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Covid-19 updates and analysis (long)

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xrugger

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Aug 15, 2001
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The news regarding corona virus is coming fast and from a variety of sources. It can be difficult to sort the wheat from the chaff particularly when it is so easy to let one’s political beliefs color the interpretations. I want to present my interpretation of where things stand right now. First, let me give you some credentials and you can judge whether my interpretations are worth your time. I have a long career as a molecular biologist running a biomedical research lab at a medical school. I have more than a passing knowledge of virology, clinical medicine, and drug development. I am part of a grant application that seeks to develop a new therapeutic approach to treat Covid-19 patients. I don’t post often but I’ve been on this board well before it was segregated into a free board and a pay board.

The bottom line is that while we know a remarkable amount about a virus that we were unaware of just a short time ago, there remains more that we don’t know. Much of the molecular nature of the virus we know from studies on the corona virus that caused SARS. The current virus is related enough to that virus that it is officially named CoV-SARS-2. We know that two host, i.e. YOU, proteins, ACE2 and TMPRSS2 are required for viral entry. The viral SPIKE protein binds to the portion of the membrane bound ACE2 that sticks outside of the cell, often a cell that lines the surface of the lung alveoli. TMPRSS2 is a protease that clips the SPIKE protein, a processing step that is required for efficient viral entry. There are therapies being developed that are directed toward interfering with these processes.

Now to address the bigger population-based questions that get at the thorny question of setting policy. Right now, anyone that operates from a political viewpoint first and foremost can find some data or some study that supports their stance. The real answer is that there are problems with what data there are and until a lot more proper testing is done, we won’t be able to make informed decisions. There are arguments over just what the real viral infection rate is in the population. Initial numbers were skewed by the fact that so few tests were available that by and large, only symptomatic people were being tested. In addition, in trying to speed the bottleneck, the CDC broke one of its own rules and there were problems with contamination in the early testing. The central government has waived some of the stringent rules regarding the development and vetting of test kits and this policy is causing a big issue currently in accurately assessing infection rates. The two recent studies from USC and Stanford (which, last I knew, had not been peer reviewed) used a test kit that had been released without FDA approval. The false positive rate of that kit is 1.7%. If one is saying that 2 to 4% of the population is showing evidence of prior infection you can see why a background like that makes those numbers dubious. Other interpretations of that data suggest that it could be ten-fold less. Testing in other countries does suggest that the circulating level of virus is in the double digits. One could use this to argue either side of open up or not. The virus has a lower mortality rate than initially thought due to the population testing bias but this also means it is more infectious than thought. Data will continue to be suspect until enough of the test kits have been properly screened by the FDA and used to evaluate a big enough sample of the population in different states. Nonetheless, I suspect that within a month we will have a reasonably good handle on the frequency of infected people in the population. No estimate I’ve seen gives numbers that approach what is needed for herd immunity. That percentage ranges from more than 60% up to 95% depending on the infectivity of the virus. A highly infectious virus, like measles, is 95%. I suspect CoV-SARS-2 will be toward the upper end of this number and that means the virus will continue to circulate with local hotspots until herd immunity is reached or a vaccine comes online.

This virus is not like influenza. I’ve seen a lot of references to the H1N1 pandemic. Influenza viruses come in a lot of flavors and it is an educated guessing game to make a vaccine that will neutralize the right strains when you have to make decisions a year and more in advance. H1N1 represented a major antigenic shift so that the vaccines for that year were completely ineffective. H1N1 is actually less infectious than the predominant flu strains and older Americans had some immunity from an outbreak that had occurred years before. Younger people had not been exposed to H1 or N1 viruses so the flu hit them harder. Yes, flu kills a lot of people and yes, there has been a substantial effort to make a ‘universal’ flu vaccine. Yes, flu tends to kill those with underlying health problems, especially lung problems but the symptoms of Covid-19 are significantly worse than from flu as evidenced by the length of ICU stays, time on a ventilator, and overall length of hospital stays. The course of Covid-19 is unpredictable, a patient can be seeming to improve and then fall off a cliff. One issue is a cytokine storm that triggers a massive inflammatory response in the lungs which can completely compromise function. This can occur in someone who is otherwise completely healthy but it cannot be predicted, at this point, who will react that way. People exposed to particulates, farmers, some construction and industrial workers, for example, should be particularly careful since they may have a high baseline of inflammation or compromise of lung function already.

I’ve been following the numbers of cases and deaths closely. While there has been a lot of argument on this board over the accuracy (or lack thereof) of predictions and numbers, there is enough of a trend that won’t make either open uppers or stay at homers happy. Both mortality and total cases for the US overall have continued at a pretty constant rate for a while now. In places the curve has begun to drop a bit but that is counterbalanced by places where numbers are increasing more than linearly. Nebraska has fared pretty well so far thanks to a low population density and few tourists bringing it in. There are a couple of worrying developments of hot spots e.g. Grand Island with the potential to cause problems for local hospitals. The difficulties faced by rural hospitals even without Covid-19 is a huge issue of national concern. Take home message: no peak but a steady ongoing course of infections and deaths averaged over the nation.

Have stay at home orders worked? To a degree, yes. Two examples: Colorado had early outbreaks thanks to infected people coming into the state to ski. Early on it was number 4 or 5 in Covid-19 cases. Colorado’s governor instituted stay at home orders and closed many businesses. It now ranks 18th in total cases among states. A second example is seen by comparing Kentucky and Tennessee. Kentucky moved sooner with business closings and promoting social distancing and has less than half the number of cases as Tennessee. Now the bad news: as I said above, overall numbers aren’t going down. They have been holding pretty steady. With some notable exceptions, hospitals have not been overrun. I anticipate that the case rate and death rate will hold steady for the next month. That means we will have over 100,000 total Covid-related deaths in the US by June. I hope I’m wrong. (I thought I was wrong once, but I was mistaken- old joke, couldn’t resist).

