Coronavirus: What questions do you have?

[Marc_G]

I've gone complete to squish the last three months. Time to rebuild my physique.

 

[cwbullet]

I've gone complete to squish the last three months. Time to rebuild my physique.

Yup, I am a little soft in the middle - may I will change tomorrow. ? Metamorphosis.

 

[cwbullet]

Just wow: Highest day of positive tests for the State of Georgia. Just short of 3K. We became overrun and the natives (locals) are growing restless. The youths are ignoring the mask suggestion except for those mandated to wear them (military). I had a lady get angry when I asked her to scoot away from me and allow me to have my 6 feet. Mind you, I was more polite than that. I simply ask her to kindly allow me my 6 feet of social distancing. Two fee what just not gonna cut it.

New article out today: we have found the cause of the damage to blood vessels and clots. The virus and inflammation cause a cytokine storm and thus results in damage to the endothelial cells. The damage results in a compound called Thrombomodulin that simply causes clots. This is one step from finding a solution. Not all conventional treatments for clotting will work with this mechanism so we must find a more targetted response.

https://www.mdlinx.com/news/covid-1...-2020&utm_source=alert&utm_campaign=ajm_50077
Thrombomodulin is found to be a part of DIC - Disseminating Intravascular Coagulation. That is the ultimate in tragic clotting disorders.

 

[OverTheTop]

The damage results in a compound called Thrombomodulin that simply causes clots. This is one step from finding a solution.

That's good news they found this.

My wife has nursed a couple of patients with DIC over the years. Bad condition.

 

[boatgeek]

Just wow: Highest day of positive tests for the State of Georgia. Just short of 3K. We became overrun and the natives (locals) are growing restless. The youths are ignoring the mask suggestion except for those mandated to wear them (military). I had a lady get angry when I asked her to scoot away from me and allow me to have my 6 feet. Mind you, I was more polite than that. I simply ask her to kindly allow me my 6 feet of social distancing. Two fee what just not gonna cut it.

New article out today: we have found the cause of the damage to blood vessels and clots. The virus and inflammation cause a cytokine storm and thus results in damage to the endothelial cells. The damage results in a compound called Thrombomodulin that simply causes clots. This is one step from finding a solution. Not all conventional treatments for clotting will work with this mechanism so we must find a more targetted response.

https://www.mdlinx.com/news/covid-1...-2020&utm_source=alert&utm_campaign=ajm_50077
Thrombomodulin is found to be a part of DIC - Disseminating Intravascular Coagulation. That is the ultimate in tragic clotting disorders.

When you said that you became overrun, does that mean by hospital admissions or just cases counts? Also, are recovery rates and/or stay length improving for people who are hospitalized?

 

[Marc_G]

Just wow: Highest day of positive tests for the State of Georgia. Just short of 3K. We became overrun and the natives (locals) are growing restless. The youths are ignoring the mask suggestion except for those mandated to wear them (military). I had a lady get angry when I asked her to scoot away from me and allow me to have my 6 feet. Mind you, I was more polite than that. I simply ask her to kindly allow me my 6 feet of social distancing. Two fee what just not gonna cut it.

New article out today: we have found the cause of the damage to blood vessels and clots. The virus and inflammation cause a cytokine storm and thus results in damage to the endothelial cells. The damage results in a compound called Thrombomodulin that simply causes clots. This is one step from finding a solution. Not all conventional treatments for clotting will work with this mechanism so we must find a more targetted response.

https://www.mdlinx.com/news/covid-1...-2020&utm_source=alert&utm_campaign=ajm_50077
Thrombomodulin is found to be a part of DIC - Disseminating Intravascular Coagulation. That is the ultimate in tragic clotting disorders.

Chuck, we hear a lot of people propounding that more cases is just from more/deeper testing. I don't agree with this but I value reports from trusted folks like you "on the ground."

Is it correct to state that what you are seeing is indeed more testing, driven by more sick people coming in the doors, and perhaps a higher positivity rate?

 

[cwbullet]

Chuck, we hear a lot of people propounding that more cases is just from more/deeper testing. I don't agree with this but I value reports from trusted folks like you "on the ground."

Is it correct to state that what you are seeing is indeed more testing, driven by more sick people coming in the doors, and perhaps a higher positivity rate?

We are testing a lot more and screening a lot less. The odd thing is that our positive rate for testing without screening is about 0.5%. Our positive rate for those we screen positive and test is around 30%. We also have about a 1 in 200 rate of people not getting tested and receiving a test elsewhere and ending up positive. I am satisfied with that rate.

