COVID-19, let's put updates here

[Heisman2]

Overview of vaccine prospects for those curious: https://blogs.sciencemag.org/pipelin...nzYroyuQ2i3FW8

Some promising appearing treatment data form a Gilead trial got leaked... I'd wait another week or so for more data on it to put out before judging it.

No major updates on treatment otherwise though I think it's becoming increasingly accepted that anticoagulation plays a role in therapy.

Regarding diagnostic testing, there is some promising data of a new test from Rutgers that is doing really well using saliva, and there was a small study showing greater sensitivity of throat washings compared to nasopharyngeal swabs. Still remains to be seen how antibody testing plays out.

Very worried about a surge in patients when the country opens back up. There are many places that still do not have adequate testing/PPE, which is a shame several months into this.

[boo99]

New Study (4/15/2020) on viral shedding

https://www.nature.com/articles/s41591-020-0869-5




And this on chemosensory dysfunction


https://onlinelibrary.wiley.com/doi/...1002/alr.22579

[Heisman2]

A chilling account of the failures of our initial COVID-19 testing. https://www.msn.com/en-us/news/us/co...27oVPXO-jiEHsA Of note, I used to work in a genetics lab where I did a lot of PCR (likely >10,000 PCR reactions in total) as well as methods development; in my mind there is absolutely no excuse for this to have taken more than 1 week to find the cause of the problem and fix it once it was identified.

[WolfRose7]

Overview of vaccine prospects for those curious: https://blogs.sciencemag.org/pipelin...nzYroyuQ2i3FW8

Some promising appearing treatment data form a Gilead trial got leaked... I'd wait another week or so for more data on it to put out before judging it.

No major updates on treatment otherwise though I think it's becoming increasingly accepted that anticoagulation plays a role in therapy.

Just a radio report over here and not data but.
Reportably Oxford University are nearing human trials for a vaccine they have "80%" faith in working. Potentially a few million vacinnes workable by September. But likely to take a few months longer for all the procedures to make legally available

[Heisman2]

Just a radio report over here and not data but.
Reportably Oxford University are nearing human trials for a vaccine they have "80%" faith in working. Potentially a few million vacinnes workable by September. But likely to take a few months longer for all the procedures to make legally available

That would be amazing if true. Fingers crossed. The one good thing about having such a widespread pandemic is that it makes it much easier to test a vaccine as there is a much large sample size to test efficacy.

Here's a study indicating ACE inhibitors and ARBs in people with hypertension are indeed helpful; thus this supports the various recommendations in place not to stop them if you are currently on them. https://www.ahajournals.org/doi/abs/...Gzarkb57uv3mQ4

[Heisman2]

More updates:

We now have an FDA approved at home test: https://www.theverge.com/2020/4/21/2...mpY9P_uQjyuk6Q Of note I am still weary of any testing at this time that is not independently validated. This test is a nasal swab only; I am VERY dubious of this having decent sensitivity.

Looks like there were a few deaths in Santa Clara much earlier than previously though, with testing showing 2 individuals who died in their home 2/6/2020 actually had COVID-19. This gives an indication this may have been in circulation quite a bit earlier than previously realized. https://www.sccgov.org/sites/covid19...YOZsNdE4hHAaFM

I had not seen this link previously but it has tabs covering projections, social distancing, testing, and more; definitely nice to look through. https://www.domo.com/covid19/daily-pulse/#overview

There are now NIH guidelines that will be updated as more evidence accumulates.

There are a handful of studies out there currently that are hot topics (HCQ/Azi increasing risk of death, high prevalence of antibodies in California, different strains in New York and California with New York being more severe); these are all awaiting peer review or have major flaws so I am not posting/discussing them.



At this point we still don't know how well immunity is conferred from having the virus, I'm still not convinced any of the antibody tests are truly accurate, and we've yet to find convincing evidence that any of the medications out there are effective, but there are hundreds of trials underway so we should continue to get more data on this in the coming weeks.

