COVID COVID-19 Coronavirus Containment Efforts

[bhobba]

Doctors need some room to prescribe drug use off-label to do what they think is best for the patient. At the same time, without clinical trials, it will be difficult to know which treatments are effective. These are professional judgement calls and depend on the context in which medicine is being practised.

Last night a commentator went ballistic about how the bureaucracy here in Aus is not active enough in trialing and supporting possible Covid treatments - listen to the first bit:
https://play.acast.com/s/sky-news-credlin/credlin-monday10thaugust

WOW - he was fired up. But as you correctly point out there is a lot of judgement calls involved here. Personally I am rather gung-ho as can be seen from my posts, but being a judgement call there is no objective way of deciding which approach is right.

Interestingly my Rheumatologist thinks when things get so bad you start using Dexamethasone, as I mentioned in a previous post, its time to call in a Rheumatologist. Rather than Dexamethasone he favors more modern Biologics, but they need to be administered by someone experienced in their use. He has told me all sorts of horror stories when you do not get the Biologic right. It turned me off them for ages before I started taking them, despite his urging for me to try it. We have newer ones now, like the one I am on, that have much less issues such as possible infection etc. Boy are they effective though - my ESR (it is a measure of general body inflammation) was hovering around 100. After my broken Femur ( which in itself causes inflammation while healing) settled down, last time I saw him it was - 1.

Thanks
Bill

 

[atyy]

Interestingly my Rheumatologist thinks when things get so bad you start using Dexamethasone, as I mentioned in a previous post, its time to call in a Rheumatologist. Rather than Dexamethasone he favors more modern Biologics, but they need to be administered by someone experienced in their use. He has told me all sorts of horror stories when you do not get the Biologic right. It turned me off them for ages before I started taking them, despite his urging for me to try it. We have newer ones now, like the one I am on, that have much less issues such as possible infection etc. Boy are they effective though - my ESR (it is a measure of general body inflammation) was hovering around 100. After my broken Femur ( which in itself causes inflammation while healing) settled down, last time I saw him it was - 1.

One of the interesting things I've come across is an attempt to use vagus nerve stimulation for COVID-19. It's also being tested for arthritis. In both cases the idea is that it reduces inflammation:
https://spectrum.ieee.org/the-human...lator-gets-emergency-approval-for-covid19-use
https://www.healio.com/news/rheumat...tients-with-ra-for-whom-there-were-no-options

 

[Astronuc]

AP reports on new cases in NZ.

WELLINGTON, New Zealand (AP) — Health authorities in New Zealand were scrambling Wednesday to trace the source of a new outbreak of the Coronavirus as the nation's largest city went back into lockdown.

Authorities have found four cases of the virus in one Auckland household from an unknown source, the first reported cases of local transmission in the country in 102 days. The news came as an unpleasant surprise to many and raised questions about whether the nation's general election would go ahead as planned next month.

Authorities said two of the people who had tested positive had traveled to the tourist city of Rotorua last weekend while suffering symptoms, and they were now trying to track their movements.
. . .
The outbreak was found after a man in his 50s went to his doctor Monday with symptoms and was swabbed twice, testing positive both times. Six other people in the man’s household were then tested, with three more testing positive.

Apparently, Aucklanders have been “strongly encouraged” but not mandated to wear masks, and that authorities were releasing 5 million masks from a central supply. New Zealanders have not widely worn masks before, even though authorities have been urging people to buy them or fashion them from scarves or bandannas just in case.

If one has respiratory symptoms, one should definitely wear a mask to prevent infection of others. Not knowing who is infected, one should wear a mask in public in order to prevent catching the virus, to the extent possible.

 

[mfb]

Authorities said two of the people who had tested positive had traveled to the tourist city of Rotorua last weekend while suffering symptoms

I really wonder how much easier it would be to contain the pandemic without people like them.

If one has respiratory symptoms, one should definitely wear a mask to prevent infection others.

Or ideally stay at home. And certainly not travel.

 

[bhobba]

I really wonder how much easier it would be to contain the pandemic without people like them.Or ideally stay at home. And certainly not travel.

We have had no community transmission here in Qld, so I do not bother wearing a mask yet. But I have no doubt it will come. However it will not worry me at all because I hardly go out. I do know people, even those not in a high risk category that also do that. I think more people should. I wince at busses that have been stopped at our state borders full of what could only be described as people that should be in an aged care facility if that was not so dangerous. They should be at home. I know everyone can't, but IMHO it is the best option for those that can.