We are starting to see some admission so I think we will see a peak to the spike soon.

 

[NOLA_BAR]

In Louisiana all three metrics have gone up, positive counts (2,000+) yesterday, positivity rate (8.83% with local rates above 10), and hospitalizations (799). What has gone down is average age (49% 29 and above). The unknown is if there will be an increase in average age and death rate as older folk get affected from community exposure. The positivity rate was below 5% during phase 1 opening, the state is now holding at phase 2.

 

[NOLA_BAR]

In Louisiana all three metrics have gone up, positive counts (2,000+) yesterday, positivity rate (8.83% with local rates above 10), and hospitalizations (799). What has gone down is average age (49% 29 and above). The unknown is if there will be an increase in average age and death rate as older folk get affected from community exposure. The positivity rate was below 5% during phase 1 opening, the state is now holding at phase 2.

Oops sorry 49% 29 and below for average positive age

 

[cwbullet]

In Louisiana all three metrics have gone up, positive counts (2,000+) yesterday, positivity rate (8.83% with local rates above 10), and hospitalizations (799). What has gone down is average age (49% 29 and above). The unknown is if there will be an increase in average age and death rate as older folk get affected from community exposure. The positivity rate was below 5% during phase 1 opening, the state is now holding at phase 2.

LA too! Crap. The South is getting hammered. It will hit NY, CT, and the NE again soon.

 

[Marc_G]

We are testing a lot more and screening a lot less. The odd thing is that our positive rate for testing without screening is about 0.5%. Our positive rate for those we screen positive and test is around 30%. We also have about a 1 in 200 rate of people not getting tested and receiving a test elsewhere and ending up positive. I am satisfied with that rate.

We are starting to see some admission so I think we will see a peak to the spike soon.

Thanks Chuck!

Just so that I and others make sure we understand the terminology properly:

Does "testing" mean checking for active infections in people with symptoms, and screening mean checking for active infections in people without apparent symptoms? Or is the screening in this case referring to other means (questions about symptoms, temp checks, etc.) of figuring out if the person is likely positive and worth doing the test for infectious COVID-19? I just want to make sure I understand. I've seen "screening" used in different contexts so want to be sure I'm clear.

 

[dhbarr]

I feel cautiously optimistic about
https://nymag.com/intelligencer/202...-on-why-things-could-be-much-better-soon.html

... large trials this summer beginning as early as July. Each one of those trials will involve roughly 30,000 volunteers
... four different vaccines with four different approaches ... so that the highest-risk people can get access right away
... manufacturing tens of millions of doses of these vaccines, even before we know if they’re going to work, to prevent long delay at the end

Your thoughts?

 

[neil_w]

I feel cautiously optimistic about
https://nymag.com/intelligencer/202...-on-why-things-could-be-much-better-soon.html
Your thoughts?

I'm hopeful for this, but even if one is approved by the end of the year, think how long it'll take to get a significant portion of the population vaccinated. We're still talking about many months of dealing with this before we get to that point.

Also, must always remember that no vaccine has ever been developed on a time frame like this, and some vaccine candidates are using unproven models. There really is a huge amount of uncertainty here.

I'm with you on cautious optimism, emphasis on "cautious".

 

[Sparky]

Just wow: Highest day of positive tests for the State of Georgia. Just short of 3K. We became overrun and the natives (locals) are growing restless. The youths are ignoring the mask suggestion except for those mandated to wear them (military). I had a lady get angry when I asked her to scoot away from me and allow me to have my 6 feet. Mind you, I was more polite than that. I simply ask her to kindly allow me my 6 feet of social distancing. Two fee what just not gonna cut it.

New article out today: we have found the cause of the damage to blood vessels and clots. The virus and inflammation cause a cytokine storm and thus results in damage to the endothelial cells. The damage results in a compound called Thrombomodulin that simply causes clots. This is one step from finding a solution. Not all conventional treatments for clotting will work with this mechanism so we must find a more targetted response.

https://www.mdlinx.com/news/covid-1...-2020&utm_source=alert&utm_campaign=ajm_50077
Thrombomodulin is found to be a part of DIC - Disseminating Intravascular Coagulation. That is the ultimate in tragic clotting disorders.

Would blood thinners help since it's a clotting feature?

 

[NOLA_BAR]

Results from a population study of the New Orleans area back in mid-May by Ochsner Health (the largest hospital operation in New Orleans).

Not yet peer-reviewed.

