Coronavirus: What questions do you have?

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Nytrunner

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Challenge vaccine trial.
16k people have signed up for a being dosed with the experimental vaccine (or placedo), isolate to build whatever immunity they will, then intentionally be exposed to the novel-Coronavirus

Thoughts?

 

cwbullet

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Challenge vaccine trial.
16k people have signed up for a being dosed with the experimental vaccine (or placedo), isolate to build whatever immunity they will, then intentionally be exposed to the novel-Coronavirus

Thoughts?

I appreciate the bravery or stupidity of being exposed to the virus. I am not sure which one this is. Either way, exposing someone to a potentially lethal virus voluntarily or involuntarily is unethical.
 

cwbullet

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Do you know if pet Bunny rabbits that stay inside are in the same classification of house cats? I've had someone ask me if bunnies can catch C-19
I suspect it can be transmitted to more than cats and humans.
 

Marc_G

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Hi Chuck, what do you make of this:


(I was able to open it without subscription)

4600 folks randomly selected in Indiana were swabbed for infection, and blood sampled for antibodies. 1.7% infectious plus 1.1% antibody positive for a 2.8% total estimated infection rate in Indiana.

Combined with known case and fatality data results mean 10/11 infections is going undetected. Overall infection death rate 0.58%.

See article for implications, but once again I burst my liberal bubble and commend my Republican governor for his handling of the situation.

Now for my question: the fact that the sampling found a larger % with active infections than it did antibody positives struck me as odd. I would have figured you are infectious for a couple weeks then no longer but the pool of antibody positives is ever growing, so I would have expected it to be larger than the number of infectious folks.
Do you have an explanation for why this might be the case other than either "a bunch of non infectious non antibody people haven't yet had time to develop a strong antibody response, but will eventulay" or "antibody response decays quickly in this case."

Would love your perspective.
 

davel

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Another patient was treated with hydroxychloroquine and azthromycin but ended up on ECMO for 2 weeks before recovering. 2 cases made public are hardly enough to base more decisions on, but are certainly helpful for researchers.
Out of curiosity, when was the HCQ/Z-pack given? I hear that it needs to be given (along with Zinc) early on, at the first sign of symptoms, and it is not nearly as effected after the infection has progressed. In a similar way that Tamiflu needs to be given early or it is not effective.
 

cwbullet

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Out of curiosity, when was the HCQ/Z-pack given? I hear that it needs to be given (along with Zinc) early on, at the first sign of symptoms, and it is not nearly as effected after the infection has progressed. In a similar way that Tamiflu needs to be given early or it is not effective.
Zinc is very controversial. It can cause loss of smell by itself and has nearly not research to support It.
 

NateB

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Out of curiosity, when was the HCQ/Z-pack given? I hear that it needs to be given (along with Zinc) early on, at the first sign of symptoms, and it is not nearly as effected after the infection has progressed. In a similar way that Tamiflu needs to be given early or it is not effective.
I have no idea exactly when those drugs were given. I can make an educated guess based on protocols, but our department for ground and air critical care transport did not play a role in this study.
 

cwbullet

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I am starting 3 sets of research in our hospital. One involving AB testing and two involving treatments.
 

Reinhard

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Now for my question: the fact that the sampling found a larger % with active infections than it did antibody positives struck me as odd. I would have figured you are infectious for a couple weeks then no longer but the pool of antibody positives is ever growing, so I would have expected it to be larger than the number of infectious folks.
Do you have an explanation for why this might be the case other than either "a bunch of non infectious non antibody people haven't yet had time to develop a strong antibody response, but will eventulay" or "antibody response decays quickly in this case."
More of a guess, but I assume the numbers will either change soon or have already since the test was performed.
I haven't come across an equivalent plot from a US state (and I'm to lazy to search or create it myself) so here again I bother you with data from the wrong side of the Atlantic.
1589534613321.png

Source: https://orf.at/corona/stories/3157533

At the peak, there were only few recovered cases compared to active cases, but this changed within a week or two. This is not data from random sampling, but I'd expect the curves to be at least somewhat similar.

Reinhard
 

cwbullet

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More of a guess, but I assume the numbers will either change soon or have already since the test was performed.
I haven't come across an equivalent plot from a US state (and I'm to lazy to search or create it myself) so here again I bother you with data from the wrong side of the Atlantic.
View attachment 416658
Source: https://orf.at/corona/stories/3157533

At the peak, there were only few recovered cases compared to active cases, but this changed within a week or two. This is not data from random sampling, but I'd expect the curves to be at least somewhat similar.