Thanks
Bill

 

[bhobba]

I am quite gung ho about deploying a vaccine, but what do people think of Russia approving theirs. Many think they have not done stage 3 trials. It's use at the moment is purely voluntary. Do people think releasing a vaccine out there for stage 3 trials in the general population a good idea - which seems the basic idea behind what Russia is doing. All are of course actually producing the Vaccine in large quantities, so it can be used immediately once considered safe. Most commentators now think we will have one by mid next year - done without skipping steps.

While I am gung ho I think the best approach is to - yes produce the vaccine during stage 3 trials, but carry out all the stages before general deployment. We can of course expedite publishing results and peer review using the internet to get the results out there and under scrutiny as quickly as possible. I think that way middle next year is probably realistic.

Thanks
Bill

 

[Vanadium 50]

It's use at the moment is purely voluntary.

Insofar as "voluntary" is a thing in Russia. (And I wouldn't say even in the US "if you non-essentials want to get back to work, you better volunteer")

 

[bhobba]

Good point. We need 3 volunteers - you, you and you.

Thanks
Bill

 

[Astronuc]

Or ideally stay at home. And certainly not travel.

Yes, of course. The context is out in public, which one has to do at some point unless one is fully self-sufficient. I usually go out in public to buy food and necessities, or go out somewhere just to get out, but maintain distance from others. I wear a mask within breathing distance of others.

 

[Ygggdrasil]

I am quite gung ho about deploying a vaccine, but what do people think of Russia approving theirs. Many think they have not done stage 3 trials. It's use at the moment is purely voluntary. Do people think releasing a vaccine out there for stage 3 trials in the general population a good idea - which seems the basic idea behind what Russia is doing. All are of course actually producing the Vaccine in large quantities, so it can be used immediately once considered safe. Most commentators now think we will have one by mid next year - done without skipping steps.

While I am gung ho I think the best approach is to - yes produce the vaccine during stage 3 trials, but carry out all the stages before general deployment. We can of course expedite publishing results and peer review using the internet to get the results out there and under scrutiny as quickly as possible. I think that way middle next year is probably realistic.

Thanks
Bill

See the discussion in this thread regarding the relative risks of skipping large-scale vaccine trials: https://www.physicsforums.com/threads/covid-vaccine-phase-3-significance.992337/

Note that it's unclear how much clinical testing the Russian vaccine has undergone (media reports suggest that phase I testing has likely completed, but not phase II testing). In all likelihood, approval of the vaccine by the Russian government is just a political stunt.

 

[Borg]

See the discussion in this thread regarding the relative risks of skipping large-scale vaccine trials: https://www.physicsforums.com/threads/covid-vaccine-phase-3-significance.992337/

Note that it's unclear how much clinical testing the Russian vaccine has undergone (media reports suggest that phase I testing has likely completed, but not phase II testing). In all likelihood, approval of the vaccine by the Russian government is just a political stunt.

From your media reports link:

In the meantime, according to certain Western media intelligence agencies from the UK, US, and Canada reported recently that Russian hackers were on the prowl, working to penetrate Western research groups working on COVID-19 vaccines. The TrialSite cannot verify if this is true, but the implication would be that Russian agents are seeking to steal proprietary vaccine information. According to CNN, The UK’s National Cyber Security Centre (NCSC) explained it was 95% certain the operation originated from APT29 (aka “The Dukes” or “Cozy Bear”), Russian hacking gangs that could be part of Russian intelligence operations.

Why worry about research and phase III trials?

 

[Astronuc]

CBS reports "Coronavirus may spread much farther than 6 feet in indoors"
https://www.cbsnews.com/news/coronavirus-spreads-farther-six-feet-indoor-spaces-poor-ventilation/

Well, duh!

Analyzing air samples in a hospital room, Lednicky's team found infectious virus can spread through the air — up to 16 feet away from an infected patient — through tiny droplets called aerosols.

"Oh, this is the smoking gun everyone has been asking for!" said Linsey Marr, a civil and environmental engineering professor at Virginia Tech who studies how viruses travel through the air.

And common areas in buildings (e.g., elevators, lobbies, corridoors, class rooms, . . . ), buses, planes and trains!

Wear a mask in public, or better yet, stay home (or in the wilderness) to the extent possible.

 

[bhobba]

Well, duh!

