COVID-19 | Corona Virus April 2020

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ElaineA

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It's always possible, but it's also impossible to underestimate the effects of old-fashioned incompetence.

And greed. Somebody is raking in huge amounts of taxpayer dollars and you can bet your ass Trump has a "you have to do me a favor, though" in there somewhere.

And still not a single GOP voice standing up saying, "Have you no decency, sir?"
 

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And still not a single GOP voice standing up saying, "Have you no decency, sir?"

That question has been asked, in essence if not in literal words.

And in answer, he has looked America in the eye and smiled as he said no. Repeatedly. Because decency is a liability in today's TeaOP.
 

Roxxsmom

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And greed. Somebody is raking in huge amounts of taxpayer dollars and you can bet your ass Trump has a "you have to do me a favor, though" in there somewhere.

And still not a single GOP voice standing up saying, "Have you no decency, sir?"

They're in with him hook, line, and sinker (and any other cliched expression indicating being fully committed to someone, wherever it takes them).
 

lizmonster

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It's always possible, but it's also impossible to underestimate the effects of old-fashioned incompetence.

What strikes me, though, is all the pushback on mail-in ballots and the resurgence of the voter fraud nonsense. Also the idea of lifting sanctions (and releasing Putin's money).

I don't think any of this was done on purpose, but I do absolutely believe they're using the pandemic as an excuse and a cover. Given that they don't seem to value human life at all (beyond their own), I don't see any incentive for them to handle this with any effectiveness at all.

Like I said, tin-foil hat. I hope it's coincidence and not conspiracy - but the end result might be the same.
 

frimble3

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It's an interesting world in which a government can run amok, and the drug-dealers who may be the saviours of the ill.
They've got sedatives and pain-relievers, and can probably get hold of paralytics and whatever else is needed. And, if they're not practical enough to do it for the general good, bet they'd work for pardons, amnesties, and possibly a hero's parade at the end of this.
"Hey, Charlie, where'd ya steal the medal from?"
"Shaddap, I got it for my services to my country and my fellow Americans."
 

MaeZe

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Updates on hydroxychloroquine that Trump was touting again today with the faulty guidance "what do you have to lose". Setting aside the horrendous outcome of "what do you have to lose" he recited to blacks during the 2016 campaign, it's not how one should be making medical decisions.

Make decisions not on things like "better safe than sorry", but on risk vs benefit and alternative options. I said this a lot in my classes when everyone wanted to take ciprofloxacin during the anthrax scare. If there are side effects and no benefit when a person is afraid but not actually exposed, then the risks outweigh the benefit.

So what about hydroxychloroquine's risks and benefits? It can have cardiac side effects, overdoses, and allergic reactions.

Where are we with the research of benefits? Two small studies done on 62 people each that had at least a semblance of proper methodology: randomized and with controls, had mixed results.

One showed an improved outcome in the treatment group and one showed no difference.

Comparing HydroxyChloroquine Trials
Today’s example: we have a clinical trial of hydroxychloroquine from Wuhan that has just published on a preprint server. What’s good is that this one is blinded, randomized, and controlled (like the earlier hydroxychloroquine which one I blogged about here from Zhejiang University, so we can actually talk about it rather than just spend all our time wondering what the heck is going on.
Links to the studies are embedded.


After five days of treatment, the treatment group showed significant improvements in comparison to the controls in fever, in cough, and in pneumonia (by CT scan). This is actually the first controlled study to show any benefit for chloroquine or hydroxychloroquine therapy against the coronavirus – it may sound odd to say that, but all the positive reports we have had up to now are anecdotal reports and open-label studies without control groups. The one controlled study we have seen, as mentioned, showed no effect. Here’s a comparison between the two:
[graph snipped]
So you can see that these two came out rather differently, with the Zhejiang study showing no detectable difference on treatment and the Wuhan one showing what looks like a real effect, especially on radiological progression of pneumonia (which I have to say is a very strong endpoint to measure). Here, then, is a good exercise in interpreting clinical trial statistics: we are now one-and-one after two small hydroxychloroquine trials: which one (if either) reflects the real-world situation?


There is a large study just beginning looking at preventing infection in healthcare workers.

Detroit Free Press: Henry Ford to lead study on whether hydroxychloroquine can prevent coronavirus
Detroit Mayor Mike Duggan and the Henry Ford Health System announced Thursday that the Detroit-based hospital system will lead the first large-scale U.S. study of the effects of using the drug hydroxychloroquine to prevent coronavirus among health care workers and first responders.

The study is to include 3,000 people to see whether treating them with the medicine can keep them from being sickened by the disease.


