The One Covid-19 Science and Medicine Thread

[a_unique_person]

Australia is heading down to 0 new infections and hardly anyone is wearing masks.

 

[DallasDad]

The big problem with using immunosuppressants is that there are always opportunistic bacteria floating around, especially in hospitals. You can have impaired lung function from COVID-19, and then pick up bacterial pneumonia. To combat that, you have to add IV antibiotics, which often stresses other organs. Careful dosing and frequent monitoring are the keys, and it's devilishly tricky to balance things even when trying to support just one dangerously ill patient, let alone when non-specialist doctors are dealing with full wards of patients in the same position.

 

[The Atheist]

The more I listen to these virologists the more they talk about not so much anti virals or fighting the virus but talking about modifying how the body deals with it.

Apparently we'll have some proper results in the next few days.

I'm still not expecting a magic bullet, but if they can come up with something even 50% effective it'd be a big improvement on where we're at right now.

Australia is heading down to 0 new infections and hardly anyone is wearing masks.

Race ya!

We're running pretty neck & neck - you're a bit better than us today on cases per capita and we were better than you yesterday.

I remain unconvinced elimination of the virus is possible, but if we can keep it down to a handful of cases a day, with 100% follow up, we could easily work through it.

 

[rjh01]

Australia is heading down to 0 new infections and hardly anyone is wearing masks.

Please note Australia is a long way from 0. In the last week Australia has had 320 new cases. This may be much better than the peak of 2,339 but the numbers came at a huge price. Last 13 days, that is 12 days after the lockdown began, the reduction of new cases has been 35-45% per week. In the next week Australia will get between 112 - 144 new cases.

If one criteria for the ending of the lockdown is no new cases then Australia will always be in lockdown.

Ref: https://www.health.gov.au/news/heal...ent-situation-and-case-numbers#current-status (but you can get similar numbers as above from any relevant reliable source).

ETA

<snip>

We're running pretty neck & neck - you're a bit better than us today on cases per capita and we were better than you yesterday.

I remain unconvinced elimination of the virus is possible, but if we can keep it down to a handful of cases a day, with 100% follow up, we could easily work through it.

If Australia and New Zealand do similar things then we can expect similar results.

ETA2. Looks like you are right. The main differences between the two countries are related to population sizes.

 

[Planigale]

Here's something I found interesting:

Dag Berild, a medical doctor and Associate Professor at Oslo University Hospital, argued that the low level of antibiotic resistant bacteria in Norwegian hospitals may also have played a role in the country's lower mortality rate.

"The argument for that is that many of the coronavirus pneumonia cases are complicated by bacterial pneumonia, so if that is the case with coronavirus, then patients in a country with a low resistance rate among bacteria would have a better prognosis than those in Italy, where they have an awful lot of resistant bacteria, particularly in Lombardy."

The article is about Norway's testing capacity which some may also find interesting:

https://www.thelocal.no/20200403/how-has-norway-managed-to-test-so-many-for-coronavirus

We are not seeing secondary bacterial pneumonia in the same way as we do for flu.

 

[Planigale]

None of the antibody tests have had anything close to adequate testing to verify sensitivity and specificity. That is probably true worldwide as well but I'm only familiar with the tests being used in the US.

WHO agrees with you.

 

[Planigale]

I cannot understand how they could measure the accuracy of these antibody tests. Like the result of a test is positive. Does it mean the person has had the virus or is it a false positive? All they can do is test people who have recently recovered and if their test is negative then probably something is wrong with the test.

To find known negative cases they can go into nursing homes where they know that no one has had the virus and test these people. If they come out positive then it is a good indication that the test is faulty.

You can compare the commercial kit to a highly sensitive highly standardised laboratory assay. PHE have been collecting acute and convalescent bloods from known cases and there will be blood samples from pre covid that are definite negatives. So you can get a good sense of a false negative and false positive rate. There will be bloods that have been standardised and have known antibody levels that tests can be measured against.