I thought that was found out ages ago when the stance on masks was changed. Some of this tuff beats me. Russia just going phase 1 trials then releasing the vaccine - even Professor Petrovsky does not want to do that and he is very gung ho - he just wants to include nursing home residents in the phase 2 trial - which as discussed in previous posts is probably not a good idea. After stage 2 he wants a 30,000 stage 3 trial before release.

Thanks
Bill

 

[bhobba]

In all likelihood, approval of the vaccine by the Russian government is just a political stunt.

It's a winner take all gamble using human lives. A discussion about it I heard last night with a group of economists said if it works, which it may, then the economic benefits would be enormous. But the inherent danger shows a massive disregard for human safety.

Thanks
Bill

 

[dlgoff]

This looks like a promising way to track the virus.

The University of Kansas School of Engineering and the Kansas Department of Health and Environment have expanded a project to detect COVID-19 virus in the wastewater systems of local communities across the state.

 

[Ygggdrasil]

The FDA has made an emergency use authorization for a new saliva-based COVID-19 test:

The new test, which is called SalivaDirect and was developed by researchers at the Yale School of Public Health, allows saliva samples to be collected in any sterile container. It is a much less invasive process than the nasal swabs currently used to test for the virus that causes Covid-19, but one that has so far yielded highly sensitive and similar results. The test, which also avoids a key step that has caused shortages of chemical reagents used in other tests, can run approximately 90 samples in fewer than three hours in a lab, although the number can be greater in big labs with automation.

Moreover, Yale intends to provide its “open source” testing protocol to laboratories around the country. Other labs can now adopt the method while using a variety of commercially available testing components that can reduce costs, speed turnaround times and increase testing frequency, according to the FDA. And because the reagents for the test cost less than $5, the Yale researchers estimated labs should charge about $10 per sample, although that remains to be seen. The testing method is available immediately, but the researchers added it can be scaled up quickly for use in the coming weeks.

https://www.statnews.com/2020/08/15...t-for-covid-19-opening-door-to-wider-testing/

Here is a non-peer-reviewed pre-print describing the method: https://www.medrxiv.org/content/10.1101/2020.08.03.20167791v1

The NBA helped provide samples to study the efficacy of their test: https://news.yale.edu/2020/06/22/yale-and-nba-partner-study-efficacy-new-covid-19-test

 

[Keith_McClary]

Russia just going phase 1 trials then releasing the vaccine

Most of the media got this wrong . This is what is happening:

Post-registration studies of a Russian vaccine against a new type of Coronavirus may begin in 7-10 days, reports TASS with reference to the director of the National Research Center (SIC) of Epidemiology and Microbiology named after N.F. Gamaleya of the Ministry of Health Alexander Gintsburg.

Several tens of thousands of people will take part in the post-registration studies, Gunzburg noted. He added that research will be carried out on the territory of the Moscow region.

Already on August 17, the Ministry of Health will receive the first version of the research protocol, Gunzburg said. According to him, the protocol can be approved within a week, which will allow starting research in 7-10 days.

On August 11, Russian President Vladimir Putin announced that Russia was the first in the world to register a Coronavirus vaccine. It was named Sputnik V.

Google translate of
https://www.gazeta.ru/science/news/2020/08/16/n_14805607.shtml

 

[mfb]

So what exactly is this "registration" then? If it's the first in the world it can't be just a larger test phase.

 

[russ_watters]

Sounds to me like Russia created a meaningless status for the purpose of being first to achieve it. Whooptey-doo.

 

[Keith_McClary]

So what exactly is this "registration" then?

Similar to "emergency use authorization" by the US FDA?
Russia’s approval of a COVID-19 vaccine is less than meets the press release

 

[Astronuc]

Long-haulers with COVID-19 are those who have persistent symptoms after months. I heard one who has had symptoms for 97 days and counting.

https://www.technologyreview.com/20...rs-are-organizing-online-to-study-themselves/

When I spoke to her 135 days after she initially fell ill, Davis was still sick, with daily fevers, joint pain, cognitive issues, and more. But she feels a renewed sense of purpose thanks to the Patient-Led Research team.

Seemingly healthy persons in their 30s and 40s have problems for months. Perhaps, the most serious is blood clots in lungs, organs and brain.
https://www.deseret.com/utah/2020/8...19-count-in-2-months-drop-in-hospitalizations

CDC assessment - https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm?s_cid=mm6930e1_w

 

[bhobba]

We all will soon be facing a hard dilemma:
https://1daysooner.org/

I of course have an opinion, but really we each must make up our own mind on this.