Finally, this was interesting. A study in CA found what looks like some of that last (third wave) flu peak was actually unrecognized COVID.

JAMA Network: Community Prevalence of SARS-CoV-2 Among Patients With Influenzalike Illnesses Presenting to a Los Angeles Medical Center in March 2020

Looking back, 5% of the cases on ILI (influenza like illness) were COVID. That is a significant percentage. More importantly, these people had very mild symptoms.

Between March 12-13 and 15-16, 2020, the Los Angeles County + University of Southern California Medical Center conducted testing among patients presenting with mild influenzalike illness to the emergency department or urgent care. Patients who had nasopharyngeal swabs tested with polymerase chain reaction assays for influenza and respiratory syncytial virus (GeneXpert Flu, Cepheid) were automatically tested for SARS-CoV-2 (Quest Diagnostics).

Only the influenza tests conducted during the day shift were automatically tested for SARS-CoV-2 because the process was manual. Patients were excluded if they had specific risk factors for SARS-CoV-2 (eg, travel exposure or known contact with a traveler, severely ill patients admitted for respiratory tract infections). Positive test results were followed up by Department of Public Health experts to assess clinical factors and demographics....

...At the Los Angeles County + University of Southern California Medical Center, the number of influenza tests ordered by physicians was relatively stable, but the percentage of positive test results for influenza declined around the time of the study (Figure 1). Across the county, sentinel testing revealed a third seasonal spike in influenzalike illnesses during the weeks before the study; no third seasonal spike was seen during the prior 4 years, and the third spike occurred later than any spike during those years (Figure 2A). This late, third seasonal influenzalike illness spike occurred even as the percentage of respiratory specimens that tested positive for influenza steadily declined (Figure 2B).

Discussion
The 5% rate of SARS-CoV-2 among patients with mild influenzalike illness without risk factors is concerning. These patients had sufficiently mild illness to be active in the community throughout their illness, increasing the possibility of transmission. Such transmission is consistent with the unusual, third countywide influenzalike illness spike that occurred late in the season and with declining rates of influenza positivity.
 

MaeZe

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It's an interesting world in which a government can run amok, and the drug-dealers who may be the saviours of the ill.
They've got sedatives and pain-relievers, and can probably get hold of paralytics and whatever else is needed. And, if they're not practical enough to do it for the general good, bet they'd work for pardons, amnesties, and possibly a hero's parade at the end of this.
"Hey, Charlie, where'd ya steal the medal from?"
"Shaddap, I got it for my services to my country and my fellow Americans."
Why would anyone want a paralytic unless you were intubating someone or had a murder planned???

Or are they black marketing these to hospitals?
 

frimble3

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Not thinking there would be much market for them normally, but if they could get the name/formula of the desired paralytics, they'd probably know guys who could make them. Presumably the same people who make meth, crack, and God knows what else. I imagine criminal gangs have chemists. If you can take poppy extract to opium to heroin, who knows what else you can do?

What you need is criminals who take pride in their work: quality control is everything.
 

Brightdreamer

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What strikes me, though, is all the pushback on mail-in ballots and the resurgence of the voter fraud nonsense. Also the idea of lifting sanctions (and releasing Putin's money).

I don't think any of this was done on purpose, but I do absolutely believe they're using the pandemic as an excuse and a cover. Given that they don't seem to value human life at all (beyond their own), I don't see any incentive for them to handle this with any effectiveness at all.

Like I said, tin-foil hat. I hope it's coincidence and not conspiracy - but the end result might be the same.

+1

This regime is run by people who seem very adept at taking advantage of any given situation for their personal gain/power grab, and not caring who or what gets hurt long-term.
 

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They're certainly using it to loosen environmental controls on both air and water.
 

Roxxsmom

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I'm curious whether anyone is collecting data on the incidence of Covid-19 in people who are taking hydroxychloroquine for Lupus or other conditions? I don't know if the therapeutic dose for Lupus would be similar to a therapeutic dose for Covid-19, but if there's an absence or under-representation of people taking this drug among the people testing positive for Covid-19, that would not be at the level of a controlled clinical trial, obviously, but it could at least evidence pointing in that direction and something supporting further study.
 

MaeZe

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I'm curious whether anyone is collecting data on the incidence of Covid-19 in people who are taking hydroxychloroquine for Lupus or other conditions? I don't know if the therapeutic dose for Lupus would be similar to a therapeutic dose for Covid-19, but if there's an absence or under-representation of people taking this drug among the people testing positive for Covid-19, that would not be at the level of a controlled clinical trial, obviously, but it could at least evidence pointing in that direction and something supporting further study.
The other place to look is going to be people taking chloroquine to prevent malaria.