Reopening soon is inevitable. I wish it would hold off for another 3 or 4 weeks until we have firmer numbers on infection rates that would inform as to how best to go about a staggered reopening, but I am realistic enough to know that it isn’t going to happen. Wrong decisions will mean an upturn in cases and deaths and could actually wind up shutting down some industries more than helping them back on their feet. I am eager to get back to work. My colleagues and I are working on developing a very promising cancer drug and progress is currently at a standstill as we cannot go to the lab for anything but essential maintenance. However, I am going to be smart about it for some time yet. I will work at home insofar as possible. I am not going to travel, I am not going to go to restaurants, not even a damn microbrewery, I am going to continue wearing a mask when out in public. How you approach it is up to you. Just realize protection is for others even more so than yourself. If you are out in public in places that everyone has to use, like the grocery store and gas station, please wear a mask and gloves. You can make decisions for yourself to go to the gym or tattoo parlor but, when in places everyone has to use, if you choose not to use protection, you may be making a life or death decision on someone else. It is not an infringement of your liberties any more than not being allowed to yell, “Fire,” in a crowded theater when there is none is an infringement upon your 1st amendment rights. It is a minor inconvenience for a common courtesy.
On a personal level, I do have a friend who died of Covid-19. I have a relative infected in a nursing home who should have died (multiple severe health problems) but somehow didn't even have symptoms. My daughter is an emergency room physician and is on the front lines.
 
I'm wearing a mask right now and I wear one all day...it sucks, my hands have never been cleaner...and I do dirty work! Can't wait for this to end. I'm going nuts with sanitizing hands, all knobs and levers, steering wheel, and tools.

I might cut my wrists open soon....
 
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The news regarding corona virus is coming fast and from a variety of sources. It can be difficult to sort the wheat from the chaff particularly when it is so easy to let one’s political beliefs color the interpretations. I want to present my interpretation of where things stand right now. First, let me give you some credentials and you can judge whether my interpretations are worth your time. I have a long career as a molecular biologist running a biomedical research lab at a medical school. I have more than a passing knowledge of virology, clinical medicine, and drug development. I am part of a grant application that seeks to develop a new therapeutic approach to treat Covid-19 patients. I don’t post often but I’ve been on this board well before it was segregated into a free board and a pay board.

The bottom line is that while we know a remarkable amount about a virus that we were unaware of just a short time ago, there remains more that we don’t know. Much of the molecular nature of the virus we know from studies on the corona virus that caused SARS. The current virus is related enough to that virus that it is officially named CoV-SARS-2. We know that two host, i.e. YOU, proteins, ACE2 and TMPRSS2 are required for viral entry. The viral SPIKE protein binds to the portion of the membrane bound ACE2 that sticks outside of the cell, often a cell that lines the surface of the lung alveoli. TMPRSS2 is a protease that clips the SPIKE protein, a processing step that is required for efficient viral entry. There are therapies being developed that are directed toward interfering with these processes.

Now to address the bigger population-based questions that get at the thorny question of setting policy. Right now, anyone that operates from a political viewpoint first and foremost can find some data or some study that supports their stance. The real answer is that there are problems with what data there are and until a lot more proper testing is done, we won’t be able to make informed decisions. There are arguments over just what the real viral infection rate is in the population. Initial numbers were skewed by the fact that so few tests were available that by and large, only symptomatic people were being tested. In addition, in trying to speed the bottleneck, the CDC broke one of its own rules and there were problems with contamination in the early testing. The central government has waived some of the stringent rules regarding the development and vetting of test kits and this policy is causing a big issue currently in accurately assessing infection rates. The two recent studies from USC and Stanford (which, last I knew, had not been peer reviewed) used a test kit that had been released without FDA approval. The false positive rate of that kit is 1.7%. If one is saying that 2 to 4% of the population is showing evidence of prior infection you can see why a background like that makes those numbers dubious. Other interpretations of that data suggest that it could be ten-fold less. Testing in other countries does suggest that the circulating level of virus is in the double digits. One could use this to argue either side of open up or not. The virus has a lower mortality rate than initially thought due to the population testing bias but this also means it is more infectious than thought. Data will continue to be suspect until enough of the test kits have been properly screened by the FDA and used to evaluate a big enough sample of the population in different states. Nonetheless, I suspect that within a month we will have a reasonably good handle on the frequency of infected people in the population. No estimate I’ve seen gives numbers that approach what is needed for herd immunity. That percentage ranges from more than 60% up to 95% depending on the infectivity of the virus. A highly infectious virus, like measles, is 95%. I suspect CoV-SARS-2 will be toward the upper end of this number and that means the virus will continue to circulate with local hotspots until herd immunity is reached or a vaccine comes online.

This virus is not like influenza. I’ve seen a lot of references to the H1N1 pandemic. Influenza viruses come in a lot of flavors and it is an educated guessing game to make a vaccine that will neutralize the right strains when you have to make decisions a year and more in advance. H1N1 represented a major antigenic shift so that the vaccines for that year were completely ineffective. H1N1 is actually less infectious than the predominant flu strains and older Americans had some immunity from an outbreak that had occurred years before. Younger people had not been exposed to H1 or N1 viruses so the flu hit them harder. Yes, flu kills a lot of people and yes, there has been a substantial effort to make a ‘universal’ flu vaccine. Yes, flu tends to kill those with underlying health problems, especially lung problems but the symptoms of Covid-19 are significantly worse than from flu as evidenced by the length of ICU stays, time on a ventilator, and overall length of hospital stays. The course of Covid-19 is unpredictable, a patient can be seeming to improve and then fall off a cliff. One issue is a cytokine storm that triggers a massive inflammatory response in the lungs which can completely compromise function. This can occur in someone who is otherwise completely healthy but it cannot be predicted, at this point, who will react that way. People exposed to particulates, farmers, some construction and industrial workers, for example, should be particularly careful since they may have a high baseline of inflammation or compromise of lung function already.