Thanks
Bill

 

[mfb]

Yet another church-induced outbreak in South Korea

The health ministry and Seoul’s city government have filed two separate criminal complaints against Jun for allegedly disrupting official efforts to contain the virus by ignoring orders to self-isolate, discouraging worshipers from getting tested and under-reporting the church’s membership to avoid broader quarantines.

 

[DrClaude]

Some American universities have now decided not to re-open in the fall:
https://finance.yahoo.com/news/coronavirus-college-classess-campus-211709998.html

 

[Astronuc]

'Silent spreaders' of COVID-19: Kids who seem healthy may be more contagious than sick adults, study says
https://www.usatoday.com/story/news...ptoms-more-contagious-than-adults/3392088001/

A new study adds to growing evidence that children are not immune to COVID-19 and may even play a larger role in community spread than previously thought.

Researchers at Massachusetts General Hospital and Mass General Hospital for Children found that among 192 children, 49 tested positive for the Coronavirus and had significantly higher levels of virus in their airways than hospitalized adults in intensive care units, according to the study published Thursday in the Journal of Pediatrics.

“Kids are not immune from this infection, and their symptoms don’t correlate with exposure and infection,” said Dr. Alessio Fasano, senior author and director of the Mucosal Immunology and Biology Researcher Center at Massachusetts General Hospital.

 

[nsaspook]

https://apnews.com/489bac2e4af8ddc0ea1a745dbf3529db

SEOUL, South Korea (AP) — South Korea is banning large gatherings, closing beaches, shutting nightspots and churches and removing fans from professional sports in strict new measures announced Saturday as it battles the spread of the coronavirus.
...
KCDC Director Jeong Eun-kyeong has endorsed even stronger restrictions. If there’s no sign that the virus spread is slowing after the weekend, she said the country should consider elevating social distancing measures to “Level 3,” which includes prohibiting gatherings of more than 10 people, shutting schools, halting professional sports and advising private companies to have employees work from home.

 

[Ygggdrasil]

Some American universities have now decided not to re-open in the fall:
https://finance.yahoo.com/news/coronavirus-college-classess-campus-211709998.html

Meanwhile, the University of Illinois, Urbana-Champaign invented and got an FDA EUA for a new saliva-based COVID-19 test and conducted >30k tests last week. This allowed them to quickly quarantine ~100 students who arrived to campus with the virus: https://www.chicagotribune.com/news...0200821-amrmeeuhfbcnld5bic2mqia6be-story.html

For perspective, the state of Illinois conducted ~170k tests and the US conducted ~2.6M tests over the same time period, according to the COVID tracking project. So, one single university accounts for nearly 20% of tests in Illinois and ~1% of tests in the US (pretty good given that UIUC has only ~62k faculty, students and staff versus populations of 13M and 330M for IL and the USA, respectively).

If they are successful at stopping community transmission through massive scale testing, isolating and contact tracing, perhaps they could serve as a good model for other universities to proceed.

 

[Haborix]

Duke University has also had some of their undergraduates return to campus recently. They appear to be keeping a weekly log of testing and results, available on this site. It appears they will be using pooled testing throughout the semester to monitor the spread of the virus.

 

[Rive]

Kind of fits with the expectations, I think...

The information technology worker didn’t develop any symptoms from his second infection, which might indicate “subsequent infections may be milder,” the researchers said.

One case is not statistics, but I think there will be more - soon.

 

[Vanadium 50]

Faye Flam has an interesting piece on Bloomberg. (Disclaimer: I have met Ms. Flam and dislike her intensely. She is not on my Christmas card list) It's titled: "Covid Spread Can’t Only Be Explained by Who’s Being ‘Bad’" and subtitled "Seeing disease in moral terms seems to be the American way. But scientists still have a lot of questions."

The mainstream narrative is that it’s all about good behavior when cases go down — mask wearing and giving up our social lives for the greater good. And conversely, bad behavior must be what makes them go up. We talk about certain regions having the virus “under control,” as if falling cases are purely a matter of will-power. A sort of moral reasoning is filling in for evidence.

But why, then, have cases plummeted in Sweden, where mask wearing is a rarity?

This is the time to use scientific methods to understand what’s happening.

One point she brings up is the issue of masks. (The following is my view) The evidence that masks are helpful on top over everything else is quite weak. Mask-wearing falls into the "it stands to reason" category - especially since the cost is low. I have also seen people jammed into buses, but it's all OK because "the mask will protect them". So the net impact may actually be negative.