Tag Archives: Coronavirus

Covid19* could be coming for you — take 2

Flattening the curve (by social isolation) was never about completely preventing new infections.  It was about slowing the rate of rise in new infections so hospitals wouldn’t be overwhelmed.  That was the state of play when I wrote the following post 29 March (seems like ages ago doesn’t it?)

A friend and his wife are getting 3 days of meals delivered to their room in their retirement home.  Clearly a great way to socially isolate themselves.  This will help ‘flatten the curve’.  What that means is that the peak won’t be as high, so we won’t run out of beds and respirators.

But look at the curve in this article — https://www.flattenthecurve.com

Now integrate the area under the curve.  Looks like the number of cases is comparable (more actually under the flattened curve).

Add this to the extreme likelihood that covid19 will become endemic in the population (given the number of cases out there).  This means that absent a vaccine or a treatment, you will meet it sooner or later with whatever biologic resources you have.

On the positive side, the amount of research into the way virus kills is only matched by the number of therapeutic trials underway (both enormous).  The way the journals have opened up so results are widely available gratis and freely shared is impressive.

There is no question that the virus has become endemic, with no study of the presence of antibodies to the virus coming in at less than 4%, and that in Manhattan coming in at 20%.

So those unhappy about loosening restrictions have essentially shifted the goals of social isolation from slowing the rate of new infections (which has happened) to preventing new infections, something that I think is impossible.  We’re about to see if there will be a massive explosion of new cases of covid19 (which is symptomatic infection with SARS-CoV-2 rather than just the presence of its genome) or not, in the 15 or so states starting to loosen restrictions.

The studies showing antibody prevalence greater than 3 – 4% (which is essentially all of them that I’m aware of) argue that we won’t see an explosion in symptomatic infections.  That’s just about everyone’s hope (even those predicting disaster) and it’s what I think will happen.   Nothing like data to prove you right or wrong.  We’re about to find out.

As always, watch out for premature celebrations of rightness or wrongness — see https://luysii.wordpress.com/2020/04/29/watch-the-press/

  • Actually the title is incorrect, but the first post in the series was written 5 weeks ago, when most people knew what COVID19 was, the point of these posts being communication.  The virus itself is not COVID19 which stands for the illness the virus produces.  A variety of names have been applied to the virus — Chinese flu, Wuhan virus, coronavirus2.  The correct name is SARS-CoV-2 — hardly rolls trippingly off the tongue does it?  One should also distinguish finding the genome of the virus (RNA) which implies active infection, from antibodies to the virus which imply a past infection (the difference between seeing a bear and seeing its tracks).  So the correct title is really SARS-CoV-2 is coming for you – take 2 (if you’re a pedant)

Watch the press

We are about to embark on a variety of social experiments, in removing the restrictions on our activities.  This will be accomplished many different ways, in many different locales (which is good, because if there ever was a country where one size does not fit all, it is the USA).  But beware of what you read about the effects. There are people who will be proved very wrong either way — if nothing happens, or if cases and deaths skyrocket.

It’s good to see that people are being explicit about their predictions.  Here are two, both of which can’t be right

https://www.theatlantic.com/health/archive/2020/04/why-georgia-reopening-coronavirus-pandemic/610882/ — Here’s how it begins —

Georgia’s Experiment in Human Sacrifice

https://www.theepochtimes.com/as-ccp-virus-brings-a-taste-of-fascism-trump-needs-to-end-us-overreaction_3330804.html

As CCP Virus Brings a Taste of Fascism, Trump Needs to End US Overreaction

Also beware of breathless reports of nothing happening in the first few days confirming that it was OK to lift restrictions, again because new cases will take a while to show up, and new deaths from the disease will take even longer.

They may be right, they may be wrong, but at least we’re about to find out.

