Parallel Approaches

There are several possible kinds of therapies for  COVID-19: vaccines, serums, antivirals – and each of those come in a number of flavors.

Which should the US fund?

All of them.

 

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251 Responses to Parallel Approaches

  1. TB says:

    Some suggestions from someone regularly exposed to cold and flu virus in hospital. I’m a nurse and around these patients frequently, and they are often not diagnosed for many hours or days so we are closely and directly exposed to people shedding virii. You can catch these through the air or droplets, true, but more importantly off your fingers.

    We are told to wash our hands to prevent this. Fine, but your hands touch things constantly. How long can you go without touching finger to an eye, nose or mouth? My suggestions is to wash your face as soon after exposure as you can. If you buy masks, buy the kind with the plastic eye shields. Not because masks filter out virii. They don’t. The mask helps you remember not to touch your face with your fingers, and the eye shield reminds you to avoid touching your eyes.

    The inner corner of the eye has a tract that leads directly back to the throat, channeling filth. Touch a door, wipe your eye, get a cold a day or two later. Or nose, or mouth. Wash hands, and face. I will wipe my face with an alcohol-soaked washcloth after an exposure. No idea if it helps, but I have not had a cold this winter in spite of frequent exposure.

    We don’t have a good handle on how this corona spreads, but most likely it spreads the same ways other corona virus spread. The same precautions should help.

  2. dearieme says:

    A friend in Singapore tells me that shops measure his temperature before they’ll let him in, and post a little sticker on him to show he’s passed the test. He’s had one business refuse him entry because he admitted to having flown in the last fortnight. “But it was from Australia” he said. “No exceptions” they said.

    He tells me that Singaporeans are pretty optimistic that they’ll escape the worst because their government is competent and dutiful, and because they expect fellow citizens to behave well.

    His own plan was to self-medicate with English blue cheese but he’s found it’s all sold out. So it may be back to the old whisky/honey/lemon juice remedy.

    • A. Mous says:

      Singapore’s PM–Lee Kuan Yew’s son–was the Senior Wrangler at Cambridge.

      Safe to say he’s our smartest world leader?

      https://en.wikipedia.org/wiki/Senior_Wrangler

      • dearieme says:

        His father, “Harry” Lee, seems to have been very highly rated by everyone in Britain who’d met him. He’d “graduated from Fitzwilliam College, Cambridge, with double starred-first-class honours in law.”

        Even in these fallen times to be Senior Wrangler is most impressive. Hats off! What a super-bright family.

      • magusjanus says:

        Not just the dad. LkY told the story how met his future wife during announcement of results at Raffles (most elite school in Singapore you need to test into). He fully expected to get first during grades announcement, got second and was flabbergasted. They then announced the first place, one of the few women there.

        He was instantly mesmerised by the competition, courted her and later married her in secret in college.

  3. ASR says:

    I’ve been involved with public health and epidemiology for much of my working life and spent the last fifteen years of my full employment as an epidemiologist in my state’s department of public health. It seems clear to me that the story (or more accurately stories) about the new Corona virus, its origins, its infectiousness, the means by which it is spread, its pathogenicity, its virulence, its current prevalence, its rate of incidence, and its case fatality rate are all false and intended to confuse, obfuscate, and probably hide some unpleasant and dangerous truths. Until we get honest data it will be hard to figure out what is really going on, let alone predict the future course of the current epidemic, and how to prepare for and mitigate the future spread of the virus. My sense is that things are worse than we’ve so far been informed and could get far worse. Spera optimo, para pessimo.

    • reinertor says:

      I don’t think all the stories and data are false, but truths are mixed up with half-truths and outright falsities, some of them deliberately, some unknowingly, that it’s difficult to know what’s going on.

  4. Smithie says:

    Spaceflight, so that not all our eggs are in one basket.

    …and to bring back the Martian Plague, which is really good at surviving and crossing the species barrier.

  5. David Chamberlin says:

    Well said, I agree with you. We are in a race to find effective therapies before Covid19 gets uncontrollably loose in a third world country and after that the rest of the world.

    • David Chamberlin says:

      meant to follow up ASR’s comment

    • TB says:

      It’s a cold virus. Not much chance of stopping it.

      • David Chamberlin says:

        There are 200 virus strains implicated in causing the common cold, that is why they are unstoppable. Flu viruses have an incubation period of one day making a quarantine impossible. Covid19 has enough incubation period 3-14 days to make a quarantine possible. Can the Chinese lower the R-naught to below one with their quarantine and actually beat it? John Barry says no if there are sufficient asymptomatic spreaders of it and every indication is there are plenty of them. The experienced epidemiologists like ASR that I have listened to and speak honestly, many don’t for fear of causing panic, are very pessimistic Covid-19 can be contained. But multiple outcomes are possible. It could mutate to be less virulent, it could dwindle away in hot weather only to come back with a vengeance in another part of the world at a much later date, who knows.

        Holding this virus at bay until an effective therapy or combination of therapies is crucial.

        • TB says:

          I hope some treatment is found to be helpful as I have zero hope that quarantine will be effective. Working with flu patients daily every winter I see just how poorly we are able to isolate them. Once isolation is in place it’s fine, but before they get to us they infect their families, the ER, everything they touch. One patient recently had given her mom a kiss and that’s how she caught the flu.

          So many minor illnesses have similar symptoms, and so many people have chronic COPD and heart failure, that often presents as if it were a cold during an exacerbation, it is impossible for people to know when to self-isolate. For quarantine to work, everyone with the sniffles or a cough would have to stay home.

        • gkai says:

          I do not not see how quarantine is more effective the longer the incubation period is. A short incubation means you do not need quarantine as much (if quarantine is defined as isolating maybe-sick patients), which is really a good news: less people to isolate, and the one you do isolate are really sick so easier to spot and more accepting the isolation.

          Any angle I consider, a long incubation period, with no symptoms but you already shred virus so you can contaminate others, is the worse.
          Sure, it means quarantine is more needed, but the longer the incubation the harder it will be to get an effective quarantine. At one point, you really need quarantine like you need world peace, free mana and Santa visiting every week end. Sure, having it would be nice and solve many problems, but you will not have it and attempts are a loss of time and resources.
          Thinking too much of impossible solution will just distract from possibles solutions…

          • David Chamberlin says:

            The reason an incubation period is very important in controlling the spread of an infectious disease is it gives you time to track down all the people that the infected person came in contact and quarantine them before they are infectious. Otherwise you have no hope of stopping the spread of the disease. With an R-0, the infection rate being over 1 it is always spreading ahead of the people being quarantined. https://www.youtube.com/watch?v=pjHbogeWiXU.Here is a podcast with John Barry that explains in further detail. He wrote the book The Great Influenza which I highly recommend reading and is now recognized as a an expert on virus pandemics.

            • gkai says:

              That I get, but the confusion is around what is incubation: is it the period before symptoms, or before the host can contaminate others? for me incubation is period before symptoms, then long incubation makes getting an effective quarantine harder. Much harder if contaminated are already contagious during most of the incubation perdiod. If incubation is the time before becoming contagious, then I have more trouble predicting the effect: on one hand, more time to put the contaminated in quarantine. On the other hand, more time for them to move around before being obviously sick, so they are also harder to detect…
              Well, I do not consider the case where contagion can occur only (well) after the symptoms…Is it even possible?

              Anyway, given that media tell covid-19 can be transmitted long before the infected show any symptoms, and call this period incubation period, it seems my definition is the one used by the media and that we are in the worst-case scenario regarding the effectiveness of quarantine measures

        • dux.ie says:

          If you do not forcibly quarantine the infected you will have the situation like that in Korea where the infected cult members are playing hide and seek with the authority. Look at the Korean current per MCapita infection rate now at about 35.0 shooting up like a rocket and it is about 7x higher than the second highest Chinese provincial current per MCapita rate of 5.0 for Zhejiang. With lock-down and enforced quarantine the current per MCapita rate for Hubei is about 100x higher than the neighboring provinces like Zhejiang without which the neighboring provinces will be in big trouble.

  6. James L. says:

    The situation is under control, and, except for China maybe, the worst is over. The quarantines have worked. COVID-19 has actually killed far fewer persons than the flu. Panicking and wasting American money now would be useless.

    • John Massey says:

      Case fatality rate is a lot higher than seasonal influenza, and it is at least as infectious as ‘flu. Outside of China, the rate of new infections keeps climbing with no sign at all of it leveling off. H1N1 is the dominant ‘flu strain this winter and it has killed a lot of people, but SARS-CoV-2 is a new disease to which there is no immunity, so it has the potential to kill a lot more people than H1N1. And the Chinese CDC are warning that it might well mutate to become more virulent.

      So yes, you are an idiot.

      • gcochran9 says:

        Thanks. I wonder if the Chinese controls have pushed their R0 under 1.0, and I also wonder how long they can sustain those controls.