[Heisman2]

People who have access to a pulse oximeter (there are phone apps that can do this but I don't know how accurate they are) can use them to help determine if they need to go to a hospital. Otherwise, if somebody notices they are breathing more quickly or more deeply than usual it would probably be worth getting checked out. https://www.nytimes.com/2020/04/20/o...te9_DioMsDw5vI

I did not listen to this but I was told it was good: https://www.nejm.org/action/showMedi...5kaLQj0T7H4TYM

There seems to be an excess of deaths in many places not attributed to COVID-19. Some of these may be unknown COVID-19 but some are likely due to people delaying care for other medical conditions. https://www.economist.com/graphic-de...vUA-LFvBlnvDPY

[Heisman2]

Some hope that a vaccine could be effective: https://www.sciencemag.org/news/2020...gQpYjCHyFzppk#

[Heisman2]

Really nice overview of the ventilator discussion regarding the different respiratory presentations seen with COVID-19: https://jamanetwork.com/journals/jam...iKxR0uL_Lr2rGY

[Heisman2]

Lots of holes can likely be poked in this but that not withstanding it estimates the presentation of COVID-19 has a heritability of 50% (essentially meaning that 50% of the variability in clinical presentation is due to genetics): https://www.medrxiv.org/content/10.1...dFJVMSER3b4GAs

This is a long but nice article on the different responses between Seattle and New York to COVID-19 and how science/politics/public policy influenced this: https://www.newyorker.com/magazine/2...CGYBqgox9o4eKs

[Heisman2]

A commentary on pseudoscience & COVID-19: https://www.nature.com/articles/d415...yaxusxWyI-hvmE

COVID-19 - A reminder to reason: https://www.nejm.org/doi/full/10.105...pU1adb5CQ7_xrQ

Overview on vaccine development with good illustrations for teaching - https://www.nature.com/articles/d415...t9E2BcNDvufR5s


It will be really interesting to see what happens with case counts as the country reopens. Keep in mind given a 5-7 day incubation period and then another 7-10 days before illness gets really bad we won't start seeing the real impact of the change for a few weeks.

[Heisman2]

Some thought that being at a higher altitude typically may help protect you from COVID-19 severity: https://www.sciencedirect.com/scienc...GPI-wlI4KZbxwA

Lots of press about this drug currently; this study indicates it is likely not a miracle drug (but it still could be helpful when given earlier): https://www.thelancet.com/journals/l...mTznUX5PRM6lL8

An article describing some aspects of doing an antibody survey for COVID-19: https://www.the-scientist.com/news-o...-DsuSu-rZaRkU8

[Heisman2]

Some more articles that people may find interesting:

What the coronavirus crisis reveals about american medicine: https://www.newyorker.com/magazine/2...L7VRY6xS4IUgBw

More indication that people who are "reinfected" actually just test positive from dead virus particles: https://www.newsweek.com/south-korea...gUS6rHlp8WJhBs

In this study every patient developed IgG antibodies giving more hope for feasibility of antibody tests: https://www.nature.com/articles/s415...WLKs09xyjR8HC4

5 questions that scientists and doctors are racing to answer (I don't feel these are the most important questions but it is what it is): https://www.washingtonpost.com/news/...rc=nl_daily202

Nice looking page on how coronavirus mutates & spreads: https://www.nytimes.com/interactive/...A6BHfphVzp0tJM

[pinggolfer96]

got my blood drawn for the antibody yesterday from quest diagnostics! ill keep everyone posted.

[Heisman2]

got my blood drawn for the antibody yesterday from quest diagnostics! ill keep everyone posted.

I'm skeptical it is accurate. Personally for anyone else seeing this I'd wait at least a few more weeks to get more reliable data if these antibody tests are reliable.

Nice quick read showing COVID-19 is much worse than the typical flu: https://blogs.scientificamerican.com...G-iq6QKlvMFo4M

[pinggolfer96]

I'm skeptical it is accurate. Personally for anyone else seeing this I'd wait at least a few more weeks to get more reliable data if these antibody tests are reliable.