I’ve been following the numbers of cases and deaths closely. While there has been a lot of argument on this board over the accuracy (or lack thereof) of predictions and numbers, there is enough of a trend that won’t make either open uppers or stay at homers happy. Both mortality and total cases for the US overall have continued at a pretty constant rate for a while now. In places the curve has begun to drop a bit but that is counterbalanced by places where numbers are increasing more than linearly. Nebraska has fared pretty well so far thanks to a low population density and few tourists bringing it in. There are a couple of worrying developments of hot spots e.g. Grand Island with the potential to cause problems for local hospitals. The difficulties faced by rural hospitals even without Covid-19 is a huge issue of national concern. Take home message: no peak but a steady ongoing course of infections and deaths averaged over the nation.

Have stay at home orders worked? To a degree, yes. Two examples: Colorado had early outbreaks thanks to infected people coming into the state to ski. Early on it was number 4 or 5 in Covid-19 cases. Colorado’s governor instituted stay at home orders and closed many businesses. It now ranks 18th in total cases among states. A second example is seen by comparing Kentucky and Tennessee. Kentucky moved sooner with business closings and promoting social distancing and has less than half the number of cases as Tennessee. Now the bad news: as I said above, overall numbers aren’t going down. They have been holding pretty steady. With some notable exceptions, hospitals have not been overrun. I anticipate that the case rate and death rate will hold steady for the next month. That means we will have over 100,000 total Covid-related deaths in the US by June. I hope I’m wrong. (I thought I was wrong once, but I was mistaken- old joke, couldn’t resist).

Reopening soon is inevitable. I wish it would hold off for another 3 or 4 weeks until we have firmer numbers on infection rates that would inform as to how best to go about a staggered reopening, but I am realistic enough to know that it isn’t going to happen. Wrong decisions will mean an upturn in cases and deaths and could actually wind up shutting down some industries more than helping them back on their feet. I am eager to get back to work. My colleagues and I are working on developing a very promising cancer drug and progress is currently at a standstill as we cannot go to the lab for anything but essential maintenance. However, I am going to be smart about it for some time yet. I will work at home insofar as possible. I am not going to travel, I am not going to go to restaurants, not even a damn microbrewery, I am going to continue wearing a mask when out in public. How you approach it is up to you. Just realize protection is for others even more so than yourself. If you are out in public in places that everyone has to use, like the grocery store and gas station, please wear a mask and gloves. You can make decisions for yourself to go to the gym or tattoo parlor but, when in places everyone has to use, if you choose not to use protection, you may be making a life or death decision on someone else. It is not an infringement of your liberties any more than not being allowed to yell, “Fire,” in a crowded theater when there is none is an infringement upon your 1st amendment rights. It is a minor inconvenience for a common courtesy.
On a personal level, I do have a friend who died of Covid-19. I have a relative infected in a nursing home who should have died (multiple severe health problems) but somehow didn't even have symptoms. My daughter is an emergency room physician and is on the front lines.
I don't see the ny numbers in your OP.
Do you know if that was the lab tested fda approved test?
The numbers are lower than the cali numbers, but a magnitude plus of tested know virus patients.

Great post, appreciate just some hard info,thank you.
 
I don't see the ny numbers in your OP.
Do you know if that was the lab tested fda approved test?
The numbers are lower than the cali numbers, but a magnitude plus of tested know virus patients.

Great post, appreciate just some hard info,thank you.
Thank you. I'm afraid I don't know which test the NY study used. The problem, as I understand it, that some of the tests that were rushed into production get false positive results from other corona viruses that people have been infected by. That is why proper vetting of the tests needs to be done. I expect that we will see some very significant state to state differences because of travel patterns and population densities.
 
Thank you for taking the time to write the long post, I found the facts informative and educational.

Due to your background, and possibly peer associations you seem to be on the cautious side about the virus. I'd be curious to know what your recommendation is long term. It is possible there will never be a vaccine. So what are we to do? Certainly "social distancing", gloves, masks for many years doesn't seem feasible to keep the curve flat. Or do you advocate that?

Due to my background, and possibly peer associations I accept a lot of risk and the possibility of dying is balanced against living life. For instance, I have ridden motorcycles all my life (always with a helmet), skied very steep slopes with rocks below, swam in riptides and so forth. I don't have a problem with the lockdown so far, but am at the point enough is enough and I want everything open, now. We fortunately have a Constitution, and it guarantees freedom of association. That is getting trampled big time right now.

As far as wearing a mask and gloves as a courtesy. Since I believe the death numbers have been fudged way up, the number of people who have had it are way more than we think, and the vast majority of people who get ill recover, I don't consider wearing a mask and gloves in public a "courtesy". I consider it encouraging people who see me wearing them to keep buying into mass-hysteria. I think doing that is actually discourteous.

Politics have nothing to do with it in my case, but mindset does. I don't care whether Trump or Obama told the country it needed to shut down. I'd disagree with either of them doing it. However, my mindset is federal, state and local governments have gotten way too big and should butt out of half the things they involve themselves with. So if that makes my opinion political, then I guess it is.

As long as I decided to respond to a covid HO thread for the first (and only) time, let me say that the way the state governments have done this is unfair because they are picking winners and losers. So for instance, the liquor store gets to stay open, but the barber next door has to close. The fabric and drape shop next to them has to close, but the Home Depot down the street is allowed to sell drapes.

Anyway, thanks again for the info, you taught me some things.
 
Yes it's worse than the flu. But shutting down everywhere and everything was dumb and likely destroyed the economy for at least a decade.

We should have just shut down the hot spots (like NYC), encouraged the elderly/sick to stay home and not have visitors, cancelled events of more than 25 people, and limited the capacity of stores/restaurants at one time. Those 4 steps alone would have done as much good as a complete shutdown, without putting 30 million people out of work.
 