 

[dann]

Here's something I found interesting:

Dag Berild, a medical doctor and Associate Professor at Oslo University Hospital, argued that the low level of antibiotic resistant bacteria in Norwegian hospitals may also have played a role in the country's lower mortality rate.

"The argument for that is that many of the coronavirus pneumonia cases are complicated by bacterial pneumonia, so if that is the case with coronavirus, then patients in a country with a low resistance rate among bacteria would have a better prognosis than those in Italy, where they have an awful lot of resistant bacteria, particularly in Lombardy."

The article is about Norway's testing capacity which some may also find interesting:

https://www.thelocal.no/20200403/how-has-norway-managed-to-test-so-many-for-coronavirus

For this reason, they will start giving pneumococcal vaccinations to everybody 65+ and other vulnerable groups in Denmark next week.

Norway must have been better prepared for testing a large number of people from the very beginning. Do you know if this is due to the many fish farms in Norway - like in the Faroe Islands?

 

[Planigale]

The more I listen to these virologists the more they talk about not so much anti virals or fighting the virus but talking about modifying how the body deals with it. it seems like the body starts to get good at fighting the virus then at the same time starts fighting itself badly. So it seems like we should be hearing a lot more about anti inflammatories and immune suppressors. We do hear a lot about steroids bad at the start of infection but good at later stages. What does Tocilizumab do?

The vast majority of people recover with no treatment. If you give everyone immunosuppressant treatment you increase risk of other infections and might increase deaths. So you need to select out those who are very likely not to recover, and the treatment needs to be given at the right time, too soon and you are likely treating people unnecessarily, too late and it might not work.

Steroids used in SARS and MERS showed no benefit and some harm, but RCT of steroids in SARS-CoV-2 infection are under way.

Tocilizumab is a synthetic antibody that binds a chemical called interleukin 6. By binding it it inactivates it. Interleukin 6 is a chemical that is involved in driving the immune response, it is normally used to switch off the inflammatory action in arthritis and some cancers of the immune system. There are other similar drugs in trials. They are usually being given only to people with advanced disease needing ICU.

 

[Planigale]

For this reason, they will start giving pneumococcal vaccinations to everybody 65+ and other vulnerable groups in Denmark next week.

Norway must have been better prepared for testing a large number of people from the very beginning. Do you know if this is due to the many fish farms in Norway - like in the Faroe Islands?

Pneumococcal vaccine is already given to the elderly and high risk groups in the UK (essentially if eligible for a flu vaccine then you are eligible for pneumonia vaccine).

 

[rjh01]

You can compare the commercial kit to a highly sensitive highly standardised laboratory assay. PHE have been collecting acute and convalescent bloods from known cases and there will be blood samples from pre covid that are definite negatives. So you can get a good sense of a false negative and false positive rate. There will be bloods that have been standardised and have known antibody levels that tests can be measured against.

Thanks. That makes sense.

 

[Ulf Nereng]

For this reason, they will start giving pneumococcal vaccinations to everybody 65+ and other vulnerable groups in Denmark next week.

Norway must have been better prepared for testing a large number of people from the very beginning. Do you know if this is due to the many fish farms in Norway - like in the Faroe Islands?

The doctor in the interview said that Norway has a high capacity to test because of the highly decentralized nature of our healthcare system. Most regional hospitals have their own testing lab, due to the long distances in Norway.

He also mentioned that there's a number of private testing labs, and this I think could be because of our large salmon farming industry.

 

[Ulf Nereng]

Interesting about UV-C light from Medcram:

https://www.youtube.com/watch?v=2U4DAQ3kjRs

(He also talks about Remdesivir at the start)

 

[Belz...]

WHO agrees with you.

And he's on first.

