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Everything posted by JamesKPolkEsq

  1. Good news for BOTL Low incidence of daily active tobacco smoking in patients with symptomatic COVID-19 Conclusions and relevance: Our cross sectional study in both COVID-19 out- and inpatients strongly suggests that daily smokers have a very much lower probability of developing symptomatic or severe SARS-CoV-2 infection as compared to the general population. Daily smokers are individuals reporting daily smoking or reporting a daily frequency of the number of cigarettes (manufactured or rolled) or other tobacco products (cigars, cigarillos, pipe, shisha). The quantities of tobacco smoked were calculated using the following equivalences: 1 cigar = 1 cigarillo = 2 cigarettes. Because this is a cross-sectional study, we cannot confirm the causality of this association. We cannot also identify which of the many compounds of tobacco exerts the protective effect of smoking on COVID-19. There are however, sufficient scientific data to suggest that smoking protection is likely to be mediated by nicotine. SARS-CoV2 is known to use the angiotensin converting enzyme 2 (ACE2) receptor for cell entry[14-16], and there is evidence that nicotine modulates ACE2 expression[17]which could in turn modulate the nicotinic acetyl choline receptor Buy some lifesaving cigars at FoH ?
  2. Italian town of 4,646 is 70% seropositive. Their death rate? 1.6% in eight weeks. The virus has torn through too many communities for a 0.1% CFR to be believed without extraordinary documented evidence.
  3. A friend of mine from college, very healthy (low BMI, low BP, no lung issues) had COVID-19 and is recovering. Her words: For me, it started with a cough. It was dry. It wasn't too bad. I thought I would get to escape easily. I hid in my apartment, and hoped it would pass. It didn't. Then it did. Then there was some fever. But I was alone, and the internet in America is out of thermometers, so I couldn't take my temperature. But when I sweated through my pants while sitting quietly, I decided probably... I had it. Being alone and being your own nurse is a thing. You have to pay attention to your body in a way that is disorientating and unfair, while your body is being disorienting and unfair. This thing comes in waves. Use those moments where you feel fine and think you've kicked to make all the food you might want to eat. For me, was soup. had no idea how bad it would get. I am so grateful I made soup for many when it was just me and an uncertain future. This thing kills your appetite, and you have to eat anyway. - The scary breathing didn't start until over two weeks in. The only thing that helped was an albuterol inhaler a doctor friend prescribed and steaming my lungs with near boiling water, eucalyptus and a towel over my head. Also, the recent things I've read suggest don't sleep on your back. Stay prone if you can, if the breathing gets bad, like an athlete trying to bike up the last hill. Basically, more of your lung volume is in your back than you think. And you need every single alveoli to work that can. I don't smoke, and craved more soft pink lung tissue as I wheezed through a night and tried to figure out if I needed to brave an overworked NYC hospital. - There is a lot of new (and this all new) research that as much motion you can do is important. Turns out a bunch of your lung volume is in your back. You need that volume. In hospitals they are putting people on their fronts to avoid putting them on ventilators. Luckily this was intuitive to me. I felt uncomfortable on my back. Sleep on your side if you can. Do yoga. Do breathing exercises, no matter how annoying. - Have a friend to check in with. Alone and sick is hard. And friends will worry. But you need a plan to get out. - I love and miss you all. Four weeks out, I still get chest pain. And I'm really lucky that this thing that keeps taking people I love and people people I love away didn't take me. But the rest of you, even the young and mighty, act like you already have it.
  4. Absolutely it's good news! By hook or crook, endgame at this point appears to require that magic number of 85% (+/- 5%) of folks that are seropositive. We need to get there as smartly as possible. The challenge at this point is : How? My guess is a combination of effective therapies and risk Mitigation. After the first wave has crested, we will have a much better understanding of the disease cycle for folks, especially the severe and critical cases. We can leverage that information to make an informed plan about how best to proceed. We're definitely not there yet, but we are moving in the right direction, Covidiots excepted.
  5. Herd immunity hypothesis officially debunked. 2.5% to 4.3% is far below herd immunity levels, typically 80% to 90% for a virus with a R0 similar to SARS-CoV-2.