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I don't see the ny numbers in your OP.
Do you know if that was the lab tested fda approved test?
The numbers are lower than the cali numbers, but a magnitude plus of tested know virus patients.

Great post, appreciate just some hard info,thank you.

I should have also mentioned that selection bias is a real problem in these studies. For example, one of the California studies solicited volunteers through Facebook ads. People that suspected they might have had the virus are more likely to volunteer to get tested. Getting rid of selection bias or properly correcting for it is at the heart of the science of polling. An interesting analysis of the most famous polling error resulting from selection bias can be seen here: https://www.math.upenn.edu/~deturck/m170/wk4/lecture/case1.html This is the presidential election of 1936 where the poll predicted a landslide win for Alf Landon over Franklin Roosevelt . . . oops.
 
Thank you. I'm afraid I don't know which test the NY study used. The problem, as I understand it, that some of the tests that were rushed into production get false positive results from other corona viruses that people have been infected by. That is why proper vetting of the tests needs to be done. I expect that we will see some very significant state to state differences because of travel patterns and population densities.
Yea, the little Ive gleamed from the approved test explained that on the fda site.
One thing it didn't give was accuracy, it's approved by the fda, but the fda said nothing on accuracy.

The 2.7 million in the test that had the protein, nyc is forty percent of the states polpulation, yet had over 1,600,000 of the cases, or 21% or so pct of the entire population of nyc.
The 21 percent in nyc vs the 13 percent seen out state shows such a density impact.
Out state, 60% of the population of ny state saw only 1,100,000 testing positive for the protein.


20 million in ny state, in which 13% have the protein,that part works, but 21% of 8 million in nyc is 1,600,000 people, the out state average must be way down vs nyc.
Somewheres in the 4% range out state.
Five times the numbers due to density alone, roughly.
 
I should have also mentioned that selection bias is a real problem in these studies. For example, one of the California studies solicited volunteers through Facebook ads. People that suspected they might have had the virus are more likely to volunteer to get tested. Getting rid of selection bias or properly correcting for it is at the heart of the science of polling. An interesting analysis of the most famous polling error resulting from selection bias can be seen here: https://www.math.upenn.edu/~deturck/m170/wk4/lecture/case1.html This is the presidential election of 1936 where the poll predicted a landslide win for Alf Landon over Franklin Roosevelt . . . oops.
I can't remember what its called, but it earnied a name. A computer chip was to come out, the greatest since tubes, the company got high acclaim everywhere.
Ooops. Nobody bought their current chip,waiting for the latest and greatest, the company tanked not having the monies for ramp up,allowing their comtetitors who had no such problem ramp theirs up.

I get it, how can it be blind when you're advertising and then not selecting on top of that.
 
Hopefully your cancer drug works because our local news was just interviewing doctors who are saying they are seeing as much as a 40% drop in cancer diagnoses. And it is not because cancer suddenly went away. People cant or are afraid to go in for their screenings. I really would like to see a model indicating how many deaths long term that will be directly and indirectly caused by the economic, social, psychological and political toll that the shutdown is taking.

Btw, thanks for the informative post
 
Thank you for taking the time to write the long post, I found the facts informative and educational.

Due to your background, and possibly peer associations you seem to be on the cautious side about the virus. I'd be curious to know what your recommendation is long term. It is possible there will never be a vaccine. So what are we to do? Certainly "social distancing", gloves, masks for many years doesn't seem feasible to keep the curve flat. Or do you advocate that?

Due to my background, and possibly peer associations I accept a lot of risk and the possibility of dying is balanced against living life. For instance, I have ridden motorcycles all my life (always with a helmet), skied very steep slopes with rocks below, swam in riptides and so forth. I don't have a problem with the lockdown so far, but am at the point enough is enough and I want everything open, now. We fortunately have a Constitution, and it guarantees freedom of association. That is getting trampled big time right now.

As far as wearing a mask and gloves as a courtesy. Since I believe the death numbers have been fudged way up, the number of people who have had it are way more than we think, and the vast majority of people who get ill recover, I don't consider wearing a mask and gloves in public a "courtesy". I consider it encouraging people who see me wearing them to keep buying into mass-hysteria. I think doing that is actually discourteous.

Politics have nothing to do with it in my case, but mindset does. I don't care whether Trump or Obama told the country it needed to shut down. I'd disagree with either of them doing it. However, my mindset is federal, state and local governments have gotten way too big and should butt out of half the things they involve themselves with. So if that makes my opinion political, then I guess it is.

As long as I decided to respond to a covid HO thread for the first (and only) time, let me say that the way the state governments have done this is unfair because they are picking winners and losers. So for instance, the liquor store gets to stay open, but the barber next door has to close. The fabric and drape shop next to them has to close, but the Home Depot down the street is allowed to sell drapes.

Anyway, thanks again for the info, you taught me some things.
You clearly missed the point on some things.....

1) With regards to your risks...those are risks for which the only one suffering the consequences is you. You are not going to pass getting killed skiing or drowning in a riptide on to someone else. If you are healthy, you may have C19 and not know.....and be passing it on to who knows how many people. It's one thing to take risks that ONLY impact you. Hell...I wouldn't even care if you drive drunk as long as you can guarantee that you're the only one that would get injured or killed....but that's not the case, hence the law against it. It's quite another to take risks that impact other people's health and life.

2) You can believe that the number are fudged....but it doesn't mean that they are. C19 was the nation's leading cause of death on April 14, with 2,407 deaths. Even if half of those were fudged, it was still the 3rd leading cause...right behind 2 things that aren't contagious diseases, and still way ahead of the flu.