 

[dann]

Interesting about UV-C light from Medcram:

https://www.youtube.com/watch?v=2U4DAQ3kjRs

(He also talks about Remdesivir at the start)

There are ongoing trials at Rigshospitalet in Copenhagen. The trials will be finished this month.
Promising drug given to first Danish corona patients (Uniavisen, March 30, 2020)

 

[rjh01]

Just noticed something odd about the number of new cases. It is happening in several countries, including Australia for the last 6 days. That is the number of new cases is stuck. Every day there are the same number of new cases plus or minus some noise. For example in America there have been about 30,000 new cases every day since 2 April.

I fear the lockdown is not working very well. It should be reducing this number and it is not. It is only holding it steady.

 

[Squeegee Beckenheim]

"85 times as many people have had the virus as they had thought"? So mortality rate is not 4%, but 1/85 of 4%, but we all know my maths.... Herd immunity, here we come!

Other coronaviruses for which this has been tested confer immunity for about a year. If the same is true for this one, then herd immunity won't happen.

 

[dann]

Just noticed something odd about the number of new cases. It is happening in several countries, including Australia for the last 6 days. That is the number of new cases is stuck. Every day there are the same number of new cases plus or minus some noise. For example in America there have been about 30,000 new cases every day since 2 April.

I fear the lockdown is not working very well. It should be reducing this number and it is not. It is only holding it steady.

Don't forget that there are probably millions of so-far-untested but actually infected cases out there. The day-to-day number of people infected with the virus reflects the number of people tested more than the actual rate of infections.
The only thing that you can count on with some reliability is the number of registered deaths and hospitalizations. It took a couple of weeks for the death toll to go down in Denmark, but it did so eventually - along with the number of 1) hospitalizations, 2) patients in intensive care and 3) on ventilators.
See the three curves here: Indlagte på danske hospitaler = Corona patients in Danish hospitals

I don't know the English word for "smittetryk" (contagiousness?), the number of new infections caused by the average person infected with the virus. In Denmark, it went down from 2.6 (March 12) to 0.6 (April 14), which is actually much more than expected:
Faldende smittetryk i Danmark er 'meget overraskende', siger Statens Serum Institut (TV2.dk, April 14, 2020)

 

[JeanTate]

The nasal swab positive rate among patients with symptoms is only about 8%. Which leaves room for lots of serum true positives. 85x 8% is not a small number.

Got any numbers for false positives on equivalent tests? Isn't HIV about 5%?

85x is given for the Stanford study, the L.A. study is not as high, but of similar magnitude. And more random, and larger sample size. I eagerly await our Serological Overlord.

If a Covid-19 antibody test has a 95% specificity, and 5 out of 100 tests come back positive, what does that tell you (assume the test has 100% sensitivity)?

 

[JeanTate]

Link to post quoted here.

Turns out the WHO situation report gives a Grand Total of 36,405 for 31 March 2020.

Also:
14509/8778 = 1.65 (not 2.00)
23335/14509 = 1.61 (not 2.00)
36405/23335 = 1.56 (not 2.00)

So what?

For one, my "supposes" were wrong* even as I wrote them.

For another, anyone who read my post could have easily discovered at least these inconsistencies.

Here are the relevant numbers for three dates in April:
4 April: 56,986 (/36405 = 1.56)
8 April: 79,235 (/56986 = 1.39)
12 April: 105,592 (/79235 = 1.33)

The data suggest that the doubling time has gone from ~five days in late March to ~eight days ~two weeks later. This is a very welcome trend, if it indeed reflects accurately how the death toll from covid-19 is changing.

*In the sense that they were obviously inconsistent with what was in the WHO situation reports, although the 36405 value was not known at the time of my post.

Something of an update.

16 April: 130,885 (/105592 = 1.24)

Fitting a linear trend line to the ratio data, and extrapolating:
20 April: 1.19 (Grand Total, global covid-19 deaths: 165,860)
24 April: 1.12 (185,763)
28 April: 1.05 (195,051)

Which is good news.

However, will Russia become the new Italy (or Spain)? Etc.