Reinhard
I don't think we have this kind of data for a state assembled yet.
 

Steve Shannon

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I live in a county which has had 11 confirmed cases. It has been 43 days since the last confirmed case, but we still have one remaining stubborn active case (11 confirmed, 10 recovered). My question is: what’s the longest active case you’ve seen?
 

cwbullet

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I live in a county which has had 11 confirmed cases. It has been 43 days since the last confirmed case, but we still have one remaining stubborn active case (11 confirmed, 10 recovered). My question is: what’s the longest active case you’ve seen?
Steve,

This is a difficult question. I have not seen many that are symptomatic for more than 2-3 weeks. I have seen a bunch of cases test positive on PCR for 45-60 days after the initial test/symptoms. We do not know what this means and have zero proof that these folks are still contagious/infective. I am not about to walking in and take a deep breath or shake hands to "roll the dice" and find out.
 

Marc_G

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I have the day off and can answer questions if you have them.

The world of COVID is rapidly changing. They have found antibodies that deactivated the virus and allowed it to be destroyed by our immune system.
Interesting work; I know folks on one of the groups exploring this approach in NY.

how long do you think it would take to turn initial work into deployable treatment given expedited trials?
 

Steve Shannon

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I have the day off and can answer questions if you have them.

The world of COVID is rapidly changing. They have found antibodies that deactivated the virus and allowed it to be destroyed by our immune system.
That sounds like a game changer. Is that part of any of the vaccine clinical trials or is that a separate research study?
 

cwbullet

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That sounds like a game changer. Is that part of any of the vaccine clinical trials or is that a separate research study?
Separate study! Part of the research being done by a private company in California. If we can find a safe way to reproduce the antibodies and use them, this could be a huge game-changer.
 

Nytrunner

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Speaking of studies and surveys, some of my older facebook acquaintances are sharing an article by the New York Post (I know.....) that is titled "Hydroxychloroquine rated ‘most effective’ coronavirus treatment, poll of doctors finds"

Upon reading the article, it's a bout a poll of ~6000 docters in different countries asking about the most effective drug for COVID treatment, and 37% of them say HCQ (32% say "Nothing" was most effective.....)

For me at least, I don't really find such a poll confidence inspiring. My suspicion is that those that share it believe it defends the statements of a certain political leader.
Additionally, they don't like Remdesivir (sp?) because China holds the patents on it.

All that fluff aside, here's the actual survey results from Sermo. Medical opinions?


 

Marc_G

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Lots of folks in one political camp cite the survey you referenced. I came to the same conclusions on that survey as you did, in particular because there's no patient data, and it relies on doctor opinions with no outcome data, and it was a survey done during the "HQ buzz" surrounding some initial good results that I don't believe were ever replicated.

Those same folks rarely cite the next report in the series, described here:


Here's an excerpt:

"According to Sermo, when participants were asked to "rate the efficacy of medications you have used or have seen used to treat COVID-19," 52 percent listed "plasma from patients who have recovered from COVID-19" as "very or extremely effective," followed by Hydroxychloroquine (Plaquenil) or Chloroquine at 38 percent, "non-approved drugs" at 37 percent, Interferon-beta at 36 percent and "traditional Chinese medicine" at 34 percent. '

Interestingly, this survey was done at at time when plasma from recovered patients was a big hot thing. I guarantee you 52% of the survey respondents didn't do valid trials all the way through to completion using plasma. And, HQ is no longer top but still rated around "non approved drugs" and "Traditional Chinese medicine." Not much of an HQ signal there even if the data were believed to represent actual results.

I file these Sermo reports -and articles written about them- in the circular bin.

Chuck, what say you?
 

cwbullet

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Lots of folks in one political camp cite the survey you referenced. I came to the same conclusions on that survey as you did, in particular because there's no patient data, and it relies on doctor opinions with no outcome data, and it was a survey done during the "HQ buzz" surrounding some initial good results that I don't believe were ever replicated.

Those same folks rarely cite the next report in the series, described here:


Here's an excerpt:

"According to Sermo, when participants were asked to "rate the efficacy of medications you have used or have seen used to treat COVID-19," 52 percent listed "plasma from patients who have recovered from COVID-19" as "very or extremely effective," followed by Hydroxychloroquine (Plaquenil) or Chloroquine at 38 percent, "non-approved drugs" at 37 percent, Interferon-beta at 36 percent and "traditional Chinese medicine" at 34 percent. '

Interestingly, this survey was done at at time when plasma from recovered patients was a big hot thing. I guarantee you 52% of the survey respondents didn't do valid trials all the way through to completion using plasma. And, HQ is no longer top but still rated around "non approved drugs" and "Traditional Chinese medicine." Not much of an HQ signal there even if the data were believed to represent actual results.