  6. 2.5% to 4.2% of California's SF Bay Area test positive for coronavirus antibodies. This puts to rest the hypothesis that there existed a large percentage of the population that had been previously exposed. There are several very positive developments on the treatment front: Covalesent plasma therapy - good evidence that it works, available today Acterma - approved drug for Rheumatoid Arthritis, strong promise to arrest CRS caused by COVID-19 Remdesivir - Phase 3 drug nucleotide analog, early evidence that it works well on severe cases! Avigan - Approved in Japan, prevents viral RNA reproduction, effective for orthmyxoviruses and potentially coronavirus Two of the most promising treatments originate from California - You're welcome everyone ?
  7. Immediately proceeds to go conspiracy theory ? There's a reason why this exact scenario, coronavirus focused, was the subject of a global pandemic tabletop exercise last year. Coronaviruses have been spread exactly this way twice in the past, MERS and SARS. It just happens that this particular strain is different than previous outbreaks in that it has a long incubation period and asymptomatic spreaders.
  8. https://www.nytimes.com/interactive/2020/04/10/upshot/coronavirus-deaths-new-york-city.html Seasonally adjusted, death rate in NYC was at least double for March. "The recent numbers are most likely an undercount. Even in normal times, death certificates take time to be processed and collected, and complete death tallies can take weeks to become final. This is especially true for cases involving coronavirus. “Covid deaths all have to be manually coded,” said Bob Anderson, chief of the mortality statistics branch at the C.D.C.’s National Center for Health Statistics, adding that death counts from New York City typically lag actual deaths by 10 or 11 days. But even if the current count is perfect, roughly 9,780 people have died of all causes over the past month in New York City, about 5,000 more than is typical."
  9. Unfortunately, Stanford scientists' extensive PCR testing (n=2,888) indicates there was no such prevalence. Samples were analyzed from upper respiratory tract patients who had been sick between for early February to late February. Zero positives were found from samples before the last week in February.
  10. Done. FDA approved this last week. Scale up is relatively easy, since it's a western blot based test. Combo IgM / IgG testing allows some confidence about the date of infection, also helpful for confirmation testing for a PCR based active infection test. https://www.fda.gov/media/136625/download We need a diagnostic grade neutralizing antibody test (no small task). Those who are seropositive for Nab are most likely to be safe from further infection.
  11. Army field hospital for Covid-19 surge leaves Seattle after 9 days. It never saw a patient Great news, the first surge in Covid patients appears to have been effectively contained in Seattle. Three cheers for an effective governmental response in the US! The model of how to control the arc of disease in the population has been effectively laid out in several places.
  12. We're in the second inning here folks. There's a long slog ahead, barring some Hail Mary therapy. Stay safe out there. It is extremely premature to discuss what happens after the pandemic recedes. Persistent reservoirs will be out there, India for example, and the fact that asymptotic carriers can slip through detection even with mature testing infrastructure makes this a public health nightmare. A few cases metastasize rapidly to a full blown crisis in a matter of weeks. Until this can be fundamentally addressed, this crisis will be ongoing.
  13. US deaths over 1,000 per day A shocking worldwide leadership failure. Both national and international officials have made highly questionable decisions, and must be held accountable. Each country has a role in the failure. We're well beyond the looking glass.
  14. Captain of aircraft carrier with growing coronavirus outbreak pleads for help from Navy “We’re very engaged in this, we’re very concerned about it and we’re taking all the appropriate steps,” Acting Navy Secretary Thomas Modly said. So far, none of the infected sailors has shown serious symptoms, but the number of those who have tested positive has jumped exponentially since the Navy reported infections in three crew members on March 24, the first time COVID-19 infections had been detected on a naval vessel at sea.
  15. This video is excellent and informative. For your family and your own health, watch it. He explains how and why people get COVID-19 and how to avoid it.
  16. Good news - California's policy of putting the state on lockdown appears effective As of Monday morning, the city reported a total of 374 confirmed infections and six deaths from the virus. While the availability of testing is still much lower than officials would like, the modest daily count compared to other major urban centers may be an encouraging sign that the early aggressive action in the country’s second most densely populated city is having its intended effect. “We have already made a difference in saving lives,” San Francisco Mayor London Breed said during a news conference Monday, though she and other officials repeatedly cautioned that US communities are still in the early stages of the battle against the virus. Stay safe all!
  17. 115 nursing home residents, staff test positive for COVID-19 in Sumner County, Tennessee Stay safe everyone.