Nice quick read showing COVID-19 is much worse than the typical flu: https://blogs.scientificamerican.com...G-iq6QKlvMFo4M

it actually the most accurate test we have thus far. its an immunoglobulin serology test taking up to 5 days to process. they had a 99% positive outcome for accuracy in results. its not the bs finger prick lol, its testing multiple markers for antibodies. ill get even more as well. I was also very very sick in early march. nothing ive ever experienced before in my life....

[Heisman2]

it actually the most accurate test we have thus far. its an immunoglobulin serology test taking up to 5 days to process. they had a 99% positive outcome for accuracy in results. its not the bs finger prick lol, its testing multiple markers for antibodies. ill get even more as well. I was also very very sick in early march. nothing ive ever experienced before in my life....

Even if it is the most accurate we don't know for sure it is accurate. I have not seen any independent data for any of the many tests in production to prove that a positive result is not simply due to cross-reactivity with the common strains of coronavirus. So you may have antibodies but without that data it's possible the antibodies are not for COVID-19. Additionally, we don't know yet if the COVID-19 antibodies are neutralizing and if so at what level immunity is conferred. Assuming the test has a high sensitivity then you can feel confident you haven't had COVID-19 if you don't have any antibodies (though I don't know the true sensitivity) but if you do have antibodies that is pretty much impossible to interpret at this time.

[boo99]

Released yesterday


Part 1: The Future of the COVID-19 Pandemic: Lessons Learned from Pandemic Influenza

https://www.cidrap.umn.edu/sites/def...oint-part1.pdf

[pinggolfer96]

thoughts???
https://www.youtube.com/watch?v=3bXWGxhd7ic

[Heisman2]

thoughts???
https://www.youtube.com/watch?v=3bXWGxhd7ic

I'm sorry, I don't have time to watch that video. I watch all youtube videos at 2x speed but even then it would be 27 minutes. Is there a specific part you are curious about or a general message the video put forth that you are questioning?

For you and everyone, here is a link where independent data of the various tests out there is going to be compared: https://finddx.shinyapps.io/COVID19DxData/

[Heisman2]

Apparently COVID-19 may have been in circulation in France in late December, a month earlier than previously thought: https://www.sciencedirect.com/scienc...cQ4tg8#fig0003

[Heisman2]

It has been several days, let's do another update.

- It has been very hard to stay on top of all of the literature. Additionally, tons of things are being put out there as pre-prints and it's unclear how much they can be trusted. Several papers have had to be retracted: https://retractionwatch.com/2020/05/...92sSz76M0Tzj48 In a sense we are all having to use a "new type" of scientific process for assimilating/sharing information. It'll be interesting to see if any changes to peer review and scientific dissemination come from this, particularly when the next pandemic inevitably hits in the future.

- Here is a large analysis indicating that when the public wears face masks it does indeed make a big difference: https://rs-delve.github.io/reports/2...dQV4fpujbWWE0s

- An article on the possible dangers of a vaccine that is not thoroughly tested for safety: https://science.sciencemag.org/conte...l6Le3M0nxlRgd0

- Nice graph here showing the time course of likely effectiveness of various diagnostic tests: https://jamanetwork.com/journals/jam...MBmMw9zCS4h1yo


Bigger picture: with the country reopening now to some degree in many places we are without question going to start seeing an increase in cases. I really hope everyone tries to do things as responsibly as possible (wear a mask, socially distance, try to avoid touching things, minimize time going out in public). Still no research to indicate any great treatments unfortunately. We are starting to see a lot of "weird" clinical presentations that may be attributed to COVID-19 but no overwhelmingly large changes to indicate big changes in the overall pathology. Still lots to learn at this point.

[Heisman2]

Just found this: here's a link attempting to calculate the effective Rnaught in each state; it will be interesting to follow as things open up more: https://rt.live/?fbclid=IwAR16aBcs6L...VVLYbM5VSRyyVE

[boo99]

I was against wearing a mask from the beginning and have refused to and I’m happy someone from the medical community has chimed in

https://www.technocracy.news/blayloc...o-the-healthy/

[Heisman2]

I was against wearing a mask from the beginning and have refused to and I’m happy someone from the medical community has chimed in

https://www.technocracy.news/blayloc...o-the-healthy/

This specific article has been discussed in physician groups; almost all of us very strongly disagree with this. I posted this above but a nice analysis showing face masks do work from a public health standpoint: https://rs-delve.github.io/reports/2...dQV4fpujbWWE0s


