Coronavirus

[kenberg]

Browsing around I saw this link for 1918.

 

https://www.medicinenet.com/script/main/art.asp?articlekey=228841

 

A couple of points.

 

1. If for some reason we want to compare 1918 with now, surely it matters that the world population in 1918 was considerably less than today's. In the time of Adam and Eve, for example, a flu that killed two people would have been very significant.

 

2. Surely we can recognize the Trump style by now. Trump displayed the absolute worst of his qualities during the last few months. So let's get people arguing about 1918. He is very good at this. He is totally incompetent at most endeavors, but great at shifting the topic. For some reason people bite again and again at the irrelevant.

[y66]

Clive Cookson at FT: Oxford recruits 2,700 virus patients for fast-growing drugs trial

 

The fastest-growing clinical trial in medical history has enrolled more than 2,700 Covid-19 patients in UK hospitals to test potential treatments for coronavirus disease — and thousands more are likely to join over the next few weeks.

 

Peter Horby, professor of infectious diseases at the University of Oxford, who is leading the project, said no controlled clinical trial — in which people are assigned at random to receive different drugs and the results compared — had ever expanded so quickly and on such a large scale.

 

“We need to recruit very fast while the epidemic is approaching its peak, so that we have enough patients to provide firm data,” he said. The trial is called Recovery, a somewhat tortured acronym for randomised evaluation of Covid-19 therapy. 

 

Prof Horby was involved in clinical trials carried out during the early weeks of the coronavirus epidemic in China. These generally ended up with too few subjects to provide firm evidence, he said, because the Chinese government’s clampdown on Covid-19 reduced transmission of the virus very quickly.

 

Scientists have not had nearly enough time to develop new treatments specifically for Covid-19, so Recovery is evaluating existing medicines that might be effective against coronavirus.

 

The trial started by examining three treatments recommended by an expert panel advising the chief medical officer. They are: the lopinavir-ritonavir combination used to treat HIV; dexamethasone, a steroid that reduces inflammation; and hydroxychloroquine, the malaria medicine.

 

Patients arriving at 130 NHS hospitals across the UK with confirmed Covid-19 are invited to take part. They are allocated randomly to four groups. Three are given one of the trial treatments and the fourth — the control group — just receives standard medical care.

 

“We can add further medicines to the trial within days,” said Prof Horby. “This week we are adding azithromycin, an antibiotic with anti-inflammatory properties.”

 

The trial also plans an extension to patients who become more severely ill, suffering a “hyper-inflammatory” reaction to Covid-19 that might destroy their lungs and other organs. They will probably receive a drug that blocks the action of interleukin-6, a molecule that plays a key role in hyper-inflammation. 

 

Recovery, funded by a £2.1m grant from the UK government, is the largest of many Covid-19 trials under way around the world. “We will co-ordinate as far as possible with the others,” said Prof Horby. “We have aligned the Recovery trial protocol with the World Health Organization’s Solidarity trial, using the same doses.”

 

Many of these trials are testing the same medicines, such as hydroxychloroquine, which President Donald Trump has mentioned on several occasions, because they are widely available and inexpensive.

 

The only clinical trial in China that has reported statistically significant results used the lopinavir-ritonavir anti-HIV combination. Prof Horby, who was part of that trial team, said: “Although the headline was that the findings were negative, most of the signals were in the direction of a positive benefit. My interpretation is that it provides a basis for a larger trial of the treatment.”

 

The Oxford team wanted to include remdesivir, the antiviral drug developed by Gilead of the US originally to treat Ebola, which some experts believe has a good chance of showing some effect against Covid-19. “But we just could not get access to enough remdesivir for our trial,” Prof Horby said. “There just isn’t enough available worldwide.”

 

Recovery has an “adaptive” design, with data analysed on a rolling basis so that any beneficial treatments can be identified as soon as possible and ineffective ones dropped from the trial.