  18. Cities that clamped down early and longer in the Spanish flu outbreak had faster growth once the danger passed. "The cities that implemented aggressive social distancing and shutdowns to contain the virus came out looking better. Implementing these policies eight days earlier, or maintaining them for 46 days longer were associated with 4% and 6% higher post-pandemic manufacturing employment, respectively. The gains for output were similar. Likewise, faster and longer-lasting distancing measures were associated with higher post-pandemic banking activity." "... cities that practiced stricter social distancing did better post-pandemic doesn’t mean those places didn't suffer economically — they did, but on balance, the distancing measures appear to have reduced the pandemic’s economic toll." Alternatively phrased: If you think shutdowns hurt the economy, you should see what pandemics do. Without faith that you aren't going to die when you interact with others, you don't have an economy.
  19. Some perspective, and looking forward. Every day, around the world, about 40 people/million die (estimated mean lifespan of 70 years). On a typical day 13200 Americans die, today we’ve lost about 500 to COVID-19, increasing our death rate by 4% (obviously much higher in the hot-spots). Italy’s population of 60 million means that on average 2,400 Italians die each day. Today, about 900 Italians died of COVID-19, increasing the death rate by nearly 40%. They are not out of the woods. https://www.washingtonpost.com/world/2020/03/28/coronavirus-latest-news/ It took 1 month to get 1,000 dead in the US from COVID-19. The next 1,000 took two days.
  20. https://jamanetwork.com/journals/jama/fullarticle/2763983 Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma In this uncontrolled case series of 5 critically ill patients with COVID-19 and acute respiratory distress syndrome (ARDS), administration of convalescent plasma containing neutralizing antibody was followed by an improvement in clinical status. All 5 patients (age range, 36-65 years; 2 women) were receiving mechanical ventilation at the time of treatment and all had received antiviral agents and methylprednisolone. Following plasma transfusion, body temperature normalized within 3 days in 4 of 5 patients, the SOFA score decreased, and Pao2/Fio2 increased within 12 days (range, 172-276 before and 284-366 after). Viral loads also decreased and became negative within 12 days after the transfusion, and SARS-CoV-2–specific ELISA and neutralizing antibody titers increased following the transfusion (range, 40-60 before and 80-320 on day 7). ARDS resolved in 4 patients at 12 days after transfusion, and 3 patients were weaned from mechanical ventilation within 2 weeks of treatment. Of the 5 patients, 3 have been discharged from the hospital (length of stay: 53, 51, and 55 days), and 2 are in stable condition at 37 days after transfusion. Good news on the convalescent plasma front - a promising therapy that requires no FDA/EMEA approval.
  21. From Ferguson's Twitter account: https://mobile.twitter.com/neil_ferguson/status/1243294815200124928 I think it would be helpful if I cleared up some confusion that has emerged in recent days. Some have interpreted my evidence to a UK parliamentary committee as indicating we have substantially revised our assessments of the potential mortality impact of COVID-19. This is not the case. Indeed, if anything, our latest estimates suggest that the virus is slightly more transmissible than we previously thought. Our lethality estimates remain unchanged. My evidence to Parliament referred to the deaths we assess might occur in the UK in the presence of the very intensive social distancing and other public health interventions now in place. His update unfortunately isn't based on the premise you put forward - instead it is based upon effective social distancing being mandated by the UK government and other public health interventions.
  22. Regardless of the case fatality rate (CFR) actual magnitude, the relationship between the two numbers for an outbreak track well. If you prefer to use the case rate (disagree with the approach), the number is a bit better but still more than doubling every week. March 18th - 191,127 cases March 25th - 413,467 cases 116% increase. Stay at home folks, stay safe. We're in the top of the second inning.
  23. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200325-sitrep-65-covid-19.pdf?sfvrsn=ce13061b_2 https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200318-sitrep-58-covid-19.pdf?sfvrsn=20876712_2 March 18th - 7800 deaths due to virus March 25th - 18426 deaths due to virus (136% increase in a week) Since case numbers aren't telling the whole picture - supply limited obviously - COVID deaths are unfortunately a proxy for cases. The virus isn't spreading completely unchecked, but it's far too great. A 136% increase in deaths is pretty far from positive by any measure.

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