I don't think we have a large enough sample size yet despite how large one million cases is.


I used to be on hydroxychloroquine but I had an allergic reaction to it.
 
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Roxxsmom

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The other place to look is going to be people taking chloroquine to prevent malaria.

I don't think we have a large enough sample size yet despite how large one million cases is.

That too, and maybe for certain other autoimmune diseases too. I was on a drug called plaquenil many years ago (it is a name for Hydroxychloroquine) as an attempt to try and treat a very bad flare of alopecia areata. Didn't work, but I remember having to go in for regular eye exams while I was taking it and having to be even more careful than usual about sunlight. Didn't cause me any issues, but maybe the dosage was lower than is generally given for malaria or would be used for anti virals?

Interestingly, the mode of action is not really understood for Plasmodium (the protist that causes malaria). It might possibly work by concentrating in the acid vesicles the organism uses to polymerize heme. Also, it's effect in autoimmune conditions is not well understood. It may interfere with antigen processing in macrophages, which could interfere with the lymphocytes recognizing certain self antigens as foreign. But doesn't that mean it would inhibit the immune system somewhat? Don't we want macrophages displaying viral antigens on their surfaces? Or is it useful in cases that go south because the immune system is overreacting to the virus. How it would affect the infectiousness or reproduction of coronavirus within infected cells, I have no idea.

I'm still struggling to find out if lethality of this virus is ever linked to a cytokine "storm," as was the issue with the H1N1 influenza during WWI. The patients' immune systems overdid it with the production of toxic defense proteins, and this killed lung tissue (this is why many victims were young, healthy people between 15-40). But most Covid-19 patients are older people, or people with co-morbidities, so I don't know if that's as likely to be an issue for them.

One question I have is whether or not someone with asthma who has the virus and is having reactive airways triggered by the infection should use their rescue inhalers or not. Would albuterol make things better or worse in their lungs? It's a bronciodilator, so it might allow more air in, but how does that affect lungs filling with fluid?
 

neandermagnon

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I'm still struggling to find out if lethality of this virus is ever linked to a cytokine "storm," as was the issue with the H1N1 influenza during WWI. The patients' immune systems overdid it with the production of toxic defense proteins, and this killed lung tissue (this is why many victims were young, healthy people between 15-40). But most Covid-19 patients are older people, or people with co-morbidities, so I don't know if that's as likely to be an issue for them.

I recently read an article that suggested that Covid-19 deaths in younger patients is linked to this. Unfortunately I can't remember where I read it and can't find the article again. This BBC article suggests an overreaction of the immune system is occurring in young Covid-19 patients https://www.bbc.co.uk/news/health-51214864 albeit it's in layman's terms and doesn't specifically mention cytokines. I also found this: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext

One question I have is whether or not someone with asthma who has the virus and is having reactive airways triggered by the infection should use their rescue inhalers or not. Would albuterol make things better or worse in their lungs? It's a bronciodilator, so it might allow more air in, but how does that affect lungs filling with fluid?


Asthma UK advice is to continue taking asthma medication as usual https://www.asthma.org.uk/advice/triggers/coronavirus-covid-19/

One of my kids is not quite in the high risk category (ticks 2 out of the 3 necessary boxes).

Though if your lungs have enough fluid in them to stop an inhaler from working you need to be in hospital, so dial 999. Same as for a severe asthma attack that's not getting better in spite of using the reliever inhaler. The only difference would be to make sure the 999 operator knows that you also have Covid-19 symptoms as well as the asthma.

quoted from article:
(phone numbers are UK specific)

If you develop symptoms of COVID-19 and you have asthma:


  • You need to stay at home until you are no longer contagious to others. You can find the detailed NHS guidance on how long to stay at home here.
  • You don't need to contact 111 to tell them you are staying at home.
  • If your COVID-19 symptoms don’t go away after 7 days, or get worse, or you are having difficulty breathing, call 111 for advice, or 999 if you need emergency care.
  • Tell them that you have asthma, and if your asthma symptoms are getting worse.
  • If you get an asthma cough and are not sure whether your cough is a symptom of COVID-19 or related to your asthma, please speak to your GP, use the online 111 service or call 111 to ensure that you get the right care.
  • Keep following your asthma action plan to manage your asthma and so you know what to do if your asthma symptoms get worse. If you are having an asthma attack, call 999 for an ambulance as usual, and tell them you have COVID-19 symptoms.
  • Carry on taking all your usual asthma medicines as normal.
 

