paper only' days the doctor had to be called as the expert witness to be able to read what they had written - as doctors handwriting cannot be read by mere mortals.

The family doctor I had in Jacksonville had all his files for all his patients in paper - had floor to ceiling vertical files that occupied an area of about 30 by 30 feet and 8 feet high.  He retired in 2018.

[54light15]

Interesting about medical record keeping practises, I was in the hospital five and a half years ago for an operation and I was surprised how everything was on paper. There didn't seem to be a lot of computerised record keeping. And the did talk about faxing documents to other doctors and such. Funny, that.