Highlights:
Sample of 2,640 people from a group of 25,000 volunteers.
Antibody test and a polymerase chain reaction, or PCR test, from May 11 to May 16.
7.8% of people in Orleans and Jefferson Parish were infected at that time.
Hard-hit neighborhoods (tracked by zip code) had sample sizes that reflected a potential of up to 25% of the population infected.
Researchers also found a 1.63% fatality rate.
40% of positive cases were asymptomatic at the time of testing.
75% of the most infectious group, those in the early days of exposure, were asymptomatic.
Black people carried a larger burden of disease at 10.3% than white residents at 5.9%.


https://www.nola.com/news/coronavirus/article_be845128-bc63-11ea-9986-47ff2e6ed184.html

 

[cwbullet]

Thanks Chuck!

Just so that I and others make sure we understand the terminology properly:

Does "testing" mean checking for active infections in people with symptoms, and screening mean checking for active infections in people without apparent symptoms? Or is the screening in this case referring to other means (questions about symptoms, temp checks, etc.) of figuring out if the person is likely positive and worth doing the test for infectious COVID-19? I just want to make sure I understand. I've seen "screening" used in different contexts so want to be sure I'm clear.

Screening is asking questions to determine the risk and symptoms. Testing is drawing blood for viral PCR testing.

 

[cwbullet]

Results from a population study of the New Orleans area back in mid-May by Ochsner Health (the largest hospital operation in New Orleans).

Not yet peer-reviewed.

Highlights:
Sample of 2,640 people from a group of 25,000 volunteers.
Antibody test and a polymerase chain reaction, or PCR test, from May 11 to May 16.
7.8% of people in Orleans and Jefferson Parish were infected at that time.
Hard-hit neighborhoods (tracked by zip code) had sample sizes that reflected a potential of up to 25% of the population infected.
Researchers also found a 1.63% fatality rate.
40% of positive cases were asymptomatic at the time of testing.
75% of the most infectious group, those in the early days of exposure, were asymptomatic.
Black people carried a larger burden of disease at 10.3% than white residents at 5.9%.


https://www.nola.com/news/coronavirus/article_be845128-bc63-11ea-9986-47ff2e6ed184.html

I think it is important to clarify one statement. "Black people carried a larger burden of disease at 10.3% than white residents at 5.9%." I think Black American experience a high severity of illness but for what reason we do not know. We need more information before we can actually say that Black Americans harbor more infections. Ther is limited evidence to suggest that. Whites have less obesity and diabetes which may play into that risk. Black women in some areas can be as high as 56-75% overweight and obese. Those are huge risks for death from COVID.

 

[NateB]

Social factors need to be considered as well as incidents of obesity, diabetes, or other disease processes which compound the risk of death from Covid. We have a huge outbreak among the Amish community right now. A few things to consider are large families, their work conditions in some factories and slaughterhouses, and many of their sects ignoring any social guidelines and continuing to hold large events and services. We have another non-black minority group who tend to live in very large groups and also have a large percentage who work the meat industry. The language barrier is a huge hurdle and it is often difficult to find good translators outside of the children due to a wide variety of dialects being used and a high rate of illiteracy in their native language.

 

[Bill S]

I think it is important to clarify one statement. "Black people carried a larger burden of disease at 10.3% than white residents at 5.9%." I think Black American experience a high severity of illness but for what reason we do not know. We need more information before we can actually say that Black Americans harbor more infections. Ther is limited evidence to suggest that. Whites have less obesity and diabetes which may play into that risk. Black women in some areas can be as high as 56-75% overweight and obese. Those are huge risks for death from COVID.

I would think that black's tendency to live in high-density city areas would tend to increase their chances of being infected, over whites in general. Yes, no?

 

[Speaknoevil]

I would think that black's tendency to live in high-density city areas would tend to increase their chances of being infected, over whites in general. Yes, no?

Wow! Culturally inappropriate. Yes, no?

 

[rharshberger]

Wow! Culturally inappropriate. Yes, no?

Not very well stated, but I think I understand what he is trying to say. High population density areas increase personal contacts and many minorities tend to live in these type areas, hence an increase in personal contacts and potential infections.

 

[NOLA_BAR]

I think it is important to clarify one statement. "Black people carried a larger burden of disease at 10.3% than white residents at 5.9%." I think Black American experience a high severity of illness but for what reason we do not know. We need more information before we can actually say that Black Americans harbor more infections. Ther is limited evidence to suggest that. Whites have less obesity and diabetes which may play into that risk. Black women in some areas can be as high as 56-75% overweight and obese. Those are huge risks for death from COVID.