I file these Sermo reports -and articles written about them- in the circular bin.

Chuck, what say you?
I have been consistent. I would not use these medications unless I was on my deathbed and it was my only option. Plaquenil, chloroquine, and azithromycin have crappy research behind them.
 

jbsommerfeldt

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Consistent, yes. We on the other end of the keyboard are expressing thoughts and emotions based on our current feelings. If you try to condense all covid information into your brain you will have no answers. This is what it is. Hurt me dont hurt me. You started to die the day you were born.

Common sense isnt common. Otherwise it wouldnt be common sense.
 

BABAR

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I live in a county which has had 11 confirmed cases. It has been 43 days since the last confirmed case, but we still have one remaining stubborn active case (11 confirmed, 10 recovered). My question is: what’s the longest active case you’ve seen?
Define “active”? I suspect this means “symptomatic”. Does NOT equate to “infectious”, but I would specify it UNDERESTIMATES THE INFECTIOUS PERIOD. we know people are infectious WHILE they are symptomatic, also and critically they are infectious BEFORE they are symptomatic, and I am not sure if (and if so how long) they may be infectious AFTER they get symptomatic
 

cwbullet

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Define “active”? I suspect this means “symptomatic”. Does NOT equate to “infectious”, but I would specify it UNDERESTIMATES THE INFECTIOUS PERIOD. we know people are infectious WHILE they are symptomatic, also and critically they are infectious BEFORE they are symptomatic, and I am not sure if (and if so how long) they may be infectious AFTER they get symptomatic
Active currently means that they shedding or releasing viral genetic products (RNA). Therefore they tets positive. This does not necessarily mean they are infectious. We do nto have a great test to determine the end of the "Infectious" or "Contagious" period in some patients because they continue to shed viral products.

We are looking at other viral markers and products to test but this is premature and not well validated.
 

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Active currently means that they shedding or releasing viral genetic products (RNA). Therefore they test positive. This does not necessarily mean they are infectious. We do nto have a great test to determine the end of the "Infectious" or "Contagious" period in some patients because they continue to shed viral products.

We are looking at other viral markers and products to test but this is premature and not well validated.
Okay, I admit that I don't completely get this even though this isn't the first time you've said it. How can someone be shedding viral products and *not* be infectious or contagious? Are they shedding dead virus products? Or are the shedding at such a low level that there aren't sufficient numbers of the virus to effectively infect another host? Or what? I'm just not understanding how this works. My assumption would have been that if they are shedding the virus, that someone could "catch" it from those "virus products." If not, what's the difference between what they are shedding and what is needed to infect people nearby?
 

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Okay, I admit that I don't completely get this even though this isn't the first time you've said it. How can someone be shedding viral products and *not* be infectious or contagious? Are they shedding dead-virus products? Or are the shedding at such a low level that there aren't sufficient numbers of the virus to effectively infect another host? Or what? I'm just not understanding how this works. My assumption would have been that if they are shedding the virus, that someone could "catch" it from those "virus products." If not, what's the difference between what they are shedding and what is needed to infect people nearby?
To be infectious, you have to shed or release the whole and active virus. The test digests the virus and tests for viral RNA. It can not test for "active viruses". We believe that many of these shedders are shedding "dead' viruses for months after recovery. Sure, they could also be producing a low level of live virus but not enough to infect. This may take months to figure out, but we there is significant evidence that some folks shed dead or complete virus for weeks to months after "cure".
 

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I have a question about paper surgical type mask. Can they be worn for extended periods of time or is there a recommended amount of time that it should be worn before taking a break between time worn? Not asking about the people who wear the mask over their mouth and not their nose, a properly worn one.
 

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Nitric oxide as a treatment for gas exchange always amuses me. Pretty much a poison but also a great little broncodialator. My wife was an ICU nurse so I learnt a lot of her stuff while she was studying and working there 🙂.
 

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I have a question about paper surgical type mask. Can they be worn for extended periods of time or is there a recommended amount of time that it should be worn before taking a break between time worn? Not asking about the people who wear the mask over their mouth and not their nose, a properly worn one.
A paper mask can be worn will soiled, wet, or damaged. Then it would be destroyed.
 
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