        If they relax, it starts spreading again. The virus will always get through.

        The only plan is to slow down the spread and hope to make therapeutic/preventive progress in the time you’ve got.

      • John Massey says:

        They have in Guangdong Province, and I think I’m right in saying that only Guangzhou and Shenzhen (and maybe a couple of the smaller cities) are still locked down. Everywhere else they have gone back to work, after doing a mandatory 14 day quarantine. I am expecting the lockdown on Shenzhen to be lifted in early March.

        But yes, it hasn’t gone anywhere. It can’t be eradicated, that would be a foolish notion. So it needs full speed ahead, on everything.

      • John Massey says:

        Greg, if you go here and scroll to the last page, you can see the bar plot for Guangdong Province. I have lots of reasons for believing the Guangdong data are genuine.

        Click to access statistics_of_the_cases_novel_coronavirus_infection_en.pdf

        So, Ro < 1, but that does not = gone away; eradicated. Can’t be.

        • gothamette says:

          Do you credit the cases in Iran as being COVID19? Hard to know what/whom to trust.

          • reinertor says:

            Iran announced it. Why would they invent such a story, which is bound to create panic and chaos inside Iran, and further erode the people’s (at least the upper middle class’s) trust in the regime..? It’s against interest.

            Probably they had lots of strange cases of flu, some of them developing into critical pneumonia, and by the time some of the patients were already in intensive care, some guy had the idea they might test it for Covid-19.

            Not a big surprise, since China is one of the remaining few countries still willing to buy at least some of Iran’s oil, and they are even friendly to each other, at times approaching quasi alliance levels. There are still regular flights between China and Iran…

        • gothamette says:

          Yes, people are returning to work, and to public transport. Swathed in plastic sheeting. What a way to live.

  7. Anonymous says:

    Diversity of options is our strength.

  8. Tim Burr says:

    I know this sounds silly, but has anyone non-Asian died from this virus?

    • John Massey says:

      You are right; it sounds silly. Plus please define who you mean by ‘Asian’.

      This idiotic idea keeps doing the rounds. You won’t shut up until some of the Pure White Race die from it, even though that won’t prove a damn thing. Is an 80 year old Mighty Whitey who is diabetic, has chronic heart disease and has been a lifelong heavy smoker more likely to die after receiving a high viral load than a healthy 20 year old Chinese person who has never smoked and receives a much smaller viral load? Obviously yes, but what does that prove?

      If the answer is no, then something really weird is going on, but I really wouldn’t bet on it.

      • gcochran9 says:

        The clearest examples of strong differential response to an infectious disease either involve one population with heavy historic exposure to that disease ( thus resistant – Africans and malaria) or a population that has been especially isolated (thus vulnerable, like Amerindians or Polynesians).

      • John Massey says:

        Tangential anecdote: In Hong Kong there is an area called Happy Valley. When the British colonised HK, Happy Valley was a malarial swamp teeming with mosquitoes, with a muddy stream flowing through it, but Cantonese farmers were farming it for rice and fishing in the stream with seeming impunity. The Brits built an army barracks nearby, and because they were there for a long haul, the married soldiers were permitted to have their families live with them. In the first few years, literally hundreds of the soldiers, their wives and kids died – the fatality rate was something like 80%, not just from malaria but a selection of other tropical diseases as well. The Cantonese farmers went on farming and fishing, and evidently not dying.

        So the Brits did what any sensible Englishman would do – they demolished the barracks and moved it somewhere else, and they kicked out the farmers and filled in the swampy ground, enclosed the stream in buried concrete culverts and built a horse racing track on top of it – no more malaria or other pestilence. I don’t know if any descendants of those Cantonese farmers still retain any malaria resistance, but I would bet they had some.

        • Tim Burr says:

          Given all that, what’s so silly about asking if there are racial/ethnic differences in how people respond to the coronavirus in question? Because it could be very important information to help save lives.

      • Rory says:

        You seem really mad. And the term Asian is pretty self-explanatory to anyone who’s not determined to be obtuse.

        • John Massey says:

          How much do you know about population genetics?

          Please enlighten me – who are ‘Asians’? Chinese + Koreans + Japanese? Okinawans? Only the Han ethnic majority of Chinese, or some or all of the 56 ethnic minorities in China? Which ones? Uyghurs? Kazakhs? How about Mongolians? Manchus? Vietnamese? Khmer? Filipinos? Indonesians? Malays? Thais? Hmong? Hazaras? Burmese? Bangladeshis? Pakistanis? Indians? Sri Lankans? Uzbeks? Tajiks? If Uyghurs are, what about Turks? Taiwanese aborigines? Sentinelese? Native Americans? Pacific Islanders? I’ve oversimplified and missed a lot of possibles out, to try to make it easier for you.

          • gothamette says:

            John,

            Ignore these assholes. They are not worth your time.

            Answer me this: why is the virus sparing little kids? I get why it’s killing older folks, people with all sorts of underlying issues… that’s such a no-brainer even I can understand it.

            But what is the fundamental reason why no kids have died? I thought that because of their underdeveloped immune systems they would be sitting ducks.

            Maybe moms & dads in Wuhan put their own quarantine on their kids as soon as the virus became apparent?

            I have no ideas, what say you?

        • Frau Katze says:

          Greg has no patience for fools. He is rude to them and frequently bans them.

          I used to dislike his approach but now I’m used to it.

    • anonymous@asdf.com says:

      Follow that line of thought and Twitter + CPP will ban you on just like @ZeroHedge. :/

    • Henry Scrope says:

      You’re only allowed to ask questions like that if you ask them in Latin.

  9. Bert says:

    There is a substantial body of theory about the evolution of virulence. The probability of transmission to a new host is a critical independent variable in this theory. From the review paper linked below, “The consensus of mathematical theory based around a transmission–virulence trade-off, therefore, is that increasing environmental transmission will lead to the evolution of increased virulence under most scenarios. ” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873896/

    If Covid-19 is currently relatively benign in many individuals, that situation is not at all guaranteed going forward. Therefore all possible treatments should be examined, especially in search of ones effective against viral variants that reproduce most rapidly after entering the new host.

  10. R49 says:

    Hello,

    what about the ship in Yokohama? Isn’t that a source of real data, in particular to the mortality? As far as I “know” (a risky word in this context), nobody on the ship died yet, correct? They already had 542+ confirmed infections on the ship. Shouldn’t it be possible to learn a lot from these data?

    Thanks for your opinions.

    • David Chamberlin says:

      You are right. It’s an experiment to see how infectious Covid-19 is and those poor bastards on that ship are the lab rats. Not that it was intentional but that is how it is. Presumably one person on that ship spread it far and wide even with the lab rats locked up in their cages and not in direct contact with each other. Now if that one person had been in a crowded third world ghetto what do you think the result would be?

      The good news is 80 percent of those infected have hardly any symptoms and the bad news is 80 percent of those infected hardly have any symptoms and spread it far and wide. The “successful” quarantine in China can’t be continued too long, people have to get out of their houses and do their jobs. They are hoping that the hot weather will greatly lower the R-0, it does that in very similar viruses.

      There has been a lot of talk that maybe the Chinese are far more vulnerable to Covid-19. That looks highly unlikely, however this virus is vastly more dangerous to the elderly, smokers, and the ill when the health system breaks down because of overload.

      • R49 says:

        Hello,

        I just read that of the now over 600 infected people on the ship, about 322 have no real symptoms, particularly neither fever nor a cough (source: faz.net). That makes it harder to spot spreaders.

    • John Massey says:

      Two from the ship have died already. There is plenty of time yet for more of them to die. The disease is long lasting and follows a progression. In the early stages it is mild, at which point some people will recover, but about day 5 some people will start getting breathing difficulty and they will become more severe cases, and some of those will progress to becoming critical, and some of those will die. As is typical of cruise ships, a high proportion of passengers are elderly, so that increases the probability by a lot that more will die.

      It turns out that the ship is worthless as an experiment, because conditions on the ship have been reported to be chaotic, and no one has been applying any kind of proper infectious disease controls on board. So, the only thing that can be concluded from it is that if you lock up a load of people in a confined environment where some of the people have a very infectious disease, and you don’t apply any effective infectious disease controls, a lot of people are going to be infected, and the number of infections will keep rising until all of the people are removed from that environment.

      I think we already knew that.

      • R49 says:

        I don’t think it is “worthless”. Because from the ship, you can deduce a mortality rate independent of Chinese communications and for a well-understood group composition. As far as I know, those data don’t exist anywhere yet.

        • John Massey says:

          Yeah? So what is the group composition? Age, gender, ethnicity, prior health conditions? Who is going to report all of that ‘well understood’ information? You?