 

Professor Kev Dhaliwal, who is about to launch a separate project at the University of Edinburgh to test anti-inflammatory drugs as Covid-19 treatments, said: “The UK is in a unique position to deliver large clinical trials because we have a unified NHS. It is difficult to carry them out in other parts of the world.”

 

Prof Horby said it was hard to give a timescale for his Recovery trial to deliver results. “The important thing is to continue recruiting very quickly and get the study done and dusted within a few weeks,” he said. “If we stretch it over four to six months we may run out of patients.

 

“We don’t want a repetition of the 2009 flu pandemic when, despite many millions of cases, there were no decent trial results — and we still don’t know what drugs work well against severe influenza.”

[Winstonm]

Browsing around I saw this link for 1918.

 

https://www.medicinenet.com/script/main/art.asp?articlekey=228841

 

A couple of points.

 

1. If for some reason we want to compare 1918 with now, surely it matters that the world population in 1918 was considerably less than today's. In the time of Adam and Eve, for example, a flu that killed two people would have been very significant.

 

2. Surely we can recognize the Trump style by now. Trump displayed the absolute worst of his qualities during the last few months. So let's get people arguing about 1918. He is very good at this. He is totally incompetent at most endeavors, but great at shifting the topic. For some reason people bite again and again at the irrelevant.

 

 

All discussions comparing the 1918 flu pandemic death totals to the present coronavirus pandemic totals are basically non-sensical as explained by this Smithsonian Magazine article:

 

The legacy of victims of the 1918 flu

 

The quest to understand the 1918 flu fueled many scientific advances, including the discovery of the influenza virus. However, the virus itself did not cause most of the deaths. Instead, a fraction of individuals infected by the virus were susceptible to pneumonia due to secondary infection by bacteria. In an era before antibiotics, pneumonia could be fatal.

 

A lack of knowledge about viruses and viral transmission combined with information system that was slow and unreliable - radio didn't really catch on until the 1920s and only about 35% of homes had phones in 1918 - contributed to the rapid spread of the virus.

 

Don't fall for yeahbutism as it is a cousin of whataboutism and both are designed to make you take your eye from the problem at hand.

[barmar]

Do I have to charge for English lessons now? At most 50 million, and at least 50 million, mean the same thing.

This reminds me of an old Saturday Night Live sketch.

 

The supervisor of a nuclear reactor (played by Ed Asner) is retiring, and he's giving instructions to his subordinates on how to manage things in his absence. He reminds them "You can't put too much water into the nucelar reactor".

 

After he leaves, an alarm about a possible meltdown goes off. The workers now realize his statement was ambiguous. Did he mean:

 

1. You must not put too much water into the reactor, and exceeding the limit will cause more problems, or

 

2. it's not possible to put too much water into the reactor, so just keep adding water until the problem is resolved.

 

However, "at most" and "at least" are not ambiguous like this, except in Pillowsky's mind.

[Cyberyeti]

Not sure if this belongs here or in its own thread.

 

Coronavirus seems to be doing strange things to social media.

 

Take the story of the Belgian 500 person orgy which is completely fake and is shown with the debunking of it in this article https://www.thequint.com/news/webqoof/belgium-health-minister-bans-sexual-activities-over-covid-19-false-fact-check, basically a serious website saw it on a news website it didn't realise was satirical.

 

I've just had a friend (who admittedly has every reason to be very angry about her situation) unfriend me on FB because I dare to question allegedly independent articles, that are all on websites founded by Labour party hacks, and haven't had a verifiable source in any of them. She believes the Tories are trying to kill off all the old and infirm to save money.

[kenberg]

Not sure if this belongs here or in its own thread.

 

Coronavirus seems to be doing strange things to social media.

 

Take the story of the Belgian 500 person orgy which is completely fake and is shown with the debunking of it in this article https://www.thequint...alse-fact-check, basically a serious website saw it on a news website it didn't realise was satirical.

 

I've just had a friend (who admittedly has every reason to be very angry about her situation) unfriend me on FB because I dare to question allegedly independent articles, that are all on websites founded by Labour party hacks, and haven't had a verifiable source in any of them. She believes the Tories are trying to kill off all the old and infirm to save money.