 

Addendum 1 May: If you have the time, please read Matt Taibbi’s latest article — https://taibbi.substack.com/p/temporary-coronavirus-censorship.
It shows just how invested the ‘don’t relax restrictions’ side is in having the experiment fail.  Toward the end of Taibbi’s article you’ll find a series of quotes in January from the same bunch showing why you shouldn’t worry about the coronavirus.  I wish I’d saved them.  I knew better, because I’d been closely following what was going on in China  since 1 Jan because I have a son, daughter-in-law and two grandchildren living in Hong Kong. Here’s a link to that old post of 27 January — https://luysii.wordpress.com/2020/01/27/what-to-do-about-the-wuhan-flu/

Here is the last post on the subject.  Good luck to us all

Gentlemen, place your bets

It’s time for us all to think like a doc who’s ordered a bunch of tests on a fairly sick patient.  The good ones don’t wait for them to come in and then figure out what to do.  They usually concentrate on the worst cases and make plans.

Before going any further, please read the following paragraph. I’m sorry to keep putting this in, but I don’t want to leave anyone behind. Finding the actual genome (RNA in this case) of a virus in an individual  is like seeing a real bear up close and personal.  This can do you some damage.  In contrast, antibodies to the virus are made by an individual who has been infected by the virus in the past.  Antibodies (proteins) and genomes (RNA) are completely different chemically.      Antibodies are like seeing the tracks of the bear without the bear itself. You can’t see tracks without the bear having been present at some point in the past.

Well we’re in that situation in the USA.  Based on many studies now (California, New York State, Prison systems) the number of people who’ve been exposed to the virus enough to develop their own antibodies to it, is anywhere from 10 – 100 times greater than the number of people in whom the viral genome has been found.  This means that the vast majority of infections with the new coronavirus are asymptomatic.

We’ll have a more accurate picture shortly, but what do you think will happen when New York State (and probably everyone else) repeats the test for antibodies in a few weeks?

Place your bets.

Once you have an antibody to a bug, you have it (at least for a few weeks to months).  This is not true for the elderly and my wife had to be re-vaccinated for measles so she doesn’t give it to our grandkids should she be exposed again.

So repeating the prevalence of antibody studies should show an increasing percentage of people with the antibodies.  The bets have to do with how much increase we will see.  Will NY go from 13% to 26% or higher?  The experience in nursing homes and the disaster in the Soldier’s Home in Holyoke MA, shows that in a vulnerable group the infection rate can explode — https://www.masslive.com/news/2020/04/coronavirus-at-holyoke-soldiers-home-additional-veteran-dies-infection-remains-stable-over-3-days.html. Out of 210 veterans living there 66 have died of COVID19 and 82 more have been infected (showing the genome), since the first case was discovered 21 March.

Showing the conflicting evidence docs have to deal with all the time — consider the prisoner studies — https://www.reuters.com/article/us-health-coronavirus-prisons-testing-in/in-four-u-s-state-prisons-nearly-3300-inmates-test-positive-for-coronavirus-96-without-symptoms-idUSKCN2270RX.

It isn’t clear which test was being used (viral genome or antibodies to the virus).  But this is a younger and healthier population.  Very surprisingly in four state prison systems — Arkansas, North Carolina, Ohio and Virginia — 96% of 3,277 inmates who tested positive for the coronavirus were asymptomatic.

So if healthy people won’t be made sick, what will happen when restrictions on activity (both personal and business) are lifted as they will be shortly?   You have two conflicting pieces of evidence to help you place your bets.  Fortunately the country has not adopted a one-size-fits-all approach, and lots of different experiments of nature will occur.

New York is the epicenter, with the most cases and very high population density.  Symptomatic cases appear to have stabilized even with a 10fold higher transmission rate (as measured by antibody prevalence) than that measured by finding the viral genome itself.

What would be your guidance here?

It’s time to pay our respects to Dr. Janeway who first focused on the innate immune system 30 years ago — https://en.wikipedia.org/wiki/Charles_Janeway.  Obviously if we had to wait the week or so for antibodies to develop to fight off infections, we’d all be dead.  The innate immune system is much older evolutionarily than antibodies and starts working immediately.  We are still finding out how complex it is. https://en.wikipedia.org/wiki/Innate_immune_system.