          Who is collecting all of that data – the Japanese authorities? Don’t make me laugh – they are frantically trying to cover up their appalling management of the situation, saying that most of the now 621 infected people were already infected when they boarded the ship. The ship departed from Yokohama at the start of the cruise on January 20, 31 days ago.

          Who is doing all of the follow up on all these passengers and reporting? Infected people have been sent to hospitals in Japan all over the place. One old guy from Hong Kong was separated from his wife when they were hospitalised in different hospitals, his mobile phone has run flat, and he can’t even find out where the Japanese have taken his wife and what has happened to her. They haven’t been able to tell him. They don’t know where they have put her.

          Know what happened to the Dutch passengers on board? They were allowed off the ship and all permitted to catch commercial flights out to wherever, so they are in the wind, infected or otherwise.

          But all of that is worth more than a systematic study of 72,000 patients published by the CCDC.

          • reiner Tor says:

            No-one said it was “worth more,” such a comparison between the CCDC data and the cruise ship data didn’t even come up in your interlocutor’s comment. He merely mentioned that all the data we currently have is from China, and those of who don’t study the Fourteen Principles of Xi Jinping Thought in their free time tend to take official Chinese data with a modicum of salt, because it’s not fully known under what circumstances those data were collected, and obviously under times of crises all political leaderships are motivated to hide a portion of the truth, especially in a totalitarian dictatorship with full control over the media and all channels of communications and the ability to arrest journalists or bloggers and vloggers for disclosing supposedly secret information.

            Therefore, the cruise ship data should have some value, as we now have something to compare Chinese data to.

            • John Massey says:

              Compare how? Please tell me, I’m all ears.

              • gothamette says:

                John,

                The fact that the Japanese and the Dutch have f’d up means that they haven’t done things they should have done. Right?

                It would be very helpful for someone to follow carefully every person who gets off the Diamond Princess and notate what happens to them.

                Will that happen? No. Should it? Yes.

          • R49 says:

            I have to say, you come across rather aggressively. And as you where asking “You?”. Why not? I have a paper with two physics nobel prize winners. You too?

            • John Massey says:

              Fine, I get it, you are a genius.

              So, please proceed. I am keen to learn from you about this.

            • R49,

              You have to understand that Massey is a great defender of the Chinese authorities In all things, and hence the minute you said that we now had a source independent of their claims on the coronavirus, you made the hair on the back of his neck stand up.

              • John Massey says:

                ‘Pincher Martin’ is a liar and a troll. Ignore him.

                Sure, I agree about what should have happened on the ship and what should happen. Problem was it didn’t, and it isn’t.

              • ‘Pincher Martin’ is a liar and a troll. Ignore him.

                What I said about ‘John Massey’ was neither a lie nor a troll job. He reflexively kowtows to the Chinese authorities. The fact he didn’t think this natural experiment on the Diamond Princess, however flawed it might be, could have some value is telling. You will certainly never hear him speak of the Chinese authorities in the same kind of denigrating terms he spoke of the Japanese authorities.

            • Maciano says:

              I noticed the Cochran comment section caught a severe case of John Massey infection myself.

              Every comment seems vulnerable to aggressive nonsense and useless brain farts.

              I hope the blog immune system will rid itself of this soon before it gets worse. At twitter every user can mute or block, but blogs have not evolved that defense yet.

      • David Chamberlin says:

        Hi John, the “experiment” that was the Diamond Princess is a very long way from worthless. It clearly illustrated to the world just how infectious Covid-19 is. It will be used to rationalize heavy investment in multiple therapies that can be used to combat this virus. Of course it isn’t an actual scientific experiment but it shows the rest of the world how fast and easily this virus can spread.

        • gothamette says:

          I’m with Chamberlin. These people should be tracked and watched.

          • j says:

            All the Israelis returned from Wuhan and the Diamond Princess are quarantined and all are well – not one has died. As far as I know, there are no deaths among the numerous people returned to their countries although probably most carried the virus. Regarding the two elderly passengers deceased on that ship, I speculate that they are within the actuarial probabilities for the large population of that pleasure ship and all the stress and trauma they all went through in the last month. In fact, thanks to the free food, spirits and sex, most trips end with someone or more DOA.

            • j says:

              In attention to the pedants roaming the interblogs, I checked my numbers. Cruises are safe (chances of dying = one in a million).

            • gothamette says:

              No deaths but have they spread the virus?

              It lurks, undetected. For an as yet unknown amount of time.

              Those Dutch should have been quarantined.

              Our evacuees, same.

            • gothamette says:

              The virus is in Iran. It will be taken to Lebanon by Shiites. does that virus respect the Lebanese Israeli border?

              • j says:

                Virus does not respect borders. Already it has been spotted in Jericho, a tropical valley near Jerusalem.

              • gothamette says:

                rumor.

              • gothamette says:

                Actually, my bad, not a rumor. A South Korean Catholic Pilgrim group wandered around Israel in the West Bank. when they went back to South Korea they were tested. 18 were infected. No one knows when they were infected. Before or after they went to Israel?

      • Wesley M says:

        They were 87 and 84 years old. The medical commentators on Japanese news programs are pointing out that it doesn’t take much to kill people in their 80s.

        Three kids under 10 in Hokkaido were diagnosed today. They’re scratching their heads about how they got out, but it’s a fairy popular tourist destination.

      • Frau Katze says:

        Cruise ships had a bad reputation with infectious diseases before Covid.

  11. reinertor says:

    My proposal for Lance Welton’s next week column:

    STILL No Non-Asian Deaths from Corona—But CNN’s Sanjay Gupta Won’t Admit It

    • John Massey says:

      Exclude the data from Hubei Province, because they have been overrun and treating only the severe cases.

      In some Chinese provinces they have 0 fatalities, and in all of the others they have fatalities in single digits, except for Henan with 12, which borders Hubei, and Heilongjiang in the far north of China where they have an anomalous cluster of 12 fatalities, so something weird that I can’t find out anything about has happened there. But I have an aunty from Heilongjiang and she tells me the winters there are truly ferocious.

      Guangdong Province, population 113.5 million, 5 fatalities.
      Zhejiang Province, population 57.4 million, 0 fatalities.

      Then remember Greg’s Regime A and Regime B. Hospitals in Guangdong and Zhejiang are Regime A, so able to keep most patients alive long enough to recover. Hospitals in Hubei are very definitely Regime B.

      So, now do the arithmetic. How many non-Asians (whoever they are) should have died by now?

      Yeah, I know, you don’t believe the Chinese data. But then you have nothing to go on at all, so you are just pissing in the wind.

    • John Massey says:

      @Reiner Tor – Headline: “China donates test kits to Japan”

      “China has donated nucleic acid test kits to the National Institute of Infectious Diseases in Japan, where more than 700 Covid-19 infections have been reported – at least 621 related to the stricken Diamond Princess cruise ship.

      “The virus has no national borders and needs to be addressed by the international community,” a spokesperson for the Chinese Embassy in Japan said on Thursday.

      Excluding the Diamond Princess cases, Japan and Singapore – which reported 84 cases, as of noon on Thursday – have both experienced the highest number of infections from the coronavirus outside mainland China.”

      Please tell me again about how Japan is much more advanced that China.

      • reiner Tor says:

        You seem like a pretty excitable fellow. I proposed Mr. Welton (or Wenton?) to continue his series (I have now read two of his articles, and the title of an earlier one), adjusting it to reality. I thought it was pretty obvious that it was in jest.

        Japan is objectively more advanced than China (per capita GDP, lots of high technologies, etc.), but the Japanese response to this outbreak was like Fukushima: nothing to write home about.

      • John Massey says:

        Yes, I am fairly excitable. But I have been told my biggest weakness is that I don’t suffer fools gladly.

    • gothamette says:

      Four of the eighteen cases in Iran have died.

      What is their ethnicity?

  12. dearieme says:

    When the hospitals overload (if they do) there will presumably be a need for triage. I can imagine that being done for the Covid-19 victims. I doubt that anyone will have the spine to apply the idea to the totality of hospital patients e.g. be prepared to displace existing patients from an ICU to release space for incoming Covid-19 patients. But I have no experience in running hospitals so I am open to correction.

  13. dux.ie says:

    https://www.bbc.com/news/business-51454859

    Coronavirus: Will someone develop a vaccine?

    The global vaccines industry is dominated by big players such as Pfizer, MSD, GlaxoSmithKline (GSK), Sanofi, and Johnson & Johnson.

    Worldwide sales of vaccines totalled $54bn last year, and have almost doubled since 2014, according to data analysts Statista. Driving this growth is the increase of infectious diseases like influenza, swine flu, hepatitis and Ebola.

    “One would think that the industry has the reserves to jump at this challenge. But none of the four top vaccine companies has shown significant interest,” says Dr Ellen ‘t Hoen, director at medicines law and policy at University Medical Center Groningen in Amsterdam.