 

The problem of mis-information is serious and yes, it might deserve a thread if its own/ I was thinking the same when griping about DT. We probably should keep this thread to the virus itself.

 

We have to trust someone, at least provisionally, but there are a lot of people who we should not trust. Sorting it all out is not obvious.

[y66]

Steven Salzberger at Forbes: Prazosin Might Be A Treatment For COVID-19. More Data Is Urgently Needed

 

Salzberger is Bloomberg Distinguished Professor of Biomedical Engineering, Computer Science, and Biostatistics at Johns Hopkins University

 

Scientists around the globe are devoting enormous resources to trying to develop new treatments for COVID-19, the pandemic that is sweeping across the world. So far, though, we don't have any effective therapies or vaccines.

 

That might be about to change. What's particularly exciting is that this new treatment uses a widely-available drug that has already been shown to be safe in humans.

 

In a new preprint, a team of my colleagues at Johns Hopkins University School of Medicine, led by Maximilian Konig, Bert Vogelstein, Joshua Vogelstein, Susan Athey, Shibin Zhou, and Chetan Bettegowda, describe the potential of prazosin to slow down and possibly prevent one of the worst effects of COVID-19: the cytokine storm.

 

[some background: a cytokine storm is an extreme immune response of your own body. When coronavirus (SARS-CoV-2) enters the lungs, your immune system responds with virus-fighting cells that release small proteins called cytokines. In some cases, the immune system just keeps amplifying its response, sending more and more cytokines even though the infection might be under control. If it gets too bad, the cytokine storm itself may be fatal. Cytokine storms have been implicated in other viral diseases, including influenza and SARS.]

 

Let me start with a caveat: if prazosin works, it isn't a cure. However, it might prevent the need to go on a ventilator, which would be a huge benefit in a country (and a world) that has a severe shortage of ventilators right now. Even more important, it might save patients with severe COVID-19 from dying.

 

Several of the scientists involved in this new study have shown previously that drugs like prazosin (which are known technically as alpha-1AR antagonists) can prevent a cytokine storm–in mice. They realized that results in mice often fail to translate to humans, but in the current pandemic, how could they find time to do a new study?

 

They didn't: instead, they looked at a medical database and collected records from 13,125 men who had acute respiratory distress (ARD) from a variety of causes in the years from 2007-2015. ARD is not the same as COVID-19, but it's similar; and if a cytokine storm occurs in ARD, patients are more likely to require a ventilator and/or die. Because prazosin is widely used by men (most commonly for enlarged prostates), they were able to compare the outcomes of men who had incidentally been taking prazosin to men who hadn't.

 

The results: men who had been taking prazosin had a 22% lower risk of either needing a ventilator or dying. That's not a huge effect, but it could be a game changer for our overwhelmed hospitals in the midst of this pandemic. Even a modest reduction in the number of patients needing ventilators–or dying–would be a huge win for public health. Also, the patients in this retrospective study weren't taking prazosin to treat their respiratory distress, and it's possible that higher doses might have a larger effect.

 

There are many more caveats here. First, the study I'm describing is a medRxiv preprint, meaning that it has not been peer-reviewed. In addition, the data are from a retrospective study of men who had a different disease, not COVID-19. So maybe prazosin won't work to prevent cytokine storms caused by the coronavirus.

 

But maybe it will. My colleagues shared their preprint with me because they are convinced that, if nothing else, their hypothesis needs to be examined by as many scientists and doctors as possible. They are starting their own clinical trial, but they hope that these preliminary findings "will inspire immediate clinical trials in countries now desperate for new ways to reduce hospital admissions, ventilator needs, sickness, and death."

[y66]

Matt Yglesias tweeted: Apple and Google are building a coronavirus tracking system into iOS and Android

[pilowsky]

This reminds me of an old Saturday Night Live sketch.