3) I might find common ground with you on some business that should have been allowed to remain open. However, I am not very sympathetic to your view that your rights are being trampled. We have health care workers and first responders in this country dying from C19, and others that either don't go home, or, if they do, they stay in the garage because they don't want to risk infecting their families. Hospitalized C19 victims get their death bed goodbyes from family over Zoom instead of in person. Given all that, I have a hard time feeling like your rights are being trampled because you can't go to the bar or whatever it is you're wanting to do. No one in the US is in their home under armed guard or lock and key. I exercise, walk the dog, go to my place of employment even though I don't have to (we're pretty spread out in my building....I'm the only one on my floor). Heck...I've even been fishing.

Maybe you can just be thankful that you and your family are still (presumably) healthy, and call it good for the time being.
 
I’m not wearing a mask. I don’t wash my hands more than I did before. I go to work everyday. I’m pretty sure I already had this stuff back in January.
The I'd recommend you get tested for the antibodies as soon as you can or are allowed to.
 
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The news regarding corona virus is coming fast and from a variety of sources. It can be difficult to sort the wheat from the chaff particularly when it is so easy to let one’s political beliefs color the interpretations. I want to present my interpretation of where things stand right now. First, let me give you some credentials and you can judge whether my interpretations are worth your time. I have a long career as a molecular biologist running a biomedical research lab at a medical school. I have more than a passing knowledge of virology, clinical medicine, and drug development. I am part of a grant application that seeks to develop a new therapeutic approach to treat Covid-19 patients. I don’t post often but I’ve been on this board well before it was segregated into a free board and a pay board.

The bottom line is that while we know a remarkable amount about a virus that we were unaware of just a short time ago, there remains more that we don’t know. Much of the molecular nature of the virus we know from studies on the corona virus that caused SARS. The current virus is related enough to that virus that it is officially named CoV-SARS-2. We know that two host, i.e. YOU, proteins, ACE2 and TMPRSS2 are required for viral entry. The viral SPIKE protein binds to the portion of the membrane bound ACE2 that sticks outside of the cell, often a cell that lines the surface of the lung alveoli. TMPRSS2 is a protease that clips the SPIKE protein, a processing step that is required for efficient viral entry. There are therapies being developed that are directed toward interfering with these processes.

Now to address the bigger population-based questions that get at the thorny question of setting policy. Right now, anyone that operates from a political viewpoint first and foremost can find some data or some study that supports their stance. The real answer is that there are problems with what data there are and until a lot more proper testing is done, we won’t be able to make informed decisions. There are arguments over just what the real viral infection rate is in the population. Initial numbers were skewed by the fact that so few tests were available that by and large, only symptomatic people were being tested. In addition, in trying to speed the bottleneck, the CDC broke one of its own rules and there were problems with contamination in the early testing. The central government has waived some of the stringent rules regarding the development and vetting of test kits and this policy is causing a big issue currently in accurately assessing infection rates. The two recent studies from USC and Stanford (which, last I knew, had not been peer reviewed) used a test kit that had been released without FDA approval. The false positive rate of that kit is 1.7%. If one is saying that 2 to 4% of the population is showing evidence of prior infection you can see why a background like that makes those numbers dubious. Other interpretations of that data suggest that it could be ten-fold less. Testing in other countries does suggest that the circulating level of virus is in the double digits. One could use this to argue either side of open up or not. The virus has a lower mortality rate than initially thought due to the population testing bias but this also means it is more infectious than thought. Data will continue to be suspect until enough of the test kits have been properly screened by the FDA and used to evaluate a big enough sample of the population in different states. Nonetheless, I suspect that within a month we will have a reasonably good handle on the frequency of infected people in the population. No estimate I’ve seen gives numbers that approach what is needed for herd immunity. That percentage ranges from more than 60% up to 95% depending on the infectivity of the virus. A highly infectious virus, like measles, is 95%. I suspect CoV-SARS-2 will be toward the upper end of this number and that means the virus will continue to circulate with local hotspots until herd immunity is reached or a vaccine comes online.

This virus is not like influenza. I’ve seen a lot of references to the H1N1 pandemic. Influenza viruses come in a lot of flavors and it is an educated guessing game to make a vaccine that will neutralize the right strains when you have to make decisions a year and more in advance. H1N1 represented a major antigenic shift so that the vaccines for that year were completely ineffective. H1N1 is actually less infectious than the predominant flu strains and older Americans had some immunity from an outbreak that had occurred years before. Younger people had not been exposed to H1 or N1 viruses so the flu hit them harder. Yes, flu kills a lot of people and yes, there has been a substantial effort to make a ‘universal’ flu vaccine. Yes, flu tends to kill those with underlying health problems, especially lung problems but the symptoms of Covid-19 are significantly worse than from flu as evidenced by the length of ICU stays, time on a ventilator, and overall length of hospital stays. The course of Covid-19 is unpredictable, a patient can be seeming to improve and then fall off a cliff. One issue is a cytokine storm that triggers a massive inflammatory response in the lungs which can completely compromise function. This can occur in someone who is otherwise completely healthy but it cannot be predicted, at this point, who will react that way. People exposed to particulates, farmers, some construction and industrial workers, for example, should be particularly careful since they may have a high baseline of inflammation or compromise of lung function already.

I’ve been following the numbers of cases and deaths closely. While there has been a lot of argument on this board over the accuracy (or lack thereof) of predictions and numbers, there is enough of a trend that won’t make either open uppers or stay at homers happy. Both mortality and total cases for the US overall have continued at a pretty constant rate for a while now. In places the curve has begun to drop a bit but that is counterbalanced by places where numbers are increasing more than linearly. Nebraska has fared pretty well so far thanks to a low population density and few tourists bringing it in. There are a couple of worrying developments of hot spots e.g. Grand Island with the potential to cause problems for local hospitals. The difficulties faced by rural hospitals even without Covid-19 is a huge issue of national concern. Take home message: no peak but a steady ongoing course of infections and deaths averaged over the nation.