    Also speaking at last week’s Aspen Institute event, Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, said no major pharmaceutical company has come forward to say it would manufacture a vaccine for Covid-19. He called it “very difficult and very frustrating”.

    “Companies that have the skill to be able to do it are not going to just sit around and have a warm facility, ready to go for when you need it,” Dr Fauci said.

    • dearieme says:

      Why would they try to develop a vaccine when, if successful, the vaccine would be stoled from them by governments urged on by the mob? Heavens, they’d be called Nazis for even daring to charge for it.

      “One would think that the industry has the reserves to jump at this challenge.” What a moron: who the devil keeps reserves unused just in case a “director at medicines law and policy” decides to direct their use.

    • gothamette says:

      Oh, capitalism. It’s got an answer for everything, except when it doesn’t.

      It even creates medical conditions that don’t exist, such as transgenderism.

    • dux.ie says:

      https://www.cuimc.columbia.edu/news/columbia-university-researchers-awarded-2-million-identify-antiviral-drugs-new-coronavirus

      Columbia University Researchers Awarded $2 Million To Identify Antiviral Drugs for New Coronavirus

      Four research teams at Columbia University will share a $2.1 million grant to mount an aggressive effort to identify potential antiviral drugs and antibodies for use against the new coronavirus, 2019-nCoV. The funding was awarded by the Jack Ma Foundation, based in Hangzhou City, Zhejiang Province, China. As part of the project, the Columbia scientists will collaborate with academic researchers in China who are fighting to control the outbreak.

      Hmmm. More more fun and game. Will the NIH ban it?? Will they fund it instead??

  14. mapman says:

    There is not much to fund in the sera business in itself – but cloning out neutralizing antibodies from patients is straightforward. The resulting monoclonals are likely to be effective (question is timing!). The biggest bang for the back is in antivirals – protease inhibitors in this case. Most difficult, though.

  15. mtkennedy21 says:

    A single case in Washington state suggests a drug treatment for the pneumonia of Covid-19.
    https://www.spokesman.com/stories/2020/jan/31/washington-state-coronavirus-patient-treated-with-/

  16. One old reader of this blog says:

    You guy should stop hyperventilating. The panicking on that issue has seriously dented the credibility of the owner of this blog. Which is really a shame because I share most of his opinions on essentially everything else. Why is it than in our circle of thought, some strange ideas always have to emerge and ridicule the rest of us?

    In addition, real men should refrain from panicking in public. This is a very effeminate thing to do.

    • gcochran9 says:

      I know history, you don’t.

    • David Chamberlin says:

      Yea I’m on edge. Maybe I should take a long cruise to take in all the sites in the South China Sea to relax. Looks like I picked the wrong time to quit chain smoking. Nobody is freaking out manly man, we are discussing an amazing event as it unfolds.

  17. reiner Tor says:

    Someone claimed that this article means that there’s a possibility with coronaviruses that, due to the presence of antibodies not only is there no immunity after recovering from the disease, but re-infection could be much worse, because somehow these viruses could use the antibodies to enter the cells. I started reading the article, but quickly realized that with no background in biochemistry I would need so much time and energy to understand it that it’s hopeless.

    Has anyone read it and give us a summary in plain English? I guess others might be interested, too.

    https://jvi.asm.org/content/94/5/e02015-19.long

    (The way I understand it, the article is about other coronaviruses, not specifically this one.)

    If re-infection is not only possible, but is usually way worse than the first time, then it might explain a lot (even above the “regime A, regime B” explanation in the previous post) about the mayhem in Wuhan relative to the much lower mortality found elsewhere. (Though the “hospitals are overwhelmed” explanation might actually be enough for that, so Occam might not like the additional explanation.)

    • John Massey says:

      Chinese doctors in Hubei are very worried, because they have found that some people who have recovered remain infectious for long afterwards, and they don’t know where to put them, and what to do with them. They need the hospital places for people who are sick. This is a serious problem. The prospect that such people might remain permanently infectious doesn’t bear thinking about.

    • John Massey says:

      A return to the ‘good old days’ of leper colonies? Covid colonies – doesn’t have a good ring to it.

    • TB says:

      Plain English:
      You catch a cornavirus and you make antibodies. You recover.
      You catch a different coronavirus and those old antibodies sort of work, attaching to the coronavirus. However, this has the effect of locking the coronavirus attaching protein in the upright position and helping it lock onto a human cell. If you have lots of these antibodies it’s actually protective, but if not enough it can make the infection worse.

      We all have lots of antibodies to many different coronavirus strains, so this probably goes on every time we catch a new coronavirus, to some extent.

  18. dux.ie says:

    US CDC seems to be having the same problems with the Japanese DMAT in CoViD19 tests. May be Japan was using the US test kits. I think the test involves finding several SARS-CoV2 virus gene segments. When the test returns only one positive identification the results are in limbo and they cannot be ruled as negative nor positive. China seems to have similar problems and they have to do the re-tests several times on different days. The positions where the swap samples are taken also greatly influence the test results. This could be the reasons why Indonesia by themselves did not find any positive result but traveller from Bali was tested positive in another country.

    https://www.politico.com/news/2020/02/20/cdc-coronavirus-116529

    Problems with CDC coronavirus test delay expanded U.S. screening

    In the United States, efforts to expand use of the CDC test have struggled after one of the three reagents upon which the test depends delivered inconclusive results during quality checks, said Kelly Wroblewski, APHL’s director of infectious diseases. Samples that test positive at any of the three labs are still being sent to CDC for retesting.

    The diagnostic test can cost up to $250 to run, depending on procedures and volume of tests a lab performs, according to Wroblewski. But it is unclear who is paying for personnel costs and other items such as personal protective gear, machines to extract RNA and sample transportation, according to APHL.

    <

    blockquote>

  19. David Chamberlin says:

    First it was coronavirus. Then it was Covid-19. Now it’s still Covid-19 as a disease, but the virus is called SARS-CoV-2. But the Chinese don’t like that name so it will get a fourth name shortly. You see SARS has a bad public image, it came from China and killed a higher percentage of people who got it. Scientists, bureaucrats, whomever is coming up with these awful names filled with hyphens, random capital letters, and numbers then changing their mind every two weeks, cut it out.
    It’s the revenge of the endangered animals those people insisted on eating. It has to be like Montezuma’s Revenge, but I can’t think of what to replace Montezuma with.

    • John Massey says:

      I was fine with Pangolin’s Revenge. I also favour Wuhan Plague.

      I think the Chinese, and a lot of others, don’t like SARS-CoV-2 because it means retrospectively renaming SARS as SARS-CoV-1, and that is problematic because they are too different. The old English guy you put me onto, Dr John Campbell, thinks it is stupid and that the WHO should have chosen a better name. You need not to make shit up, Dave – you don’t actually know why the Chinese CDC don’t like the name.

      • David Chamberlin says:

        Geez there you go again getting all sensitive about China. Here you go straight from Science https://www.youtube.com/watch?v=pjHbogeWiXU. I’ll quote for you “Zieber says WHO has informed him the name doesn’t sit well with China. which has resisted any comparisons between the current crises and traumatic SARS epidemic.” It goes on saying Who isn’t happy with the name and they don’t plan on adopting it. Go ahead, read what I made up. Don’t I have a good imagination.

        • John Massey says:

          Yeah, I’m all sensitive about China. I kowtow to Beijing 3 times every morning (ask me some time what the Chinese Communists did to my wife’s family in 1949). That’s why I dubbed it the Wuhan Plague, so that they should never be allowed to forget how it started, who started it and how. That article explains why the virus name doesn’t sit well with China, which isn’t what you said.

        • John Massey says:

          To show how I’m all sensitive about China, I’ll relate this: The Chinese CDC has issued a statement praising the Japanese health authorities for the quarantine measures applied on the Diamond Princess. They must be joking. What was and still is happening on the Diamond Princess is utterly appalling, That can only be a political statement by the Chinese, which means the Chinese CDC are lying about what they really think, in effect. Why? I have no idea. Either they are lying, or they are complete idiots, and they don’t seem to be complete idiots, but I’m not ruling that out.

  20. John Massey says:

    John Campbell’s latest update worth watching. I can augment what he said about the case in Hong Kong – some people made some illegal alterations to the sewerage connections in their bathroom. It happens – pipes get in the way, so dumb people who don’t know what they are doing make alterations that don’t have approval from the Building Authority. Not everyone, obviously. Anyway, fecal route of transmission is confirmed, as if we couldn’t already guess that. A similar thing happened with SARS in 2003, and 49 people died because of it, out of 300+ people infected in the same building – the weirdness about that was that it traveled upwards in the building, and it was through the drainage system, not the sewerage system, because of fecal contaminated aerosol being sucked into bathrooms from the drain outlets when people turned on the exhaust fans in their bathrooms. Shouldn’t happen but did.