ElaineA

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They're in with him hook, line, and sinker (and any other cliched expression indicating being fully committed to someone, wherever it takes them).

I know, but at some point, doesn't basic decent human nature kick in for even *one* of them? I find it astounding, every time they show themselves anew, that every single one of them seem to exhibit not one iota of care for anyone outside of their little coterie. Or even for those inside of it, but who are not part of the financial or political leadership. It just strains everything I thought I armchair-understood about human psychology to have such a huge group of Machiavellis having swarmed together to work in concert.
 

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Stay home and starve or go out and get shot.... oh wait he didn't mean it. :Jaw:


Familiar?


On the press conference front, things must not be going well if Trump's nasty mood is any indication. He gives a press conference with nothing new to say then gets mad at being hit with the same questions he either can't or won't answer.

He went on again telling people to take the magical drug hydroxycloroquine. He holds out the number of people who don't survive after going on the ventilator never saying what the number is. For anyone who wants to know, there is data in two studies showing 30-35% of people survive to come off the ventilator and recover. Personally, I find that very encouraging.


He also lied about people cheating with mail-in voting.
 
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lizmonster

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He also lied about people cheating with mail-in voting.

It sounds weird to say don't be distracted by the pandemic, but: don't get distracted by the pandemic. On that front the White House is utterly useless, and they know it as well as we do. Nothing he says is relevant to it, beyond sowing chaos.

The voter fraud fiction? That they're going to stick with. That they're going to use. They're bad at fixing problems, but they're great at grabbing opportunity.
 

MaeZe

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I know, but at some point, doesn't basic decent human nature kick in for even *one* of them? I find it astounding, every time they show themselves anew, that every single one of them seem to exhibit not one iota of care for anyone outside of their little coterie. Or even for those inside of it, but who are not part of the financial or political leadership. It just strains everything I thought I armchair-understood about human psychology to have such a huge group of Machiavellis having swarmed together to work in concert.

Scary as it sounds, how did so many people follow Hitler? Or Pol Pot?
 

Roxxsmom

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I know, but at some point, doesn't basic decent human nature kick in for even *one* of them? I find it astounding, every time they show themselves anew, that every single one of them seem to exhibit not one iota of care for anyone outside of their little coterie. Or even for those inside of it, but who are not part of the financial or political leadership. It just strains everything I thought I armchair-understood about human psychology to have such a huge group of Machiavellis having swarmed together to work in concert.

People are so good at compartmentalizing. Most, I suspect, feel compassion for an individual person who is suffering in front of them. But making the connection between a choice made by Trump in terms of policies or funding or personnel at the CDC? That's too abstract. So they hang on his sad little scrunched up face (he's probably been studying pictures of Paul Ryan and practicing in front of a mirror in an attempt to get that expression "right") and his breezy assurances as evidence that he cares and that he has confidence in his own abilities.

There's also a very serious issue, one that has plagued the human race since its inception, I think, is that empathy can be very selective. People tend to relate more to those who are familiar to them, or who are in close proximity to them, to those they consider to be like themselves. So for many, seeing images and hearing accounts of "the other" suffering don't register fully, or they might rationalize that "those people" are somehow to blame for their predicament. I suppose it's a way of dealing with cognitive dissonance.

The good news is that we are capable of shifting our perception of who we regard as like us. Human empathy can even extend to other species, and it often does. But it takes work, exposure, and experience to do this, and it can lead to some rather uncomfortable emotions.


I suspect not, because the whole rationale for not showing decisive leadership in this crisis has been fear of one element of his base, which is bizarre blend of Libertarians, rich people, and the more authoritarian-minded Religious Right. Those "don't tell me what to do" people are still out there, and he relies on them for support.

However, I could certainly see him and others turning a blind eye to bands of armed vigilantes who take it upon themselves to start shooting people who are out and about when they "shouldn't" be, or who have out-of-state-plates, or who appear to be ill (which likely means not white) in public spaces. They don't even have to say they thought their victim might have been armed now, simply insist the victim was coughing and posing a threat to the shooter and/or their family/

Of course, Trump has shown himself perfectly capable of turning 180 degrees from a previous position and convincing his base he's been there all along. I suspect he's still more likely to lift the order before it's wise to, though, because he cares more about seeing an economic bounce of some kind before November.

Then there's the Putin approach, which is to utilize tracking technology to enforce strict stay-at-home orders. I'd lay odds that this technology will stay in use after the Covid-19 outbreak is over too. I'd also lay odds that Russians will find ways to hack or circumvent this technology with varying degrees of success. That sort of thing would be harder to implement here, though, where we can't even seem to get a national shelter in place order at all, and some argue that the Constitution wouldn't allow it.
 