 

The supervisor of a nuclear reactor (played by Ed Asner) is retiring, and he's giving instructions to his subordinates on how to manage things in his absence. He reminds them "You can't put too much water into the nucelar reactor".

 

After he leaves, an alarm about a possible meltdown goes off. The workers now realize his statement was ambiguous. Did he mean:

 

1. You must not put too much water into the reactor, and exceeding the limit will cause more problems, or

 

2. it's not possible to put too much water into the reactor, so just keep adding water until the problem is resolved.

 

However, "at most" and "at least" are not ambiguous like this, except in Pillowsky's mind.

 

One of the most important things about trying to be funny Barry is attention to detail. There is only one l in Pilowsky. So if I were to refer to you as Barry Mangolin that would be humorous - no doubt you copped that one a lot. My mother Marl also messed up words occasionally and my Father called them 'Marlopropisms' she was a demon at scrabble. Since I have a medical degree I suppose you could call me Pillowsky as a joke, but as my Father would say "it's like a joke except for the bit at the end". Your comment is unfortunately not far from the truth. In Australia, the Department of Health ran a campaign to stop pregnant people (women obviously for those not medically qualified, or Arnold Schwarzenegger) smoking because it would cause intrauterine growth retardation (small sick babies). Tragically, many women started smoking more so that they would have easier deliveries. To the point. At most 50 million people died. True. When it is stated that at least 50 million died this statistic is also true. BUT the true statistic is 20 to 50 million. many of which were CAUSED by the advice of the white house Surgeon-General and the cramming of unfortunate souls onto Troop ships (I wonder if some were cruise ships?). If it makes you feel better to make Pilowsky jokes in a time of personal difficulty, that's fine by me. You are at the end of a very long line. I'll go back to helping people: like you should be: any way that's what's in Pillowsky's mind.

[johnu]

Lots of new trials of drugs going on, most of them seem to have much more promise than chloroquine and other closely related drugs.

 

One is Alvesco Three Cases of the Early to Mid-stages of COVID-19 Pneumonia Improved by Inhalation of Ciclesonide

 

Emergency meeting on measures against new coronavirus infections" conducted on February 19, was started in 3 patients with hypoxia and CT findings on February 20, and we report the favorable progress. In the case report, it was explained to all patients, and the consent was obtained.

More anecdotal evidence, but some of these stories seem promising. Hope the trials prove that they are really effective.

[smerriman]

At most 50 million people died. True. When it is stated that at least 50 million died this statistic is also true.

:blink: After all the responses, you still haven't learnt?

[Chas_P]

:blink: After all the responses, you still haven't learnt?

 

It's almost gotten like the old Abbott and Costello routine, "Who's on first". Comical. But we all need that now. Something to laugh at.

[helene_t]

NZ is not doing badly, and possibly on course to eradicating Covid. And we don't have widespread social irresponsibility and needless politicizing like certain other countries.

 

But NZ is also a bit over-hyped due to Jacindamania. Plenty of other countries have similar statistics. Australia's numbers look better than NZ's, and they do more testing than we do. And Greenland seems to have gotten rid of it with all known cases recovered and no new cases for a week by now.

[pilowsky]

:blink: After all the responses, you still haven't learnt?

...don't you have anything better to do with your time? the rest of the par reads...." this statistic is also true. BUT the true statistic is 20 to 50 million." In other words, 50 WAS the upper limit and most of that was caused as it seems to be now by the stupidity, moral turpitude and rank incompetence of the administration. Get a grip and stop wasting time on the Forums and do something useful. I am not paying you to make snide remarks about me. I am also endlessly patient. If I make a mistake I'll thank you for it and move on. It's called learning. That's not what is happening here. 20-50 million people died. Now stop farnarkling about and get back to work. You are fortunate to live in NZ a country that is likely to escape relatively unscathed compared to most.

[smerriman]

Sorry, but if you're going to consistently make 100% false statements, you're going to be consistently corrected.

 

"At least" is a synonym for "greater than or equal to". 20-50 million is not "greater than" 50 million, and it is not "equal" to 50 million [unless there were exactly 50 million deaths].