    • David Chamberlin says:

      All you have to do to plumbing to make it leak fecal vapors is remove the P trap. People who replace sinks without installing the P trap can smell shit. Happens all the time.

    • John Massey says:

      Also need the P trap to always have some water in it, instead of letting it dry out, otherwise aerosols carrying fecal matter can travel back up through the P trap when you turn on the exhaust fan with the door closed. That’s not a problem with sinks because people are pouring water down them all the time. But it is a problem with P traps on the drainage pipes carrying water from the bathroom floor drains, unless people pour say a litre of water down them at least once a week.

      But that’s not what happened with the latest HK case – they altered the sewerage vent pipe, illegally – they cut the vent pipe to the riser that goes up the side of the building and vents above the roof.

    • gothamette says:

      http://www.cidrap.umn.edu/news-perspective/2020/02/studies-show-covid-19-virus-likely-has-multiple-infection-routes

      “The results of the study are the first to show COVID-19 could be transmitted via respiratory, fecal-oral, or body fluid routes, the authors say. They also warn that a patient with negative oral swabs after several days of illness may still be capable of transmitting the virus.

  21. dux.ie says:

    There are lots of age related data but they will only make sense if compared with respect to the pop age distributions, e.g. the results for old people could be that there are just more old people in the country. I have invented the Infection Demographic ratio IDR for that and if the ratio is greater than 1 then the result is over-represented. Vibrant pop will have a exponentially dropping demographic curve with more younger people while countries like China and Japan should have more flatten curves. For Diamond Princess the age demographic percentage rises with age till age 70.

    For China the Infection Demographic ratio IDR is greater than 1 after age 70. Though the values after than do not change much the IDR values have gone off the chart, probably due to the higher smoking rate and air pollution. However the corresponding values for the Diamond Princess are greater than 1 but levelling off. The old people on Diamond Princes must be quite fit to travel in the first place and on average they might not smoke that much. In China the data will include those people that are not the fit.

  22. R49 says:

    Hello,

    I’d like your advice on another real world problem, please. I am organising a reasonably big science/engineering conference in May in a German city, with about 1.000 attendees and 40 speakers. Most attendees are country-locals, a few fly in, mostly from the UK (Oxbridge). Many of the speakers fly in, e.g. from the U.S. We’ll have to open the registration platform about on March 1st, so there is a big decision point approaching.

    a) Would you cancel the conference, because you think that up to then the epidemic has spread enough to Europe to justify cancellation?
    b) Or do you think we can just weasel through before the to-be-expected wave hits?
    c) Or do you think there is no signifikant risk anyway?

    We are torn between a) and b).

    Thank you for your time and effort.

    • Bert says:

      Factors to consider: Avoiding the Concord Fallacy, the problems associated with running a rump conference when speakers cancel at the last minute, recriminations that Monday morning quarterbacks will provide, the age distribution of attendees, protecting the intellectual capital embodied in your speakers.

    • dearieme says:

      Look for analogies e.g. the American response after terrorist attacks in Europe.

      The UK people can always drive or take the train: the Yanks can only fly.

    • Alex says:

      My workplace already cancelled a big event we were organizing in March with quite a few attendees and speakers from East Asia, SE Asia, MENA. I am in Europe.

    • j says:

      Hard decision. By May flu-like diseases may disappear. Yet, if the panic lasts, it may take longer for people to recover their courage. You should hedge. For example, inviting many locals, young people, lowering the price, adding attractions (a science star), and organize people who cannot reject the Invitation (military, universities, public employees). Link the event with a concert or other cultural event.

      • j says:

        Ten days later I have changed my opinion. Italy has been hit by the virus and all Europe has restricted travel. This is no time for congresses.

    • R49 says:

      Thanks for your answers above.

      In the meantime, Corona has made it to Northern Italy, in Lombardy, and the first cities there have closed schools etc. Among the newly infected, 5 are hospital workers who treated the patient, his wife, his jogging partner, three other patients and three elder men who visited the cafe of the patient’s father. OMG.

      My guess is that it will take only 1-6 weeks before similar cases will be in other European countries, and then the question really is who would then want to organize or go to a medium-size conference :-/. My inclination is cancelling. Oh dear!

      • dearieme says:

        If events are being cancelled in the famously well-run island state of Singapore then there must be quite a good case for cancelling in continental states such as Germany.

        Apart from anything else will people who fly in find it easy to fly home again without compulsory quarantine? That might really put them off coming.

      • David Chamberlin says:

        Weighing the probabilities from what we know now this coronavirus will get out and greatly discourage people from taking plane trips. The question is when and to what degree. You are probably right to cancel your May conference. While I have led the chorus in the pessimism that coronavirus can be contained I do not agree that it will be nearly as bad as the Spanish Flu. Medicine has come a long way in 102 years and everything else being equal the mortality rate should be greatly reduced and shall target the elderly. It will be rough times but the dire predictions that some here are predicting I find unlikely. By 2021 life should return to normal as multiple therapies become available.

        • reiner Tor says:

          Most generic drugs (i.e. most drugs) are produced in India, dependent on Chinese suppliers. I read that unless the lockdown in China is lifted soon, antibiotics production will take a hit.

          In other words, while theoretically secondary bacterial infections should cause no problems, in practice they might still be major killers.

          There might even be simple bacterial epidemics due to a lack of antibiotics.

      • gothamette says:

        The elderly Italian had already been admitted to a hospital for something else.

        Did he get the virus while in hospital, or before, and they just didn’t know that he was sick with COVID19?

    • R49 says:

      Hello,

      just FYI we did cancel the conference yesterday, at least in its physical form. Cancellation fees are about 100k$ for the venue… plus a base fee for the food that will never be cooked. Well. We’ll try to do a virtual form instead, with Zoom for video and Slack for audience commentary.

      In any case I wanted to say “thank you” for the advice given here, it helped to shape the decision.

      Cheers.

  23. Erik Sieven says:

    How long do they want to keep the lock-down of public life in China? As far as I understand still up to today almost everywhere in China people have to stay in their apartments, only one person allowed to leave per day to buy food etc. But this can’t really stop the Virus, because after the lock-down is over it will all start again, like it did in the first place. Only difference then it will start from a much higher starting point like it did some weeks ago in Wuhan. It sounds gruesome: but if no cure / immunization is found the only way to deal with it might be just let it happen. Let practically all people get infected and treat those who are infected as good as possible. As I said a gruesome thought, with a mortality rate of maybe around 2%. Or am I missing something?

    • reiner Tor says:

      If they just let the epidemic run its course, death rates would be even higher than they are currently in Wuhan. People would refuse to go to work (even in essential jobs), leading to a collapse of the infrastructure etc. Eventually more people would die due to the secondary effects. (Even with the lockdown that might be the case.)

      Unfortunately modern society is not very well-prepared for a major epidemic.

      • dearieme says:

        “Unfortunately modern society is not very well-prepared for a major epidemic.”

        You might have thought that countries with huge military and security establishments might have planned for this sort of thing: the USA and China, principally.

        To be fair, the US security establishment seems to while away the hours trying to stage coups against their President. What the military brass do with their time I have no idea: fight internal political wars presumably, wrestling over money.

      • gothamette says:

        Modern society would be brought to a halt by a 1918 style epidemic.

    • reiner Tor says:

      Another issue is severe illnesses, if they didn’t do anything to stop the epidemic, some 20-30 of people could fall ill at the same time. Even death rates aside, this could in itself cause enormous disruptions.

    • gothamette says:

      “As far as I understand still up to today almost everywhere in China people have to stay in their apartments, only one person allowed to leave per day to buy food etc. ”

      Not really. I’ve seen pics of people in offices, swathed in plastic sheeting, in front of their computer terminals.

      And this:

      https://news.sky.com/video/shanghais-ballet-dancers-train-wearing-face-masks-amid-coronavirus-outbreak-11939311

      I guess that’s one advantage of the niqab and the burka.

    • dux.ie says:

      How long do they want to keep the lock-down of public life in China?

      Previously I was puzzling about the difference between ‘Current Confirmed’ and ‘Cumulated Confirmed’ and I did not find any explaination. However it was soon deduced that NCurrent = NCumulated – NRecovered – NDeath. NCumulated is the proxy for the potency of SARS-CoV2, NCurrent is the proxy for the live pool of infection source. Thus theoretically the restrictions will be lifted when NCurrent=0 (through cured or death) however because of economics and other reasons, in practice the restrictions might be lifted when the per capita Current Confirmed is at about the same level as when the situations were serious enough to have data formally collected, i.e. at about 0.5 per million capita, for Guangdong that could be when NCurrent ≤ 52. For Hubei the NCurrent trend is still increasing (due to the log scale used the increases seem to be quite small).

      It is interesting that despite many claimed of trans-provincial infections, in practice the Hubei lockdown is pretty effective judging from the per capita confirmed differences between Hubei which stand out high above other provinces which have roughly about the same per capita NCurrent Confirmed.