Have stay at home orders worked? To a degree, yes. Two examples: Colorado had early outbreaks thanks to infected people coming into the state to ski. Early on it was number 4 or 5 in Covid-19 cases. Colorado’s governor instituted stay at home orders and closed many businesses. It now ranks 18th in total cases among states. A second example is seen by comparing Kentucky and Tennessee. Kentucky moved sooner with business closings and promoting social distancing and has less than half the number of cases as Tennessee. Now the bad news: as I said above, overall numbers aren’t going down. They have been holding pretty steady. With some notable exceptions, hospitals have not been overrun. I anticipate that the case rate and death rate will hold steady for the next month. That means we will have over 100,000 total Covid-related deaths in the US by June. I hope I’m wrong. (I thought I was wrong once, but I was mistaken- old joke, couldn’t resist).

Reopening soon is inevitable. I wish it would hold off for another 3 or 4 weeks until we have firmer numbers on infection rates that would inform as to how best to go about a staggered reopening, but I am realistic enough to know that it isn’t going to happen. Wrong decisions will mean an upturn in cases and deaths and could actually wind up shutting down some industries more than helping them back on their feet. I am eager to get back to work. My colleagues and I are working on developing a very promising cancer drug and progress is currently at a standstill as we cannot go to the lab for anything but essential maintenance. However, I am going to be smart about it for some time yet. I will work at home insofar as possible. I am not going to travel, I am not going to go to restaurants, not even a damn microbrewery, I am going to continue wearing a mask when out in public. How you approach it is up to you. Just realize protection is for others even more so than yourself. If you are out in public in places that everyone has to use, like the grocery store and gas station, please wear a mask and gloves. You can make decisions for yourself to go to the gym or tattoo parlor but, when in places everyone has to use, if you choose not to use protection, you may be making a life or death decision on someone else. It is not an infringement of your liberties any more than not being allowed to yell, “Fire,” in a crowded theater when there is none is an infringement upon your 1st amendment rights. It is a minor inconvenience for a common courtesy.
On a personal level, I do have a friend who died of Covid-19. I have a relative infected in a nursing home who should have died (multiple severe health problems) but somehow didn't even have symptoms. My daughter is an emergency room physician and is on the front lines.

treatment options- what would u take if your or your family was positive? Any preventative supplements?
 
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Yes it's worse than the flu. But shutting down everywhere and everything was dumb and likely destroyed the economy for at least a decade.

We should have just shut down the hot spots (like NYC), encouraged the elderly/sick to stay home and not have visitors, cancelled events of more than 25 people, and limited the capacity of stores/restaurants at one time. Those 4 steps alone would have done as much good as a complete shutdown, without putting 30 million people out of work.
treatment options- what would u take if your or your family was positive? Any preventative supplements?
treatment options- what would u take if your or your family was positive? Any preventative supplements?
 
I’m not wearing a mask. I don’t wash my hands more than I did before. I go to work everyday. I’m pretty sure I already had this stuff back in January.

If you live in Nebraska, hadn't traveled to either coast, or hung around anybody who had, your chances of having been infected with this particular virus in January are probably little more than your chances of being struck by lightning in Nebraska in January. Starting about the middle of February, I'm not nearly as certain.
 
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If you live in Nebraska, hadn't traveled to either coast, or hung around anybody who had, your chances of having been infected with this particular virus in January are probably little more than your chances of being struck by lightning in Nebraska in January. Starting about the middle of February, I'm not nearly as certain.
Earliest known infection February 4th I believe, before the Washington case, in Cali
I should correct that, that was death, they likely got it early January
 
Thank you for taking the time to write the long post, I found the facts informative and educational.

Due to your background, and possibly peer associations you seem to be on the cautious side about the virus. I'd be curious to know what your recommendation is long term. It is possible there will never be a vaccine. So what are we to do? Certainly "social distancing", gloves, masks for many years doesn't seem feasible to keep the curve flat. Or do you advocate that?

Due to my background, and possibly peer associations I accept a lot of risk and the possibility of dying is balanced against living life. For instance, I have ridden motorcycles all my life (always with a helmet), skied very steep slopes with rocks below, swam in riptides and so forth. I don't have a problem with the lockdown so far, but am at the point enough is enough and I want everything open, now. We fortunately have a Constitution, and it guarantees freedom of association. That is getting trampled big time right now.

As far as wearing a mask and gloves as a courtesy. Since I believe the death numbers have been fudged way up, the number of people who have had it are way more than we think, and the vast majority of people who get ill recover, I don't consider wearing a mask and gloves in public a "courtesy". I consider it encouraging people who see me wearing them to keep buying into mass-hysteria. I think doing that is actually discourteous.

Politics have nothing to do with it in my case, but mindset does. I don't care whether Trump or Obama told the country it needed to shut down. I'd disagree with either of them doing it. However, my mindset is federal, state and local governments have gotten way too big and should butt out of half the things they involve themselves with. So if that makes my opinion political, then I guess it is.

As long as I decided to respond to a covid HO thread for the first (and only) time, let me say that the way the state governments have done this is unfair because they are picking winners and losers. So for instance, the liquor store gets to stay open, but the barber next door has to close. The fabric and drape shop next to them has to close, but the Home Depot down the street is allowed to sell drapes.

Anyway, thanks again for the info, you taught me some things.