Like everything else, the innate immune system weakens with age, possibly explaining the difference in clinical outcome between the vets at the Soldier’s home and the prison inmates.

It’s hard to place a bet when you’re wishing for the best possible outcome as are most of us. Some people are highly invested in the worst possible scenarios, particularly those who’ve predicted them.  My guess is that we won’t see a surge in fatal or symptomatic cases as things open up.  What’s yours?

Gentlemen, place your bets

It’s time for us all to think like a doc who’s ordered a bunch of tests on a fairly sick patient.  The good ones don’t wait for them to come in and then figure out what to do.  They usually concentrate on the worst cases and make plans.

Before going any further, please read the following paragraph. I’m sorry to keep putting this in, but I don’t want to leave anyone behind. Finding the actual genome (RNA in this case) of a virus in an individual  is like seeing a real bear up close and personal.  This can do you some damage.  In contrast, antibodies to the virus are made by an individual who has been infected by the virus in the past.  Antibodies (proteins) and genomes (RNA) are completely different chemically.      Antibodies are like seeing the tracks of the bear without the bear itself. You can’t see tracks without the bear having been present at some point in the past.

Well we’re in that situation in the USA.  Based on many studies now (California, New York State, Prison systems) the number of people who’ve been exposed to the virus enough to develop their own antibodies to it, is anywhere from 10 – 100 times greater than the number of people in whom the viral genome has been found.  This means that the vast majority of infections with the new coronavirus are asymptomatic.

We’ll have a more accurate picture shortly, but what do you think will happen when New York State (and probably everyone else) repeats the test for antibodies in a few weeks?

Place your bets.

Once you have an antibody to a bug, you have it (at least for a few weeks to months).  This is not true for the elderly and my wife had to be re-vaccinated for measles so she doesn’t give it to our grandkids should she be exposed again.

So repeating the prevalence of antibody studies should show an increasing percentage of people with the antibodies.  The bets have to do with how much increase we will see.  Will NY go from 13% to 26% or higher?  The experience in nursing homes and the disaster in the Soldier’s Home in Holyoke MA, shows that in a vulnerable group the infection rate can explode — https://www.masslive.com/news/2020/04/coronavirus-at-holyoke-soldiers-home-additional-veteran-dies-infection-remains-stable-over-3-days.html. Out of 210 veterans living there 66 have died of COVID19 and 82 more have been infected (showing the genome), since the first case was discovered 21 March.

Showing the conflicting evidence docs have to deal with all the time — consider the prisoner studies — https://www.reuters.com/article/us-health-coronavirus-prisons-testing-in/in-four-u-s-state-prisons-nearly-3300-inmates-test-positive-for-coronavirus-96-without-symptoms-idUSKCN2270RX.

It isn’t clear which test was being used (viral genome or antibodies to the virus).  But this is a younger and healthier population.  Very surprisingly in four state prison systems — Arkansas, North Carolina, Ohio and Virginia — 96% of 3,277 inmates who tested positive for the coronavirus were asymptomatic.

So if healthy people won’t be made sick, what will happen when restrictions on activity (both personal and business) are lifted as they will be shortly?   You have two conflicting pieces of evidence to help you place your bets.  Fortunately the country has not adopted a one-size-fits-all approach, and lots of different experiments of nature will occur.

New York is the epicenter, with the most cases and very high population density.  Symptomatic cases appear to have stabilized even with a 10fold higher transmission rate (as measured by antibody prevalence) than that measured by finding the viral genome itself.

What would be your guidance here?

It’s time to pay our respects to Dr. Janeway who first focused on the innate immune system 30 years ago — https://en.wikipedia.org/wiki/Charles_Janeway.  Obviously if we had to wait the week or so for antibodies to develop to fight off infections, we’d all be dead.  The innate immune system is much older evolutionarily than antibodies and starts working immediately.  We are still finding out how complex it is. https://en.wikipedia.org/wiki/Innate_immune_system.