      The situation in South Korea seems to be out of control and the infection rate is approaching the per capita values of other Chinese provinces excluding Hubei. Japan seems to be also on a steady increasing rate to reach there.

      • dux.ie says:

        Hubei NDeath curve is on different scale in order to be visible in the chart.

      • John Massey says:

        In Guangdong, I think they will lift the lockdowns on Guangzhou and Shenzhen (no other cities there locked down that I know of (do you, dux?), and already back to work) after they have 14 days with no new infections. I was tipping that to happen at the start of March, but Shenzhen just got 1 new case, so I guess that will restart the 14 day period for Shenzhen. They have still had only 2 infections. Guangdong is already well past R0 < 1.

        • John Massey says:

          Sorry, in the second last line ‘infections’ should be ‘deaths’.

        • John Massey says:

          NCurrent are known infected and bottled up in isolation, remember, so not live pool of infectious in practice.

          • dux.ie says:

            From CNCDC data, out of 44.672 infected, 3.8% are healthcare workers. In previous SARS epidemic the percentage was about 18%. Accident can happen. Lancet reported a case where the protection glove of the nurse was broken by scratching on the zipper. Healthcare workers are potential super-spreaders because they are in contact with many already sick people with other diseases.

            According to the Japanese whistle-blower Prof Iwata the Diamond Princess on board medical doctor was infected and she did not wear any personal protection gear as she claimed that it was no point as she was already infected. She did not understand that the protection gear also should protect her patients from her. She could be the super-spreader on Diamond Princess.

            Iwata also mentioned that the Japanese medical team was sloppy about CoViD19 and rejected his opinions as they are THE DOCTORS and he is just a PhD in disease control even with experience with SARS in China and Ebola in Africa. Quarantine does not mean that the disease absolutely will not spread

            • John Massey says:

              Yes, true. I picked that up on Iwata’s video, before he took it down.

              But in the case of a super-spreader in a hospital, that should show up as a cluster of new cases, no? That’s partly why I am guessing they will wait until they have 14 days without a new known case in shut-down cities in Guangdong. (I can’t see in detail what is happening elsewhere vs time, and can’t keep all of the numbers in my head.) It’s not perfect, but they can’t wait forever or what reiner Tor said will come true. Today’s China Daily has Xi JInping saying that a balance needs to be struck between disease control and productivity. I wouldn’t like to be in the position of having to make those kinds of decisions.

  24. gothamette says:

    What is the difference between a serum and an antiviral?

  25. Andrew Oh-Willeke says:

    There aren’t many points upon which I can say this, but on this one, I totally agree with you.

  26. David Chamberlin says:

    It looks like the first city outside of China to blow up with cases of Coronavirus will be Tehran. They report only 18 cases in Iraq but far more ominous is 4 dead. It takes weeks for this virus to progress to the point of killing so it’s been spreading in Qom, 1 million and and Tehran 7 million for weeks. Really no concrete evidence that there are more than 18 cases so far in Iran but it’s highly likely there is and I see very little hope of stopping it.

    Hope to be wrong, doubt that I am. Once it takes off in Tehran with it’s poverty, shaky government, third world health system, and over crowding….there won’t be any autocratic government to enforce a real quarantine.

    WHO warns window of containment narrowing after deaths in Iran. Idiots. They should have shut down air traffic between China and Iran weeks earlier than they did.

    • David Chamberlin says:

      Please watch this. https://www.youtube.com/watch?v=VasccCzr2TY

      John Campbell has some terrible news coming out of Iran regarding Covid19. The whole 11 minute talk is very much worth listening to but the Iran news starts around 6:10 and is absolutely chilling. John has been in communication with doctors in Iran and the news is terrible. Please listen.

      • R49 says:

        Thanks. Sounds realistic. Brrrr….

      • reiner Tor says:

        Thanks. It was worth my time, despite me hating videos. (I actually only hate because my music player stops on my phone. Imagine a four hour Wagner opera stopping right at three and a half hours for a YouTube video!)

        Scary.

        Now either East Asians are less susceptible, or the Chinese are lying. (BTW I think the South Korean data also shows that the Chinese must be economical with the truth. It’s spreading much easier in South Korea than in China, if official Chinese data are to be believed…)

        • David Chamberlin says:

          There is a more likely explanation of why this virus has different effects in different places at different times. This virus is constantly mutating and changing it’s effect it has on people. That has been the history of many viruses.

      • swampr says:

        Thanks. “Please tell the world what is happening” Gulp.

        • David Chamberlin says:

          I cannot predict what will happen in Italy, South Korea, or China, these governments are capable of enforcing a strict quarantine that might work, but Iran? Idiots denied the coronavirus was spreading and encouraged everyone to get out and vote in the national election. Meaning they all crowded together at polling stations. Meaning the government will be rightfully blamed when the epidemic spreads rapidly, it just sounds like a perfect storm, a perfect environment for this virus to really take off, even worse than Wuhan. Let’s hope it hasn’t mutated to be more lethal.

  27. dux.ie says:

    Just when you thought that this cannot be any worst Singapore discovered a case of dual CoVid19 and Dengue Fever on the same patient.

    https://www.straitstimes.com/singapore/coronavirus-all-patients-warded-with-woman-who-has-both-dengue-and-covid-19-also?xtor=CS3-18&utm_source=STiPhone&utm_medium=share&utm_term=2020-02-20%2020%3A02%3A43
    Coronavirus: S’pore confirms first patient with both Covid-19 and dengue

    Why this is serious? Virus has the ability to swap genes. The alleged HIV gene fragment in SARS-CoV2 could have been acquired naturally in such reassortment manner. Reassortment is also the reason that this year’s flu vaccines are not effective the next year. This might be also the reason that HIV drugs could be effective against CoViD19.

    https://www.ncbi.nlm.nih.gov/pubmed/25007845
    Influenza A virus reassortment
    Reassortment is the process by which influenza viruses swap gene segments. This genetic exchange is possible due to the segmented nature of the viral genome and occurs when two differing influenza viruses co-infect a cell.

    https://www.panspermia.org/virus.htm
    Viruses today spread genes among bacteria and humans and other cells, as they always have… We are our viruses — Lynn Margulis, 1998

    Last season Philippines had about 140K+ cases of dengue fever (which also has no known cure), Singapore had about 60K+, so are many other tropical countries and they could be imported into temperate countries spread by mosquitos. The new hybrid CoViD.?? strain might also be transmitted by mosquitos.

    https://www.sciencenews.org/article/dengue-cases-americas-have-reached-all-time-high
    The Americas set a gloomy record in 2019: the most dengue cases ever reported. More than 2.7 million cases of the mosquito-borne disease have struck the region, largely in Brazil, the Pan American Health Organization reported on November 13.

  28. Le Ed says:

    Dengue fever is a mosquito-borne tropical disease caused by the dengue virus. Symptoms typically begin three to fourteen days after infection. These may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic skin rash. Recovery generally takes two to seven days.

    Aren´t you over- reacting just a little bit?

  29. dearieme says:

    On the subject of prisons in China, what will happen in the concentration camps full of Uighurs?

  30. another fred says:

    Any advice on what to do to get one’s immune system revved in preparation?

    I am trying to get sun for vitamin D, eating leafy greens ( always do anyway), taking C, and selenium (I take that anyway). I understand this thing kills via a cytokine storm and vitamin D is supposed to help keep those in line.

    Reading up, cytokine storms look kind of random other than the effect of vitamin D. Young healthy people can be susceptible, but older are more so (I am past 70).

  31. gothamette says:

    OK, here is what I don’t understand. Or rather, what I do.

    The virus (SARS-CoV-2) is new; it will infect everyone. No one is immune.

    But most people won’t get sick. Their immune systems will fight off the virus. But some people will get sick, because their immune systems can’t cope.

    Of that number, most will survive. Some (so far, the old and infirm, although the doctors who have died were young) will die.

    The doctors who have died concern me. My guess is that they were infected, fought it off, and then reinfected. And the virus won. It’s like playing Russian roulette. At some point, that bullet will find you.

    Is this how it works? Be nice.

    • David Chamberlin says:

      John Campbell, kind of my go to guy for straight talk on SARS-CoV 2 puts it quite simple, “we are still in the middle ages in understanding viruses.” We do not understand this virus very much at all. Dr Seheult has 23 updates on Youtube explaining the complex medical decline that happens when peoples lungs are attacked by this virus.

      • gothamette says:

        So viruses understand us better than we understand them.

        I have been advised to school myself on a concept called viral load. I will do so.

        But clearly, people would be wise not to assume that this virus cannot kill kids. If the viral load is high enough, it can.

    • Frau Katze says:

      It’s the secondary pneumonia that’s killing people, not the virus itself.