Let me see if I respond to some of your queries but recognize I will be getting more into the realm of opinion or informed judgement. First, let me say I wish I had had the chance to ski with you. I love the steeps but age and injury have begun to catch up to me. Yes, it is possible there will never be a vaccine. It takes more than antibodies, it takes a vaccine to have an antigen that will produce neutralizing antibodies. That isn't always a given e.g. HIV. However, I believe that for corona viruses the thought it that a protective vaccine is highly possible. It takes time to establish that, to establish safety, and then to produce hundreds of millions of doses. Heck, it takes a year to produce the flu vaccine and that is conveniently grown in eggs and that doesn't work for corona virus.
Given the recognition that the virus is more infectious than previously assumed and given that reopening is a foregone conclusion there will be an uptick in cases particularly in places that have not been as slammed as NYC and NOLA and which therefore have fewer (presumably) immune individuals. Yes, this will lead to more deaths than had restrictions been kept in place but frankly while the restrictions have had a positive effect in keeping most hospitals from being overrun, I've been disappointed that the new case rate and mortality rate have been holding pretty much steady nationwide because we actually aren't very good at self-quarantining. I don't anticipate a second wave because I don't the first wave is going to decrease.
As I said in my OP, I advocate wearing a mask and gloves in places where all people have no choice but to go like grocery stores and gas stations. It is not inducing hysteria, this is common sense. If you are infectious, you will infect others. Now if it is a going to a bar, a restaurant, a gym that won't work but I sure as heck wouldn't want to be one of the employees at one of those places. I will choose not to go to those places for the foreseeable future. I am concerned enough about going back into the laboratory, an environment largely populated by young, immortals as I once was. Let me relate a story a colleague and collaborator emailed me today. He had been to the grocery story wearing a mask and was loading his groceries into his car. A guy walks up to him and says "I ain't wearin' no mask, motherf***er. Ain't no virus gonna kill me. F*** your mask." Unfortunately, that seems to be the attitude of some on this board. In a society your actions have consequences beyond yourself, particularly when it comes to a highly infectious virus.
As I've discussed in long buried posts, probably the most important role of government is the protection of its citizens. It is, therefore, the duty of the government to prepare for worst case scenarios. That is one reason why we spend so much on our military. Would you want a military that wasn't continually anticipating and preparing for a worst case scenario? I'd rather the government err on the side of caution here. It is not trampling your liberties, it is fulfilling the constitutional imperative of a government.
Yes, your mindset is based on your political beliefs and, yes, I agree that decisions naming which businesses are essential does seem pretty arbitrary. They are difficult decisions and I'm glad I'm not the one who has to make them.
 
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Let me see if I respond to some of your queries but recognize I will be getting more into the realm of opinion or informed judgement. First, let me say I wish I had had the chance to ski with you. I love the steeps but age and injury have begun to catch up to me. Yes, it is possible there will never be a vaccine. It takes more than antibodies, it takes a vaccine have an antigen that will produce neutralizing antibodies. That isn't always a given e.g. HIV. However, I believe that for corona viruses the thought it that a protective vaccine is highly possible. It takes time to establish that, to establish safety, and then to produce hundreds of millions of doses. Heck, it takes a year to produce the flu vaccine and that is conveniently grown in eggs and that doesn't work for corona virus.
Given the recognition that there have been a lot more people infected with the virus than previously assumed (and therefore probably now immune though even that is not yet a given)
I think people need a better definition on herd effect. Isn't it fair to say, the higher we get to that magic 60% (or whatever it works out to be), that it does have effects, slowing down infections, simply by reducing opportunity?
It likely has other obvious effects such as less people getting sick etc

I think theres other misunderstandings as well, like once we hit that magic percentage, the virus goes away.
 
I think people need a better definition on herd effect. Isn't it fair to say, the higher we get to that magic 60% (or whatever it works out to be), that it does have effects, slowing down infections, simply by reducing opportunity?
It likely has other obvious effects such as less people getting sick etc

I think theres other misunderstandings as well, like once we hit that percentage, the virus goes away.

The magic number in this case will be higher than 60%. Take that to the bank. You are absolutely correct herd effect simply means that you slow down infection by limiting the density of individuals that are infectable. However, if that density is low enough, given the infectivity of the particular virus, the infection transmission can no longer be sustained. We were there with measles until people quit vaccinating their children and now there have been more measles cases in the last couple of years than was seen for many years before, often with devastating consequences. The danger here is people saying let's just let the virus go and have everyone get it. This would lead to societal chaos, overrun our hospitals, particularly in rural areas and probably bankrupt them in the process. This attitude is also unethical IMO because instead of taking care of the most vulnerable in our society, we would essentially be making them cannon fodder.
 
More on ventilators






How wrong is this? No wonder Cuomo is putting in legislation that won't allow civil suits
against hospitals over this.

Edit: The complete post isn't showing up. Here is the quote.

"One problem is the sheer number of patients. Another is we are early intubating these patients given data suggesting improved outcomes and also to avoid aerosolizing procedures to protect staff."

 
If you live in Nebraska, hadn't traveled to either coast, or hung around anybody who had, your chances of having been infected with this particular virus in January are probably little more than your chances of being struck by lightning in Nebraska in January. Starting about the middle of February, I'm not nearly as certain.
I work in a non-medical career that interacts with lots of people from everywhere. In late December, early January my workplace was running thin. I have done this career for over twenty years, and this was the one and only time we were worn so thin we worked on skeleton crews that was just stupid. Minimum shifts of 7 were regularly running with 5, then 4, then 3 one day. We all had similar symptoms. I had a fever followed by a crazy cough that kept me awake for about a week, followed by several more weeks of low grade cough and no ability to breathe right. At its peak, I would wake up coughing uncontrollably and thought I was choking. It just eventually went away. Probably took at least a month before I felt right. I had my flu shot. I have friends in Texas and California that both had the exact same mystery illness the same time period. What did we all have?
 
What is the real death rate anyway? An early "Covid" death in PA was a head injury.

"A 61-year-old Warren County man who tested positive for COVID-19 died Friday at St. Luke’s Hospital in Fountain Hill, according to Lehigh County Coroner Eric Minnich. He said the primary cause of the man’s death was a head injury from a fall at home, but that the virus was listed as a contributing factor to his death."


https://www.lehighvalleylive.com/co...n-is-latest-from-pa-to-die-from-covid-19.html

Dude, we know you want it to be a conspiracy. Side effects of many viruses are dizziness and issues when trying to get up.