To address some of the specific points in that article:
- most people are not going to wear an N95 mask all day long; most people will be wearing surgical masks or cloth masks. That said, may people can wear N95s all day long and not suffer hypercapnia. Lots of physicians in other parts of the world who work on tuberculosis wards do this regularly

- rebreathing the virus is not going to cause you to become more sick. That's just so incredibly dumb that I have a hard time believing anything else he says. He is a neurosurgeon with clearly poor understanding of infectious disease. If the virus is already inside you, replicating significantly, and you are coughing, the simple act of coughing is going to cause some of the virus to go up into your nasal passages as coughing is going to aerosolize the virus to some degree and not all of that will be expelled from the body. The simple act of breathing is not going to expel a significant amount of the virus.


Here's a ******** post from Jennifer Kasten, a prominent physician-scientist who has worked hard to dispel many of these myths that I'll copy/paste below: https://www.********.com/jenniferkas...048?__tn__=K-R

Spoiler!

Facemasks, facemasks, facemasks! The transmission control strategy so effective, safe, and nice, we say it thrice! (Now, with numbers!)

FACEMASKS: SAFE FOR DOCTORS AND THOSE WHO PLAY THEM ON TV

Much of the worry about masks centers on misunderstandings about carbon dioxide.

Ever had surgery? Did you notice all the fully alert, bustling, masked people- many of whom wear masks for 24+ hours in a row (������������‍♀️been there, got the scrub top). Medical types prefer to keep their wits about them. Operating, making snappy decisions, flirting with the scrub nurse (that’s for the TV docs)- it requires those masked people to be firing on all cylinders. If wearing a mask led to re-inhalation of one’s own carbon dioxide (called “hypercapnia”) and the resultant sleepiness and trouble thinking as mask detractors claim, we’d all be wandering around maimed from zombified surgeons. And there would be way fewer baby showers for the TV OR staff.

More specifically, the porous nature of the material used for both medical-grade masks and cloth masks fully permits normal respiration. If you can inhale through it, you can exhale through it. There is no trapping and recirculating of air (otherwise it would blow up like a balloon when you breathe out).

LYING ABOUT HAVING AN OBSTRUCTIVE AIRWAY DISEASE IS LIKE BUYING A SERVICE DOG VEST FOR YOUR IGUANA AND I DON’T WANT TO SIT NEXT TO YOUR IGUANA, KAREN

Also circulating around is a printable card citing the Americans with Disabilities Act and stating the bearer does not need to comply with masking, which anyone can print.

Firstly, COPD patients are extremely vulnerable to viral infections and could use the extra protection masking affords. Many people with mild, well-controlled COPD can tolerate a mask just fine, since the added resistance is minimal, but people with more severe disease cannot.

Ever been on a flight with someone’s pet in a fake service dog vest? How did lying work out? Don’t be an emotional support peacock.

FACEMASKS: THEY’RE ABOUT YOUR FACE, BUT NOT AN ABOUT-FACE

There is confusion about why initially masks were NOT recommended, but now they are. In early March the world experienced a catastrophic shortage in Personal Protective Equipment, most of which was made in China. Frontline health care workers were barebacking it, despite caring for patients suffering from a lethal infectious disease. Many became infected, and some died. Hospitals rationed equipment like it was the elixir of life. We came up with clever ways to reuse and sterilize masks. We all remembered fondly the days when we just *threw the extra gloves which come out of the box all glommed together away* like we were glove billionaires or something.

Against that backdrop the public was advised not to wear masks. That was not because masks weren’t safe, effective, or a great idea. It was because masks were RATIONED where they were needed most.

Now, things have opened up- medical masks are available again. Cloth face coverings, which are insufficient for frontline health care work around massive doses of virus, have been proven effective for the general public. Masking is now strongly recommended. Nothing about the virus or our understanding of it has changed.