  32. swampr says:

    Serums–interesting to see how this turns out:

    “Another treatment recommended by the National Health Commission in guidelines updated on Tuesday was the transfusion of blood from recovered patients, which would contain antivirals. Xu said that by the end of Thursday more than 100 Covid-19 survivors had donated their blood, enough to be administered to more than 200 acute or severe patients.”

    https://www.scmp.com/tech/science-research/article/3051820/chinese-trials-gileads-antiviral-drug-treat-coronavirus-still

  33. dearieme says:

    Fans of the English Premier League are presumably wondering whether Liverpool can win enough points to be guaranteed to be champions before the season is abandoned because of the plague.

    Or could they play the remaining games for TV audiences only while excluding crowds?

    How about the Six Nations rugby championship? Will Ireland want to host Italian fans on March 7th? Will English fans want to travel to Italy on March 14th?

    Will the soccer authorities seize the chance to prohibit the players spitting on the pitch the whole time? Could such a prohibition work?

    If the rugby authorities insist that the players mustn’t hug the game could not be played.

    The cricket: will the England tour to Sri Lanka take place? Will the England fans want to travel? Will the Sri Lanka fans want to welcome them?

    Other sports: look, other sports don’t really matter. Apart from darts and snooker I suppose.

    • John Massey says:

      Tokyo Olympic Games in July? They would have to be a bit of a risk at this point. I realize they pale into insignificance next to the EPL, but it could be Genzebe Dibaba’s last chance to get an Olympic Gold. A lot of athletes did not go to Rio in 2016 because of Zika.

      London has offered itself as Plan B in case Tokyo becomes unworkable, because it has all of the necessary facilities from 2012, but Japan has already rejected that and is adamant the Games will go on in Tokyo. The Chairman of IOC says there is a deadline 3 months out by which a decision needs to be made on whether they move to London. If it gets down to 2 months and Tokyo is not looking feasible, they will have to be cancelled – first time since WWII.

      • dearieme says:

        Yup, the Ireland vs Italy rugby match has been postponed.

        Italian league soccer matches are to be played behind closed doors (some or all?).

        Not the slightest chance of an Olympics in London I’d have thought. Thank God bloody Blair isn’t still PM.

      • gothamette says:

        Actually – in this day & age, you don’t need to have an Olympics in one place. You can have several different competitions in different places. The big audience is on TV anyway.
        But that kind of goes against the “spirit” of the Olympics – a friendly get-together of amateur athletes….

        ….Oh wait, that went the way of the dodo a long time ago.

      • Frau Katze says:

        How about this year’s Hajj, starting at the tail end of July? Last year they had 1.7 million people.

        I believe the Hajj has had problems with epidemics in the past but not recently.

  34. John Massey says:

    Greg and anyone else with a functioning brain – some interesting and useful data plots here:

    https://nucleuswealth.com/articles/updated-coronavirus-statistics-cases-deaths-mortality-rate/

    • j says:

      Hainan infected. No more cruises there.

    • Frau Katze says:

      What do you know about the mass quarantine in China as described by someone writing to Dr Campbell, on the video of Feb 27? It appears most citizens are cooperating.

      One question: where are they getting food?

      Local farms seems a logical place but are these rural areas not also at risk of the virus?

  35. another fred says:

    Here is some interesting information about cytokine storms, apparently the main source of fatalities from Covid-19. There appears to be a possible genetic effect.

    https://www.uab.edu/reporter/know-more/publications/item/8909-here-s-a-playbook-for-stopping-deadly-cytokine-storm-syndrome

    If you follow the link to the Journal of Immunology, in that article you find:

    “The presence of a monoallelic cytolytic pathway gene defect in combination with a hyperinflammatory state from any of a variety of potential triggers is consistent with a two-hit or multihit model of HLH disease development. Indeed, we are perhaps only beginning to recognize the tip of the iceberg in terms of triggers of secondary HLH and MAS. Everything from influenza (27) to dengue hemorrhagic fever (28), from systemic lupus erythematosus (29) to systemic juvenile idiopathic arthritis (30), and from T cell leukemia (31) to non–Hodgkin lymphoma (32) has been reported in association with secondary HLH and MAS. Whether cytolytic defects are associated with all of these associations, however, currently remains unclear.”

    • another fred says:

      I also recall seeing a recent article about a family in China where four of five were found dead with the fifth in intensive care. That would fit the “double hit” model, especially if the one found alive is one of the parents.

    • Anonymous says:

      Also in the first article:

      “But for other patients, new treatments can calm the storm and bring remarkable recoveries. Cron and Behrens “both got interested in this through a patient we saw in Pennsylvania,” Cron said. “Probably the sickest patient I ever saw come out of the ICU unscathed.” The doctors treated her with anakinra, a cytokine-targeting therapy that was approved to treat the autoimmune disease rheumatoid arthritis. “She turned around and it was magical,” Cron recalled. “We’re both research scientists, so he developed a mouse model [of cytokine storm syndrome] and I’ve been studying the genetic and human aspects. We’ve identified new genes not previously described as a part of this genetic workup.””

      Anakinra:
      https://en.wikipedia.org/wiki/Anakinra

      • Rosenmops says:

        Interesting. I hadn’t heard of Anakinra (Kineret) before. I wonder if it differs much from other biologics used to treat autoimmune diseases. Enbrel, Remicade, Humira, Orencia, etc.

        From: https://www.webmd.com/rheumatoid-arthritis/biologics#1

        There are several. They include:

        B-cell inhibitor: They affect B cells, which are white blood cells that carry a protein that can trigger your immune response.

        Interleukin-1 (IL-1) blocker: Stops production of an inflammatory chemical your body makes

        Interleukin-6 (IL-6) or interleukin-17 blocker: Stops inflammatory chemicals from attaching to cells

        Janus kinase (JAK) inhibitor: Blocks proteins that trigger the inflammation process

        T-cell inhibitor: Blocks communication between T cells, a type of white blood cell

        Tumor necrosis factor (TNF) inhibitor: Blocks a chemical your body makes that drives the inflammation process

        Apparently Kineret works by blocking Interleukin-1.

        I have taken several TNF blocking biologics for rheumatoid arthritis. They are immune suppressants, which, combined with the fact I am in my 60’s, has me scared witless over covid-19. I figure I’m a sitting duck. I have had pneumonia several times before, and when ever I get a cold it goes straight to my lungs. I’m seriously thinking of not leaving the house for awhile.

    • Rosenmops says:

      It says 10 to 15% of the population may be susceptible to cytokine storm syndrome. That is approximately the portion of people who tend to get very ill from covid-19

      • Frau Katze says:

        Have you seen the curves for death rate and age? Some were put together using Chinese data. They show a sharp rise with age. I know people don’t trust their data. That’s likely correct in general but they have no reason lie about this.

        My understanding (could be wrong) was that cytokines storms were most likely to be generated by the young and healthy.

  36. another fred says:

    The fifth (surviving) victim was the wife of one of the four. The four who died were parents and two siblings.

    “Virus Kills Chinese Film Director and Family in Wuhan”

    https://www.yahoo.com/entertainment/virus-kills-chinese-film-director-100442476.html

    • gothamette says:

      Not particularly old.

    • Frau Katze says:

      Seems like he needed oxygen but the hospitals were full: “ A note written by Chang, said to be his last words, has gone viral on the Chinese Internet. Chang wrote that his father succumbed to the illness on the first day of the Lunar New Year (January 25). “My father had a fever, cough and trouble breathing. [We] tried to send him to the hospital but none of the hospitals we visited took him, because they had no more beds,” he wrote.”

  37. David Chamberlin says:

    “I think the likely outcome is it will not be containable.” Atlantic article here https://www.theatlantic.com/health/archive/2020/02/covid-vaccine/607000/

    Not the only possible outcome, just the most likely at this point in time. The hard fought efforts of multiple modern nations that have outbreaks and seem to be containing them isn’t going to work when coronavirus runs amok in nations like Iran and then spills over into neighboring nations because of porous borders.

    • dearieme says:

      I dare say he’s right. But there was no acknowledgement that there might be an opportunity to get some gains by slowing down the spread, partly because it would lead to less overloading of hospitals. Maybe the overloading is going to be so overwhelming that the gain scarce matters.

      I – a complete non-expert – decided that we were in real trouble when I realised that the dégringolade aboard the cruise ship meant that the virus was highly infectious, and the sustained draconian restrictions in China meant it was lethal. Or, at least, lethal to people old enough to be on the politburo.

      In other words there was no need to form any opinion of the truthfulness, accuracy, or completeness of the figures reported by the Chinese government.

      (If I’ve said most of this before, apologies.)

      • David Chamberlin says:

        You make a good point, slow it’s spread as much as possible so that the hospitals are not overloaded. This is key to reducing the mortality rate. CDC said it’s not a matter of if the coronavirus spreads but when. 80% of the population that contracts this will have mild to no symptoms. 2020 is projecting to be a shitty year but panic proclaiming this to be the plague is ignorant and stupid.