 

Either your knowledge of English isn't great, or you are truly trolling everyone.

[pilowsky]

Really. You have nothing better to do with your time?

[y66]

NYT: Restarting America Means People Will Die. So When Do We Do It?

[smerriman]

Really. You have nothing better to do with your time?

That depends - do you think 'nothing better' and 'nothing worse' mean the same thing too? ;)

[Stephen Tu]

Unfortunately the CDC has one article stating

"at least 50 million"

https://www.cdc.gov/...demic-h1n1.html

but a different article stating"as many as 50 million"

https://www.cdc.gov/...flupandemic.htm

which imply entirely different things (>= 50,000,000 vs. <= 50,000,000). Scientists sometimes aren't as precise with English as they ought to be.

 

But the second article also links to

https://science.scie...745/77.abstract

which estimates "20-50 million"

 

How any of this matters, I don't know. In any case I would never believe anything the current president says without checking with more reputable sources. He obviously wants to claim as horrendous numbers as possible in comparison so that whatever figure we end up with whether 60k, 120k, or 240k, he can declare victory and his awesomeness, even though this would be achieved in spite of his actions rather than because of them.

[thepossum]

It's rare that I side with Chas, but in this case he's correct. "At least 50 million" means that 50 million is the low end of the estimate, and it could have been more.

 

Its sad you had to explain this Barmar

 

I must admit I am feeling less concerned about the intellect of any on this site who ever attacked me before, if this is the level of people's understanding of anything

 

I had been planning to raise some serious issues about this terrible pandemmic which have been concerning me. The conflict between control and freedom. The meaning of life and existence. How this issue is challenging all our values. Where to from here. The state of the world economy during and post pandemic. Is there a chance of a vaccine and if not where to from here. Ethics. Law. Philosophy. Science. The arts. Anything

 

But at least I now know the level at which to pitch any future posts and threads :)

[helene_t]

I once overheard a call center agent telling a customer that "there's no maximum order which you must place". I tried, unsuccessfully, to explain to her that the policy she was trying to convey was that there was no minimum order.

 

But "at least" vs "at most" I would think that nobody older than five years could get confused about.

 

Maybe it depends on your native language. Expressions like "I couldn't care less" and "You may not do it" might suggest to native English speakers that the language cannot be assumed to be logical, and a lot of seemingly self-explanatory idioms have to be root learned?

[pilowsky]

So, when is a revoke not established 🙂.

[y66]

Tim Culpan at Bloomberg: Taiwan’s Viral Success Makes It Harder to Ignore

 

On Jan. 14, the World Health Organization sent a tweet that turned out to be one of the most significant statements in the world’s fight against the virus now known as Covid-19. Based on information from China, the global health agency wrote, the new coronavirus didn’t appear to spread via human-to-human transmission.

 

Two weeks earlier, health authorities in Taiwan had reached the opposite conclusion. Not only did Taiwan’s Centers for Disease Control surmise that people were passing the disease to each other, they notified the WHO of their suspicions through the UN agency’s International Health Regulations reporting window, a platform for sharing information and updates.

 

“We tried to get clarification from the IHR on what’s going on in Wuhan,” Taiwan Foreign Minister Joseph Wu told me. “But the response from the WHO was, ‘OK, we’ll take it from here.’” The Taiwanese never heard back.

 

That incident marked a crucial early moment in the WHO’s failure, in tandem with China, to stop the epidemic. It also reflects what has become an impossible needle for the Geneva-based authority to thread between an increasingly dominant member, Beijing, and one of the only stars in this pandemic, which can’t even walk in the front door. The absurdity hit a public peak when a senior official couldn’t even acknowledge Taiwan’s existence in an interview with a Hong Kong broadcaster.