YOUR MASK IS NOT A VIRUS CLUB MED

Some people have argued that breathing into your mask sprays it chock full o’virus, and then you’ll reinfect yourself constantly, like some kind of COVID Dutch oven. Firstly- anything that comes out of you was already in you, and can’t make you sicker. It’s sort of like how eating your own arm can’t make you gain weight. And also remember, coronaviruses can’t live outside their host cell long. A trip outside into your mask is not a relaxing day at the spa, it’s an event which results in likely viral denaturing and degradation.

That being said, you should launder your cloth mask in hot water frequently. And don’t handle anyone else’s, because then you could get their virus, and don’t let them handle yours.

JUST LIKE LOADING THE DISHWASHER, THERE’S ONE RIGHT WAY TO WEAR A MASK

And that way is: over your mouth and nose. Not folded up on your chin. The virus doesn’t burrow into your beard, so no need to protect it. That’s the equivalent of frisbee-ing in the plates into the bottom rack.

I FEEL FINE. NO, REALLY. WHY SHOULD I WEAR A MASK?

If you’re healthy and well you could easily be an asymptomatic case. Remember up to 85% of transmission events are from people who feel well and therefore don’t modify their behavior, so infect others. If you feel sick, you should definitely wear a mask, to protect others (and you shouldn’t be out and about). If you are medically fragile you should wear a mask, to protect others and yourself.

I BELIEVE YOU MENTIONED NUMBERS

Facemasking is the single most effective strategy to reduce COVID transmission. NO MATTER THE RISK, FOR AN INDIVIDUAL OR A PLACE, IT’S LOWER WITH MASKING. Summary of the evidence:

-a mathematical model for COVID in New York and Washington shows: a) if 80% of people wear cloth masks which are 20% effective, mortality is reduced by up to 65% in low-prevalence Washington. B ) In high-prevalence New York, wearing 50% effective masks reduces mortality by up to 45%. (1)
THIS MODEL EQUATES MASK-WEARING TO THE REDUCTION IN BETA (# OF CONTACTS AN INFECTIOUS CASE HAS) SEEN IN VERY STRICT SOCIAL DISTANCING. MEANING EPIDEMIOLOGICALLY, MASKS REPLACE LOCKDOWN.

-a mathematical model for influenza showed if only 25% of people wore masks which were only 20% effective, there would be a 30% drop in transmission. (2)

-Korean study showed 30% reduction in infectious SARS-CoV-2 with cloth masks at 8 inches away from an infected person (3)

-Hong Kong study showed masking was very effective at reducing transmission of alpha coronaviruses (4)

-homemade cloth masks reduce influenza transmission by about 45% (5)

-masks made from pillowcases and t-shirts are about 1/3 as effective as medical grade masks (6)

-homemade masks made from four layers of paper and 1 layer of cloth were 95% as effective as N-95s against aerosols (also 6)

-98% of the populations of Hong Kong and Singapore have worn masks in public since their COVID outbreaks, with phenomenal containment (7)

SOURCES

1. Gunnel AB et al. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Inf Dis Model 5;293-308.

2. Tracht SMDV, Hyman J. Mathematical modeling of the effectiveness of facemasks in reducing the spread of novel influenza A (H1N1). PLoS One 2010;5(2)e:9018.

3. Kim SH et al. Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2: A Controlled Comparison in 4 Patients. Ann Int Med https://doi.org/10.7326/M20-1342

4. Leung NHL et al. Respiratory virus shedding in exhaled breath and the efficacy of face masks. Nat. Med. 2020. https://doi.org/10.1038/s41591-020-0843-2

5. Long Y, Hu T, Liu L, Chen R, Guo Q, Yang L, Cheng Y, Huang J, Du L. Effectiveness of N95 respirators versus surgical masks against influenza: a systematic review and meta‐analysis. J. Evid. Based Med. 2020. Mar 13. https://doi.org/10.1111/jebm.12381

6. Davies A, Thompson K‐A, Giri K, Kafatos G, Walker J, Bennett A. Testing the efficacy of homemade masks: would they protect in an influenza pandemic? Disaster Med. Public Health Prep. 2013; 7: 413– 8.