  38. erica says:

    Dr. Cochran, have you communicated w/ Paul Ewald about the subject? If so, can you share his thoughts about it so far?

  39. dearieme says:

    In case of doubt: when I say “there was no need to form any opinion of the truthfulness, accuracy, or completeness of the figures reported by the Chinese government” I mean “What sort of blithering idiots took the Chinese data seriously?”

    It’s no use saying “it’s all we’ve got”. If it’s rubbish, bin it. That should be the universal rule with rotten data.

    • David Chamberlin says:

      Speaking of nations you can’t trust Trump was furious that the CDC came out with the announcement that it was a matter of when the coronavirus would spread not if. The truth tanked the markets so he wanted it suppressed. So he moved to “tighten control of coronavirus messaging by government health officials and scientists directing them to clear all statements through the office of Vice President Pence.” So instead of experts telling us what is happening it will be our Vice President. China is far from the only nation strongly suspected of cooking the books.

      • gda53 says:

        Since the left is willing to play naked raw power politics about something that should be a totally bi-partisan issue, it’s no wonder Trump has needed to grab hold of the narrative, before the idiotic fear mongering and finger pointing collapses the entire economy, all in order to achieve their sole aim, to “get Trump”.

        Let’s remember that Trump is the most open politician (pretty much) ever. So if you’re likely to get any straight talk out of DC, it’ll be coming from him.

        Lucky for the US, Trump put on travel restrictions from China very early (you may remember the “racist” accusations over that far-sighted action).

        You should believe only those you have come to trust. Which pretty much excludes the entire MSM.

        • Tim Burr says:

          A virus is probably the best candidate the Dems can field.

          • Anonymous says:

            Dude, they have a sterling field who are going to wipe the floor with Trump. I mean, even Corn Pop was defeated by Biden and Pocahontas is a PoC.

        • David Chamberlin says:

          You will be relieved to know that your man Trump calls the coronavirus a hoax. It’s those dirty no good democrats new hoax. He also says

          “one day like a miracle coronavirus will disappear.”
          “Vice President Pence is really very expert in the field.” (In infectious disease)
          “It’s a little like the regular flu that we have shots for and essentially we will have a flu shot for this in a fairly quick manner.”
          “this is the flu. This is like the flu and this is much different than Ebola.”

          Why we can all sleep easier now.

          • Tim Burr says:

            Plus that Orange Hair! I mean, really!

          • Tl Howard says:

            He didn’t call it a hoax. He said the partisan efforts to say the administration wasn’t doing all it could to protect the population is a “hoax.”

            He also said VP Pence had a lot of experience working with people in medical research, that the VP knew many them personally.

            Guess I can sleep easier knowing people like you believe everything you hear or read or simply enjoy being partisan.

            • Tl Howard says:

              BTW, the same people screaming “This administration isn’t handling this properly and you should be scared” are the same folks that called him “racist” when weeks ago he put on travel restrictions.

              Oh, and yeah, they are the same people who cheered 3 judges of the 9th Circuit when yesterday they ruled that migrants being held in Mexico must be allowed to enter (through CA, btw, which has cases of Covid-19.)

              Shove it.

              • gothamette says:

                @T1 Howard,

                You are full of shit. Not worth my time pointing out exactly how. Just saying.

              • Peripatetic Commenter says:

                It is amusing that the Chinese claimed the US and Australia were racist for instituting travel bans with China while at the same time instituting massive internal travel bans (after all, what is a lock down but a travel ban.)

                Ohhh, Now I get it. It’s all in the terminology. It’s a lock down not a travel ban and it’s the Chinese restricting travel by Chinese. Not racist!

              • David Chamberlin says:

                It’s always fun pissing off the Trumpies, but no useful conversation can ever come from it so I’m done pushing this in a political direction. Trump said some unbelievably stupid things about coronavirus and all I did was quote him. Rant all you like. Adios.

              • gothamette says:

                It was totally irresponsible for Trump to have used that word in relation to this, even in a reference. I heard that in his second presser he was more lucid but I didn’t watch.

              • Tl Howard says:

                You’re full of shit. The opposition party, which is hardly the “loyal opposition” any more, has used its media arm to twist and turn anything he says in order to undermine him and they don’t give a damn if it hurts the country.

              • gothamette says:

                Remember to wash your hands.

              • TB says:

                Wash hands and FACE!
                People seem to forget the face.

              • John Massey says:

                Wash face, hands and ARSE! People seem to forget the arse. Except the French, who have special arse-washing machines.

              • gda53 says:

                “It’s always fun pissing off the Trumpies,” – said the political partisan who lied about Trump calling coronavirus a hoax.

                ” I’m done pushing this in a political direction”, says he, immediately after bleating his blatant political partisan nonsense. Then, like a coward, he runs away from dialogue. TDS much, David?

                Let me repeat.You should believe only those you have come to trust. Which pretty much excludes the entire MSM. And Mr Chamberlin, of course.

                Tl Howard seems to have things about right. Too bad some who should know better (and whom I usually expect better of) seem unsettled by his common sensical comments.

              • David Chamberlin says:

                Political conversations are so boring and pointless these days. Back to coronavirus and the right bipartisan response. The US is fucking it up already. Test every person with the symptoms, not just 400 and some that have been to Wuhan or thereabouts. South Korea has a drive through where you don’t even get out of your car and get tested. Brilliant idea. Don’t let the potentially infected go to an already crowded hospital. China after an initial screw up has really done a great job of limiting the spread of the disease. The rest of the world can learn from what works and what doesn’t. Trump is an ignoranus. That’s worse than an ignoramus, that’s someone who is so ignorant they are proud of it. I have no religion or political slant. I find it very sad everybody has to believe in simple answers to complex questions. Just be a realist, keep looking, keep being fascinated, remain humble that the world is complex and individually we know so little.

          • Rosenmops says:

            Can we not have any forums that don’t dissolve into political bickering?

  40. gothamette says:

    The little bugger is in Iceland.

  41. John Massey says:

    I was wrong, and gothamette and David Chamberlin were right (and whoever else disagreed with me). There is something we can learn from the Diamond Princess, because the WHO is still tracking all of the people who were on board.

    The infection rate among people who were on the Diamond Princess is now up to 19%, and all of those infections had to have happened in the space of a couple of weeks. So in a situation where there is minimal or no effective infectious disease control, the coronavirus is more infectious than seasonal influenza (where there is no effective disease control other than the minority of people who get an annual ‘flu vaccination). People have been saying that, but this is proof.

    The difference in R0 between where there are stringent infection containment and control measures and where there aren’t, and the % of a population who could be infected in both of those scenarios, is HUGE.

    • gothamette says:

      “So in a situation where there is minimal or no effective infectious disease control”

      I would say that the DP is a situation where people are forcibly enclosed. It would be comparable to being in an old-folk’s home or a prison.

      If this gets loose in a retirement home it’s the Diamond Princess all over again. Prepare for a lot of very angry, stressed-out middle aged kids. Lost productivity. Lawsuits.

      Someone tell me I’m catastrophizing.

      “19%” – let’s keep watching. How long? I dunno.

      • dearieme says:

        I agree – a hellish situation in the Care Homes seems possible. Moreover a hospital triage regime is likely to have to shrug its shoulders at most of the poor old souls.

        Though some of them might welcome the release. Wasn’t pneumonia “the old man’s friend”?

        Hm, am I being too alarmist? I hope so. Meanwhile the papers report a story that Her Majesty’s Government is considering using Hyde Park as a morgue. Is that a euphemism for using it for plague pits? For God’s sake don’t call that a “fall back position”.

    • gothamette says:

      Better example is that Korean doomsday cult. Taken from a tweet:

      “In Daegu, 1900 Shincheonji Church members have been tested for coronavirus.

      1300 had symptoms & 600 did not.

      Among those 1300 with symptoms, 87.5% were confirmed with the virus .

      BUT out of the 600 WITHOUT symptoms, 70% were confirmed with coronavirus.”

      Yikes yikes yikes. Did they purposely intend to infect one another? Have coronavirus-swapping parties?

    • R49 says:

      “I was wrong”: True, you were, but you are right now – bravo!

  42. R49 says:

    There is a new paper out on “Cell”. The authors from Germany write that they have investigated the pathway that SARS-CoV-2 uses to infect lung cells. In particular, they found the docking protein (ACE2) and that a transmembrane protease, TMPRSS2, is nearly essential for the virus to enter the cell. There are known TMPRSS2 inhibitors, such as camostat, which is already approved in Japan as a medication for pancreatitis. This means clinical trials could start immediately.

    Is the world getting lucky 😀 ?!?

    https://www.cell.com/cell/fulltext/S0092-8674(20)30229-4

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