 

Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus (2019-nCoV) identified in #Wuhan, #China🇨🇳. 7:18 AM - Jan 14, 2020

Taiwan’s success in controlling Covid-19 has bolstered its global standing even amid a multi-year campaign by Beijing to stifle and isolate the place. Left flat-footed by the WHO, nations are expanding bilateral ties with Taipei to bolster their own Covid-19 responses. A consensus is also starting to emerge in the international community that Taiwan should be given access to the WHO and other multilateral agencies, even as China's opposition grows louder.

 

Forced to develop its own health vigilance systems, Taiwan, with a population of 23 million, took a separate approach to handling the virus. When the WHO recommended against restrictions on travelers from China, officials in Taiwan implemented bans from the original affected areas and later widened them. As the WHO advised that masks weren’t necessary, Taiwan ramped up production and issued them to citizens.

 

As the pandemic spreads around the world, Taiwan has recorded just 339 cases and 5 deaths, 1 compared to official figures of more than 82,000 cases in China and more than 10 times that number globally. The vast majority of Taiwan’s cases are of citizens returning from Europe or the Americas.

 

Being left in the international wilderness is nothing new to Taiwan. It’s recognized as a country by only 15 mostly tiny nations with which it has diplomatic ties. China lays claim to its territory, viewing it as unfinished business from the civil war that brought the Chinese Communist Party to power in 1949. Bloomberg Opinion columnist Hal Brands notes that the WHO has become a tool of China’s foreign policy aimed at isolating Taiwan and its democratic government.

 

The diplomatic difficulty this causes for Taiwan in dealing with the UN and its agencies is becoming hard to sustain; who shares what, when, how and at what level has been a problem in aviation and other sectors as well as health. The pandemic, however, is making what often seems a local problem more visible and relevant to the wider world.

 

Over the past week, the WHO has insisted it “works with Taiwanese health experts and authorities.” Taipei responded that information it shares to a WHO database doesn’t get distributed to member states. Taiwan noted that while it and the WHO both participate in a third-party sharing network, its health officials are cut off from the UN agency’s global alert network.

 

“We don’t know what we don’t know. We don’t know what the WHO is telling the Chinese CDC,” said Huang SongEn, an epidemiologist at Taiwan’s health ministry. “It’s a black hole.”

 

If there’s any upside, it’s that this emergency has spurred officials in the U.S., Japan and the European Union to quickly expand bilateral ties so that they can learn from Taiwan’s success. Last month, Washington’s representative to Taipei issued a joint statement with Wu announcing increased cooperation including research and development, contact-tracing, and scientific conferences.

 

“We continue to look to other countries who’ve had longer experience with Covid-19 to share information,” Sarah Bennett, head of the U.S. CDC’s International Task Force for Covid-19, told a teleconference when asked about its relationship with Taiwan. The European Union said it's working with the Taiwan government's Academia Sinica to develop a rapid test.

 

In the complex diplomacy involving Taiwan, and in fighting the pandemic, this kind of stuff matters. Since the outbreak accelerated in January, Japan, the U.S., U.K., EU and Australia are among those that have joined the call for Taiwan to be given access to the WHO.

 

Taiwan officials shy away from criticizing the WHO. They want to be a member and get the same recognition and access to multilateral institutions as any other. In speeches and press conferences on Covid-19, President Tsai Ing-wen has repeated a mantra she’s used before to highlight the country’s commitment to global issues like health and the environment: Taiwan Can Help.

 

Tsai argues that Taiwan’s willingness to offer solid medical and technical assistance in this crisis makes the case for a seat at the global table. The international community is starting to agree.

[kenberg]

Hoping to bring the "at least" versus "at most" to an end:

Do we all agree that:

if 49 million died then "at least 50 million died" is false and "at most 50 million died" is true

while

if 51 million died then "at least 50 million died" is true and "at most 50 million died" is false

?

If we all agree with that, which I hope we all do, then we can, but we do not have to, go on to sources that appear to say there is wide disagreement about how many died. I readily acknowledge I have no idea as to how many died, and the literature suggests that those who have tried hard to get it right are not so certain either.

[pilowsky]

That's why Ken gets the big bucks