7. Ma Q‐X, Shan H, Zhang H‐L, Li G‐M, Yang R‐M, Chen J‐M. Potential utilities of mask wearing and instant hand hygiene for fighting SARS‐CoV‐2. J. Med. Virol. 2020 Mar 31. https://doi.org/10.1002/jmv.25805

My recommendation to everyone; practice wearing a mask in your own home so you can get used to it such that you are not touching your face a lot to adjust the mask, and then wear one when you go out in public, particularly if you will be going to public places (ie, the grocery store).

[boo99]

^^Thank you for all the links above

Always valuable to read other input on the masks


My biggest concern as a personal trainer is reopening our gyms and I know they will try and enforce masks which is gong to get into many heated arguments.

No one I know or train who lifts/bodybuilds or powerlifts will put on a mask. Ain’t gonna happen. It would and will totally screw up the workout.

The clients, my friends who powerlift and myself will not ever wear masks while lifting. Breathing would be compromised and so will the workout. I can’t imagine anyone doing Tabata without passing out with a mask on which a lot of my clients love.

[muruku]

good stuff fellas, gonna get myself caught up

[Heisman2]

^^Thank you for all the links above

Always valuable to read other input on the masks


My biggest concern as a personal trainer is reopening our gyms and I know they will try and enforce masks which is gong to get into many heated arguments.

No one I know or train who lifts/bodybuilds or powerlifts will put on a mask. Ain’t gonna happen. It would and will totally screw up the workout.

The clients, my friends who powerlift and myself will not ever wear masks while lifting. Breathing would be compromised and so will the workout. I can’t imagine anyone doing Tabata without passing out with a mask on which a lot of my clients love.

Yeah, that's much trickier. As I've said before I'm not really commenting on policy issues in this thread, just the scientific aspects of things. Wearing masks will help protect everyone in general but if it makes exercise less safe (or increases the risk of self-innoculation due to needing to adjust the mask frequently with likely facial contortions due to lifting), then you may be able to make an effective argument in gym settings they could do more harm than good.

[CommitmentRulz]

There is confusion about why initially masks were NOT recommended, but now they are. In early March the world experienced a catastrophic shortage in Personal Protective Equipment, most of which was made in China. Frontline health care workers were barebacking it, despite caring for patients suffering from a lethal infectious disease. Many became infected, and some died. Hospitals rationed equipment like it was the elixir of life. We came up with clever ways to reuse and sterilize masks. We all remembered fondly the days when we just *threw the extra gloves which come out of the box all glommed together away* like we were glove billionaires or something.

Against that backdrop the public was advised not to wear masks. That was not because masks weren’t safe, effective, or a great idea. It was because masks were RATIONED where they were needed most.

That's NOT what we were told - at all. The statement was...

World Health Organization:
"There is currently no evidence that wearing a mask (whether medical or other types) by healthy persons in the wider community setting, including universal community masking, can prevent them from infection with respiratory viruses, including COVID-19."

By contrast, the Centres for Disease Control and Prevention (CDC) in the United States has recently recommended everyone wear a (cloth) mask. However, this is to prevent infected people passing on the infection, not to prevent the wearer getting infected.

So, you can see why there is confusion over the necessity/advantages of mask use.

[Heisman2]

That's NOT what we were told - at all. The statement was...

World Health Organization:
"There is currently no evidence that wearing a mask (whether medical or other types) by healthy persons in the wider community setting, including universal community masking, can prevent them from infection with respiratory viruses, including COVID-19."

By contrast, the Centres for Disease Control and Prevention (CDC) in the United States has recently recommended everyone wear a (cloth) mask. However, this is to prevent infected people passing on the infection, not to prevent the wearer getting infected.

So, you can see why there is confusion over the necessity/advantages of mask use.

I agree with you. I think they actually stated it for the reason that she listed (to help prevent hoarding as healthcare workers were in more dire need), but nonetheless they said it, stupidly I might add, and at one point the CDC even suggested cloth masks would be effective for healthcare workers, which I'm still very irritated about. There was never any valid reason to think masks wouldn't be helpful for this coronavirus when we used them in hospital settings for the common coronaviruses we see all the time.