Maybe the guy was sick, weak and dehydrated and fell trying to get up, or while walking or showering. Which if those conditions led to his fall, would absolutely make it a contributing factor. Most 61 year olds don’t just fall around the house for no reason.

https://www.wkbw.com/news/local-new...up-without-fainting-and-i-cant-taste-anything

https://www.today.com/health/3-young-people-coronavirus-tell-first-hand-stories-t176519

29-year-old Tarek Soliman who lives in New York City. He started to feel sick two weeks ago — “headaches, it wasn’t that serious,” he told TODAY. But by the next day, he felt “terrible. I had chills, body aches.”

The symptoms persisted for five more days, at which point he went to an urgent care center. During his visit, he fainted and was put in an ambulance. He stayed in the hospital for 10 hours.

https://www.joplinglobe.com/news/lo...cle_ca3215c5-a685-509a-b342-0b782d74cd18.html

Initially, James Andrews called the doctor’s office for advice. When her breathing got worse, he made the decision to dial 911. By the time she stepped on their dock, she found she couldn’t walk.
 
The magic number in this case will be higher than 60%. Take that to the bank. You are absolutely correct herd effect simply means that you slow down infection by limiting the density of individuals that are infectable. However, if that density is low enough, given the infectivity of the particular virus, the infection transmission can no longer be sustained. We were there with measles until people quit vaccinating their children and now there have been more measles cases in the last couple of years than was seen for many years before, often with devastating consequences. The danger here is people saying let's just let the virus go and have everyone get it. This would lead to societal chaos, overrun our hospitals, particularly in rural areas and probably bankrupt them in the process. This attitude is also unethical IMO because instead of taking care of the most vulnerable in our society, we would essentially be making them cannon fodder.
Here's my problem with that.
We are the home of the brave, true,and while some will always throw caution to the wind, we are also the land of the free. We have given up our freedoms to use our lands, to work, allowed great harm to us by not working, the worries, the stress.
Societal chaos is being created,and we have evidence of this. Those who'd normally be far too busy working to ever go and protest are out there carrying signs,mostly small business owners whose time usually is too taken up for their concerns to protest on the things they care greatly about.
People out of work, their futures not put on hold, but threatened.

So, weighing whats already been given vs chaos, and whats being lost vs what weve seen world wide, I don't see this assumed chaos, I understand the concerns, but Ive seen the other suffering, which is mounting like a wave that will squash this tiny one in a thousand death rate from the virus.

That wont be chaos, that will be a torn societal infrastructure created by those looking only at one part, nowhere near the greater part.

My main concerns are shifting. We assumed this virus was nothing in mid February, theres a much larger,far deadlier monster heading our way, will we do it again?
 
We have the same death rate as last year
https://www.macrotrends.net/countries/USA/united-states/death-rate

Not sure of its accuracy, but it looks pure factual data

You can not compare year over year yet for any 2020 data yet, death info in the US lags.

Here will be your most accurate source...broken down by age groups, states, place of death, flu, COVID and Pneumonia.

It’s not fully up to date yet, missing at least 2 weeks of the highest COVID deaths, but you can already see that despite influenza season being much longer than COVID, more people have already died from COVID in the age groups from 45 and up than the flu this year, despite the most draconian measures in US history. And 25-45 group looks like it will also surpass influenza in the US.

Basically it shows what people knew, COVID 19 is more deadly than the current flu season despite getting a much later start. Also, flu shots save lives.

https://www.cdc.gov/nchs/nvss/vsrr/COVID19/

Previous analyses of provisional data completeness from 2015 suggested that mortality data is approximately 27% complete within 2 weeks, 54% complete within 4 weeks, and at least 75% complete within 8 weeks of when the death occurred (8). Pneumonia deaths are 26% complete within 2 weeks, 52% complete within 4 weeks, and 72% complete within 8 weeks (unpublished). Data timeliness has improved in recent years, and current timeliness is likely higher than published rates.
 
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You can not compare year over year yet for any 2020 data yet, death info in the US lags.

Here will be your most accurate source...broken down by age groups, states, place of death, flu, COVID and Pneumonia.

It’s not fully up to date yet, missing at least 2 weeks of the highest COVID deaths, but you can already see that despite influenza season being much longer than COVID, more people have already died from COVID in the age groups from 45 and up than the flu this year, despite the most draconian measures in US history. And 25-45 group looks like it will also surpass influenza in the US.

Basically it shows what people knew, COVID 19 is more deadly than the current flu season despite getting a much later start. Also, flu shots save lives.

https://www.cdc.gov/nchs/nvss/vsrr/COVID19/

Previous analyses of provisional data completeness from 2015 suggested that mortality data is approximately 27% complete within 2 weeks, 54% complete within 4 weeks, and at least 75% complete within 8 weeks of when the death occurred (8). Pneumonia deaths are 26% complete within 2 weeks, 52% complete within 4 weeks, and 72% complete within 8 weeks (unpublished). Data timeliness has improved in recent years, and current timeliness is likely higher than published rates.
I dont care how people die when you start with pandemic, that screams death.
Add more,whatever the complications, it should be more.

Look at the previous five years, starting at 2018 and going back, we likely wont reach those numbers, pandemic and all.

I wont take my eye off the ball here, we are talking pandemic,death,high numbers.
 
Early on, I wouldnt accept the approach of someone talking big picture deaths or death rates.
I'm past that now.
Now, seeing other damage that's being self created, this is rising fast, death rate vs other costs.
Say,50,000 deaths from the virus so far, now without projecting forwards, we know 2.8 million americans die each year.
This could be 2% plus max to that total.
So, 2.8 million isnt even 1% of our population, then 2 plus % of less than 1% added by the virus of that?

We better start looking around some
 
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