I don't think anyone is completely sure why the racial disparity. This was something that was recognized fairly early, and there is a lot of study locally on that part of the data. The coronavirus data that has been continuously published by LDH has been pretty transparent, you can map it down to the census tract level, so there is good demographic support information available.

 

[Stefan2k4]

New article out today: we have found the cause of the damage to blood vessels and clots. The virus and inflammation cause a cytokine storm and thus results in damage to the endothelial cells. The damage results in a compound called Thrombomodulin that simply causes clots. This is one step from finding a solution. Not all conventional treatments for clotting will work with this mechanism so we must find a more targetted response.

Does Warfarin work against this mechanism?

 

[NOLA_BAR]

Social factors need to be considered as well as incidents of obesity, diabetes, or other disease processes which compound the risk of death from Covid. We have a huge outbreak among the Amish community right now. A few things to consider are large families, their work conditions in some factories and slaughterhouses, and many of their sects ignoring any social guidelines and continuing to hold large events and services. We have another non-black minority group who tend to live in very large groups and also have a large percentage who work the meat industry. The language barrier is a huge hurdle and it is often difficult to find good translators outside of the children due to a wide variety of dialects being used and a high rate of illiteracy in their native language.

Yes, I would guess a lot of this plays a role. The health risks, multi-generation households, occupational exposure risks.

 

[BABAR]

Wow! Culturally inappropriate. Yes, no?

Not every suggestion that there are differences between racial or ethnic groups is inappropriate, whether it is FACTUALLY true or not. Example is the observation that apparently most NFL and NBA players are black.
Or that the proportion of Jewish Nobel prize winner is far greater than the proportion of population in general. (For the record, I am neither)

In fact, the data itself says

“Black people carried a larger burden of disease at 10.3% than white residents at 5.9”

Is an observation, not a critique of racial factors. It is likely multifactorial, and since reducing morbidity and mortality among ALL racial groups is the goal, it requires a frank and objective look at all the possible differences, rather than pretending such differences don’t exist.

There is a major difference between considering that differences may exist, vs implying that such differences SHOULD exist. The first is science. The second is bigotry.

 

[Bill S]

Not every suggestion that there are differences between racial or ethnic groups is inappropriate, whether it is FACTUALLY true or not. Example is the observation that apparently most NFL and NBA players are black.
Or that the proportion of Jewish Nobel prize winner is far greater than the proportion of population in general. (For the record, I am neither)

In fact, the data itself says

“Black people carried a larger burden of disease at 10.3% than white residents at 5.9”

Is an observation, not a critique of racial factors. It is likely multifactorial, and since reducing morbidity and mortality among ALL racial groups is the goal, it requires a frank and objective look at all the possible differences, rather than pretending such differences don’t exist.

There is a major difference between considering that differences may exist, vs implying that such differences SHOULD exist. The first is science. The second is bigotry.

Well said. Those who say "Wow! Culturally inappropriate. Yes, no? " are letting personal feelings and politics get in the way of trying to get at the truth, no matter how "insensitive" it may be. Facts are supposed to be superior to feelings, but many people are incapable of seeing the difference.

 

[dhbarr]

Sticking to study results and avoiding causitive speculation is a good way to help reduce possible appearance of insensitivity.

 

[Bill S]

Sticking to study results and avoiding causitive speculation is a good way to help reduce possible appearance of insensitivity.

Perhaps you may think so, but speculation is how we come up with new ideas to look into. Being more concerned about peoples feelings than exploring uncomfortable ideas hampers that effort. I don't give a damn about appearing insensitive in this matter.

 

[NOLA_BAR]

Sorry guys. The main reason I posted it is that it was an attempt at an early population study. We had this singular event called Mardi Gras February 25 and there was this eerily quiet till March 9th when the first positive was announced. I think the ability to put a hard date on when the virus was considered first introduced and the relatively compact geography of the city made the study appropriate to see how far it had penetrated the overall population. If you look at the graph of cases for the state you can clearly see the effect of a successful lock down. This is because the New Orleans area was responsible for the majority of the cases. Now other parts of the state are the main drivers of increase in cases. I think we can all agree this virus does not pull punches for anyone. Do your best to stay out of its reach.

The story has been updated with a link to the actual paper. The conclusions are the same.
https://www.nola.com/news/coronavirus/article_231a4410-bd1f-11ea-830e-f773f7ca9e21.html

 

[cwbullet]

When you said that you became overrun, does that mean by hospital admissions or just cases counts? Also, are recovery rates and/or stay length improving for people who are hospitalized?

Outpatient services. We are starting to see admission but numbers are moderate now.