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Diana Hignutt

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I know, but at some point, doesn't basic decent human nature kick in for even *one* of them? I find it astounding, every time they show themselves anew, that every single one of them seem to exhibit not one iota of care for anyone outside of their little coterie. Or even for those inside of it, but who are not part of the financial or political leadership. It just strains everything I thought I armchair-understood about human psychology to have such a huge group of Machiavellis having swarmed together to work in concert.

Narcissistic leaders appeal to narcissists. It's a great pyramid of NPD.
 

neandermagnon

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There's also a very serious issue, one that has plagued the human race since its inception, I think, is that empathy can be very selective. People tend to relate more to those who are familiar to them, or who are in close proximity to them, to those they consider to be like themselves. So for many, seeing images and hearing accounts of "the other" suffering don't register fully, or they might rationalize that "those people" are somehow to blame for their predicament. I suppose it's a way of dealing with cognitive dissonance.

The good news is that we are capable of shifting our perception of who we regard as like us. Human empathy can even extend to other species, and it often does. But it takes work, exposure, and experience to do this, and it can lead to some rather uncomfortable emotions.

I don't think the problem relates to sameness/differentness. It's more that we evolved for population sizes where you had around 80-100 people in your immediate tribe and maybe you knew a few other tribes, so max 500 people. Nearly everyone is born with empathy for other humans that we interact with and get to know, and not just humans, other animals too. But people we don't know, like when someone talks about faceless, nameless people on some other continent that we can't even see, let alone interact with as individuals, that's where empathy often fails.

Right wing political leaders exploit this by making this hypothetical other that we don't know and can't interact with into the enemy. In worst cases, completely dehumanising them (which actively makes it harder for the target audience to experience empathy for them). That's also why you get people who are racist-except-for-my-friend-Abdul and those who will say that so-and-so that they know from the hated group is okay and not like all the others. It's hard to fear and hate someone you interact with, who smiles and says hi. It's easy to hate a faceless, nameless other that you've never met. The other isn't necessarily an ethnic group, it can be other groups that are picked on by right wing politicians and media, such as homeless people, people on benefits/welfare, single mothers, etc etc. Always someone that the target audience hasn't interacted with (and if they have interacted with one or two of them, they're the rare exception that isn't like all the others).

To have empathy towards people we haven't met, that takes learning. And the best way to teach it is to let them get to know the people, to see their faces, hear their voices, know their names, hear their stories. I know someone who runs trans awareness courses for schools, colleges etc and she says that the single most effective way to get people to empathise with trans people and understand the issues they face is to show them videos of trans people telling first hand accounts of their life and the difficulties they face. People's empathy kicks in when they get the chance to know people as individuals.

Another example, remember when loads of people suddenly found they did have empathy for Syrian refugees, after they saw pictures of a little dead toddler washed up on a beach. Suddenly the dead toddler was a real person with a name and a face and a family and a little life snuffed out in the most horrific of circumstances.

As a genus, humans are incredibly co-operative, empathetic and altruistic. It's a big part of our evolutionary niche. Problem is we evolved in small populations at low population densities and now live in the world where there's around 8 billion of us. A number we can't even imagine. A population we cannot possibly get to know.
 

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Navy commander relieved of duty for sounding alarm about COVID outbreak on board get a resounding cheer as he leaves the ship:

CNN: Commander of aircraft carrier hit by coronavirus removed for 'poor judgment' after sounding alarm

What has happened to my country?

And we all knew this was coming on the White House Survivor show:
Politico: Trump fires intelligence community watchdog who defied him on whistleblower complaint


Edited to add: better videos of the send off here: Stars and Stripes: 'Captain Crozier! Captain Crozier!': Videos show sailors sending off ousted USS Roosevelt commander with cheers

Also: Stars and Stripes: Lawmakers call for probe into firing of virus-stricken aircraft carrier's commander

While the GOP legislators are still investigating the Inspector General about the mistakes on the FISA warrant applications investigating Russian interference in the 2016 election. I guess to make incompetrumpetty happy???

And now Captain Crozier has tested positive for COVID-19.

I'm disgusted with how the Navy is handling this. They have 4,800 people aboard a filthy floating Petri dish, at least 150 of whom are confirmed positive, and it's just going to get worse if they don't get everyone off the boat and disinfect the whole thing from top to bottom. Social distancing on an aircraft carrier is impossible. And from scuttlebutt coming from various friends on different ships/installations, the military is not handling COVID-19 well *at all*. I wish I could say I'm surprised, but I'm not.
 
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