Like everything else, the innate immune system weakens with age, possibly explaining the difference in clinical outcome between the vets at the Soldier’s home and the prison inmates.

It’s hard to place a bet when you’re wishing for the best possible outcome as are most of us. Some people are highly invested in the worst possible scenarios, particularly those who’ve predicted them.  My guess is that we won’t see a surge in fatal or symptomatic cases as things open up.  What’s yours?

Addendum 27 April ’20.  People who have predicted terrible things happening by opening up some of the restrictions have their egos and reputations involved if they are proved wrong.  So beware breathless reports of spikes in incidence, hospitalization, deaths occurring in the first few days after the restrictions are lifted.  Remember the mean incubation period is 5 days with a range of up to 11 days. 

What to do about the Wuhan flu

This was published 27 Jan ’20.  Nothing has been altered (other than this).

What to do about the Wuhan flu?  The short answer is to lay in a month or two of dried food and drink, and have plenty of bottled water around.

The long answer depends on whether the new corona virus (called 2019-nCOV) becomes a pandemic and if the (symptomatic) case fatality rate continues at 3.5% (based on 80 deaths in 2,800 cases as of yesterday).

With a son, Chinese daughter in law and two grandchildren living in Hong Kong, I’ve followed the outbreak ever since hearing of it 1 January.

The best and most current source of info about the outbreak is the South China Morning Post — https://www.scmp.com.  It is in English and is not a government mouth piece.

Here’s the bad news

(1) As of a few days ago the virus had been found in 29/31 Chinese provinces.  This means that confining the virus to China is nearly impossible — how do you cut off a billion or so people from the rest of the world?

(2) Here’s more from today

  • Hong Kong University  faculty of medicine dean Gabriel Leung says research shows self-sustaining human-to-human transmission is already happening in all major mainland cities.   Here’s a link
  • https://www.scmp.com/news/hong-kong/health-environment/article/3047813/china-coronavirus-hong-kong-medical-experts-call
  •  Why is this significant?  You have to know how docs operate.  When I wanted information about some issue or disease, I’d call a doc whose opinion and background I respected.  It is likely that Leung made this statement after calling med school deans he personally knew in major mainland cities.

(3) There is no treatment, in the sense of stopping the virus in its tracks.  All we have is supportive care, oxygen rest, medication for fever, bronchodilators.  This is true for the vast majority of viruses.  Remember the joke that modern medical science can cure a cold in 14 days, but otherwise it takes two weeks.

(4) We know that you don’t have to be clinically ill to transmit the disease.  Screening new arrivals for fever is well and good but that won’t totally prevent spread.

(5) Some individuals are what is called ‘superspreaders’ — one individual infected 15 hospital personnel.

(6) I wouldn’t hope for a specific treatment any time soon — look how long it took to get any treatment for AIDS, despite the huge amount of resources devoted to it.

Here is some good news. It is quite possible that there are many more cases out there with people who were either asymptomatic or  just mildly ill.  The classic example is polio, in which for every case with paralysis there were 99 cases with mild GI illness or nothing at all.

This will need to wait until we can test people for antibodies to 2019-nCOV to find out how many people have had it.  This is probably at least a month away

Vaccines (if they can be made) are even more months away.  We’ll just have to hunker down and hope for the best.

Why lay in dried food ?– in a pandemic people will panic and clear out all food they can get their hands on.  There were pictures of empty bins in a Wuhan food market last week.

People are getting serious about it.  From Reuters -“U.S. President Donald Trump offered China whatever help it needed on Monday”.  It would be nice to have some of our people from the Center for Disease Control over there. Hopefully the Chinese won’t be too proud to accept the offer.

Addendum 28 Jan — apparently the US (in the form of the CDC) is begging China to let them help out — sad — why should they have to beg?  Apparently the first overture was 3 weeks ago ! ! ! ! — https://www.scmp.com/news/china/article/3047967/china-coronavirus-washington-asks-beijing-permission-send-health-team